Lumizyme (alglucosidase alfa) for Pompe disease
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What is Lumizyme for Pompe disease?
Lumizyme (alglucosidase alfa) is an enzyme replacement therapy approved for Pompe disease. It works to ease breathing and improve motor function in patients with the genetic disorder.
The treatment was developed by Sanofi. Outside the U.S., it is marketed under the brand name Myozyme.
Therapy snapshot
| Brand name: | Lumizyme |
| Chemical name: | Alglucosidase alfa |
| Usage: | Enzyme replacement therapy used to ease breathing and improve motor function |
| Administration: | Intravenous infusion |
How does Lumizyme work?
Pompe disease is an inherited condition caused by a genetic mutation that impairs the function of the enzyme acid alpha-glucosidase (GAA). This enzyme normally breaks down a complex sugar molecule called glycogen. As a result, glycogen builds up to toxic levels in body tissues, especially in muscle.
Excess glycogen impairs normal cellular functions and causes cell death, resulting in muscle weakness and loss of respiratory function. It can potentially lead to heart failure.
An enzyme replacement treatment, Lumizyme contains a functional version of the GAA enzyme that can be delivered to cells, thereby facilitating glycogen clearance. Thus, the therapy can reduce the severity of Pompe disease symptoms experienced by patients.
Who can take Lumizyme?
In the U.S., Lumizyme is approved to treat all types of Pompe disease. The therapy also is approved for this indication in other markets, including in the EU and Canada, where it is marketed as Myozyme.
Who should not take Lumizyme?
The U.S. prescribing information for Lumizyme lists no contraindications. However, the therapy has boxed warnings noting the risk of:
- allergic and anaphylactic reactions, which may be life-threatening
- worsening of heart or lung function in patients with infantile-onset Pompe who have pre-existing cardiac or respiratory problems
- immune-mediated reactions such as high levels of protein in urine and skin lesions with tissue death.
How is Lumizyme administered?
Lumizyme is given via an intravenous (into-the-vein) infusion every two weeks. The approved dosage is 20 milligrams per kilogram of body weight (mg/kg).
The initial infusion rate should be no faster than 1 mg/kg/hour; it may be gradually increased up to a maximum of 7 mg/kg/hour based on the patient’s tolerance to the infusion rate.
The infusion rate may be slowed or paused if patients experience any mild to moderate allergic reactions. If a severe reaction occurs, the infusion should be discontinued.
Lumizyme in clinical trials
The initial approval of Lumizyme in the U.S. was supported by data from a Phase 3 clinical trial (NCT00158600) completed in 2007. It enrolled 90 ambulatory people ages 8 and older with late-onset Pompe disease. Some patients required assistive walking devices.
Participants were randomly assigned to infusions of Lumizyme (20 mg/kg) or a placebo, given every other week for 78 weeks. A total of 81 patients completed the trial.
The study’s main efficacy goals were to assess the treatment’s impact on the distance participants could walk in six minutes — a common measure of motor function — as well as forced vital capacity (FVC), a test of lung function based on how much air someone can forcibly exhale in one breath.
Results showed that, in the patients on Lumizyme, six-minute walk distances increased by an average of 25.1 meters (about 82 feet). Meanwhile, the walked distance decreased by an average of 3 meters (about 10 feet) in patients on the placebo.
Similarly, average FVC increased by 1.2 percentage points for patients on Lumizyme, whereas it decreased by 2.2 percentage points for those given the placebo.
Trials in infantile-onset disease
Three clinical trials provided the basis for Lumizyme’s approval to treat infantile-onset Pompe disease in the U.S.
One Phase 2/3 study (NCT00059280) enrolled 18 babies, ages 7 months or younger, who showed clinical signs of Pompe disease with heart involvement. Patients were treated with Lumizyme at 20 or 40 mg/kg every other week for at least one year.
By 18 months of age, 15 of the children (83%) were alive and free of ventilator support, the results showed. The other three children were alive and required invasive ventilator support.
These findings markedly contrasted with the typical course of infantile-onset disease without treatment. No differences were seen between the two dosing regimens tested.
Another Phase 1/2Â trial (NCT00053573) enrolled 21 children, ranging in age from 3 months to 3.5 years. Five of these children were on ventilator support when they started treatment. All participants received Lumizyme at 20 mg/kg every other week for a median of 120 weeks.
