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Risdiplam in Type 1 Spinal Muscular Atrophy.

Giovanni Baranello1, Basil T Darras1, John W Day1

  • 1From the Dubowitz Neuromuscular Centre, National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health University College London, and Great Ormond Street Hospital Trust, London (G.B.), Roche Products, Welwyn Garden City (M.E.-K.), and the Muscular Dystrophy UK Oxford Neuromuscular Centre, Department of Paediatrics, University of Oxford, Oxford (L.S.) - all in the United Kingdom; the Developmental Neurology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan (G.B., R.M.), and the Pediatric Neurology Institution, Catholic University and Nemo Pediatrico, Fondazione Policlinico Gemelli IRCCS, Rome (E.M.); the Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston (B.T.D.); the Department of Neurology, Stanford University, Palo Alto, CA (J.W.D.); Centre de Référence des Maladies Neuromusculaires, Queen Fabiola Children's University Hospital, Université Libre de Bruxelles, Brussels (N.D.), the Neuromuscular Reference Center, Universitair Ziekenhuis Gent, Ghent (N.D.), and the Division of Child Neurology, Centre de Références des Maladies Neuromusculaires, Department of Pediatrics, University Hospital Liege and University of Liege, Liege (L.S.) - all in Belgium; the Division of Pediatric Neurology, University Children's Hospital Basel (A.K.), Pharma Development Safety (M.G.), Product Development Medical Affairs-Neuroscience and Rare Disease (K.G., P.F.), and Pharma Development Neurology (R.S.S.), F. Hoffmann-La Roche, and Roche Pharmaceutical Research and Early Development, Roche Innovation Center Basel (O.K., H.K., T.S.), Basel, and Pediatric Neurology, Inselspital, University of Bern, Bern (A.K.) - both in Switzerland; the Discipline of Physiotherapy, Faculty of Medicine and Health, University of Sydney, Sydney (K.R.); and I-Motion, Hôpital Armand Trousseau, Paris (L.S.).

The New England Journal of Medicine
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Summary

Risdiplam treatment increased functional SMN protein levels in infants with type 1 spinal muscular atrophy. The higher dose of 0.2 mg/kg/day was selected for further study, with some infants achieving the ability to sit.

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Area of Science:

  • Neurology
  • Genetics
  • Pharmacology

Background:

  • Type 1 spinal muscular atrophy (SMA) is a rare, progressive neuromuscular disease.
  • It is caused by insufficient levels of functional survival motor neuron (SMN) protein.
  • Risdiplam is an oral medication that enhances SMN protein levels by modifying SMN2 pre-messenger RNA splicing.

Purpose of the Study:

  • To evaluate the safety, pharmacokinetics, and pharmacodynamics of risdiplam in infants with type 1 SMA.
  • To determine the optimal dose of risdiplam for further clinical trials.
  • To explore the efficacy of risdiplam in improving motor function.

Main Methods:

  • A two-part, phase 2-3, open-label study was conducted.
  • 21 infants (1-7 months old) with type 1 SMA were enrolled.
  • Infants received either a low dose (0.08 mg/kg/day) or a high dose (0.2 mg/kg/day) of risdiplam.

Main Results:

  • Risdiplam treatment increased median SMN protein levels by 3.0-fold (low dose) and 1.9-fold (high dose) after 12 months.
  • Serious adverse events included pneumonia and respiratory infections.
  • Seven infants in the high-dose group achieved the ability to sit independently for at least 5 seconds.

Conclusions:

  • Oral risdiplam effectively increases functional SMN protein levels in infants with type 1 SMA.
  • The higher dose of 0.2 mg/kg/day was chosen for the next phase of the study.
  • Risdiplam shows potential for improving motor function in infants with this condition.