GlaxoSmithKline (GSK), Fondazione Telethon (Telethon) and Ospedale San Raffaele (OSR) today announced that the European Commission has approved Strimvelis, the first ex-vivo stem cell gene therapy to treat patients with a very rare disease called ADA-SCID (Severe Combined Immunodeficiency due to Adenosine Deaminase deficiency).
A child born with ADA-SCID does not have a healthy, fully-functioning immune system and as a consequence, is unable to fight off everyday infections. Strimvelis (autologous CD34+ cells transduced to express ADA) is the first corrective gene therapy for children to be awarded regulatory approval anywhere in the world. It is indicated for the treatment of patients with ADA-SCID for whom no suitable human leukocyte antigen (HLA)-matched related stem cell donor is available.
ADA-SCID affects an estimated 15 children per year in Europe and following today’s approval, patients with the condition who are referred for treatment will be able to receive the gene therapy at Ospedale San Raffaele in Milan.
Martin Andrews, Head of the Rare Disease Unit, GSK said: «Today’s approval is the result of many years’ work with our collaborators in Milan and is the next step towards bringing life-changing treatment to patients with ADA-SCID and their families. This is the start of a new chapter in the treatment of rare genetic diseases and we hope that this therapeutic approach could also be used to help patients with other rare diseases in the future».
The marketing authorisation decision was based on data collected from 18 children treated with Strimvelis. A 100% survival rate at three years post-treatment with Strimvelis was observed for all children in the pivotal study (n=12) and every child receiving the treatment who contributed to the marketing authorisation data package is alive today (n=18), with a median follow-up duration of approximately seven years. Full results of the analysis have recently been published in BLOOD.
Professor Alessandro Aiuti, Clinical Research Coordinator at San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), a joint research collaboration between OSR and Telethon, said: «We are delighted with today’s news, which marks the culmination of more than 20 years of research and development at Tiget. This innovative, individualised treatment approach uses a patient’s own gene modified stem cells to correct the root cause of the disease. It has been gratifying for all of us to see patients affected by this severe immune deficiency growing over the years, being able to play with other children and going to school. Working alongside GSK, we can now make Strimvelis available to ADA-SCID patients and transform the lives of children who so desperately need it».
Nicola Bedin, CEO of Ospedale San Raffaele, said: «This great achievement would not have been possible without the effective collaboration between OSR, Telethon and GSK, which has brought together years of scientific research, first-class medical practice and expertise in product development. Going forward we hope to build on our shared mission to develop and deliver more much-needed new medicines to patients with rare diseases».
Francesca Pasinelli, General Manager of Fondazione Telethon, said: «This is a memorable day, not only for us, but overall for the people we work for: with Strimvelis we can keep our promise to patients. We can say that we have pioneered a model whereby the charity organisation acts not only as a funding agency, but plays a primary role in managing the development of research to ensure that each step of the process leads to the ultimate goal, which is to provide accessible therapy to patients».
ADA-SCID is a very rare disorder caused by a faulty gene inherited from both parents. This faulty gene stops the production of an essential protein called adenosine deaminase (ADA), which is required for the production of lymphocytes (a type of white blood cell). Children born with ADA-SCID do not develop a healthy immune system so cannot fight off everyday infections, which results in severe and life-threatening illness. Without prompt treatment, the disorder often proves fatal within the child’s first year of life. ADA-SCID is estimated to occur in approximately 15 patients per year in Europe.
Strimvelis is only administered once and does not rely on a third-party donor, so there is no risk of immune incompatibility causing rejection (graft versus host disease), which is a common side effect of bone marrow transplant treatment. With Strimvelis, the patient’s own bone marrow cells are removed, and a vector is used to insert a normal copy of the ADA gene into the cells. This step is known as transduction. The gene-corrected cells are then re-introduced to the patient via an intravenous infusion, after which some of the cells home back to the bone marrow. In order to improve the engraftment of the gene-modified cells in the patient’s bone marrow, patients are also pre-treated with low dose chemotherapy. Within the primary data package which formed the basis of marketing authorisation, a 100% survival rate at 3 years post-treatment with Strimvelis (primary endpoint) was observed for all 12 children in the pivotal study, with 92% having intervention-free survival (i.e. did not require enzyme replacement therapy for a period of >3 months post-treatment or hematopoietic stem cell transplantation). All 18 children treated with Strimvelis who contributed data to the marketing authorisation application are alive today with a median follow-up duration of approximately 7 years, with the first of these having received this gene therapy over 13 years ago. Intervention-free survival within the evaluable population (n=17) was 82%. Overall the safety findings are in line with those expected in children with ADA-SCID who have undergone treatment with low-dose chemotherapy and who are undergoing immune recovery. A significant reduction in severe infections has been documented and no leukaemic events have been observed to date. About the GSK / Telethon / OSR collaboration The gene therapy for the treatment of ADA-SCID was originally developed in Milan by Ospedale San Raffaele (OSR) and Fondazione Telethon (Telethon), through their joint San Raffaele Telethon Institute for Gene Therapy (SR-Tiget) and was taken forward by GSK through a strategic collaboration formed in 2010 between GSK, OSR and Telethon. Within the collaboration GSK, working with the biotechnology company MolMed S.p.A, has applied its expertise in product development to optimise, standardise and characterise a manufacturing process that was previously only suitable for clinical trials into one that has been demonstrated to be robust and suitable for commercial supply.
Important Safety Information for Strimvelis in the European Union
Overall the safety findings in the study were in line with those expected in children with ADA-SCID who have undergone treatment with low-dose chemotherapy and who are undergoing immune recovery. Adverse events were reported for all 18 patients; the most frequently reported being usual childhood infections including upper respiratory tract infection, gastroenteritis and rhinitis. Of the 39 serious adverse events which were reported post-GT, 62% were infections, with the most common being device-related infections, for example, from the central venous catheter (CVC) used during the treatment. Five patients reported SAEs due to CVC infection, three due to gastroenteritis and three due to pneumonia. A number of patients also experienced neurologic, CNS or hearing impairments which continued post-GT. No leukaemic events have been observed to date.Strimvelis is a trade mark of the GSK group of companies.