Open-Label Extension Study of the Long-Term Effects of Migalastat HCL in Patients With Fabry Disease

An Open-Label Extension Study to Evaluate the Long-Term Safety and Efficacy of Migalastat Hydrochloride Monotherapy in Subjects With Fabry Disease

This is an open-label extension study intended to provide continued treatment with migalastat hydrochloride (HCl) for participants with Fabry disease who completed treatment of a previous migalastat HCl study. The study assessed the long-term safety and effectiveness of migalastat HCl.

Study Overview

• Status: Completed
• Conditions: Fabry Disease
• Intervention / Treatment: Drug: migalastat HCl 150 mg

• Study Type: Interventional
• Enrollment (Actual): 84
• Phase: Phase 3

Expanded Access

Approved for sale to the public. See expanded access record.

Contacts and Locations

Study Locations

• Argentina
  • Pilar, Argentina, B1629ODT
    • Clinical Study Site
• Australia
  • Adelaide, Australia, 5000
    • Clinical Study Site
  • Parkville, Australia, 3050
    • Clinical Study Site
• Austria
  • Wien, Austria, 1090
    • Clinical Study Site
• Belgium
  • Edegem, Belgium, 2650
    • Clinical Study Site
• Brazil
  • Porto Alegre, Brazil, 90035-903
    • Clinical Study Site
• Canada
  • Quebec
    • Montreal, Quebec, Canada, H4J 1C5
      • Clinical Study Site
• Denmark
  • Copenhagen, Denmark, 2100
    • Clinical Study Site
• Egypt
  • Cairo, Egypt, 11451
    • Clinical Study Site
• France
  • Garches, France, 92380
    • Clinical Study Site
  • Lille, France, 59037
    • Clinical Study Site
• Italy
  • Firenze, Italy, 50134
    • Clinical Study Site
  • Roma, Italy, 00168
    • Clinical Study Site
• Japan
  • Niigata, Japan, 951-8520
    • Clinical Study Site
  • Osaka-shi, Japan, 545-8586
    • Clinical Study Site
  • Tokyo, Japan, 105-8471
    • Clinical Study Site
  • Osaka
    • Suita, Osaka, Japan, 565-0871
      • Clinical Study Site
• Spain
  • Barcelona, Spain, 08025
    • Clinical Study Site
• Turkey
  • Ankara, Turkey, 06500
    • Clinical Study Site
• United Kingdom
  • London, United Kingdom, NW3 2QG
    • Clinical Study Site
  • London, United Kingdom, WC1N3BG
    • Clinical Study Site
• United States
  • Georgia
    • Atlanta, Georgia, United States, 30322
      • Clinical Study Site
  • Kansas
    • Kansas City, Kansas, United States, 66160
      • Clinical Study Site
  • Michigan
    • Grand Rapids, Michigan, United States, 49525
      • Clinical Study Site
  • New York
    • New York, New York, United States, 10016
      • Clinical Study Site
  • Oregon
    • Portland, Oregon, United States, 97239
      • Clinical Study Site
  • Texas
    • Dallas, Texas, United States, 75226
      • Clinical Study Site
  • Virginia
    • Fairfax, Virginia, United States, 22030
      • Clinical Study Site

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Participant had completed treatment in a previous study of migalastat HCl given as a monotherapy
• Male and female participant agreed to use protocol-identified acceptable contraception
• Participant was willing to provide written informed consent and authorization for use and disclosure of Personal Health Information (PHI)

Exclusion Criteria:

• Participant's last available estimated glomerular filtration rate (eGFR) in the previous study was <30 milliliter (mL)/minute (min)/1.73 meters squared (m^2); unless there was measured GFR available within 3 months of Baseline Visit, which was >30 mL/min/1.73 m^2
• Participant had undergone, or was scheduled to undergo kidney transplantation or was currently on dialysis
• Participant had a documented transient ischemic attack, stroke, unstable angina, or myocardial infarction within the 3 months before Baseline Visit
• Participant had clinically significant unstable cardiac disease in the opinion of the investigator (for example, cardiac disease requiring active management, such as symptomatic arrhythmia, unstable angina, or New York Heart Association class III or IV congestive heart failure)
• Participant had a history of allergy or sensitivity to AT1001 (including excipients) or other iminosugars (for example, miglustat, miglitol)
• Participant required treatment with Glyset® (miglitol) or Zavesca® (miglustat)
• Participants with severe or unsuitable concomitant medical condition
• Participants with clinically significant abnormal laboratory value(s) and/or clinically significant electrocardiogram (ECG) findings

Study Plan

How is the study designed?

