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migalastat

Phase 3

Fabry Disease | Small molecule | Metabolic |Amicus Therapeutics, Inc.|Last Updated: May 15, 2026

Success Probability
Approval Probability 71%
TA Base Rate26%
Adjusted LOA41%
ML RiskLOW_RISK
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Market & Valuation
rNPV $3.2B
Market Size $9.4B
Revenue Basis $1.6B
Competitors 6
Premium
Trial Design
RandomizedDouble-BlindCONTROLLEDDMCBiomarker
Total Trials13
Total Enrollment357
FDA Designations
No designations recorded
Clinical Trials (13)
NCT IDTitlePhaseStatusEnrollmentVelocityDesignStartCompletionLast UpdatedSitesCountries
NCT06904261A Study of Migalastat in Pediatric Subjects (2 to <12 Yrs) With Fabry Disease and Amenable GLA VariantsPHASE3 RECRUITING 8Jan 8, 2026Dec 1, 2028May 15, 202611 United States, Belgium +3
NCT04020055A Study to Evaluate Migalastat in Fabry Subjects With Amenable GLA Variant and Renal DiseasePHASE3 ACTIVE NOT_RECRUITING 14Oct 31, 2022Dec 31, 2026Apr 3, 202612 United States, Australia +4
NCT04049760Safety, Pharmacodynamics, and Efficacy of Migalastat in Pediatric Subjects (Aged >12 Years) With Fabry DiseasePHASE3 COMPLETED 16Oct 11, 2019Nov 29, 2024Feb 5, 20266 United States, United Kingdom
NCT03500094Safety, Pharmacokinetics, Pharmacodynamics, and Efficacy of Migalastat in Pediatric Subjects (Aged 12 to <18 Years)PHASE3 COMPLETED 22Sep 27, 2018Feb 6, 2021Nov 30, 20218 United States, United Kingdom
NCT02194985Open-Label Extension Study of the Long-Term Effects of Migalastat HCL in Patients With Fabry DiseasePHASE3 COMPLETED 84Mar 14, 2015Oct 23, 2019Dec 21, 202028 United States, Argentina +13
NCT01218659Study to Compare the Efficacy and Safety of Oral AT1001 and Enzyme Replacement Therapy in Patients With Fabry DiseasePHASE3 COMPLETED 68Sep 8, 2011May 28, 2015Nov 1, 201825 United States, Australia +8
NCT00925301Study of the Effects of Oral AT1001 (Migalastat Hydrochloride) in Patients With Fabry DiseasePHASE3 COMPLETED 67Oct 23, 2009Jan 29, 2014Oct 30, 201828 United States, Argentina +11
NCT01196871Drug-Drug Interaction Study Between AT1001 (Migalastat Hydrochloride) and Agalsidase in Participants With Fabry DiseasePHASE2 COMPLETED 20Feb 2, 2011Oct 9, 2012Dec 19, 201810 United States, Australia +3
NCT00304512A 12-Week Safety and Pharmacodynamic Study of AT1001 (Migalastat Hydrochloride) in Female Participants With Fabry DiseasePHASE2 COMPLETED 9Sep 7, 2006May 9, 2008Oct 3, 20186 United States, Australia +4
NCT00283959A 12-Week Safety and Pharmacodynamic Study of AT1001 (Migalastat Hydrochloride) in Participants With Fabry DiseasePHASE2 COMPLETED 4Jun 27, 2006May 8, 2008Oct 31, 20182 Australia, Brazil
NCT00283933A 24-Week Safety and Pharmacodynamic Study of AT1001 (Migalastat Hydrochloride) in Participants With Fabry DiseasePHASE2 COMPLETED 5May 9, 2006Mar 12, 2008Sep 7, 20182 France, United Kingdom
NCT00214500A Study of AT1001 (Migalastat Hydrochloride) in Participants With Fabry DiseasePHASE2 COMPLETED 9Jan 2, 2006Jan 29, 2008Oct 30, 20185 United States
NCT02082327A Phase 1 Study To Evaluate the Safety of Migalastat Hydrochloride Given Intravenously to Healthy VolunteersPHASE1 COMPLETED 31Mar 1, 2014Jun 1, 2014Jun 18, 20141 Netherlands
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Study Endpoints
Primary Endpoints
Safety: Incidence of TEAEs, SAEs, and AEs leading to discontinuation of study drug
Day 1 (after dosing) through Month 12 and follow-up (30 days after last dose)
Pharmacokinetics (PK): Maximum Observed Plasma Concentration (Cmax) of Migalastat
0 to 12 hours postdose during the first month of study and trough samples at Months 6 and 12
Pharmacokinetics (PK): Minimum Observed Plasma Concentration (Cmin) of Migalastat
0 to 12 hours postdose during the first month of study and trough samples at Months 6 and 12
Pharmacokinetics (PK): Area Under The Plasma Concentration-time Curve Over The Dosing Interval (AUCtau) of Migalastat
0 to 12 hours postdose during the first month of study and trough samples at Months 6 and 12
Maximum observed concentration (Cmax)
Baseline through Month 12

