Clinical Trial Update, Funding Cuts, Glow for Galactosemia and more

 Last November our galactosemia community held our breath while we waited for the FDA to make a decision about Govorestat, the clinical trial drug Francesca is on. An approval would mean we would have the first ever treatment for our community – not a cure, but a treatment. A step in the right direction. A denial would mean not only do we not have a treatment to offer our community, but all the kids (including Francesca) who are in the clinical trial, would have to discontinue the drug.

In the months leading up to the decision, all signs pointed to yes…or so we were told. I don’t know

what was happening behind the scenes but it’s safe to say many in our community were left feeling confused, heartbroken and betrayed. I’m not going to get into details because there are things I have no way of knowing, but it does feel like many things were mishandled and miscommunicated and now our community, our kids who have given literal years to do this drug trial, will suffer.

Instead of approving Govorestat, the FDA sent a Complete Response Letter (CRL) to Applied Therapeutics. A CRL is a formal letter issued from the FDA stating that the application under review cannot be approved in its current state. That letter, which is not public, explains the issues found and what could be done to address the issues before a resubmission. The letter called out issues with dosing errors, data integrity and protocol adherence. Without knowing specifics, it felt pretty serious, and raised a lot of questions and concerns as a parent with a child involved. A parent who was told with much certainty the drug was going to be approved. For Applied Therapeutics’ part, they acknowledged the issues and believed they had already been resolved in previous communication with the FDA, including providing the data in question.

During all this the CEO stepped down and new Applied Therapeutics leadership was introduced. There have been lawsuits introduced by shareholders and our community has heard very little other than, they are working to get a meeting with the FDA and find a path forward and are still very much committed to galactosemia and our community. For now, the clinical trial participants can stay on Govorestat, which should be a relief. Unfortunately, personally – we’ve ran into a bit of a snag. Clinical trial patients are being moved to the “Expanded Access Program” which allows patients to have access to the drug while it’s still being investigated. As part of the EAP, other individuals with galactosemia who were not part of the clinical trial can also start receiving the drug. At the end of last year, we started talking to the girls’ pediatrician about the program and if she would be willing to participate so Amelia could start the medicine. We had a few months of back and forth, paperwork, etc. but earlier this month we hit a roadblock. We received a personal call from their doctor (who we love and I support 100%) with news that took the wind out of me. Being part of a practice, her partners (and their lawyers) saw it as too much of a risk to sign on to the clinical study. By taking over the girls’ care and medical appointments and medicine distribution she would be named a Principal Investigator…for a company who has recently been named in several lawsuits. It’s a risk and one they are not willing to take and while it is heartbreaking for us, I do understand.

So, what does that mean for Francesca and Amelia? I’m not sure. We do know there are a couple

providers in Michigan who are seeing EAP patients so our clinical trial nurse is checking to see if any of them would take on Francesca and Amelia. This isn’t the best-case scenario – but it might be our only chance to keep Francesca on drug and allow Amelia to start it. And it would mean more travel for appointments, especially for Amelia who will have more appointments since she’ll be starting the drug for the first time. Of course, then I wonder, is it worth it? If the drug isn’t approved, they will eventually have to stop it any way. So would a bunch of doctor appointments, blood draws and hours of travel worth it? I really don’t know.

But what I do know is some families have seen significant improvement since starting the drug. There are kids who haven’t had seizures since starting, others have seen a decrease in tremors and still others have seen a significant improvement in comprehension and memory. And I would say that is where Francesca fits in. Has it been a miracle drug for her? No, but she wasn’t in a place with severe complications that we needed a miracle. But for others? This has absolutely been a miracle drug for the families who are no longer experiencing seizures, tremors and more. The thought of this medicine not being approved and having to stop it is devastating to think about.

As for Francesca, we have definitely seen an improvement in her reading and math. Do I think it’s all the drug’s doing? Maybe, maybe not. She is also on an IEP now and has some accommodations that have made a difference. And she’s receiving tutoring twice a week. Before the drug, Francesca was consistently bringing home 60% and below test scores. This year we see many more math tests coming home with 70-80%. She continues to try so hard and have such a good attitude. Her drive is more powerful than her struggles and I am so proud of her. And that does make me worry what will happen if she stops the drug, especially as we anticipate middle school next year. It’s going to be a whole new world for her. Faster paced, more homework and more demanding. How will she handle it on drug let alone without it? I can’t think about it for too long or I spiral and that does no one any good.

