Summary of medicine characteristics - Galafold
1. NAME OF THE MEDICINAL PRODUCT
Galafold 123 mg hard capsules
2. QUALITATIVE AND QUANTITATIVE COMPOSITION
Each capsule contains migalastat hydrochloride equivalent to 123 mg migalastat.
For the full list of excipients, see section 6.1.
3. PHARMACEUTICAL FORM
Hard capsule.
Size 2 hard capsule (6.4×18.0 mm) with an opaque blue cap and opaque white body with “A1001” printed in black, containing white to pale brown powder.
4. CLINICAL PARTICULARS4.1 Therapeutic indications
Galafold is indicated for long-term treatment of adults and adolescents aged 12 years and older with a confirmed diagnosis of Fabry disease (a-galactosidase A deficiency) and who have an amenable mutation (see the tables in section 5.1).
4.2 Posology and method of administration
Treatment with Galafold should be initiated and supervised by specialist physicians experienced in the diagnosis and treatment of Fabry disease. Galafold is not intended for concomitant use with enzyme replacement therapy (see section 4.4).
Posology
The recommended dosage regimen is 123 mg migalastat (1 capsule) taken once every other day at the same time of the day.
Missed dose
Galafold should not be taken on 2 consecutive days. If a dose is missed entirely for the day, the patient should take the missed dose of Galafold only if it is within 12 hours of the normal time the dose is taken. If more than 12 hours has passed the patient should resume taking Galafold at the next planned dosing day and time according to the every other day dosing schedule.
Special populations
Elderly , population
No dosage adjustment is required based on age (see section 5.2).
Renal impairment
Galafold is not recommended for use in patients with Fabry disease who have estimated GFR less than 30 mL/min/1.73 m2 (see section 5.2).
Hepatic impairment
No dosage adjustment of Galafold is required in patients with hepatic impairment (see section 5.2).
Paediatric , population
Adolescents aged > 12 to < 18 years and weighing > 45 kg
123 mg migalastat (1 capsule) taken once every other day at the same time of the day (see section 5.2).
Children <12 years
The safety and efficacy of Galafold in children aged less than 12 years have not yet been established. No data are available.
Method of administration
For oral use. Galafold exposure is decreased by approximately 40% when taken with food and therefore food should not be consumed at least 2 hours before and 2 hours after taking Galafold to give a minimum 4 hours fast. Clear liquids, including carbonated drinks, can be consumed during this period. Galafold should be taken every other day at the same time of day to ensure optimal benefits to the patient.
Capsules must be swallowed whole. The capsules must not be cut, crushed, or chewed.
4.3 Contraindications
Hypersensitivity to the active substance or to any of the excipients listed in section 6.1.
4.4 Special warnings and precautions for use
It is advised to periodically monitor renal function, echocardiographic parameters and biochemical markers (every 6 months) in patients initiated on or switched to migalastat. In case of meaningful clinical deterioration, further clinical evaluation or discontinuation of treatment with Galafold should be considered.
Galafold is not indicated for use in patients with non-amenable mutations (see section 5.1).
No reduction in proteinuria was observed in patients treated with Galafold. Galafold is not recommended for use in patients with severe renal insufficiency, defined as estimated GFR less than 30 mL/min/1.73m2 (see section 5.2).
Limited data suggest that co-administration of a single dose of migalastat and a standard enzyme replacement therapy infusion results in an increased exposure to agalsidase of up to 5-fold. This study also indicated that agalsidase has no effect on the pharmacokinetics of migalastat. Galafold is not intended for concomitant use with enzyme replacement therapy.
Paediatric population 123 mg migalastat capsules are not for children (> 12 years) weighing less than 45 kg, (see section 5.2).
4.5 Interaction with other medicinal products and other forms of interaction
Based upon in vitro data, migalastat is not an inducer of CYP1A2, 2B6, or 3A4. Furthermore, migalastat is not an inhibitor or a substrate of CYP1A2, 2A6, 2B6, 2C8, 2C9, 2C19, 2D6, 2E1, or 3A4/5. Migalastat is not a substrate for MDR1 or BCRP, nor is it an inhibitor of BCRP, MDR1, or BSEP human efflux transporters. In addition, migalastat is not a substrate for MATE1, MATE2-K, OAT1, OAT3, or OCT2, nor is it an inhibitor of OATP1B1, OATP1B3, OAT1, OAT3, OCT1, OCT2, MATE1, or MATE2-K human uptake transporters.
4.6 Fertility, pregnancy and lactation
Women of childbearing potential/Contraception in males and females
Galafold is not recommended in women of childbearing potential not using contraception.
Pregnancy
There are limited data from the use of Galafold in pregnant women. In rabbits, developmental toxicity was observed only at maternally toxic doses (see section 5.3). Galafold is not recommended during pregnancy.
Breast-feeding
It is not known whether Galafold is secreted in human milk. However, migalastat has been shown to be expressed in the milk of lactating rats. Accordingly, a risk of migalastat exposure to the breast-feeding infant cannot be excluded. A decision must be made whether to discontinue breast-feeding or to discontinue Galafold, taking into account the benefit of breast-feeding for the child relative to the benefit of therapy for the mother.
Fertility
The effects of Galafold on fertility in humans have not been studied. Transient and fully reversible infertility in male rats was associated with migalastat treatment at all doses assessed. Complete reversibility was seen after 4 weeks off-dose. Similar findings have been noted pre-clinically following treatment with other iminosugars (see section 5.3). Migalastat did not affect fertility in female rats.
4.7 Effects on ability to drive and use machines
Galafold has no or negligible influence on the ability to drive and use machines.
4.8 Undesirable effects
Summary of the safety profile
The most common adverse reaction was headache, which was experienced by approximately 10% of patients who received Galafold.
Tabulated list of adverse reactions
Frequencies are defined as: very common (>1/10), common (>1/100 to <1/10), uncommon (>1/1,000 to <1/100), rare (>1/10,000 to <1/1,000), very rare (<1/10,000) and not known (cannot be estimated from the available data). Within each frequency grouping, adverse reactions are presented in order of decreasing frequency within each System Organ Class.
Table 1: Adverse reactions with Galafold
| System organ class | Very common | Common |
| Psychiatric disorders | Depression | |
| Nervous system disorders | Headache | Paraesthesia Dizziness Hypoaesthesia |
| Ear and labyrinth disorders | Vertigo | |
| Cardiac disorders | Palpitations | |
| Respiratory, thoracic, and mediastinal disorders | Dyspnoea Epistaxis | |
| Gastrointestinal disorders | Diarrhoea Nausea Abdominal pain Constipation Dry mouth Defaecation urgency Dyspepsia | |
| Skin and subcutaneous tissue disorders | Rash Pruritus | |
| Musculoskeletal and connective tissue disorders | Muscle spasms Myalgia Torticollis Pain in extremity | |
| Renal and urinary disorders | Proteinuria | |
| General disorders and administration site conditions | Fatigue Pain | |
| Investigations | Blood creatine phosphokinase increased Weight increased |
Adolescent population
The safety assessment in 21 adolescents (12 to <18 years of age and weighing > 45 kg) is based on 1-year safety data from the open label AT1001–020 trial in which subjects received the same dosage regimen as adults (see section 5.2). No age-specific differences in adverse reactions were observed between adolescent and adult subjects. The frequency, type and severity of adverse reactions in adolescents are expected to be the same as in adults based on these data.
Reporting of suspected adverse reactions
Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the national reporting system listed in Appendix V.
4.9 Overdose
In case of overdose, general medical care is recommended. Headache and dizziness were the most common adverse reactions reported at doses of Galafold of up to 1250 mg and 2000 mg, respectively.
5. PHARMACOLOGICAL PROPERTIES5.1 Pharmacodynamic properties
Pharmacotherapeutic group: Other alimentary tract and metabolism products, various alimentary tract and metabolism products, ATC code: A16AX14
Fabry disease is a progressive X-linked lysosomal storage disorder which affects males and females. Fabry disease-causing mutations in the GLA gene result in a deficiency of the lysosomal enzyme a-galactosidase A (a-Gal A) that is required for glycosphingolipid substrate (e.g., GL-3, lyso-Gbs) metabolism. Reduced a-Gal A activity is, therefore, associated with the progressive accumulation of substrate in vulnerable organs and tissues, which leads to the morbidity and mortality associated with Fabry disease.
Mechanism of action
Certain GLA mutations can result in the production of abnormally folded and unstable mutant forms of a-Gal A. Migalastat is a pharmacological chaperone that is designed to selectively and reversibly bind with high affinity to the active sites of certain mutant forms of a-Gal A, the genotypes of which are referred to as amenable mutations. Migalastat binding stabilises these mutant forms of a-Gal A in the endoplasmic reticulum and facilitates their proper trafficking to lysosomes. Once in lysosomes dissociation of migalastat restores a-Gal A activity, leading to the catabolism of GL-3 and related substrates.
The GLA mutations amenable to treatment with Galafold are listed in Table 2 below. The GLA mutations are also accessible by health care providers at.
The nucleotide changes listed represent potential DNA sequence changes that result in the amino acid mutation. The amino acid mutation (protein sequence change) is most relevant when determining amenability. If a double mutation is present on the same chromosome (males and females), that patient is amenable if the double mutation is present in one entry in Table 2 (e.g., D55V/Q57L). If a double mutation is present on different chromosomes (only in females) that patient is amenable if either one of the individual mutations is present in Table 2.
