Methods of treating Fabry patients having renal impairment
Provided are methods for treatment of Fabry disease in patients having HEK assay amenable mutations in α-galactosidase A. Certain methods comprise administering migalastat or a salt thereof every other day, such as administering about 150 mg of migalastat hydrochloride every other day.
1. A method of stabilizing renal function in enzyme replacement therapy (ERT)-experienced patients diagnosed with Fabry disease and having renal impairment, the method comprising:
administering to a group of Fabry disease patients having renal impairment and a HEK assay amenable α-galactosidase A mutation, about 100 mg to about 150 mg free base equivalent (FBE) of migalastat at a frequency of once every other day,
wherein the administration is effective to (i) increase the mean white blood cell (WBC) α-galactosidase A activity in the patients, and (ii) provide a mean annualized rate of change in eGFR CKD-EPI of greater than −1.0 mL/min/1.73 m 2 .
2. The method of claim 1 , wherein the patients have mild renal impairment with an eGFR of 60 to 90 mL/min/1.73 m 2 .
3. The method of claim 1 , wherein the patients have moderate renal impairment with an eGFR of 30 to 59 mL/min/1.73 m 2 .
4. The method of claim 1 , wherein the patients have severe renal impairment with an eGFR of less than 30 mL/min/1.73 m 2 .
5. The method of claim 1 , wherein the patients have a proteinuria level of less than 100 mg/24 hr prior to initiating the administration of the migalastat.
6. The method of claim 1 , wherein the patients have a proteinuria level of 100 to 1,000 mg/24 hr prior to initiating the administration of the migalastat.
7. The method of claim 1 , wherein the patients have a proteinuria level of greater than 1,000 mg/24 hr prior to initiating the administration of the migalastat.
8. The method of claim 1 , wherein the migalastat is in a solid dosage form.
9. The method of claim 1 , wherein the migalastat is administered orally.
10. The method of claim 1 , wherein the migalastat is administered for at least 28 days.
11. The method of claim 1 , wherein the migalastat is administered for at least 6 months.
12. The method of claim 1 , wherein the migalastat is administered for at least 12 months.
13. The method of claim 1 , comprising administering about 123 mg FBE.
14. The method of claim 1 , comprising administering about 123 mg of migalastat free base.
15. The method of claim 1 , comprising administering about 150 mg of migalastat hydrochloride.
16. The method of claim 1 , wherein the patients have moderate renal impairment, and wherein the administration is effective to provide a mean increase in WBC α-galactosidase A activity of about 1.44 MU/hr/mg.
17. The method of claim 1 , wherein the patients have mild renal impairment, and wherein the administration is effective to provide a mean increase in WBC α-galactosidase A activity of about 1.64 MU/hr/mg.
18. The method of claim 1 , wherein the HEK assay amenable mutation is a mutation that is shown to have a relative increase of ≥1.20-fold and an absolute increase of ≥3.0% wild-type when the mutation is expressed in HEK-293 cells incubated in the presence of 10 μM migalastat compared to HEK-293 cells without migalastat.
19. The method of claim 1 , wherein the migalastat is administered as migalastat free base.
20. The method of claim 1 , wherein the migalastat is administered as a pharmaceutically acceptable salt.
21. A method of stabilizing renal function in a patient diagnosed with Fabry disease and having mild renal impairment with an eGFR of 60 to 90 mL/min/1.73 m2, the method comprising:
administering to the patient about 100 mg to about 150 mg free base equivalent (FBE) of migalastat at a frequency of once every other day, and
increasing white blood cell (WBC) α-galactosidase A activity in the patient,
wherein the administration of the migalastat is effective to stabilize renal function in the patient,
wherein the patient has a HEK assay amenable mutation in α-galactosidase A, wherein the HEK assay amenable mutation is a mutation that is shown to have a relative increase of ≥1.20-fold and an absolute increase of ≥3.0% wild-type when the mutation is expressed in HEK-293 cells incubated in the presence of 10 μM migalastat compared to HEK-293 cells without migalastat,
wherein the patient is an enzyme replacement therapy (ERT)-experienced patient, and
wherein the patient has a proteinuria level of 100 to 1,000 mg/24 hr prior to initiating the administration of the migalastat.
22. The method of claim 21 , wherein the migalastat is administered as migalastat free base.
23. The method of claim 21 , wherein the migalastat is administered as a pharmaceutically acceptable salt.