Fabry disease: Multi-disciplinary evaluation after 15 years of treatment with agalsidase beta

Politei, Juan; Cabrera, Gustavo; Durand, Consuelo; Frabasil, Joaquín; Schenone, Andrea

doi:10.1016/j.ymgme.2017.12.321

Cited by 1 publication

(2 citation statements)

References 10 publications

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“…6 Department of Nephrology, Royal Melbourne Hospital, Parkville, VIC, Australia. 7 Department of Medicine, University of Melbourne -Parkville Campus, Parkville, VIC, Australia. 8 Department of Endocrinology and Clinical Nutrition, University Hospital Zurich and University of Zurich, Zurich, Switzerland.…”

Section: Abbreviationsmentioning

confidence: 99%

“…Judging prognosis and, thus, when to initiate FD-specific treatment is a clinical challenge complicated by evidence that the best outcomes are associated with early treatment initiation. Long-term studies of patients with FD who initiated disease-specific therapy at an early stage have shown that it has a stabilizing effect on renal and cardiac parameters [6,7]. Studies in vitro have implicated LysoGb3 in the formation of fibrosis and, in particular, the presence of renal or cardiac fibrosis on biopsy seems to mark a pivotal stage in FD after which disease-specific therapy becomes less effective [8].…”

Section: Introductionmentioning

confidence: 99%

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Do clinical guidelines facilitate or impede drivers of treatment in Fabry disease?

Hughes

Aguiar

Lidove

et al. 2022

Orphanet J Rare Dis

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Background Variable disease progression confounds accurate prognosis in Fabry disease. Evidence supports the long-term benefit of early intervention with disease-specific therapy, but current guidelines recommend treatment initiation based on signs that may present too late to avoid irreversible organ damage. Findings from the ‘PRoposing Early Disease Indicators for Clinical Tracking in Fabry Disease’ (PREDICT-FD) initiative included expert consensus on 27 early indicators of disease progression in Fabry disease and on drivers of and barriers to treatment initiation in Fabry disease. Here, we compared the PREDICT-FD indicators with guidance from the European Fabry Working Group and various national guidelines to identify differences in signs supporting treatment initiation and how guidelines themselves might affect initiation. Finally, anonymized patient histories were reviewed by PREDICT-FD experts to determine whether PREDICT-FD indicators supported earlier treatment than existing guidance. Results Current guidelines generally aligned with PREDICT-FD on indicators of renal involvement, but most lacked specificity regarding cardiac indicators. The prognostic significance of neurological indicators such as white matter lesions (excluded by PREDICT-FD) was questioned in some guidelines and excluded from most. Some PREDICT-FD patient-reported signs (e.g., febrile crises) did not feature elsewhere. Key drivers of treatment initiation in PREDICT-FD were: (A) male sex, young age, and clinical findings (e.g., severe pain, organ involvement), (B) improving clinical outcomes and preventing disease progression, and (C) a family history of Fabry disease (especially if outcomes were severe). All guidelines aligned with (A) and several advocated therapy for asymptomatic male patients. There was scant evidence of (B) in current guidance: for example, no countries mandated ancillary symptomatic therapy, and no guidance advocated familial screening with (C) when diagnosis was confirmed. Barriers were misdiagnosis and a lack of biomarkers to inform timing of treatment. Review of patient histories generally found equal or greater support for treatment initiation with PREDICT-FD indicators than with other guidelines and revealed that the same case and guideline criteria often yielded different treatment recommendations. Conclusions Wider adoption of PREDICT-FD indicators at a national level could promote earlier treatment in Fabry disease. Clearer, more concise guidance is needed to harmonize treatment initiation in Fabry disease internationally.

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Section: Abbreviationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%