Kidney Interstitial Capillary GL-3 Results for 60-Week Treatment on Migalastat HCl Presented at American Society of Nephrology Kidney Week
Pharmacodynamic Markers Indicate Stable Renal Function in Patients With Amenable Mutations
CRANBURY, N.J., Nov. 5, 2012 (GLOBE NEWSWIRE) -- Amicus Therapeutics (Nasdaq:FOLD) today announced updated data from an open-label, Phase 2 extension study (Study 205/FAB-CL-205) to investigate the long-term safety, tolerability and pharmacodynamics of migalastat HCl in 23 patients with Fabry disease who completed an initial Phase 2 study. Amicus in collaboration with GlaxoSmithKline (GSK) is developing the investigational pharmacological chaperone Migalastat HCl for the treatment of Fabry disease. Results1 from Study 205 were presented at the American Society of Nephrology (ASN) Kidney Week 2012.
Pol F. Boudes, MD, Chief Medical Officer of Amicus Therapeutics stated, "Fabry is a broad spectrum disease that affects males and females resulting in various symptoms. In our Phase 2 studies, kidney biopsies from both males and females with amenable mutations have shown decreases in interstitial capillary GL-3, a key biomarker of disease. Collectively these results support the ongoing investigation of migalastat HCl monotherapy in Phase 3 studies. We believe that migalastat HCl has the potential to become an important new treatment option for Fabry patients with amenable mutations."
Key Study 205 Results Presented at ASN:
- Enrolled 23 total subjects who completed primary treatment period (12 or 24 weeks) and treatment extension (24 to 84 weeks) in 4 Phase 2 studies (Studies FAB-CL-201-204).
- No drug-related serious adverse events. The most common adverse events in 6 out of 23 subjects were arthralgia, fatigue, back pain, and pain in extremity.
- 8 patients had evaluable paired kidney biopsies from baseline in primary study and follow-up in Study 205 (60-week median treatment duration in Study 205 prior to biopsy). Median decrease in interstitial capillary globotriaosylceramide (GL-3) was 78% in the 5 patients (2 males and 3 females) with genetic mutations amenable to migalastat HCl monotherapy in a cell-based assay. Median increase in interstitial capillary GL-3 was 114% in 3 females with non-amenable mutations.
- Renal function remained stable in patients with amenable mutations as demonstrated by estimated glomerular filtration rate (eGFR) and proteinuria.
- Median treatment duration on migalastat HCl was 5.2 years (4.7 to 6.4 years) in 17 subjects who completed Study 205 – final data analysis ongoing
- 16 out of 17 subjects who completed Study 205 are now enrolled in a separate open-label extension study (MGM116041)
GL-3 in Renal Peritubular Capillary Cells (PTCs, or Interstitial Capillaries)
GL-3 is the lipid substrate that accumulates in tissues affected by Fabry disease, including the kidney. GL-3 inclusions in PTCs - also referred to as interstitial capillaries - are measured by histology from kidney biopsies. Reduction of GL-3 in renal PTCs previously supported conditional approval of enzyme replacement therapy (ERT) for Fabry disease by the U.S. Food and Drug Administration (FDA).
Previous scientific presentations2 highlighted changes in interstitial capillary GL-3 from baseline to various time points in initial Phase 2 studies (Studies 202-204). Changes in interstitial capillary GL-3 from baseline (in Studies 202-204) to follow-up (Study 205) were presented for the first time at ASN 2012. Pathologists blinded to biopsy sequence assessed a total of 8 evaluable paired kidney biopsies by histology using the published, quantitative Barisoni Lipid Inclusion Scoring System (BLISS)3 by virtual microscopy.
Estimated glomerular filtration rate (eGFR) remained stable. In 9 male evaluable patients, decreases in proteinuria from baseline were observed in 8 patients with amenable mutations, with an increase reported in 1 non-amenable patient.