To characterize the pharmacokinetics (PK) of migalastat and validate the population PK (popPK) model and simulations.

Time to maximum concentration (tmax)
Baseline through Month 12

To characterize the pharmacokinetics (PK) of migalastat and validate the population PK (popPK) model and simulations.

Apparent terminal elimination half-life (t½)
Baseline through Month 12

To characterize the pharmacokinetics (PK) of migalastat and validate the population PK

Concentration at the end of a dosing interval at steady state (Ctrough)
Baseline through Month 12

To characterize the pharmacokinetics (PK) of migalastat and validate the population PK (popPK) model and simulations.

Average plasma migalastat concentration over the dosing interval (Cavg)
Baseline through Month 12

To characterize the pharmacokinetics (PK) of migalastat and validate the population PK (popPK) model and simulations.

Area under the concentration-time curve at steady state during the dosing interval (AUC0-τ)
Baseline through Month 12

To characterize the pharmacokinetics (PK) of migalastat and validate the population PK (popPK) model and simulations.

Area under the concentration-time curve from zero time (pre-dose) extrapolated to infinite time (AUC0-∞)
Baseline through Month 12

To characterize the pharmacokinetics (PK) of migalastat and validate the population PK (popPK) model and simulations.

Apparent plasma clearance (CL/F)
Baseline through Month 12

To characterize the pharmacokinetics (PK) of migalastat and validate the population PK

Apparent terminal phase volume of distribution (Vz/F)
Baseline through Month 12

To characterize the pharmacokinetics (PK) of migalastat and validate the population PK (popPK) model and simulations.

Dialysis clearance (CLD)
Baseline through Month 12

To characterize the pharmacokinetics (PK) of migalastat and validate the population PK (popPK) model and simulations.

Volume of dialysate collected during the interval (VD)
Baseline through Month 12

To characterize the pharmacokinetics (PK) of migalastat and validate the population PK (popPK) model and simulations.

Mean migalastat concentration in dialysate (CD)
Baseline through Month 12

To characterize the pharmacokinetics (PK) of migalastat and validate the population PK (popPK) model and simulations.

Amount recovered in dialysate (AeD)
Baseline through Month 12

To characterize the pharmacokinetics (PK) of migalastat and validate the population PK (popPK) model and simulations.

Fraction of the dose recovered in dialysate (FeD)
Baseline through Month 12

To characterize the pharmacokinetics (PK) of migalastat and validate the population PK (popPK) model and simulations.

Mean migalastat plasma concentration during the dialysis interval (P)
Baseline through Month 12

To characterize the pharmacokinetics (PK) of migalastat and validate the population PK (popPK) model and simulations.

Mean inlet area under the curve (AUCinlet)
Baseline through Month 12

To characterize the pharmacokinetics (PK) of migalastat and validate the population PK (popPK) model and simulations.

Mean outlet area under the curve (AUCoutlet)
Baseline through Month 12

To characterize the pharmacokinetics (PK) of migalastat and validate the population PK (popPK) model and simulations.

Extraction ratio (ED)
Baseline through Month 12

To characterize the pharmacokinetics (PK) of migalastat and validate the population PK (popPK) model and simulations.

Dialyzer blood flow (QD)
Baseline through Month 12

To characterize the pharmacokinetics (PK) of migalastat and validate the population PK (popPK) model and simulations.

Cumulative amount excreted over all collection intervals (Ae0-τ)
Baseline through Month 12

To characterize the pharmacokinetics (PK) of migalastat and validate the population PK (popPK) model and simulations.

Fraction of the dose recovered after the last measurable time point postdose (Fe0-τ)
Baseline through Month 12

To characterize the pharmacokinetics (PK) of migalastat and validate the population PK (popPK) model and simulations.