Table 2: Galafold (migalastat) amenability table
| Nucleotide change | Nucleotide change | Protein sequence change |
| c.7C>G | c.C7G | L3V |
| c.8T>C | c.T8C | L3P |
| c.[11G>T; 620A>C] | c.G11T/A620C | R4M/Y207S |
| c.13A>G | c.A13G | N5D |
| Nucleotide change | Nucleotide change | Protein sequence change |
| c.15C>G | c.C15G | N5K |
| c.16C>A | c.C16A | P6T |
| c.16C>T | c.C16T | P6S |
| c.17C>A | c.C17A | P6Q |
| c.17C>G | c.C17G | P6R |
| c.17C>T | c.C17T | P6L |
| c.19G>A | c.G19A | E7K |
| c.20A>T | c.A20T | E7V |
| c.21A>T | c.A21T | E7D |
| c.22C>A | c.C22A | L8I |
| c.23T>A | c.T23A | L8Q |
| c.23T>C | c.T23C | L8P |
| c.25C>T | c.C25T | H9Y |
| c.26A>G | c.A26G | H9R |
| c.26A>T | c.A26T | H9L |
| c.27T>A | c.T27A | H9Q |
| c.28C>A | c.C28A | L10M |
| c.28C>G | c.C28G | L10V |
| c.29T>A | c.T29A | L10Q |
| c.29T>C | c.T29C | L10P |
| c.29T>G | c.T29G | L10R |
| c.31G>A | c.G31A | G11S |
| c.31G>C | c.G31C | G11R |
| c.31G>T | c.G31T | G11C |
| c.32G>A | c.G32A | G11D |
| c.32G>T | c.G32T | G11V |
| c.34T>A | c.T34A | C12S |
| c.34T>C | c.T34C | C12R |
| c.34T>G | c.T34G | C12G |
| c.35G>A | c.G35A | C12Y |
| c.37G>A | c.G37A | A13T |
| c.37G>C | c.G37C | A13P |
| c.38C>A | c.C38A | A13E |
| c.38C>G | c.C38G | A13G |
| c.40C>G | c.C40G | L14V |
| c.40C>T | c.C40T | L14F |
| c.41T>A | c.T41A | L14H |
| c.43G>A | c.G43A | A15T |
| c.44C>G | c.C44G | A15G |
| c.49C>A | c.C49A | R17S |
| c.49C>G | c.C49G | R17G |
| c.49C>T | c.C49T | R17C |
| c.50G>A | c.G50A | R17H |
| c.50G>C | c.G50C | R17P |
| c.52T>A | c.T52A | F18I |
| c.53T>G | c.T53G | F18C |
| c.54C>G | c.C54G | F18L |
| c.58G>C | c.G58C | A20P |
| c.59C>A | c.C59A | A20D |
| c.59C>G | c.C59G | A20G |
| Nucleotide change | Nucleotide change | Protein sequence change |
| c.62T>A | C.T62A | L21H |
| c.64G>A | C.G64A | V22I |
| c.64G>C | C.G64C | V22L |
| c.64G>T | C.G64T | V22F |
| c.65T>C | C.T65C | V22A |
| c.65T>G | C.T65G | V22G |
| c.67T>A | C.T67A | S23T |
| c.67T>C | C.T67C | S23P |
| c.70T>C or c.70T>A | C.T70C or C.T70A | W24R |
| c.70T>G | c.T70G | W24G |
| c.71G>C | c.G71C | W24S |
| c.72G>C or c.72G>T | c.G72C or c.G72T | W24C |
| c.73G>C | c.G73C | D25H |
| c.77T>A | c.T77A | I26N |
| c.79C>A | c.C79A | P27T |
| c.79C>G | c.C79G | P27A |
| c.79C>T | c.C79T | P27S |
| c.80C>T | c.C80T | P27L |
| c.82G>C | c.G82C | G28R |
| c.82G>T | c.G82T | G28W |
| c.83G>A | c.G83A | G28E |
| c.85G>C | c.G85C | A29P |
| c.86C>A | c.C86A | A29D |
| c.86C>G | c.C86G | A29G |
| c.86C>T | c.C86T | A29V |
| c.88A>G | c.A88G | R30G |
| c.94C>A | c.C94A | L32M |
| c.94C>G | c.C94G | L32V |
| c.95T>A | c.T95A | L32Q |
| c.95T>C | c.T95C | L32P |
| c.95T>G | c.T95G | L32R |
| c.97G>C | c.G97C | D33H |
| c.97G>T | c.G97T | D33Y |
| c.98A>C | c.A98C | D33A |
| c.98A>G | c.A98G | D33G |
| c.98A>T | c.A98T | D33V |
| c.99C>G | c.C99G | D33E |
| c.100A>C | C.A100C | N34H |
| c.100A>G | C.A100G | N34D |
| c.101A>C | C.A101C | N34T |
| c.101A>G | C.A101G | N34S |
| c.102T>G or c.102T>A | C.T102G or C.T102A | N34K |
| c.103G>C or c.103G>A | C.G103C or C.G103A | G35R |
| c.104G>A | C.G104A | G35E |
| c.104G>C | C.G104C | G35A |
| c.104G>T | C.G104T | G35V |
| c.106T>A | C.T106A | L36M |
| c.106T>G | C.T106G | L36V |
| c.107T>C | C.T107C | L36S |
| c.107T>G | C.T107G | L36W |
| Nucleotide change | Nucleotide change | Protein sequence change |
| c.108G>C or c.108G>T | C.G108C or C.G108T | L36F |
| c.109G>A | C.G109A | A37T |
| c.109G>T | C.G109T | A37S |
| c.110C>A | C.C110A | A37E |
| c.110C>G | C.C110G | A37G |
| c.110C>T | C.C110T | A37V |
| c.112A>G | C.A112G | R38G |
| c.112A>T | C.A112T | R38W |
| c.113G>T | C.G113T | R38M |
| c.114G>C | C.G114C | R38S |
| c.115A>G | C.A115G | T39A |
| c.115A>T | C.A115T | T39S |
| c.116C>A | C.C116A | T39K |
| c.116C>G | C.C116G | T39R |
| c.116C>T | C.C116T | T39M |
| c.121A>G | C.A121G | T41A |
| c.122C>A | C.C122A | T41N |
| c.122C>G | C.C122G | T41S |
| c.122C>T | C.C122T | T41I |
| c.124A>C or c.124A>T | C.A124C or C.A124T | M42L |
| c.124A>G | C.A124G | M42V |
| c.125T>A | C.T125A | M42K |
| c.125T>C | C.T125C | M42T |
| c.125T>G | C.T125G | M42R |
| c.126G>A or c.126G>C or c.126G>T | C.G126A or C.G126C or C.G126T | M42I |
| c.128G>C | C.G128C | G43A |
| c.133C>A | C.C133A | L45M |
| c.133C>G | C.C133G | L45V |
| c.136C>A | C.C136A | H46N |
| c.136C>G | C.C136G | H46D |
| c.137A>C | C.A137C | H46P |
| c.138C>G | C.C138G | H46Q |
| c.142G>C | C.G142C | E48Q |
| c.143A>C | C.A143C | E48A |
| c.149T>A | C.T149A | F50Y |
| c.151A>G | C.A151G | M51V |
| c.152T>A | C.T152A | M51K |
| c.152T>C | C.T152C | M51T |
| c.152T>G | C.T152G | M51R |
| c.153G>A or c.153G>T or c.153G>C | C.G153A or C.G153T or C.G153C | M51I |
| c.157A>C | C.A157C | N53H |
| c.[157A>C; 158A>T] | C.A157C/A158T | N53L |
| c.157A>G | C.A157G | N53D |
| c.157A>T | C.A157T | N53Y |
| c.158A>C | C.A158C | N53T |
| c.158A>G | C.A158G | N53S |
| c.158A>T | C.A158T | N53I |
| c.159C>G or c.159C>A | C.C159G or C.C159A | N53K |
| Nucleotide change | Nucleotide change | Protein sequence change |
| c.160C>G | c.C160G | L54V |
| c.160C>T | c.C160T | L54F |
| c.161T>A | c.T161A | L54H |
| c.161T>C | c.T161C | L54P |
| c.161T>G | c.T161G | L54R |
| c.163G>C | c.G163C | D55H |
| c.163G>T | c.G163T | D55Y |
| c.164A>C | c.A164C | D55A |
| c.164A>G | c.A164G | D55G |
| c.164A>T | c.A164T | D55V |
| c.[164A>T; 170A>T] | c.A164T/A170T | D55V/Q57L |
| c.165C>G | c.C165G | D55E |
| c.167G>A | c.G167A | C56Y |
| c.167G>T | c.G167T | C56F |
| c.168C>G | c.C168G | C56W |
| c.170A>G | c.A170G | Q57R |
| c.170A>T | c.A170T | Q57L |
| c.172G>A | c.G172A | E58K |
| c.175G>A | c.G175A | E59K |
| c.175G>C | c.G175C | E59Q |
| c.176A>C | c.A176C | E59A |
| c.176A>G | c.A176G | E59G |
| c.176A>T | c.A176T | E59V |
| c.177G>C | c.G177C | E59D |
| c.178C>A | c.C178A | P60T |
| c.178C>G | c.C178G | P60A |
| c.178C>T | c.C178T | P60S |
| c.179C>A | c.C179A | P60Q |
| c.179C>G | c.C179G | P60R |
| c.179C>T | c.C179T | P60L |
| c.182A>T | c.A182T | D61V |
| c.183T>A | c.T183A | D61E |
| c.184 185insTAG | c.184 185insTAG | S62delinsLA |
| c.184T>C | c.T184C | S62P |
| c.184T>G | c.T184G | S62A |
| c.185C>A | c.C185A | S62Y |
| c.185C>G | c.C185G | S62C |
| c.185C>T | c.C185T | S62F |
| c.190A>C | c.A190C | I64L |
| c.190A>G | c.A190G | I64V |
| c.193A>G | c.A193G | S65G |
| c.193A>T | c.A193T | S65C |
| c.195T>A | c.T195A | S65R |
| c.196G>A | c.G196A | E66K |
| c.197A>G | c.A197G | E66G |
| c.197A>T | c.A197T | E66V |
| c.198G>C | c.G198C | E66D |
| c.199A>C | c.A199C | K67Q |
| c.199A>G | c.A199G | K67E |
| c.200A>C | c.A200C | K67T |
| Nucleotide change | Nucleotide change | Protein sequence change |
| c.200A>T | C.A200T | K67M |
| c.201G>C | C.G201C | K67N |
| c.202C>A | C.C202A | L68I |
| c.205T>A | C.T205A | F69I |
| c.206T>A | C.T206A | F69Y |
| c.207C>A or c.207C>G | C.C207A or c.C207G | F69L |
| c.208A>T | C.A208T | M70L |
| c.209T>A | C.T209A | M70K |
| c.209T>G | C.T209G | M70R |
| c.210G>C | C.G210C | M70I |
| c.211G>C | c.G211C | E71Q |
| c.212A>C | c.A212C | E71A |
| c.212A>G | c.A212G | E71G |
| c.212A>T | C.A212T | E71V |
| c.213G>C | C.G213C | E71D |
| c.214A>G | C.A214G | M72V |
| c.214A>T | C.A214T | M72L |
| c.215T>C | C.T215C | M72T |
| c.216G>A or c.216G>T or c.216G>C | C.G216A or C.G216T or C.G216C | M72I |
| c.217G>A | C.G217A | A73T |
| c.217G>T | C.G217T | A73S |
| c.218C>T | C.C218T | A73V |
| c.220G>A | C.G220A | E74K |
| c.221A>G | C.A221G | E74G |
| c.221A>T | C.A221T | E74V |
| c.222G>C | C.G222C | E74D |
| c.223C>T | C.C223T | L75F |
| c.224T>C | C.T224C | L75P |
| c.226A>G | C.A226G | M76V |
| c.227T>C | C.T227C | M76T |
| c.229G>A | C.G229A | V77I |
| c.229G>C | C.G229C | V77L |
| c.232T>C | C.T232C | S78P |
| c.233C>T | C.C233T | S78L |
| c.235G>A | C.G235A | E79K |
| c.235G>C | C.G235C | E79Q |
| c.236A>C | C.A236C | E79A |
| c.236A>G | C.A236G | E79G |
| c.236A>T | C.A236T | E79V |
| c.237A>T | C.A237T | E79D |
| c.238G>A | C.G238A | G80S |
| c.238G>T | C.G238T | G80C |
| c.239G>A | C.G239A | G80D |
| c.239G>C | C.G239C | G80A |
| c.239G>T | C.G239T | G80V |
| c.242G>T | C.G242T | W81L |
| c.244A>G | C.A244G | K82E |
| c.245A>C | C.A245C | K82T |
| c.245A>G | C.A245G | K82R |
| Nucleotide change | Nucleotide change | Protein sequence change |
| c.245A>T | C.A245T | K82M |
| c.246G>C | c.G246C | K82N |
| c.247G>A | C.G247A | D83N |
| c.248A>C | c.A248C | D83A |
| c.248A>G | C.A248G | D83G |
| c.248A>T | C.A248T | D83V |
| c.249T>A | C.T249A | D83E |
| c.250G>A | C.G250A | A84T |
| c.250G>C | c.G250C | A84P |
| c.250G>T | C.G250T | A84S |
