Abstract
Type 1 Gaucher disease (GD1) is caused by the deficiency in the lysosomal enzyme glucocerebrosidase and causes the accumulation of glucocerebroside mainly in macrophages, inducing deterioration of the organs in which it is deposited.The new substrate inhibitor Eliglustat (ELI), approved by EMA in 2015 and available in Spain since January 2017, has proved to be an effective therapy that selectively inhibits the enzyme glucosylceramide synthase, decreasing the accumulation of substrate. It is indicated in GD1 extensive, intermediate or poor metabolizers of the cytochrome CYP2D6. The phase 2 and 3 clinical trials have demonstrated improvement and stabilization of the parameters in the naïve patients and in switched from enzyme replacement therapy. In this work we present the design of a prospective follow-up post-authorization study (GEE-ELI-2017-01) to asure the traceability of eliglustat therapy in Spanish GD1patients (TRAZELGA) is exposed. MethodsThe national multi-center study TRAZELGA, designed as a tool to uniformly evaluate the response to ELI therapy during one year, analyzing clinical parameters, biomarkers, changes in medullary infiltration quantified by MRI and DEXA, compliance and side effects. In addition, a quality of life sub-study is included as well as an exploratory study to analyze immune system activation markers (cytokine profile, ferritin, lipocalin, gamma globulins, oxidative stress markers). All the current recommendations previous ELI therapy have been reinforced, including cardiac, hepatic and renal function assessment and suitability according concomitant medications. An electronic tool has been designed to help physicians to easily registry and update the patient information. All the current rules for data protection were taken in account. Results: 40 GD1 patients have started oral treatment with Eliglustat. In this presentation we provide preliminary results of 32 patients whom fulfilled 6 months of follow-up (median age: 43.8 years (23-75), 47% males), genotype c.1226A>G in homozygosity (29.4%), c.1226A>G/c.1448T>C (41.2% ), other double heterozygotes with c.1226A>G (29.4%); metabolism of CYP2D6 (12% poor metabolizers, 64.5% intermediate and 33.5% extensive), no patient received the treatment in first line and its baseline characteristics (table1), are from patients stabilized with ERT (23 cases) or miglustat (9).Two splenectomized patients, 3 patients with palpable splenomegaly at the time of inclusion, 6 patients with multimorbidities and polymedications and 6 patients complained of fatigue as the main symptom before inclusion in the study. The median follow-up is 6 (6-14) months. Conclusions: The acceptance of the project in the medical community has been excellent with a good inclusion page. At the end of the one year follow-up period we will be available to analyze the influence of Eliglustat on biomarkers, markers of inflammation, bone mineral density also to provide information about adherence and adverse events in every day clinical practice.
This work has been partially granted by FEETEG
No relevant conflicts of interest to declare.
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