agalsidase alfa + agalsidase beta + pegunigalsidase alfa

Combination therapy consisting of **agalsidase alfa**, **agalsidase beta**, and **pegunigalsidase alfa**, all of which are recombinant forms of human alpha-galactosidase A used as enzyme replacement therapies (ERTs) for **Fabry disease**. - **Agalsidase alfa** and **agalsidase beta** are both recombinant, human α-galactosidase A enzymes, differing in production method and glycosylation patterns. Both are administered intravenously and are taken up by cells via the mannose-6-phosphate receptor pathway[1][7]. - **Pegunigalsidase alfa** is a PEGylated, recombinant α-galactosidase A, distinguished by prolonged half-life, PEG modification to reduce immunogenicity, and production in plant cell cultures that results in different glycosylation. Pegunigalsidase alfa enters cells via non-mannose-6-phosphate pathways[1][11][15]. All three drugs act by supplementing deficient or absent α-galactosidase A activity in Fabry disease patients, reducing accumulation of globotriaosylceramide (Gb3) and related glycolipids in lysosomes, with the aim of improving organ function and alleviating disease manifestations[1][15]. Currently, there are no approved branded products or recognized protocols using this specific triple combination therapy together. Each drug is primarily used as monotherapy, sometimes compared or sequentially administered in clinical trials[1][13][15].