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 mild renal impairment with an eGFR of 60 to 90 mL/min/1.73 m 2 , the method comprising:
administering to, a group of Fabry disease patients having mild 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) reduce mean globotriaosylceramide (GL-3) accumulated in organs of the patients, (ii) reduce mean plasma globotriaosylsphingosine (lyso-Gb3) in the patients, and (iii) stabilize mean renal function in the patients; and
wherein administration of a single dose of the migalastat to the patients is effective to provide (i) a mean plasma migalastat increase in AUC 0-∞ by about 1.2-fold compared to healthy control subjects, and (ii) no increase in mean plasma migalastat Cmax compared to health control subjects.
2. The method of claim 1 , wherein administration is effective to provide (i) a mean annualized rate of change in eGFR CKD-EPI of greater than −1.0 mL/min/1.73 m 2 , (ii) a mean reduction in kidney interstitial capillary GL-3 inclusions of about 0.30, and (iii) a mean reduction in plasma lyso-Gb3 of about 7.7 nmol/L.
3. The method of claim 2 , wherein the administration is effective to reduce mean globotriaosylceramide (GL-3) accumulated in the patients' kidneys and hearts.
4. The method of claim 2 , wherein the patients have a proteinuria level of less than 100 mg/24 hr prior to initiating the administration of the migalastat.
5. The method of claim 2 , wherein the patients have a proteinuria level of 100 to 1,000 mg/24 hr prior to initiating the administration of the migalastat.
6. The method of claim 2 , wherein the patients have a proteinuria level of greater than 1,000 mg/24 hr prior to initiating the administration of the migalastat.
7. The method of claim 2 , comprising orally administering the migalastat as a salt comprising about 150 mg of migalastat hydrochloride for at least 28 days, wherein the migalastat hydrochloride is in solid dosage form.
8. The method of claim 2 , wherein the HEK assay amenable mutation is a mutation that, when the mutation is expressed in HEK-293 cells incubated in the presence of 10 μM migalastat compared to HEK-293 cells without migalastat, is shown to have (1) a relative increase of at least 20% α-galactosidase A activity and (2) an absolute increase of at least 3% of the wild-type α-galactosidase A activity.
9. A method of stabilizing renal function in patients diagnosed with Fabry disease and having moderate renal impairment with an eGFR of 30 to 59 mL/min/1.73 m 2 , the method comprising:
administering, to a group of Fabry disease patients having moderate 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) reduce mean globotriaosylceramide (GL-3) accumulated in an organ of the patients, (ii) reduce mean plasma globotriaosylsphingosine (lyso-Gb3) in the patients, and (iii) stabilize mean renal function in the patients; and
wherein administration of a single dose of the migalastat to the patients is effective to provide (i) a mean plasma migalastat increase in AUC 0∞ of about 1.8-fold compared to healthy control subjects, and (ii) no increase in mean plasma migalastat Cmax compared to healthy control subjects.
10. The method of claim 9 , wherein the patients are enzyme replacement therapy (ERT)-experienced patients.
11. The method of claim 9 , wherein administration is effective to provide (i) a mean annualized rate of change in eGFR CKD-EPI of greater than −1.0 mL/min/1.73 m 2 , (ii) a mean reduction in kidney interstitial capillary GL-3 inclusions of about 0.39, and (iii) a mean reduction in plasma lyso-Gb3 of about 29.0 nmol/L.
12. The method of claim 9 , wherein the administration is effective to reduce mean globotriaosylceramide (GL-3) accumulated in the patients' kidneys and hearts.
13. The method of claim 9 , wherein the patients have a proteinuria level of less than 100 mg/24 hr prior to initiating the administration of the migalastat.
14. The method of claim 9 , wherein the patients have a proteinuria level of 100 to 1,000 mg/24 hr prior to initiating the administration of the migalastat.
15. The method of claim 9 , wherein the patients have a proteinuria level of greater than 1,000 mg/24 hr prior to initiating the administration of the migalastat.
16. The method of claim 9 , comprising orally administering the migalastat as a salt comprising about 150 mg of migalastat hydrochloride for at least 28 days, wherein the migalastat hydrochloride is in solid dosage form.
17. The method of claim 9 , wherein the HEK assay amenable mutation is a mutation that, when the mutation is expressed in HEK-293 cells incubated in the presence of 10 μM migalastat compared to HEK-293 cells without migalastat, is shown to have (1) a relative increase of at least 20% α-galactosidase A activity and (2) an absolute increase of at least 3% of the wild-type α-galactosidase A activity.
18. A method of stabilizing renal function in patients diagnosed with Fabry disease and having severe renal impairment with an eGFR less than 30 mL/min/1.73 m 2 , the method comprising:
administering, to a group of Fabry disease patients having severe 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) reduce mean globotriaosylceramide (GL-3) accumulated in the kidney and heart of the patients, (ii) reduce mean plasma globotriaosylsphingosine (lyso-Gb3) in the patients, and (iii) stabilize mean renal function in the patients;
wherein administration of a single dose of the migalastat to the patients is effective to provide (i) a mean plasma migalastat increase in AUC 0-∞ of about 4.5-fold compared to healthy control subjects, and (ii) no increase in mean plasma migalastat Cmax compared to healthy control subjects.
19. The method of claim 18 , wherein the patients are enzyme replacement therapy (ERT)-experienced patients.
20. The method of claim 18 , wherein the administration is effective to reduce mean globotriaosylceramide (GL-3) accumulated in the patients' kidneys and hearts.
21. The method of claim 18 , wherein the patients have a proteinuria level of less than 100 mg/24 hr prior to initiating the administration of the migalastat.
22. The method of claim 18 , wherein the patients have a proteinuria level of 100 to 1,000 mg/24 hr prior to initiating the administration of the migalastat.
23. The method of claim 18 , wherein the patients have a proteinuria level of greater than 1,000 mg/24 hr prior to initiating the administration of the migalastat.
24. The method of claim 18 , comprising orally administering the migalastat as a salt comprising about 150 mg of migalastat hydrochloride for at least 28 days, wherein the migalastat hydrochloride is in solid dosage form.
25. The method of claim 18 , wherein the HEK assay amenable mutation is a mutation that, when the mutation is expressed in HEK-293 cells incubated in the presence of 10 μM migalastat compared to HEK-293 cells without migalastat, is shown to have (1) a relative increase of at least 20% α-galactosidase A activity and (2) an absolute increase of at least 3% of the wild-type α-galactosidase A activity.