Enzyme Replacement Therapy for Fabry Disease — What to Keep in Mind

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by Vaidyanathan |

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preparing for ERT

Enzyme replacement therapy (ERT), such as Fabrazyme, addresses the primary cause of Fabry disease — mutations in the GLA gene that lead to the lack of alpha-galactosidase A enzyme, which is needed to break down a type of fat called globotriaosylceramide (Gb3 or GL-3).

A deficiency in naturally-occurring alpha-galactosidase A can cause Gb3 to build-up in cells and tissues of the body, leading to several symptoms including heart disease, kidney dysfunction, Fabry crises, and various skin and eye problems.

Here are a few things to keep in mind about ERT.

Start ERT early

ERT cannot reverse organ damage and ERT may not be beneficial once symptoms advance significantly. That’s why ERT should be started as soon as a Fabry disease diagnosis is confirmed.

Be prepared for long-term therapy

ERT is a lifelong treatment. Stopping it midway may result in the symptoms of the disease recurring.

A typical ERT session lasts a few hours and is administered intravenously, usually once every two weeks. Discuss with your doctor a mutually convenient time so that you are able to accommodate these sessions in your schedule.

A personalized treatment plan can help organize your therapy sessions and track outcomes.

Be aware of the outcomes

ERT is not a cure, but a treatment to help manage the symptoms of Fabry disease. Its outcome depends on multiple factors, which can vary for each individual such as age, sex, and the type of Fabry disease. Discuss with your doctor how beneficial ERT may be in your particular case.

Plan your finances

Although your health insurance may cover the majority of the expenses, ERT still may put a strain on your resources. Make sure you have adequate funds,  keeping in mind the long-term nature of the treatment and any contingency needs that may arise during the course of the therapy.

Take supplementary measures as necessary

For ERT to be effective, several supplementary measures are necessary. These include following a proper diet, staying physically active, and managing stress.

If you are experiencing kidney problems, you may need to take medications such as angiotensin-converting enzyme (ACE) inhibitors and angiotensin 2 receptor blockers alongside ERT. It also is a good idea to discuss with your doctor the possible future need for dialysis or a kidney transplant.

Keep a tab on allergies

ERT can sometimes cause allergic reactions as your body “thinks” that the enzyme is a foreign invader. This can be in the form of a rash, fever, hives, or in rare cases anaphylaxis, which can be life-threatening. Monitor yourself for such symptoms and inform your doctor immediately if you spot anything out of the ordinary.

Check your ‘CRIM’ status

Your cross-reactive immunological material (CRIM) status indicates how much natural alpha-galactosidase A activity you have. This an important factor in predicting the possible outcomes of ERT.

Those with CRIM-negative status have no natural alpha-galactosidase A enzyme activity. It is more likely that the bodies of these patients will mount an immune reaction against the newly introduced enzyme, leading to poor response to ERT. These patients will need to be treated with immuno-modulating medication before ERT.

CRIM-positive patients, however, have a little natural enzyme activity (at least 1%), which means their bodies already are accustomed to the enzyme and unlikely to mount an immune response against it. These patients are likely to respond better to ERT than CRIM-negative patients.


Last updated: Jan. 14, 2020


Fabry 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.