Renal clearance (CLr)
Baseline through Month 12

To characterize the pharmacokinetics (PK) of migalastat and validate the population PK (popPK) model and simulations.

Incidence of Treatment-emergent Adverse Events (TEAEs), Serious Adverse Events (SAEs), and AEs (Adverse Events) Leading to Discontinuation of Study Drug
Entire study

Number of subjects with TEAE, SAE, and AE leading to discontinuation during the study period

Number Of Participants Who Experienced Treatment-related Treatment-emergent Adverse Events (TEAEs)
Day 1 (after dosing) through Month 12 and follow-up (30 days after last dose)

TEAEs included adverse events that began on or after the first dose of study drug until 30 days after the last dose. Treatment-related TEAEs were defined as TEAEs that had an investigator-defined relationship to study drug of "Definite," "Probable," or "Possible." A summary of serious and all other non-serious adverse events, regardless of causality, is located in the Reported Adverse Events module.

PK: Maximum Observed Plasma Concentration (Cmax) Of Migalastat
0 to 12 hours postdose during the first month of study and trough samples at Months 6 and 12

PK sampling was performed on 1 occasion at steady-state during the first month of the study. Adolescent participants were randomized to 3 sparse PK sampling groups based on optimal sampling theory. Each blood sample could have been taken at any time within the following time point ranges. Time point ranges for all 3 sparse sampling groups are arranged here in chronological order: 1 to 1.25h, 1.5 to 2h, 2.75 to 3.25h, 3.25 to 3.75h, 3.75 to 4.25h, 5 to 5.5h, 5.25 to 5.75h, 6.5 to 7h, 8.25 to 8.75h, 8.75 to 9.25h, and 10.75 to 11.25h post-dose. The combined sampling scheme resulted in rich data over an approximate 12-hour time course for AUC and Cmax estimation. Additional trough samples were taken at Months 6 and 12. These trough samples (48h) assisted in estimating the terminal elimination phase for the AUC. Simulations were conducted to predict steady-state PK profiles and parameters for adolescent age subgroups 12 to \<16 years, 16 to \<18 years, and overall, 12 to \<18 years.

Number Of Participants Experiencing Adverse Events (AEs)
Day 1 after first dose to approximately 30 days after last treatment, median duration of 3.1 years

An AE was defined as any untoward medical occurrence in a participant administered migalastat that did not necessarily have a causal relationship with the treatment. Each AE was recorded at time of reporting; visits typically occurred every 6 months. Serious AEs were life threatening or resulted in death, resulted in disability/incapacity, hospitalization or prolonged hospitalization, or a congenital anomaly. The criteria for AE severity were: Mild: awareness of sign or symptom, does not interfere with normal everyday activities; Moderate: discomforting, interferes with normal everyday activities, but able to function; Severe: incapacitating, prevents normal everyday activities or significantly affects clinical status and requires medical intervention. A summary of serious and all other non-serious AEs regardless of causality is located in the Reported Adverse Events module.

Annualized Rate Of Change From Baseline To Month 18 In Measured Glomerular Filtration Rate
Baseline to Month 18

To assess renal function, measured glomerular filtration rate (GFR) was measured by the plasma clearance of unlabeled iohexol (mGFR-iohexol), a non-ionic contrast agent. The annualized rate of change in mGFR-iohexol from Baseline to Month 18 was analyzed using an analysis of covariance (ANCOVA) model with the following factors as covariates: treatment group, sex, age, Baseline GFR (mGFR-iohexol), and Baseline 24-hour (hr) urine protein. A threshold of \<2.2 milliliter (mL)/minute (min)/1.73 meter squared (m\^2)/year was established to compare migalastat to ERT. This difference of 2.2 mL/min/1.73 m2/year is based on the smallest expected rate of decline in estimated glomerular filtration rate (eGFR) for participants treated with agalsidase alfa for 18 months.

