Event-free survival of maralixibat-treated patients with Alagille syndrome compared to a real-world cohort from GALA
Por:
Hansen BE, Vandriel SM, Vig P, Garner W, Mogul DB, Loomes KM, Piccoli DA, Rand EB, Jankowska I, Czubkowski P, Gliwicz-Miedzinska D, Gonzales EM, Jacquemin E, Bouligand J, D'Antiga L, Nicastro E, Arnell H, Fischler B, Sokal É, Demaret T, Siew S, Stormon M, Karpen SJ, Romero R, Ebel NH, Feinstein JA, Roberts AJ, Evans HM, Sundaram SS, Chaidez A, Hardikar W, Shankar S, Fischer RT, Lacaille F, Debray D, Lin HC, Jensen MK, Jaramillo C, Karthikeyan P, Indolfi G, Verkade HJ, Larson-Nath C, Quiros-Tejeira RE, Valentino PL, Rogalidou M, Dezsofi A, Squires JE, Schwarz K, Calvo PL, Bernabeu JQ, Zizzo AN, Nebbia G, Bulut P, Santos-Silva E, Fawaz R, Nastasio S, Karnsakul W, Tamara ML, Molera C, Kelly D, Sandahl TD, Jimenez-Rivera C, Banales JM, Mujawar Q, Li LT, She H, Wang JS, Kim KM, Oh SH, Sanchez MC, Cavalieri ML, Lee WS, Hajinicolaou C, Lertudomphonwanit C, Waisbourd-Zinman O, Arikan C, Alam S, Carvalho E, Melere M, Eshun J, Önal Z, Desai DM, Wiecek S, Pinto RB, Wolters VM, Garcia J, Beretta M, Kerkar N, Brecelj J, Rock N, Lurz E, Blondet N, Shah U, Thompson RJ and Kamath BM
Publicada:
1 jun 2024
Ahead of Print:
1 dic 2023
Resumen:
Background and Aims: Alagille syndrome (ALGS) is characterized by chronic cholestasis with associated pruritus and extrahepatic anomalies. Maralixibat, an ileal bile acid transporter inhibitor, is an approved pharmacologic therapy for cholestatic pruritus in ALGS. Since long-term placebo-controlled studies are not feasible or ethical in children with rare diseases, a novel approach was taken comparing 6-year outcomes from maralixibat trials with an aligned and harmonized natural history cohort from the Global ALagille Alliance (GALA) study. Approach and Results: Maralixibat trials comprise 84 patients with ALGS with up to 6 years of treatment. GALA contains retrospective data from 1438 participants. GALA was filtered to align with key maralixibat eligibility criteria, yielding 469 participants. Serum bile acids could not be included in the GALA filtering criteria as these are not routinely performed in clinical practice. Index time was determined through maximum likelihood estimation in an effort to align the disease severity between the two cohorts with the initiation of maralixibat. Event-free survival, defined as the time to first event of manifestations of portal hypertension (variceal bleeding, ascites requiring therapy), surgical biliary diversion, liver transplant, or death, was analyzed by Cox proportional hazards methods. Sensitivity analyses and adjustments for covariates were applied. Age, total bilirubin, gamma-glutamyl transferase, and alanine aminotransferase were balanced between groups with no statistical differences. Event-free survival in the maralixibat cohort was significantly better than the GALA cohort (HR, 0.305; 95% CI, 0.189-0.491; p < 0.0001). Multiple sensitivity and subgroup analyses (including serum bile acid availability) showed similar findings. Conclusions:This study demonstrates a novel application of a robust statistical method to evaluate outcomes in long-term intervention studies where placebo comparisons are not feasible, providing wide application for rare diseases. This comparison with real-world natural history data suggests that maralixibat improves event-free survival in patients with ALGS.
