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Galafold (migalastat hydrochloride) – Summary of product characteristics - Amicus Therapeu

Updated on site: 07-Oct-2017

Medication nameGalafold
ATC CodeAmicus Therapeu
Substancemigalastat hydrochloride
ManufacturerAuthorised

This medicinal product is subject to additional monitoring. This will allow quick identification of new safety information. Healthcare professionals are asked to report any suspected adverse reactions. See section 4.8 for how to report adverse reactions.

1.NAME OF THE MEDICINAL PRODUCT

Galafold 123 mg hard capsules

2.QUALITATIVE AND QUANTITATIVE COMPOSITION

Each capsule contains migalastat hydrochloride equivalent to 123 mg migalastat. For the full list of excipients, see section 6.1.

3.PHARMACEUTICAL FORM

Hard capsule.

Size 2 hard capsule (6.4x18.0 mm) with an opaque blue cap and opaque white body with “A1001” printed in black, containing white to pale brown powder.

4.CLINICAL PARTICULARS

4.1Therapeutic indications

Galafold is indicated for long-term treatment of adults and adolescents aged 16 years and older with a confirmed diagnosis of Fabry disease (α-galactosidase A deficiency) and who have an amenable mutation (see the tables in section 5.1).

4.2Posology and method of administration

Treatment with Galafold should be initiated and supervised by specialist physicians experienced in the diagnosis and treatment of Fabry disease. Galafold is not intended for concomitant use with enzyme replacement therapy (see section 4.4).

Posology

The recommended dosage regimen in adults and adolescents 16 years and older is 123 mg migalastat (1 capsule) once every other day at the same time of day.

Missed dose

Galafold should not be taken on 2 consecutive days. If a dose is missed entirely for the day, patients should resume taking Galafold at the next dosing day and time.

Paediatric population

The safety and efficacy of Galafold in children aged 0 to 15 years has not yet been established. No data are available.

Special populations

Elderly population

No dosage adjustment is required based on age (see section 5.2).

Renal impairment

Galafold is not recommended for use in patients with Fabry disease who have estimated GFR less than 30 mL/min/1.73 m2 (see section 5.2).

Hepatic impairment

No dosage adjustment of Galafold is required in patients with hepatic impairment (see section 5.2).

Method of administration

For oral use. Galafold exposure is decreased by approximately 40% when taken with food, therefore it should not be taken within 2 hours before or after food. Galafold should be taken every other day at the same time of day to ensure optimal benefits to the patient.

Capsules must be swallowed whole. The capsules must not be cut, crushed, or chewed.

4.3Contraindications

Hypersensitivity to the active substance or to any of the excipients listed in section 6.1.

4.4Special warnings and precautions for use

It is advised to periodically monitor renal function, echocardiographic parameters and biochemical markers (every 6 months) in patients initiated on or switched to Galafold. In case of meaningful clinical deterioration, further clinical evaluation or discontinuation of treatment with Galafold should be considered.

Galafold is not indicated for use in patients with non-amenable mutations (see section 5.1).

No reduction in proteinuria was observed in patients treated with Galafold.

Galafold is not recommended for use in patients with severe renal insufficiency, defined as estimated GFR less than 30 mL/min/1.73m2 (see section 5.2).

Limited data suggest that co-administration of a single dose of Galafold and a standard enzyme replacement therapy infusion results in an increased exposure to agalsidase of up to 5-fold. This study also indicated that agalsidase has no effect on the pharmacokinetics of migalastat. Galafold is not intended for concomitant use with enzyme replacement therapy.

4.5Interaction with other medicinal products and other forms of interaction

Based upon in vitro data, migalastat is not an inducer of CYP1A2, 2B6, or 3A4. Furthermore, migalastat is not an inhibitor or a substrate of CYP1A2, 2A6, 2B6, 2C8, 2C9, 2C19, 2D6, 2E1, or 3A4/5. Migalastat is not a substrate for MDR1 or BCRP, nor is it an inhibitor of BCRP, MDR1, or BSEP human efflux transporters. In addition, migalastat is not a substrate for MATE1, MATE2-K, OAT1, OAT3, or OCT2, nor is it an inhibitor of OATP1B1, OATP1B3, OAT1, OAT3, OCT1, OCT2, MATE1, or MATE2-K human uptake transporters.

4.6Fertility, pregnancy and lactation

Women of childbearing potential/Contraception in males and females

Galafold is not recommended in women of childbearing potential not using contraception.

Pregnancy

There are limited data from the use of Galafold in pregnant women. In rabbits, developmental toxicity was observed only at maternally toxic doses (see section 5.3). Galafold is not recommended during pregnancy.

Breast-feeding

It is not known whether Galafold is secreted in human milk. However, migalastat has been shown to be expressed in the milk of lactating rats. Accordingly, a risk of migalastat exposure to the breast-feeding infant cannot be excluded. A decision must be made whether to discontinue breast-feeding or to discontinue Galafold, taking into account the benefit of breast-feeding for the child relative to the benefit of therapy for the mother.

Fertility

The effects of Galafold on fertility in humans have not been studied. Transient and fully reversible infertility in male rats was associated with migalastat treatment at all doses assessed. Complete reversibility was seen after 4 weeks off-dose. Similar findings have been noted pre-clinically following treatment with other iminosugars (see section 5.3). Migalastat did not affect fertility in female rats.

4.7Effects on ability to drive and use machines

Galafold has no or negligible influence on the ability to drive and use machines.

4.8Undesirable effects

Summary of the safety profile

The most common adverse reaction was headache, which was experienced by approximately 10% of patients who received Galafold.

Tabulated list of adverse reactions

Frequencies are defined as: very common (≥ 1/10), common (≥ 1/100 to < 1/10), uncommon (≥1/1,000 to <1/100), rare (≥1/10,000 to <1/1,000), very rare (<1/10,000) and not known (cannot be estimated from the available data). Within each frequency grouping, adverse reactions are presented in order of decreasing frequency within each System Organ Class.

Table 1: Adverse reactions with Galafold in clinical trials

System Organ Class

Very common

Common

 

 

 

Psychiatric disorders

 

Depression

 

 

 

Nervous system disorders

Headache

Paraesthesia

 

 

Dizziness

 

 

Hypoaesthesia

 

 

 

Ear and labyrinth disorders

 

Vertigo

 

 

 

Cardiac disorders

 

Palpitations

 

 

 

Respiratory, thoracic, and

 

Dyspnoea

mediastinal disorders

 

Epistaxis

 

 

 

 

 

Gastrointestinal disorders

 

Diarrhoea

 

 

Nausea

 

 

Abdominal pain

 

 

Constipation

 

 

Dry mouth

 

 

Defaecation urgency

 

 

Dyspepsia

 

 

 

Skin and subcutaneous tissue

 

Rash

disorders

 

Pruritus

 

 

 

 

 

Musculoskeletal and

 

Muscle spasms

connective tissue disorders

 

Myalgia

 

Torticollis

 

 

Pain in extremity

 

 

 

Renal and urinary disorders

 

Proteinuria

 

 

 

General disorders and

 

Fatigue

administration site conditions

 

Pain

 

 

 

Investigations

 

Blood Creatine Phosphokinase

 

 

increased

 

 

Weight increased

 

 

 

Reporting of suspected adverse reactions

Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the national reporting system listed in Appendix V.

4.9Overdose

In case of overdose, general medical care is recommended. Headache and dizziness were the most common adverse reactions reported at doses of Galafold of up to 1250 mg and 2000 mg, respectively.

5.PHARMACOLOGICAL PROPERTIES

5.1Pharmacodynamic properties

Pharmacotherapeutic group: {not yet assigned}; ATC code: {not yet assigned}

Fabry disease is a progressive X-linked lysosomal storage disorder which affects males and females. Fabry disease-causing mutations in the GLA gene result in a deficiency of the lysosomal enzyme α-galactosidase A (α-Gal A) that is required for glycosphingolipid substrate (e.g., GL-3, lyso-Gb3) metabolism. Reduced α-Gal A activity is, therefore, associated with the progressive accumulation of substrate in vulnerable organs and tissues, which leads to the morbidity and mortality associated with Fabry disease.

Mechanism of action

Certain GLA mutations can result in the production of abnormally folded and unstable mutant forms of α-Gal A. Migalastat is a pharmacological chaperone that is designed to selectively and reversibly bind with high affinity to the active sites of certain mutant forms of α-Gal A, the genotypes of which are referred to as amenable mutations. Migalastat binding stabilizes these mutant forms of α-Gal A in the endoplasmic reticulum and facilitates their proper trafficking to lysosomes. Once in lysosomes dissociation of migalastat restores α-Gal A activity, leading to the catabolism of GL-3 and related substrates.

The GLA mutations amenable and not amenable to treatment with Galafold are listed in Table 2 and Table 3 respectively below. The GLA mutations are also accessible by health care providers

at www.galafoldamenabilitytable.com.

The nucleotide changes listed represent potential DNA sequence changes that result in the amino acid mutation. The amino acid mutation (protein sequence change) is most relevant when determining amenability. If a double mutation is present on the same chromosome (males and females), that patient is amenable if the double mutation is present in one entry in Table 2 (e.g., D55V/Q57L). If a double mutation is present on different chromosomes (only in females) that patient is amenable if either one of the individual mutations is present in Table 2.