Annualized Rate Of Change From Baseline To Month 18 In eGFR
Baseline to Month 18

The eGFR assessed by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation was calculated using the following: eGFR-CKD-EPI = 141 x min (Serum Creatinine/κ,1)\^(α) x max(Serum Creatinine/κ,1)\^(-1.209) x 0.993\^(Age) x 1.1018 (if female) x 1.159 (if African American or black) where: κ is 0.7 for females and 0.9 for males; α is -0.329 for females and -0.411 for males; min indicates the minimum of Serum Creatinine/κ or 1; max indicates the maximum of Serum Creatinine/κ or 1. The annualized rate of change in eGFR-CKD-EPI from Baseline to Month 18 was analyzed using an ANCOVA model with the following factors as covariates: treatment group, sex, age, Baseline GFR (eGFR-CKD-EPI), and Baseline 24-hr urine protein. A threshold of \<2.2 mL/min/1.73m\^2/year was established to compare migalastat to ERT. This difference of 2.2 mL/min/1.73 m2/year is based on the smallest expected rate of decline in eGFR for participants treated with agalsidase alfa for 18 months.

Percentage Of Participants With At Least A 50% Reduction From Baseline To Month 6 In The Average Number Of Kidney Interstitial Capillary (IC) Globotriaosylceramide (GL-3) Inclusions
Baseline, Month 6

Renal biopsies were taken at Baseline and Month 6 (Stage 1). The specimens were evaluated using virtual microscopy. The annotation, scoring, and adjudication of the kidney histology assessments were performed by the Clinical Pathology Endpoints Committee. The number of kidney IC GL-3 inclusions was assessed by 3 renal pathologists who were blinded to treatment assignments, participants' data, and biopsy sequence. One pathologist served as annotator and identified the 300 capillaries on up to 8 slides per specimen to be scored. Two pathologists served as scorers; these pathologists completed the blinded paired assessments. Each pathologist served as annotator/adjudicator for 1/3 of the cases. Paired assessments were undertaken at Baseline and Month 6. Assessments were made using digital images. A responder was defined as a participant with a ≥50% reduction from Baseline to Month 6 in the average number of kidney IC GL-3 inclusions.

Change In Area Under The Plasma Concentration Versus Time Curve (AUC) For Active α-Galactosidase A (α-Gal A) Levels After Administration Of Migalastat
0 hr, 2 hr, 2 days, 7 days, 14 days post dose

This measure characterized the effects of migalastat on the plasma PK of agalsidase by measurement of the active α-Gal A enzyme level in plasma using a qualified assay that measured the rate of enzyme activity using an artificial, fluorescent substrate. The agalsidase plasma PK parameter values for AUC extrapolated from time 0 to infinity (AUCinfinity) and AUC to the last time point at which concentration is quantified (AUC0-t) are reported in hr\*\[nanomoles/hr/milliliter\] (hr\*\[nmol/hr/mL\]). In Period 1 of Stages 1 and 2, blood samples were collected: immediately before the agalsidase infusion and over a 24-hr period after infusion; on Days 2, 7, and 14. In Period 2 of Stages 1 and 2, blood samples were collected: prior to dosing with migalastat (2 hr prior to the agalsidase infusion) and 1 hr after migalastat dosing; immediately before initiation of the agalsidase infusion and over a 24-hr period after initiation of the agalsidase infusion; on Days 2, 7, and 14.

Change In Maximum Observed Plasma Concentration (Cmax) For Active α-Gal A Levels After Administration Of Migalastat
0 hr, 2 hr, 2 days, 7 days, 14 days post dose

This measure characterized the effects of migalastat on the plasma PK of agalsidase by measurement of the active α-Gal A enzyme level in plasma using a qualified assay that measured the rate of enzyme activity using an artificial, fluorescent substrate. The agalsidase plasma PK parameter value for Cmax is reported in nmol/hr/mL. In Period 1 of Stages 1 and 2, blood samples were collected: immediately before the agalsidase infusion and over a 24-hr period after infusion; on Days 2, 7, and 14. In Period 2 of Stages 1 and 2, blood samples were collected: prior to dosing with migalastat (2 hr prior to the agalsidase infusion) and 1 hr after migalastat dosing; immediately before initiation of the agalsidase infusion and over a 24-hr period after initiation of the agalsidase infusion; on Days 2, 7, and 14.

