The FDA has approved eliglustat (Cerdelga – Genzyme), an oral glucosylceramide synthase inhibitor, for treatment of adults with type 1 Gaucher disease. Eliglustat is metabolized primarily by CYP2D6. Because patients who are CYP2D6 ultra-rapid metabolizers may not achieve therapeutic concentrations and a specific dosage cannot be recommended for indeterminate metabolizers, the FDA has approved the drug only for patients who are extensive, intermediate, or poor metabolizers of CYP2D6.

The FDA has approved taliglucerase alfa (ta lee gloo´ se rays; Elelyso – Pfizer/Protalix), a recombinant form of glucocerebrosidase, for treatment of adults with Type 1 Gaucher disease. These patients have a genetic deficiency of the lysosomal enzyme glucocerebrosidase that leads to accumulation of glucosylceramide in the lysosomes of reticuloendothelial cells, primarily in the liver, spleen and bone marrow.1

Taliglucerase is the third form of the enzyme to become available in the US. Imiglucerase (Cerezyme) and velaglucerase (Vpriv) are produced in mammalian cell lines. Taliglucerase is produced using carrot plant root cells, which is less costly, according to the manufacturer.

In one trial, taliglucerase significantly reduced spleen volume and increased serum hemoglobin.2 In a trial in patients receiving chronic imiglucerase therapy, summarized in the package insert, clinical parameters remained stable following a switch to an equal dose of taliglucerase.

All 3 of these enzymes are usually given as an IV infusion over 1-2 hours every 2 weeks. Infusion reactions are common. Anaphylaxis and development of IgG anti-drug antibodies have been reported. For 1 year's treatment of a 70-kg patient at 60 units/kg every 2 weeks, taliglucerase will cost $324,870, imiglucerase $432,978 and velaglucerase $368,550.3

1. TM Cox. Gaucher disease: clinical profile and therapeutic developments. Biologics 2010; 4:299.

2. A Zimran et al. Pivotal trial with plant cell-expressed recombinant glucocerebrosidase, taliglucerase alfa, a novel enzyme replacement therapy for Gaucher disease. Blood 2011; 118:5767.

3. Wholesale acquisition cost (WAC). Source: PricePointRx™. Reprinted with permission by FDB. All rights reserved. ©2012. http://www.firstdatabank.com/support/drug-pricing-policy.aspx. Accessed June 20, 2012. Actual retail prices may be higher.

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The FDA has approved velaglucerase alfa (Vpriv – Shire), a new formulation of glucocerebrosidase prepared from human fibroblasts, for treatment of the nonneurologic form of Gaucher’s disease (Type 1). Patients with Gaucher’s disease have a congenital deficiency of glucocerebrosidase that leads to accumulation of glucosylceramide, the end-product of sphingolipid catabolism, in the lysozymes of reticuloendothelial cells in the liver, spleen and bone marrow.Velaglucerase is the second form of the enzyme now available in the US; imiglucerase (Cerezyme – Genzyme), which is produced by recombinant DNA technology from Chinese hamster ovary cells, was marketed earlier but has recently been in short supply.1 These agents are usually given as an IV infusion every 2 weeks. Both velaglucerase and imiglucerase have been shown to increase serum hemoglobin concentrations and platelet counts and decrease the size of the spleen. Velaglucerase contains the exact amino acid sequence of the human enzyme, while imiglucerase has one amino acid difference, but their activities are similar.2 The main difference between them may be in their cost. Cerezyme costs about $200,000 per year, while Vpriv is expected to cost about 15% less.2

1. Differentiation will be key challenge for Shire’s Gaucher disease drug Vpriv. The Pink Sheet. March 8, 2010; 72: 27.
2. B Brumshtein et al. Characterization of gene-activated human acid-beta-glucosidase: crystal structure, glycan composition, and internalization into macrophages. Glycobiology 2010; 20:24.

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