Diagnosis and treatment trends in mucopolysaccharidosis I: findings from the MPS I Registry

Abstract

Our objective was to assess how the diagnosis and treatment of mucopolysaccharidosis I (MPS I) have changed over time. We used data from 891 patients in the MPS I Registry, an international observational database, to analyze ages at symptom onset, diagnosis, treatment initiation, and treatment allocation (hematopoietic stem cell transplantation, enzyme replacement therapy with laronidase, both, or neither) over time for all disease phenotypes (Hurler, Hurler–Scheie, and Scheie syndromes). The interval between diagnosis and treatment has become shorter since laronidase became available in 2003 (gap during 2006–2009: Hurler—0.2 year, Hurler–Scheie—0.5 year, Scheie—1.4 years). However, the age at diagnosis has not decreased for any MPS I phenotype over time, and the interval between symptom onset and treatment initiation remains substantial for both Hurler–Scheie and Scheie patients (gap during 2006–2009, 2.42 and 6.71 years, respectively). Among transplanted patients, an increasing proportion received hematopoietic stem cells from cord blood (34 out of 64 patients by 2009) and was also treated with laronidase (42 out of 45 patients by 2009). Conclusions: Despite the availability of laronidase since 2003, the diagnosis of MPS I is still substantially delayed for patients with Hurler–Scheie and Scheie phenotypes, which can lead to a sub-optimal treatment outcome. Increased awareness of MPS I signs and symptoms by primary care providers and pediatric subspecialists is crucial to initiate early treatment and to improve the quality of life of MPS I patients.

Evaluation of Demographic and Clinical Characteristics of Patients with Mucopolysaccharidosis

“…Similar to ours, several studies from different countries showed that the diagnosis was established on average 2-3 years after the onset of symptoms (20,(25)(26)(27)(28)(29). In a case of MPS, since patients exhibit different organ/system manifestations, they present to physicians from different branches including pediatricians, geneticists, cardiologists, ophthalmologists, orthopedists, and neurosurgery, and are diagnosed with different disorders such as primary valvular heart disease, Perthes disease, congenital talipes equinovarus, spondyloepiphyseal dysplasia, cataract, rheumatoid arthritis, craniosynostosis, pseudoachondroplasia, and inguinal hernia (23,27,29,30).…”

Aminoglycoside-Induced Premature Stop Codon Read-Through of Mucopolysaccharidosis Type I Patient Q70X and W402X Mutations in Cultured Cells

“…Current therapies for MPS I include enzyme replacement therapy and bone marrow transplantation (Brooks 2002;Moore et al 2008;D'Aco et al 2012). While these therapies are effective for somatic tissue pathology, there are limitations with regard to the treatment of neuropathology.…”

Otolaryngological findings in mucopolysaccharidosis

“…[1] Clinical manifestations Clinical manifestations of mucopolysaccharidosis type I (MPS I) show a chronic multisystemic and progressive course. [8] The disease is highly heterogeneous, spanning a spectrum of severity. Children with Hurler syndrome appear normal at birth and develop the characteristic appearance over the first years of life.…”