NIH Funding Cuts

As if this hasn’t been enough to navigate, we received another blow last month. The announcement of

NIH Grant funding cuts, specifically a cap on indirect costs. This is another situation I’m not going to pretend to know or understand the ins and outs. What I do know is our top galactosemia doctors and researchers reached out to the Galactosemia Foundation and asked us to send out messages to our community on their behalf. These doctors have labs on college universities. They have ongoing galactosemia research that could be impacted and even stopped if the NIH indirect costs get capped. This was a quote from the statement for the doctors/researchers:

“No system is perfect, and we all support the idea of improved efficiency, but the current proposed 15% cap and immediate time frame would be devastating for most US research universities and hospitals.

The situation is dire, and we fear not only for the future of galactosemia research in the US, but also for all other university-based biomedical research in the US, including studies to improve understanding and treatments for cancer, heart disease, autism, Alzheimer’s, and more.”

You can read the entire statement on the Galactosemia Foundation’s website.

What Now?

We have a drug that didn’t get approved, we have research that might be ended due to funding cuts, we don’t know if Francesca will be able to continue on drug or if Amelia will be able to start taking it.

So, what do we do now?

We do what we always do in times of waiting. In times of fear.  In times of “what if”.

We advocate. We educate. We fundraise. And we don’t give up.

Glow for Galactosemia

In about a month, we will be holding our annual Glow for Galactosemia fundraiser, where we’ll do all
three, we’ll advocate, we’ll educate and we’ll fundraise, with all proceeds benefiting the Galactosemia Foundation. The first year we held the event at our church and it was all about fundraising with our friends and family. Fast forward five years later and the event has turned into so much more than just fundraising, it’s a chance for families impacted by galactosemia to spend time together. What started with our family and one other family impacted by galactosemia, we now have 5-6 galactosemia families in attendance plus their family and friends. These families don’t just attend the event, but they have stepped up and help make it happen – from getting safe food donations, to bringing silent auction items to inviting their loved ones. I am so grateful for all of them and having a network of people so close in proximity so we don’t have to travel this journey alone.

If you haven’t seen the social posts or Facebook event information – here is your invitation! Please join us for Glow for Galactosemia!

When you sign up at Run Signup it will have the date of April 26 and a location of Roanoke, VA. You can disregard both of those things. Our event is a virtual component to the larger in-person race event. You will want to sign up for the Virtual event and join our team: MIGalactoGang.

Here are some helpful links:

Facebook event info: https://www.facebook.com/share/15wWQVoq9K/

Run Signup link: https://runsignup.com/RaceGroups/68674/Groups/1748212

If you can’t make the event, here are a couple other ways you can support the Galacto Girls:

·       You can still register for the event, receive an official event t-shirt and support from wherever you are by posting on social media to help with advocacy and awareness.

·       Donate an item for our silent auction – think sports memorabilia, event tickets, vacation home rental, theme baskets (sports, summer fun, movie night, etc.), paintings or other homemade items!

·       Make a donation – On the runsignup “Donate” page you can either select “Galacto Girls” under the Fundraiser tab or “MiGalactoGang” under the Team Fundraiser.

Why we fundraise

Whether you’re hearing this for the first time or have been inundated over the last 5 – 10 years by my donation requests for birthday fundraisers, rare disease day, zebra antics, Glow fundraisers and more, thank you for your support. I’m sure my requests feel like a lot. I know that because asking year after year for different events feels like a lot. But as I’ve said before, there’s not a lot I can control on this galactosemia road. I can’t control funding cuts that may stop research, I can’t stop the learning delays,

seizures and infertility that might impact my girls, I can’t control the FDA and make them approve a drug that has helped many of our community members. But I can advocate and share our story and why research and a treatment are necessary. I can educate others to help them understand what galactosemia is and how they can help keep our galacto girls safe and help them succeed. And I can fundraise to help support future research, education opportunities for our community and more.

As a reminder, the Galactosemia Foundation is a nonprofit and Galactosemia is a rare disease. We do not get government funding or grants. All the money that is raised is done from a volunteer board and members of our community. And as an organization, the Galactosemia Foundation funds around $150,000 of research every two years. Your donation could be supporting the next break through or treatment for galactosemia. Or when I allow myself to really dream and hope, your donation could fund a cure.