| c.251C>A | c.C251A | A84E |
| c.251C>G | c.C251G | A84G |
| c.251C>T | c.C251T | A84V |
| c.253G>A | C.G253A | G85S |
| c.[253G>A; 254G>A] | C.G253A/G254A | G85N |
| c.[253G>A; 254G>T; 255T>G] | C.G253A/G254T/T255G | G85M |
| c.253G>C | c.G253C | G85R |
| c.253G>T | C.G253T | G85C |
| c.254G>A | C.G254A | G85D |
| c.254G>C | c.G254C | G85A |
| c.257A>T | C.A257T | Y86F |
| c.260A>G | C.A260G | E87G |
| c.261G>C or c.261G>T | c.G261C or c.G261T | E87D |
| c.262T>A | C.T262A | Y88N |
| c.262T>C | c.T262C | Y88H |
| c.263A>C | c.A263C | Y88S |
| c.263A>G | C.A263G | Y88C |
| c.265C>G | c.C265G | L89V |
| c.265C>T | c.C265T | L89F |
| c.271A>C | c.A271C | I91L |
| c.271A>T | C.A271T | I91F |
| c.272T>C | c.T272C | I91T |
| c.272T>G | C.T272G | I91S |
| c.273T>G | C.T273G | I91M |
| c.286A>G | C.A286G | M96V |
| c.286A>T | C.A286T | M96L |
| c.287T>C | c.T287C | M96T |
| c.288G>A or c.288G>T or c.288G>C | C.G288A or c.G288T or c.G288C | M96I |
| c.289G>A | C.G289A | A97T |
| c.289G>C | c.G289C | A97P |
| c.289G>T | C.G289T | A97S |
| c.290C>A | c.C290A | A97D |
| c.290C>T | c.C290T | A97V |
| c.293C>A | c.C293A | P98H |
| c.293C>G | c.C293G | P98R |
| c.293C>T | c.C293T | P98L |
| c.295C>G | c.C295G | Q99E |
| c.296A>C | c.A296C | Q99P |
| c.296A>G | C.A296G | Q99R |
| Nucleotide change | Nucleotide change | Protein sequence change |
| c.296A>T | C.A296T | Q99L |
| c.301G>C | C.G301C | D101H |
| c.302A>C | C.A302C | D101A |
| c.302A>G | C.A302G | D101G |
| c.302A>T | C.A302T | D101V |
| c.303T>A | C.T303A | D101E |
| c.304T>A | C.T304A | S102T |
| c.304T>C | C.T304C | S102P |
| c.304T>G | C.T304G | S102A |
| c.305C>T | c.C305T | S102L |
| c.310G>A | C.G310A | G104S |
| c.311G>A | C.G311A | G104D |
| c.311G>C | C.G311C | G104A |
| c.311G>T | C.G311T | G104V |
| c.313A>G | C.A313G | R105G |
| c.314G>A | C.G314A | R105K |
| c.314G>C | C.G314C | R105T |
| c.314G>T | C.G314T | R105I |
| c.316C>A | C.C316A | L106I |
| c.316C>G | C.C316G | L106V |
| c.316C>T | C.C316T | L106F |
| c.317T>A | C.T317A | L106H |
| c.317T>C | C.T317C | L106P |
| c.319C>A | C.C319A | Q107K |
| c.319C>G | C.C319G | Q107E |
| c.320A>G | C.A320G | Q107R |
| c.321G>C | C.G321C | Q107H |
| c.322G>A | C.G322A | A108T |
| c.323C>A | C.C323A | A108E |
| c.323C>T | C.C323T | A108V |
| c.325G>A | C.G325A | D109N |
| c.325G>C | C.G325C | D109H |
| c.325G>T | C.G325T | D109Y |
| c.326A>C | C.A326C | D109A |
| c.326A>G | C.A326G | D109G |
| c.327C>G | C.C327G | D109E |
| c.328C>A | C.C328A | P110T |
| c.334C>G | C.C334G | R112G |
| c.335G>A | C.G335A | R112H |
| c.335G>T | C.G335T | R112L |
| c.337T>A | C.T337A | F113I |
| c.337T>C or c.339T>A or c.339T>G | C.T337C or C.T339A or C.T339G | F113L |
| c.337T>G | C.T337G | F113V |
| c.338T>A | C.T338A | F113Y |
| c.341C>T | C.C341T | P114L |
| c.343C>A | C.C343A | H115N |
| c.343C>G | C.C343G | H115D |
| c.346G>C | C.G346C | G116R |
| c.350T>C | C.T350C | I117T |
| Nucleotide change | Nucleotide change | Protein sequence change |
| c.351T>G | C.T351G | I117M |
| c.352C>T | c.C352T | R118C |
| c.361G>A | C.G361A | A121T |
| c.362C>T | c.C362T | A121V |
| c.367T>A | C.T367A | Y123N |
| c.367T>G | C.T367G | Y123D |
| c.368A>C | c.A368C | Y123S |
| c.368A>G | C.A368G | Y123C |
| c.368A>T | C.A368T | Y123F |
| c.370G>A | C.G370A | V124I |
| c.371T>G | C.T371G | V124G |
| c.373C>A | c.C373A | H125N |
| c.373C>G | c.C373G | H125D |
| c.373C>T | c.C373T | H125Y |
| c.374A>G | C.A374G | H125R |
| c.374A>T | C.A374T | H125L |
| c.376A>G | C.A376G | S126G |
| c.376A>T | C.A376T | S126C |
| c.377G>T | C.G377T | S126I |
| c.379A>G | C.A379G | K127E |
| c.383G>A | C.G383A | G128E |
| c.383G>C | c.G383C | G128A |
| c.385C>G | c.C385G | L129V |
| c.388A>C | c.A388C | K130Q |
| c.389A>T | C.A389T | K130M |
| c.390G>C | c.G390C | K130N |
| c.391C>G | c.C391G | L131V |
| c.397A>C | c.A397C | I133L |
| c.397A>G | C.A397G | I133V |
| c.397A>T | C.A397T | I133F |
| c.398T>C | c.T398C | I133T |
| c.399T>G | C.T399G | I133M |
| c.[399T>G; 434T>C] | c.T399G/T434C | I133M/F145S |
| c.403G>A | C.G403A | A135T |
| c.403G>T | C.G403T | A135S |
| c.404C>A | c.C404A | A135E |
| c.404C>G | c.C404G | A135G |
| c.404C>T | c.C404T | A135V |
| c.406G>A | C.G406A | D136N |
| c.407A>C | c.A407C | D136A |
| c.407A>T | C.A407T | D136V |
| c.408T>A or c.408T>G | C.T408A or c.T408G | D136E |
| c.409G>A | C.G409A | V137I |
| c.409G>C | c.G409C | V137L |
| c.410T>A | C.T410A | V137D |
| c.410T>C | c.T410C | V137A |
| c.410T>G | C.T410G | V137G |
| c.413G>C | c.G413C | G138A |
| c.415A>C | c.A415C | N139H |
| c.415A>T | C.A415T | N139Y |
| Nucleotide change | Nucleotide change | Protein sequence change |
| c.416A>G | c.A416G | N139S |
| c.416A>T | C.A416T | N139I |
| c.417T>A | C.T417A | N139K |
| c.418A>C | c.A418C | K140Q |
| c.418A>G | C.A418G | K140E |
| c.419A>C | c.A419C | K140T |
| c.419A>G | c.A419G | K140R |
| c.419A>T | C.A419T | K140I |
| c.420A>T | C.A420T | K140N |
| c.421A>T | C.A421T | T141S |
| c.427G>A | C.G427A | A143T |
| c.428C>A | c.C428A | A143E |
| c.428C>G | c.C428G | A143G |
| c.428C>T | c.C428T | A143V |
| c.430G>A | C.G430A | G144S |
| c.430G>C | c.G430C | G144R |
| c.430G>T | C.G430T | G144C |
| c.431G>A | C.G431A | G144D |
| c.431G>C | c.G431C | G144A |
| c.431G>T | C.G431T | G144V |
| c.433T>G | C.T433G | F145V |
| c.434T>A | C.T434A | F145Y |
| c.434T>C | c.T434C | F145S |
| c.434T>G | C.T434G | F145C |
| c.435C>G | c.C435G | F145L |
| c.436C>A | c.C436A | P146T |
| c.436C>G | c.C436G | P146A |
| c.436C>T | c.C436T | P146S |
| c.437C>A | c.C437A | P146H |
| c.437C>G | c.C437G | P146R |
| c.437C>T | c.C437T | P146L |
| c.440G>C | c.G440C | G147A |
| c.442A>G | C.A442G | S148G |
| c.442A>T | C.A442T | S148C |
| c.443G>C | c.G443C | S148T |
| c.446T>G | C.T446G | F149C |
| c.449G>A | C.G449A | G150E |
| c.449G>T | C.G449T | G150V |
| c.451T>G | C.T451G | Y151D |
| c.452A>C | c.A452C | Y151S |
| c.452A>G | C.A452G | Y151C |
| c.454T>A | C.T454A | Y152N |
| c.454T>C | c.T454C | Y152H |
| c.454T>G | C.T454G | Y152D |
| c.455A>C | c.A455C | Y152S |
| c.455A>G | C.A455G | Y152C |
| c.455A>T | C.A455T | Y152F |
| c.457G>A | C.G457A | D153N |
| c.457G>C | c.G457C | D153H |
| c.457G>T | C.G457T | D153Y |
| Nucleotide change | Nucleotide change | Protein sequence change |
| c.458A>C | c.A458C | D153A |
| c.458A>T | C.A458T | D153V |
| c.465T>A or c.465T>G | C.T465A or c.T465G | D155E |
| c.466G>A | C.G466A | A156T |
| c.466G>T | C.G466T | A156S |
| c.467C>G | c.C467G | A156G |
| c.467C>T | c.C467T | A156V |
| c.469C>A | c.C469A | Q157K |
| c.469C>G | c.C469G | Q157E |
| c.470A>C | c.A470C | Q157P |
| c.470A>T | C.A470T | Q157L |
| c.471G>C or c.471G>T | c.G471C or c.G471T | Q157H |
| c.472A>G | C.A472G | T158A |
| c.472A>T | C.A472T | T158S |
| c.473C>A | c.C473A | T158N |
| c.473C>T | c.C473T | T158I |
| c.475T>A | C.T475A | F159I |
| c.475T>G | C.T475G | F159V |
| c.476T>A | C.T476A | F159Y |
| c.476T>G | C.T476G | F159C |
| c.477T>A | C.T477A | F159L |
| c.478G>A | C.G478A | A160T |
| c.478G>T | C.G478T | A160S |
| c.479C>A | c.C479A | A160D |
| c.479C>G | c.C479G | A160G |
| c.479C>T | c.C479T | A160V |
| c.481G>A | C.G481A | D161N |
| c.481G>C | c.G481C | D161H |
| c.481G>T | C.G481T | D161Y |
| c.482A>T | C.A482T | D161V |
| c.484T>G | C.T484G | W162G |
| c.485G>C | c.G485C | W162S |
| c.490G>A | C.G490A | V164I |
| c.490G>T | C.G490T | V164L |
| c.491T>C | c.T491C | V164A |
| c.493G>A | C.G493A | D165N |
| c.493G>C | c.G493C | D165H |
| c.494A>C | c.A494C | D165A |
| c.494A>G | C.A494G | D165G |
| c.495T>A | C.T495A | D165E |
| c.496 497delinsTC | c.496 497delinsTC | L166S |
| c.496C>A | c.C496A | L166M |
| c.496C>G | c.C496G | L166V |
| c.[496C>G; 497T>G] | c.C496G/T497G | L166G |
| c.497T>A | C.T497A | L166Q |
| c.499C>A | c.C499A | L167I |
| c.499C>G | c.C499G | L167V |
| c.505T>A | C.T505A | F169I |
| c.505T>G | C.T505G | F169V |
| c.506T>A | C.T506A | F169Y |
| Nucleotide change | Nucleotide change | Protein sequence change |
| c.506T>C | C.T506C | F169S |
| c.506T>G | C.T506G | F169C |
| c.507T>A | C.T507A | F169L |
| c.511G>A | C.G511A | G171S |
| c.512G>C | C.G512C | G171A |
| c.512G>T | C.G512T | G171V |
| c.517T>C | C.T517C | Y173H |
| c.518A>C | C.A518C | Y173S |
| c.518A>G | C.A518G | Y173C |
| c.518A>T | C.A518T | Y173F |
| c.520T>C | C.T520C | C174R |
| c.520T>G | C.T520G | C174G |
| c.523G>C | C.G523C | D175H |
| c.523G>T | C.G523T | D175Y |
| c.524A>G | C.A524G | D175G |
| c.524A>T | C.A524T | D175V |
| c.525C>G or c.525C>A | C.C525G or C.C525A | D175E |
