Valproic Acid Combo Therapy Fails to Improve Survival of SMA Type I Infants, Clinical Trial Shows

Some discouraging news for the SMA community, as, according to the results of the CARNIVAL clinical trial, Valproic acid, also known as VPA, combined with L-carnitine does not improve the survival of SMA type I patients Previous studies suggested that VPA is a potential therapeutic candidate for SMA. In the CARNIVAL Type I trial, researchers led by Boston's Massachusetts General Hospital set out to investigate the safety and therapeutic potential of VPA, combined with L-carnitine, in infants with SMA. L-carnitine is a compound involved in cellular energy production. The Phase 2 study enrolled 37 infants with SMA type I aged two weeks to 12 months from seven clinics in the United States and Canada, and one in Germany. Cure SMA and Cure SMA Canada funded the study for the North American sites. Patients completed two screening visits within a two-week period to establish disease parameters at baseline. The babies then received two daily doses of L-carnitine and VPA. Researchers measured treatment effects at three and six months and compared them to an untreated, matched disease group of 57 type I infants. They chose controls retrospectively from a larger cohort of 151 SMA type I infants enrolled in the  University of Utah's Project Cure SMA database. The study's primary endpoint was to determine the treatment's safety and adverse effects. Secondary endpoints included survival, time to death or ventilator dependence, defined as more than 16 hours of ventilator support per day. Researchers detected 245 adverse effects, mostly related to respiratory problems, in 95 percent of patients. These resulted in 14 deaths. Overall, the CARNIVAL Type I trial proves no survival benefit for infants with SMA type I treated with L-carnitine/VPA.

Spotlight Innovation, Indiana University to Jointly Research, Develop New SMA Therapies

Spotlight Innovation has entered into a sponsored research agreement with Indiana University to develop safe and effective therapeutic options for the treatment of spinal muscular atrophy. The partnership will seek to continue development of STL-182, the company’s lead product candidate for treating SMA. STL-182 is an orally-available small molecule that has been shown to have potential therapeutic effect in the treatment of SMA. Spotlight has previously reported that STL-182 has shown the potential in SMA mouse models to restore neuromuscular function by stabilizing such SMN protein levels. Dr. Elliot Androphy, inventor of the therapy, is also the chair of the Department of Dermatology of Indiana University School of Medicine. At Indiana, Androphy has used a novel, cell-based high throughput screen for compounds that increase SMN protein levels – work that has led to the identification of pre-clinical drug candidates for SMA.

Molecule Shows Potential to Treat Mild Cases of SMA in Early Study

According to a new study, a molecule known as A15/283 being developed to treat SMA , has shown significant efficacy in male mouse models of the disease. A15/283 is a DNA sequence that binds to mRNAs, which are the intermediary molecules between the DNA and the protein. Since mRNAs must be single-stranded in order to become “translated” into proteins, the binding of this DNA sequence to mRNA molecules renders the mRNA unable to be turned into a protein, as the molecule is now double-stranded. Using this technique against a degradation protein that would otherwise degrade SMN will likely boost SMN levels. Researchers gave A15/283 to mouse models of SMA lacking the SMN protein once and again three days after birth. Results showed gender-specific improvement of tail necrosis in male mice. Researchers also observed a modest increase in SMN protein levels, leading to significant improvement in certain symptoms specific to SMA in mice. Researchers also concluded that early administration of A15/283 led to a near-total correction in expression levels due to increases in the SMN protein. “These results in the mouse model are very promising for the possible treatment of mild spinal muscular atrophy cases in children,” Dr. Ravindra Singh, a professor of biomedical sciences at Iowa State's College of Veterinary Medicine, said in a press release. “We’re hoping this line of research could someday lead to clinical trials, but more work remains before that can happen.”

