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Author Notes:


Dawn A. Laney, Dominique P. Germain and Joao Paulo Oliveira contributed equally to this work.

All persons who meet authorship criteria are listed as authors, and all authors certify that they have participated sufficiently in the work to take public responsibility for the content, including participation in the concept, design, research, writing or revision of the manuscript. Conception and design of manuscript were done by D.A.L., D.P.G., R.J.H., A.O., J.P.O. and J.M.P. Research, provision of data, drafting and revision of manuscript were carried out by A.P.B., G.H.C., G-R..H., D.A.L., D.P.G., R.J.H., D.-M.N., A.O., J.P.O., J.M.P., H.T., M.T. and W.R.W. All authors approved the version of the manuscript to be published.

The authors would like to recognize our patients living with FD, who challenge us daily to better understand the impact of the disease on their lives.

See publication for list of disclosures.


Research Funding:

A.O. research is supported by FIS/FEDER funds [PI19/00815, DTS18/00032, ERA-PerMed-JTC2018 (KIDNEY ATTACK AC18/00064 and PERSTIGAN AC18/00071), ISCIII-RETIC REDinREN RD016/0009], Sociedad Española de Nefrología, FRIAT, Comunidad de Madrid en Biomedicina B2017/BMD-3686 CIFRA2-CM. D.P.G. is supported by the French ‘Plan National Maladies Rares’.


  • Science & Technology
  • Life Sciences & Biomedicine
  • Urology & Nephrology
  • chloroquine
  • COVID-19
  • enzyme replacement therapy
  • Fabry disease
  • lysosome
  • pathogenesis
  • prevention
  • SARS-CoV-2

Fabry disease and COVID-19: international expert recommendations for management based on real-world experience

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Journal Title:



Volume 13, Number 6


, Pages 913-925

Type of Work:

Article | Final Publisher PDF


The rapid spread of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 has raised questions about Fabry disease (FD) as an independent risk factor for severe COVID-19 symptoms. Available real-world data on 22 patients from an international group of healthcare providers reveals that most patients with FD experience mild-to-moderate COVID-19 symptoms with an additional complication of Fabry pain crises and transient worsening of kidney function in some cases; however, two patients over the age of 55 years with renal or cardiac disease experienced critical COVID-19 complications. These outcomes support the theory that pre-existent tissue injury and inflammation may predispose patients with more advanced FD to a more severe course of COVID-19, while less advanced FD patients do not appear to be more susceptible than the general population. Given these observed risk factors, it is best to reinforce all recommended safety precautions for individuals with advanced FD. Diagnosis of FD should not preclude providing full therapeutic and organ support as needed for patients with FD and severe or critical COVID-19, although a FD-specific safety profile review should always be conducted prior to initiating COVID-19-specific therapies. Continued specific FD therapy with enzyme replacement therapy, chaperone therapy, dialysis, renin–angiotensin blockers or participation to clinical trials during the pandemic is recommended as FD progression will only increase susceptibility to infection. In order to compile outcome data and inform best practices, an international registry for patients affected by Fabry and infected by COVID-19 should be established.

Copyright information:

© The Author(s) 2020. Published by Oxford University Press on behalf of ERA-EDTA.

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (https://creativecommons.org/licenses/by-nc/4.0/).
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