Real life data: follow-up assessment on Spanish Gaucher disease patients treated with eliglustat. TRAZELGA project
Authors: Serrano-Gonzalo Irene , de Frutos Laura López , Lahoz-Gil Carlos , Delgado-Mateos Francisco , Fernández-Galán María Ángeles , Morales-Conejo Montserrat , Calle-Gordo María Victoria , Ibarretxe-Gerediaga Daiana , Madinaveitia-Ochoa Andrés , Albarracin-Arraigosa Antonio , Balanzat-Muñoz José , Correcher-Medina Patricia , García-Frade Luis Javier , Hernández-Rivas Jesús María , Labbadia Francesca , López-Dupla Jesus Miguel , Lozano-Almela María Luisa , Mora-Casterá Elvira , Noya-Pereira María Soledad , Ruíz-Guinaldo María Ángeles , del Mar Tormo-Díaz María , Vitoria-Miñana Isidro , Arévalo-Vargas Isidro , Andrade-Campos Marcio , Giraldo Pilar 
Published: December 2023

Abstract
Background
The availability of multiple treatments for type 1 Gaucher disease increases the need for real-life studies to evaluate treatment efficacy and safety and provide clinicians with more information to choose the best personalized therapy for their patients.

Aims
To determine whether treatment with eliglustat produces, in adult GD1 patients, ans optimal response in daily clinical practice.

Methods
We designed a real-life study with 2 years of follow-up (TRAZELGA [GEE-ELI-2017-01]) to uniformly evaluate the response and adverse events to eliglustat treatment. This study, conducted in 30 patients across Spain and previously treated with other therapies, included the evaluation of safety and efficacy by assessing visceral enlargement, bone disease (DEXA and T and Z scores), concomitant treatments and adverse events, as well as a quality of life evaluation (SF-36). In addition, the quantification of classical biomarkers (chitotriosidase activity, CCL18/PARC and glucosylsphingosine (GluSph)) and new candidates for GD biomarkers (YKL-40, cathepsin S, hepcidin and lipocalin-2 determined by immunoassay) were also assessed. Non-parametric statistical analysis was performed and p < 0.05 was considered statistically significant.

Main Results
Thirty patients were enrolled in the study. The median age was 41.5 years and the male–female ratio was 1.1:1. 84% of the patients had received ERT and 16% SRT as previous treatment. The most common symptoms at baseline were fatigue (42%) and bone pain (38%), no patient had a bone crisis during the study, and two years after switching, 37% had reduced their use of analgesics. Patient-reported outcomes showed a significant increase in physical function scores (p = 0.027) and physical pain scores (p = 0.010). None of the enrolled patients discontinued treatment due to adverse events, which were mild and transient in nature, mainly gastrointestinal and skin dryness. None of the biomarkers show a significant increase or decompensation after switching. CCL18/PARC (p = 0.0012), YKL-40 (p = 0.00004) and lipocalin-2 (p = 0.0155) improved after two years and GluSph after one year (p = 0.0008) and two years (p = 0.0245) of oral therapy.

Conclusion
In summary, this real-life study, showed that eliglustat maintains stability and can improve quality of life with few side effects. Significant reductions in classic and other novel biomarkers were observed after two years of therapy.