Table 2: Galafold (migalastat) amenability table

Nucleotide change

Nucleotide change

Protein sequence change

 

 

 

c.7C>G

c.C7G

L3V

c.8T>C

c.T8C

L3P

c.[11G>T; 620A>C]

c.G11T/A620C

R4M/Y207S

c.37G>A

c.G37A

A13T

c.37G>C

c.G37C

A13P

c.43G>A

c.G43A

A15T

c.44C>G

c.C44G

A15G

c.53T>G

c.T53G

F18C

c.58G>C

c.G58C

A20P

c.59C>A

c.C59A

A20D

c.70T>C or c.70T>A

c.T70C or c.T70A

W24R

c.70T>G

c.T70G

W24G

c.72G>C or c.72G>T

c.G72C or c.G72T

W24C

c.95T>C

c.T95C

L32P

c.97G>T

c.G97T

D33Y

c.98A>G

c.A98G

D33G

c.100A>G

c.A100G

N34D

c.101A>C

c.A101C

N34T

c.101A>G

c.A101G

N34S

c.102T>G or c.102T>A

c.T102G or c.T102A

N34K

c.103G>C or c.103G>A

c.G103C or c.G103A

G35R

c.104G>A

c.G104A

G35E

c.104G>T

c.G104T

G35V

c.107T>C

c.T107C

L36S

c.107T>G

c.T107G

L36W

c.108G>C or c.108G>T

c.G108C or c.G108T

L36F

c.109G>A

c.G109A

A37T

c.110C>T

c.C110T

A37V

c.122C>T

c.C122T

T41I

c.124A>C or c.124A>T

c.A124C or c.A124T

M42L

c.124A>G

c.A124G

M42V

c.125T>A

c.T125A

M42K

c.125T>C

c.T125C

M42T

c.125T>G

c.T125G

M42R

c.126G>A or c.126G>C or

c.G126A or c.G126C or c.G126T

M42I

c.126G>T

 

 

c.137A>C

c.A137C

H46P

c.142G>C

c.G142C

E48Q

c.152T>A

c.T152A

M51K

c.153G>A or c.153G>T or

c.G153A or c.G153T or c.G153C

M51I

c.153G>C

 

 

c.157A>G

c.A157G

N53D

 

 

Table 2: Galafold (migalastat) amenability table

Nucleotide change

Nucleotide change

Protein sequence change

 

 

 

c.[157A>C; 158A>T]

c.A157C/A158T

N53L

c.160C>T

c.C160T

L54F

c.161T>C

c.T161C

L54P

c.164A>G

c.A164G

D55G

c.164A>T

c.A164T

D55V

c.[164A>T; 170A>T]

c.A164T/A170T

D55V/Q57L

c.167G>T

c.G167T

C56F

c.167G>A

c.G167A

C56Y

c.170A>T

c.A170T

Q57L

c.175G>A

c.G175A

E59K

c.178C>A

c.C178A

P60T

c.178C>T

c.C178T

P60S

c.179C>T

c.C179T

P60L

c.196G>A

c.G196A

E66K

c.197A>G

c.A197G

E66G

c.207C>A or c.207C>G

c.C207A or c.C207G

F69L

c.214A>G

c.A214G

M72V

c.216G>A or c.216G>T or

c.G216A or c.G216T or c.G216C

M72I

c.216G>C

 

 

c.218C>T

c.C218T

A73V

c.227T>C

c.T227C

M76T

c.239G>A

c.G239A

G80D

c.247G>A

c.G247A

D83N

c.253G>A

c.G253A

G85S

c.254G>A

c.G254A

G85D

c.[253G>A; 254G>A]

c.G253A/G254A

G85N

c.[253G>A; 254G>T; 255T>G]

c.G253A/G254T/T255G

G85M

c.261G>C or c.261G>T

c.G261C or c.G261T

E87D

c.265C>T

c.C265T

L89F

c.272T>C

c.T272C

I91T

c.288G>A or c.288G>T or

c.G288A or c.G288T or c.G288C

M96I

c.288G>C

 

 

c.289G>C

c.G289C

A97P

c.290C>T

c.C290T

A97V

c.305C>T

c.C305T

S102L

c.311G>T

c.G311T

G104V

c.316C>T

c.C316T

L106F

c.322G>A

c.G322A

A108T

c.326A>G

c.A326G

D109G

c.334C>G

c.C334G

R112G

c.335G>A

c.G335A

R112H

c.337T>A

c.T337A

F113I

c.337T>C or c.339T>A or

c.T337C or c.T339A or c.T339G

F113L

c.339T>G

 

 

c.352C>T

c.C352T

R118C

c.361G>A

c.G361A

A121T

c.368A>G

c.A368G

Y123C

c.373C>T

c.C373T

H125Y

c.374A>T

c.A374T

H125L

c.376A>G

c.A376G

S126G

Table 2: Galafold (migalastat) amenability table

Nucleotide change

Nucleotide change

Protein sequence change

 

 

 

c.383G>A

c.G383A

G128E

c.399T>G

c.T399G

I133M

c.404C>T

c.C404T

A135V

c.408T>A or c.408T>G

c.T408A or c.T408G

D136E

c.416A>G

c.A416G

N139S

c.419A>C

c.A419C

K140T

c.427G>A

c.G427A

A143T

c.431G>A

c.G431A

G144D

c.431G>T

c.G431T

G144V

c.434T>C

c.T434C

F145S

c.436C>T

c.C436T

P146S

c.437C>G

c.C437G

P146R

c.454T>C

c.T454C

Y152H

c.455A>G

c.A455G

Y152C

c.466G>A

c.G466A

A156T

c.467C>T

c.C467T

A156V

c.471G>C or c.471G>T

c.G471C or c.G471T

Q157H

c.484T>G

c.T484G

W162G

c.493G>C

c.G493C

D165H

c.494A>G

c.A494G

D165G

c.[496C>G; 497T>G]

c.C496G/T497G

L166G

c.496C>G

c.C496G

L166V

c.496_497delinsTC

c.496_497delinsTC

L166S

c.499C>G

c.C499G

L167V

c.506T>C

c.T506C

F169S

c.511G>A

c.G511A

G171S

c.520T>C

c.T520C

C174R

c.520T>G

c.T520G

C174G

c.525C>G or c.525C>A

c.C525G or c.C525A

D175E

c.539T>G

c.T539G

L180W

c.540G>C

c.G540C

L180F

c.548G>C

c.G548C

G183A

c.548G>A

c.G548A

G183D

c.550T>A

c.T550A

Y184N

c.551A>G

c.A551G

Y184C

c.553A>G

c.A553G

K185E

c.559A>G

c.A559G

M187V

c.559_564dup

c.559_564dup

p.M187_S188dup

c.560T>C

c.T560C

M187T

c.561G>T or c.561G>A or

c.G561T or c.G561A or c.G561C

M187I

c.561G>C

 

 

c.572T>A

c.T572A

L191Q

c.581C>T

c.C581T

T194I

c.584G>T

c.G584T

G195V

c.586A>G

c.A586G

R196G

c.593T>C

c.T593C

I198T

c.595G>A

c.G595A

V199M

c.596T>C

c.T596C

V199A

c.596T>G

c.T596G

V199G

c.599A>G

c.A599G

Y200C

Table 2: Galafold (migalastat) amenability table

Nucleotide change

Nucleotide change

Protein sequence change

 

 

 

c.602C>T

c.C602T

S201F

c.602C>A

c.C602A

S201Y

c.608A>T

c.A608T

E203V

c.609G>C or c.609G>T

c.G609C or c.G609T

E203D

c.613C>A

c.C613A

P205T

c.613C>T

c.C613T

P205S

c.614C>T

c.C614T

P205L

c.619T>C

c.T619C

Y207H

c.620A>C

c.A620C

Y207S

c.623T>G

c.T623G

M208R

c.628C>T

c.C628T

P210S

c.629C>T

c.C629T

P210L

c.638A>G

c.A638G

K213R

c.638A>T

c.A638T

K213M

c.640C>T

c.C640T

P214S

c.641C>T

c.C641T

P214L

c.643A>G

c.A643G

N215D

c.644A>G

c.A644G

N215S

c.644A>T

c.A644T

N215I

c.[644A>G; 937G>T]

c.A644G/G937T

N215S/D313Y

c.646T>G

c.T646G

Y216D

c.647A>G

c.A647G

Y216C

c.655A>C

c.A655C

I219L

c.656T>A

c.T656A

I219N

c.656T>C

c.T656C

I219T

c.659G>A

c.G659A

R220Q

c.659G>C

c.G659C

R220P

c.662A>C

c.A662C

Q221P

c.671A>C

c.A671C

N224T

c.671A>G

c.A671G

N224S

c.673C>G

c.C673G

H225D

c.683A>G

c.A683G

N228S

c.687T>A or c.687T>G

c.T687A or c.T687G

F229L

c.695T>C

c.T695C

I232T

c.713G>A

c.G713A

S238N

c.716T>C

c.T716C

I239T

c.720G>C or c.720G>T

c.G720C or c.G720T

K240N

c.724A>G

c.A724G

I242V

c.724A>T

c.A724T

I242F

c.725T>A

c.T725A

I242N

c.725T>C

c.T725C

I242T

c.728T>G

c.T728G

L243W

c.729G>C or c.729G>T

c.G729C or c.G729T

L243F

c.730G>A

c.G730A

D244N

c.730G>C

c.G730C

D244H

c.733T>G

c.T733G

W245G

c.740C>G

c.C740G

S247C

c.747C>G or c.747C>A

c.C747G or c.C747A

N249K

c.749A>C

c.A749C

Q250P

c.749A>G

c.A749G

Q250R

Table 2: Galafold (migalastat) amenability table

Nucleotide change

Nucleotide change

Protein sequence change

 

 

 

c.750G>C

c.G750C

Q250H

c.758T>C

c.T758C

I253T

c.758T>G

c.T758G

I253S

c.760-762delGTT

c.760_762delGTT

p.V254del

c.769G>C

c.G769C

A257P

c.770C>G

c.C770G

A257G

c.772G>C or c.772G>A

c.G772C or c.G772A

G258R

c.773G>T

c.G773T

G258V

c.776C>G

c.C776G

P259R

c.776C>T

c.C776T

P259L

c.779G>A

c.G779A

G260E

c.779G>C

c.G779C

G260A

c.781G>A

c.G781A

G261S

c.781G>C

c.G781C

G261R

c.781G>T

c.G781T

G261C

c.788A>G

c.A788G

N263S

c.790G>T

c.G790T

D264Y

c.794C>T

c.C794T

P265L

c.800T>C

c.T800C

M267T

c.805G>A

c.G805A

V269M

c.806T>C

c.T806C

V269A

c.809T>C

c.T809C

I270T

c.810T>G

c.T810G

I270M

c.811G>A

c.G811A

G271S

c.[811G>A; 937G>T]

c.G811A/G937T

G271S/D313Y

c.812G>A

c.G812A

G271D

c.823C>G

c.C823G

L275V

c.827G>A

c.G827A

S276N

c.829T>G

c.T829G

W277G

c.831G>T or c.831G>C

c.G831T or c.G831C

W277C

c.832A>T

c.A832T

N278Y

c.835C>G

c.C835G

Q279E

c.838C>A

c.C838A

Q280K

c.840A>T or c.840A>C

c.A840T or c.A840C

Q280H

c.844A>G

c.A844G

T282A

c.845C>T

c.C845T

T282I

c.850A>G

c.A850G

M284V

c.851T>C

c.T851C

M284T

c.860G>T

c.G860T

W287L

c.862G>C

c.G862C

A288P

c.866T>G

c.T866G

I289S

c.868A>C or c.868A>T

c.A868C or c.A868T

M290L

c.869T>C

c.T869C

M290T

c.870G>A or c.870G>C or

c.G870A or c.G870C or c.G870T

M290I

c.870G>T

 

