Evaluation of impact of anti-idursulfase antibodies during long-term idursulfase enzyme replacement therapy in mucopolysaccharidosis II patients

R Giugliani, P Harmatz, S A Jones, N J Mendelsohn, A Vellodi, Y Qiu, C J Hendriksz, S Vijayaraghavan, D A H Whiteman, A Pano, R Giugliani, P Harmatz, S A Jones, N J Mendelsohn, A Vellodi, Y Qiu, C J Hendriksz, S Vijayaraghavan, D A H Whiteman, A Pano

Abstract

Objectives: This 109-week, nonrandomized, observational study of mucopolysaccharidosis II (MPS II) patients already enrolled in the Hunter Outcome Survey (HOS) (NCT00882921), assessed the long-term immunogenicity of idursulfase, and examined the effect of idursulfase-specific antibody generation on treatment safety (via infusion-related adverse events [IRAEs]) and pharmacodynamics (via urinary glycosaminoglycans [uGAGs]).

Methods: Male patients ≥ 5 years, enrolled in HOS regardless of idursulfase treatment status were eligible. Blood/urine samples for anti-idursulfase antibody testing and uGAG measurement were collected every 12 weeks.

Results: Due to difficulties in enrolling treatment-naïve patients, data collection was limited to 26 enrolled patients of 100 planned patients (aged 5.1-35.5 years) all of whom were non-naïve to treatment. Fifteen (58%) patients completed the study. There were 11/26 (42%) seropositive patients at baseline (Ab +), and 2/26 (8%) others developed intermittent seropositivity by Week 13. A total of 9/26 patients (35%) had ≥ 1 sample positive for neutralizing antibodies. Baseline uGAG levels were low due to prior idursulfase treatment and did not change appreciably thereafter. Ab + patients had persistently higher uGAG levels at entry and throughout the study than Ab - patients. Nine of 26 (34%) patients reported IRAEs. Ab + patients appeared to have a higher risk of developing IRAEs than Ab - patients. However, the relative risk was not statistically significant and decreased after adjustment for age.

Conclusions: 50% of study patients developed idursulfase antibodies. Notably Ab + patients had persistently higher average uGAG levels. A clear association between IRAEs and antibodies was not established.

Keywords: Cognitive impairment; Enzyme replacement therapy; Glycosaminoglycans; Hunter syndrome; Idursulfase; Immunogenicity; Neutralizing antibodies.

Figures

Fig. 1
Fig. 1
Mean normalized uGAG (μg/mg) by visit and IgG Ab status (A) and NAb status (B). Ab, antibody; IgG, immunoglobulin G; NAb, neutralizing antibodies; uGAG, urinary glycosaminoglycan.

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Source: PubMed

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