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Web End = Pediatr Nephrol (2017) 32:9197 DOI 10.1007/s00467-016-3438-x
ORIGINAL ARTICLE
Switching from immediate- to extended-release cysteamine in nephropathic cystinosis patients: a retrospective real-life single-center study
Thurid Ahlenstiel-Grunow1 & Nele K. Kanzelmeyer1 & Kerstin Froede1 &
Martin Kreuzer1 & Jens Drube1 & Christian Lerch1 & Lars Pape1
Received: 4 April 2016 /Revised: 28 April 2016 /Accepted: 16 May 2016 /Published online: 27 June 2016 # IPNA 2016
AbstractBackground Nephropathic cystinosis is a rare lysosomal storage disease which is characterized by the accumulation of free cystine in lysosomes and subsequent intracellular crystal formation of cystine throughout the body. If not treated with cysteamine, a cystine-depleting agent, end-stage renal disease will develop early, followed by multiple organ failure as the disease progresses. The established cysteamine formulation requires a strict dosing regimen at 6-h intervals. An extended release (ER) twice-daily formulation has recently been developed. The aim of our study was to evaluate the implementation and outcomes of this option in routine care.
Methods All pediatric cystinosis patients records in Hannover Medical School were screened, and data on cysteamine therapy, tolerability, dosing, estimated glomerular filtration rates (eGFR), white blood cell cystine levels, and proton pump inhibitor (PPI) use were extracted for the period January 2014 to January 2016. Results The median age of the 12 patients enrolled in the study was 12.5 (range 118) years. At the end of the study period ten of these patients received ER-cysteamine. There were no additional side effects. Halitosis/bad breath was often subjectively judged as improved or eliminated, and PPI use could be stopped in one of three patients. The main reasons for switching to the ER formulation were difficult night-time administration and uncontrolled disease. Mean eGFR values remained stable with a median of 67 ml/min/1.73 m2 before and after the transition. White blood cell (WBC) cystine values remained low after the switch (1 nmol/mg protein before and after transition; p = 0.64).
Conclusions In this single-center cohort, the switch from IR-to ER-cysteamine was safe and effective over the short term and provided advantages in terms of frequency of administration and less halitosis/bad breath. The long-term benefit of this option needs to be evaluated in future studies.
Keywords Nephropathic cystinosis . Cysteamine . Fanconi syndrome . Lysosomal...