 

c.871G>A

c.G871A

A291T

c.877C>A

c.C877A

P293T

c.881T>C

c.T881C

L294S

c.884T>G

c.T884G

F295C

c.886A>G

c.A886G

M296V

Table 2: Galafold (migalastat) amenability table

Nucleotide change

Nucleotide change

Protein sequence change

 

 

 

c.886A>T or c.886A>C

c.A886T or c.A886C

M296L

c.887T>C

c.T887C

M296T

c.888G>A or c.888G>T or

c.G888A or c.G888T or c.G888C

M296I

c.888G>C

 

 

c.893A>G

c.A893G

N298S

c.897C>G or c.897C>A

c.C897G or c.C897A

D299E

c.898C>T

c.C898T

L300F

c.899T>C

c.T899C

L300P

c.901C>G

c.C901G

R301G

c.902G>C

c.G902C

R301P

c.902G>A

c.G902A

R301Q

c.902G>T

c.G902T

R301L

c.907A>T

c.A907T

I303F

c.908T>A

c.T908A

I303N

c.911G>A

c.G911A

S304N

c.911G>C

c.G911C

S304T

c.919G>A

c.G919A

A307T

c.922A>G

c.A922G

K308E

c.924A>T or c.924A>C

c.A924T or c.A924C

K308N

c.925G>C

c.G925C

A309P

c.926C>T

c.C926T

A309V

c.928C>T

c.C928T

L310F

c.931C>G

c.C931G

L311V

c.935A>G

c.A935G

Q312R

c.936G>T or c.936G>C

c.G936T or c.G936C

Q312H

c.937G>T

c.G937T

D313Y

c.[937G>T; 1232G>A]

c.G937T/G1232A

D313Y/G411D

c.938A>G

c.A938G

D313G

c.946G>A

c.G946A

V316I

c.947T>G

c.T947G

V316G

c.950T>C

c.T950C

I317T

c.955A>T

c.A955T

I319F

c.956T>C

c.T956C

I319T

c.959A>T

c.A959T

N320I

c.962A>G

c.A962G

Q321R

c.962A>T

c.A962T

Q321L

c.963G>C or c.963G>T

c.G963C or c.G963T

Q321H

c.964G>A

c.G964A

D322N

c.964G>C

c.G964C

D322H

c.966C>A or c.966C>G

c.C966A or c.C966G

D322E

c.968C>G

c.C968G

P323R

c.973G>A

c.G973A

G325S

c.973G>C

c.G973C

G325R

c.978G>C or c.978G>T

c.G978C or c.G978T

K326N

c.979C>G

c.C979G

Q327E

c.980A>T

c.A980T

Q327L

c.983G>C

c.G983C

G328A

c.989A>G

c.A989G

Q330R

c.1001G>A

c.G1001A

G334E

c.1010T>C

c.T1010C

F337S

Table 2: Galafold (migalastat) amenability table

Nucleotide change

Nucleotide change

Protein sequence change

 

 

 

c.1012G>A

c.G1012A

E338K

c.1016T>A

c.T1016A

V339E

c.1027C>A

c.C1027A

P343T

c.1028C>T

c.C1028T

P343L

c.1033T>C

c.T1033C

S345P

c.1046G>C

c.G1046C

W349S

c.1055C>G

c.C1055G

A352G

c.1055C>T

c.C1055T

A352V

c.1061T>A

c.T1061A

I354K

c.1066C>G

c.C1066G

R356G

c.1066C>T

c.C1066T

R356W

c.1067G>A

c.G1067A

R356Q

c.1067G>C

c.G1067C

R356P

c.1072G>C

c.G1072C

E358Q

c.1073A>C

c.A1073C

E358A

c.1073A>G

c.A1073G

E358G

c.1074G>T or c.1074G>C

c.G1074T or c.G1074C

E358D

c.1076T>C

c.T1076C

I359T

c.1078G>A

c.G1078A

G360S

c.1078G>T

c.G1078T

G360C

c.1079G>A

c.G1079A

G360D

c.1082G>A

c.G1082A

G361E

c.1082G>C

c.G1082C

G361A

c.1084C>A

c.C1084A

P362T

c.1085C>T

c.C1085T

P362L

c.1087C>T

c.C1087T

R363C

c.1088G>A

c.G1088A

R363H

c.1102G>A

c.G1102A

A368T

c.1117G>A

c.G1117A

G373S

c.1124G>A

c.G1124A

G375E

c.1153A>G

c.A1153G

T385A

c.1168G>A

c.G1168A

V390M

c.1172A>C

c.A1172C

K391T

c.1184G>A

c.G1184A

G395E

c.1184G>C

c.G1184C

G395A

c.1192G>A

c.G1192A

E398K

c.1202_1203insGACTTC

c.1202_1203insGACTTC

p.T400_S401dup

c.1208T>C

c.T1208C

L403S

c.1225C>G

c.C1225G

P409A

c.1225C>T

c.C1225T

P409S

c.1225C>A

c.C1225A

P409T

c.1228A>G

c.A1228G

T410A

c.1229C>T

c.C1229T

T410I

c.1232G>A

c.G1232A

G411D

c.1235C>A

c.C1235A

T412N

c.1253A>G

c.A1253G

E418G

c.1261A>G

c.A1261G

M421V

NP GAL 0719

The mutations not amenable to treatment with Galafold are listed in Table 3 below.

UNKNOWN in the column of ‘protein sequence change’ indicate that the changes to the protein sequence caused by the mutations cannot be readily deduced from the nucleotide changes and need to be experimentally determined. In these cases, the question marks in the accompanying parentheses indicate that the changes provided therein have not been experimentally confirmed and may not be correct.

Table 3: Mutations not amenable to Galafold (migalastat)

Nucleotide change

Nucleotide change

Protein Sequence

 

 

change

c.1A>C or c.1A>T

c.A1C or c.A1T

M1L

c.1A>G

c.A1G

M1V

c.2T>G

c.T2G

M1R

c.2T>C

c.T2C

M1T

c.2T>A

c.T2A

M1K

c.3G>A or c.3G>T or c.3G>C

c.G3A or c.G3T or c.G3C

M1I

c.19G>T

c.G19T

E7X

c.41T>C

c.T41C

L14P

c.43G>C

c.G43C

A15P

c.44C>A

c.C44A

A15E

c.46C>G

c.C46G

L16V

c.47T>A

c.T47A

L16H

c.47T>C

c.T47C

L16P

c.47T>G

c.T47G

L16R

c.53T>C

c.T53C

F18S

c.56T>A

c.T56A

L19Q

c.56T>C

c.T56C

L19P

c.59C>T

c.C59T

A20V

c.61C>T

c.C61T

L21F

c.62T>C

c.T62C

L21P

c.62T>G

c.T62G

L21R

c.71G>A or c.72G>A

c.G71A or c.G72A

W24X

c.92C>T

c.C92T

A31V

c.109G>C

c.G109C

A37P

c.118C>G

c.C118G

P40A

c.118C>T

c.C118T

P40S

c.119C>A

c.C119A

P40H

c.119C>G

c.C119G

P40R

c.119C>T

c.C119T

P40L

c.127G>C

c.G127C

G43R

c.127G>A

c.G127A

G43S

c.128G>A

c.G128A

G43D

c.128G>T

c.G128T

G43V

c.131G>A or c.132G>A

c.G131A or c.G132A

W44X

c.132G>T or c.132G>C

c.G132T or c.G132C

W44C

c.134T>C

c.T134C

L45P

c.134T>G

c.T134G

L45R

c.134_138delTGCACinsGCTCG

c.134_138delTGCACinsGCTCG

L45R/H46S

c.136C>T

c.C136T

H46Y

c.137A>T

c.A137T

H46L

c.137A>G

c.A137G

H46R

c.[138C>G; 153G>T; 167G>T]

c.C138G/G153T/G167T

H46Q/M51I/C56F

Table 3: Mutations not amenable to Galafold (migalastat)

Nucleotide change

Nucleotide change

Protein Sequence

 

 

change

c.139T>C or c.139T>A

c.T139C or c.T139A

W47R

c.139T>G

c.T139G

W47G

c.140G>A or 141G>A

c.G140A or G141A

W47X

c.140G>T

c.G140T

W47L

c.141G>C or c.141G>T

c.G141C or c.G141T

W47C

c.142G>A

c.G142A

E48K

c.144G>T or c.144G>C

c.G144T or c.G144C

E48D

c.145C>T

c.C145T

R49C

c.145C>A

c.C145A

R49S

c.145C>G

c.C145G

R49G

c.146G>C

c.G146C

R49P

c.146G>T

c.G146T

R49L

c.149T>G

c.T149G

F50C

c.154T>G

c.T154G

C52G

c.154T>C

c.T154C

C52R

c.154T>A or c.155G>C

c.T154A or c.G155C

C52S

c.155G>A

c.G155A

C52Y

c.156C>A

c.C156A

C52X

c.156C>G

c.C156G

C52W

c.166T>G

c.T166G

C56G

c.166T>A or c.167G>C

c.T166A or c.G167C

C56S

c.168C>A

c.C168A

C56X

c.187T>C

c.T187C

C63R

c.188G>A

c.G188A

C63Y

c.187T>A or c.188G>C

c.T187A or c.G188C

C63S

c.194G>C (putative splicing site)

c.G194C (putative splicing site)