A Young Woman’s SMA Fundraising Journey from Lemonade Stand to Gala Celebrating Spinraza

Alyssa Silva was 8 years old when she set up a lemonade stand one summer day and saved the proceeds to benefit spinal muscular atrophy, which she had been diagnosed with at 5 months old. Although modest, her lemonade sales set the tone for years to come – she had been bitten by the fundraising bug. Now, at age 26, Silva’s nonprofit business WOW (Working on Walking) is holding a major fundraiser on Saturday, Aug. 26, in Providence, Rhode Island. This gala is different than the others and especially dear to Silva. It celebrates the first year that Biogen’s Spinraza, the first approved treatment for SMA, has been on the market. Spinraza was authorized in December 2016, which is when Silva began treatment. At the time she was in the middle of a clinical trial and the commercialization of the new drug. Biogen is the major sponsor of Saturday’s gala. “It’s a brand-new event this year. It’s both terrifying and exciting at the same time,” said Silva, who lives in nearby Cumberland with her parents. She said 100 percent of the proceeds will benefit SMA. They will be split between Cure SMA and Boston Children’s Hospital, which has an SMA clinic that distributes Spinraza. “The SMA clinic at Boston Children’s needs the money for research – they don’t get a lot from the hospital, so we give money to them,” Silva said. Tickets to the gala are $85, more than for any event WOW has held before. There will be food stations, a band, dancing, silent auctions and raffles. The wheelchair-bound young woman writes a blog called, a column for SMA News Today called “Life, One Cup at a Time,” and graduated from college in 2013 with a business degree in marketing. She hopes to be a writer some day, though she doubts she’ll ever stop raising money for SMA. “It’s my joy, my passion project, but I don’t see it as the main component of my future,” she said. One year, 500 people attended the golf and dinner fundraiser. The annual WOW event generated $37,000 one year. In 2014 Silva decided to obtain nonprofit certification for WOW. Regarding the breakthrough SMA drug, Silva said Spinraza has improved her speech, respiratory function, and stamina. Although she classifies the changes as less than sweeping, the therapy "has made a big difference in my life,” she said. Her family has been her strength through the difficulties she's endured with SMA, Silva said. Her parents and big brother Adam, who is married and lives down the street, have been instrumental in helping her stay optimistic about her future, she said.

AAN Forms Therapy Pricing Panel to Help Neurologists Treat SMA and Other Diseases

As potentially lifesaving, but costly, therapies become available for rare genetic diseases — such as Spinraza (nusinersen) for spinal muscular atrophy — neurologists are finding themselves in the increasingly uncomfortable position of deciding which patients are most likely to benefit, and how they can help families pay for such treatments. In response, the Minneapolis-based American Academy of Neurology (AAN) has formed a Neurology Drug Pricing Task Force to make recommendations and provide guidance to AAN members feeling overwhelmed at these tasks. Its goal, said Dr. Nicholas E. Johnson, a pediatric neurologist and assistant professor at the University of Utah who heads the effort, is to try to define a workable ground between “what the [treatment’s] label says” about who might receive it, and “what the insurance company says” about whom it will cover. “It’s nearly a full-time effort for a single staff person to work through the insurance approvals,” Johnson told SMA News Today in a phone interview from Salt Lake City, where he also has a practice. “This is a national problem from the physician’s side, because these drugs provide some risk in that they have to be administered through a spinal tap, and because these drugs carry such a high cost.” Spinraza received approval from the U.S. Food and Drug Administration (FDA) in December 2016 as the first disease-modifying treatment for all forms of SMA. Manufactured by Biogen, it has shown highly promising results in clinical trials in young children, but carries a high price tag. Treatment costs an average of $750,000 for the first year and $375,000 for every year after that. “We’ve been trying to get this medicine for a few adults with SMA and have been denied coverage,” Johnson said. “Thankfully, Biogen’s Patient Assistance Program has stepped in to help these patients out. In the long run, the AAN is there to provide advocacy for both neurologists and the patients they care for, and to make sure patients are provided medications that have disease-modifying, life-altering effects in a sustainable fashion.” Normally, doctors have some leeway in using new medications in various settings and on a variety of patients, Johnson said. But in Spinraza’s case, “even though it was approved for all ages and all types of SMA, there’s very limited data in adults who have SMA, so this is a real challenge for providers,” he added. The task force hasn’t yet offered any recommendations, and those made will require AAN leadership approval before being publicized. Besides Spinraza, therapies it will look at include Brineura for Batten disease, estimated to cost $702,000 a year, and Exondys 51 for Duchenne muscular dystrophy, which costs an estimated $300,000 annually. “Even though it’s a rare disease, there are quite a few patients out there with SMA,” he said. “Utah’s state Medicaid budget is around $100 million a year. If you consider the costs of this drug for our 130 SMA patients, it would easily dwarf the rest of the budget. So we regard this as a very urgent issue.”