Nitisinone arrests ochronosis and decreases rate of progression of Alkaptonuria: Evaluation of the effect of nitisinone in the United Kingdom National Alkaptonuria Centre



Ranganath, LR, Khedr, M ORCID: 0000-0002-4998-2397, Milan, AM ORCID: 0000-0002-0452-2338, Davison, AS ORCID: 0000-0001-5501-4475, Hughes, AT, Usher, JL, Taylor, S, Loftus, N, Daroszewska, A ORCID: 0000-0002-6692-6610, West, E
et al (show 17 more authors) (2018) Nitisinone arrests ochronosis and decreases rate of progression of Alkaptonuria: Evaluation of the effect of nitisinone in the United Kingdom National Alkaptonuria Centre. Molecular genetics and metabolism, 125 (1-2). 127 - 134.

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Abstract

Question Does Nitisinone prevent the clinical progression of the Alkaptonuria? Findings In this observational study on 39 patients, 2 mg of daily nitisinone inhibited ochronosis and significantly slowed the progression of AKU over a three-year period. Meaning Nitisinone is a beneficial therapy in Alkaptonuria. Background Nitisinone decreases homogentisic acid (HGA), but has not been shown to modify progression of Alkaptonuria (AKU). Methods Thirty-nine AKU patients attended the National AKU Centre (NAC) in Liverpool for assessments and treatment. Nitisinone was commenced at V1 or baseline. Thirty nine, 34 and 22 AKU patients completed 1, 2 and 3 years of monitoring respectively (V2, V3 and V4) in the VAR group. Seventeen patients also attended a pre-baseline visit (V0) in the VAR group. Within the 39 patients, a subgroup of the same ten patients attended V0, V1, V2, V3 and V4 visits constituting the SAME Group. Severity of AKU was assessed by calculation of the AKU Severity Score Index (AKUSSI) allowing comparison between the pre-nitisinone and the nitisinone treatment phases. Results The ALL (sum of clinical, joint and spine AKUSSI features) AKUSSI rate of change of scores/patient/month, in the SAME group, was significantly lower at two (0.32 ± 0.19) and three (0.15 ± 0.13) years post-nitisinone when compared to pre-nitisinone (0.65 ± 0.15) (p < .01 for both comparisons). Similarly, the ALL AKUSSI rate of change of scores/patient/month, in the VAR group, was significantly lower at one (0.16 ± 0.08) and three (0.19 ± 0.06) years post-nitisinone when compared to pre-nitisinone (0.59 ± 0.13) (p < .01 for both comparisons). Combined ear and ocular ochronosis rate of change of scores/patient/month was significantly lower at one, two and three year's post-nitisinone in both VAR and SAME groups compared with pre-nitisinone (p < .05). Conclusion This is the first indication that a 2 mg dose of nitisinone slows down the clinical progression of AKU. Combined ocular and ear ochronosis progression was arrested by nitisinone.

Item Type: Article
Uncontrolled Keywords: Alkaptonuria, AKUSSI, Severity, Nitisinone, Homogentisic acid, Natural history
Depositing User: Symplectic Admin
Date Deposited: 03 Aug 2018 07:27
Last Modified: 15 Oct 2021 07:11
DOI: 10.1016/j.ymgme.2018.07.011
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3024424