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2018 ; 13
(1
): 68
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Migalastat improves diarrhea in patients with Fabry disease: clinical-biomarker
correlations from the phase 3 FACETS trial
#MMPMID29703262
Schiffmann R
; Bichet DG
; Jovanovic A
; Hughes DA
; Giugliani R
; Feldt-Rasmussen U
; Shankar SP
; Barisoni L
; Colvin RB
; Jennette JC
; Holdbrook F
; Mulberg A
; Castelli JP
; Skuban N
; Barth JA
; Nicholls K
Orphanet J Rare Dis
2018[Apr]; 13
(1
): 68
PMID29703262
show ga
BACKGROUND: Fabry disease is frequently characterized by gastrointestinal
symptoms, including diarrhea. Migalastat is an orally-administered small molecule
approved to treat the symptoms of Fabry disease in patients with amenable
mutations. METHODS: We evaluated minimal clinically important differences (MCID)
in diarrhea based on the corresponding domain of the patient-reported
Gastrointestinal Symptom Rating Scale (GSRS) in patients with Fabry disease and
amenable mutations (N?=?50) treated with migalastat 150 mg every other day or
placebo during the phase 3 FACETS trial (NCT00925301). RESULTS: After 6 months,
significantly more patients receiving migalastat versus placebo experienced
improvement in diarrhea based on a MCID of 0.33 (43% vs 11%; p?=?.02), including
the subset with baseline diarrhea (71% vs 20%; p?=?.02). A decline in kidney
peritubular capillary globotriaosylceramide inclusions correlated with diarrhea
improvement; patients with a reduction >?0.1 were 5.6 times more likely to have
an improvement in diarrhea than those without (p?=?.031). CONCLUSIONS: Migalastat
was associated with a clinically meaningful improvement in diarrhea in patients
with Fabry disease and amenable mutations. Reductions in kidney
globotriaosylceramide may be a useful surrogate endpoint to predict clinical
benefit with migalastat in patients with Fabry disease. TRIAL REGISTRATION:
NCT00925301 ; June 19, 2009.
|1-Deoxynojirimycin/*analogs & derivatives/therapeutic use
[MESH]