So, I know my requests can be a lot. But so is navigating the uncertainties of life with galactosemia. Thank you for coming along side us year after year, fundraiser after fundraiser. It does not go unnoticed. It keeps pushing me forward, it gives purpose to our journey and fills me with hope. I hope you’ll join us at Glow for Galactosemia 2025.

Hey FDA! Our galactosemia community is small but resilient (and loud) - and we deserve a treatment!

The day Francesca was diagnosed with galactosemia - a disease we had never heard of and could barely pronounce - we knew the possible long-term complications. But unlike many of our friends in the galactosemia community, the galacto girls were largely unaffected. No speech delays, no apraxia, no fine motor skill issues, tremors or seizures. Yet. But we knew the reality. They would likely somehow be impacted. We just didn't know when, or how severely. We would leave each specialist appointment with glowing reports of no concerns, but also with words of caution that many of the delays don't show up until elementary school age. That's when the math and reading challenges will be more noticeable. And then of course we heard the stories of Primary Ovarian Insufficiency (POI) that will likely make having families difficult, if not impossible for them. 

Still largely unaffected - when a clinical trial started for the first ever possible treatment of galactosemia

- we didn't immediately get involved. But when you're a rare disease - every participant makes a difference. So when they announced a clinical trial site was opening up 45 minutes away for us, we enrolled Francesca (actually we enrolled both galacto girls, but because of Amelia's small size and low BMI she wasn't eligible to participate.) So we enrolled in the clinical trial for what we thought would be a year - until Applied Therapeutics could provide data showing a reduction of galactitol in the study participants while proving the drug was safe. 

Read about the start of the clinical trial:

https://galactosemiagirl.blogspot.com/2021/07/the-galacto-girls-join-clinical-trial.html

https://galactosemiagirl.blogspot.com/2021/07/francesca-starts-clinical-trial.html

During the clinical trial there was a change in leadership in the rare disease division of the FDA. And with new leaders, come new rules. The accelerated approval option Applied Therapeutics was told they would likely have was taken off the table. Suddenly, showing the galactitol reduction wasn't enough. And our hopes of a treatment slowly started to fade. You see, getting a drug through a clinical trial and approved to market can take years. Ultimately you need to prove the drug is safe and it works. But that gets a lot more complicated when a rare disease is involved. First, you don't have a big candidate pool to recruit from for the trial, then some who want to participate aren't eligible (like in Amelia's case) and you add in having some of the study participants on placebo...it makes proving the drug works (by reaching statistical significance as determined by the FDA) extremely difficult. 

About a year ago, when what Applied Therapeutics would have to prove and deliver changed, the Galactosemia Foundation rallied our community, upped our advocacy game and made sure the FDA knew why we needed a treatment. We understood that while there wasn't yet enough data to show this medicine would work, we knew it was safe. And we knew it was reducing galactitol. And that was enough. We knew it was better for our kids to be receiving it, while data was gathered to prove that it worked, then wait until statistical significance was reached. So we wrote letters to the FDA, we contacted our legislatures via email and left voicemails. We got automated and short replies back from the FDA - we were told we had been heard. But that was it. And we saw no movement from it. 

Read my blog from last year about our advocacy efforts:
https://galactosemiagirl.blogspot.com/2022/02/the-clinical-trial-fda-congress-and.html

Earlier this week Applied Therapeutics announced its 18 month data. The evidence is compelling - there were notable gains made in the kids who were on drug - but it fell just short of being statistically significant. 

According to Applied Therapeutics data showed the Govorestat treatment improved life skills, behavior, cognition, fine motor skills, adaptive skills and tremor vs. placebo. The one place statistical significance was not seen (put had positive trending) was speech. While we don't know for sure, it could possibly be because speech therapy is an existing effective treatment and many kids are already receiving this treatment (including those on placebo). So when they combined all the data at the end (with three out of four criteria meeting the statistical significance.) The final number fell short and did not meet statistical significance. 