UNKNOWN (S65T )

c.194G>T (putative splicing site)

c.G194T (putative splicing site)

UNKNOWN (S65I )

c.196G>C

c.G196C

E66Q

c.[196G>C; 1061T>A]

c.G196C/T1061A

E66Q/I354K

c.202C>T

c.C202T

L68F

c.206T>C

c.T206C

F69S

c.208A>G

c.A208G

M70V

c.215T>G

c.T215G

M72R

c.218C>A

c.C218A

A73E

c.227T>G

c.T227G

M76R

c.228G>C or c.228G>A or

c.G228C or c.G228A or c.G228T

M76I

c.228G>T

 

 

c.233C>G or c.233C>A

c.C233G or c.C233A

S78X

c.235G>T

c.G235T

E79X

c.241T>C or c.241T>A

c.T241C or c.T241A

W81R

c.242G>A or c.243G>A

c.G242A or c.G243A

W81X

c.242G>C

c.G242C

W81S

c.243G>T or c.243G>C

c.G243T or c.G243C

W81C

c.244A>T

c.A244T

K82X

c.256T>G

c.T256G

Y86D

c.256T>C

c.T256C

Y86H

c.257A>G

c.A257G

Y86C

c.258T>G or c.258T>A

c.T258G or c.T258A

Y86X

c.262T>G

c.T262G

Y88D

c.266T>A

c.T266A

L89H

Table 3: Mutations not amenable to Galafold (migalastat)

Nucleotide change

Nucleotide change

Protein Sequence

 

 

change

c.266T>C

c.T266C

L89P

c.266T>G

c.T266G

L89R

c.268T>C

c.T268C

C90R

c.269G>A

c.G269A

C90Y

c.270C>A

c.C270A

C90X

c.274G>C

c.G274C

D92H

c.274G>A

c.G274A

D92N

c.274G>T

c.G274T

D92Y

c.275A>G

c.A275G

D92G

c.275A>T

c.A275T

D92V

c.277G>A

c.G277A

D93N

c.277G>T

c.G277T

D93Y

c.278A>G

c.A278G

D93G

c.278A>T

c.A278T

D93V

c.279C>G or c.279C>A

c.C279G or c.C279A

D93E

c.280T>G

c.T280G

C94G

c.280T>A or c.281G>C

c.T280A or c.G281C

C94S

c.[280T>A; 281G>C]

c.T280A/G281C

C94T

c.281G>A

c.G281A

C94Y

c.281G>T

c.G281T

C94F

c.283T>G

c.T283G

W95G

c.284G>A or c.285G>A

c.G284A or c.G285A

W95X

c.284G>T

c.G284T

W95L

c.284G>C

c.G284C

W95S

c.285G>T or c.285G>C

c.G285T or c.G285C

W95C

c.295C>T

c.C295T

Q99X

c.299G>A

c.G299A

R100K

c.299G>C

c.G299C

R100T

c.305C>G or c.305C>A

c.C305G or c.C305A

S102X

c.307G>C

c.G307C

E103Q

c.307G>T

c.G307T

E103X

c.317T>G

c.T317G

L106R

c.319C>T

c.C319T

Q107X

c.320A>T

c.A320T

Q107L

c.331C>T

c.C331T

Q111X

c.334C>T

c.C334T

R112C

c.334C>A

c.C334A

R112S

c.338T>C

c.T338C

F113S

c.347G>T

c.G347T

G116V

c.350T>G

c.T350G

I117S

c.355C>T

c.C355T

Q119X

c.354_368del15

c.354_368del15

Q119_Y123del5

c.358C>G

c.C358G

L120V

c.[358C>T; 359T>C]

c.C358T/T359C

L120S

c.359T>C

c.T359C

L120P

c.[359T>C; 361G>A]

c.T359C/G361A

L120P/A121T

c.361G>C

c.G361C

A121P

c.369T>G or c.369T>A

c.T369G or c.T369A

Y123X

c.371T>A

c.T371A

V124D

c.374A>C

c.A374C

H125P

Table 3: Mutations not amenable to Galafold (migalastat)

Nucleotide change

Nucleotide change

Protein Sequence

 

 

change

c.379A>T

c.A379T

K127X

c.386T>C

c.T386C

L129P

c.389A>G

c.A389G

K130R

c.392T>A

c.T392A

L131Q

c.392T>C

c.T392C

L131P

c.394G>A or c.394G>C

c.G394A or c.G394C

G132R

c.395G>A

c.G395A

G132E

c.395G>C

c.G395C

G132A

c.398T>A

c.T398A

I133N

c.400T>C

c.T400C

Y134H

c.400T>G

c.T400G

Y134D

c.401A>C

c.A401C

Y134S

c.402T>G or c.402T>A

c.T402G or c.T402A

Y134X

c.406G>C

c.G406C

D136H

c.406G>T

c.G406T

D136Y

c.412G>A or c.412G>C

c.G412A or c.G412C

G138R

c.413G>A

c.G413A

G138E

c.416A>C

c.A416C

N139T

c.422C>A

c.C422A

T141N

c.422C>T

c.C422T

T141I

c.424T>C

c.T424C

C142R

c.425G>A

c.G425A

C142Y

c.426C>A

c.C426A

C142X

c.426C>G

c.C426G

C142W

c.427G>C

c.G427C

A143P

c.439G>A or c.439G>C

c.G439A or c.G439C

G147R

c.440G>A

c.G440A

G147E

c.443G>A

c.G443A

S148N

c.442A>C or c.444T>A or

c.A442C or c.T444A or c.T444G

S148R

c.444T>G

 

 

c.453C>G or c.453C>A

c.C453G or c.C453A

Y151X

c.456C>A or c.456C>G

c.C456A or c.C456G

Y152X

c.463G>C

c.G463C

D155H

c.467C>A

c.C467A

A156D

c.469C>T

c.C469T

Q157X

c.484T>C or c.484T>A

c.T484C or c.T484A

W162R

c.485G>A or c.486G>A

c.G485A or c.G486A

W162X

c.485G>T

c.G485T

W162L

c.486G>C or c.486G>T

c.G486C or c.G486T

W162C

c.488G>T

c.G488T

G163V

c.491T>G

c.T491G

V164G

c.493G>T

c.G493T

D165Y

c.494A>T

c.A494T

D165V

c.500T>A

c.T500A

L167Q

c.500T>C

c.T500C

L167P

c.503A>G

c.A503G

K168R

c.504A>C or c.504A>T

c.A504C or c.A504T

K168N

c.508G>A

c.G508A

D170N

c.508G>C

c.G508C

D170H

c.509A>G

c.A509G

D170G

Table 3: Mutations not amenable to Galafold (migalastat)

Nucleotide change

Nucleotide change

Protein Sequence

 

 

change

c.509A>T

c.A509T

D170V

c.511G>C

c.G511C

G171R

c.511G>T

c.G511T

G171C

c.512G>A

c.G512A

G171D

c.514T>G

c.T514G

C172G

c.514T>C

c.T514C

C172R

c.514T>A or c.515G>C

c.T514A or c.G515C

C172S

c.515G>T

c.G515T

C172F

c.515G>A

c.G515A

C172Y

c.516T>G

c.T516G

C172W

c.519C>A or c.519C>G

c.C519A or c.C519G

Y173X

c.522T>A

c.T522A

C174X

c.523G>A

c.G523A

D175N

c.530T>A

c.T530A

L177X

c.547G>A (putative splicing site)

c.G547A (putative splicing site)

UNKNOWN (G183S )

c.548G>T

c.G548T

G183V

c.552T>A or c.552T>G

c.T552A or c.T552G

Y184X

c.553A>T

c.A553T

K185X

c.557A>C

c.A557C

H186P

c.560T>G

c.T560G

M187R

c.572T>C

c.T572C

L191P

c.588A>T or c.588A>C

c.A588T or c.A588C

R196S

c.601T>C

c.T601C

S201P

c.604T>C

c.T604C

C202R

c.605G>A

c.G605A

C202Y

c.606T>G

c.T606G

C202W

c.607G>A

c.G607A

E203K

c.610T>C or c.610T>A

c.T610C or c.T610A

W204R

c.611G>A or 612G>A

c.G611A or G612A

W204X

c.612G>T or c.612G>C

c.G612T or c.G612C

W204C

c.614C>G

c.C614G

P205R

c.617T>C

c.T617C

L206P

c.620A>G

c.A620G

Y207C

c.626G>A

c.G626A

W209X

c.634C>T

c.C634T

Q212X

c.639G>A (putative splicing site)

c.G639A (putative splicing site)

UNKNOWN

c.[644A>G; 811G>A]

c.A644G/G811A

N215S/G271S

c.[644A>G; 811G>A; 937G>T]

c.A644G/G811A/G937T

N215S/G271S/D313Y

c.648T>A or c.648T>G

c.T648A or c.T648G

Y216X

c.658C>T

c.C658T

R220X

c.661C>T

c.C661T

Q221X

c.666C>A or c.666C>G

c.C666A or c.C666G

Y222X

c.667T>G

c.T667G

C223G

c.667T>C

c.T667C

C223R

c.668G>A

c.G668A

C223Y

c.670A>G

c.A670G

N224D

c.674A>G

c.A674G

H225R

c.676T>C or c.676T>A

c.T676C or c.T676A

W226R

c.677G>A or c.678G>A

c.G677A or c.G678A

W226X

c.678G>T or c.678G>C

c.G678T or c.G678C

W226C

Table 3: Mutations not amenable to Galafold (migalastat)

Nucleotide change

Nucleotide change

Protein Sequence

 

