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Exagamglogene autotemcel

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Exagamglogene autotemcel
Clinical data
Trade namesCasgevy
Other namesCTX001, exa-cel
AHFS/Drugs.comMonograph
MedlinePlusa624018
License data
Routes of
administration		Intravenous
ATC code
Legal status
Legal status
Identifiers
DrugBank
UNII
KEGG

Exagamglogene autotemcel, sold under the brand name Casgevy, is a gene therapy used for the treatment of sickle cell disease[1][3] and transfusion-dependent beta thalassemia.[1] It was developed by Vertex Pharmaceuticals and CRISPR Therapeutics.[7]

The treatment was approved in the United Kingdom for the treatment of sickle cell disease and transfusion-dependent beta thalassemia in November 2023.[8][9][10] It was approved in the United States for the treatment of sickle cell disease in December 2023 and for the treatment of transfusion-dependent beta thalassemia in January 2024.[11][12][13]

Exagamglogene autotemcel is the first cell-based gene therapy treatment utilizing CRISPR/Cas9 gene editing technology to be approved by the US Food and Drug Administration (FDA).[11] The most common side effects include low levels of platelets and white blood cells, mouth sores, nausea, musculoskeletal pain, abdominal pain, vomiting, febrile neutropenia (fever and low white blood cell count), headache, and itching.[11]

Medical uses

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In the UK, exagamglogene autotemcel is indicated for the treatment of transfusion-dependent beta thalassemia and sickle cell disease in patients aged 12 years and older who should be treated with hematopoietic stem cell transplantation but for whom a suitable stem cell donor is not available.[1]

In the US, exagamglogene autotemcel is indicated for the treatment of sickle cell disease in people aged 12 years and older with recurrent vaso-occlusive crises,[4] and for the treatment of people with transfusion-dependent beta-thalassemia.[4][14]

The gene therapy is made from the recipient's own blood stem cells, which are modified, and are given back as a one-time, single-dose infusion as part of a hematopoietic (blood) stem cell transplant.[11] Prior to treatment, the recipient's own stem cells are collected, and then the recipient must undergo myeloablative conditioning (high-dose chemotherapy), a process that removes cells from the bone marrow so they can be replaced with the modified cells in exagamglogene autotemcel.[11] The modified blood stem cells are transplanted back into the recipient where they engraft (attach and multiply) within the bone marrow and increase the production of fetal hemoglobin (HbF), a type of hemoglobin that facilitates oxygen delivery.[11]

Side effects

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The most common side effects observed in clinical studies included low levels of platelets and white blood cells, mouth sores, nausea, musculoskeletal pain, abdominal pain, vomiting, febrile neutropenia (fever and low white blood cell count), headache and itching.[11]

History

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The safety and effectiveness of exagamglogene autotemcel were evaluated in an ongoing single-arm, multi-center trial in adult and adolescent participants with sickle cell disease.[11] Participants had a history of at least two protocol-defined severe vaso-occlusive crises during each of the two years prior to screening.[11] The primary efficacy outcome was freedom from severe vaso-occlusive crisis episodes for at least twelve consecutive months during the 24-month follow-up period.[11] A total of 44 participants were treated with exagamglogene autotemcel.[11] Of the 31 participants with sufficient follow-up time to be evaluable, 29 (93.5%) achieved this outcome.[11] All treated participants achieved successful engraftment with no participants experiencing graft failure or graft rejection.[11]

The US Food and Drug Administration (FDA) granted the application for exagamglogene autotemcel priority review, orphan drug, fast track, and regenerative medicine advanced therapy designations.[11] The FDA granted approval of Casgevy to Vertex Pharmaceuticals.[11]

Society and culture

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In December 2023, the Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency (EMA) adopted a positive opinion, recommending the granting of a conditional marketing authorization for the medicinal product Casgevy, intended for the treatment of transfusion‑dependent β‑thalassemia and sickle cell disease.[5][15] As Casgevy is an advanced therapy medicinal product, the CHMP positive opinion is based on an assessment by the Committee for Advanced Therapies.[5] The applicant for this medicinal product is Vertex Pharmaceuticals (Ireland) Limited.[5] Exagamglogene autotemcel was approved for medical use in the European Union in February 2024.[5][6]

Economics

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The therapy has a US list price of US$2.2 million.[16] The cost effectiveness threshold of the therapy in the US is estimated to be between $1.35 million and $2.05 million[17] depending on perspective (healthcare vs limited societal) and assuming the willingness to pay for 1 quality-adjusted life year (QALY) at $100,000–$150,000.[18]

The UK price is estimated to be £1 million.[19][20]

