Fabry disease Enzyme Enhancement on migalastat Study: FEES

Background: There is limited information on the alpha-galactosidase A (alpha-Gal-A) in vivo response in Fabry patients receiving migalastat. In this single centre study, we evaluated changes from baseline in alpha-Gal A activity, lyso-Gb3 and other assessments in patients on migalastat. Results: 79 patients were recruited (48 M:31F; median duration receiving migalastat 3.8 years [range = 0.4-14.9 years]). N215S was the commonest genotype in males (67 %) and females (29 %). Leukocyte alpha-Gal-A showed a positive change from baseline in males (n = 4; median = 20.05); females (n = 8; median = 26). Of these, 3 males and 1 female had N215S (median = 16.7), while 7 females and 1 male had other genotypes (median = 26). No significant changes observed in plasma alpha-Gal-A. Cross-sectional analysis of post-baseline data confirmed leukocyte alpha-Gal-A enhancement in males (n = 47; median = 20); females (n = 30; median = 72); N215S (n = 41; median = 29) and other genotypes (n = 36; median = 36.5). Plasma and dried blood spot (DBS) lyso-Gb3 correlated at baseline and post-baseline (r = 0.77 and r = 0.96; p=<0.0001). Conclusions: In the 12 patients with paired data, there was a median enzyme enhancement of 17.4 (relative change = 2.54) and 33 (relative change = 0.87) in males and in females, respectively. The cross-sectional postbaseline data in 47 patients corroborated leukocyte alpha-Gal-A enhancement on migalastat. Plasma and DBS lysoGb3 correlated well supporting DBS utility for disease monitoring.