And while I understand the need to have a number to reach, something to measure success by - not everything is about the numbers. While the FDA might not have found the results statistically significant, ask the mom who has seen a reduction of tremors in her child since starting the clinical trial, ask the dad whose child can remember and comprehend things better, who is making friends easier and regulating better. Families are seeing positive changes since being in the clinical trial. And the thought of this drug not getting approved because it fell just short of the required statistical significance when families have real life evidence that it is working and is safe, is heartbreaking. Numbers are important. They aren't everything. And we need the FDA to know that the evidence is compelling and it matters and we need them to approve the drug as soon as possible. I'll make a quick side note here - the study hasn't been unblinded yet - so as I write this, we are assuming the families who are seeing improvements are on drug. As for us, I am about 99% sure Francesca is on a placebo, which is important to know for the next part.

And then there is our story. . Earlier this week, I sat in a room next to my husband and surrounded by a
group of educators trying to figure out how to best keep Francesca from falling even further behind in math and reading. We knew last year she was a little behind, but it was hard to know if it was a complication from her galactosemia or the result of the pandemic and the online school, etc. But this year she continued to fall behind her peers. Thankfully there was a tutoring opportunity available and she's been receiving reading and math tutoring two days a week for the last few month. And while we are seeing some improvement in reading - she isn't making progress in math. My standard joke of "she has two journalism major parents, she'll need a math tutor anyway" isn't funny anymore. She is struggling. And as I sat around the table with her principal, a psychologist, a social worker, her teacher and another support staff member I realized how lucky we are to be in a school district that is proactive and set up to help struggling kids. I have a feeling not everyone is that lucky. This wasn't a meeting I requested. Her teacher saw a struggling kid and did everything she could to make this meeting happen. She even said in the meeting that it is heartbreaking to see how hard Francesca tries. And always with a smile and a great attitude. But she's just not retaining the information. She's not making progress. And I heard the words from a fellow galacto mom in my head "Jodie, she needs to get on the drug...I feel like you would see big changes." And my eyes filled up with tears. I have a kid who is struggling and many resources to help her - but they aren't working. And there is a drug that is proving successful for many families. But it may not get approved because it didn't reach statistical significance in 1 area. 

So what's next? The study should be unblinded soon and if Francesca was on placebo we will be able to switch her to active drug. We will need to make a trip to Ann Arbor for this and then she'll have monitoring (blood draws) for a while after she starts. There are some known rare side effects so she will be monitored for the first few months to make sure she doesn't experience them. 

Applied Therapeutics will be requesting a meeting with the FDA in the next 30 days to discuss the results and why the drug should be approved. In the meantime, the Galactosemia Foundation is setting up a communications push to rally our community, family and friends to help us communicate the need for a drug and urge the FDA to carefully consider galactosemia patient and caregiver experiences during their review of this potential treatment. The numbers are compelling but the real life stories are more important. Every day our kids don't have a treatment is another day damage is being done to their bodies. We need the FDA to see it from our perspective. The data might not seem significant to them, but it has been life-changing to some of the families who are participating in the clinical trial. We need these kids to continue to receive this medicine. And we need it available to all those living with galactosemia. 

In the coming days and weeks the Galactosemia Foundation will be creating resources and putting them on our website to help our community, family and friends come alongside us in advocating for the approval of the medicine. I'll be posting on our Adventures of Galacto Girls Facebook page when these items are available with specific ways you can help. 

Here is the Galactosemia Foundation press release calling for the FDA to take the patient voice into account.

Here is an article our VP Brittany Cudzilo was part of talking about the challenges we're facing. 

The Clinical Trial, The FDA, Congress and an important revelation

I have been posting the last couple weeks on social media about the clinical trial, the FDA and congress. It probably seemed confusing and lacked background because there wasn't a lot of time to explain, I just needed to act. It was an exhausting couple of weeks between trying to advocate for my Galacto Girls while being down with COVID and navigating everything else in life. If I'm being honest, my mental health took a hit and it almost brought me to my knees at church this morning - but more about that later.

First - I'll give some background. Here is a Facebook post I made on Jan. 31.

Most of you know I was down with COVID last week - but I couldn’t be completely down because well, kids…but more importantly I had to fight for my rare disease kiddos and their chance at a possible treatment. So, between naps and headaches and coughing spells I recorded a plea for the FDA and shared my story. I wrote and sent off emails to individuals at the FDA and after returning to work spent my lunch hours emailing and leaving voicemails with my local legislators sharing our story and asking them to fight for us.

I’ve also been busy working with my amazing fellow Galactosemia Foundation board members to put out a press release with a statement and call to action from the foundation.

