Methods of treating a subject with an alkaline phosphatase deficiency
Disclosed herein are methods for treating a subject with an alkaline phosphatase deficiency, further comprising monitoring additional anaiytes, e.g., calcium, parathyroid hormone and/or vitamin D, with treatment modifications as indicated by the levels, e.g., serum levels, of the additional anaiytes.
1. A method of maintaining calcium homeostasis in a subject treated with an alkaline phosphatase for an alkaline phosphatase deficiency, wherein the alkaline phosphatase is asfotase alfa comprising the amino acid sequence of SEQ ID NO: 1, wherein the subject is determined to have a serum calcium concentration of less than 8.5 mg/dL comprising administering to the subject a therapeutic agent that increases the serum calcium concentration in the subject to 8.5 mg/dL or higher.
2. The method of claim 1 , wherein the alkaline phosphatase deficiency is hypophosphatasia.
3. The method of claim 1 , wherein the alkaline phosphatase is a tissue non-specific alkaline phosphatase, a placental alkaline phosphatase, an intestinal alkaline phosphatase, an engineered alkaline phosphatase, a fusion protein comprising an alkaline phosphatase moiety, or a chimeric alkaline phosphatase.
4. The method of claim 1 , wherein, following administration of the therapeutic agent, the subject is determined to have a serum calcium concentration of higher than 10.5 mg/dL, and the method further comprises administering an additional therapeutic agent that reduces the serum calcium concentration in the subject to 10.5 mg/dL or lower.
5. The method of claim 1 , wherein the method further comprises administering calcium or vitamin D to the subject, wherein the subject has a statistically significant low serum concentration of parathyroid hormone.
6. The method of claim 1 , wherein the method further comprises administering vitamin D or a functional analog thereof to the subject, wherein the subject has a statistically significant low serum concentration of vitamin D.
7. The method of claim 2 , further comprising administering vitamin D to the subject.
8. The method of claim 7 , wherein the vitamin D is administered orally, intramuscularly, or intravenously.
9. The method of claim 1 , wherein the alkaline phosphatase is administered in a dosage of from about 2 mg/kg/week to 9 mg/kg/week, or a comparable daily dosage.
10. The method of claim 1 , wherein the therapeutic agent is calcium gluconate, or calcium chloride.
11. The method of claim 1 , wherein the therapeutic agent is vitamin D or a functional vitamin D analog.
12. The method of claim 1 , wherein the therapeutic agent is parathyroid hormone (PTH) or a functional PTH analog.
13. The method of claim 4 , wherein the third therapeutic agent is wherein the therapeutic agent is a calcimimetic.
14. The method of claim 13 , wherein the calcimimetic is cinacalcet.
15. The method of claim 4 , wherein the additional therapeutic agent is a bisphosphonate.
16. The method of claim 4 , wherein the additional therapeutic agent is prednisone.
17. The method of claim 4 , wherein the additional therapeutic agent is an intravenous fluid.
18. The method of claim 4 , wherein the additional therapeutic agent is a diuretic.
19. The method of claim 2 , further comprising administering vitamin K to the subject.
20. The method of claim 2 , further comprising administering vitamin B to the subject.
21. The method of claim 2 , further comprising administering a multivitamin to the subject.
22. The method of claim 1 , wherein the subject has a serum calcium concentration of 7.0 mg/dL or lower to 0.5 mg/dL or lower.