Phase 1-2 Trial of AAVS3 Gene Therapy in Patients with Hemophilia B
Chowdary, P;Shapiro, S;Makris, M;Evans, G;Boyce, S;Talks, K;Dolan, G; ...Nathwani, A;+ view allChowdary, P;Shapiro, S;Makris, M;Evans, G;Boyce, S;Talks, K;Dolan, G;Reiss, U;Phillips, M;Riddell, A;Peralta, MR;Quaye, M;Patch, DW;Tuddenham, E;Dane, A;Watissée, M;Long, A;Nathwani, A; - view fewer (2022) Phase 1-2 Trial of AAVS3 Gene Therapy in Patients with Hemophilia B.The New England Journal of Medicine, 387 (3) pp. 237-247.10.1056/NEJMoa2119913.
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Abstract
BACKGROUND: FLT180a (verbrinacogene setparvovec) is a liver-directed adeno-associated virus (AAV) gene therapy that uses a synthetic capsid and a gain-of-function protein to normalize factor IX levels in patients with hemophilia B. METHODS: In this multicenter, open-label, phase 1-2 trial, we assessed the safety and efficacy of varying doses of FLT180a in patients with severe or moderately severe hemophilia B (factor IX level, ≤2% of normal value). All the patients received glucocorticoids with or without tacrolimus for immunosuppression to decrease the risk of vector-related immune responses. After 26 weeks, patients were enrolled in a long-term follow-up study. The primary end points were safety and efficacy, as assessed by factor IX levels at week 26. RESULTS: Ten patients received one of four FLT180a doses of vector genomes (vg) per kilogram of body weight: 3.84×1011 vg, 6.40×1011 vg, 8.32×1011 vg, or 1.28×1012 vg. After receiving the infusion, all the patients had dose-dependent increases in factor IX levels. At a median follow-up of 27.2 months (range, 19.1 to 42.4), sustained factor IX activity was observed in all the patients except one, who resumed factor IX prophylaxis. As of the data-cutoff date (September 20, 2021), five patients had normal factor IX levels (range, 51 to 78%), three patients had levels from 23 to 43%, and one had a level of 260%. Of the reported adverse events, approximately 10% were related to FLT180a and 24% to immunosuppression. Increases in liver aminotransferase levels were the most common FLT180a-related adverse events. Late increases in aminotransferase levels occurred in patients who had received prolonged tacrolimus beyond the glucocorticoid taper. A serious adverse event of arteriovenous fistula thrombosis occurred in the patient with high factor IX levels. CONCLUSIONS: Sustained factor IX levels in the normal range were observed with low doses of FLT180a but necessitated immunosuppression with glucocorticoids with or without tacrolimus. (Funded by Freeline Therapeutics; ClinicalTrials.gov numbers, NCT03369444 and NCT03641703; EudraCT numbers, 2017-000852-24 and 2017-005080-40.).
| Type: | Article |
|---|---|
| Title: | Phase 1-2 Trial of AAVS3 Gene Therapy in Patients with Hemophilia B |
| Location: | United States |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1056/NEJMoa2119913 |
| Publisher version: | https://doi.org/10.1056/NEJMoa2119913 |
| Language: | English |
| Additional information: | This version is the version of record. For information on re-use, please refer to the publisher's terms and conditions. |
| UCL classification: | UCL >Provost and Vice Provost Offices >School of Life and Medical Sciences >Faculty of Medical Sciences UCL >Provost and Vice Provost Offices >School of Life and Medical Sciences >Faculty of Medical Sciences >Cancer Institute >Research Department of Haematology UCL >Provost and Vice Provost Offices >School of Life and Medical Sciences UCL UCL >Provost and Vice Provost Offices >School of Life and Medical Sciences >Faculty of Medical Sciences >Cancer Institute |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10153268 |
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