Journal of Pediatric Neurology
DOI: 10.1055/s-0043-1778099
Original Article

The Impact of Pabinafusp Alfa on the Disease Burden in Hunter's Syndrome: Patient-Reported Outcomes

Ana Maria Martins
1   Centro de Referências em Erros Inatos do Metabolismo (CREIM), Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
,
Marco Antônio Curiati
1   Centro de Referências em Erros Inatos do Metabolismo (CREIM), Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
,
Carmen Curiati Mendes
1   Centro de Referências em Erros Inatos do Metabolismo (CREIM), Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
,
Edna Tiemi Sakata
1   Centro de Referências em Erros Inatos do Metabolismo (CREIM), Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
,
Carolina Fischinger Moura de Souza
2   Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, Brazil
3   Casa dos Raros, Porto Alegre, Rio Grande do Sul, Brazil
,
Roberto Giugliani
2   Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, Brazil
3   Casa dos Raros, Porto Alegre, Rio Grande do Sul, Brazil
4   Programa de Pós-graduação em Genética e Biologia Molecular da Universidade Federal do Rio Grande do Sul, Rio Grande do Sul, Brazil
5   Dasa Genômica, São Paulo, Brazil
6   Instituto Nacional de Genética Populacional NAGEMP, Porto Alegre, Rio Grande do Sul, Brazil
› Author Affiliations
Funding Financial support has been provided to support medical writing of the manuscript by JCR Pharmaceuticals, but the publication was developed independently by the authors who are entirely responsible for the scientific content of the manuscript. Camilla Patti provided medical writer services for the elaboration of this manuscript.

Abstract

Severe mucopolysaccharidosis type II (MPS-II) patients present with progressive mental impairment and reduced life expectancy. While current available treatment cannot cross the blood–brain barrier, the enzyme replacement therapy with pabinafusp alfa (a recombinant iduronate-2-sulfatase fused to an antihuman transferrin receptor antibody) was designed to penetrate it using transferrin receptor-mediated transcytosis. In this cross-sectional retrospective study, we aimed to report the impact of this new therapy using patient-reported outcomes. Data were collected using standardized questionnaire replied by patients or their caregivers (as proxies). Nine patients received intravenous administration of pabinafusp alfa for at least 104 weeks. All patient showed improvements in behavior (mainly aggressiveness), speech, motor ability, muscle strength, facial expression, breathing, and cognitive skills. Gait improvement was also found in 78% of participants. Caregivers also reported improvements in emotion demonstration as ability to smile, establish eye contact, and give hugs. Collectively, our results indicate a positive impact of pabinafusp alfa on quality of life of individuals with MPS-II and their relatives/caregivers. Future studies are warranted to elucidate the mechanisms underlying these beneficial effects.

Informed Consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Declaration of Helsinki 2013, as revised in 2000. The Ethics Committee from the Universidade Federal de São Paulo approved the study under the #0613/2018 protocol. Written informed consent for publication were obtained from the patients or the legal responsible of the patients.


Animal Rights

This article does not contain any studies with animal subjects performed by any of the authors.


Authors' Contribution

A.M.M., M.A.C., C.C.M., and E.T.S. conceived and designed the manuscript and conducted data collection and analysis. All authors revised the text critically and approved the final manuscript.




Publication History

Received: 16 April 2023

Accepted: 04 December 2023

Article published online:
01 March 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 Muenzer J. The mucopolysaccharidoses: a heterogeneous group of disorders with variable pediatric presentations. J Pediatr 2004; 144 (5, Suppl): S27-S34
  • 2 Wraith JE, Scarpa M, Beck M. et al. Mucopolysaccharidosis type II (Hunter syndrome): a clinical review and recommendations for treatment in the era of enzyme replacement therapy. Eur J Pediatr 2008; 167 (03) 267-277
  • 3 Mohamed S, He QQ, Singh AA, Ferro V. Mucopolysaccharidosis type II (Hunter syndrome): clinical and biochemical aspects of the disease and approaches to its diagnosis and treatment. Adv Carbohydr Chem Biochem 2020; 77: 71-117
  • 4 Neufeld EF, Muenzer J. The mucopolysaccharidosis. In: Valle DL, Antonarakis S, Ballabio A, Beaudet AL, Mitchell GA. eds. The Online Metabolic and Molecular Bases of Inherited Disease. New York, United States: McGraw-Hill; 2019: 3421-3452
  • 5 Scarpa M, Almássy Z, Beck M. et al; Hunter Syndrome European Expert Council. Mucopolysaccharidosis type II: European recommendations for the diagnosis and multidisciplinary management of a rare disease. Orphanet J Rare Dis 2011; 6: 72
  • 6 Kuratsubo I, Suzuki Y, Orii KO, Kato T, Orii T, Kondo N. Psychological status of patients with mucopolysaccharidosis type II and their parents. Pediatr Int 2009; 51 (01) 41-47
  • 7 Shapiro EG, Eisengart JB. The natural history of neurocognition in MPS disorders: a review. Mol Genet Metab 2021; 133 (01) 8-34
  • 8 Roberts J, Stewart C, Kearney S. Management of the behavioural manifestations of Hunter syndrome. Br J Nurs 2016; 25 (01) 22-30 , 24, 26–30
  • 9 Muenzer J, Wraith JE, Beck M. et al. A phase II/III clinical study of enzyme replacement therapy with idursulfase in mucopolysaccharidosis II (Hunter syndrome). Genet Med 2006; 8 (08) 465-473
  • 10 Sohn YB, Cho SY, Park SW. et al. Phase I/II clinical trial of enzyme replacement therapy with idursulfase beta in patients with mucopolysaccharidosis II (Hunter syndrome). Orphanet J Rare Dis 2013; 8: 42
  • 11 Giugliani R, Martins AM, So S. et al. Iduronate-2-sulfatase fused with anti-hTfR antibody, pabinafusp alfa, for MPS-II: a phase 2 trial in Brazil. Mol Ther 2021; 29 (07) 2378-2386
  • 12 Raluy-Callado M, Chen WH, Whiteman DA, Fang J, Wiklund I. The impact of Hunter syndrome (mucopolysaccharidosis type II) on health-related quality of life. Orphanet J Rare Dis 2013; 8: 101
  • 13 Weldring T, Smith SM. Patient-reported outcomes (PROs) and patient-reported outcome measures (PROMs). Health Serv Insights 2013; 6: 61-68
  • 14 Shapiro EG, Escolar ML, Delaney KA, Mitchell JJ. Assessments of neurocognitive and behavioral function in the mucopolysaccharidoses. Mol Genet Metab 2017; 122S: 8-16
  • 15 Quinn J, Georgiadis A, Lewis HB, Jurecki E. Measuring burden of illness in phenylketonuria (PKU): development of the PKU symptom severity and impacts scale as a robust patient-reported outcome. Adv Ther 2022; 39 (02) 971-991
  • 16 Brands MM, Güngör D, van den Hout JM. et al. Pain: a prevalent feature in patients with mucopolysaccharidosis. Results of a cross-sectional national survey. J Inherit Metab Dis 2015; 38 (02) 323-331
  • 17 Doward LC, Gnanasakthy A, Baker MG. Patient reported outcomes: looking beyond the label claim. Health Qual Life Outcomes 2010; 8: 89