1
|
Bjoraker KJ, Eggerding C, Ellenberg E, Hollander S, Holmes BM, Lindstrom K, McNutt M, Miller S, Northrup H, Rogers M, Rose S, Scott M, Shim S, Wardley B, Wessenberg L, Bilder DA. Best practice recommendations for the management of anxiety during the pegvaliase journey. Mol Genet Metab 2024; 141:107737. [PMID: 38043481 DOI: 10.1016/j.ymgme.2023.107737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/16/2023] [Accepted: 11/16/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Pegvaliase, an enzyme substitution therapy, is a treatment option for phenylketonuria (PKU). Due to the neuropathophysiology and disease burden of PKU, individuals can experience baseline anxiety unrelated to pegvaliase therapy. In addition, there are aspects of pegvaliase therapy that may be anxiety-inducing for those considering or receiving treatment. The aim of this manuscript is to present best practice recommendations for the identification and management of anxiety symptoms that can occur along the pegvaliase journey. METHODS A modified Delphi approach was used to seek consensus among a multidisciplinary panel of experts. To this end, an in-person meeting was held that was preceded by a medical specialist- and patient-specific survey to develop preliminary recommendations on ways to address anxiety along the pegvaliase journey. After the meeting, an additional survey was conducted to rank the proposed solutions and mitigation strategies from which a set of recommendations was developed. All recommendations were voted on with the aim of consensus generation, defined as achieving ≥75% agreement among experts. RESULTS The panel reached consensus on a total of 28 best practice recommendations for the management of anxiety during the pre-treatment, induction and titration, early maintenance (pre-efficacy), and late maintenance (post-efficacy) stages. The recommendations offer strategies to identify and address the most common causes of pegvaliase-related anxiety, including self-injection, side effects, the titration schedule, prescribed dietary changes, and variable time to efficacy. Overall, managing anxiety in those considering or receiving pegvaliase involves patient-centered communication, shared decision-making, and personalized treatment plans. CONCLUSIONS The best practice recommendations described herein can guide healthcare providers in proactively addressing anxiety during the different stages of pegvaliase treatment, and support providers with initiating and managing pegvaliase in individuals who may experience baseline and treatment-related anxiety.
Collapse
Affiliation(s)
| | | | | | - Suzanne Hollander
- Department of Clinical Nutrition, Boston Children's Hospital, Boston, MA, USA; Division of Genetics and Genomics, Boston Children's Hospital, Boston, MA, USA
| | - Brittany M Holmes
- Division of Genetics and Genomics, Boston Children's Hospital, Boston, MA, USA
| | | | - Markey McNutt
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Suzanne Miller
- Program for Inherited Metabolic Diseases, Mount Sinai Health System, New York, NY, USA
| | - Hope Northrup
- Department of Pediatrics, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth) and Children's Memorial Hermann Hospital, Houston, TX, USA
| | | | - Sarah Rose
- BioMarin Pharmaceutical Inc., Novato, CA, USA.