| c.526A>T | C.A526T | S176C |
| c.528T>A | C.T528A | S176R |
| c.529T>A | C.T529A | L177M |
| c.529T>G | C.T529G | L177V |
| c.530T>C | C.T530C | L177S |
| c.530T>G | C.T530G | L177W |
| c.531G>C | C.G531C | L177F |
| c.532G>A | C.G532A | E178K |
| c.532G>C | C.G532C | E178Q |
| c.533A>C | C.A533C | E178A |
| c.533A>G | C.A533G | E178G |
| c.538T>A | C.T538A | L180M |
| c.538T>G | C.T538G | L180V |
| c.539T>C | C.T539C | L180S |
| c.539T>G | C.T539G | L180W |
| c.540G>C or c.540G>T | C.G540C or C.G540T | L180F |
| c.541G>A | C.G541A | A181T |
| c.541G>C | C.G541C | A181P |
| c.542C>T | C.C542T | A181V |
| c.544G>T | C.G544T | D182Y |
| c.545A>C | C.A545C | D182A |
| c.545A>G | C.A545G | D182G |
| c.545A>T | C.A545T | D182V |
| c.546T>A | C.T546A | D182E |
| c.548G>A | C.G548A | G183D |
| c.548G>C | C.G548C | G183A |
| c.550T>A | C.T550A | Y184N |
| c.550T>C | C.T550C | Y184H |
| c.551A>C | C.A551C | Y184S |
| c.551A>G | C.A551G | Y184C |
| c.551A>T | C.A551T | Y184F |
| c.553A>C | C.A553C | K185Q |
| c.553A>G | C.A553G | K185E |
| Nucleotide change | Nucleotide change | Protein sequence change |
| c.554A>C | c.A554C | K185T |
| c.554A>T | C.A554T | K185M |
| c.555G>C | c.G555C | K185N |
| c.556C>A | c.C556A | H186N |
| c.556C>G | c.C556G | H186D |
| c.556C>T | c.C556T | H186Y |
| c.557A>T | C.A557T | H186L |
| c.558C>G | c.C558G | H186Q |
| c.559 564dup | c.559 564dup | p.M187 S188dup |
| c.559A>T | C.A559T | M187L |
| c.559A>G | C.A559G | Ml 87 V |
| c.560T>C | c.T560C | M187T |
| c.561G>T or c.561G>A or c.561G>C | C.G561T or c.G561A or c.G561C | M187I |
| c.562T>A | C.T562A | S188T |
| c.562T>C | c.T562C | S188P |
| c.562T>G | C.T562G | S188A |
| c.563C>A | c.C563A | S188Y |
| c.563C>G | c.C563G | S188C |
| c.563C>T | c.C563T | S188F |
| c.565T>G | C.T565G | L189V |
| c.566T>C | c.T566C | L189S |
| c.567G>C or c.567G>T | c.G567C or c.G567T | L189F |
| c.568G>A | C.G568A | A190T |
| c.568G>T | C.G568T | A190S |
| c.569C>A | c.C569A | A190D |
| c.569C>G | c.C569G | A190G |
| c.569C>T | c.C569T | A190V |
| c.571C>A | c.C571A | L191M |
| c.571C>G | c.C571G | L191V |
| c.572T>A | C.T572A | L191Q |
| c.574A>C | c.A574C | N192H |
| c.574A>G | C.A574G | N192D |
| c.575A>C | c.A575C | N192T |
| c.575A>G | C.A575G | N192S |
| c.576T>A | C.T576A | N192K |
| c.577A>G | C.A577G | R193G |
| c.577A>T | C.A577T | R193W |
| c.578G>C | c.G578C | R193T |
| c.578G>T | C.G578T | R193M |
| c.580A>C | c.A580C | T194P |
| c.580A>G | C.A580G | T194A |
| c.580A>T or c.581C>G | C.A580T or c.C581G | T194S |
| c.581C>A | c.C581A | T194N |
| c.581C>T | c.C581T | T194I |
| c.583G>A | C.G583A | G195S |
| c.583G>C | c.G583C | G195R |
| c.583G>T | C.G583T | G195C |
| c.584G>T | C.G584T | G195V |
| c.586A>G | C.A586G | R196G |
| Nucleotide change | Nucleotide change | Protein sequence change |
| c.587G>A | C.G587A | R196K |
| c.587G>C | C.G587C | R196T |
| c.587G>T | C.G587T | R196I |
| c.589A>G | C.A589G | S197G |
| c.589A>T | C.A589T | S197C |
| c.590G>A | C.G590A | S197N |
| c.590G>C | C.G590C | S197T |
| c.590G>T | C.G590T | S197I |
| c.593T>C | c.T593C | I198T |
| c.593T>G | C.T593G | I198S |
| c.594T>G | C.T594G | I198M |
| c.595G>A | C.G595A | V199M |
| c.595G>C | c.G595C | V199L |
| c.596T>A | C.T596A | V199E |
| c.596T>C | c.T596C | V199A |
| c.596T>G | C.T596G | V199G |
| c.598T>A | C.T598A | Y200N |
| c.599A>C | c.A599C | Y200S |
| c.599A>G | C.A599G | Y200C |
| c.601T>A | C.T601A | S201T |
| c.601T>G | C.T601G | S201A |
| c.602C>A | c.C602A | S201Y |
| c.602C>G | c.C602G | S201C |
| c.602C>T | c.C602T | S201F |
| c.607G>C | c.G607C | E203Q |
| c.608A>C | c.A608C | E203A |
| c.608A>G | C.A608G | E203G |
| c.608A>T | C.A608T | E203V |
| c.609G>C or c.609G>T | c.G609C or c.G609T | E203D |
| c.610T>G | C.T610G | W204G |
| c.611G>C | c.G611C | W204S |
| c.611G>T | C.G611T | W204L |
| c.613C>A | C.C613A | P205T |
| c.613C>T | C.C613T | P205S |
| c.614C>T | C.C614T | P205L |
| c.616C>A | C.C616A | L206I |
| c.616C>G | C.C616G | L206V |
| c.616C>T | C.C616T | L206F |
| c.617T>A | C.T617A | L206H |
| c.617T>G | C.T617G | L206R |
| c.619T>C | C.T619C | Y207H |
| c.620A>C | C.A620C | Y207S |
| c.620A>T | C.A620T | Y207F |
| c.623T>A | C.T623A | M208K |
| c.623T>G | C.T623G | M208R |
| c.625T>A | C.T625A | W209R |
| c.625T>G | C.T625G | W209G |
| c.627G>C | C.G627C | W209C |
| c.628C>A | C.C628A | P210T |
| c.628C>T | C.C628T | P210S |
| Nucleotide change | Nucleotide change | Protein sequence change |
| c.629C>A | c.C629A | P210H |
| c.629C>T | c.C629T | P210L |
| c.631T>C | c.T631C | F211L |
| c.631T>G | C.T631G | F211V |
| c.632T>A | C.T632A | F211Y |
| c.632T>C | c.T632C | F211S |
| c.632T>G | C.T632G | F211C |
| c.635A>C | c.A635C | Q212P |
| c.636A>T | C.A636T | Q212H |
| c.637A>C | c.A637C | K213Q |
| c.637A>G | C.A637G | K213E |
| c.638A>G | C.A638G | K213R |
| c.638A>T | C.A638T | K213M |
| c.640C>A | c.C640A | P214T |
| c.640C>G | c.C640G | P214A |
| c.640C>T | c.C640T | P214S |
| c.641C>A | c.C641A | P214H |
| c.641C>G | c.C641G | P214R |
| c.641C>T | c.C641T | P214L |
| c.643A>C | c.A643C | N215H |
| c.643A>G | C.A643G | N215D |
| c.643A>T | C.A643T | N215Y |
| c.644A>C | c.A644C | N215T |
| c.644A>G | C.A644G | N215S |
| c.[644A>G; 937G>T] | C.A644G/G937T | N215S/D313Y |
| c.644A>T | C.A644T | N215I |
| c.645T>A | C.T645A | N215K |
| c.646T>A | C.T646A | Y216N |
| c.646T>C | c.T646C | Y216H |
| c.646T>G | C.T646G | Y216D |
| c.647A>C | c.A647C | Y216S |
| c.647A>G | C.A647G | Y216C |
| c.647A>T | C.A647T | Y216F |
| c.649A>C | c.A649C | T217P |
| c.649A>G | C.A649G | T217A |
| c.649A>T | C.A649T | T217S |
| c.650C>A | c.C650A | T217K |
| c.650C>G | c.C650G | T217R |
| c.650C>T | c.C650T | T217I |
| c.652G>A | C.G652A | E218K |
| c.652G>C | c.G652C | E218Q |
| c.653A>C | c.A653C | E218A |
| c.653A>G | C.A653G | E218G |
| c.653A>T | C.A653T | E218V |
| c.654A>T | C.A654T | E218D |
| c.655A>C | c.A655C | I219L |
| c.655A>T | C.A655T | I219F |
| c.656T>A | C.T656A | I219N |
| c.656T>C | c.T656C | I219T |
| c.656T>G | C.T656G | I219S |
| Nucleotide change | Nucleotide change | Protein sequence change |
| c.657C>G | c.C657G | I219M |
| c.659G>A | C.G659A | R220Q |
| c.659G>C | c.G659C | R220P |
| c.659G>T | C.G659T | R220L |
| c.661C>A | c.C661A | Q221K |
| c.661C>G | c.C661G | Q221E |
| c.662A>C | c.A662C | Q221P |
| c.662A>G | C.A662G | Q221R |
| c.662A>T | C.A662T | Q221L |
| c.663G>C | c.G663C | Q221H |
| c.664T>A | C.T664A | Y222N |
| c.664T>C | c.T664C | Y222H |
| c.664T>G | C.T664G | Y222D |
| c.665A>C | c.A665C | Y222S |
| c.665A>G | C.A665G | Y222C |
| c.670A>C | c.A670C | N224H |
| c.671A>C | c.A671C | N224T |
| c.671A>G | C.A671G | N224S |
| c.673C>G | c.C673G | H225D |
| c.679C>G | c.C679G | R227G |
| c.682A>C | c.A682C | N228H |
| c.682A>G | C.A682G | N228D |
| c.683A>C | c.A683C | N228T |
| c.683A>G | C.A683G | N228S |
| c.683A>T | C.A683T | N228I |
| c.685T>A | C.T685A | F229I |
| c.686T>A | C.T686A | F229Y |
| c.686T>C | c.T686C | F229S |
| c.687T>A or c.687T>G | C.T687A or c.T687G | F229L |
| c.688G>C | c.G688C | A230P |
| c.689C>A | c.C689A | A230D |
| c.689C>G | c.C689G | A230G |
| c.689C>T | c.C689T | A230V |
| c.694A>C | c.A694C | I232L |
| c.694A>G | C.A694G | I232V |
| c.695T>C | c.T695C | I232T |
| c.696T>G | C.T696G | I232M |
| c.698A>C | c.A698C | D233A |
| c.698A>G | C.A698G | D233G |
| c.698A>T | C.A698T | D233V |
| c.699T>A | C.T699A | D233E |
| c.703T>A | C.T703A | S235T |
| c.703T>G | C.T703G | S235A |
| c.710A>T | C.A710T | K237I |
| c.712A>G | C.A712G | S238G |
| c.712A>T | C.A712T | S238C |
| c.713G>A | C.G713A | S238N |
| c.713G>C | c.G713C | S238T |
| c.713G>T | C.G713T | S238I |
| c.715A>T | C.A715T | I239L |
| Nucleotide change | Nucleotide change | Protein sequence change |
| c.716T>C | c.T716C | I239T |
| c.717A>G | C.A717G | I239M |
| c.718A>G | C.A718G | K240E |
| c.719A>G | c.A719G | K240R |
| c.719A>T | C.A719T | K240M |
| c.720G>C or c.720G>T | c.G720C or c.G720T | K240N |
| c.721A>T | C.A721T | S241C |
| c.722G>C | c.G722C | S241T |
| c.722G>T | C.G722T | S241I |
| c.724A>C | c.A724C | I242L |
| c.724A>G | C.A724G | I242V |
| c.724A>T | C.A724T | I242F |
| c.725T>A | C.T725A | I242N |
| c.725T>C | c.T725C | I242T |
| c.725T>G | C.T725G | I242S |
| c.726C>G | c.C726G | I242M |
| c.727T>A | C.T727A | L243M |
| c.727T>G | C.T727G | L243V |
| c.728T>C | c.T728C | L243S |
| c.728T>G | C.T728G | L243W |
| c.729G>C or c.729G>T | c.G729C or c.G729T | L243F |
| c.730G>A | C.G730A | D244N |
| c.730G>C | c.G730C | D244H |
| c.730G>T | C.G730T | D244Y |
