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Less Frequent Elfabrio Dosing Shows Promise in Fabry Disease

• A Phase 3 clinical study suggests that less frequent dosing of Elfabrio (pegunigalsidase alfa) is safe and effective for adults with stable Fabry disease. • The BRIGHT study evaluated Elfabrio administered every four weeks at 2mg/kg, compared to the approved bi-weekly regimen of 1mg/kg. • Results indicated that Elfabrio maintained effective bloodstream levels, with mostly mild to moderate side effects and no new immune reactions. • Further research with a larger patient population is needed to confirm these findings and explore less-frequent dosing as a treatment option.

Treatment with Elfabrio (pegunigalsidase alfa) at less frequent intervals and a higher dose appears safe and effective for adults with stable Fabry disease, according to data from the Phase 3 BRIGHT clinical study.

BRIGHT Study Details

Developed by Chiesi Global Rare Diseases and Protalix Biotherapeutics, Elfabrio is approved in the U.S., the European Union, and the U.K. for intravenous infusion at a dose of 1 mg/kg every other week. The BRIGHT (NCT03180840) study aimed to assess the feasibility of administering Elfabrio at less frequent intervals. The results of the study, "A phase III, open-label clinical trial evaluating pegunigalsidase alfa administered every 4  weeks in adults with Fabry disease previously treated with other enzyme replacement therapies," were published in the Journal of Inherited Metabolic Disease.

Fabry Disease and Enzyme Replacement Therapy

Fabry disease results from a deficiency in the alpha-galactosidase A (alpha-Gal A) enzyme, leading to the accumulation of fatty substances like globotriaosylceramide (Gb3) in various organs, causing a range of symptoms and complications. Enzyme replacement therapy (ERT) is a common treatment, providing a version of the missing alpha-Gal A enzyme to alleviate symptoms.
Elfabrio, a PEGylated ERT, offers enhanced stability and prolonged presence in the bloodstream compared to traditional ERTs. The BRIGHT study investigated the safety and efficacy of Elfabrio administered every four weeks at 2mg/kg in adults with Fabry disease who had been on other ERTs every two weeks for at least three years. The primary focus was to monitor treatment-related side effects over one year.

Study Outcomes

The study involved 30 patients, predominantly male, with most having previously used Fabrazyme (agalsidase beta). Elfabrio maintained effective bloodstream levels throughout the four-week interval. Nine patients experienced mild to moderate side effects, with no severe adverse events reported. Importantly, no new immune reactions were observed.
Kidney health, assessed via eGFR, remained relatively stable during the study. Levels of lyso-Gb3, a Fabry disease biomarker, remained steady in female participants but showed a slight increase in some men with prior immune responses.

Implications and Future Directions

Giacomo Chiesi, executive vice president of Chiesi Global Rare Diseases, stated that Chiesi is dedicated to evaluating additional evidence to confirm the long-term results of this administration schedule. While the findings suggest that Elfabrio administered every four weeks is generally safe for adults with stable Fabry disease, further research involving a larger patient cohort is necessary to validate these results before less frequent dosing can be considered a viable treatment option.
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Reference News

[1]
Less frequent Elfabrio dosing for Fabry disease appears to be safe, effective
fabrydiseasenews.com · Nov 2, 2024

Elfabrio (pegunigalsidase alfa) administered every 4 weeks at 2 mg/kg appears safe and effective for stable Fabry diseas...

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