Ultimately, I don’t know if what we’ve done is enough. I don’t know if our stories will make a difference when they meet this week, but I know our small but mighty rare disease community showed up and did everything we could to be heard - and we will continue to fight. Our kids deserve nothing less. And here is my shameless plug to register for our Glow for Galactosemia event. This is how we raise funds. This is how we raise awareness about our ultra-rare disease. This is how we fight.

So, let me give some background to set the scene for all of this.

When Applied Therapeutics (AT) started the clinical trial that Francesca is enrolled in, they were working closely with the FDA to make sure it would be part of the accelerated approval program. This program is really our only shot at getting a medicine available for an ultra-rare disease like galactosemia. I'm sure I'm oversimplifying but in most cases, to get a drug approved by the FDA - not only do you need to prove it is safe but you also need to prove that it works. With a disease that impacts millions of people, it isn't hard to enroll candidates in the clinical trial and prove its effectiveness. But for a disease like galactosemia that only impacts 30,000-70,000... that is much harder to do. Not only do you not have a lot of people eligible for the clinical trial - but it will take much longer to reach statistical significance with data to prove that it works. So, the trial started with the understanding that the FDA would approve the drug once it was proved safe, based on biomarker data - or data that showed it was making the expected change for those who were on the drug in this study - in our case it is showing that galactitol (the thing they believe is responsible for many of the complications) is reduced. And Applied Therapeutics has proved that - those on the trial are experiencing a reduction of galactitol. But for reasons we don't quite understand, the FDA is now saying that isn't enough and AT would likely need to show long-term outcomes for it to be approved. Again, because we are a rare disease - because it is a small clinical trial - it will likely take years to prove that it is making a difference. No company is going to have the money or time to invest in such an effort. It was a miracle that a company even took notice of galactosemia in the first place and last week we watched the chance for a treatment start slipping away - without a good explanation of why.

Oh well, better luck next time, right? WRONG. Enter a group of amazing and determined mamas with a cause. Two weeks ago, we started a grassroots effort to rally support from the families involved in the clinical trial. We all wrote emails to the FDA - introducing our children, explaining what life with this disease looks like, imploring them not to give up on our rare disease. One of the mom's created a moving video from her story and included pictures of our kiddos. (You can watch it here: https://youtu.be/tAP1-kQmags).

Meanwhile, the Galactosemia Foundation was working on the issue from several different angles and with the help of many partners. But we knew the importance of parents reaching out with their personal stories. Then on Jan. 25, we found out that the Congress Health subcommittee was meeting with the FDA on Feb. 3, so our focus shifted. We went from contacting the FDA (who we knew had heard us at this point from returned phone calls and email replies), to contacting our local representatives, specifically those who are on rare disease caucus. We wanted to make sure when they met with the FDA on Thursday, they had heard the word "galactosemia" and our kids' stories. I don't even remember who I left voicemails with and who I sent emails to but I did reach out to my representative (Elissa Slotkin) and then to Congressman Upton, who I knew was going to be at the meeting. This was my email:

Dear Congressman Upton, I sent this email to Elissa Slotkin, as she is my representative, but wanted to share with you as well since I know you are part of the Rare Disease Caucus.
My name is Jodie Solari and I have two daughters with a rare disease called Galactosemia. This progressive disease can cause a host of complications including cataracts, cognitive challenges and learning disabilities, speech disorders, neurological/motor impairments, primary ovarian insufficiency and growth delay.

When my oldest daughter Francesca was born in 2012 the only treatment was a galactose free diet. But diet adherence doesn’t ensure a complication-free life. Francesca’s body creates galactose at a higher level than any food she could consume. And because she does not have the enzymes to break down the galactose her body creates, it acts as a poison to her, potentially causing damage to her eyes, brain, liver and reproductive organs.

In 2018 we started to learn about a possible clinical trial for a drug to treat Galactosemia. We were filled with hope. In the summer of 2021, Francesca joined the clinical trial. It was at the same time that we learned Applied Therapeutics was granted fast track designation by the FDA for AT-007. The understanding was because the drug will treat a serious condition and fulfill an unmet medical need, it would be fast tracked and likely receive accelerated approval based on the reduction of Galactitol. We cannot wait for outcomes to approve this drug. Every minute we wait, more damage is being done to our children.