 

change

c.679C>T

c.C679T

R227X

c.680G>A

c.G680A

R227Q

c.680G>C

c.G680C

R227P

c.688G>A

c.G688A

A230T

c.691G>A

c.G691A

D231N

c.692A>G

c.A692G

D231G

c.692A>T

c.A692T

D231V

c.695T>G

c.T695G

I232S

c.700G>T

c.G700T

D234Y

c.701A>T

c.A701T

D234V

c.702T>G or c.702T>A

c.T702G or c.T702A

D234E

c.704C>A

c.C704A

S235Y

c.704C>G

c.C704G

S235C

c.704C>T

c.C704T

S235F

c.706T>C or c.706T>A

c.T706C or c.T706A

W236R

c.707G>A or c.708G>A

c.G707A or c.G708A

W236X

c.707G>T

c.G707T

W236L

c.708G>C or c.708G>T

c.G708C or c.G708T

W236C

c.712A>C or c.714T>A or

c.A712C or c.T714A or c.T714G

S238R

c.714T>G

 

 

c.718A>T

c.A718T

K240X

c.734G>A or c.735G>A

c.G734A or c.G735A

W245X

c.734G>T

c.G734T

W245L

c.739T>C

c.T739C

S247P

c.748C>T

c.C748T

Q250X

c.751G>T

c.G751T

E251X

c.755G>C

c.G755C

R252T

c.770C>A

c.C770A

A257D

c.778G>C or c.778G>A

c.G778C or c.G778A

G260R

c.782G>A

c.G782A

G261D

c.782G>T

c.G782T

G261V

c.784T>A or c.784T>C

c.T784A or c.T784C

W262R

c.785G>A or c.786G>A

c.G785A or c.G786A

W262X

c.785G>T

c.G785T

W262L

c.786G>C or c.786G>T

c.G786C or c.G786T

W262C

c.789T>A or c.789T>G

c.T789A or c.T789G

N263K

c.790G>T; c.805G>A

c.G790T/G805A

D264Y/V269M

c.791A>C

c.A791C

D264A

c.791A>T

c.A791T

D264V

c.793C>T

c.C793T

P265S

c.794C>G

c.C794G

P265R

c.796G>C

c.G796C

D266H

c.796G>T

c.G796T

D266Y

c.796G>A

c.G796A

D266N

c.797A>C

c.A797C

D266A

c.797A>G

c.A797G

D266G

c.797A>T

c.A797T

D266V

c.798T>A or c.798T>G

c.T798A or c.T798G

D266E

c.800T>G

c.T800G

M267R

c.801G>A (putative splicing site)

c.G801A (putative splicing site)

UNKNOWN (M267I )

Table 3: Mutations not amenable to Galafold (migalastat)

Nucleotide change

Nucleotide change

Protein Sequence

 

 

change

c.803T>C

c.T803C

L268S

c.806T>A

c.T806A

V269E

c.[806T>G; 937G>T]

c.T806G/G937T

V269G/D313Y

c.808A>T

c.A808T

I270F

c.811G>T

c.G811T

G271C

c.812G>T

c.G812T

G271V

c.815A>G

c.A815G

N272S

c.816C>A or c.816C>G

c.C816A or c.C816G

N272K

c.817T>C or c.819T>A or

c.T817C or c.T819A or c.T819G

F273L

c.819T>G

 

 

c.820G>A

c.G820A

G274S

c.820G>T

c.G820T

G274C

c.821G>T

c.G821T

G274V

c.823C>T

c.C823T

L275F

c.824T>A

c.T824A

L275H

c.826A>G

c.A826G

S276G

c.826A>T

c.A826T

S276C

c.830G>A or c.831G>A

c.G830A or c.G831A

W277X

c.835C>T

c.C835T

Q279X

c.835C>A

c.C835A

Q279K

c.836A>G

c.A836G

Q279R

c.837G>C or c.837G>T

c.G837C or c.G837T

Q279H

c.838C>T

c.C838T

Q280X

c.845C>A

c.C845A

T282N

c.847C>T

c.C847T

Q283X

c.848A>C

c.A848C

Q283P

c.848A>G

c.A848G

Q283R

c.853G>C

c.G853C

A285P

c.854C>A

c.C854A

A285D

c.859T>C or c.859T>A

c.T859C or c.T859A

W287R

c.859T>G

c.T859G

W287G

c.860G>A or c.861G>A

c.G860A or c.G861A

W287X

c.861G>C or c.861G>T

c.G861C or c.G861T

W287C

c.863C>A

c.C863A

A288D

c.865A>T

c.A865T

I289F

c.871G>C

c.G871C

A291P

c.874G>A

c.G874A

A292T

c.874G>C

c.G874C

A292P

c.875C>T

c.C875T

A292V

c.877C>G

c.C877G

P293A

c.877C>T

c.C877T

P293S

c.878C>A

c.C878A

P293H

c.878C>T

c.C878T

P293L

c.881T>G or c.881T>A

c.T881G or c.T881A

L294X

c.890C>G

c.C890G

S297C

c.890C>T

c.C890T

S297F

c.892A>C

c.A892C

N298H

c.894T>G or c.894T>A

c.T894G or c.T894A

N298K

c.896A>G

c.A896G

D299G

c.899T>A

c.T899A

L300H

Table 3: Mutations not amenable to Galafold (migalastat)

Nucleotide change

Nucleotide change

Protein Sequence

 

 

change

c.901C>T

c.C901T

R301X

c.916C>T

c.C916T

Q306X

c.929T>G

c.T929G

L310R

c.931C>T

c.C931T

L311F

c.932T>C

c.T932C

L311P

c.932T>G

c.T932G

L311R

c.934C>T

c.C934T

Q312X

c.935A>C

c.A935C

Q312P

c.947T>A

c.T947A

V316E

c.949A>T

c.A949T

I317F

c.950T>A

c.T950A

I317N

c.950T>G

c.T950G

I317S

c.958A>T

c.A958T

N320Y

c.960T>G or c.960T>A

c.T960G or c.T960A

N320K

c.961C>G

c.C961G

Q321E

c.961C>T

c.C961T

Q321X

c.963_964GG>CA

c.G963C/G964A

Q321H/D322N

c.974G>A

c.G974A

G325D

c.979C>A

c.C979A

Q327K

c.982G>A or c.982G>C

c.G982A or c.G982C

G328R

c.982G>T

c.G982T

G328W

c.983G>A

c.G983A

G328E

c.983G>T

c.G983T

G328V

c.988C>T

c.C988T

Q330X

c.997C>T

c.C997T

Q333X

c.998A>G

c.A998G

Q333R

c.1012G>T

c.G1012T

E338X

c.1016T>G

c.T1016G

V339G

c.1018T>C or c.1018T>A

c.T1018C or c.T1018A

W340R

c.1019G>C

c.G1019C

W340S

c.1019G>A or c.1020G>A

c.G1019A or c.G1020A

W340X

c.1021G>A

c.G1021A

E341K

c.1021G>T

c.G1021T

E341X

c.1023A >C or c.1023A>T

c.A1023C or c.A1023T

E341D

c.1024C>G

c.C1024G

R342G

c.1024C>T

c.C1024T

R342X

c.1025G>A

c.G1025A

R342Q

c.1025G>C

c.G1025C

R342P

c.1025G>T

c.G1025T

R342L

c.1031T>C

c.T1031C

L344P

c.1034C>G or c.1034C>A

c.C1034G or c.C1034A

S345X

c.1042G>C

c.G1042C

A348P

c.1045T>C or c.1045T>A

c.T1045C or c.T1045A

W349R

c.1046G>A or c.1047G>A

c.G1046A or c.G1047A

W349X

c.1048G>C

c.G1048C

A350P

c.1054G>C

c.G1054C

A352P

c.1055C>A

c.C1055A

A352D

c.1058T>G

c.T1058G

M353R

c.1065C>A or c.1065C>G

c.C1065A or c.C1065G

N355K

c.1069C>T

c.C1069T

Q357X

Table 3: Mutations not amenable to Galafold (migalastat)

Nucleotide change

Nucleotide change

Protein Sequence

 

 

change

c.1072G>A

c.G1072A

E358K

c.1081G>T

c.G1081T

G361X

c.1081G>A or c.1081G>C

c.G1081A or c.G1081C

G361R

c.1088G>C

c.G1088C

R363P

c.1095T>A or c.1095T>G

c.T1095A or c.T1095G

Y365X

c.1115T>A

c.T1115A

L372Q

c.1115T>C

c.T1115C

L372P

c.1115T>G

c.T1115G

L372R

c.1117G>C

c.G1117C

G373R

c.1118G>A

c.G1118A

G373D

c.1124_1129del

c.1124_1129del

G375_V376del

c.1129_1140dup

c.1129_1140dup

A377_P380dup

c.1130C>A

c.C1130A

A377D

c.1132T>C

c.T1132C

C378R

c.1133G>A

c.G1133A

C378Y

c.1144T>C

c.T1144C

C382R

c.1145G>A

c.G1145A

C382Y

c.1146C>G

c.C1146G

C382W

c.1147T>C or c.1149C>G or

c.T1147C or c.C1149G or

F383L

c.1149C>A

c.C1149A

 

c.1151T>A

c.T1151A

I384N

c.1153A>C

c.A1153C

T385P

c.1156C>T

c.C1156T

Q386X

c.1157A>C

c.A1157C

Q386P

c.1163T>C

c.T1163C

L388P

c.1165C>G

c.C1165G

P389A

c.1166C>G

c.C1166G

P389R

c.1166C>T

c.C1166T

P389L

c.1181_1183dup

c.1181_1183dup

L394_G395insV

c.1187T>A

c.T1187A

F396Y

c.1192G>T

c.G1192T

E398X

c.1193A>C

c.A1193C

E398A

c.1196G>A or c.1197G>A

c.G1196A or c.G1197A

W399X

c.1196G>C

c.G1196C

W399S

c.1202C>G or c.1202C>A

c.C1202G or c.C1202A

S401X

c.1215T>A

c.T1215A

S405R

c.1217A>G

c.A1217G

H406R

c.1219A>G

c.A1219G

I407V

c.1220T>A

c.T1220A

I407K

c.1220T>G

c.T1220G

I407R

c.1226_1231del

c.1226_1231del

p.409_410delinsR

c.1228A>C

c.A1228C

T410P

c.1229C>A

c.C1229A

T410K

c.1241T>C

c.T1241C

L414S

c.1243C>T

c.C1243T

L415F

c.1244T>C

c.T1244C

L415P

c.1246C>T

c.C1246T

Q416X

c.1247A>C

c.A1247C

Q416P

c.1247_1248CT>AA

c.C1247A/T1248A

L417K

c.1250T>G

c.T1250G

L417R

Table 3: Mutations not amenable to Galafold (migalastat)

Nucleotide change

Nucleotide change

Protein Sequence

 

 

change

c.1250T>C

c.T1250C

L417P

c.1288T>C

c.T1288C

X430Q

g.941_5845del

c.1-179_369+577del

p.?(Exon1_2del)

g.?_?del

c.?_?

