Gene Therapy with Fidanacogene Elaparvovec in Adults with Hemophilia B.
Journal
The New England journal of medicine
ISSN: 1533-4406
Titre abrégé: N Engl J Med
Pays: United States
ID NLM: 0255562
Informations de publication
Date de publication:
26 Sep 2024
26 Sep 2024
Historique:
medline:
25
9
2024
pubmed:
25
9
2024
entrez:
25
9
2024
Statut:
ppublish
Résumé
Fidanacogene elaparvovec, an adeno-associated virus (AAV) gene-therapy vector for hemophilia B containing a high-activity human factor IX variant (FIX-R338L/FIX-Padua), was associated with sustained factor IX activity in a phase 1-2a study. We conducted a phase 3 open-label study of fidanacogene elaparvovec at a dose of 5×10 Of 316 men who underwent screening for the lead-in study, 204 (64.6%) were not eligible; 188 (59.5%) of those were ineligible owing to the presence of anti-AAV neutralizing antibodies. Of the 45 participants who received fidanacogene elaparvovec, 44 completed at least 15 months of follow-up. The annualized rate of bleeding for all bleeding episodes decreased by 71%, from 4.42 (95% confidence interval [CI], 1.80 to 7.05) at baseline to 1.28 (95% CI, 0.57 to 1.98) after gene therapy, a treatment difference of -3.15 episodes (95% CI, -5.46 to -0.83; P = 0.008). This result shows the noninferiority and superiority of fidanacogene elaparvovec to prophylaxis. At 15 months, the mean factor IX activity was 26.9% (median, 22.9%; range, 1.9 to 119.0) by one-stage SynthASil assay. A total of 28 participants (62%) received glucocorticoids for increased aminotransferase levels or decreased factor IX levels (or both) starting between 11 and 123 days. No infusion-related serious adverse events, thrombotic events, development of factor IX inhibitors, or malignant conditions were observed. Fidanacogene elaparvovec was superior to prophylaxis for the treatment of participants with hemophilia B, leading to reduced bleeding and stable factor IX expression. (Funded by Pfizer; BENEGENE-2 ClinicalTrials.gov number, NCT03861273.).
Sections du résumé
BACKGROUND
BACKGROUND
Fidanacogene elaparvovec, an adeno-associated virus (AAV) gene-therapy vector for hemophilia B containing a high-activity human factor IX variant (FIX-R338L/FIX-Padua), was associated with sustained factor IX activity in a phase 1-2a study.
METHODS
METHODS
We conducted a phase 3 open-label study of fidanacogene elaparvovec at a dose of 5×10
RESULTS
RESULTS
Of 316 men who underwent screening for the lead-in study, 204 (64.6%) were not eligible; 188 (59.5%) of those were ineligible owing to the presence of anti-AAV neutralizing antibodies. Of the 45 participants who received fidanacogene elaparvovec, 44 completed at least 15 months of follow-up. The annualized rate of bleeding for all bleeding episodes decreased by 71%, from 4.42 (95% confidence interval [CI], 1.80 to 7.05) at baseline to 1.28 (95% CI, 0.57 to 1.98) after gene therapy, a treatment difference of -3.15 episodes (95% CI, -5.46 to -0.83; P = 0.008). This result shows the noninferiority and superiority of fidanacogene elaparvovec to prophylaxis. At 15 months, the mean factor IX activity was 26.9% (median, 22.9%; range, 1.9 to 119.0) by one-stage SynthASil assay. A total of 28 participants (62%) received glucocorticoids for increased aminotransferase levels or decreased factor IX levels (or both) starting between 11 and 123 days. No infusion-related serious adverse events, thrombotic events, development of factor IX inhibitors, or malignant conditions were observed.
CONCLUSIONS
CONCLUSIONS
Fidanacogene elaparvovec was superior to prophylaxis for the treatment of participants with hemophilia B, leading to reduced bleeding and stable factor IX expression. (Funded by Pfizer; BENEGENE-2 ClinicalTrials.gov number, NCT03861273.).
Identifiants
pubmed: 39321362
doi: 10.1056/NEJMoa2302982
doi:
Substances chimiques
Factor IX
9001-28-9
factor IX-Padua
0
Banques de données
ClinicalTrials.gov
['NCT03861273']
Types de publication
Journal Article
Multicenter Study
Clinical Trial, Phase III
Equivalence Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
1108-1118Investigateurs
Simon McRae
(S)
John Rasko
(J)
Chee Wee Tan
(CW)
Monica Cerqueira
(M)
Margareth Ozelo
(M)
Alfonso Iorio
(A)
Davide Matino
(D)
Jerome Teitel
(J)
Laurent Frenzel
(L)
Anne Lienhart
(A)
Claude Negrier
(C)
Robert Klamroth
(R)
Johannes Oldenburg
(J)
Olga Katsarou
(O)
Akira Ishiguro
(A)
Keiji Nogami
(K)
Hazzaa Alzahrani
(H)
Jan Astermark
(J)
Shyh-Shin Chiou
(SS)
Sheng-Chieh Chou
(SC)
Jiaan-Der Wang
(JD)
Ali Bülent Antmen
(AB)
Kaan Kavakli
(K)
Vahap Okan
(V)
Fahri Şahin
(F)
Catherine Bagot
(C)
Adam Cuker
(A)
Andrew Leavitt
(A)
Sharon Pennington
(S)
Amy D Shapiro
(AD)
Michael Wang
(M)
Informations de copyright
Copyright © 2024 Massachusetts Medical Society.