Filiaciones:
Hansen BE:
Toronto General Hospital University Health Network, Toronto, ON, Canada
Institute of Health Policy, Management and Evaluation, Toronto, ON, Canada
Department of Epidemiology, Erasmus MC, Rotterdam, Netherlands
Vandriel SM:
The Hospital for Sick Children and the University of Toronto, Division of Gastroenterology, Hepatology and Nutrition, Toronto, ON, Canada
Vig P:
Mirum Pharmaceuticals, Inc., Foster City, CA, USA
Garner W:
Mirum Pharmaceuticals, Inc., Foster City, CA, USA
Mogul DB:
Mirum Pharmaceuticals, Inc., Foster City, CA, USA
Loomes KM:
The Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine, Division of Gastroenterology, Hepatology and Nutrition, Philadelphia, PA, USA
Piccoli DA:
The Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine, Division of Gastroenterology, Hepatology and Nutrition, Philadelphia, PA, USA
Rand EB:
The Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine, Division of Gastroenterology, Hepatology and Nutrition, Philadelphia, PA, USA
Jankowska I:
The Children's Memorial Health Institute, Department of Gastroenterology, Hepatology, Nutrition Disturbances and Pediatrics, Warsaw, Poland
Czubkowski P:
The Children's Memorial Health Institute, Department of Gastroenterology, Hepatology, Nutrition Disturbances and Pediatrics, Warsaw, Poland
Gliwicz-Miedzinska D:
The Children's Memorial Health Institute, Department of Gastroenterology, Hepatology, Nutrition Disturbances and Pediatrics, Warsaw, Poland
Gonzales EM:
Service d'Hépatologie et de Transplantation Hépatique Pédiatriques, Centre de Référence de l'Atrésie des Voies Biliaires et des Cholestases Génétiques (AVB-CG), FSMR FILFOIE, ERN RARE LIVER, Hôpital Bicêtre, AP-HP, Faculté de Médecine Paris-Saclay, Le Kremlin-Bicêtre, and Inserm U1193, Hépatinov, Université Paris-Saclay, Orsay, France
Jacquemin E:
Service d'Hépatologie et de Transplantation Hépatique Pédiatriques, Centre de Référence de l'Atrésie des Voies Biliaires et des Cholestases Génétiques (AVB-CG), FSMR FILFOIE, ERN RARE LIVER, Hôpital Bicêtre, AP-HP, Faculté de Médecine Paris-Saclay, Le Kremlin-Bicêtre, and Inserm U1193, Hépatinov, Université Paris-Saclay, Orsay, France
Bouligand J:
Service de Génétique Moléculaire, Pharmacogénétique et Hormonologie, Hôpitaux Universitaires Paris-Saclay, Assistance PubliqueHôpitaux de Paris, Centre Hospitalier Universitaire de Bicêtre, Le Kremlin-Bicêtre, France
D'Antiga L:
Ospedale Papa Giovanni XXIII, Pediatric Hepatology, Gastroenterology and Transplantation, Bergamo, Italy
Nicastro E:
Ospedale Papa Giovanni XXIII, Pediatric Hepatology, Gastroenterology and Transplantation, Bergamo, Italy
Arnell H:
Astrid Lindgren Children's Hospital, Department of Paediatric Gastroenterology, Hepatology and Nutrition, Karolinska University Hospital and Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
Fischler B:
Astrid Lindgren Children's Hospital, Department of Paediatric Gastroenterology, Hepatology and Nutrition, Karolinska University Hospital and CLINTEC, Karolinska Institutet, Stockholm, Sweden
Sokal É:
Cliniques Universitaires Saint-Luc, Service De Gastroentérologie & Hépatologie Pédiatrique, Brussels, Belgium
Demaret T:
Cliniques Universitaires Saint-Luc, Service De Gastroentérologie & Hépatologie Pédiatrique, Brussels, Belgium
Siew S:
The Children's Hospital at Westmead, Department of Gastroenterology, Sydney, NSW, Australia
Stormon M:
The Children's Hospital at Westmead, Department of Gastroenterology, Sydney, NSW, Australia
Karpen SJ:
Children's Healthcare of Atlanta & Emory University School of Medicine, Division of Pediatric Gastroenterology, Hepatology & Nutrition, Atlanta, Georgia
Romero R:
Children's Healthcare of Atlanta & Emory University School of Medicine, Division of Pediatric Gastroenterology, Hepatology & Nutrition, Atlanta, Georgia
Ebel NH:
Division of Gastroenterology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
Feinstein JA:
Department of Pediatrics (Cardiology), Stanford University School of Medicine, Lucile Packard Children's Hospital, Palo Alto, CA, USA
Roberts AJ:
Starship Child Health, Department of Paediatric Gastroenterology, Auckland, New Zealand
Evans HM:
Starship Child Health, Department of Paediatric Gastroenterology, Auckland, New Zealand
Sundaram SS:
Section of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics and the Digestive Health Institute, Children's Hospital of Colorado and University of Colorado School of Medicine, Aurora, CO, USA