|About The Phase 2 and Phase 2 Extension Studies|
|Phase 2 Protocols Represented in Study 205 (n = 23)|
| Phase 2 |
| Treatment Period |
| Migalastat HCl |
| Extension |
|Kidney Biopsies*|| # in |
| # in Study |
|Study 201 (n=9 males)||12||25, 100 and 250 mg twice-daily (BID) then 50 mg once-daily (QD)||84||No||6||6|
|Study 202 (n=4 males)||12||150 mg, every-other-day (QOD)***||36||Yes||3||2|
|Study 203 (n=5 males)||24||150 mg QOD***||24||Yes||5||3|
|Study 204 (n=9 females)||12||50, 150***, or 250 mg QOD||36||Yes||9||5|
|*Per protocols, no kidney biopsies in Study 201; kidney biopsies in Studies 202-204 at baseline, after primary treatment period, and after extension period|
|**Retrospectively identified as amenable to migalastat HCl in a cell-based assay|
|***Dose selected for Phase 3 studies (150 mg QOD)|
Study 205 is an open-label extension study to investigate the long-term safety, tolerability and pharmacodynamics of migalastat HCl that enrolled 23 patients with Fabry disease who completed four open-label Phase 2 studies (Study 201, -202, -203 and -204) to evaluate the safety and tolerability of various doses and dose regimens of oral migalastat HCl. In addition to safety and tolerability, Study 205 is evaluating globotriaosylceramide (GL-3) in interstitial capillaries, an important biomarker for Fabry disease, as well as kidney function as measured by estimated glomerular filtration rate (eGFR) and proteinuria.
About Migalastat HCl
Amicus in collaboration with GlaxoSmithKline (GSK) is developing the investigational pharmacological chaperone migalastat HCl for the treatment of Fabry disease. Amicus has commercial rights to all Fabry products in the United States and GSK has commercial rights to all of these products in the rest of world.
As a monotherapy, migalastat HCl is designed to bind to and stabilize, or "chaperone" a patient's own alpha-galactosidase A (alpha-Gal A) enzyme in patients with genetic mutations that are amenable to this chaperone in a cell-based assay. Migalastat HCl monotherapy is in Phase 3 development (Study 011 and Study 012) for Fabry patients with amenable mutations. Study 011 is a placebo-controlled study intended primarily to support U.S. registration, and Study 012 is comparing open-label migalastat HCl to ERT to primarily support global registration.
For patients currently receiving ERT for Fabry disease, migalastat HCl in combination with ERT may improve ERT outcomes by keeping the infused alpha-Gal A enzyme in its properly folded and active form. Migalastat HCl co-administered with ERT is in Phase 2 (Study 013) and migalastat HCl co-formulated with JCR Pharmaceutical Co. Ltd's proprietary investigational ERT (JR-051, recombinant human alpha-Gal A enzyme) is in preclinical development.
About Fabry Disease
Fabry disease is an inherited lysosomal storage disorder caused by deficiency of an enzyme called alpha-galactosidase A (alpha-Gal A). The role of alpha-Gal A within the body is to break down specific lipids in lysosomes, including globotriaosylceramide (GL-3, also known as Gb3). Lipids that can be degraded by the action of α-Gal are called "substrates" of the enzyme. Reduced or absent levels of alpha-Gal A activity leads to the accumulation of GL-3 in the affected tissues, including the kidneys, heart, central nervous system, and skin. This accumulation of GL-3 is believed to cause the various symptoms of Fabry disease, including pain, kidney failure, and increased risk of heart attack and stroke.
It is currently estimated that Fabry disease affects approximately 5,000 to 10,000 people worldwide. However, several literature reports suggest that Fabry disease may be significantly under diagnosed, and the prevalence of the disease may be much higher.
About Amicus Therapeutics
Amicus Therapeutics (Nasdaq:FOLD) is a biopharmaceutical company at the forefront of developing therapies for rare diseases. The Company is developing orally-administered, small molecule drugs called pharmacological chaperones, a novel, first-in-class approach to treating a broad range of human genetic diseases. Amicus' late-stage programs for lysosomal storage disorders include migalastat HCl monotherapy in Phase 3 for Fabry disease; migalastat HCl co-administered with enzyme replacement therapy (ERT) in Phase 2 for Fabry disease; and AT2220 co-administered with ERT in Phase 2 for Pompe disease.
2. Shiffmann, et al., LDN WORLD 2011, Long-Term Safety, Tolerability, and Assessments of Renal Function in Adult Fabry Patients Receiving Treatment with AT1001 (Migalastat Hydrochloride), a Pharmacological Chaperone
Giugliani, et al., LDN WORLD 2012, Oral Migalastat HCL (AT1001/GR181314A) as an Investigational Therapy Evaluated in Females with Fabry Disease
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