Diagnosis, treatment, management and monitoring of patients with tyrosinaemia type 1: Consensus group recommendations from the German-speaking countries.

Diana Ballhausen, Susanne Morlot, Cecilia Janson-Mutsaerts, Eberhard Mönch, Tobias Hagedorn, Daniela Karall, Sabine Scholl-Bürgi, Peter Freisinger, Johannes Häberle, Stephan Vom Dahl, Nils Janzen, Natalie Weinhold, Uta Meyer, Karin Lange, Jiri Zeman, Dorothea Haas, Anibh M Das, Johannes Sander, Stefanie Rosenbaum-Fabian

Journal: Journal of inherited metabolic disease 2024;48(1):e12824

PMID: 39676394

Abstract

Hepatorenal tyrosinaemia (HT1) is an autosomal recessive disorder of tyrosine degradation resulting in hepatic and renal dysfunction, neurological sequelae may occur in some patients. The use of nitisinone (NTBC) has revolutionised treatment and outcome of this disorder. NTBC has to be combined with a low protein diet. While NTBC modulates the disease course in HT1 patients, several issues are open. Optimal dosage, doses per day, therapeutic range of NTBC concentration, mode of protein restriction and biomarkers are not well defined. HCC and neurocognitive deficits are long-term sequelae. Early diagnosis and treatment are essential to minimise the risk for these complications. Clinical guidance for management of HT1-patients is required. Randomised clinical studies are difficult in the presence of therapeutic options. We discussed these issues in a consensus group of 10 paediatricians, 1 adult hepatologist, 1 geneticist, 2 dieticians, 2 newborn screening specialists with experience in HT1, 1 psychologist and 2 representatives of a patient group from the German-speaking countries (DACH). Recommendations were based on scientific literature and expert opinion, also taking into account recent experience with newborn screening. There was strong consensus that newborn screening using succinylacetone (SA) and early treatment are essential for a good outcome. The dose of NTBC should be as low as possible without losing metabolic control. This has to be accompanied by a low protein diet, in some patients a simplified diet without calculation of protein intake. Specific education and psychosocial support are recommended. Indications for liver transplantation were defined. Monitoring shall include clinical findings, levels of SA, tyrosine, phenylalanine and NTBC in (dried) blood.

© 2024 The Author(s). Journal of Inherited Metabolic Disease published by John Wiley & Sons Ltd on behalf of SSIEM.

Address: Hannover Medical School, Department of Paediatrics, Hannover, Germany.; Pediatric Metabolic Unit, Pediatrics, Woman-Mother-Child Department, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.; Medical Faculty, Center for Pediatric and Adolescent Medicine, Division of Pediatric Neurology and Metabolic Medicine, Heidelberg University, Heidelberg, Germany.; Division of Metabolism and Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland.; German Patients Association for PKU and Allied Metabolic Disorders, Deutsche Interessengemeinschaft Phenylketonurie und verwandte angeborene Stoffwechselstörungen (DIG PKU) e.V, Fürth, Germany.; Metabolic Screening Laboratory, Screening-Labor Hannover, Hannover, Germany.; Hannover Medical School, Department of Clinical Chemistry, Hannover, Germany.; Metabolic Screening Laboratory, Screening-Labor Hannover, Hannover, Germany.; Department of Paediatrics, Klinik für Kinder- und Jugendmedizin, Kreiskliniken Reutlingen, Reutlingen, Germany.; Clinic for Paediatrics, Division of Inherited Metabolic Disorders, Medical University of Innsbruck, Innsbruck, Austria.; Charité, University hospital, Berlin, Germany.; Department of Human Genetics, Hannover Medical School, Hannover, Germany.; Department of General Paediatrics, Adolescent Medicine and Neonatology, Faculty of Medicine, Medical Centre-University of Freiburg, Freiburg, Germany.; Clinic for Gastroenterology, Hepatology and Infectiology, University Clinic Düsseldorf, Düsseldorf, Germany.; Department of Paediatrics, Charité University hospital, Berlin, Germany.; Department of Paediatrics and Inherited Metabolic Disorders, General Faculty Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic.; Department of Medical Psychology, Hannover Medical School, Hannover, Germany.
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