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Novartis reveals hard-hitting five-year data for its gene therapy Zolgensma in spinal muscular atrophy

Published on 25/03/20 at 12:50pm

Novartis has revealed five-year data on its gene therapy Zolgensma, boasting that the one-time infusion demonstrated “rapid, significant and clinically meaningful therapeutic benefit” in spinal muscular atrophy (SMA) patients.

One of the studies, the Phase 3 SPR1NT trial, tested the therapy in presymptomatic SMA patients, at least six weeks old, with two or three copies of the SMN2 gene. This totalled 14 patients with two copies and 15 patients with three copies.

All two-copy patients either achieved or maintained a Children's Hospital of Philadelphia Infant Test of Neuromuscular Disorders (CHOP INTEND) score of at least 50, and nine scored at least 58, three of which were for three consecutive visits. Untreated patients rarely score at least 40. Eight patients of this group were able to sit independently for at least 30 seconds, seven of which were within normal development milestones.

In the three-copy group, four were able to stand unsupported for at least three seconds, and three were able to walk independently, all within normal development.

Some patients had not passed the developmental window for these milestones, and these will be reported at a later date.

All of these patients suffered at least one adverse event; 17 of these were determined to be treatment-related, the most common of which were pyrexia and upper respiratory tract infection.

The STR1VE-US Phase 3 study was designed to assess Zolgensma in symptomatic SMA type 1 patients with SMA Type 1, younger than six months at the time of dosing, with one or two copies of the SMN2 backup gene and who have bi-allelic SMN1 gene deletion or point mutations.  

The findings revealed that 91% of 22 patients achieved event-free survival within 14 months, meeting the study’s co-primary endpoint.  59% were able to sit for at least 30 seconds at 18 months of age – a crucial milestone and something which has never before been seen in the natural history of the disease.

Furthermore, 41% showed the “ability to thrive” by the time the same age, defined by achievements such as maintaining weight consistent with their gender and age, tolerating thin liquid or not requiring the use of a feeding tube or other non-oral nutrition.

“The bar for treatment efficacy in SMA Type 1 patients has been raised beyond event-free survival and motor milestone achievement, and the expectation is now that these patients maintain the ability to thrive, an unprecedented and challenging endpoint,” remarked Lisa Deschamps, Chief Business Officer at AveXis. “Further, with hundreds of patients now treated, including some more than five years post-treatment and more than five years old, these new data further reinforce the profound benefit a one-time dose of Zolgensma has on SMA patients.”

These findings were originally due to be presented at the 2020 MDA Annual Conference, but the event was forced to cancellation as a result of the global COVID-19 outbreak. They were instead revealed during a virtual clinical trial session conducted by the Muscular Dystrophy Association (MDA).

“SMA is a disease that robs babies of the ability to talk, eat, sit up and even breathe. In complete contrast to the natural course of the disease, patients who received Zolgensma soon after birth before the onset of symptoms are achieving age-appropriate motor milestone development – an extraordinary outcome for SMA patients,” commented Dr Olga Santiago, Chief Medical Officer at AveXis. “These SPR1NT data demonstrate the truly transformational impact a one-time dose of gene therapy can have, and further underscore the importance of newborn screening and early intervention to alter the course of the disease.”

Novartis received approval for the gene therapy to treat SMA in Japan just last week.

Matt Fellows

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