Long-Term Outcomes of Systemic Therapies for Hurler Syndrome: an International Multicenter Comparison
© American College of Medical Genetics and Genomics ORIGINAL RESEARCH ARTICLE Long-term outcomes of systemic therapies for Hurler syndrome: an international multicenter comparison Julie B. Eisengart, PhD1, Kyle D. Rudser, PhD2, Yong Xue, MD, PhD3, Paul Orchard, MD4, Weston Miller, MD4, Troy Lund, MD, PhD4, Ans Van der Ploeg, MD, PhD5, Jean Mercer, RGN, RSCN6, Simon Jones, MBChB7, Karl Eugen Mengel, MD8, Seyfullah Gökce, MD8, Nathalie Guffon, MD9, Roberto Giugliani, MD, PhD10, Carolina F.M. de Souza, MD, PhD10, Elsa G. Shapiro, PhD1,11 and Chester B. Whitley, PhD, MD12 Purpose: Early treatment is critical for mucopolysaccharidosis type I Results: Survival was worse when comparing ERT versus HCT, and (MPS I), justifying its incorporation into newborn screening. Enzyme Untreated versus ERT. The cumulative incidences of hydrocephalus replacement therapy (ERT) treats MPS I, yet presumptions that ERT – and cervical spinal cord compression were greater in ERT versus HCT. cannot penetrate the blood brain barrier (BBB) support recommen- Findings persisted in the sensitivity analysis. dations that hematopoietic cell transplantation (HCT) treat the severe, neurodegenerative form (Hurler syndrome). Ethics precludes rando- Conclusion: As newborn screening widens treatment opportunity for mized comparison of ERT with HCT, but insight into this comparison Hurler syndrome, this examination of early treatment quantifies some is presented with an international cohort of patients with Hurler ERT benefit, supports presumptions about BBB impenetrability, and syndrome who received long-term ERT from a young age. aligns with current guidelines to treat with HCT. Methods: Long-term survival and neurologic outcomes were Genet Med compared among three groups of patients with Hurler syndrome: 18 advance online publication 8 March 2018 treated with ERT monotherapy (ERT group), 54 who underwent HCT (HCT group), and 23 who received no therapy (Untreated).
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