Spinal muscular atrophy (SMA) is a rare genetic disease that progressively affects motor neurons in the spine and brainstem. It leads to weakness of voluntary muscles, which can affect speaking, eating, walking, and breathing, among other things.
SMA is typically diagnosed through genetic testing or newborn screening in infants and children. As noted in a 2019 article from the American Academy of Pediatrics, it’s the most common inherited cause of childhood mortality.
There are four types of SMA: type 1, type 2, type 3, and type 4.
According to the Muscular Dystrophy Association, children who display symptoms at birth or during infancy often have type 1 SMA, which significantly impacts motor function. The earlier symptoms begin, the greater the impact, with type 1 being the most impactful.
But a new innovative gene therapy approved in May 2019 to treat children less than 2 years old is providing hope for families affected by SMA.
Onasemnogene abeparvovec-xioi (brand name Zolgensma) is the first gene therapy approved to treat children living with SMA.
In May 2019, the
Specifically, Zolgensma is indicated for children 2 years old and younger without end-stage weakness.
The single dose gene therapy is given as a one-time infusion into the vein using an IV. The procedure takes several hours, with the infusion running for 60 minutes.
After the infusion is complete, the healthcare team will monitor your child for 2 hours. Both during the infusion and after, your child’s vitals will be monitored. Follow-up appointments that include lab tests are required for up to 1 year.
SMA affects the motor nerve cells in the spinal cord. This disease is caused by an inherited faulty SMN1 gene. This causes children to have problems holding their heads up, breathing, and swallowing.
Mutations caused by the SMN1 gene are classified based on the age of onset and severity, with the most common and severe being infantile-onset SMA. Unfortunately, many children affected by type 1 SMA don’t survive past early childhood.
The one-time-only dose of Zolgensma targets the genetic root cause of SMA and replaces the function of the missing or nonworking SMN1 gene with a new, working copy of a human SMN gene. This helps the motor neurons work properly.
It’s important to note that Zolgensma doesn’t change or become part of the child’s DNA.
Researchers indicate that the earlier children receive spinal muscular atrophy gene therapy, the better the results. Children who get this one-time intravenous administration of Zolgensma may notice an improvement in muscle movement and function.
Clinical trials also show a decreased need for respiratory support and an improvement in survival rate. Trials haven’t focused on children with advanced SMA.
According to the data, the most common side effects of Zolgensma are elevated liver enzymes and vomiting.
Children with a preexisting liver impairment face an increased risk for serious liver injury if treated with Zolgensma. Because of this, liver function should be assessed prior to treatment and monitored for a minimum of 3 months after treatment, according to safety information from Novartis.
Thorough screening and careful post-gene transfer management is critical to the safety and effectiveness of replacement therapy with onasemnogene abeparvovec-xioi.
Experts are hopeful about the future with SMA gene therapy.
According to a 2020 study published in the journal Pediatrics, safety and early outcome from the first 21 children (ages 1 to 23 months) treated in Ohio shows that gene transfer was well tolerated in children 6 months old and younger.
Older children, however, experienced higher elevations in aspartate aminotransferase, alanine aminotransferase, and γ-glutamyl transpeptidase, which required a higher dose of prednisolone.
Overall, researchers believe the results of the study are promising. More specifically, they report that symptomatic patients experienced functional improvements in motor functioning, both subjective and objective.
What’s more, researchers also report that five children treated prior to symptom onset didn’t develop the signs of weakness typical of SMA.
One concern to note is the
There are still ongoing clinical trials testing the efficacy and safety of Zolgensma in various patients, representing different ages and SMA types.
Considering the recent approval for use and high cost of Zolgensma, continued research is needed. At this time, approval for use is also limited to those under 2 years of age.
Other FDA-approved treatments currently used to treat SMA include Spinraza and Evrysdi.
Spinraza is approved for all ages and types of SMA. It’s a intrathecal injection, meaning it’s injected into the spinal fluid and must be administered by a healthcare professional. Dosage involves four injections over the first 2 months, followed by maintenance doses every 4 months.
Evrysdi is approved for those 2 months of age and older. It’s a daily oral medication taken at home.
There are other treatments still being researched.
Spinal muscular atrophy is a rare but serious genetic disease that affects the peripheral nervous system, central nervous system, and voluntary muscle movement. Children with type 1 SMA face a greater impact on motor function.
Results from ongoing clinical trials show promising improvements in the quality of life for those affected by SMA, thanks to gene replacement therapy.
For more information about single-dose gene replacement therapy for spinal muscular atrophy, talk to your doctor.