| c.731A>C | c.A731C | D244A |
| c.731A>G | c.A731G | D244G |
| c.731A>T | C.A731T | D244V |
| c.732C>G | c.C732G | D244E |
| c.733T>G | C.T733G | W245G |
| c.735G>C | c.G735C | W245C |
| c.736A>G | C.A736G | T246A |
| c.737C>A | c.C737A | T246K |
| c.737C>G | c.C737G | T246R |
| c.737C>T | c.C737T | T246I |
| c.739T>A | C.T739A | S247T |
| c.739T>G | C.T739G | S247A |
| c.740C>A | c.C740A | S247Y |
| c.740C>G | c.C740G | S247C |
| c.740C>T | c.C740T | S247F |
| c.742T>G | C.T742G | F248V |
| c.743T>A | C.T743A | F248Y |
| c.743T>G | C.T743G | F248C |
| c.744T>A | C.T744A | F248L |
| c.745A>C | c.A745C | N249H |
| c.745A>G | C.A745G | N249D |
| c.745A>T | C.A745T | N249Y |
| c.746A>C | c.A746C | N249T |
| c.746A>G | C.A746G | N249S |
| c.746A>T | C.A746T | N249I |
| c.747C>G or c.747C>A | c.C747G or c.C747A | N249K |
| Nucleotide change | Nucleotide change | Protein sequence change |
| c.748C>A | C.C748A | Q250K |
| c.748C>G | C.C748G | Q250E |
| c.749A>C | C.A749C | Q250P |
| c.749A>G | C.A749G | Q250R |
| c.749A>T | C.A749T | Q250L |
| c.750G>C | C.G750C | Q250H |
| c.751G>A | C.G751A | E251K |
| c.751G>C | C.G751C | E251Q |
| c.752A>G | C.A752G | E251G |
| c.752A>T | C.A752T | E251V |
| c.754A>G | C.A754G | R252G |
| c.757A>G | C.A757G | I253V |
| c.757A>T | C.A757T | I253F |
| c.758T>A | C.T758A | I253N |
| c.758T>C | c.T758C | I253T |
| c.758T>G | C.T758G | I253S |
| C.760–762delGTT or c.761–763del | c.760_762delGTT or c.761 763del | p.V254del |
| c.760G>T | C.G760T | V254F |
| c.761T>A | C.T761A | V254D |
| c.761T>C | C.T761C | V254A |
| c.761T>G | C.T761G | V254G |
| c.763G>A | C.G763A | D255N |
| c.763G>C | C.G763C | D255H |
| c.763G>T | C.G763T | D255Y |
| c.764A>C | C.A764C | D255A |
| c.764A>T | C.A764T | D255V |
| c.765T>A | C.T765A | D255E |
| c.766G>C | C.G766C | V256L |
| c.767T>A | C.T767A | V256D |
| c.767T>G | C.T767G | V256G |
| c.769G>A | C.G769A | A257T |
| c.769G>C | C.G769C | A257P |
| c.769G>T | C.G769T | A257S |
| c.770C>G | C.C770G | A257G |
| c.770C>T | C.C770T | A257V |
| c.772G>C or c.772G>A | C.G772C or C.G772A | G258R |
| c.773G>A | C.G773A | G258E |
| c.773G>T | C.G773T | G258V |
| c.775C>A | C.C775A | P259T |
| c.775C>G | C.C775G | P259A |
| c.775C>T | C.C775T | P259S |
| c.776C>A | C.C776A | P259Q |
| c.776C>G | C.C776G | P259R |
| c.776C>T | C.C776T | P259L |
| c.778G>T | C.G778T | G260W |
| c.779G>A | C.G779A | G260E |
| c.779G>C | C.G779C | G260A |
| c.781G>A | C.G781A | G261S |
| c.781G>C | C.G781C | G261R |
| Nucleotide change | Nucleotide change | Protein sequence change |
| c.781G>T | c.G781T | G261C |
| c.782G>C | c.G782C | G261A |
| c.787A>C | c.A787C | N263H |
| c.788A>C | c.A788C | N263T |
| c.788A>G | c.A788G | N263S |
| c.790G>A | c.G790A | D264N |
| c.790G>C | c.G790C | D264H |
| c.790G>T | c.G790T | D264Y |
| c.793C>G | c.C793G | P265A |
| c.794C>A | c.C794A | P265Q |
| c.794C>T | c.C794T | P265L |
| c.799A>G | c.A799G | M267V |
| c.799A>T | c.A799T | M267L |
| c.800T>C | c.T800C | M267T |
| c.802T>A | c.T802A | L268I |
| c.804A>T | c.A804T | L268F |
| c.805G>A | c.G805A | V269M |
| c.805G>C | c.G805C | V269L |
| c.806T>C | c.T806C | V269A |
| c.808A>C | c.A808C | I270L |
| c.808A>G | c.A808G | I270V |
| c.809T>C | c.T809C | I270T |
| c.809T>G | c.T809G | I270S |
| c.810T>G | c.T810G | I270M |
| c.811G>A | c.G811A | G271S |
| c.[811G>A; 937G>T] | c.G811A/G937T | G271S/D313Y |
| c.812G>A | c.G812A | G271D |
| c.812G>C | c.G812C | G271A |
| c.814A>G | c.A814G | N272D |
| c.818T>A | c.T818A | F273Y |
| c.823C>A | c.C823A | L275I |
| c.823C>G | c.C823G | L275V |
| c.827G>A | c.G827A | S276N |
| c.827G>C | c.G827C | S276T |
| c.829T>G | c.T829G | W277G |
| c.830G>T | c.G830T | W277L |
| c.831G>T or c.831G>C | c.G831T or c.G831C | W277C |
| c.832A>T | c.A832T | N278Y |
| c.833A>T | c.A833T | N278I |
| c.835C>G | c.C835G | Q279E |
| c.838C>A | c.C838A | Q280K |
| c.839A>G | c.A839G | Q280R |
| c.839A>T | c.A839T | Q280L |
| c.840A>T or c.840A>C | c.A840T or c.A840C | Q280H |
| c.841G>C | c.G841C | V281L |
| c.842T>A | c.T842A | V281E |
| c.842T>C | c.T842C | V281A |
| c.842T>G | c.T842G | V281G |
| c.844A>G | c.A844G | T282A |
| c.844A>T | c.A844T | T282S |
| Nucleotide change | Nucleotide change | Protein sequence change |
| c.845C>T | c.C845T | T282I |
| c.847C>G | c.C847G | Q283E |
| c.848A>T | C.A848T | Q283L |
| c.849G>C | c.G849C | Q283H |
| c.850A>G | C.A850G | M284V |
| c.850A>T | C.A850T | M284L |
| c.851T>C | c.T851C | M284T |
| c.852G>C | c.G852C | M284I |
| c.853G>A | C.G853A | A285T |
| c.854C>G | c.C854G | A285G |
| c.854C>T | c.C854T | A285V |
| c.856C>G | c.C856G | L286V |
| c.856C>T | c.C856T | L286F |
| c.857T>A | C.T857A | L286H |
| c.860G>T | C.G860T | W287L |
| c.862G>C | c.G862C | A288P |
| c.862G>T | C.G862T | A288S |
| c.863C>G | c.C863G | A288G |
| c.863C>T | c.C863T | A288V |
| c.865A>C | c.A865C | I289L |
| c.865A>G | C.A865G | I289V |
| c.866T>C | c.T866C | I289T |
| c.866T>G | C.T866G | I289S |
| c.868A>C or c.868A>T | c.A868C or c.A868T | M290L |
| c.868A>G | C.A868G | M290V |
| c.869T>C | c.T869C | M290T |
| c.870G>A or c.870G>C or c.870G>T | C.G870A or c.G870C or c.G870T | M290I |
| c.871G>A | C.G871A | A291T |
| c.871G>T | C.G871T | A291S |
| c.872C>G | c.C872G | A291G |
| c.874G>T | C.G874T | A292S |
| c.875C>G | c.C875G | A292G |
| c.877C>A | c.C877A | P293T |
| c.880T>A | C.T880A | L294I |
| c.880T>G | C.T880G | L294V |
| c.881T>C | c.T881C | L294S |
| c.882A>T | C.A882T | L294F |
| c.883T>A | C.T883A | F295I |
| c.883T>G | C.T883G | F295V |
| c.884T>A | C.T884A | F295Y |
| c.884T>C | c.T884C | F295S |
| c.884T>G | C.T884G | F295C |
| c.886A>G | C.A886G | M296V |
| c.886A>T or c.886A>C | C.A886T or c.A886C | M296L |
| c.887T>C | c.T887C | M296T |
| c.888G>A or c.888G>T or c.888G>C | C.G888A or c.G888T or c.G888C | M296I |
| c.889T>A | C.T889A | S297T |
| c.892A>G | C.A892G | N298D |
| Nucleotide change | Nucleotide change | Protein sequence change |
| c.893A>C | C.A893C | N298T |
| c.893A>G | C.A893G | N298S |
| c.893A>T | C.A893T | N298I |
| c.895G>A | C.G895A | D299N |
| c.895G>C | C.G895C | D299H |
| c.897C>G or c.897C>A | C.C897G or c.C897A | D299E |
| c.898C>A | C.C898A | L300I |
| c.898C>G | C.C898G | L300V |
| c.898C>T | C.C898T | L300F |
| c.899T>C | C.T899C | L300P |
| c.901C>G | c.C901G | R301G |
| c.902G>A | C.G902A | R301Q |
| c.902G>C | c.G902C | R301P |
| c.902G>T | C.G902T | R301L |
| c.904C>A | c.C904A | H302N |
| c.904C>G | c.C904G | H302D |
| c.904C>T | c.C904T | H302Y |
| c.905A>T | C.A905T | H302L |
| c.907A>G | C.A907G | I303V |
| c.907A>T | C.A907T | I303F |
| c.908T>A | C.T908A | I303N |
| c.908T>C | c.T908C | I303T |
| c.908T>G | C.T908G | I303S |
| c.911G>A | C.G911A | S304N |
| c.911G>C | C.G911C | S304T |
| c.911G>T | C.G911T | S304I |
| c.916C>G | C.C916G | Q306E |
| c.917A>C | C.A917C | Q306P |
| c.917A>T | C.A917T | Q306L |
| c.919G>A | C.G919A | A307T |
| c.919G>C | C.G919C | A307P |
| c.919G>T | C.G919T | A307S |
| c.920C>A | C.C920A | A307D |
| c.920C>G | C.C920G | A307G |
| c.920C>T | C.C920T | A307V |
| c.922A>C | C.A922C | K308Q |
| c.922A>G | C.A922G | K308E |
| c.923A>G | C.A923G | K308R |
| c.923A>T | C.A923T | K308I |
| c.924A>T or c.924A>C | C.A924T or C.A924C | K308N |
| c.925G>A | C.G925A | A309T |
| c.925G>C | C.G925C | A309P |
| c.926C>A | C.C926A | A309D |
| c.926C>T | C.C926T | A309V |
| c.928C>A | C.C928A | L310I |
| c.928C>G | C.C928G | L310V |
| c.928C>T | C.C928T | L310F |
| c.931C>A | C.C931A | L311I |
| c.931C>G | C.C931G | L311V |
| c.934C>A | C.C934A | Q312K |
| Nucleotide change | Nucleotide change | Protein sequence change |
| c.934C>G | c.C934G | Q312E |
| c.935A>G | C.A935G | Q312R |
| c.935A>T | C.A935T | Q312L |
| c.936G>T or c.936G>C | C.G936T or c.G936C | Q312H |
| c.937G>T | C.G937T | D313Y |
| c.[937G>T; 1232G>A] | C.G937T/G1232A | D313Y/G411D |
| c.938A>G | C.A938G | D313G |
| c.938A>T | C.A938T | D313V |
| c.939T>A | C.T939A | D313E |
| c.940A>G | C.A940G | K314E |
| c.941A>C | c.A941C | K314T |
| c.941A>T | C.A941T | K314M |
| c.942G>C | c.G942C | K314N |
| c.943G>A | C.G943A | D315N |
| c.943G>C | c.G943C | D315H |
| c.943G>T | C.G943T | D315Y |
| c.944A>C | c.A944C | D315A |
| c.944A>G | C.A944G | D315G |
| c.944A>T | C.A944T | D315V |
| c.946G>A | C.G946A | V316I |
| c.946G>C | c.G946C | V316L |
| c.947T>C | c.T947C | V316A |
| c.947T>G | C.T947G | V316G |
| c.949A>C | c.A949C | I317L |
| c.949A>G | C.A949G | I317V |
| c.950T>C | c.T950C | I317T |
| c.951T>G | C.T951G | I317M |
| c.952G>A | C.G952A | A318T |
| c.952G>C | c.G952C | A318P |
