Abstract
Migalastat (Galafold™)—a small molecule drug developed by Amicus Therapeutics that restores the activity of specific mutant forms of α-galactosidase—has been approved for the treatment of Fabry disease in the EU in patients with amenable mutations. Fabry disease is a rare disorder that results in a deficiency or absence of α-galactosidase, leading to accumulation of globotriaosylceramide in the lysosomes of various cells. This article summarizes the milestones in the development of migalastat leading to this first approval in the EU for the long-term treatment of adults and adolescents aged ≥16 years with a confirmed diagnosis of Fabry disease.
Similar content being viewed by others
References
Amicus Therapeutics. Amicus Therapeutics announces European Commission approval for Galafold™ (migalastat) in patients with Fabry disease in European Union [media release]. 31 May 2016. http://www.amicustherapeutics.com.
European Medicines Agency. Galafold 123 mg hard capsules: summary of product characteristics. 2016. http://www.ema.europa.eu/. Accessed 22 June 2016.
Benjamin ER, Khanna R, Schilling A, et al. Co-administration with the pharmacological chaperone AT1001 increases recombinant human alpha-galactosidase A tissue uptake and improves substrate reduction in Fabry mice. Mol Ther. 2012;20(4):717–26.
Germain DP, Giugliani R, Hughes DA, et al. Safety and pharmacodynamic effects of a pharmacological chaperone on alpha-galactosidase A activity and globotriaosylceramide clearance in Fabry disease: report from two phase 2 clinical studies. Orphanet J Rare Dis. 2012;7:91.
Johnson FK, Mudd PN, Janmohamed SG. Relative bioavailability and the effect of meal type and timing on the pharmacokinetics of migalastat in healthy volunteers. Clin Pharmacol Drug Dev. 2015;4(3):193–202.
Mudd PN, Johnson FK, Churchill A. A phase 1 study to investigate the absorption, metabolism and excretion of [14C] migalastat hydrochloride following a single oral administration in healthy volunteers [abstract no. 1699358]. Clin Pharmacol Drug Dev. 2013;2(Suppl 1):18–9.
Johnson FK, Mudd PN Jr, Sitaraman S, et al. An open-label study to determine the safety and pharmacokinetics of AT1001 in subjects with impaired renal function and healthy subjects with normal renal function [abstract no. PII-92]. Clin Pharmacol Ther. 2013;93(Suppl 1):S85.
Benjamin ER, Hamler R, Brignol N, et al. Migalastat reduces plasma globotriaosylsphingosine (lyso-Gb3) in Fabry patients: results from the FACETS phase 3 study [abstract no. P-448]. J Inherit Metab Dis. 2014;37(Suppl 1):S161.
Germain DP, Bichet DG, Giugliani R, et al. Subjects treated with migalastat continue to demonstrate stable renal function and reduced left ventricular mass index over 3 years in a long-term extension study of Fabry disease [abstract no. O-050]. J Inherit Metab Dis. 2015;38(Suppl 1):S56.
Germain DP, Bichet D, Giugliani R, et al. Treatment with migalastat results in reduced levels of disease substrate and stable renal function in a phase 3 study of Fabry disease [abstract no. O-060]. J Inherit Metab Dis. 2014;37(Suppl 1):S43.
Schiffmann R, Bichet DG, Germain DP, et al. Improvement in gastrointestinal symptoms observed in the phase 3 FACETS (AT1001-011) study of migalastat in patients affected with Fabry disease [abstract plus poster]. Mol Genet Metab. 2015;114(2):S103–4.
Hughes D, Bichet DG, Giugliani R, et al. Long-term efficacy and safety of migalastat compared to enzyme replacement therapy in Fabry disease: phase 3 study results [abstract no. 115]. Mol Genet Metab. 2015;114(2):S57.
Giugliani R, Waldek S, Germain DP, et al. A phase 2 study of migalastat hydrochloride in females with Fabry disease: selection of population, safety and pharmacodynamic effects. Mol Genet Metab. 2013;109(1):86–92.
Warnock DG, Bichet DG, Holida M, et al. Oral migalastat HCl leads to greater systemic exposure and tissue levels of active alpha-galactosidase A in fabry patients when co-administered with infused agalsidase. PLoS One. 2015;10(8):e0134341.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Disclosure
The preparation of this review was not supported by any external funding. During the peer review process the manufacturer of the agent under review was offered an opportunity to comment on the article. Changes resulting from any comments received were made by the author on the basis of scientific completeness and accuracy. A. Markham is a contracted employee of Adis, Springer SBM.
Additional information
This profile has been extracted and modified from the AdisInsight database. AdisInsight tracks drug development worldwide through the entire development process, from discovery, through pre-clinical and clinical studies to market launch and beyond.
Rights and permissions
About this article
Cite this article
Markham, A. Migalastat: First Global Approval. Drugs 76, 1147–1152 (2016). https://doi.org/10.1007/s40265-016-0607-y
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40265-016-0607-y