UNKNOWN (del

 

 

Exon1_2?)

c.18delA

c.18delA

p.P6fs*114

c.26delA

c.26delA

p.H9Lfs*111

c.32delG

c.32delG

p.G11Afs*109

c.33delC

c.33delC

p.G11fs*109

c.34_42del

c.34_42del

p.C12_L14del

c.34_57del

c.34_57del

p.C12_L19del

c.35_47del

c.35_47del

p.C12Ffs*104

c.42_48delTGCGCTT

c.42_48delTGCGCTT

p.L14Sfs*12

c.58_72del

c.58_72del

p.A20_W24del

c.58_83del

c.58_83del

p.A20_G28delfs*2

c.85dupG

c.85dupG

p.A29Gfs*1

c.89delG

c.89delG

p.R30Kfs*89

c.123delC

c.123delC

p.T41fs*79

c.123_126dupCATG

c.123_126dupCATG

p.G43Hfs*13

c.124_125del

c.124_125del

p.M42Gfs*12

c.125_137del

c.125_137del

p.M42Tfs*74

c.147_148insCCC

c.147_148insCCC

p.49insP

c.147_148insCGC

c.147_148insCGC

p.R49ins

c.154delT

c.154delT

p.C52Afs*68

c.157_160delAACC

c.157_160delAACC

p.C52fs*67

c.162delT

c.162delT

p.L54fs*66

c.172delG

c.172delG

p.E58Kfs*61

c.181_182dupA

c.181_182dupA

p.D61Efs*5

c.184delT

c.184delT

p.S62Pfs*58

c.186delC

c.186delC

p.S62fs*58

g.2594_10904dup

c.195-2500_999+197dup

UNKNOWN

g.3422_6041delinsCG

c.194+2049_369+773del2620ins

UNKNOWN

 

CG

 

g.?_?del

c.195-?_547+?del

UNKNOWN (del

 

 

Exon2_3?)

g.?_?dup

c.?_?dup

UNKNOWN

 

 

(Exon2_4dup?)

g.2934_6378del

c.194+1561_370-891del

UNKNOWN

 

 

(E66_Y123del; del

 

 

Exon2?)

g.3396_6012del

c.194+2023_370-1257del

UNKNOWN

 

 

(E66_Y123del; del

 

 

Exon2?)

g.3260_6410del

c.194+1887_370-859del

UNKNOWN

 

 

(E66_Y123del; del

 

 

Exon2?)

g.2979_6442del

c.194+1606_369+1174del

UNKNOWN

 

 

(E66_Y123del; del

 

 

Exon2)

c.210insT

c.210insT

p.E71X

Table 3: Mutations not amenable to Galafold (migalastat)

Nucleotide change

Nucleotide change

Protein Sequence

 

 

change

c.214delA

c.214delA

p.M72Wfs*47

c.256delT

c.256delT

p.Y88Mfs*42

g.5052_5079del28

g.5052_5079del28

UNKNOWN

g.5106_5919delins231

c.207_369+651del814ins231

UNKNOWN (del

 

 

Exon2?)

c.259_276del

c.259_276del

p.87_92del

c.267_268dupCT

c.267_268dupCT

p.C90Sfs*31

c.270delC

c.270delC

p.C90X

c.281_286delinsT

c.281_286delinsT

p.C94Ffs*26

c.290delC

c.290delC

p.A97Vfs*22

c.297_298del

c.297_298del

p.Q99fs*22

c.297_300delAAGA

c.297_300delAAGA

p.Q99fs*19

c.305delC

c.305delC

p.S102X

c.317_327del

c.317_327del

p.S102fs*16

c.323_324insCAGA

c.323_324insCAGA

p.D109Rfs*14

c.336del18

c.336del18

p.113del6aa

c.354_368del

c.354_368del

p.Q119_Y123del

c.358del6

c.358del6

p.120del2aa/L120H

c.363delT

c.363delT

p.A121fs*8

g.5271_9366del4096insT

c.369+3_639+954del3129insT

UNKNOWN (del Exon3

 

 

and 4?)

g.6009_9741del

c.369+741_640-390del

UNKNOWN (del Exon3

 

 

and 4?)

g.6547_9783del

c.369+1279_640-348del

UNKNOWN (del Exon3

 

 

and 4?)

g.6736_11545del

c.370-533_c.1290+277del

UNKNOWN (del

 

 

Exon3_7?)

g.7086_7487del

c.370-183_547+41del

UNKNOWN (del

 

 

Exon3?)

g.>5.5kbdel to 3UTR

c.?_?del

UNKNOWN

 

 

(delExon3_3’UTR?)

c.[374A>T; 383G>A]

c.A374T/G383A

H125L/G128E

c.402delT

c.402delT

p.Y134X

c.409delG

c.409delG

p.V137Lfs*27

c.413dupG

c.413dupG

p.G138fs*2

c.421delA

c.421delA

p.T141Pfs*23

c.426dupC

c.426dupC

p.A143Rfs*13

c.452delA

c.452delA

p.Y151Sfs*13

c.457_459del

c.457_459del

p.153delD

c.477delT

c.477delT

p.F159Lfs*5

c.486_498del

c.486_498del

p.W162Cfs*1

c.512delG

c.512delG

p.G171Vfs*19

c.516insGAC

c.516insGAC

p.152insD

c.520delT

c.520delT

p.C174Vfs*17

c.560delT

c.560delT

p.M187Sfs*3

c.568delG

c.568delG

p.A190Pfs*1

c.590delG

c.590delG

p.S197Tfs*42

c.[604T>C; 644A>G]

c.T604C/A644G

p.C202R/N215S

c.606delT

c.606delT

p.C202Wfs*37

c.613_621del

c.613_621del

p.205_207del

Table 3: Mutations not amenable to Galafold (migalastat)

Nucleotide change

Nucleotide change

Protein Sequence

 

 

change

c.614delC

c.614delC

p.P205Lfs*34

c.618_619del

c.618_619del

p.L206fs*24

c.621dupT

c.621dupT

p.M208Yfs*24

g.?_?del

c.?_?del

UNKNOWN (del

 

 

Exon5_7?)

g.[10237_11932del;

g.[10237_11932del;

UNKNOWN

11933_12083inv;

11933_12083inv;

 

12084_12097del]

12084_12097del]

 

c.646dupT

c.646dupT

p.Y216Lfs*15

c.646delT

c.646delT

p.Y216Ifs*23

c.650_663dup14

c.650_663dup14

p.Q221fs*23

c.672_673ins37

c.672_673ins37

p.H225Tfs*18

c.674_732del

c.674_732del

p.H225Lfs*5

c.678delG

c.678delG

p.A230Lfs*9

c.700_702del

c.700_702del

p.D234del

c.715_717del

c.715_717del

p.delI239

c.716dupT

c.716dupT

p.I239fs*10

c.718_719del

c.718_719del

p.K240Efs*8

c.719dupA

c.719dupA

p.K240fs*9

c.722delG

c.722delG

p.S241Ifs*27

c.723dupT

c.723dupT

p. I242Yfs*8

c.736_739delinsCAA

c.736_739delinsCAA

p.T246Qfs*21

c.732delC

c.732delC

p.D244fs*24

c.741ins9

c.741ins9

p.247ins3

c.744delT

c.744delT

p.F248Lfs*20

c.744_745del

c.744_745del

p.F248Lfs*6

c.746_747del

c.746_747del

p.N249Tfs*5

c.756delA

c.756delA

p.I253Vfs*14

c.759delT

c.759delT

p.I253Mfs*15

c.760dupG

c.760dupG

p.V254Gfs*1

c.761_762del

c.761_762del

p.V254Gfs*9

c.774_775del

c.774_775del

p.G258fx*5

c.777delA

c.777delA

p.P259fs*9

c.782dupG

c.782dupG

p.G261fs*3

c.802-2_802-3delCA

c.802-2_802-3delCA

UNKNOWN

c.803_806delTAGT

c.803_806delTAGT

p.L268X

c.807delG

c.807delG

p.V269fs*12

c.833dupA

c.833dupA

p.N278Kfs*20

c.833delA

c.833delA

p.N278Ifs*3

c.833_845del

c.833_845del

p.W277fs*34

c.838_849del

c.838_849del

p.Q280_283del

c.841_844delGTAA

c.841_844delGTAA

p.Q280fs*34

c.842_844del

c.842_844del

p.V281AdelT282

c.848_851delAGAT

c.848_851delAGAT

Q283Rfs*33

c.858_863delinsTTGG

c.858_863delinsTTGG

p.W287fs*9

c.863delC

c.863delC

p.A288Vfs*29

c.881delT

c.881delT

p.L294Yfs*22

c.891dupT

c.891dupT

p.N298X

c.892_893insT

c.892_893insT

p.N298Ifs*1

c.893_894insG

c.893_894insG

p.N298Kfs*1

Table 3: Mutations not amenable to Galafold (migalastat)

Nucleotide change

Nucleotide change

Protein Sequence

 

