TY - JOUR
T1 - Nusinersen versus sham control in later-onset spinal muscular atrophy
AU - Mercuri, Eugenio Maria
AU - Mazzone, Elena Stacy
AU - Schneider-Moser, Elisabeth Margarete Ute
AU - Piastra, Marco
PY - 2018
Y1 - 2018
N2 - 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 leastsquares 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 (â¥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).
AB - 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 leastsquares 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 (â¥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).
KW - Age of Onset
KW - Child
KW - Child, Preschool
KW - Double-Blind Method
KW - Female
KW - Humans
KW - Infant
KW - Injections, Spinal
KW - Least-Squares Analysis
KW - Male
KW - Medicine (all)
KW - Motor Skills
KW - Oligonucleotides
KW - Oligonucleotides, Antisense
KW - Spinal Muscular Atrophies of Childhood
KW - Age of Onset
KW - Child
KW - Child, Preschool
KW - Double-Blind Method
KW - Female
KW - Humans
KW - Infant
KW - Injections, Spinal
KW - Least-Squares Analysis
KW - Male
KW - Medicine (all)
KW - Motor Skills
KW - Oligonucleotides
KW - Oligonucleotides, Antisense
KW - Spinal Muscular Atrophies of Childhood
UR - http://hdl.handle.net/10807/117760
UR - http://www.nejm.org/medical-index
UR - https://www.ncbi.nlm.nih.gov/pubmed/29443664
U2 - 10.1056/NEJMoa1710504
DO - 10.1056/NEJMoa1710504
M3 - Article
SN - 0028-4793
VL - 378
SP - 625
EP - 635
JO - THE NEW ENGLAND JOURNAL OF MEDICINE
JF - THE NEW ENGLAND JOURNAL OF MEDICINE
ER -