AveXis receives positive CHMP opinion for Zolgensma

AveXis, a Novartis company, today announced that the Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency (EMA) has adopted a positive opinion recommending conditional marketing authorization of Zolgensma^® (onasemnogene abeparvovec) for the treatment of patients with 5q spinal muscular atrophy (SMA) with a bi-allelic mutation in the SMN1 gene and a clinical diagnosis of SMA Type 1; or for patients with 5q SMA with a bi-allelic mutation in the SMN1 gene and up to three copies of the SMN2 gene. A rare, genetic neuromuscular disease caused by a lack of a functional SMN1 gene, SMA results in the rapid and irreversible loss of motor neurons, affecting muscle functions, including breathing, swallowing and basic movement.^2,3 Zolgensma is a one-time gene therapy designed to address the genetic root cause of the disease by replacing the function of the missing or nonworking SMN1 gene. Zolgensma is administered during a single intravenous (IV) infusion, delivering a new working copy of the SMN gene into a patient’s cells, halting disease progression. The positive opinion is an important step towards offering a new treatment option in Europe for babies and young children with SMA.

The European Commission (EC) reviews the CHMP recommendation and usually delivers its final decision in approximately two months. The decision will be applicable to all 27 European Union member states, as well as Iceland, Norway, Liechtenstein and the United Kingdom.

“Today’s positive CHMP opinion for Zolgensma marks a critical step closer to EC approval and to bringing the only gene therapy for SMA to Europe, helping to address the devastating impact the disease has on patients and their families,” said Dave Lennon, president of AveXis. “Zolgensma provides a transformational new way to treat this rare but debilitating disease – delivering a potentially life-saving medicine with a one-time administered treatment. Given the urgency to treat SMA and the novel nature of gene therapy, we need to be equally innovative in advancing access, so we are offering governments and reimbursement bodies a ‘Day One’ access program to enable rapid access to Zolgensma upon approval.”

“In the most severe forms of the disease, children who are not treated are unable to lift their heads, sit, stand, or even swallow, and typically do not survive beyond two years of age unless permanently ventilated,” said Dr. Francesco Muntoni, Professor and Pediatric Neurologist at Great Ormond Street Hospital for Children, London. “The results we have seen for Zolgensma to date from the STR1VE clinical trial show an impressive survival rate at the conclusion of the study, with the majority of patients being able to sit without support. And through follow-up on the START trial, an average of 4.5 years later, we can see the long-term potential this significant gene therapy may have for children with this rare disease.”

The CHMP positive opinion is based on the completed Phase 3 STR1VE-US and Phase 1 START trials that evaluated the efficacy and safety of a one-time IV infusion of Zolgensma in symptomatic SMA Type 1 patients <6 months of age at dosing, who had one or two copies of the SMN2 backup gene, or two copies of the SMN2 backup gene, respectively. STR1VE-EU, a comparable Phase 3 study is ongoing. Zolgensma demonstrated prolonged event-free survival; rapid motor function improvement, often within one month of dosing; and, sustained milestone achievement, including the ability to sit without support, a milestone never achieved in untreated Type 1 patients.⁴

Additional supportive data included interim results from the ongoing SPR1NT trial, a Phase 3, open-label, single-arm study of a single, one-time IV infusion of Zolgensma in presymptomatic patients (<6 weeks at age of dosing) genetically defined by bi-allelic deletion of SMN1 with 2 or 3 copies of SMN2. These data demonstrate rapid, age‑appropriate major milestone gain, reinforcing the critical importance of early intervention in SMA patients.⁴

The most commonly observed side effects after treatment were elevated liver enzymes and vomiting. Acute serious liver injury and elevated aminotransferases can occur. Patients with pre-existing liver impairment may be at higher risk. Prior to infusion, physicians should assess liver function of all patients by clinical examination and laboratory testing. And, they should administer systemic corticosteroid to all patients before and after treatment, and then continue to monitor liver function for at least 3 months after infusion.⁴

“We are delighted to know that EMA considers a new treatment effective to fight SMA and that it can benefit a part of our community. We rely on all relevant stakeholders, to work at their best to get it to patients without any delay. SMA Europe will continue working to ensure that all patients living with SMA in Europe have the possibility to access any treatment that can be beneficial for them in a timely and sustainable way,” said Mencía de Lemus, President of SMA Europe.

Zolgensma “Day One” access program

SMA is a significant burden to the healthcare system in Europe with cumulative estimated healthcare costs per child ranging between €2.5 to €4 million within the first 10 years alone.¹
Designed to work within existing pricing and reimbursement frameworks, yet recognizing the novel nature of a one-time gene therapy for a devastating and progressive disease, the “Day One” access program offers ministries of health and reimbursement bodies (in countries without pre-existing early access pathways) a variety of flexible options that can be implemented immediately at time of approval. The program is designed to ensure that the cost of patients treated before national pricing and reimbursement agreements are in place, are aligned with the value-based prices negotiated following clinical and economic assessments. The program is meant to ensure the continued integrity of the local pricing and reimbursement framework. AveXis is already in advanced discussions with multiple countries in Europe to agree on terms of the program. The following options can be customized for each country:

• Retroactive rebates ensuring early access costs are aligned with negotiated prices following local clinical and economic assessment processes
• Deferred payments and installment options allowing reimbursement bodies to manage budget impact during the early access phase
• Outcomes-based rebates negotiated following clinical and economic assessments can be applied to patients treated during the early access period
• Robust training for treating institutions on administration and follow-up care
• Access to RESTORE, a global SMA registry of patients who have been diagnosed with SMA that draws upon existing country registries

Source: Novartis (press release)