 

change

c.902dupG

c.902dupG

p.R301fs*13

c.909_918del

c.909_918del

p.I303Mfx*10

c.914delC

c.914delC

p.P305Lfs*11

c.931delC

c.931delC

p.L311Ffs*5

c.941_961del

c.941_961del

p.D315_Q321del

c.946delG

c.946delG

p.V316X

c.946_954dup

c.946_954dup

p.V316_A318dup

c.950_954dupTTGCC

c.950_954dupTTGCC

p.A318fs*31

c.972delG

c.972delG

p.G325Afs*21

c.974dupG

c.974dupG

p.G325fs*7

c.986delA

c.986delA

p.Y329Sfs*18

c.988delC

c.988delC

p.Q330Sfs*17

c.946_966del

c.946_966del

p.V316_D322del

c.994delA

c.994delA

p.R332Dfs*15

c.994dupA

c.994dupA

p.R332Kfs*5

c.996_999del

c.996_999del

p.R332fs*14

c.997dupC

c.997dupC

p.Q333Pfs*5

c.1011_1029del

c.1011_1029del

p.F337fs*4

c.1017_1020delins24

c.1017_1020delins24

p.V339fs*7

c.1017_1027del

c.1017_1027del

p.V339fs*5

c.1021delG

c.1021delG

p.E341Nfs*6

c.1025delG

c.1025delG

p.R342Hfs*5

c.1028delC

c.1028delC

p.343Lfs*3

c.1029_1030delTC

c.1029_1030delTC

p.P343fs*29

c.1030_1031insT

c.1030_1031insT

p.L344fs*30

c.1033_1034del

c.1033_1034del

p.S345Rfs*28

c.1037delG

c.1037delG

p.G346Afs*1

c.1040dupT

c.1040dupT

p.L347Ffs*27

c.1041dupA

c.1041dupA

p.L347fs*27

c.1042dupG

c.1042dupG

p.A348Gfs*26

c.1043_1044insG

c.1043_1044insG

p.A348fs*26

c.1049delC

c.1049delC

p.A350Vfs*1

c.1055_1056delCT

c.1055_1056delCT

p.A352Dfs*20

c.1055_1057dup

c.1055_1057dup

p.353insT

c.1057_1058del

c.1057_1058del

p.M353Dfs*20

c.1072_1074del

c.1072_1074del

p.358delE

c.1074_1075del

c.1074_1075del

p.E358Dfs*15

c.1077delT

c.1077delT

p.I359Mfs*31

c.1081_1100del

c.1081_1100del

p.G360fs*7

c.1086_1098del

c.1086_1098del

p.P362fs*24

c.1088delG

c.1088delG

p.R363Pfs*27

c.1091_1092del

c.1091_1092del

p.S364Lfs*9

c.1093dupT

c.1093dupT

p.Y365Lfs*9

c.1095delT

c.1095delT

p.Y365X

c.1096_1100del

c.1096_1100del

p.Y365fs*7

c.1102delG

c.1102delG

p.A368Qfs*21

c.1102delGinsTTATAC

c.1102delGinsTTATAC

p.A368delinsFYfs*23

c.1114_1115insTCCC

c.1114_1115insTCCC

p.G373Pfs*1

c.1122_1125del

c.1122_1125del

p.K374fs*15

c.1123_1175del

c.1123_1175del

p.G375_R392del

Table 3: Mutations not amenable to Galafold (migalastat)

Nucleotide change

Nucleotide change

Protein Sequence

 

 

change

c.1139delC

c.1139delC

p.380Lfs*10

c.1145_1149del

c.1145_1149del

p.C382Yfs*14

c.1146_1148del

c.1146_1148del

p.383delF

c.1151_1152delinsAT

c.1151_1152delinsAT

p.I384N

c.1156_1157del

c.1156_1157del

p.Q386Afs*10

c.1167dupT

c.1167dupT

p.P389fs*9

c.1168insT

c.1168insT

p.V390fs*9

c.1176_1179del

c.1176_1179del

p.R392Sfs*1

c.1177_1178del

c.1177_1178del

p.K393Afs*4

c.1181_1192del

c.1181_1192del

p.L394_E398delinsQ

c.1187dupT

c.1187dupT

p.F396fs*2

c.1187delT

c.1187delT

p.F396Sfs*7

c.1188delC

c.1188delC

p.F396fs*7

c.1193_1196delAATG

c.1193_1196delAATG

p.E398Gfs*3

c.1201dupT

c.1201dupT

p.S401Ffs*49

c.1202dupC

c.1202dupC

p.R402Kfs*48

c.1208delT

c.1208delT

p.L403X

c.1208ins21

c.1208ins21

UNKNOWN

c.1209_1211del

c.1209_1211del

p.404delR

c.1223delA

c.1223delA

p.N408Ifs*9

c.1235_1236del

c.1235_1236del

p.T412Sfs*37

c.1277_1278del

c.1277_1278del

p.K426Rfs*23

c.1281_1282insCTTA

c.1281_1282insCTTA

p.L429Ifs*21

c.1284_1287del

c.1284_1287del

p.L428Ffs*23

IVS1+2T>C

c.194+2T>C

UNKNOWN

IVS1+39delAT

c.194+39delAT

UNKNOWN

IVS1-1G>A

c.195-1G>A

UNKNOWN

IVS1-1G>T

c.195-1G>T

UNKNOWN

IVS1-2A>G

c.195-2A>G

UNKNOWN

IVS1-2A>G; IVS1-49T>C

c.[195-2A>G; 195-49T>C]

UNKNOWN

IVS2+1G>A

c.369+1G>A

UNKNOWN

IVS2+1G>T

c.369+1G>T

UNKNOWN

IVS2+2T>G

c.369+2T>G

UNKNOWN

IVS2-2A>G

c.370-2A>G

UNKNOWN

IVS3+1G>A

c.547+1G>A

UNKNOWN

IVS3+1G>C

c.547+1G>C

UNKNOWN

IVS3-162A>T

c.548-162A>T

UNKNOWN

IVS3-2A>G

c.548-2A>G

UNKNOWN

IVS3-1G>A

c.548-1G>A

UNKNOWN

IVS3-1G>C

c.548-1G>C

UNKNOWN

IVS3-1G>T

c.548-1G>T

UNKNOWN

IVS4+1G>A

c.639+1G>A

UNKNOWN

IVS4+1G>C

c.639+1G>C

UNKNOWN

IVS4+4A>T

c.639+4A>T

UNKNOWN

IVS4+861C>T

c.639+861C>T

UNKNOWN

IVS4+919G>A

c.639+919G>A

UNKNOWN

IVS4-859C>T

c.640-859C>T

UNKNOWN

IVS4-11T>A

c.640-11T>A

UNKNOWN

IVS4-3C>G

c.640-3C>G

UNKNOWN

Table 3: Mutations not amenable to Galafold (migalastat)

Nucleotide change

Nucleotide change

Protein Sequence

 

 

change

IVS4-2A>T

c.640-2A>T

UNKNOWN

IVS4-1G>A

c.640-1G>A

UNKNOWN

IVS4-1G>T

c.640-1G>T

UNKNOWN

IVS5+2T>C

c.801+2T>C

UNKNOWN

IVS5+3A>G

c.801+3A>G

UNKNOWN

IVS5+3A>T

c.801+3A>T

UNKNOWN

IVS5+4A>G

c.801+4A>G

UNKNOWN

IVS5-2A>G

c.802-2A>G

UNKNOWN

IVS6+1G>T

c.999+1G>T

UNKNOWN

IVS6+2T>C

c.999+2T>C

UNKNOWN

IVS6-2A>G

c.1000-2A>G

UNKNOWN

IVS6-2A>T

c.1000-2A>T

UNKNOWN

IVS6-1G>A

c.1000-1G>A

UNKNOWN

IVS6-1G>C

c.1000-1G>C

UNKNOWN

IVS6-10G>A; IVS6-22C>T

c.[1000-10G>A; 1000-22C>T]

UNKNOWN

 

 

NP GAL 0719

Not all mutations have been tested.

Pharmacodynamic effects

Treatment with Galafold in Phase 2 pharmacodynamic trials generally resulted in increases in endogenous α-Gal A activity in WBCs, as well as in skin and kidney for the majority of patients. In patients with amenable mutations, GL-3 levels tended to decrease in urine and in kidney interstitial capillaries.

Clinical efficacy and safety

The clinical efficacy and safety of Galafold have been evaluated in two Phase 3 pivotal trials and an open-label extension (OLE) trial. All patients received the recommended dosage of 123 mg Galafold every other day.

The first Phase 3 trial (ATTRACT) was a randomised open-label active comparator trial that evaluated the efficacy and safety of Galafold compared to enzyme replacement therapy (ERT) (agalsidase beta, agalsidase alfa) in 52 male and female patients with Fabry disease who were receiving ERT prior to trial entry and who have amenable mutations (ERT-experienced trial). The study was structured in two periods. During the first period (18-months) ERT-experienced patients were randomised to switch from ERT to Galafold or continue with ERT. The second period was an optional 12-month open-label extension in which all subjects received Galafold.

The second Phase 3 trial (FACETS) was a 6-month randomised double-blind placebo-controlled trial (through month 6) with an 18-month open-label period to evaluate the efficacy and safety of Galafold in 50 male and female patients with Fabry disease who were naïve to ERT, or had previously been on ERT and had stopped for at least 6 months and who have amenable mutations (ERT-naïve trial).

Renal Function

In the ERT-experienced trial, renal function remained stable for up to 18 months of treatment with Galafold. Mean annualised rate of change in eGFRCKD-EPI was -0.40 mL/min/1.73 m2 (95% CI: -2.272, 1.478; n=34) in the Galafold group compared to -1.03 mL/min/1.73 m2 (95% CI: -3.636, 1.575; n=18) in the ERT group. The mean annualised rate of change from baseline in eGFRCKD-EPI in patients treated for 30 months with Galafold was -1.72 mL/min/1.73 m2 (95% CI: -2.653, -0.782; n=31).

In the ERT- naïve trial and open label extension, renal function remained stable for 3 years of treatment with Galafold. After an average of 36 months of treatment, the mean annualised rate of change in eGFRCKD-EPI was -0.81 mL/min/1.73 m2 (95% CI: -2.00, 0.37). No clinically significant differences were observed during the initial 6-month placebo-controlled period.