Design Details

• Primary Purpose: TREATMENT
• Allocation: NA
• Interventional Model: SINGLE_GROUP
• Masking: NONE

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
EXPERIMENTAL: Migalastat HCl 150 mg; Migalastat HCl 150 milligram (mg).	Drug: migalastat HCl 150 mg; Migalastat HCl 150 mg (equivalent to 123 mg migalastat) was provided as capsules in blister packs. One capsule was taken orally every other day.; Other Names: AT1001; Galafold

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number Of Participants Experiencing Adverse Events (AEs)	An AE was defined as any untoward medical occurrence in a participant administered migalastat that did not necessarily have a causal relationship with the treatment. Each AE was recorded at time of reporting; visits typically occurred every 6 months. Serious AEs were life threatening or resulted in death, resulted in disability/incapacity, hospitalization or prolonged hospitalization, or a congenital anomaly. The criteria for AE severity were: Mild: awareness of sign or symptom, does not interfere with normal everyday activities; Moderate: discomforting, interferes with normal everyday activities, but able to function; Severe: incapacitating, prevents normal everyday activities or significantly affects clinical status and requires medical intervention. A summary of serious and all other non-serious AEs regardless of causality is located in the Reported Adverse Events module.	Day 1 after first dose to approximately 30 days after last treatment, median duration of 3.1 years

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Annualized Rate Of Change In The Estimated Glomerular Filtration Rate (eGFR)	The annualized rate of change in the eGFR was assessed per participant by the slope of the simple linear regression between the observed values and the assessment times. It was calculated by using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation (eGFR [CKD-EPI]) and the Modification of Diet in Renal Disease (MDRD) equation (eGFR [MDRD]). The equations are as follows: eGFR [MDRD] = 175 × (1/Serum Creatinine in mg/deciliter^1.154) × (1/Age in years^0.203) × 0.742 [if female] × 1.212 [if black] × 0.808 [if Japanese]; eGFR [CKD-EPI] = 141 × min(Serum creatinine [Scr]/k, 1)α × max(Scr/k, 1) - 1.209 × 0.993Age × 1.018 [if female] × 1.159 [if black], where Scr is serum creatinine, k is 0.7 for females and 0.9 for males, α is -0.329 for females and -0.411 for males, min indicates the minimum of Scr/k or 1, and max indicates the maximum of Scr/k or 1. Participants with at least a Baseline and a post-Baseline value are presented.	Baseline to approximately 30 days after last treatment, median duration of 3.1 years
Change From Baseline In eGFR At End Of Study	The change from baseline in eGFR was calculated using eGFR[CKD-EPI] and eGFR[MDRD] equations. Baseline was defined as the data collected at Month 0, if not available, it was the last visit of the previous (feeder) study if done within 6 months. End of Study was the last recorded observation for each participant (approximately 30 days after last treatment). Only participants with both a Baseline value and an End of Study value were included in the change from baseline analysis.	Baseline to approximately 30 days after last treatment, median duration of 3.1 years
Change From Baseline In Plasma Globotriaosylsphingosine (Lyso-Gb3) To End Of Study	Concentrations of lyso-Gb3 were measured in plasma using a qualified assay. Baseline was defined as the data collected at Month 0, if not available, it was the last visit of the previous (feeder) study if done within 6 months. End of study was the last recorded observation for each participant (approximately 30 days after last treatment). Only participants with both a Baseline value and an End of Study value were included in the change from baseline analysis.	Baseline to approximately 30 days after last treatment, median duration of 3.1 years
Change From Baseline In White Blood Cell α-Gal A Activity To End Of Study	The activity of the α-galactosidase A (α-Gal A) enzyme was measured in leukocyte lysate by a validated fluorometric assay method, using 4-methylumbelliferone as a reference. The activity values obtained were normalized to protein (measured using a colorimetric assay). Baseline was defined as the data collected at Month 0, if not available, it was the last visit of the previous (feeder) study if done within 6 months. End of Study was the last recorded observation for each participant (approximately 30 days after last treatment). Results for male participants are reported. Only participants with both a Baseline value and an End of Study value were included in the change from baseline analysis.	Baseline to approximately 30 days after last treatment, median duration of 3.1 years
Change From Baseline In 24-hour Urine Protein To End Of Study	A 24-hour urine sample was collected to measure 24-hour urine protein. Baseline was defined as the data collected at Month 0, if not available, it was the last visit of the previous (feeder) study if done within 6 months. End of Study was the last recorded observation for each participant (approximately 30 days after last treatment). Only participants with both a Baseline value and an End of Study value were included in the change from baseline analysis.	Baseline to approximately 30 days after last treatment, median duration of 3.1 years
Change From Baseline In Left Ventricular Mass (LVM) To End Of Study	LVM was measured by echocardiography. Baseline was defined as the data collected at Month 0, if not available, it was the last visit of the previous (feeder) study if done within 6 months. End of Study was the last recorded observation for each participant (approximately 30 days after last treatment). Only participants with both a Baseline value and an End of Study value were included in the change from baseline analysis.	Baseline to approximately 30 days after last treatment, median duration of 3.1 years
Change From Baseline In Left Ventricular Mass Index (LVMi) To End Of Study	LVMi was measured by echocardiography. Baseline was defined as the data collected at Month 0, if not available, it was the last visit of the previous (feeder) study if done within 6 months. End of Study was the last recorded observation for each participant (approximately 30 days after last treatment). Only participants with both a Baseline value and an End of Study value were included in the change from baseline analysis.	Baseline to approximately 30 days after last treatment, median duration of 3.1 years
Change From Baseline In Patient Reported Quality Of Life To End Of Study, As Assessed By The Short Form-36 (SF-36) Questionnaire	The SF-36 is a participant self-rated questionnaire that is a general measure of perceived health status comprising 36 questions, which yields an 8-scale health profile (Physical Functioning, Role Physical, Bodily Pain, General Health, Vitality, Social Functioning, Role Emotional, and Mental Health). Scores on each item are summed and averaged (range: 0=worst to 100=best). Scores were normed to the US population. Higher score indicates less disability. A positive change from baseline indicates improvement. Baseline was defined as the data collected in the last visit of the previous (feeder) study. Only participants with both a Baseline value and an End of Study value were included in the change from baseline analysis.	Baseline to approximately 30 days after last treatment, median duration of 3.1 years

