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The patient journey
with Fabry disease

The patient journey with Fabry disease

Fabry disease has a profound emotional and physical impact on affected individuals and their families.1 Disease manifestations in patients with the same gene mutation, even males from the same family, may vary, making counseling difficult.1 

Alongside the physical symptoms, patients can feel anxiety concerning disease progression, guilt related to passing the disease on to children, and other strong emotions such as anger, grief or hopelessness.1 Their self-esteem and self-identity can also be affected.1 Genetic counselling is critical following diagnosis to provide patients with a better understanding of their condition.1 

Fabry disease may affect women and men differently

The conception of the expression of Fabry disease in females has drastically changed over the last decade.2 Female heterozygotes were erroneously described as “carriers of the defective gene” more or less safeguarded against developing disease manifestations and symptoms.3 

Disease expression in females is variable, and clinical phenotypes range from asymptomatic patients to women with disease manifestations as severe as observed in classically affected males.2  

In female patients with Fabry disease: 

    Their alpha‐galactosidase A activity may be within the normal range and therefore, the definitive diagnostic confirmation should be made by genetic analysis in suspected cases.³

    Onset of symptoms has been reported to occur at a mean age of 9 years in boys and 13 years in girls.2

    A high percentage of females develop vital organ involvement including the kidneys, heart and/or brain about a decade later than males.3

FEMALE PATIENTS SHOULD BE ASSESSED AND MONITORED IN A MANNER SIMILAR TO THAT RECOMMENDED FOR MEN.1

 

Fabry families – family tree and genetics

Screening family members 

Clinical and genetic screening of the at-risk members of families of newly diagnosed patients is of critical importance, as additional family members with Fabry disease may be identified from each individual index patient. One pedigree review study found that, on average, there were at least five family members diagnosed with Fabry disease following the diagnosis of a patient.1  

Screening family membersScreening family members

Fabry disease inheritance patterns 

Parents should be informed about the likelihood that siblings, relatives, and future children will inherit the disease. Affected mothers have a 50% chance of passing the defective gene on to all offspring whether boys or girls. Sons who inherit the gene will be affected; her daughters may display a spectrum of clinical involvement.2  

Fathers with Fabry disease pass on the defective gene to none of their sons and all of their daughters. Previously unrecognized family members, males and females, can be identified at an early stage of the disease via screening for the mutation among family members.2 

Family planning 

Pre-conception or prenatal genetic counseling should be offered to all male and female patients of reproductive age, discussing Fabry disease's X-linked pattern of inheritance, availability of both prenatal diagnosis using cultured amniocytes or chorionic villi for molecular testing and preimplantation genetic diagnosis for selection of unaffected embryos.1  

Pre-conception genetic counseling is important when pregnancy is being considered, as some adjunctive therapies routinely used to treat Fabry symptoms are teratogenic and may pose a risk to fetal development.

Learn more about how we can make a change for patients with Fabry

References:

  1. Ortiz A, et al. Mol Genet Metab. 2018;123(4):416-427.  
  2. Martins, AM, et al. The Journal of pediatrics. 2009;155(4): S19-S31. 
  3. Germain DP. Fabry disease. Orphanet J Rare Dis. 2010;5:30.

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Rethink Fabry

Iš svetainės „Naujas požiūris į Fabry ligą“ išeinate Dėmesio: interneto svetainė, į kurią esate nukreipiami, nepriklauso „Chiesi“ ir nėra pastarosios kaip nors valdoma

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