N Engl J Med. 2018 Feb 15;378(7):625-635. doi: 10.1056/NEJMoa1710504.
Nusinersen versus Sham Control in Later-Onset Spinal Muscular Atrophy.
Mercuri E1,
Darras BT1,
Chiriboga CA1,
Day JW1,
Campbell C1,
Connolly AM1,
Iannaccone ST1,
Kirschner J1,
Kuntz NL1,
Saito K1,
Shieh PB1,
Tulinius M1,
Mazzone ES1,
Montes J1,
Bishop KM1,
Yang Q1,
Foster R1,
Gheuens S1,
Bennett CF1,
Farwell W1,
Schneider E1,
De Vivo DC1,
Finkel RS1;
CHERISH Study Group.
Bradley WG, Kaufmann P, Dickson PI, Reingold SC, Davis CS, Arredondo K, Castro D, Cowie M, Farrow-Gillespie A, Hebert A, Kauk M, Miller N, Nelson L, Spain T Jr, Cappell J, Constantinescu A, Cruz R, Dastgir J, Dunaway S, Engelstad K, Khandji AG, Kramer S, Marra J, Popolizio M, Salazar R, Weimer LH, Aziz-Zaman S, LaMarca N, Ghosh P, Al-Ghamdi F, Liew W, Graham R, Berde C, Sethna N, Koka A, Wang L, Laine R, Souris M, Ordonez G, Harrington T, Szelag H, Pasternak A, Mirek E, Quigley J, Berry D, Civitello M, Endsley JD, Eden C, Leon W, O'Reardon K, Sigurdardottir L, Johnson C, Turner J, Vega M, Weber-Guzman F, Zinn M, Tesi Rocha AC, Watson K, D'Souza G, Ramamurthi RJ, Gee R, Kitsuwa-Lowe J, Hagerman K, Crasta S, Welsh L, Paulose S, McFall D, Perez J, Patnaik S, Sanjanwala B, Sakamuri S, Proud C, Purse BP, Duong TT, Sampson J, Tennekoon G, Brandsema J, Glanzman A, Flickinger J, Toms M, Adang L, Stanford D, Mayer O, Zigmont J, Chadehumbe M, Kichula E, Finanger E, Russman B, Roberts C, Frank A, Benjamin D, Zilke K, Golumbek PT, Zaidman CM, Anand P, Gadeken R, Siener C, Epstein L, Krueger J, Goldman S, Krosschell K, Blomgren C, Choi HW, Kurz J, Parsons J, Janas J, Yang M, Ballard A, Carry T, Shea S, Bielsky A, Booker K, Camuto A, Lord-Halvorson S, Gibbons M, Zimmerman C, Allen V, Fuhr P, Kelley C, Johnson H, Tran V, VanderVeen G, Fowler E, Parziale N, Rao L, Skura C, Shu F, Oskoui M, Zielinski D, Poulin C, Ingelmo PM, Desilets ST, Dinunzio P, Rivera G, Srour M, Arpin S, Goobie S, Gibson P, Scholtes C, McDonald W, Zapata E, Nguyen CE, Servais L, Gargaun E, Le Moing AG, Gidaro T, Vialle R, Guye ML, Lilien C, Olliver G, Gilabert S, Borell S, Wider S, Stein S, Vogt S, Krüger M, Pechmann A, Rippberger B, Eckenweiler M, Schara U, Koelbel H, Andres B, Rupprich K, Gangfuss A, Jachertz P, Della Marina A, Sponemann N, Pane M, Palermo C, Piastra M, Fanelli L, De Sanctis R, Genovese O, Antonaci L, Pera MC, Lamendola P, Messina S, Vita G, Di Bella V, Sframeli M, la Rosa M, Barcellona C, Distefano MG, Cavallaro F, Versaci A, De Luca F, Vita G, Nacimento Osorio A, Tizzano E, Ortez Gonzalez CI, Ortigoza Escobar JD, Colomer Oferil J, Medina Cantillo J, Rotger AF, Vigo Morancho M, Eldblom J, Darin N, Kroksmark AK, Lindstedt A, Michael E, Kimber E, Wahlgren L, Chan SH, Chim S, Chiu J, Ho ACC, Ip JKJ, Lam WWM, Ng MC, Wan C, Wong VCN, Yue Y, Arakawa R, Yamauchi A, Nagata S, Ito Y, Nakatsukasa H, Takeshita A, Hirasawa K, Ikai T, Eto K, Otamni Y, Takeshima Y, Fukuda N, Tanaka Y, Shimomura H, Lee T, Shibano T, Tachikawa T, Chae JH, Lim BC, Shin HI, Kim SY, Choi SA, Son WS, Jo H, Chun SM, Kim H.
- 1
- From the Department of Pediatric Neurology, Catholic University, Rome (E.M., E.S.M.); the Department of Neurology, Boston Children's Hospital, Boston (B.T.D.), and Biogen, Cambridge (R.F., S.G., W.F.) - both in Massachusetts; the Departments of Neurology (C.A.C., J.M., D.C.D.), Pediatrics (C.A.C., D.C.D.), and Rehabilitation and Regenerative Medicine (J.M.), Columbia University Medical Center, New York; the Department of Neurology, Stanford School of Medicine, Stanford (J.W.D.), David Geffen School of Medicine at University of California, Los Angeles, Los Angeles (P.B.S.), and Ionis Pharmaceuticals, Carlsbad (K.M.B., Q.Y., C.F.B., E.S.) - all in California; Children's Hospital-London Health Sciences Centre, London, ON, Canada (C.C.); the Department of Neurology, Washington University School of Medicine, St. Louis (A.M.C.); the Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas (S.T.I.); the Department of Neuropediatrics and Muscle Disorders, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg, Germany (J.K.); the Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital, Chicago (N.L.K.); the Institute of Medical Genetics and Department of Pediatrics, Tokyo Women's Medical University, Tokyo (K.S.); the Department of Pediatrics, Gothenburg University, Queen Silvia Children's Hospital, Gothenburg, Sweden (M.T.); and the Division of Neurology, Department of Pediatrics, Nemours Children's Hospital, Orlando, FL (R.S.F.).
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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