FDA Approves Gene Therapy for Deadly Form of Muscular Dystrophy

Elevidys, the first gene therapy for treating the rare and deadly muscle disorder Duchenne muscular dystrophy (DMD) has been approved by the U.S. Food and Drug Administration (FDA) in children aged 4 and 5 years, without a pre-existing medical reason that prevents this therapy. This approval addresses an urgent unmet medical need and is an important advancement in the treatment of Duchenne muscular dystrophy, a devastating condition with limited treatment options, that leads to a progressive deterioration of an individual’s health over time().

The FDA remains committed to facilitating the development of innovative new therapies to reduce the impact of debilitating diseases and to improve outcomes and quality of life for those affected.

Duchenne muscular dystrophy is a rare and serious genetic condition that worsens over time, leading to weakness and wasting away of the body’s muscles. The disease occurs due to a defective gene that results in the absence of dystrophin, a protein that helps keep the body’s muscle cells intact.

As a result of this genetic defect, individuals with DMD may have symptoms such as trouble walking and running, falling frequently, fatigue, learning disabilities/difficulties, heart issues as a result of the impact on heart muscle functioning, and breathing problems due to weakening of respiratory muscles involved in lung function.

Symptoms of muscle weakness associated with DMD typically begin in childhood, often between 3 to 6 years of age. DMD mainly affects males and in rare cases may affect females. About one in every 3,300 boys are affected by this disorder.

As the disease progresses, life-threatening heart and respiratory problems can occur. Although disease severity and life expectancy vary, patients often succumb to the disease in their 20s or 30s because of heart and/or respiratory failure.

First Gene Therapy for Deadly Form of Muscular Dystrophy Gets FDA Approval for Young Kids

Most current treatment approaches address the symptoms of the disease, but not its underlying genetic cause. Treatments include corticosteroid medications to slow down the progression of muscle weakness, stretching, and exercise programs, and the use of equipment such as braces or a wheelchair as walking becomes more difficult.

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Antisense oligonucleotides (ASOs) facilitate exon skipping for specific DMD gene mutations, but the ASOs can only address a minority of the gene mutations and require repeated administration.

Elevidys is a recombinant gene therapy designed to deliver into the body a gene that leads to the production of Elevidys micro-dystrophin, a shortened protein that contains selected domains of the dystrophin protein present in normal muscle cells. The product is administered as a single intravenous dose.

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Elevidys was approved through the Accelerated Approval pathway, under which the FDA may approve drugs for serious or life-threatening diseases where there is an unmet medical need and the drug is shown to have a clinical benefit to patients. This pathway generally provides patients earlier access to promising new drugs while the company conducts clinical trials to verify the predicted clinical benefit().

The FDA granted approval based on an evaluation of data submitted by the sponsor. In one study which involved two parts, individuals in part 1—which was randomized, double-blind, and placebo-controlled—were treated with either Elevidys or placebo and followed for 48 weeks.

In part 2 of the study, individuals who received a placebo during part 1 were treated with Elevidys, and individuals treated with Elevidys during part 1 received a placebo. All individuals were followed for an additional 48 weeks.

The accelerated approval of Elevidys was based on data from the randomized clinical trial that established that Elevidys increased the expression of the Elevidys micro-dystrophin protein observed in Elevidys-treated individuals aged 4 to 5 years with DMD.

The FDA concluded that the data submitted by the applicant demonstrated that an increase in this surrogate endpoint (expression of Elevidys micro-dystrophin) is reasonably likely to predict clinical benefit in individuals 4 to 5 years of age with DMD who do not have significant pre-existing antibody titers.

The required study is designed to assess whether Elevidys improves physical function and mobility in ambulatory DMD patients with a confirmed mutation in the DMD gene. The study is ongoing and fully enrolled. The agency will review the data from this trial as quickly as possible to consider if further action, such as a revised indication or withdrawal of Elevidys, may be necessary.

The most reported side effects by individuals who received Elevidys were vomiting, nausea, acute liver injury, pyrexia (fever), and thrombocytopenia (abnormally low platelet count in the blood). Patients’ liver function should be monitored before treatment with Elevidys, and weekly for the first three months after treatment.

Patients given Elevidys may also be at risk for severe immune-mediated myositis (muscle inflammation). Additionally, myocarditis (inflammation of heart muscle) and elevations of troponin-I (a heart protein found in the blood after heart muscle injury) have been observed following the use of Elevidys in clinical trials.

References:

1. Duchenne muscular dystrophy - (https://www.nature.com/articles/s41572-021-00248-3)
2. Gene Therapy for Duchenne Muscular Dystrophy - (https://content.iospress.com/articles/journal-of-neuromuscular-diseases/jnd210678)

Source-IANS