Intracerebroventricular cerliponase alfa for CLN2 disease: Clinical practice considerations from US clinics

ABSTRACT Background Neuronal ceroid lipofuscinosis type 2 (CLN2) disease is a rare, autosomal recessive, neurodegenerative lysosomal storage disorder caused by tripeptidyl peptidase 1 (TPP1) deficiency. Cerliponase alfa, a recombinant human TPP1 enzyme, is the first and only approved treatment for CLN2 disease and the first approved enzyme replacement therapy administered via intracerebroventricular (ICV) infusion. Methods A meeting of healthcare professionals from US institutions with experience in cerliponase alfa treatment of children with CLN2 disease was held in November 2018. Key common practices were identified, and later refined during the drafting of this manuscript, that facilitate safe chronic administration of cerliponase alfa. Results Key practices include developing a multidisciplinary team of clinicians, pharmacists, and coordinators, and institution-specific processes. Infection risk may be reduced through strict aseptic techniques and minimizing connections and disconnections during infusion. The impact of ICV device design on port needle stability during extended ICV infusion is a critical consideration in device selection. Monitoring for central nervous system infection is performed at each patient contact, but with flexibility in the degree of monitoring. Although few institutions had experienced positive cerebrospinal fluid (CSF) test results, the response to a positive CSF culture should be determined on a case-by-case basis, and the ICV device should be removed if CSF infection is confirmed. Conclusions The key common practices and flexible practices used by institutions with cerliponase alfa experience may assist other institutions in process development. Continued sharing of experiences will be essential for developing standards and patient care guidelines.