| c.953C>A | c.C953A | A318D |
| c.953C>T | c.C953T | A318V |
| c.955A>T | C.A955T | I319F |
| c.956T>C | c.T956C | I319T |
| c.957C>G | c.C957G | I319M |
| c.958A>C | c.A958C | N320H |
| c.959A>C | c.A959C | N320T |
| c.959A>G | C.A959G | N320S |
| c.959A>T | C.A959T | N320I |
| c.961C>A | c.C961A | Q321K |
| c.962A>G | C.A962G | Q321R |
| c.962A>T | C.A962T | Q321L |
| c.963G>C or c.963G>T | c.G963C or c.G963T | Q321H |
| c.964G>A | C.G964A | D322N |
| c.964G>C | c.G964C | D322H |
| c.965A>C | c.A965C | D322A |
| c.965A>T | C.A965T | D322V |
| c.966C>A or c.966C>G | c.C966A or c.C966G | D322E |
| c.967C>A | c.C967A | P323T |
| c.968C>G | c.C968G | P323R |
| c.970T>G | C.T970G | L324V |
| Nucleotide change | Nucleotide change | Protein sequence change |
| c.971T>G | C.T971G | L324W |
| c.973G>A | C.G973A | G325S |
| c.973G>C | c.G973C | G325R |
| c.973G>T | C.G973T | G325C |
| c.974G>C | c.G974C | G325A |
| c.974G>T | C.G974T | G325V |
| c.976A>C | c.A976C | K326Q |
| c.976A>G | C.A976G | K326E |
| c.977A>C | c.A977C | K326T |
| c.977A>G | C.A977G | K326R |
| c.977A>T | C.A977T | K326M |
| c.978G>C or c.978G>T | c.G978C or c.G978T | K326N |
| c.979C>G | c.C979G | Q327E |
| c.980A>C | c.A980C | Q327P |
| c.980A>T | C.A980T | Q327L |
| c.981A>T | C.A981T | Q327H |
| c.983G>C | c.G983C | G328A |
| c.985T>A | C.T985A | Y329N |
| c.985T>C | c.T985C | Y329H |
| c.985T>G | C.T985G | Y329D |
| c.986A>G | C.A986G | Y329C |
| c.986A>T | C.A986T | Y329F |
| c.988C>A | c.C988A | Q330K |
| c.988C>G | c.C988G | Q330E |
| c.989A>C | c.A989C | Q330P |
| c.989A>G | C.A989G | Q330R |
| c.990G>C | c.G990C | Q330H |
| c.991C>G | c.C991G | L331V |
| c.992T>A | C.T992A | L331H |
| c.992T>C | c.T992C | L331P |
| c.992T>G | C.T992G | L331R |
| c.994A>G | C.A994G | R332G |
| c.995G>C | c.G995C | R332T |
| c.995G>T | C.G995T | R332I |
| c.996A>T | C.A996T | R332S |
| c.997C>G | c.C997G | Q333E |
| c.998A>C | c.A998C | Q333P |
| c.998A>T | C.A998T | Q333L |
| c.1000G>C | c.G1000C | G334R |
| c.1001G>A | c.G1001A | G334E |
| c.1001G>T | C.G1001T | G334V |
| c.1003G>T | C.G1003T | D335Y |
| c.1004A>C | c.A1004C | D335A |
| c.1004A>G | C.A1004G | D335G |
| c.1004A>T | C.A1004T | D335V |
| c.1005C>G | c.C1005G | D335E |
| c.1006A>G | C.A1006G | N336D |
| c.1006A>T | C.A1006T | N336Y |
| c.1007A>C | c.A1007C | N336T |
| c.1007A>G | C.A1007G | N336S |
| Nucleotide change | Nucleotide change | Protein sequence change |
| c.1007A>T | c.A1007T | N336I |
| c.1009T>G | c.T1009G | F337V |
| c.1010T>A | c.T1010A | F337Y |
| c.1010T>C | c.T1010C | F337S |
| c.1010T>G | c.T1010G | F337C |
| c.1011T>A | c.T1011A | F337L |
| c.1012G>A | c.G1012A | E338K |
| c.1013A>C | c.A1013C | E338A |
| c.1013A>G | c.A1013G | E338G |
| c.1013A>T | c.A1013T | E338V |
| c.1014A>T | c.A1014T | E338D |
| c.1015G>A | c.G1015A | V339M |
| c.1016T>A | c.T1016A | V339E |
| c.1016T>C | c.T1016C | V339A |
| c.1021G>C | c.G1021C | E341Q |
| c.1022A>C | c.A1022C | E341A |
| c.1027C>A | c.C1027A | P343T |
| c.1027C>G | c.C1027G | P343A |
| c.1027C>T | c.C1027T | P343S |
| c.1028C>T | c.C1028T | P343L |
| c.1030C>G | c.C1030G | L344V |
| c.1030C>T | c.C1030T | L344F |
| c.1031T>G | c.T1031G | L344R |
| c.1033T>C | c.T1033C | S345P |
| c.1036G>T | c.G1036T | G346C |
| c.1037G>A | c.G1037A | G346D |
| c.1037G>C | c.G1037C | G346A |
| c.1037G>T | c.G1037T | G346V |
| c.1039T>A | c.T1039A | L347I |
| c.1043C>A | c.C1043A | A348D |
| c.1046G>C | c.G1046C | W349S |
| c.1046G>T | c.G1046T | W349L |
| c.1047G>C | c.G1047C | W349C |
| c.1048G>A | c.G1048A | A350T |
| c.1048G>T | c.G1048T | A350S |
| c.1049C>G | c.C1049G | A350G |
| c.1049C>T | c.C1049T | A350V |
| c.1052T>A | c.T1052A | V351E |
| c.1052T>C | c.T1052C | V351A |
| c.1054G>A | c.G1054A | A352T |
| c.1054G>T | c.G1054T | A352S |
| c.1055C>G | c.C1055G | A352G |
| c.1055C>T | c.C1055T | A352V |
| c.1057A>T | c.A1057T | M353L |
| c.1058T>A | c.T1058A | M353K |
| c.1058T>C | c.T1058C | M353T |
| c.1061T>A | c.T1061A | I354K |
| c.1061T>G | c.T1061G | I354R |
| c.1063A>C | c.A1063C | N355H |
| c.1063A>G | c.A1063G | N355D |
| Nucleotide change | Nucleotide change | Protein sequence change |
| c.1063A>T | C.A1063T | N355Y |
| c.1064A>G | C.A1064G | N355S |
| c.1066C>G | C.C1066G | R356G |
| c.1066C>T | C.C1066T | R356W |
| c.1067G>A | C.G1067A | R356Q |
| c.1067G>C | C.G1067C | R356P |
| c.1067G>T | C.G1067T | R356L |
| c.1069C>G | C.C1069G | Q357E |
| c.1072G>C | C.G1072C | E358Q |
| c.1073A>C | C.A1073C | E358A |
| c.1073A>G | C.A1073G | E358G |
| c.1074G>T or c.1074G>C | C.G1074T or C.G1074C | E358D |
| c.1075A>C | C.A1075C | I359L |
| c.1075A>G | C.A1075G | I359V |
| c.1075A>T | C.A1075T | I359F |
| c.1076T>A | C.T1076A | I359N |
| c.1076T>C | C.T1076C | I359T |
| c.1076T>G | C.T1076G | I359S |
| c.1078G>A | C.G1078A | G360S |
| c.1078G>C | C.G1078C | G360R |
| c.1078G>T | C.G1078T | G360C |
| c.1079G>A | C.G1079A | G360D |
| c.1079G>C | C.G1079C | G360A |
| c.1082G>A | C.G1082A | G361E |
| c.1082G>C | C.G1082C | G361A |
| c.1084C>A | C.C1084A | P362T |
| c.1084C>G | C.C1084G | P362A |
| c.1084C>T | C.C1084T | P362S |
| c.1085C>A | C.C1085A | P362H |
| c.1085C>G | C.C1085G | P362R |
| c.1085C>T | C.C1085T | P362L |
| c.1087C>A | C.C1087A | R363S |
| c.1087C>G | C.C1087G | R363G |
| c.1087C>T | C.C1087T | R363C |
| c.1088G>A | C.G1088A | R363H |
| c.1088G>T | C.G1088T | R363L |
| c.1090T>C | C.T1090C | S364P |
| c.1091C>G | C.C1091G | S364C |
| c.1093T>A | C.T1093A | Y365N |
| c.1093T>G | C.T1093G | Y365D |
| c.1094A>C | C.A1094C | Y365S |
| c.1094A>T | C.A1094T | Y365F |
| c.1096A>C | C.A1096C | T366P |
| c.1096A>T | C.A1096T | T366S |
| c.1097C>A | C.C1097A | T366N |
| c.1097C>T | C.C1097T | T366I |
| c.1099A>C | C.A1099C | I367L |
| c.1099A>T | C.A1099T | I367F |
| c.1101C>G | C.C1101G | I367M |
| c.1102G>A | C.G1102A | A368T |
| Nucleotide change | Nucleotide change | Protein sequence change |
| c.1102G>C | c.G1102C | A368P |
| c.1103C>G | c.C1103G | A368G |
| c.1105G>A | c.G1105A | V369I |
| c.1105G>C | c.G1105C | V369L |
| c.1105G>T | c.G1105T | V369F |
| c.1106T>C | c.T1106C | V369A |
| c.1106T>G | c.T1106G | V369G |
| c.1108G>A | c.G1108A | A370T |
| c.1108G>C | c.G1108C | A370P |
| c.1109C>A | c.C1109A | A370D |
| c.1109C>G | c.C1109G | A370G |
| c.1109C>T | c.C1109T | A370V |
| c.1111T>A | c.T1111A | S371T |
| c.1112C>G | c.C1112G | S371C |
| c.1117G>A | c.G1117A | G373S |
| c.1117G>T | c.G1117T | G373C |
| c.1118G>C | c.G1118C | G373A |
| c.1120A>G | c.A1120G | K374E |
| c.1121A>C | c.A1121C | K374T |
| c.1121A>G | c.A1121G | K374R |
| c.1121A>T | c.A1121T | K374I |
| c.1123G>C | c.G1123C | G375R |
| c.1124G>A | c.G1124A | G375E |
| c.1124G>C | c.G1124C | G375A |
| c.1126G>A | c.G1126A | V376M |
| c.1126G>C | c.G1126C | V376L |
| c.1127T>A | c.T1127A | V376E |
| c.1127T>G | c.T1127G | V376G |
| c.1129G>A | c.G1129A | A377T |
| c.1129G>C | c.G1129C | A377P |
| c.1129G>T | c.G1129T | A377S |
| c.1130C>G | c.C1130G | A377G |
| c.1135A>G | c.A1135G | N379D |
| c.1136A>C | c.A1136C | N379T |
| c.1136A>T | c.A1136T | N379I |
| c.1137T>A | c.T1137A | N379K |
| c.1138C>A | c.C1138A | P380T |
| c.1138C>G | c.C1138G | P380A |
| c.1139C>A | c.C1139A | P380H |
| c.1139C>G | c.C1139G | P380R |
| c.1139C>T | c.C1139T | P380L |
| c.1142C>A | c.C1142A | A381D |
| c.1147T>A | c.T1147A | F383I |
| c.1148T>A | c.T1148A | F383Y |
| c.1148T>G | c.T1148G | F383C |
| c.1150A>T | c.A1150T | I384F |
| c.1151T>C | c.T1151C | I384T |
| c.1152C>G | c.C1152G | I384M |
| c.1153A>G | c.A1153G | T385A |
| c.1154C>T | c.C1154T | T385I |
| Nucleotide change | Nucleotide change | Protein sequence change |
| c.1156C>A | c.C1156A | Q386K |
| c.1157A>T | c.A1157T | Q386L |
| c.1158G>C | c.G1158C | Q386H |
| c.1159C>A | c.C1159A | L387I |
| c.1159C>T | c.C1159T | L387F |
| c.1160T>A | c.T1160A | L387H |
| c.1160T>G | c.T1160G | L387R |
| c.1162C>A | c.C1162A | L388I |
| c.1162C>G | c.C1162G | L388V |
| c.1162C>T | c.C1162T | L388F |
| c.1163T>A | c.T1163A | L388H |
| c.1163T>G | c.T1163G | L388R |
| c.1168G>A | c.G1168A | V390M |
| c.1171A>C | c.A1171C | K391Q |
| c.1171A>G | c.A1171G | K391E |
| c.1172A>C | c.A1172C | K391T |
| c.1172A>G | c.A1172G | K391R |
| c.1172A>T | c.A1172T | K391I |
| c.1173A>T | c.A1173T | K391N |
| c.1174A>G | c.A1174G | R392G |
| c.1174A>T | c.A1174T | R392W |
| c.1175G>A | c.G1175A | R392K |
| c.1175G>C | c.G1175C | R392T |
| c.1175G>T | c.G1175T | R392M |
| c.1177A>C | c.A1177C | K393Q |
| c.1177A>G | c.A1177G | K393E |
| c.1178A>C | c.A1178C | K393T |
| c.1179G>C | c.G1179C | K393N |
