PT - JOURNAL ARTICLE AU - Derralynn A Hughes AU - Daniel G Bichet AU - Roberto Giugliani AU - Robert J Hopkin AU - Eva Krusinska AU - Kathleen Nicholls AU - Iacopo Olivotto AU - Ulla Feldt-Rasmussen AU - Norio Sakai AU - Nina Skuban AU - Gere Sunder-Plassmann AU - Roser Torra AU - William R Wilcox TI - Long-term multisystemic efficacy of migalastat on Fabry-associated clinical events, including renal, cardiac and cerebrovascular outcomes AID - 10.1136/jmg-2022-108669 DP - 2022 Dec 21 TA - Journal of Medical Genetics PG - jmedgenet-2022-108669 4099 - http://jmg.bmj.com/content/early/2022/12/21/jmg-2022-108669.short 4100 - http://jmg.bmj.com/content/early/2022/12/21/jmg-2022-108669.full AB - Background Fabry disease is a rare, multisystemic disorder caused by GLA gene variants that lead to alpha galactosidase A deficiency, resulting in accumulation of glycosphingolipids and cellular dysfunction. Fabry-associated clinical events (FACEs) cause significant morbidity and mortality, yet the long-term effect of Fabry therapies on FACE incidence remains unclear.Methods This posthoc analysis evaluated incidence of FACEs (as a composite outcome and separately for renal, cardiac and cerebrovascular events) in 97 enzyme replacement therapy (ERT)-naïve and ERT-experienced adults with Fabry disease and amenable GLA variants who were treated with migalastat for up to 8.6 years (median: 5 years) in Phase III clinical trials of migalastat. Associations between baseline characteristics and incidence of FACEs were also evaluated.Results During long-term migalastat treatment, 17 patients (17.5%) experienced 22 FACEs and there were no deaths. The incidence rate of FACEs was 48.3 events per 1000 patient-years overall. Numerically higher incidence rates were observed in men versus women, patients aged >40 years versus younger patients, ERT-naïve versus ERT-experienced patients and men with the classic phenotype versus men and women with all other phenotypes. There was no statistically significant difference in time to first FACE when analysed by patient sex, phenotype, prior treatment status or age. Lower baseline estimated glomerular filtration rate (eGFR) was associated with an increased risk of FACEs across patient populations.Conclusions The overall incidence of FACEs for patients during long-term treatment with migalastat compared favourably with historic reports involving ERT. Lower baseline eGFR was a significant predictor of FACEs.Data are available on reasonable request. Requests for access to data may be submitted to Amicus Therapeutics, Inc.