Long-term efficacy and safety of migalastat treatment in Fabry disease: 30-month results from the open-label extension of the randomized, phase 3 ATTRACT study

Abstract

Results from the 18-month randomized treatment period of the phase 3 ATTRACT study demonstrated the efficacy and safety of oral migalastat compared with enzyme replacement therapy (ERT) in patients with Fabry disease who previously received ERT. Here, we report data from the subsequent 12-month, migalastat-only, open-label extension (OLE) period. ATTRACT (Study AT1001-012; NCT01218659) was a randomized, open-label, active-controlled study in patients aged 16-74 years with Fabry disease, an amenable GLA variant, and an estimated glomerular filtration rate (eGFR) ≥30 mL/min/1.73 m2. During the OLE, patients who received migalastat 150 mg every other day (QOD) during the randomized period continued receiving migalastat (Group 1 [MM]); patients who received ERT every other week discontinued ERT and started migalastat treatment (Group 2 [EM]). Outcome measures included eGFR, left ventricular mass index (LVMi), composite clinical outcome (renal, cardiac or cerebrovascular events), and safety. Forty-six patients who completed the randomized treatment period continued into the OLE (Group 1 [MM], n = 31; Group 2 [EM], n = 15). eGFR remained stable in both treatment groups. LVMi decreased from baseline at month 30 in Group 1 (MM) in patients with left ventricular hypertrophy at baseline. Only 10% of patients experienced a new composite clinical event with migalastat treatment during the OLE. No new safety concerns were reported. In conclusion, in patients with Fabry disease and amenable GLA variants, migalastat 150 mg QOD was well tolerated and demonstrated durable, long-term stability of renal function and reduction in LVMi.

Keywords: Chaperone; Clinical trial; Fabry disease; Lysosomal disorders; Migalastat.

Conflict of interest statement

Declaration of competing interest UFR has served on advisory boards for Amicus Therapeutics, Shire, Freeline, and Sanofi Genzyme, as a speaker for Amicus Therapeutics and Sanofi Genzyme, and has received research funding from Shire, Amicus Therapeutics, and Sanofi Genzyme. DH has received honoraria and research funding from Amicus Therapeutics, Shire, Sanofi Genzyme, Protalix, and Actelion. GSP has served on advisory boards for Amicus Therapeutics and Greenovation, as a speaker for Sanofi Genzyme, and has received research funding from Amicus Therapeutics, Idorsia, and Shire. SS has served as an investigator for Amicus Therapeutics. K Nedd received fees from Sanofi Genzyme and Shire-Takeda. IO has received research funding from and served as a speaker for Shire, Sanofi Genzyme, and MyoKardia. DO has served on advisory boards for Sanofi Genzyme. TH has nothing to disclose. TO has received research funding from DSP, Sanofi Genzyme, and Avrobio. NS, JY, and JAB are employees of and hold stock in Amicus Therapeutics. K Nicholls has served on advisory boards for Amicus Therapeutics, Sanofi Genzyme, and Shire, as a speaker for Amicus Therapeutics, and has received research funding from Sanofi Genzyme and Shire.

Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.