| c.1180C>A | c.C1180A | L394I |
| c.1181T>A | c.T1181A | L394Q |
| c.1181T>C | c.T1181C | L394P |
| c.1181T>G | c.T1181G | L394R |
| c.1183G>C | c.G1183C | G395R |
| c.1184G>A | c.G1184A | G395E |
| c.1184G>C | c.G1184C | G395A |
| c.1186T>A | c.T1186A | F396I |
| c.1186T>G | c.T1186G | F396V |
| c.1187T>G | c.T1187G | F396C |
| c.1188C>G | c.C1188G | F396L |
| c.1189T>A | c.T1189A | Y397N |
| c.1189T>C | c.T1189C | Y397H |
| c.1190A>C | c.A1190C | Y397S |
| c.1190A>G | c.A1190G | Y397C |
| c.1190A>T | c.A1190T | Y397F |
| c.1192G>A | c.G1192A | E398K |
| c.1192G>C | c.G1192C | E398Q |
| c.1193A>G | c.A1193G | E398G |
| c.1195T>A | c.T1195A | W399R |
| c.1195T>G | c.T1195G | W399G |
| Nucleotide change | Nucleotide change | Protein sequence change |
| c.1198A>C | c.A1198C | T400P |
| c.1198A>G | c.A1198G | T400A |
| c.1198A>T | c.A1198T | T400S |
| c.1199C>A | c.C1199A | T400N |
| c.1199C>T | c.C1199T | T400I |
| c.1201T>A | c.T1201A | S401T |
| c.1201T>G | c.T1201G | S401A |
| c.1202 1203insGACTTC | c.1202 1203insGACTTC | p.T400 S401dup |
| c.1202C>T | c.C1202T | S401L |
| c.1204A>G | c.A1204G | R402G |
| c.1204A>T | c.A1204T | R402W |
| c.1205G>C | c.G1205C | R402T |
| c.1205G>T | c.G1205T | R402M |
| c.1206G>C | c.G1206C | R402S |
| c.1207T>G | c.T1207G | L403V |
| c.1208T>C | c.T1208C | L403S |
| c.1209A>T | c.A1209T | L403F |
| c.1210A>G | c.A1210G | R404G |
| c.1211G>A | c.G1211A | R404K |
| c.1211G>C | c.G1211C | R404T |
| c.1211G>T | c.G1211T | R404I |
| c.1212A>T | c.A1212T | R404S |
| c.1213A>G | c.A1213G | S405G |
| c.1216C>G | c.C1216G | H406D |
| c.1217A>T | c.A1217T | H406L |
| c.1218C>G | c.C1218G | H406Q |
| c.1219A>T | c.A1219T | I407L |
| c.1220T>C | c.T1220C | I407T |
| c.1221A>G | c.A1221G | I407M |
| c.1222A>C | c.A1222C | N408H |
| c.1222A>G | c.A1222G | N408D |
| c.1222A>T | c.A1222T | N408Y |
| c.1223A>C | c.A1223C | N408T |
| c.1225C>A | c.C1225A | P409T |
| c.1225C>G | c.C1225G | P409A |
| c.1225C>T | c.C1225T | P409S |
| c.1226C>T | c.C1226T | P409L |
| c.1228A>G | c.A1228G | T410A |
| c.1228A>T | c.A1228T | T410S |
| c.1229C>T | c.C1229T | T410I |
| c.1231G>A | c.G1231A | G411S |
| c.1231G>T | c.G1231T | G411C |
| c.1232G>A | c.G1232A | G411D |
| c.1232G>C | c.G1232C | G411A |
| c.1232G>T | c.G1232T | G411V |
| c.1234A>C | c.A1234C | T412P |
| c.1234A>G | c.A1234G | T412A |
| c.1234A>T | c.A1234T | T412S |
| c.1235C>A | c.C1235A | T412N |
| Nucleotide change | Nucleotide change | Protein sequence change |
| c.1235C>T | c.C1235T | T412I |
| c.1237G>A | c.G1237A | V413I |
| c.1237G>T | c.G1237T | V413F |
| c.1238T>G | c.T1238G | V413G |
| c.1240T>G | c.T1240G | L414V |
| c.1242G>C | c.G1242C | L414F |
| c.1243C>A | c.C1243A | L415I |
| c.1244T>A | c.T1244A | L415H |
| c.1246C>G | c.C1246G | Q416E |
| c.1247A>T | c.A1247T | Q416L |
| c.1248G>C | c.G1248C | Q416H |
| c.1249C>A | c.C1249A | L417I |
| c.1252G>A | c.G1252A | E418K |
| c.1252G>C | c.G1252C | E418Q |
| c.1253A>C | c.A1253C | E418A |
| c.1253A>G | c.A1253G | E418G |
| c.1254A>T | c.A1254T | E418D |
| c.1255A>G | c.A1255G | N419D |
| c.1255A>T | c.A1255T | N419Y |
| c.1256A>C | c.A1256C | N419T |
| c.1256A>G | c.A1256G | N419S |
| c.1256A>T | c.A1256T | N419I |
| c.1258A>C | c.A1258C | T420P |
| c.1258A>T | c.A1258T | T420S |
| c.1259C>A | c.C1259A | T420K |
| c.1259C>G | c.C1259G | T420R |
| c.1261A>G | c.A1261G | M421V |
| c.1261A>T | c.A1261T | M421L |
| c.1262T>A | c.T1262A | M421K |
| c.1262T>C | c.T1262C | M421T |
| c.1262T>G | c.T1262G | M421R |
| c.1263G>C | c.G1263C | M421I |
| c.1265A>C | c.A1265C | Q422P |
| c.1267A>T | c.A1267T | M423L |
| c.1268T>A | c.T1268A | M423K |
| c.1268T>C | c.T1268C | M423T |
| c.1269G>C | c.G1269C | M423I |
| c.1271C>T | c.C1271T | S424L |
| c.1275A>C | c.A1275C | L425F |
| c.1279G>A | c.G1279A | D427N |
| c.1286T>G | c.T1286G | L429R |
Pharmacodynamic effects
Treatment with Galafold in phase 2 pharmacodynamic studies generally resulted in increases in endogenous a-Gal A activity in WBCs, as well as in skin and kidney for the majority of patients. In patients with amenable mutations, GL-3 levels tended to decrease in urine and in kidney interstitial capillaries.
Clinical efficacy and safety
The clinical efficacy and safety of Galafold have been evaluated in two phase 3 pivotal clinical studies and two open-label extension (OLE) clinical studies. All patients received the recommended dosage of 123 mg Galafold every other day.
The first phase 3 clinical study (ATTRACT) was a randomised open-label active comparator study that evaluated the efficacy and safety of Galafold compared to enzyme replacement therapy (ERT) (agalsidase beta, agalsidase alfa) in 52 male and female patients with Fabry disease who were receiving ERT prior to clinical study entry and who have amenable mutations (ERT-experienced clinical study). The clinical study was structured in two periods. During the first period (18-months) ERT-experienced patients were randomised to switch from ERT to Galafold or continue with ERT. The second period was an optional 12-month open-label extension in which all subjects received Galafold.
The second phase 3 clinical study (FACETS) was a 6-month randomised double-blind placebo-controlled study (through month 6) with an 18-month open-label period to evaluate the efficacy and safety of Galafold in 50 male and female patients with Fabry disease who were naïve to ERT, or had previously been on ERT and had stopped for at least 6 months and who have amenable mutations (ERT-naïve study).
The first OLE clinical study (AT1001–041) included patients from phase 2 and phase 3 studies and has completed. The mean extent of exposure to the marketed dose of migalastat 123 mg QOD in patients completing study AT1001–041 was 3.57 (±1.23) years (n=85). The maximum exposure was 5.6 years.
The second OLE clinical study (AT1001–042) included patients that either transferred from OLE study AT1001–041 or directly from phase 3 study ATTRACT. The mean extent of exposure to the marketed dose of Galafold 123 mg QOD in patients completing this study was 32.3 (±12.3) months (n=84). The maximum exposure was 51.9 months.
Renal , function
In the ERT-experienced clinical study, renal function remained stable for up to 18 months of treatment with Galafold. Mean annualised rate of change in eGFRCKD-EPI was –0.40 mL/min/1.73 m2 (95% CI: –2.272, 1.478; n=34) in the Galafold group compared to –1.03 mL/min/1.73 m2 (95% CI: –3.636, 1.575; n=18) in the ERT group. The mean annualised rate of change from baseline in eGFRCKD-EPI in patients treated for 30 months with Galafold was –1.72 mL/min/1.73 m2 (95% CI: –2.653, –0.782; n=31).
In the ERT-naïve clinical study and open-label extension, renal function remained stable for up to 5 years of treatment with Galafold. After an average of 3.4 years of treatment, the mean annualised rate of change in eGFRckd-epi was –0.74 mL/min/1.73 m2 (95% CI: –1.89, 0.40; n=41). No clinically significant differences were observed during the initial 6-month placebo-controlled period.
Data for the annualised rate of change for eGRFCKD-EPI was pooled for ERT-naïve subjects and ERT-experienced subjects with amenable mutations; the results showed the durability of renal stabilization up to 8.6 years in annualised rate of change. After a mean duration of 5.2 years, ERT-naïve patients had a mean annualised rate of change from baseline of –1.71 mL/min/1.73 m2 (CI: –2.83, –0.60; n=47). After a mean duration of 4.3 years, ERT-experienced patients had a mean annualised rate of change from baseline of –1.78 mL/min/1.73 m2 (CI: –3.76, 0.20; n=49).
Left ventricular mass index (LVMi)
In the ERT-experienced clinical study, following 18 months of treatment with Galafold there was a statistically significant decrease in LVMi (p<0.05). The baseline values were 95.3 g/m2 for the Galafold arm and 92.9 g/m2 for the ERT arm and the mean change from baseline in LVMi at month 18 was –6.6 (95% CI: –11.0, –2.1; n=31) for Galafold and –2.0 (95% CI: –11.0, 7.0; n=13) for ERT. The change from baseline to month 18 in LVMi (g/m2) in patients with left ventricular hypertrophy (females with baseline LVMi >95 g/m2 and males with baseline LVMi >115 g/m2) was –8.4 (95% CI: –15.7, 2.6; n=13) for Galafold and 4.5 (95% CI: –10.7, 18.4; n=5) for ERT. After 30 months treatment with Galafold, the mean change from baseline in LVMi was –3.8 (95% CI: –8.9, 1.3; n=28) and the mean change from baseline in LVMi in patients with left ventricular hypertrophy at baseline was –10.0 (95% CI: –16.6, –3.3; n=10).
