Spinraza Clinical Trial Updates Confirm Treatment Benefits in All SMA Types

Spinraza Clinical Trial Updates Confirm Treatment Benefits in All SMA Types

A Phase 3 clinical trial evaluating Spinraza (nusinersen) in children with type 2 spinal muscular atrophy (SMA) may play a decisive role in whether private insurers cover the treatment in later-onset SMA patients — those with type 2 and type 3.

The study was the focus of an Emerging Science Session presentation Tuesday at the annual American Academy of Neurology meeting in Boston. Dr. Richard Finkel, a trial investigator and chief of neurology at Nemours Children’s Hospital in Orlando, Florida, delivered the presentation.

The high cost of Spinraza has been an issue in whether insurers should cover the drug.

CHERISH (NCT02292537) investigated the effectiveness of Spinraza, versus a placebo, in 126 children between the ages of 2 and 12 who were diagnosed with SMA after they were 6 months old. All were able to sit, but not walk, independently. Each was treated with four 12-mg doses of Spinraza or a placebo over 15 months.

Data from an interim analysis, released in November, showed a significant improvement in motor skills and muscle function, as measured by a greater than three-point improvement in the Hammersmith Functional Motor Scale-Expanded (HFMSE) after 15 months. Mean improvement in the CHERISH trial was four points in treated children, compared with a 1.9-point decrease in the non-treated group.

That data, together with promising interim results from another Phase 3 trial in infants with type 1 SMA, led to Spinraza becoming the first SMA therapy to receive U.S. Food and Drug Administration approval to treat SMA types 1–4 in children and adults, in December 2016. The other trial was the ENDEAR study (NCT02193074).

The $125,000-per-vial price that Biogan put on Spinraza was met with criticism and concern, however. That price means the first year of treatment will likely cost $625,000 to $750,000 for five or six injections. And subsequent years of three injections annually will be about $375,000.

Two insurance companies, Humana and Anthem, announced they will cover Spinraza only in patients with SMA type 1, and only if they respond to treatment. United Healthcare has said it will cover patients with SMA type 1, 2 and 3, but with limitations on its initial and continued use.

Biogen, which is licensing Spinraza from Ionis Pharmaceuticals, has set up a program to help families with health insurance approvals and financial support.

Both CHERISH and ENDEAR were stopped early after Spinraza proved effective. The enrolled children were moved to an ongoing open-label extension study, SHINE (NCT02594124), where all patients are receiving the treatment.

In additional presentations at the Boston meeting, Biogen researchers showcased data from the ENDEAR and NURTURE trials.

A Monday morning presentation of data from ENDEAR showed that participants continued improving, compared with a previous interim analysis. Fifty-one percent of treated children met motor developmental milestones, compared with none of those receiving the sham procedure, the results indicated.

Spinraza also nearly halved the risk of a patient having to go on ventilation, or a patient dying, and it increased patients’ overall survival. A majority, 71 percent, improved their scores on the CHOP INTEND assessment of neuromuscular function, compared with 3 percent in the control group.

The NURTURE Phase 2 study (NCT02386553) looked at Spinraza in infants with a genetically confirmed SMA diagnosis who had yet to develop symptoms. The children were followed from just after birth to 2 1/2 years of age.

The trial’s main outcome measure, to be presented on Thursday afternoon, was the time to death or a patient having to go on mechanical ventilation.

This ongoing study has enrolled 20 participants, of which 13 had two copies of the SMN2 gene. Such a low gene copy number is usually seen in patients with SMA type 1.

As of  Oct. 31, 2016, all children in the study were alive without the need for ventilation. This meant that the study met its primary endpoint, as did the earlier trials of the treatment.

Researchers also examined motor developmental milestones using the Hammersmith Infant Neurological Examination (HINE) scale. It showed improvements in 89 percent of treated infants, who also had weight gain similar to that in normally developing children. Muscle electrical properties also improved in most children.

Biogen explained the design of the CHERISH study in a poster session showcased on Tuesday.

15 comments

  1. Atif says:

    Dear Concern’s
    My name is atif ali and im from pakistan my 6years old son suffring from SMA2 his desease diagnosed at age of 2year i tried lot of doctors and discussed with neurologist but not found any treatment please help me to treatment for my son i am very upset in pakistan there is no any oppertunity for schools and treatment of my son when i read about spinraza i got hope for my son i can not afford price of treatment but i have bleleave on GOD please contact and help me for treatment for my son i will be very thankfull.