At the end of study, 15 of the 21 participants were alive — causes of death were cardiac and/or respiratory failure in all cases — and of the 16 who had been off ventilation at the study’s start, seven still did not need ventilatory support. Improvements in motor function also were reported in several patients. Again, these findings markedly differed from what would be expected in untreated infantile-onset Pompe.
The third study enrolled 18 babies with Pompe disease who were identified via a newborn screening program, and who started on Lumizyme treatment within the first few months of life (prior to 6 months of age). At age 18 months, all evaluable patients (16 in total) were alive without a need for ventilation.
Common side effects of Lumizyme
The most common side effects of Lumizyme reported in clinical trials were:
- anaphylaxis (a severe allergic reaction)
- rash
- fever
- flushing or feeling hot
- hives or welts (urticaria)
- headache
- excessive sweating
- nausea
- cough
- decreased amounts of oxygen in the blood
- abnormally fast heart rate and/or breathing
- chest discomfort
- dizziness
- muscle twitching
- agitation
- skin turning bluish (cyanosis)
- redness of the skin (erythema)
- increased blood pressure
- pallor
- rigors (sudden bouts of cold shivering)
- tremor
- vomiting
- fatigue
- muscle pain
Allergic reactions
Lumizyme carries a boxed warning for severe allergic reactions, including anaphylaxis, which can occur during or after infusions of Lumizyme. Patients should be closely monitored for signs and symptoms of allergic reactions, and the treating clinicians should be prepared to administer appropriate treatment if a reaction occurs.
Risk of worsening heart and/or lung issues in some patients
Patients with Pompe disease who have compromised cardiac or respiratory function may be at risk of a sudden worsening of heart/lung status during Lumizyme infusions. Thus, these patients require additional monitoring.
Caution also should be used when administering general anesthesia for the placement of a central venous catheter for Lumizyme infusion, as an irregular heartbeat, resulting in cardiac arrest or death, has been observed in infantile-onset Pompe disease patients with heart enlargement.
Infusion-associated reactions
Immune system activation resulting in skin lesions associated with tissue death, damage to small blood vessels in the kidneys, and elevated protein levels in urine may occur while on Lumizyme treatment. Patients should be monitored for these immune-mediated reactions and treatment discontinuation may be required if they happen. The risks and benefits of readministering Lumizyme after an immune-mediated reaction should be considered.
Risk of antibody development
Patients with infantile-onset Pompe disease should undergo a cross-reactive immunologic material (CRIM) assessment early on, as the CRIM status can influence the patients’ response to treatment. Clinical specialists in immune tolerance induction in Pompe disease should be involved to optimize treatment.
Pregnancy and breastfeeding
Data from post-marketing and case reports have shown no association between the use of Lumizyme and any complications related to pregnancy, including major birth defects, miscarriage, or adverse maternal or fetal outcomes.
The medication’s use in pregnancy should be tailored to the individual, taking into account that untreated Pompe disease may result in worsening symptoms during pregnancy. Individuals on Lumizyme who are or may become pregnant are encouraged to enroll in the Pompe patient registry.
Lumizyme is present in human breastmilk, but there are no reports of adverse effects on breastfed infants. Patients who are breastfeeding while on Lumizyme may consider interrupting breastfeeding, or pumping and discarding breast milk around the time they receive infusions, to reduce exposure to the nursing baby.
Pompe Disease News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.
FAQs about Lumizyme
The U.S. Food and Drug Administration first approved Lumizyme in 2010 to treat late-onset Pompe disease in patients ages 8 and older. The agency expanded Lumizyme’s approval to cover patients of all ages in 2014.
Available data have shown no association between Lumizyme use and complications during pregnancy, including major birth defects, miscarriage, or adverse maternal or fetal outcomes. Use of Lumizyme during pregnancy should be tailored according to the needs of the patient, and pregnant patients are encouraged to enroll in a patient registry that is tracking outcomes for pregnant patients and their children.
There is no data showing an interaction between alcohol and Lumizyme. However, as alcohol can interact with many medications, it is always advised that patients ask their clinicians about the use of alcohol while taking this medication.
Some patients in clinical studies have seen improvements as early as three months after treatment initiation. In the clinical trial in late-onset Pompe patients that supported Lumizyme’s initial 2010 approval in the U.S., an increase in the average six-minute walk distance (a measure of motor function) and lung function was evident by 12 weeks after starting therapy. That said, Lumizyme can act on every individual differently, and the timing of its effects will vary from person to person.
Hair loss and weight gain have not been reported as common side effects of Lumizyme. Patients who experience unexpected changes after starting treatment are encouraged to consult their healthcare providers.
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