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Expert Recommendations and Clinical Considerations in the Use of Onasemnogene Abeparvovec Gene Therapy for Spinal Muscular Atrophy

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source: Muscle and Nerves

year: 2021

authors: Elizabeth A. Kichula, Crystal M. Proud, Michelle A. Farrar, Jennifer M. Kwon, Kayoko Saito, Isabelle Desguerre, Hugh J. McMillan


Spinal muscular atrophy (SMA) is an autosomal recessive, neurodegenerative disease caused by biallelic mutations in the survival motor neuron 1 (SMN1) gene. SMA is characterized by motor neuron degeneration, resulting in progressive muscle atrophy and weakness. Before the emergence of disease-modifying therapies, children with the most severe form of SMA would never achieve the ability to sit independently. Only 8% survived beyond 20 months of age without permanent ventilator support. One such therapy, onasemnogene abeparvovec, an adeno-associated virus–based gene replacement therapy, delivers functional human SMN through a one-time intravenous infusion.

In addition to substantially improving survival, onasemnogene abeparvovec was found to increase motor milestone attainment and reduce the need for respiratory or nutritional support in many patients. This expert opinion provides recommendations and practical considerations on the patient-centered decisions to use onasemnogene abeparvovec. Recommendations include the need for patient-centered multidisciplinary care and patient selection to identify those with underlying medical conditions or active infections to reduce risks.


organization: Children's Hospital of Philadelphia, USA; Children's Hospital of the King's Daughters, USA; Sydney Children's Hospital Network, Australia; School of Medicine and Public Health, USA; Institute of Medical Genetics, Japan; Necker-Enfants Malades Hospital, France; Children's Hospital of Eastern Ontario, Canada

DOI: 10.1002/mus.27363

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