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Disease burden of Crigler-Najjar syndrome: systematic review and future perspectives.

Abstract

BACKGROUND AND AIM

Crigler-Najjar syndrome (CNS) results from biallelic mutations of UGT1A1 causing partial or total loss of uridine 5´-diphosphate glucuronyltransferase activity leading to unconjugated hyperbilirubinemia and its attendant risk for irreversible neurological injury (kernicterus). CNS is exceedingly rare and has been only partially characterized through relatively small studies, each comprising between two and 57 patients.

METHODS

We conducted a systematic literature review to consolidate data on the patient, caregiver, and societal burden of CNS.

RESULTS

We identified 28 articles on clinical aspects of CNS, but found no published data on its humanistic or economic burden. In patients with complete UGT1A1 deficiency (type 1 CNS [CNS-I]), unconjugated bilirubin levels increase 3-6 mg/dL per day during the newborn period and reach neurologically dangerous levels between 5 and 14 days of age. Phototherapy is the mainstay of treatment, but poses significant challenges to patients and their families. Despite consistent phototherapy, patients with CNS-I have worsening hyperbilirubinemia with advancing age. Liver transplantation is the only definitive therapy for CNS-I and is increasingly associated with excellent long-term survival, but also incurs high costs, medical and surgical morbidities, and risks of immunosuppression.

CONCLUSIONS

CNS is associated with a substantial burden, even with existing standards of care. The development of novel disease-modifying therapies has the potential to reduce disease burden and improve the lives of CNS patients and their families.

Authors+Show Affiliations

King's College Hospital NHS Foundation Trust, London, UK.Division of Pediatric Pathology, Department of Pathology and Laboratory Medicine and Neuroscience Research Center, Medical College of Wisconsin, Milwaukee, WI.Hillman Center for Pediatric Transplantation, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.Hillman Center for Pediatric Transplantation, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.Hillman Center for Pediatric Transplantation, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.Clinic for Special Children, Strasburg, PA, USA.Bridge Medical Consulting Ltd, London, UK.Audentes Therapeutics, San Francisco, CA, USA.Audentes Therapeutics, San Francisco, CA, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31495946

Citation

Dhawan, Anil, et al. "Disease Burden of Crigler-Najjar Syndrome: Systematic Review and Future Perspectives." Journal of Gastroenterology and Hepatology, 2019.
Dhawan A, Lawlor MW, Mazariegos GV, et al. Disease burden of Crigler-Najjar syndrome: systematic review and future perspectives. J Gastroenterol Hepatol. 2019.
Dhawan, A., Lawlor, M. W., Mazariegos, G. V., McKiernan, P., Squires, J. E., Strauss, K. A., ... Prasad, S. (2019). Disease burden of Crigler-Najjar syndrome: systematic review and future perspectives. Journal of Gastroenterology and Hepatology, doi:10.1111/jgh.14853.
Dhawan A, et al. Disease Burden of Crigler-Najjar Syndrome: Systematic Review and Future Perspectives. J Gastroenterol Hepatol. 2019 Sep 8; PubMed PMID: 31495946.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Disease burden of Crigler-Najjar syndrome: systematic review and future perspectives. AU - Dhawan,Anil, AU - Lawlor,Michael W, AU - Mazariegos,George V, AU - McKiernan,Patrick, AU - Squires,James E, AU - Strauss,Kevin A, AU - Gupta,Digant, AU - James,Emma, AU - Prasad,Suyash, Y1 - 2019/09/08/ PY - 2019/01/04/received PY - 2019/08/28/revised PY - 2019/08/28/accepted PY - 2019/9/10/entrez KW - Clinical burden KW - Crigler-Najjar KW - Mortality KW - Phototherapy KW - Transplantation JF - Journal of gastroenterology and hepatology JO - J. Gastroenterol. Hepatol. N2 - BACKGROUND AND AIM: Crigler-Najjar syndrome (CNS) results from biallelic mutations of UGT1A1 causing partial or total loss of uridine 5´-diphosphate glucuronyltransferase activity leading to unconjugated hyperbilirubinemia and its attendant risk for irreversible neurological injury (kernicterus). CNS is exceedingly rare and has been only partially characterized through relatively small studies, each comprising between two and 57 patients. METHODS: We conducted a systematic literature review to consolidate data on the patient, caregiver, and societal burden of CNS. RESULTS: We identified 28 articles on clinical aspects of CNS, but found no published data on its humanistic or economic burden. In patients with complete UGT1A1 deficiency (type 1 CNS [CNS-I]), unconjugated bilirubin levels increase 3-6 mg/dL per day during the newborn period and reach neurologically dangerous levels between 5 and 14 days of age. Phototherapy is the mainstay of treatment, but poses significant challenges to patients and their families. Despite consistent phototherapy, patients with CNS-I have worsening hyperbilirubinemia with advancing age. Liver transplantation is the only definitive therapy for CNS-I and is increasingly associated with excellent long-term survival, but also incurs high costs, medical and surgical morbidities, and risks of immunosuppression. CONCLUSIONS: CNS is associated with a substantial burden, even with existing standards of care. The development of novel disease-modifying therapies has the potential to reduce disease burden and improve the lives of CNS patients and their families. SN - 1440-1746 UR - https://www.unboundmedicine.com/medline/citation/31495946/Disease_burden_of_Crigler-Najjar_syndrome:_systematic_review_and_future_perspectives L2 - https://doi.org/10.1111/jgh.14853 DB - PRIME DP - Unbound Medicine ER -