Unexpected Hypotension in a Female Patient with Fabry Disease: Switching from Agalsidase α to β after Long-term ERT

Intern Med. 2025 Aug 1;64(15):2369-2374. doi: 10.2169/internalmedicine.4685-24. Epub 2025 Feb 8.

Abstract

Fabry disease is a rare X-linked lysosomal storage disorder. Enzyme replacement therapies (ERTs), such as agalsidase α and β, are available treatment options. While infusion-related reactions (IRRs) are known to occur at the initiation of ERT owing to immune responses, there is limited information on IRRs during long-term ERT. We report the case of a female patient with Fabry disease who developed unexpected hypotension after six years of stable treatment with agalsidase α, leading to a switch to agalsidase β. Continuous monitoring may be essential to identify potential IRRs in female patients with Fabry disease receiving long-term ERT.

Keywords: Fabry disease; enzyme replacement therapy; female; infusion-related reactions.

Publication types

  • Case Reports

MeSH terms

  • Drug Substitution*
  • Enzyme Replacement Therapy* / adverse effects
  • Fabry Disease* / diagnosis
  • Fabry Disease* / drug therapy
  • Female
  • Humans
  • Hypotension* / chemically induced
  • Hypotension* / diagnosis
  • Hypotension* / etiology
  • Isoenzymes / administration & dosage
  • Isoenzymes / adverse effects
  • Isoenzymes / therapeutic use
  • Middle Aged
  • Recombinant Proteins
  • Time Factors
  • alpha-Galactosidase* / administration & dosage
  • alpha-Galactosidase* / adverse effects
  • alpha-Galactosidase* / therapeutic use

Substances

  • agalsidase alfa
  • agalsidase beta
  • alpha-Galactosidase
  • Isoenzymes
  • Recombinant Proteins