Change In Time To Maximum Observed Plasma Concentration (Tmax) And Terminal Elimination Half-life (T1/2) For Active α-Gal A Levels After Administration Of Migalastat
0 hr, 2 hr, 2 days, 7 days, 14 days post dose

This measure characterized the effects of migalastat on the plasma PK of agalsidase by measurement of the active α-Gal A enzyme level in plasma using a qualified assay that measured the rate of enzyme activity using an artificial, fluorescent substrate. The agalsidase plasma PK parameter values for tmax and t1/2 are reported in hr. In Period 1 of Stages 1 and 2, blood samples were collected: immediately before the agalsidase infusion and over a 24-hr period after infusion; on Days 2, 7, and 14. In Period 2 of Stages 1 and 2, blood samples were collected: prior to dosing with migalastat (2 hr prior to the agalsidase infusion) and 1 hr after migalastat dosing; immediately before initiation of the agalsidase infusion and over a 24-hr period after initiation of the agalsidase infusion; on Days 2, 7, and 14.

Change In AUC For Total α-Gal A Protein Levels After Administration Of Migalastat
0 hr, 2 hr, 2 days, 7 days, 14 days post dose

This measure characterized the effects of migalastat on the plasma PK of agalsidase by measurement of the α-Gal A protein level in plasma by Western blot using anti-human Gal A antibody. The agalsidase plasma PK parameter value for AUC0-t is reported in hr\*\[nanogram (ng)/hr/mL\]. In Period 1 of Stages 1 and 2, blood samples were collected: immediately before the agalsidase infusion and over a 24-hr period after infusion; on Days 2, 7, and 14. In Period 2 of Stages 1 and 2, blood samples were collected: prior to dosing with migalastat (2 hr prior to the agalsidase infusion) and 1 hr after migalastat dosing; immediately before initiation of the agalsidase infusion and over a 24-hr period after initiation of the agalsidase infusion; on Days 2, 7, and 14.

Change In Percentage Of AUCinfinity Extrapolated From The Last Time Point At Which Concentration Is Quantified To Infinity (AUCextrapolated %) For Total α-Gal A Protein Levels After Administration Of Migalastat
0 hr, 2 hr, 2 days, 7 days, 14 days post dose

This measure characterized the effects of migalastat on the plasma PK of agalsidase by measurement of the α-Gal A protein level by Western blot using anti-human Gal A antibody. The agalsidase plasma PK parameter values for AUCextrapolated % are reported. AUCextrapolated % is reported instead of AUCinfinity because small but quantifiable concentrations of α-Gal A protein past 24 hr post-dose extrapolated to infinity comprised \>50% of total AUC in most participants and were unevaluable. In Period 1 of Stages 1 and 2, blood samples were collected: immediately before the agalsidase infusion and over a 24-hr period after infusion; on Days 2, 7, and 14. In Period 2 of Stages 1 and 2, blood samples were collected: prior to dosing with migalastat (2 hr prior to the agalsidase infusion) and 1 hour after migalastat dosing; immediately before initiation of the agalsidase infusion and over a 24-hr period after initiation of the agalsidase infusion; on Days 2, 7, and 14.

Change In Cmax For Total α-Gal A Protein Levels After Administration Of Migalastat
0 hr, 2 hr, 2 days, 7 days, 14 days post dose

This measure characterized the effects of migalastat on the plasma PK of agalsidase by measurement of the α-Gal A protein level in plasma by Western blot using anti-human Gal A antibody. The agalsidase plasma PK parameter values for Cmax is reported in nmol/hr/mL. In Period 1 of Stages 1 and 2, blood samples were collected: immediately before the agalsidase infusion and over a 24-hr period after infusion; on Days 2, 7, and 14. In Period 2 of Stages 1 and 2, blood samples were collected: prior to dosing with migalastat (2 hr prior to the agalsidase infusion) and 1 hr after migalastat dosing; immediately before initiation of the agalsidase infusion and over a 24-hr period after initiation of the agalsidase infusion; on Days 2, 7, and 14.

Change In Tmax And T1/2 For Total α-Gal A Protein Levels After Administration Of Migalastat
0 hr, 2 hr, 2 days, 7 days, 14 days post dose

This measure characterized the effects of migalastat on the plasma PK of agalsidase by measurement of the total α-Gal A protein level in plasma by Western blot using anti-human Gal A antibody. The agalsidase plasma PK parameter values for tmax and t1/2 are reported in hr. In Period 1 of Stages 1 and 2, blood samples were collected: immediately before the agalsidase infusion and over a 24-hr period after infusion; on Days 2, 7, and 14. In Period 2 of Stages 1 and 2, blood samples were collected: prior to dosing with migalastat (2 hr prior to the agalsidase infusion) and 1 hr after migalastat dosing; immediately before initiation of the agalsidase infusion and over a 24-hr period after initiation of the agalsidase infusion; on Days 2, 7, and 14.

