Enzyme replacement therapy (ERT) with recombinant human alpha-Gal A (agalsidase beta) or gene-activated alpha-Gal A (agalsidase alfa) is the current standard of care for Fabry disease.
We are developing oral migalastat as a monotherapy for Fabry disease patients with genetic mutations that are amenable to this chaperone therapy. Many individuals with Fabry disease make some alpha-Gal A enzyme that is capable of degrading substrate. However, because of a genetic mutation, the endogenously produced alpha-Gal A is not effectively delivered to lysosomes to reduce GL-3. As a monotherapy, migalastat is an investigational oral, small molecule drug designed to bind to and stabilize the endogenous alpha-Gal A that is made in the patient’s own cells, with the intention of enabling its trafficking to lysosomes (designed to act as a “pharmacological chaperone”). Once delivered to lysosomes, the alpha-Gal A enzyme can degrade the accumulated GL-3. This approach is designed for patients with amenable mutations that could be capable of responding to oral migalastat as a monotherapy treatment on the basis of their genotype.
If approved, we estimate that approximately 30-50% of the Fabry disease population is 16 and older and have amenable mutations and may be eligible to receive migalastat monotherapy.
We conducted two Phase 3 global registration studies (the FACETS Study, Study 011, and the ATTRACT Study, Study 012) of migalastat monotherapy. Both studies enrolled males and females with Fabry disease who have alpha-Gal A mutations that are amenable to chaperone monotherapy.
Study 011 was a 24-month study that investigated the safety and efficacy of oral migalastat, (150 mg every other day) compared to placebo in Fabry disease patients naïve to or not receiving ERT. The study began with a 6-month, double-blind, placebo-controlled treatment period, after which all patients were treated with migalastat for a 6-month, open-label follow-up period, and a subsequent 12-month, open-label extension phase. The primary analysis in Study 011 measured the reduction of the disease substrate GL-3 in the interstitial capillaries of the kidneys following treatment with migalastat. Secondary endpoints in Study 011 included renal function, cardiac parameters (e.g. left ventricular mass index, LVMi), gastrointestinal symptoms, and clinical events.
Study 012 was a 30-month study that investigated the safety and efficacy of oral migalastat (150 mg, every other day) compared to standard of care infused ERTs (agalsidase alfa and agalsidase beta). Patients on a stable dose and regimen of ERT were randomized to switch to migalastat or remain on ERT for an 18-month, open-label primary treatment period, after which all patients were treated with migalastat for a 12-month, open-label extension phase. The co-primary endpoints in Study 012 measured comparability of migalastat and ERT on renal function (mean annualized change in measured (iohexol) glomerular filtration rate (mGFR) and estimated GFR (eGFR) for migalastat and ERT).
Regulatory authorities in the U.S., EU, Australia, and Switzerland have granted orphan drug designation for migalastat.
For Fabry disease patients who do not have amenable mutations, we are leveraging our CHART™ platform to investigate migalastat in combination with a novel ERT. In combination with ERT, migalastat is designed to bind to infused alpha-Gal A in circulation with the intention of stabilizing the active form of the enzyme.
We are in preclinical development with our own proprietary cell line to produce a novel ERT for the treatment of Fabry disease, to be formulated with migalastat.
Completed. Patients are eligible to roll over into Study 041 upon completion of the primary treatment and open-label extension periods in the FACETS (Study 011), ATTRACT (Study 012), or Phase 2 Extension Study 205.
Open-label extension study to evaluate long-term safety and efficacy of migalastat.
More information: www.clinicaltrials.gov: NCT01458119
Recruiting. Intended to provide continued treatment with migalastat for subjects with Fabry disease who completed treatment of a previous migalastat monotherapy study.
Open-label extension study to assess the long-term safety and effectiveness of migalastat in subjects with Fabry disease who completed migalastat treatment in a previous study.
More information: www.clinicaltrials.gov: NCT02194985
Ongoing, currently recruiting. Physicians may request permission to treat specific patients with migalastat. Patients have amenable GLA mutations, do not meet eligibility criteria for existing migalastat clinical studies, and are unsuitable for or unable to access ERT.
Open-label treatment in up to 20 patients for 6 months with renewal every 6 months.
More information: www.clinicaltrials.gov: NCT01476163
Study of the Effects of Oral Migalastat (AT1001) in Patients with Fabry Disease
Completed. In December 2011, the study completed enrollment of 67 patients, who were identified as having amenable GLA mutations and met additional entry criteria.
Placebo-controlled, double-blind Phase 3 study of migalastat.
More information: www.clinicaltrials.gov: NCT00925301
Study to Compare the Efficacy and Safety of Oral Migalastat (AT1001) and Enzyme Replacement Therapy in Patients with Fabry Disease
Completed. Enrolled more than 50 patients, who were identified as having amenable GLA mutations and had been receiving enzyme replacement therapy (ERT) for at least 12 months.
Randomized, open-label, 18-month Phase 3 study investigating the safety and efficacy of migalastat compared to current standard of care ERTs Fabrazyme® (agalsidase beta) or Replagal® (agalsidase alfa) for Fabry disease.
More information: www.clinicaltrials.gov: NCT01218659.