Pharmacokinetic profile of recombinant human N-acetylgalactosamine 4-sulphatase enzyme replacement therapy in patients with mucopolysaccharidosis VI (Maroteaux–Lamy syndrome): a phase I/II study

Abstract

Aim: Mucopolysaccharidosis VI (Maroteaux-Lamy syndrome) is a lysosomal storage disease caused by a deficiency of the enzyme N-acetylgalactosamine 4-sulphatase (ASB). Enzyme replacement therapy with recombinant human ASB (rhASB) has been studied in a randomized, double-blind, two-dose (0.2 and 1.0 mg/kg/week) phase I/II study (n=7) followed by an open-label single dose (1.0 mg/kg/week) extension study. We report the pharmacokinetic profile of rhASB and the impact of antibody development. Methods: Pharmacokinetic analysis was performed at weeks 1, 2, 12, 24, 83, 84 and 96. Infusions were administered over 4 hours using a ramp-up protocol. Plasma ASB and rhASB antibody concentrations and urine glycosaminoglycan (GAG) concentrations were determined. Results: The area under the plasma concentration-time curve (AUC 07t ) for the high-dose group increased from week 1 to week 2, but remained unchanged at weeks 12 and 24. A large difference in mean AUC 07t was observed between the low-and high-dose groups. Pharmacokinetic results at weeks 83, 84 and 96 were similar to those at week 24. Six patients developed antibodies to rhASB. One patient developed high antibody levels in combination with a high ASB concentration, while a second patient also developed high antibody levels with undetectable ASB concentrations. Antibodies from the second patient blocked detection of ASB. By week 72, antibody levels had decreased in all patients. The high-dose rhASB produced a more rapid and greater percentage reduction in urinary GAG concentrations than the lower dose (70% versus 55% at 24 weeks). Antibody levels did not appear to influence urinary GAG concentrations.Conclusion: Pharmacokinetic parameters appear to be independent of the duration of treatment and are not linear between the 0.2 and 1.0 mg/kg/week doses. Antibodies to rhASB develop in most patients, but their concentration decreases over time. Antibody formation may influence pharmacokinetic parameters during the early phases of treatment, although it appears to have limited impact on biochemical efficacy.

Intrathecal enzyme replacement therapy: Successful treatment of brain disease via the cerebrospinal fluid

“…Rare lysosomal storage disorders, such as mucopolysaccharidosis I (MPS I, Hurler syndrome), MPS VI (Maroteaux-Lamy syndrome), Gaucher disease, and Fabry disease are currently treated by intravenous enzyme replacement therapy [10][11][12][13][14][15][16]. Enzyme replacement therapy has successfully treated some aspects of the physical disease in MPS patients and has been well tolerated.…”

Eficácia e segurança da terapia com idursulfase em pacientes com mucopolissacaridose tipo II, com e sem comparação com placebo: revisão sistemática e metanálise

“…Não encontramos na literatura quais seriam os valores considerados clinicamente relevantes, mas alguns autores, avaliando MPS VI, consideram arbitrariamente o aumento superior a 10 o como significativo 25,26 . Portanto, houve mudanças clinicamente relevantes na mobilidade articular do cotovelo (diferença média não relatada) 13 , ombro (aproximadamente 12 o , abdução, flexão-extensão) 16 e quadril (aproximadamente 14 o , flexão), este último avaliado apenas por um pequeno estudo (n = 10 pacientes) 15 .…”

Enzymes, 6. Enzymes in Therapy

“…Patients suffer from growth retardation as well as from bone and joint changes, hepatosplenomegaly, enlargement of heart valves, and cardiomyopathy. A recombinant arylsulfatase B (galsulfase) [56] was approved in 2005 for treatment of this inborn error of metabolism. Clinical trials have demonstrated that Naglazyme provides clinically important benefits for MPS VI patients, specifically improved endurance.…”