    • Magdalena Kegel says:

      Dear Atif,
      I am very sorry to hear about your son. We are a news and information site about SMA, and we are, unfortunately, not able to help setting up treatments for patients. I really do hope that you find a solution to get access to Spinraza.

      I am also not sure if you are still in Pakistan or elsewhere. If you are in the U.S. or Europe, there is a possibility for your son to join a clinical trial. Please check back here for more information about clinical trials.

  2. Dhaval says:

    My son age 1 month is diagnosed for SMA in India, i have not found any treatment or cure please help me to find the treatment or any clinical trial.

    • Magdalena Kegel says:

      Hi Dhaval,
      I’m sorry to hear about your son. I am not sure there are any trials ongoing in India. Please search the https://clinicaltrials.gov registry to find trials in your area. If you sign up for the SMA News Today newsletter, we frequently also include information about available clinical trials.
      I really do hope you will find care for your son.

  3. Robert Tihanyi says:

    Is it possible for a child in Vietnam to be considered for a Spinraza trial? I believe that this child is on a respirator and also that the parents would have practically no chance of being able to afford the drug at the prices given. He is very ill and I am asking if he could be considered for inclusion in one of the existing trials.

    • Magdalena Kegel says:

      Hi Robert,
      We at SMA News Today are not involved in the clinical trials, we merely report on them. Please contact trial staff directly. You can find contact details in the trial registration pages if you follow the links (starting with NCT) provided in the article. I hope you will find care for the child.

  4. RN says:

    Why does the article says “first SMA therapy to receive U.S. Food and Drug Administration approval to treat SMA types 1–3 in children and adults”? Is it proven that it does not have any effect on Type 4? My wife has been diagnosed SMA type 4 and I was still hopeful that Spinraza might help her one day. This is the only source that excluded Type 4. Do you have a reference?

    • Magdalena Kegel says:

      Hi,
      Thank you for making us aware of the error. Spinraza is, just like you say, approved for children and adults with SMA, without any restrictions regarding type. I have now updated the article.

  5. MOSCHETTI Fabio Massimo says:

    Hi. I’m writing from Italy and at the moment medical specialists refer that Spinraza is adopted, in Italy, to treat only SMA Type 1,2 and 3. My wife with SMA type 4 would be escluded from therapy. A genetist from Gemelli Hospital of Rome says to me that there aren’t evidencies of efficiency in the treatment of adults with nusinersen because of the absence of experimentation on them. Therefore the benefit/cost ratio for adults may be dubt or limited considering the form of treatment (intratertial injections)and the evolution of desease. What about? Thks.

  6. Ehab Nabih says:

    Dear

    do you have any evidence prove that the medicine has treated any of the SMA during the first year of use of Spinraza

    Ehab Nabih

  7. Ehab Nabih says:

    Dear all
    have you got any news of success of anyone tool the medicine and now they are walking

    please update us since the cost is very high then the hope should be equal

    ehab

  8. Ardeshir Viccaji says:

    It appears that no trials are being done for SMA treatment in Pakistan. A friend has reported a 2 month old baby in Pakistan with this ailment . Of course the price of medication would be impossible to meet , so the child is doomed .
    PLEASE advise me if there is any way out of this Dilemma in 3rd world countries or if any trials are likely to take place elsewhere in a neighbouring country.

    • Magdalena Kegel says:

      Hi Ardeshir,
      Unfortunately, there doesn’t seem to be any SMA trials in Pakistan. At the moment, I am really sorry to say that I don’t have any information about Spinraza trials in neighboring countries either, but this may change in the future. The best I can advise you at the moment is to check back with https://clinicaltrials.gov — a site you can search for trials by country.

  9. Younus Ali says:

    Hi magdanela, my name is younus ali from pakistan, my daughter is diagnosed with SMA 1, she is currently admit at ziauddin hospital karachi with phnemonia, i just read about spinraza, and its cost, please help me in this hard situation of my life, if you have any solution or any help please contact me at +93334 6253654 or younuskhanyousufzai@hotmail.com

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