In the ERT-naïve clinical study, Galafold resulted in a statistically significant decrease in LVMi (p<0.05); the mean change from baseline in LVMi at month 18 to 24 was –7.7 (95% CI: –15.4, –0.01; n=27). After follow-up in the OLE, the mean change from baseline in LVMi at month 36 was –8.3 (95% CI: –17.1, 0.4; n=25) and at month 48 was –9.1 (95% CI: –20.3, 2.0; n=18). The mean change from baseline in LVMi at month 18 to 24 in patients with left ventricular hypertrophy at baseline (females with baseline LVMi >95 g/m2 or males with baseline LVMi >115 g/m2) was –18.6 (95% CI: –38.2, 1.0; n=8). After follow-up in the OLE, the mean change from baseline in LVMi at month 36 in patients with left ventricular hypertrophy at baseline was –30.0 (95%) CI: –57.9, –2.2; n=4) and at month 48 was –33.1 (CI: –60.9, –5.4; n=4). No clinically significant differences in LVMi were observed during the initial 6-month placebo-controlled period.
In the ERT-experienced and ERT-naïve clinical studies, after follow up in OLE clinical study AT1001–042, the mean change in LVMi from AT1001–042 baseline was 1.2 g/m2 (95% CI: –5.3, 7.7; n=15) and –5.6 g/m2 (95% CI: –28.5, 17.2; n=4) respectively, for patients treated with Galafold for an average of 2.4 and 2.9 years (up to 4.0 and 4.3 years, respectively).
Disease substrate
In the ERT-experienced clinical study, plasma lyso-Gb3 levels slightly increased but remained low in patients with amenable mutations treated with Galafold for the 30-month duration of the study. Plasma lyso-Gb3 levels also remained low in patients on ERT for up to 18 months.
In the ERT- naïve clinical study, Galafold showed statistically significant reductions in plasma lyso-Gb3 concentrations and kidney interstitial capillary GL-3 inclusions in patients with amenable mutations. Patients randomised to Galafold in Stage 1 demonstrated statistically significant greater reduction (±SEM) in mean interstitial capillary GL-3 deposition (-0.25±0.10; –39%) at month 6 compared to placebo (+0.07 ± 0.13; +14%) (p=0.008). Patients randomised to placebo in Stage 1 and switched to Galafold at month 6 (Stage 2) also demonstrated statistically significant decreases in interstitial capillary GL-3 inclusions at month 12 (-0.33±0.15; –58%) (p=0.014). Qualitative reductions in GL-3 levels were observed in multiple renal cell types: podocytes, mesangial cells, and glomerular endothelial cells, respectively, over 12 months of treatment with Galafold.
Composite clinical outcomes
In the ERT-experienced clinical study, an analysis of a composite clinical outcome composed of renal, cardiac, and cerebrovascular events, or death, showed that the frequency of events observed in the Galafold treatment group was 29% compared to 44% in the ERT group over 18 months. The frequency of events in patients treated with Galafold over 30 months (32%) was similar to the 18-month period.
Patient-reported outcome – gastrointestinal symptoms rating scale
In the ERT-naïve clinical study, analyses of the Gastrointestinal Symptoms Rating Scale demonstrated that treatment with Galafold was associated with statistically significant (p<0.05) improvements versus placebo from baseline to month 6 in the diarrhoea domain, and in the reflux domain for patients with symptoms at baseline. During the open-label extension, statistically significant (p<0.05) improvements from baseline were observed in the diarrhoea and indigestion domains, with a trend of improvement in the constipation domain.
Paediatric population
In Study AT1001–020, a 1-year, Phase 3b, open-label, uncontrolled, multicentre study, the safety, PK, pharmacodynamic (PD), and efficacy of migalastat treatment was evaluated in 21 adolescent subjects (12 to < 18 years of age and weighing > 45 kg) with Fabry disease and who have amenable mutations of the gene encoding a-galactosidase A ( GLA ). Subjects were either naïve to enzyme replacement therapy (ERT) or had stopped ERT at least 14 days before screening. The mean number of years since diagnosis of Fabry disease was 10.2 (± 4.12) years.
At 1 year, the efficacy results in adolescents on the same dosing regimen as adults were consistent in renal, cardiac, and pharmacodynamic results as well as responses to patient-reported outcomes. The overall mean (SD) change from baseline in eGFR was –1.6 (15.4) mL/min/1.73 m2 (n=19). The overall mean (SD) change from baseline for LVMi was –3.9 (13.5) g/m2 (n=18). LVMi decreased in 10 subjects and increased in 8 subjects, but all subjects remained within normal limits at 12 months. Baseline plasma lyso-Gb3 was 12.00 ng/mL and the overall mean (SD) change from baseline in plasma lyso-Gb3 was –0.06 (32.9) (n=19). A reduction in plasma lyso-Gb3 from baseline was observed in ERT-naïve subjects (median –2.23 ng/ml, n=9) and levels remained generally stable in ERT-experienced subjects (median 0.54 ng/ml, n=10). There were no notable changes in patient reported outcomes.
The European Medicines Agency has deferred the obligation to submit the results of studies with Galafold in one or more subsets of the paediatric population in the treatment of Fabry disease (see section 4.2 for information on paediatric use).
5.2 Pharmacokinetic properties
Absorption
The absolute bioavailability (AUC) for a single oral 150 mg migalastat hydrochloride dose or a single 2-hour 150 mg intravenous infusion was approximately 75%. Following a single oral dose of 150 mg migalastat hydrochloride solution, the time to peak plasma concentration was approximately 3 hours. Plasma migalastat exposure (AUCo—, ) and Cmax demonstrated dose-proportional increases at migalastat hydrochloride oral doses from 50 mg to 1,250 mg in adults.
Migalastat administered with a high-fat meal, or 1 hour before a high-fat or light meal, or 1 hour after a light meal, resulted in significant reductions of 37% to 42% in mean total migalastat exposure (AUC0-,) and reductions of 15% to 40% in mean peak migalastat exposure (Cmax) compared with the fasting state (see section 4.2).
Distribution
In healthy volunteers, the volume of distribution (Vz/F) of migalastat following ascending single oral doses (25 to 675 mg migalastat hydrochloride) ranged from 77 to 133 L, indicating it is well distributed into tissues and greater than total body water (42 litres). There was no detectable plasma protein binding following administration of [14C]-migalastat hydrochloride in the concentration range between 1 and 100 pM.
Biotransformation
Based upon in vivo data, migalastat is a substrate for UGT, being a minor elimination pathway. Migalastat is not a substrate for P-glycoprotein (P-gP) in vitro and it is considered unlikely that migalastat would be subject to drug-drug interactions with cytochrome P450s. A pharmacokinetic study in healthy male volunteers with 150 mg [14C]-migalastat hydrochloride revealed that 99% of the radiolabelled dose recovered in plasma was comprised of unchanged migalastat (77%) and 3 dehydrogenated O-glucuronide conjugated metabolites, M1to M3 (13%). Approximately 9% of the total radioactivity was unassigned.
Elimination
A pharmacokinetic study in healthy male volunteers with 150 mg [14C]-migalastat hydrochloride revealed that approximately 77% of the radiolabeled dose was recovered in urine of which 55% of was excreted as unchanged migalastat and 4% as combined metabolites M1, M2 and M3. Approximately 5% of the total sample radioactivity was unassigned components. Approximately 20% of the total radiolabeled dose was excreted in faeces, with unchanged migalastat being the only measured component.
Following ascending single oral doses (25 to 675 mg migalastat hydrochloride), no trends were found for clearance, CL/F. At the 150 mg dose, CL/F was approximately 11 to 14 L/hr. Following administration of the same doses, the mean elimination half-life (t1/2) ranged from approximately 3 to 5 hours.
Special populations
Patients with renal impairment
Galafold has not been studied in patients with Fabry disease who have a GFR less than
30 mL/min/1.73 m2. In a single dose study with Galafold in non-Fabry subjects with varying degrees of renal insufficiency, exposures were increased by 4.3-fold in subjects with severe renal impairment (GFR <30 mL/min/1.73 m2).
Patients with hepatic impairment
No studies have been carried out in subjects with impaired hepatic function. From the metabolism and excretion pathways, it is not expected that a decreased hepatic function may affect the pharmacokinetics of migalastat.
Elderly ( 65 years)
Clinical studies of Galafold included small number of patients aged 65 and over. The effect of age was evaluated in a population pharmacokinetic analysis on plasma migalastat clearance in the ERT-naive study population. The difference in clearance between Fabry patients > 65 years and those < 65 years was 20%, which was not considered clinically significant.
Paediatric , population
The pharmacokinetics of migalastat were characterised in 20 adolescent subjects (12 to < 18 years and weighing >45 kg) with Fabry disease who received the same dosage regimen as adults (123 mg migalastat capsule every other day) in an open label phase 3b trial (AT1001–020).
Assessment of bioequivalence of exposure was simulated in adolescent subjects (12 to < 18 years) weighing > 45 kg and receiving migalastat 123 mg once every other day compared to adults receiving the same dosing regimen. Model derived AUCtau in adolescent subjects (12 to < 18 years) were similar to adult exposures.
Gender
The pharmacokinetic characteristics of migalastat were not significantly different between females and males in either healthy volunteers or in patients with Fabry disease.
5.3 Preclinical safety data
Non-clinical studies suggest no specific hazard for humans on the basis of single-and repeat-dose studies, with the exception of transient and fully reversible infertility in male rats associated with migalastat treatment. The infertility associated with migalastat treatment was reported at clinically relevant exposures. Complete reversibility was seen after 4 weeks off-dose. Similar findings have been noted pre-clinically following treatment with other iminosugars. In the rabbit embryo-foetal toxicity study, findings including embryo-foetal death, a reduction in mean foetal weight, retarded ossification, and slightly increased incidences of minor skeletal abnormalities were observed only at doses associated with maternal toxicity.
In a rat 104-week carcinogenicity study, there was an increased incidence of pancreatic islet cell adenomas in males at a dose level 19-fold higher than the exposure (AUC) at the clinically efficacious dose. This is a common spontaneous tumour in ad libitum -fed male rats. In the absence of similar findings in females, no findings in the genotoxicity battery or in the carcinogenicity study with Tg.rasH2 mice, and no pre-neoplastic pancreatic findings in the rodents or monkeys, this observation in male rats is not considered related to treatment and its relevance to humans is unknown.
6. PHARMACEUTICAL PARTICULARS6.1 List of excipients
Capsule contents
Pregelatinised starch (maize)
Magnesium stearate
Capsule shell
Gelatin
Titanium dioxide (E171)
Indigo carmine (E132)
Printing ink
Shellac
Black iron oxide
Potassium hydroxide
6.2 Incompatibilities
Not applicable.
6.3 Shelf life
4 years
6.4 Special precautions for storage
This medicinal product does not require any special temperature storage conditions. Store in the original package in order to protect from moisture.
6.5 Nature and contents of container
PVC / PCTFE / PVC/Al blister.
Pack size of 14 capsules.
6.6 Special precautions for disposal
Any unused medicinal product or waste material should be disposed of in accordance with local requirements.
7. MARKETING AUTHORISATION HOLDER
Amicus Therapeutics Europe Limited
Block 1, Blanchardstown Corporate Park
Ballycoolin Road
Blanchardstown, Dublin
D15 AKK1
Ireland
Tel: +353 (0) 1 588 0836
Fax: +353 (0) 1 588 6851
e-mail:
8. MARKETING AUTHORISATION NUMBER(S)
EU/1/15/1082/001
9. DATE OF FIRST AUTHORISATION/RENEWAL OF THE AUTHORISATION
Date: of first authorisation: 26 May 2016
Date of latest renewal: 11 February 2021