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Impact of enzyme replacement therapy on survival in adults with Pompe disease: results from a prospective international observational study

Deniz Güngör12, Michelle E Kruijshaar12, Iris Plug12, Ralph B D’Agostino3, Marloes LC Hagemans12, Pieter A van Doorn14, Arnold JJ Reuser15 and Ans T van der Ploeg126*

Author Affiliations

1 Center for Lysosomal and Metabolic Diseases, Erasmus MC University Medical Center, Rotterdam, the Netherlands

2 Department of Paediatrics, Erasmus MC University Medical Center, Rotterdam, the Netherlands

3 Department of Mathematics and Statistics, Boston University, Harvard Clinical Research Institute, Boston, MA, USA

4 Department of Neurology, Erasmus MC University Medical Center, Rotterdam, the Netherlands

5 Department of Clinical Genetics, Erasmus MC University Medical Center, Rotterdam, the Netherlands

6 Department of Paediatrics, Center for Lysosomal and Metabolic Diseases, Erasmus MC University Medical Center – Sophia Children’s Hospital, P.O. Box 2060, Rotterdam, CB 3000, the Netherlands

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Orphanet Journal of Rare Diseases 2013, 8:49  doi:10.1186/1750-1172-8-49

Published: 27 March 2013

Abstract

Background

Pompe disease is a rare metabolic myopathy for which disease-specific enzyme replacement therapy (ERT) has been available since 2006. ERT has shown efficacy concerning muscle strength and pulmonary function in adult patients. However, no data on the effect of ERT on the survival of adult patients are currently available. The aim of this study was to assess the effect of ERT on survival in adult patients with Pompe disease.

Methods

Data were collected as part of an international observational study conducted between 2002 and 2011, in which patients were followed on an annual basis. Time-dependent Cox’s proportional hazards models were used for univariable and multivariable analyses.

Results

Overall, 283 adult patients with a median age of 48 years (range, 19 to 81 years) were included in the study. Seventy-two percent of patients started ERT at some time during follow-up, and 28% never received ERT. During follow-up (median, 6 years; range, 0.04 to 9 years), 46 patients died, 28 (61%) of whom had never received ERT. After adjustment for age, sex, country of residence, and disease severity (based on wheelchair and ventilator use), ERT was positively associated with survival (hazard ratio, 0.41; 95% CI, 0.19 to 0.87).

Conclusion

This prospective study was the first to demonstrate the positive effect of ERT on survival in adults with Pompe disease. Given the relatively recent registration of ERT for Pompe disease, these findings further support its beneficial impact in adult patients.

Keywords:
Pompe disease; Survival; Acid maltase deficiency; Lysosomal storage disease; Glycogen storage disease type II; Enzyme replacement therapy; Alglucosidase alfa