References

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  1. ^ a b c d "Summary of Product Characteristics". Medicines and Healthcare products Regulatory Agency (MHRA). 15 November 2023. Archived from the original (PDF) on 8 December 2023. Retrieved 9 December 2023.
  2. ^ "Casgevy 4–13 x 10Exp6 cells/mL dispersion for infusion". Electronic Medicines Compendium. 24 November 2023. Archived from the original on 9 December 2023. Retrieved 9 December 2023.
  3. ^ a b "Casgevy- exagamglogene autotemcel injection, suspension". DailyMed. 22 January 2024. Retrieved 3 March 2024.
  4. ^ a b c "Casgevy". U.S. Food and Drug Administration (FDA). 8 December 2023. Archived from the original on 19 December 2023. Retrieved 8 December 2023. Public Domain This article incorporates text from this source, which is in the public domain.
  5. ^ a b c d e "Casgevy EPAR". European Medicines Agency (EMA). 14 December 2023. Archived from the original on 19 December 2023. Retrieved 16 December 2023. Text was copied from this source which is copyright European Medicines Agency. Reproduction is authorized provided the source is acknowledged.
  6. ^ a b "Casgevy product information". Union Register of medicinal products. 12 February 2024. Retrieved 19 February 2024.
  7. ^ Stein R (31 October 2023). "FDA advisers see no roadblocks for gene-editing treatment for sickle cell disease". NPR. Archived from the original on 4 December 2023. Retrieved 4 December 2023.
  8. ^ "MHRA authorises world-first gene therapy that aims to cure sickle-cell disease and transfusion-dependent β-thalassemia". Medicines and Healthcare products Regulatory Agency (MHRA) (Press release). 16 November 2023. Archived from the original on 25 November 2023. Retrieved 8 December 2023.
  9. ^ Sheridan C (November 2023). "The world's first CRISPR therapy is approved: who will receive it?". Nature Biotechnology. 42 (1): 3–4. doi:10.1038/d41587-023-00016-6. PMID 37989785. S2CID 265350318. Archived from the original on 4 December 2023. Retrieved 4 December 2023.
  10. ^ "Vertex and CRISPR Therapeutics Announce Authorization of the First CRISPR/Cas9 Gene-Edited Therapy, Casgevy (exagamglogene autotemcel), by the United Kingdom MHRA for the Treatment of Sickle Cell Disease and Transfusion-Dependent Beta Thalassemia" (Press release). Vertex Pharmaceuticals. 16 November 2023. Archived from the original on 22 November 2023. Retrieved 9 December 2023 – via Business Wire.
  11. ^ a b c d e f g h i j k l m n o "FDA Approves First Gene Therapies to Treat Patients with Sickle Cell Disease". U.S. Food and Drug Administration (FDA). 8 December 2023. Archived from the original on 8 December 2023. Retrieved 8 December 2023. Public Domain This article incorporates text from this source, which is in the public domain.
  12. ^ "Vertex and CRISPR Therapeutics Announce US FDA Approval of Casgevy (exagamglogene autotemcel) for the Treatment of Sickle Cell Disease" (Press release). Vertex Pharmaceuticals. 8 December 2023. Archived from the original on 9 December 2023. Retrieved 9 December 2023 – via Business Wire.
  13. ^ Commissioner, Office of the (16 January 2024). "FDA Roundup: January 16, 2024". FDA. Retrieved 19 January 2024.
  14. ^ "FDA Roundup: January 16, 2024". U.S. Food and Drug Administration (FDA) (Press release). 16 January 2024. Archived from the original on 17 January 2024. Retrieved 17 January 2024.
  15. ^ "First gene editing therapy to treat beta thalassemia and severe sickle cell disease". European Medicines Agency (EMA) (Press release). 15 December 2023. Archived from the original on 16 December 2023. Retrieved 16 December 2023.
  16. ^ Feuerstein A (8 December 2023). "In historic decision, FDA approves a CRISPR-based medicine for treatment of sickle cell disease". STAT. Archived from the original on 9 December 2023. Retrieved 10 December 2023.
  17. ^ "ICER Publishes Final Evidence Report on Gene Therapies for Sickle Cell Disease". Institute for Clinical and Economic Review. Archived from the original on 4 December 2023. Retrieved 4 December 2023.
  18. ^ "Value Assessment Framework". Institute for Clinical and Economic Review. Archived from the original on 14 November 2023. Retrieved 10 December 2023.
  19. ^ Pinkstone J, Searles M (16 November 2023). "Life-changing blood disease treatment approved at £1m cost per patient". The Telegraph. Archived from the original on 10 December 2023. Retrieved 10 December 2023.
  20. ^ Wong C (November 2023). "UK first to approve CRISPR treatment for diseases: what you need to know". Nature. 623 (7988): 676–677. Bibcode:2023Natur.623..676W. doi:10.1038/d41586-023-03590-6. PMID 37974039.

Further reading

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