Abstract
Background
Nephropathic cystinosis is a rare lysosomal storage disease which is characterized by the accumulation of free cystine in lysosomes and subsequent intracellular crystal formation of cystine throughout the body. If not treated with cysteamine, a cystine-depleting agent, end-stage renal disease will develop early, followed by multiple organ failure as the disease progresses. The established cysteamine formulation requires a strict dosing regimen at 6-h intervals. An extended release (ER) twice-daily formulation has recently been developed. The aim of our study was to evaluate the implementation and outcomes of this option in routine care.
Methods
All pediatric cystinosis patients’ records in Hannover Medical School were screened, and data on cysteamine therapy, tolerability, dosing, estimated glomerular filtration rates (eGFR), white blood cell cystine levels, and proton pump inhibitor (PPI) use were extracted for the period January 2014 to January 2016.
Results
The median age of the 12 patients enrolled in the study was 12.5 (range 1–18) years. At the end of the study period ten of these patients received ER-cysteamine. There were no additional side effects. Halitosis/bad breath was often subjectively judged as improved or eliminated, and PPI use could be stopped in one of three patients. The main reasons for switching to the ER formulation were difficult night-time administration and uncontrolled disease. Mean eGFR values remained stable with a median of 67 ml/min/1.73 m2 before and after the transition. White blood cell (WBC) cystine values remained low after the switch (1 nmol/mg protein before and after transition; p = 0.64).
Conclusions
In this single-center cohort, the switch from IR- to ER-cysteamine was safe and effective over the short term and provided advantages in terms of frequency of administration and less halitosis/bad breath. The long-term benefit of this option needs to be evaluated in future studies.
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Acknowledgments
The authors thank Susanne Merk who provided medical writing services and Felicity Kay for English language correction.
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Lars Pape has received research grants, speaker’s honoraria, and travel grants from Raptor Pharmaceuticals and Orphan Europe. All other authors declare no conflicts of interest.
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The study was supported by an unrestricted grant by Raptor Pharmaceuticals. Good Publication Practice Guidelines for pharmaceutical companies were adhered to [13]. The manuscript was not seen or reviewed at any stage by Raptor Pharmaceuticals.
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Ahlenstiel-Grunow, T., Kanzelmeyer, N.K., Froede, K. et al. Switching from immediate- to extended-release cysteamine in nephropathic cystinosis patients: a retrospective real-life single-center study. Pediatr Nephrol 32, 91–97 (2017). https://doi.org/10.1007/s00467-016-3438-x
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DOI: https://doi.org/10.1007/s00467-016-3438-x