Change In AUC For Migalastat After Administration Of Agalsidase
0 hr, 1 day post dose

This measure characterized the effects of agalsidase on the plasma PK of migalastat using a validated liquid chromatography-tandem mass spectrometry (LC-MS) assay. The migalastat plasma PK parameter values for AUCinfinity and AUC0-t are reported in hr\*\[ng/hr/mL\]. In Period 2 of Stages 1 and 2, blood samples were collected: just before dosing with migalastat (2 hr prior to the agalsidase infusion) and at 1 hr after migalastat dosing; immediately before the agalsidase infusion and over a 24-hr period after infusion. In Period 3 (Stage 1 only), blood samples were collected before dosing and over the 24-hr period after administration of migalastat.

Change In Cmax For Migalastat After Administration Of Agalsidase
0 hr, 1 day post dose

This measure characterized the effects of agalsidase on the plasma PK of migalastat using a validated liquid LC-MS assay. The migalastat plasma PK parameter values for Cmax are reported in nmol/hr/mL. In Period 2 of Stages 1 and 2, blood samples were collected: just before dosing with migalastat (2 hr prior to the agalsidase infusion) and at 1 hr after migalastat dosing; immediately before the agalsidase infusion and over a 24-hr period after infusion. In Period 3 (Stage 1 only), blood samples were collected before dosing and over the 24-hr period after administration of migalastat.

Change In Tmax And T1/2 For Migalastat After Administration Of Agalsidase
0 hr, 1 day post dose

This measure characterized the effects of agalsidase on the plasma PK of migalastat using a validated LC-MS assay. The migalastat plasma PK parameter values for tmax and t1/2 are reported in hr. In Period 2 of Stages 1 and 2, blood samples were collected: just before dosing with migalastat (2 hr prior to the agalsidase infusion) and at 1 hr after migalastat dosing; immediately before the agalsidase infusion and over a 24-hr period after infusion. In Period 3 (Stage 1 only), blood samples were collected before dosing and over the 24-hr period after administration of migalastat.

Number Of Participants Who Experienced Severe Treatment-emergent Adverse Events (TEAEs)
Day 1 (after dosing) through Week 48

TEAEs were defined as any adverse event with start date on or after administration of study drug or pre-existing conditions that worsened on or after the start of the first study drug administration (on Day 1). A severe adverse event was defined as an adverse event that was incapacitating and required medical intervention. The number of participants who experienced one or more severe TEAEs after dosing on Day 1 through Week 48 is presented. A summary of serious and all other non-serious adverse events regardless of causality is located in the Reported Adverse Events module.

Plasma pharmacokinetics of migalastat
Pre-dose, 0.25, 0.5, 1, 1.5, 2.0, 2.5, 3, 4, 6, 8, 10, 12, 16, 24, 48

To investigate the effect on the body of migalastat following a single 2 hour IV infusion in healthy subjects.

Safety and tolerability of migalastat
48 hours

Adverse events, clinical laboratory test values, vital signs, ECG, physical examinations

