A comprehensive study on the effect of alglucosidase alpha and immunomodulation on survival, motor and cardiac outcome, creatine kinase and antibody titers in classic infantile Pompe disease: the Monza experience.
Faraguna MC, Crescitelli V, Bonanomi S, Kullmann GA, Boffi ML, Pretese R, Risca G, Tedesco LM, Pozzi K, Serafini M, van den Hout JM, van der Ploeg AT, Balduzzi AC, Gasperini S
Current opinion in immunology, 2026 Jan 22
Abstract
We report on 13 classic infantile Pompe patients, including four cross-reactive immunological material negative (31%), treated with alglucosidase alpha (rhGAA) at Fondazione IRCCS San Gerardo, Monza, between 2003 and 2024. Median age at rhGAA initiation was 3.3 months, with nine patients (69%) starting on doses > 20 mg/kg/every other week. With a median follow-up of 6.9 years, the 5- and 10-year survival was 92%. Four patients died, and three became ventilator-dependent. Hypertrophic cardiomyopathy normalized in all patients, though electrocardiogram abnormalities persisted in 36%. Walking was achieved by 10 (77%). Ten patients received immune tolerance induction (77%, five primary, two secondary, three both), and seven received long-term sirolimus. Nine developed anti-rhGAA, of whom five (38%) had high-sustained antibody titers (HSAT). All had elevated creatine kinase at diagnosis; creatine phosphokinase normalized over time in four patients on 40 mg/kg/week since start without HSAT. This study offers real-world insight into managing classic infantile Pompe disease and compares the cohort's outcome to international experiences.