| | - Mia Scott
- Individual with PKU, Tucson, AZ, USA
| | - Soo Shim
- Ann and Robert H. Lurie Children's Hospital, Chicago, IL, USA
| | | | | | - Deborah A Bilder
- Department of Psychiatry, University of Utah Huntsman Mental Health Institute, Salt Lake City, UT, USA
| |
Collapse
|
2
|
Adams D, Andersson HC, Bausell H, Crivelly K, Eggerding C, Lah M, Lilienstein J, Lindstrom K, McNutt M, Ray JW, Saavedra H, Sacharow S, Starin D, Tiffany-Amaro J, Thomas J, Vucko E, Wessenberg LB, Whitehall K. Use of pegvaliase in the management of phenylketonuria: Case series of early experience in US clinics. Mol Genet Metab Rep 2021; 28:100790. [PMID: 34430209 PMCID: PMC8369061 DOI: 10.1016/j.ymgmr.2021.100790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 08/03/2021] [Indexed: 11/14/2022] Open
Abstract
Objective To present a case series that illustrates real-world use of pegvaliase based on the initial experiences of US healthcare providers. Methods Sixteen healthcare providers from 14 centers across the US with substantial clinical experience in treating patients with phenylketonuria (PKU) with pegvaliase in the two-plus years since FDA approval (May 2018) provided cases that exemplified important lessons from their initial experiences treating patients with pegvaliase. Key lessons from each case and takeaway points were discussed in both live and virtual meetings. Results Fifteen cases of adults with PKU (eight males, seven females), representing a spectrum of age (18 to 53 years), previous PKU care, comorbidities, and socioeconomic situations were reviewed and discussed. Full extended case reports are included in the Supplement. The cases showed that treating patients with a daily injectable can be challenging due to a patient's financial problems, treatment challenges, and neuropsychological and psychiatric comorbidities, which can be identified before starting pegvaliase, but do not prohibit successful treatment. The authors agreed that patient education on adverse events (AEs), time to efficacy, dietary changes, and food preparation is an ongoing process that should start prior to initiating pegvaliase treatment. Treatment goals and planned dietary changes once efficacy is reached should be defined prior to treatment initiation and re-evaluated throughout the course of therapy. Each patient's titration schedule and dietary adjustments are unique, depending on occurrence of AEs and individual goals of treatment. Despite the AE profile of pegvaliase, all but two patients remained motivated to continue treatment and achieved efficacy (except one patient in whom titration was still ongoing). AEs occurring early in the treatment pathway may require prolongation of the titration phase and/or concomitant medication use, but do not seem indicative of future tolerability or eventual efficacy. Close follow-up of patients during titration and maintenance to help with dietary changes is important. Conclusion This case series provides real-world experience on the use of pegvaliase. Until data from registries and independent research become available, the data presented herein can support appropriate management of patients receiving pegvaliase in clinical practice.
Collapse
Key Words
- ACMG, American College of Medical Genetics and Genomics
- AEs, adverse events
- Adverse events
- BH4, tetrahydrobiopterin
- Case series
- HCP, healthcare provider
- I/T/M, induction, titration, and maintenance
- PAH, phenylalanine hydroxylase
- PEGylated phenylalanine ammonia lyase
- PKU diet
- PKU, phenylketonuria
- Pegvaliase
- Phe, phenylalanine
- Phenylketonuria
Collapse
Affiliation(s)
- Darius Adams
- Atlantic Health Morristown Medical Center, Morristown, NJ, USA
| | - Hans C Andersson
- Hayward Genetics Center, Tulane University Medical School, New Orleans, LA, USA
| | - Heather Bausell
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Kea Crivelly
- Hayward Genetics Center, Tulane University Medical School, New Orleans, LA, USA
| | | | - Melissa Lah
- Indiana University School of Medicine, Indianapolis, IN, USA
| | | | | | - Markey McNutt
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Joseph W Ray
- University of Texas Medical Branch, Galveston, TX, USA
| | - Heather Saavedra
- The University of Texas Health Science Center at Houston - McGovern Medical School, Houston, TX, USA
| | | | - Danielle Starin
- Rare Disease Institute, Children's National, Washington, DC, USA
| | | | - Janet Thomas
- University of Colorado School of Medicine, Aurora, CO, USA
| | - Erika Vucko
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | | | | |
Collapse
|
5
|
Abstract
Because the cot-2 and inv loci of Neurospora crassa are closely linked, the invertase from the morphological mutant, cot-2, was examined. The cot-2 strains produce an invertase with altered heat sensitivity, Km, and ratio of heavy to light forms. The cellular localization of cot-2 invertase is different from that of the wild type. There were no observable changes in the energy of activation or the pH optimum of cot-2 invertase, and some of the differences detected were not apparent under culture conditions that promoted wild-type growth. Since recombination (about 5 percent) occurred between cot-2 and inv and culture conditions affected the enzyme characteristics, we suggest cot-2 determines, in part, the carbohydrate composition of the enzyme.
Collapse
|