G Biolcati1, E Marchesini2, F Sorge1, L Barbieri1, X Schneider-Yin3, E I Minder3. 1. Porphyria Centre, San Gallicano Dermatological Institute, IRCCS - IFO, Rome, Italy. 2. FarmED Service, Pharmacovigilance - Pharmacy - IFO, Rome, Italy. 3. Institute of Laboratory Medicine, Municipal Hospital Triemli, Zurich, Switzerland.
Abstract
BACKGROUND: In erythropoietic protoporphyria (EPP), an inherited disease of porphyrin-biosynthesis, the accumulation of protoporphyrin in the skin causes severely painful phototoxic reactions. Symptom prevention was impossible until recently when afamelanotide became available. Afamelanotide-induced skin pigmentation has statistically significantly improved light-tolerance, although the clinical significance of the statistical effect was unknown. OBJECTIVES: To assess clinical effectiveness by recording compliance and safety during prolonged use. METHODS: We report longitudinal observations of 115 ambulatory patients with EPP, who were treated with a total of 1023 afamelanotide implants over a period of up to 8 years at two porphyria centres; one in Rome, Italy, and the other in Zurich, Switzerland. RESULTS: Since the treatment first became available in 2006, the number of patients treated with 16 mg afamelanotide implants rose continuously until June 2014, when 66% of all patients with EPP known to the porphyria centres were treated. Only three patients considered afamelanotide did not meet their expectations for symptom improvement; 23% discontinued the treatment for other, mostly compelling, reasons such as pregnancy or financial restrictions. The quality of life (QoL) scores, measured by an EPP-specific questionnaire, were 31 ± 24% of maximum prior to afamelanotide treatment, rose to 74% after starting afamelanotide and remained at this level during the entire observation period. Only minor adverse events attributable to afamelanotide, predominantly nausea, were recorded. CONCLUSION: Based on the improved QoL scores, high compliance and low discontinuation rates, we conclude that afamelanotide exhibits good clinical effectiveness and good safety in EPP under long-term routine conditions.
BACKGROUND: In erythropoietic protoporphyria (EPP), an inherited disease of porphyrin-biosynthesis, the accumulation of protoporphyrin in the skin causes severely painful phototoxic reactions. Symptom prevention was impossible until recently when afamelanotide became available. Afamelanotide-induced skin pigmentation has statistically significantly improved light-tolerance, although the clinical significance of the statistical effect was unknown. OBJECTIVES: To assess clinical effectiveness by recording compliance and safety during prolonged use. METHODS: We report longitudinal observations of 115 ambulatory patients with EPP, who were treated with a total of 1023 afamelanotide implants over a period of up to 8 years at two porphyria centres; one in Rome, Italy, and the other in Zurich, Switzerland. RESULTS: Since the treatment first became available in 2006, the number of patients treated with 16 mg afamelanotide implants rose continuously until June 2014, when 66% of all patients with EPP known to the porphyria centres were treated. Only three patients considered afamelanotide did not meet their expectations for symptom improvement; 23% discontinued the treatment for other, mostly compelling, reasons such as pregnancy or financial restrictions. The quality of life (QoL) scores, measured by an EPP-specific questionnaire, were 31 ± 24% of maximum prior to afamelanotide treatment, rose to 74% after starting afamelanotide and remained at this level during the entire observation period. Only minor adverse events attributable to afamelanotide, predominantly nausea, were recorded. CONCLUSION: Based on the improved QoL scores, high compliance and low discontinuation rates, we conclude that afamelanotide exhibits good clinical effectiveness and good safety in EPP under long-term routine conditions.
Authors: Manisha Balwani; Hetanshi Naik; Karl E Anderson; D Montgomery Bissell; Joseph Bloomer; Herbert L Bonkovsky; John D Phillips; Jessica R Overbey; Bruce Wang; Ashwani K Singal; Lawrence U Liu; Robert J Desnick Journal: JAMA Dermatol Date: 2017-08-01 Impact factor: 10.282
Authors: Janneke G Langendonk; Manisha Balwani; Karl E Anderson; Herbert L Bonkovsky; Alexander V Anstey; D Montgomery Bissell; Joseph Bloomer; Chris Edwards; Norbert J Neumann; Charles Parker; John D Phillips; Henry W Lim; Iltefat Hamzavi; Jean-Charles Deybach; Raili Kauppinen; Lesley E Rhodes; Jorge Frank; Gillian M Murphy; Francois P J Karstens; Eric J G Sijbrands; Felix W M de Rooij; Mark Lebwohl; Hetanshi Naik; Colin R Goding; J H Paul Wilson; Robert J Desnick Journal: N Engl J Med Date: 2015-07-02 Impact factor: 91.245