We currently live in a constant state of unknowns. Will our girls have seizures? When will they start? What about the tremors? Will they be able to have children? How will the constant buildup of galactose in their blood impact them? Will their brain function diminish? When? How will they live on their own with this disease?

The only thing we knew for sure from the beginning…there was no possible treatment. Until now. Which is why my girls - and many others in our small but mighty community - need the accelerated approval of AT-007. The longer we wait, the more damage their little bodies will experience, damage that cannot be reversed.

It is my understanding the FDA could be making a decision soon about the drug. As a mom of these beautiful girls my voice only goes so far. I need the help of the Rare Disease Caucus; I need your help Congressman Upton. Please ask the FDA to pause on any communication and decision about this drug. Can you please help me implore the FDA to not turn their backs on Galactosemia, on our community and on Francesca and Amelia? Jan. 28 Dear Congressman Upton, Here is some additional information specific to my request for your help on behalf of my children with Galactosemia.

Next week the health committee will have a hearing on Reauthorization of the
Prescription Drug User Free Act – which means there could be changes made to FDA’s Accelerated Approval process.

As a mother with two children who have Galactosemia – a rare disease with no treatment, the FDA’s accelerated approval process is the only hope we have of getting a treatment approved and available to our children.

When my oldest daughter Francesca was born in 2012 the only treatment was a galactose free diet. But diet adherence doesn’t ensure a complication-free life. Francesca’s body creates galactose at a higher level than any food she could consume. And because she does not have the enzymes to break down the galactose her body creates, it acts as a poison to her, potentially causing damage to her eyes, brain, liver and reproductive organs.

In 2018 we started to learn about a possible clinical trial for a drug to treat Galactosemia.

We were filled with hope. In the summer of 2021, Francesca joined the clinical trial. It was at the same time that we learned Applied Therapeutics was granted fast track designation by the FDA for AT-007. The understanding was because the drug will treat a serious condition and fulfill an unmet medical need, it would be fast tracked and likely receive accelerated approval based on the reduction of Galactitol. We cannot wait for outcomes to approve this drug. Every minute we wait, more damage is being done to our children.

Although the Galactosemia program had previously been discussed as a candidate for accelerated approval based on reduction in galactitol, the FDA has now indicated that clinical outcomes data will likely be required for approval. While assessments are happening every six months in the clinical trial, reaching statistical significance and providing clinical outcome data could take years. Our kids don’t have years. The longer we wait, the more damage their little bodies will experience.

Our Galactosemia community – and many other rare disease communities – need the Accelerated Approval program to continue, and we need a treatment for Galactosemia to be part of the program.

Please keep us in mind next week when the health committee meets and considers changes to the FDA’s Accelerated Approval process.

Unfortunately, I didn't hear back from either representative and Congressman Upton did not bring it up at the meetings on Feb. 3, but Congressman Curtis from Utah did. He had moms across the U.S. cheering and in tears. Just hearing the words "galactosemia" and "AT-007" mentioned in Congress was a defining moment for us. As parents and advocates we can only do so much, but Congressman Curtis gave us a voice. It was such a moment of hope. There were other members who also brought up rare diseases in general and were helping us fight for our cause.

So now we wait. And we hope for the best. Which leads me to the revelation I had today at church. When we started the clinical trial, I was cautiously optimistic at best about the success of the drug, but I knew if it was safe, it was worth trying. But today at church I lost it. The tears of fear and frustration from the last couple weeks broke loose. And then I realized something. I cannot put so much hope into a drug or in any earthly cure or process. I can advocate for it and I can support it, but my joy and my happiness cannot be tied up in. Because human things fail and let us down and drugs don't always work. So, in the midst of this realization I laid it down before Jesus. I laid down my fears, my hopes, my children's futures, whether they include a treatment or a cure or a life of manageable challenges. I cannot control it so I cannot let the emotion of finding a treatment or cure consume me. That's not to say I'm giving up. I will continue to fight, I will continue to advocate but above all, I will continue to pray. I will let God's will and direction dictate my actions and not fear. I will remember God's got this. He's got my girls and their futures in the palm of His hand. And He doesn't make mistakes.

Francesca Starts the Clinical Trial

 Since I know we have followers on here and across other social media platforms, I wanted to share the updates I posted about the clinical trial on Facebook. It was a challenging week, but Francesca was a rock star and I am so, so proud of her. I am home for a couple days and then heading back Sunday night for the week, with Amelia. 