Secondary Endpoints
Pharmacodynamic: Change in plasma levels of lyso-Gb3 and its analogs from baseline
Baseline to Months 3, 6, and 12/ET
Efficacy: Change in eGFR from baseline
Baseline to Months 1, 3, 6, and 12/ET
Efficacy: Change in urine protein and albumin/microalbumin levels from baseline
Baseline to Months 3, 6, and 12/ET
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Study Design & Arms
AllocationNA
MaskingNONE
ModelSINGLE_GROUP
PurposeTREATMENT
Treatment Arms
ArmTypeDescription
Migalastat HCl 20 mg Dispersible TabletsEXPERIMENTALMigalastat will be administered every other day (QOD). The initial dose will be based on body weight at baseline.
Cohort 1: Severe Renal ImpairmentEXPERIMENTALAll subjects will receive migalastat 123 mg, equivalent to 150 mg migalastat HCl (hereafter, migalastat) at a dose regimen based on their eGFRMDRD result at Visit 1. Subjects will take 1 migalastat capsule orally with water either every 4 or 7 days.
Cohort 2: End-Stage Renal DiseaseEXPERIMENTALAll hemodialysis subjects will receive migalastat 123 mg, equivalent to 150 mg migalastat HCl (hereafter, migalastat). Subjects will take 1 migalastat capsule orally with water every other week.
migalastat HCl 150 mgEXPERIMENTALOne migalastat 123 mg capsule equivalent to 150 mg migalastat HCl will be administered every other day (QOD) during the treatment period.
MigalastatEXPERIMENTALParticipants received 150 mg migalastat orally QOD during the 18-month randomized treatment period and the optional 12-month OLE period. Participants received an inactive reminder capsule on alternate days during both treatment periods.
ERTACTIVE_COMPARATORParticipants received ERT (either agalsidase alfa or agalsidase beta) as prescribed by the participant's treating physician and administered in accordance with the approved prescribing information during the 18-month randomized treatment period. Participants were required to be given \>80% of the currently labeled dose and regimen during the 18-month randomized treatment period. During the optional 12-month OLE period, participants received 150 mg migalastat orally QOD. Participants received an inactive reminder capsule on alternate days during the OLE.
PlaceboPLACEBO_COMPARATORPlacebo capsule taken orally QOD for 6 months.
Agalsidase Beta (0.5 mg/kg)-Migalastat (150 mg)EXPERIMENTAL -
Agalsidase Beta (1.0 mg/kg)-Migalastat (150 mg)EXPERIMENTAL -
Agalsidase Alfa (0.2 mg/kg)-Migalastat (150 mg)EXPERIMENTAL -
Agalsidase Beta (0.5 mg/kg)-Migalastat (450 mg)EXPERIMENTAL -
Agalsidase Beta (1.0 mg/kg)-Migalastat (450 mg)EXPERIMENTAL -
Agalsidase Alfa (0.2 mg/kg)-Migalastat (450 mg)EXPERIMENTAL -
Migalastat Low Dose 50 mgEXPERIMENTALMigalastat 50 mg was administered orally QOD during the 12-week treatment period and then during the optional 36-week treatment extension period.
Migalastat Middle Dose 150 mgEXPERIMENTALMigalastat 150 mg was administered orally QOD during the 12-week treatment period and then during the optional 36-week treatment extension period.
Migalastat High Dose 250 mgEXPERIMENTALMigalastat 250 mg was administered orally QOD during the 12-week treatment period and then during the optional 36-week treatment extension period.
0.3 mg/kgEXPERIMENTALIV infusion of migalastat HCl or placebo
1 mg/kgEXPERIMENTALIV infusion of migalastat HCl or placebo
10 mg/kgEXPERIMENTALIV infusion of migalastat HCl or placebo
150 mg IVEXPERIMENTAL150 mg single IV infusion
150 mg oralEXPERIMENTAL150 mg single oral dose
Interventions
NameTypeDescription
Migalastat HCl 20 mgDRUGMigalastat will be supplied as 20-mg dispersible tablets. Migalastat 20-mg dispersible tablets contain 16 mg migalastat free base.
migalastat HCl 150 mgDRUGmigalastat HCl 150 mg capsule
migalastat hydrochlorideDRUG150-mg capsule administered orally QOD
agalsidaseBIOLOGICALAgalsidase via intravenous infusion as prescribed by the participant's treating physician and in accordance with the approved prescribing information
PlaceboDRUGOral capsule QOD
Migalastat HClDRUGOral capsules, single dose
Agalsidase BetaBIOLOGICALIV infusion, single dose
Agalsidase AlfaBIOLOGICALIV infusion, single dose
IV migalastat HClDRUG -
IV placeboDRUG -
oral migalastat HClDRUG -
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Eligibility Criteria
Age Range2 Years — 11 Years
SexALL
Healthy VolunteersNo
Study Sites11

Inclusion Criteria * Male or female subjects, diagnosed with Fabry disease who are between ages 2 and \< 12 years at randomization (subjects aged 11 years must have birthdays \> 30 days after randomization) * Subject's parent or legally authorized representative is willing and able to provide writt...

Countries:United StatesBelgiumGermanySpainUnited KingdomAustraliaJapanPortugalArgentinaAustriaBrazilCanadaDenmarkEgyptFranceItalyTurkey (Türkiye)PolandNetherlands
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Recent Changes (Last 90 Days)
LOWMay 26, 2026NCT06904261primaryCompletionDate: changed
LOWMay 26, 2026NCT04020055primaryCompletionDate: changed
LOWMay 24, 2026NCT06904261studyFirstPostDate: changed
LOWMay 24, 2026NCT04020055studyFirstPostDate: changed