Chaidez A:
Section of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics and the Digestive Health Institute, Children's Hospital of Colorado and University of Colorado School of Medicine, Aurora, CO, USA
Hardikar W:
Royal Children's Hospital, Department of Gastroenterology and Clinical Nutrition, Melbourne, Vic, Australia
Shankar S:
Mazumdar Shaw Medical Center, Narayana Health, Bangalore, India
Fischer RT:
Children's Mercy Kansas City, Department of Gastroenterology, Section of Hepatology, Kansas City, MO, USA
Lacaille F:
Department of Pediatric Gastroenterology, and Nutrition, Necker-Enfants Malades Hospital, University of Paris, Paris, France
Debray D:
Pediatric liver unit, National Reference Centre for Rare Pediatric Liver Diseases (Biliary Atresia and Genetic Cholestasis), FILFOIE, ERN RARE LIVER, Necker-Enfants Malades Hospital, University of Paris, Paris, France
Lin HC:
Oregon Health and Science University, Division of Pediatric Gastroenterology, Department of Pediatrics, Portland, OR, USA
Jensen MK:
University of Utah, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Primary Children's Hospital, Salt Lake City, UT, USA
Jaramillo C:
University of Utah, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Primary Children's Hospital, Salt Lake City, UT, USA
Karthikeyan P:
Leeds Teaching Hospitals NHS Trust, Leeds Children's Hospital, Leeds, UK
Indolfi G:
Department Neurofarba, University of Florence and Meyer Children's University Hospital, Paediatric and Liver Unit, Florence, Italy
Verkade HJ:
University Medical Center Groningen, Department of Pediatrics, Center for Liver, Digestive, and Metabolic Diseases, Groningen, The Netherlands
Larson-Nath C:
University of Minnesota, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Minneapolis, MN, USA
Quiros-Tejeira RE:
Children's Hospital & Medical Center and University of Nebraska Medical Center, Department of Pediatrics, Omaha, NE, USA
Valentino PL:
Gastroenterology & Hepatology Division, Department of Pediatrics, University of Washington, Seattle Children's Hospital, Seattle, WA, USA
Rogalidou M:
Division of Gastroenterology & Hepatology, "Agia Sofia" Children's Hospital, First Department of Pediatrics, University of Athens, Athens, Greece
Dezsofi A:
First Department of Paediatrics, Semmelweis University, Budapest, Hungary
Squires JE:
University of Pittsburgh School of Medicine, Division of Pediatric Gastroenterology and Hepatology, Department of Pediatrics, Pittsburgh, PA, USA
Schwarz K:
University of California San Diego, Rady Children's Hospital San Diego, Division of Pediatric Gastroenterology, San Diego, CA, USA
Calvo PL:
Pediatric Gastroenterology Unit, Regina Margherita Children's Hospital, Azienda Ospedaliera-Universitaria Citta' della Salute e della Scienza, Turin, Italy
Bernabeu JQ:
Hospital Universitari Vall d'Hebron, Pediatric Hepatology and Liver Transplant Department, Barcelona, Spain
Department of Liver and Gastrointestinal Diseases, Biodonostia Health Research Institute - Donostia University Hospital, University of the Basque Country (UPV/EHU), San Sebastian, Spain
Zizzo AN:
Children's Hospital, London Health Sciences Centre, Division of Paediatric Gastroenterology and Hepatology, Western University, London, ON, Canada
Nebbia G:
Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Servizio di Epatologia Pediatrica, Milan, Italy
Bulut P:
Phoenix Children's Hospital, Division of Pediatric Gastroenterology and Hepatology, Phoenix, AZ, USA
Santos-Silva E:
Centro Hospitalar Universitário Do Porto, Pediatric Gastroenterology Unit, Porto, Portugal
Fawaz R:
Yale University School of Medicine, Department of Pediatrics, New Haven, CT, USA
Nastasio S:
Boston Children's Hospital and Harvard Medical School, Division of Gastroenterology, Hepatology, & Nutrition, Boston, MA, USA
Karnsakul W:
Johns Hopkins University School of Medicine, Department of Pediatrics, Baltimore, MD, USA
Tamara ML:
Paediatric Gastroenterology Unit, Cruces University Hospital, Bilbao, Spain
Molera C:
Pediatric Gastroenterology Hepatology and Nutrition Unit, Hospital Sant Joan de Déu, Esplugues de Llobregat, Spain
Kelly D:
Liver Unit, Birmingham Women's & Children's Hospital NHS Trust and University of Birmingham, Birmingham, UK
Sandahl TD:
Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
Jimenez-Rivera C:
Children's Hospital of Eastern Ontario, Division of Gastroenterology, Hepatology and Nutrition, Ottawa, ON, Canada
Banales JM:
Department of Hepatology and Gastroenterology, Biodonostia Health Research Institute - Donostia University Hospital, Universidad del País Vasco (UPV/EHU), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), San Sebastián, Spain
Mujawar Q:
University of Manitoba, Section of Pediatric Gastroenterology, Department of Pediatrics, Winnipeg, MB, Canada
Li LT:
Children's Hospital of Fudan University, The Center for Pediatric Liver Diseases, Shanghai, China
She H:
Children's Hospital of Fudan University, The Center for Pediatric Liver Diseases, Shanghai, China
Wang JS:
Children's Hospital of Fudan University, The Center for Pediatric Liver Diseases, Shanghai, China
Kim KM:
Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center Children's Hospital, Seoul, South Korea
Oh SH:
Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center Children's Hospital, Seoul, South Korea
Sanchez MC:
Hospital Italiano Buenos Aires, Pediatric Gastroenterology and Hepatology Division, Buenos Aires, Argentina
Cavalieri ML:
Hospital Italiano Buenos Aires, Pediatric Gastroenterology and Hepatology Division, Buenos Aires, Argentina
Lee WS:
Faculty of Medicine, Department of Paediatrics, University of Malaya, Kuala Lumpur, Malaysia
Hajinicolaou C:
Division of Paediatric Gastroenterology, Chris Hani Baragwanath Academic Hospital, Department of Paediatrics and Child Health, University of the Witwatersrand, Johannesburg, South Africa
Lertudomphonwanit C:
Ramathibodi Hospital Mahidol University, Division of Gastroenterology, Department of Pediatrics, Bangkok, Thailand
Waisbourd-Zinman O:
Schneider Children's Medical Center of Israel, Institute of Gastroenterology, Nutrition and Liver Diseases, Petah Tikva, Sackler Faculty of Medicine, Tel-Aviv University, Israel
Arikan C:
Koc University School of Medicine, Department of Pediatric Gastroenterology and Organ Transplant, Istanbul, Turkey
Alam S:
Institute of Liver and Biliary Sciences, Department of Pediatric Hepatology, New Delhi, India
Carvalho E:
Pediatric Gastroenterology Department, Hospital de Base do Distrito Federal, Hospital da Crianca de Brasília, Centro Universitário de Brasília, Brasília, DF, Brazil
Melere M:
Pediatric Gastroenterology Service, Hospital da Criança Santo Antônio, Universidade Federal de Ciências da Saúde de Porto Alegre, Complexo Hospitalar Santa Casa, Porto Alegre, RS, Brazil
Eshun J:
Department of Pediatric Gastroenterology, Le Bonheur Children's Hospital and The University of Tennessee Health Science Center, Memphis, Tennessee
Önal Z:
Pediatric Gastroenterology, Hepatology and Nutrition Department, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
Desai DM:
Solid Organ Transplant Department, Children's Health - Children's Medical Center, Dallas, Texas
Wiecek S:
Medical University of Silesia in Katowice, Department of Pediatrics, Katowice, Poland
Pinto RB:
Division of Pediatric Gastroenterology of Hospital da Criança Conceição do Grupo Hospitalar Conceição, Porto Alegre, RS, Brazil
Wolters VM:
Department of Pediatric Gastroenterology, University Medical Center Utrecht, Utrecht, Netherlands
Garcia J:
Division of Pediatric Gastroenterology, Hepatology and Nutrition/Miami Transplant Institute, University of Miami, Miami, Florida
Beretta M:
Faculty of Health Sciences, Wits Donald Gordon Medical Centre, University of the Witwatersrand, Johannesburg, South Africa
Kerkar N:
University of Rochester Medical Center, Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Rochester, NY, USA
Brecelj J:
University Medical Center Ljubljana, Pediatric Gastroenterology, Hepatology and Nutrition, and Department of Pediatrics, Faculty of Medicine, Ljubljana, Slovenia
Rock N:
Swiss Pediatric Liver Center, Division of Pediatric Specialties, Department of Pediatrics, Gynecology, and Obstetrics, University Hospitals Geneva and University of Geneva, Geneva, Switzerland
Lurz E:
Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany
Blondet N:
Gastroenterology & Hepatology Division, Department of Pediatrics, University of Washington, Seattle Children's Hospital, Seattle, WA, USA
Shah U:
Harvard Medical School, Massachusetts General Hospital for Children, Boston, MA, USA
Thompson RJ:
Institute of Liver Studies, King's College London, London, UK
Kamath BM:
The Hospital for Sick Children and the University of Toronto, Division of Gastroenterology, Hepatology and Nutrition, Toronto, ON, Canada
Green Submitted, Green Published
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