Left Ventricular Mass Index (LVMi)

In the ERT-experienced trial, following 18 months of treatment with Galafold there was a statistically significant decrease in LVMi (p< 0.05). The baseline values were 95.3 g/m2 for the Galafold arm and 92.9 g/m2 for the ERT arm and the mean change from baseline in LVMi at Month 18 was -6.6

(95% CI: -11.0, -2.1; n=31) for Galafold and -2.0 (95% CI: -11.0, 7.0; n=13) for ERT. The change from baseline to Month 18 in LVMi (g/m2) in patients with left ventricular hypertrophy (females with baseline LVMi > 95 g/m2 and males with baseline LVMi > 115 g/m2) was -8.4 (95% CI: -15.7, 2.6; n=13) for migalastat and 4.5 (95% CI: -10.7, 18.4; n=5) for ERT. After 30 months treatment with Galafold, the mean change from baseline in LVMi was -3.8 (95% CI: -8.9, 1.3; n=28) and the mean change from baseline in LVMi in patients with left ventricular hypertrophy at baseline was -10.0 (95% CI: -16.6, -3.3; n=10).

In the ERT-naïve trial, Galafold resulted in a statistically significant decrease in LVMi (p< 0.05); the mean change from baseline in LVMi at Month 18 to 24 was -7.7 (95% CI: -15.4, -0.01; n=27). After follow up in the OLE, the mean change from baseline in LVMi at Month 30 to 36 was -17.0 (95% CI: -26.2, -7.9; n=15). The mean change from baseline in LVMi at Month 18 to 24 in patients with left ventricular hypertrophy at baseline (females with baseline LVMi > 95 g/m2 or males with baseline LVMi > 115 g/m2) was -18.6 (95% CI: -38.2, 1.0; n=8). After follow up in the OLE, the mean change from baseline in LVMi in patients with left ventricular hypertrophy at baseline at Month 30 to 36 was -30.0 (95% CI: -57.9, -2.2; n=4). No clinically significant differences in LVMi were observed during the initial 6-month placebo-controlled period.

Disease Substrate

In the ERT-experienced trial, plasma lyso-Gb3 levels slightly increased but remained low in patients with amenable mutations treated with Galafold for the 30 month duration of the study. Plasma lyso- Gb3 levels also remained low in patients on ERT for up to 18 months.

In the ERT- naïve trial, Galafold showed statistically significant reductions in plasma lyso-Gb3 concentrations and kidney interstitial capillary GL-3 inclusions in patients with amenable mutations. Patients randomised to Galafold in Stage 1 demonstrated statistically significant greater reduction (±SEM) in mean interstitial capillary GL-3 deposition (-0.25±0.10; -39%) at month 6 compared to placebo (+0.07 ± 0.13; +14%) (p=0.008). Patients randomised to placebo in Stage 1 and switched to Galafold at month 6 (Stage 2) also demonstrated statistically significant decreases in interstitial capillary GL-3 inclusions at month 12 (-0.33±0.15; -58%) (p=0.014). Qualitative reductions in GL-3 levels were observed in multiple renal cell types: podocytes, mesangial cells, and glomerular endothelial cells, respectively, over 12 months of treatment with Galafold.

Composite Clinical Outcomes

In the ERT-experienced trial, an analysis of a composite clinical outcome composed of renal, cardiac, and cerebrovascular events, or death, showed that the frequency of events observed in the Galafold treatment group was 29% compared to 44% in the ERT group over 18 months. The frequency of events in patients treated with Galafold over 30 months (32%) was similar to the 18 month period.

Patient-Reported Outcome - Gastrointestinal Symptoms Rating Scale

In the ERT-naïve trial, analyses of the Gastrointestinal Symptoms Rating Scale demonstrated that treatment with Galafold was associated with statistically significant (p<0.05) improvements versus placebo from baseline to month 6 in the diarrhoea domain, and in the reflux domain for patients with symptoms at baseline. During the open-label extension, statistically significant (p<0.05) improvements from baseline were observed in the diarrhoea and indigestion domains, with a trend of improvement in the constipation domain.

Paediatric population

The European Medicines Agency has deferred the obligation to submit the results of studies with Galafold in one or more subsets of the paediatric population in the treatment of Fabry disease (see section 4.2 for information on paediatric use).

5.2Pharmacokinetic properties

Absorption

The absolute bioavailability (AUC) for a single oral 150 mg migalastat hydrochloride dose or a single 2-hour 150 mg intravenous infusion was approximately 75%. Following a single oral dose of 150 mg migalastat hydrochloride solution, the time to peak plasma concentration was approximately 3 hours. Plasma migalastat exposure (AUC0-∞ ) and Cmax demonstrated dose-proportional increases at migalastat hydrochloride oral doses from 50 mg to 1,250 mg.

Migalastat administered with a high-fat meal, or 1 hour before a high-fat or light meal, or 1 hour after a light meal, resulted in significant reductions of 37% to 42% in mean total migalastat exposure (AUC0-∞) and reductions of 15% to 40% in mean peak migalastat exposure (Cmax) compared with the fasting state. See section 4.2.

Distribution

In healthy volunteers, the volume of distribution (Vz/F) of migalastat following ascending single oral doses (25-675 mg migalastat HCl) ranged from 77 to 133 L, indicating it is well distributed into tissues and greater than total body water (42 litres). There was no detectable plasma protein binding following administration of [14C]-migalastat hydrochloride in the concentration range between 1 and 100 M.

Biotransformation

Based upon in vivo data, migalastat is a substrate for UGT, being a minor elimination pathway. Migalastat is not a substrate for P-glycoprotein (P-gP) in vitro and it is considered unlikely that migalastat would be subject to drug-drug interactions with cytochrome P450s. A pharmacokinetic trial in healthy male volunteers with 150 mg [14C]-migalastat HCl revealed that 99% of the radiolabeled dose recovered in plasma was comprised of unchanged migalastat (77%) and 3 dehydrogenated O-glucuronide conjugated metabolites, M1to M3 (13%). Approximately 9% of the total radioactivity was unassigned.

Elimination

A pharmacokinetic trial in healthy male volunteers with 150 mg [14C]-migalastat hydrochloride revealed that approximately 77% of the radiolabeled dose was recovered in urine of which 55% of was excreted as unchanged migalastat and 4% as combined metabolites M1, M2 and M3. Approximately 5% of the total sample radioactivity was unassigned components. Approximately 20% of the total radiolabeled dose was excreted in faeces, with unchanged migalastat being the only measured component.

Following ascending single oral doses (25-675 mg migalastat hydrochloride), no trends were found for clearance, CL/F). At the 150 mg dose, CL/F was approximately 11 to 14 L/hr. Following administration of the same doses, the mean elimination half-life (t1/2) ranged from approximately 3 to 5 hours.

Special populations

Patients with renal impairment

Galafold has not been studied in patients with Fabry disease who have a GFR less than

30 mL/min/1.73 m2. In a single dose study with Galafold in non-Fabry subjects with varying degrees of renal insufficiency, exposures were increased by 4.3-fold in subjects with severe renal impairment (GFR < 30 mL/min/1.73 m2).

Patients with hepatic impairment

No studies have been carried out in subjects with impaired hepatic function. From the metabolism and excretion pathways, it is not expected that a decreased hepatic function may affect the pharmacokinetics of migalastat.

Elderly (> 65 years)

Clinical studies of Galafold included small number of patients aged 65 and over. The effect of age was evaluated in a population pharmacokinetic analysis on plasma migalastat clearance in the ERT-naïve study population. The difference in clearance between Fabry patients ≥ 65 years and those < 65 years was 20%, which was not considered clinically significant.

Gender

The pharmacokinetic characteristics of migalastat were not significantly different between females and males in either healthy volunteers or in patients with Fabry disease.

5.3Preclinical safety data

Non-clinical studies suggest no specific hazard for humans on the basis of single-and repeat-dose studies, with the exception of transient and fully reversible infertility in male rats associated with migalastat treatment. The infertility associated with migalastat treatment was reported at clinically relevant exposures. Complete reversibility was seen after 4 weeks off-dose. Similar findings have been noted pre-clinically following treatment with other iminosugars. In the rabbit embryo-foetal toxicity study, findings including embryo-foetal death, a reduction in mean foetal weight, retarded ossification, and slightly increased incidences of minor skeletal abnormalities were observed only at doses associated with maternal toxicity.

In a rat 104-week carcinogenicity study, there was an increased incidence of pancreatic islet cell adenomas in males at a dose level 19-fold higher than the exposure (AUC) at the clinically efficacious dose. This is a common spontaneous tumour in ad libitum-fed male rats. In the absence of similar findings in females, no findings in the genotoxicity battery or in the carcinogenicity study with Tg.rasH2 mice, and no pre-neoplastic pancreatic findings in the rodents or monkeys, this observation in male rats is not considered related to treatment and its relevance to humans is unknown.

6.PHARMACEUTICAL PARTICULARS

6.1List of excipients

Capsule contents

Pregelatinised starch (maize)

Magnesium stearate

Capsule shell

Gelatin

Titanium dioxide (E171)

Indigotine (E132)

Printing ink

Shellac

Black iron oxide

Potassium hydroxide

6.2Incompatibilities

Not applicable.

6.3Shelf life

4 years

6.4Special precautions for storage

This medicinal product does not require any special temperature storage conditions. Store in the original package in order to protect from moisture.

6.5Nature and contents of container

PVC / PCTFE / PVC/Al blister.

Pack size of 14 capsules.

6.6Special precautions for disposal

Any unused medicinal product or waste material should be disposed of in accordance with local requirements.

7.MARKETING AUTHORISATION HOLDER

Amicus Therapeutics UK Ltd Phoenix House,

Oxford Road,

Tatling End, Gerrards Cross, Buckinghamshire SL9 7AP

United Kingdom

tel +44 1753 888 567 fax +44 1753 437 192

e-mail info@amicusrx.co.uk

8.MARKETING AUTHORISATION NUMBER(S)

EU/1/15/1082/001

9.DATE OF FIRST AUTHORISATION/RENEWAL OF THE AUTHORISATION

26 May 2016

10.DATE OF REVISION OF THE TEXT

DD month YYYY

Detailed information on this medicinal product is available on the website of the European Medicines Agency http://www.ema.europa.eu.

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