Etranacogene dezaparvovec for hemophilia B gene therapy

Abstract

The treatment landscape for hemophilia has been rapidly changing with introduction of novel therapies. Gene therapy for hemophilia is a promising therapeutic option for sustained endogenous factor production to mitigate the need for prophylactic treatment to prevent spontaneous and traumatic bleeding. Etranacogene dezaparvovec is an investigational factor IX (FIX) gene transfer product that utilizes the adeno-associated virus (AAV) 5 vector with a liver-specific promoter and a hyperactive FIX transgene. Here, the development of etranacogene dezaparvovec and available efficacy and safety data from clinical trials are reviewed. Overall, etranacogene dezaparvovec provides sustained FIX expression for more than 2 years and allows for a bleed and infusion-free life in the majority of patients. Safety, efficacy, and quality-of-life data will inform shared decision-making for patients who are considering gene therapy. Long-term follow-up regarding duration of expression and safety are crucial. Plain Language Summary Factor IX Padua gene therapy to boost clotting factor and prevent bleeding for people living with hemophilia B People living with hemophilia have low or missing clotting factor, which can lead to bleeding that is unexpected or caused by a traumatic event (such as a sports injury or surgery). There are two main types of hemophilia: clotting factor (F)VIII deficiency (known as hemophilia A) and FIX deficiency (known as hemophilia B). People living with the severe or moderately severe forms of hemophilia (clotting factor levels below 3% of normal) need regular treatment, typically by infusions into the vein, to stop or prevent bleeding and damage to their joints. Gene therapy is currently being investigated as a new treatment option that introduces a working copy of the clotting factor gene to the liver. Following treatment, clotting factor is produced by the liver. Etranacogene dezaparvovec [Et-ra-na-co-gene dez-a-par-vo-vec] is a form of gene therapy for people living with hemophilia B. This form of gene therapy includes a modified form of FIX (FIX Padua) which produces high levels of FIX activity compared with normal FIX. It is being tested to see whether individuals will have low rates of bleeding and not need to treat themselves with clotting factor. In the clinical trials, participants with FIX levels below 2% (of normal) receive a single gene therapy infusion. The results of the trials have so far shown that patients given etranacogene dezaparvovec have continuous production of FIX, whereby they have reported much less bleeding and factor treatment. Questions relating to the safety of the gene therapy and how long it works will hopefully be answered through long-term follow-up of the patients once the trials are completed.

Valoctocogene Roxaparvovec and Etranacogene Dezaparavovec: Novel Gene Therapies for Hemophilia A and B

“…One participant had a hypersensitivity reaction during infusion after 10% of the drug had been administered, and drug administration was stopped. 23,24 Spontaneous bleeds decreased by 71% (P = 0.007) and joint bleeds decreased by 78% (P < 0.001). Improvement in quality of life using the Hem-A-QoL questionnaire showed statistically significant results over 12 months (mean score decreases 5.5 from 25.6 at baseline to 20.1 at 12 months [95% CI, −7.4 to −3.6]).…”

Evaluating Gene Therapy as a Potential Paradigm Shift in Treating Severe Hemophilia

“…Many of the questions about gene therapies for hemophilia focus on long-term efficacy. Although the expectation is a single infusion with durable efficacy, the actual duration of treatment effectiveness is largely unknown [ 3 , 28 ]. Notably, the durability of valoctocogene roxaparvovec therapy is shorter than the durability of etranacogene dezaparvovec-drlb therapy [ 19 , 20 , 25 , 26 ].…”

“…In addition to examining questions about efficacy over time, it is critical to consider concerns about long-term safety, especially with regard to liver health [ 3 , 28 ]. Prolonged immunosuppression with corticosteroids and other immunosuppressants causes undesirable side effects but is an important tool for managing ALT elevations.…”

“…Clearly, patients undergoing gene therapy for hemophilia will need to actively maintain their liver health by avoiding excessive alcohol intake and hepatotoxic medications. Maintaining liver health will be necessary to maintain gene expression [ 3 , 28 ].…”

Gene Therapy Products Approved in 2022

“…The FDA examined the safety and effectiveness of Hemgenix in two studies including 57 adult men with severe or moderate hemophilia B, aged 18 to 75. Its efficacy was determined based on reductions in annual bleeding rate (ABR) in men [9]. The study of 54 participants showed increases in patients' Factor IX activity levels and a 54% reduction in annual bleeding rate from baseline [10].…”