Clinical Trial Diaries - Day 1: Francesca was a rockstar. We left Williamston at 6:30 a.m. and she was not impressed - her exact words were “oh man, it’s not even morning time yet.” Things kicked off at 8 a.m.:

• vitals
• blood draw
• ecg
• neuro exam
• a feel and function test
• eye exam

It wasn’t all work. We had a great tour of the hospital and found a lot of great superheroes who are almost as amazing as our Galacto Girl! The only meltdown was when we got back to the hotel and she was so frustrated about not being able to see because of getting her eyes dilated. 

I am in awe of my girl. She was full of smiles all day, rolled with some unexpected bumps and is still smiling while we watch a movie before bed. Tomorrow will be another long day - including a 90 minute MRI. Please keep the prayers coming. I definitely felt them today! And we appreciate all the messages we received. Love you all. 

Clinical Trial Diaries - Day 2: Today started out promising and is ending okay but the middle was rough. Francesca rocked her speech and language assessment and was amazing for the MRI. She had to lay still for an hour - I don’t know a lot of adults who could do it, but she was great. We got back to the hotel around 2 and Francesca was so excited to go swimming. But she thought the water was super cold and that made her sad. I think she was mostly crying because she was frustrated with herself for being too cold but still wanting to swim. She just sat on the window ledge behind the curtains in our hotel room and sobbed. Then I got a call from the doctor. It turns out Francesca has a UTI - which they found from the urine analysis they did. She is not complaining and doesn’t have any symptoms. It’s a long, boring story but ultimately the plan is to still give her the first dose of the trial drug tomorrow but then also start her on an antibiotic. Then she won’t take the trial drug again until after she’s done with the antibiotics. It’s the best course of action to treat the infection but make sure she is officially enrolled in the trial. Soooo after that news she really wanted to try the pool again. And she did great! We’ll be heading back to the hospital at 6:30 tomorrow morning. She’ll have to fast for a few hours in the morning which will be tough and she’ll receive the first does of the medication. Then it will be a long day of getting labs every 2 hours, until around 8 p.m. tomorrow night. Thanks for the continued love and support of our #galactogirls. 

Clinical Trial Diaries - Day 3: It was a long and uneventful but emotional day. Francesca got her first dose of the medicine (or placebo) at 7:40 this morning. A few hours later she started her antibiotic for the UTI. By the afternoon she was just over it. We both were. We left the hospital at 8 p.m. and returned to the hotel to the most thoughtful gift. Sara Armstrong had dropped off a gift basket with balloons from her daughter (Francesca’s friend), Wesley. As a side note, one of the things I always dreaded/worried about was sending Francesca to birthday parties because of her dietary restrictions. The first friend birthday party I allowed her to go to was Wesley’s. I remember feeling bad/like an inconvenience when I talked to Sara - but she was amazing and I knew our girl was in good hands. I appreciate you, Sara! It quickly went from a terrible day to the best day ever. (It was also helped by opening her “brave bag” from Dawn and family.) Because she’s not getting any more trial medicine until she’s done with the antibiotic, tomorrow’s visit will be quick and we hope to be home by lunchtime! Chris will take her Tuesday to her pediatrician for a urine recheck and if everything looks good she should start receiving the trial drug later next week. I can’t believe our brave girl will be 7 tomorrow. I am so blessed to be her mama.

Clinical Trial Diaries - Day 4: It was a quick visit this morning with a blood draw and visit from the doctor. The only pic I took was after coming out of the bathroom to find her across the hall in the office with the doctor and Jackie, the coordinator who had been amazing to us this week! We were home by 9 a.m. and she received the best birthday surprise - a loft bed made by Uncle Andy! I am so proud of this kid. It was not an easy week, but she did it (most of it anyway) with a smile on her face. And she’s been telling Amelia about all the things she can expect next week. Happy Birthday to the OG #GalactoGirl.

The Galacto Girls Join the Clinical Trial

 

Well, things just got real. We’ve been planning on enrolling the girls in the first ever clinical trial for a potential drug treatment for galactosemia for a few months now. Last week, we thought they would be going in August – after we return from our annual vacation in the U.P. Then I got a voicemail on Saturday asking if I could call them back, it was urgent. The direction from the sponsor was if we wanted to be part of the trial, we needed to come in yet this month. So, as of now (but things with this trial change a lot and quickly) I will be taking Francesca to Ann Arbor next Monday and staying until Thursday. Then I will return the following Monday - Thursday with Amelia. And then we’ll go on our vacation. (Insert wild laughter and hyperventilating here.)

