Abstract
Background: Fabry disease is a rare lysosomal storage disorder, linked to the X chromosome, and caused by the deficiency or absence of the enzyme ?-galactosidase-A. Nephropathy together with heart disease and neurological involvement lead to premature death.
Purpose: This review describes oral migalastat monotherapy in patients with Fabry disease and “amenable” mutations.
Methodology: An oral pharmacological chaperone called Migalastat (Galafold®), stabilizes and facilitates the trafficking of “amenable” mutated forms of the enzyme to the lysosomes, thus increasing its activity.
Results: The phase III FACETS and ATTRACT studies have demonstrated safety and efficacy compared to available enzyme replacement therapies; achieving renal function stabilization, reduction of left ventricular mass and maintenance of plasmatic Lyso-Gb3 levels.
Conclusions: Migalastat was generally well tolerated in both trials. Subsequent extension publications showed similar results, confirming the safety and efficacy both in patients who were previously on enzyme replacement therapy and have been switched to migalastat, as well as in patients who have started migalastat as their first treatment.
References
Ortiz A, Germain DP, Desnick RJ, Politei J, Mauer M, Burlina A, et al. Fabry disease revisited: Management and treatment recommendations for adult patients. Mol Genet Metab. 2018 abr.;123(4):416-27. https://doi.org/10.1016/j.ymgme.2018.02.014
Echevarria L, Benistan K, Toussaint A, Dubourg O, Hagege AA, Eladari D, et al. X-chromosome inactivation in female patients with Fabry disease. Clin Genet. 2016 en.;89(1):44-54. https://doi.org/10.1111/cge.12613
Perretta F, Antongiovanni N, Jaurretche S. Major Organic Involvement in Women with Fabry Disease in Argentina. Sci World J. 2018 my. 21;2018:6515613. https://doi.org/10.1155/2018/6515613
Arends M, Wanner C, Hughes D, Mehta A, Oder D, Watkinson OT, et al. Characterization of Classical and Nonclassical Fabry Disease: A Multicenter Study. J Am Soc Nephrol. 2017 my.;28(5):1631-41. https://doi.org/10.1681/ASN.2016090964
Jaurretche S, Antongiovanni N, Perretta F. Fabry nephropathy. Role of nephrologist and clinical variables associated with the diagnosis. Nefrol. 2019;39(3):294-300. https://doi.org/10.1016/j.nefro.2018.10.017
Barros LR, Jiménez SJ, Roncallo A, López F, Conde JC, Martínez T, et al. Consenso colombiano de expertos sobre recomendaciones basadas en evidencias para el diagnóstico, el tratamiento y el seguimiento de la enfermedad de Fabry con compromiso renal. Rev Colomb Nefrol. 2022 9(1):e591. https://doi.org/10.22265/acnef.9.1.591
Perretta F. Migalastat: A un año como opción terapéutica oral para la enfermedad de Fabry en Argentina. Rev Nefrol Argent. 2021;19(1).
Khanna R, Soska R, Lun Y, Feng J, Frascella M, Young B, et al. The pharmacological chaperone 1-deoxygalactonojirimycin reduces tissue globotriaosylceramide levels in a mouse model of Fabry disease. Mol Ther. 2010;18(1):23-33. https://doi.org/10.1038/mt.2009.220
Johnson FK, Mudd PN, Bragat A, Adera M, Boudes P. Pharmacokinetics and Safety of Migalastat HCl and Effects on Agalsidase Activity in Healthy Volunteers. Clin Pharmacol Drug Develop. 2013;2(2):120-32. https://doi.org/10.1002/cpdd.1
Germain DP, Giugliani R, Hughes DA, Mehta A, Nicholls K, Barisoni L, et al. Safety and pharmacodynamic effects of a pharmacological chaperone on ?-galactosidase A activity and globotriaosylceramide clearance in Fabry disease: report from two phase 2 clinical studies. Orphanet J Rare Dis. 2012 nov. 24;7:91. https://doi.org/10.1186/1750-1172-7-91
Young-Gqamana B, Brignol N, Chang HH, Khanna R, Soska R, Fuller M, et al. Migalastat HCl reduces globotriaosylsphingosine (lyso-Gb3) in Fabry transgenic mice and in the plasma of Fabry patients. PLoS One. 2013;8(3):e57631. https://doi.org/10.1371/journal.pone.0057631