Collaborators and Investigators

• Sponsor: Amicus Therapeutics

Publications and helpful links

General Publications

• Narita I, Ohashi T, Sakai N, Hamazaki T, Skuban N, Castelli JP, Lagast H, Barth JA. Efficacy and safety of migalastat in a Japanese population: a subgroup analysis of the ATTRACT study. Clin Exp Nephrol. 2020 Feb;24(2):157-166. doi: 10.1007/s10157-019-01810-w. Epub 2019 Dec 30.

Study record dates

Study Major Dates

• Study Start (ACTUAL): March 14, 2015
• Primary Completion (ACTUAL): October 23, 2019
• Study Completion (ACTUAL): October 23, 2019

Study Registration Dates

• First Submitted: July 17, 2014
• First Submitted That Met QC Criteria: July 17, 2014
• First Posted (ESTIMATE): July 21, 2014

Study Record Updates

• Last Update Posted (ACTUAL): December 21, 2020
• Last Update Submitted That Met QC Criteria: November 25, 2020
• Last Verified: November 1, 2020

More Information

Terms related to this study

• Keywords: Amicus Therapeutics; AT1001; Galafold; Migalastat
• Additional Relevant MeSH Terms: Cardiovascular Diseases; Vascular Diseases; Metabolic Diseases; Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Genetic Diseases, Inborn; Genetic Diseases, X-Linked; Metabolism, Inborn Errors; Lysosomal Storage Diseases; Lipid Metabolism Disorders; Brain Diseases, Metabolic; Brain Diseases, Metabolic, Inborn; Sphingolipidoses; Lysosomal Storage Diseases, Nervous System; Cerebral Small Vessel Diseases; Lipidoses; Lipid Metabolism, Inborn Errors; Fabry Disease
• Other Study ID Numbers: AT1001-042; 2014-002701-38 (EUDRACT_NUMBER)