So – a little background on how we got here. A few years ago, we learned some really exciting news – there was a drug company interested in developing a treatment for galactosemia. As a rare disease this was huge; companies don’t take interest in rare diseases like galactosemia. We had no idea what the timeline would look like or what it would mean for our galacto girls, but we were hopeful. When the clinical trial started, I was excited but didn’t plan to enroll the girls for two reasons. First, they are thriving. They aren’t currently experiencing any delays, so I didn’t feel the urgent need to get them on the medicine. The clinical trial was also taking place exclusively in Atlanta and the initial stay lasted around 7 days. I just couldn’t see how we could make the logistics work…until a couple months ago. Earlier this summer, they announced additional testing sites were opening, including one in Ann Arbor, Michigan – less than an hour from where we live. And they were enrolling in Part B, which would only require a 2-3 day clinic stay for the initial visit.

I knew then that we had to do it, for a couple reasons. First, we are a rare disease community – if we want to show the FDA that there is a need to get this potential treatment fast tracked and available for our kids, we need to show up for the trial. Second, while my girls don’t have any known impacts now, research indicates that over time they will be impacted – their bodies will continue to create galactose, and without a way to break it down – it will act as a poison attacking their organs and causing issues that could result in tremors, seizures or a host of other issues. I need to fight for my kids to have the best chance at a healthy life, and that means getting them on a potential treatment, as soon as possible.

So, what is the point of the clinical trial? Applied Therapeutics believes many of the long-term complications are created by galactitol. Galactitol only exists in people with galactosemia and occurs when aldose reductase changes galactose into toxic galactitol. (Huh? It’s confusing, I know! Watch this video for a better explanation: https://youtu.be/U_uInPTBmLA.)  Anyway, the medication they are testing has been shown to lower the amount of galactitol in participants without raising the Gal-1-P (amount of galactose in the blood). Currently they are wrapping up Part A, which is determining the correct dose for each of the three age groups. (Ages are 2-6, 7-13 and 14-17).

As participants in part B, the girls will receive the medicine (or could be given the placebo…it’s a double-blind study so we won’t know what they get until the end of the trial) and go through extensive multiple-day testing (think MRI, EKG, blood work, speech and language, eye exam and neuro testing). After the initial clinic visit, a nurse will do home health visits at 30 days and 60 days. Then we will return to the clinic at 90 days. After that they will receive monthly blood draws (at home) and we will return every 6 months for 1-2 days of testing, until the end of the clinical trial.  

The galacto girls had their initial blood test to confirm their diagnosis and provide additional necessary medical information in early June. And we had been waiting for next steps…until I got the call over the weekend.

So, yes – I’m panicking. I honestly don’t know how I’m going to make it through the next few weeks. It’s a huge time commitment. It’s a sacrifice. It’s hard to watch the girls go through the anxiety of the blood draws. But it’s even harder to think about a future with no treatment, with no hope of mitigating the deficits they will most likely experience over time. It’s for a better future – for our galacto girls and all our friends with galactosemia.

And yet, nothing is promised. Will the medicine work? Will it really make a difference and reduce the long-term complications? I have no idea. But we are showing up for our small but mighty rare community. And if it doesn’t work – we’ll be ready for the next opportunity. Because my girls deserve to live the best possible life, even if it means long days, sleepless nights and discomfort for a short time. That is what I am going to keep telling myself – when I start to doubt that it’s worth it, when I want to quit, when the tears come (from both me and them, probably), when it seems like they can’t take another needle poke. It will be worth it. Maybe not today, maybe not in a year or even two– but eventually, if it helps with the complications, it will be worth it. And even if it doesn’t – we will know we did everything we could while we wait for a successful treatment.

So, if everything happens as currently planned, I’ll be taking Francesca on Monday, July 12 and staying until Thursday, July 15…which happens to be our sweet girl’s 7^th birthday. Not the best way to celebrate, but it is out of our control. Then I will return the following week with Amelia. Please keep us in your prayers over the next few weeks. I’m not sure how we’re going to do it, but we will. Because we can do hard things.