Giugliani R, Waldek S, Germain DP, Nicholls K, Bichet DG, Simosky JK, et al. A Phase 2 study of migalastat hydrochloride in females with Fabry disease: selection of population, safety and pharmacodynamic effects. Mol Genet Metab. 2013 my.;109(1):86-92. https://doi.org/10.1016/j.ymgme.2013.01.009
Benjamin ER, Della Valle MC, Wu X, Katz E, Pruthi F, Bond S, et al. The validation of pharmacogenetics for the identification of Fabry patients to be treated with migalastat. Genet Med. 2017 abr.;19(4):430-8. https://doi.org/10.1038/gim.2016.122
Amicus Therapeutics. Galafold (migalastat) amenability table. Amicus Therapeutics; 2017. https://www.galafoldamenabilitytable.com/hcp
Johnson FK, Mudd PN, Janmohamed SG. Relative bioavailability and the effect of meal type and timing on the pharmacokinetics of migalastat in healthy volunteers. Clin Pharmacol Drug Dev. 2015;4(3):193-202. https://doi.org/10.1002/cpdd.147
Amicus Therapeutics. Galafold™ (Migalastat) Capsules, for Oral Use: US Prescribing Information. 2018. https://www.accessdata.fda.gov/drugsatfda_docs/nda/2018/208623Orig1s000Approv.pdf
Germain DP, Hughes DA, Nicholls K, Bichet DG, Giugliani R, Wilcox WR, et al. Treatment of Fabry's Disease with the Pharmacologic Chaperone Migalastat. N Engl J Med. 2016 ag. 11;375(6):545-55. https://doi.org/10.1056/NEJMoa1510198
Hughes DA, Nicholls K, Shankar SP, Sunder-Plassmann G, Koeller D, Nedd K, et al. Oral pharmacological chaperone migalastat compared with enzyme replacement therapy in Fabry disease: 18-month results from the randomised phase III ATTRACT study. J Med Genet. 2017 abr.;54(4):288-296. https://doi.org/10.1136/jmedgenet-2016-104178
Feldt-Rasmussen U, Hughes D, Sunder-Plassmann G, Shankar S, Nedd K, Olivotto I, et al. Long-term efficacy and safety of migalastat treatment in Fabry disease: 30-month results from the open-label extension of the randomized, phase 3 ATTRACT study. Mol Genet Metab. 2020;131(1-2):219-28. https://doi.org/10.1016/j.ymgme.2020.07.007
Bichet DG, Torra R, Wallace E, Hughes D, Giugliani R, Skuban N, et al. Long-term follow-up of renal function in patients treated with migalastat for Fabry disease. Mol Genet Metab Rep. 2021 ag. 4;28:100786. https://doi.org/10.1016/j.ymgmr.2021.100786
Mauer M, Sokolovskiy A, Barth JA, Castelli JP, Williams HN, Benjamin ER, et al. Reduction of podocyte globotriaosylceramide content in adult male patients with Fabry disease with amenable GLA mutations following 6 months of migalastat treatment. J Med Genet. 2017 nov.;54(11):781-6. https://doi.org/10.1136/jmedgenet-2017-104826
European Medicines Agency. Migalastat (Galafold). EU Summary of Product Characteristics; 2016. https://www.ema.europa.eu/en/documents/product-information/galafold-epar-product-information_en.pdf
McCafferty EH, Scott LJ. Migalastat: A Review in Fabry Disease. Drugs. 2019 abr.;79(5):543-54. https://doi.org/10.1007/s40265-019-01090-4
Weidemann F, Jovanovic A, Herrmann K, Vardarli I. Chaperone Therapy in Fabry Disease. Int J Mol Sci. 2022 febr. 8;23(3):1887. https://doi.org/10.3390/ijms23031887
Parenti G, Andria G, Valenzano KJ. Pharmacological Chaperone Therapy: Preclinical Development, Clinical Translation, and Prospects for the Treatment of Lysosomal Storage Disorders. Mol Ther. 2015 jul.;23(7):1138-48. https://doi.org/10.1038/mt.2015.62
Parenti G. Treating lysosomal storage diseases with pharmacological chaperones: from concept to clinics. EMBO Mol Med. 2009 ag.;1(5):268-79. https://doi.org/10.1002/emmm.200900036
Müntze J, Gensler D, Maniuc O, Liu D, Cairns T, Oder D, et al. Oral Chaperone Therapy Migalastat for Treating Fabry Disease: Enzymatic Response and Serum Biomarker Changes After 1 Year. Clin Pharmacol Ther. 2019 my.;105(5):1224-33. https://doi.org/10.1002/cpt.1321
Riccio E, Zanfardino M, Ferreri L, Santoro C, Cocozza S, Capuano I, et al. Switch from enzyme replacement therapy to oral chaperone migalastat for treating fabry disease: real-life data. Eur J Hum Genet. 2020 dic.;28(12):1662-8. https://doi.org/10.1038/s41431-020-0677-x
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.