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Enzyme replacement therapy in juvenile glycogenosis type II: a longitudinal study

Abstract

Glycogenosis type II, a genetic muscle-wasting disorder, results in a spectrum of clinical phenotypes. Enzyme replacement therapy is effective in the infantile form of the disease, while little is known about its effectiveness in late-onset disease, especially in juvenile patients. The purpose of this retrospective cohort study was to assess the long-term effects of enzyme replacement therapy (ERT) in juvenile glycogenosis type II (GSDII). Eight Italian juvenile GSDII patients, receiving biweekly infusions of 20 mg/kg recombinant human α-glucosidase for at least 72 months, were enrolled (median age at therapy start was 11.8 years). Six-minute walk test (6MWT) and forced vital capacity (FVC), measured in upright position, were chosen as the principal outcome measures. Global motor disability (modified Walton scale (WS)), muscle enzymes levels [creatine phosphokinase (CK), lactate dehydrogenase (LDH), aspartate transaminase (AST), alanine transaminase (ALT)] and body mass index (BMI) were also analysed both at baseline (therapy start) and annually afterwards. At baseline, most patients (six out of eight) did not show muscle function impairment (WS ≤ 2). The performance at 6MWT showed a slight improvement during follow-up as well as FVC. Muscle enzymes levels showed a clear decrease after the 1st year of treatment while remained stable afterwards. An overall decrease in BMI was also observed during follow-up, although at the individual level, trends were variable. Conclusion: ERT is effective in stabilising both motor and lung functions in juvenile patients with GSDII, possibly slowing down the rate of disease progression. Randomised controlled trials are needed to understand whether early treatment allows juvenile patients to reach adulthood with a more beneficial residual muscular function than untreated patients.

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Abbreviations

ERT:

Enzyme replacement therapy

GSDII:

Glycogenosis type II

GAA:

Acid α-glucosidase

LOTS:

Late-onset treatment study

FVC:

Forced vital capacity

6MWT:

Six-minute walk test

CK:

Creatine phosphokinase

Pt:

Patient

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Funding

No external funding was secured for this study.

Conflict of interest

Annalisa Sechi and Giovanni Ciana were sponsored by Genzyme Corp. to participate in several conferences. Bruno Bembi provided scientific consultancy for Genzyme Corp., Shire and Actelion Pharmaceuticals Ltd. The other authors have no conflicts of interest to disclose. Authors have no financial relationships relevant to this article to disclose.

Author information

Correspondence to Bruno Bembi.

Additional information

Dr. L. Deroma and Dr. M. Guerra contributed equally to the study.

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Deroma, L., Guerra, M., Sechi, A. et al. Enzyme replacement therapy in juvenile glycogenosis type II: a longitudinal study. Eur J Pediatr 173, 805–813 (2014). https://doi.org/10.1007/s00431-013-2258-2

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Keywords

  • Enzyme replacement therapy
  • Glycogen storage disease type II
  • Pulmonary function
  • Exercise tolerance