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Nusinersen versus Sham Control in Later-Onset Spinal Muscular Atrophy

Journal article
Authors E. Mercuri
B. T. Darras
C. A. Chiriboga
J. W. Day
C. Campbell
A. M. Connolly
S. T. Iannaccone
J. Kirschner
N. L. Kuntz
K. Saito
P. B. Shieh
Mar Tulinius
E. S. Mazzone
J. Montes
K. M. Bishop
Q. Yang
R. Foster
S. Gheuens
C. F. Bennett
W. Farwell
E. Schneider
D. C. De Vivo
R. S. Finkel
Cherish Study Grp Cherish Study Grp
Published in New England Journal of Medicine
Volume 378
Issue 7
Pages 625-635
ISSN 0028-4793
Publication year 2018
Published at Institute of Clinical Sciences, Department of Pediatrics
Pages 625-635
Language en
Links dx.doi.org/10.1056/NEJMoa1710504
Keywords functional motor scale, lumbar puncture, headache, children, severity, backache, protein, trials, General & Internal Medicine
Subject categories Pediatrics

Abstract

BACKGROUND Nusinersen is an antisense oligonucleotide drug that modulates pre-messenger RNA splicing of the survival motor neuron 2 (SMN2) gene. It has been developed for the treatment of spinal muscular atrophy (SMA). METHODS We conducted a multicenter, double-blind, sham-controlled, phase 3 trial of nusinersen in 126 children with SMA who had symptom onset after 6 months of age. The children were randomly assigned, in a 2: 1 ratio, to undergo intrathecal administration of nusinersen at a dose of 12 mg (nusinersen group) or a sham procedure (control group) on days 1, 29, 85, and 274. The primary end point was the least-squares mean change from baseline in the Hammersmith Functional Motor Scale-Expanded (HFMSE) score at 15 months of treatment; HFMSE scores range from 0 to 66, with higher scores indicating better motor function. Secondary end points included the percentage of children with a clinically meaningful increase from baseline in the HFMSE score (>= 3 points), an outcome that indicates improvement in at least two motor skills. RESULTS In the prespecified interim analysis, there was a least-squares mean increase from baseline to month 15 in the HFMSE score in the nusinersen group (by 4.0 points) and a least-squares mean decrease in the control group (by -1.9 points), with a significant between-group difference favoring nusinersen (least-squares mean difference in change, 5.9 points; 95% confidence interval, 3.7 to 8.1; P< 0.001). This result prompted early termination of the trial. Results of the final analysis were consistent with results of the interim analysis. In the final analysis, 57% of the children in the nusinersen group as compared with 26% in the control group had an increase from baseline to month 15 in the HFMSE score of at least 3 points (P< 0.001), and the overall incidence of adverse events was similar in the nusinersen group and the control group (93% and 100%, respectively). CONCLUSIONS Among children with later-onset SMA, those who received nusinersen had significant and clinically meaningful improvement in motor function as compared with those in the control group. (Funded by Biogen and Ionis Pharmaceuticals; CHERISH ClinicalTrials. gov number, NCT02292537.)

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