Persistence of haemostatic response following gene therapy with valoctocogene roxaparvovec in severe haemophilia A
K John Pasi, Michael Laffan, Savita Rangarajan, Tara M Robinson, Nina Mitchell, Will Lester, Emily Symington, Bella Madan, Xinqun Yang, Benjamin Kim, Glenn F Pierce, Wing Yen Wong, K John Pasi, Michael Laffan, Savita Rangarajan, Tara M Robinson, Nina Mitchell, Will Lester, Emily Symington, Bella Madan, Xinqun Yang, Benjamin Kim, Glenn F Pierce, Wing Yen Wong
Abstract
Introduction: Valoctocogene roxaparvovec is an investigational AAV5-based factor VIII (FVIII) gene therapy that has demonstrated sustained clinical benefit in people with severe haemophilia A.
Aim: To report safety, tolerability, efficacy, and quality of life (QOL) among participants who received valoctocogene roxaparvovec in a phase 1/2 clinical study (NCT02576795).
Methods: Men ≥18 years of age with severe haemophilia A (FVIII ≤1 IU/dl) without history of FVIII inhibitors or anti-AAV5 antibodies received a single infusion of valoctocogene roxaparvovec and were followed for 5 years (6 × 1013 vg/kg dose, n = 7) and 4 years (4 × 1013 vg/kg dose, n = 6).
Results: Over the past 2 years, few adverse events and no FVIII inhibitors were reported. Per chromogenic substrate (CSA) assay at years 5 and 4, four of seven and three of six participants in the 6 × 1013 and 4 × 1013 vg/kg cohorts, respectively, maintained median FVIII levels >5 IU/dl, corresponding to mild haemophilia. By regression analysis, rate of change in FVIII activity was -0.14 (95% confidence interval [CI]: -.32 to .03) IU/dl/wk in the 6 × 1013 vg/kg cohort in year 5 and -.06 (95% CI: -.14 to .01) IU/dl/wk in the 4 × 1013 vg/kg cohort in year 4. No participants resumed FVIII prophylaxis, and eight of 13 participants reported zero bleeds in the past 2 years. Improved QOL from baseline persisted in the 6 × 1013 vg/kg cohort; all six Haemo-QOL-A domain scores increased. For the 4 × 1013 vg/kg cohort, high baseline Haemo-QOL-A scores persisted.
Conclusion: These results demonstrate transgene expression and haemostatic response for up to 5 years in individuals with haemophilia A.
Keywords: factor VIII; genetic therapy; haemophilia A; haemostasis; quality of life.
Conflict of interest statement
K John Pasi is an employee for Roche and reports receiving consulting payments from Alnylam, APCintex, BioMarin, Bioverativ, Catalyst Bio, Catapult, Chugai, Roche, Novo Nordisk, Sanofi, and Sobi; participating as a clinical trial investigator for BioMarin, Sanofi, and UniQure; receiving speaker fees from Bayer, BioMarin, Biotest, Novo Nordisk, Sanofi, Shire, Sobi, Octapharma, Pfizer, and UniQure; and receiving travel support from Alnylam, Bayer, BioMarin, Bioverativ, Novo Nordisk, Octapharma, Pfizer, Sobi, Sanofi, and Shire. Michael Laffan reports receiving grants from BioMarin; personal fees from Bayer, LEO Pharma, LFB Biopharmaceuticals, Pfizer, Roche, Shire, and Sobi; and travel support from Bayer, LFB Biopharmaceuticals, and Sobi. Savita Rangarajan reports receiving grants from Roche and Sangamo; travel support from Reliance Life Sciences and Shire/Takeda; and consulting payments from Pfizer, Reliance Life Sciences, Sanofi, and Shire/Takeda. Will Lester reports receiving grants from BioMarin; personal fees from Bayer, LFB, Novo Nordisk, Sobi, and Takeda; and travel support from Takeda and CSL. Emily Symington reports receiving grants from BioMarin and travel support from CSL Behring and Novo Nordisk. Bella Madan reports nothing to disclose. Nina Mitchell is a former employee of BioMarin Pharmaceutical and may own stock. Tara M. Robinson, Xinqun Yang, Benjamin Kim, and Wing Yen Wong are employees and stockholders of BioMarin Pharmaceutical. Glenn F. Pierce is an employee of Voyager Therapeutics; reports receiving consulting payments from Ambys Medicines, BioMarin Pharmaceutical, BridgeBio, CRISPR Therapeutics, Decibel Therapeutics, Frontera, Generation Bio, Geneception, Novo Nordisk, Pfizer, Regeneron, Spark, and Third Rock Ventures; and is a board member of the World Federation of Haemophilia, Voyager Therapeutics, Global Blood Therapeutics, VarmX, and the Medical and Scientific Advisory Council of the US National Haemophilia Foundation.
© 2021 The Authors. Haemophilia published by John Wiley & Sons Ltd.
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Source: PubMed