WHY SPINRAZA/ABOUT SPINRAZA

SPINRAZA has been studied for over 8 years in the longest SMA clinical trial program to date1

Studies have evaluated the effectiveness of SPINRAZA for improving survival, overall motor function, and walking ability1,2

TRIALS FOR PRESYMPTOMATIC AND EARLY-ONSET SMA

Supportive trial: NURTURE3,4

Study: A phase 2, open-label, multicenter, multinational, single-arm trial

Treatment duration: Ongoing (latest data cut is after approximately 5 years of follow up)

Participants: 25 presymptomatic infants who were genetically diagnosed with SMA (2 SMN2 copies, n=15; 3 SMN2 copies, n=10) and were aged ≤6 weeks

Primary endpoint: Survival without the need for respiratory intervention

Safety: Consistent with the SPINRAZA Prescribing Information

SEE RESULTS
Pivotal trial: ENDEAR2,5

Study: A phase 3, multicenter, double-blind, randomized (2:1), sham-controlled trial

Treatment duration: 13 months

Participants: 121 patients with early-onset SMA, aged ≤7 months

Primary endpoints:

  • Improvement in motor function as measured by proportion of patients meeting the criteria for motor milestone responder using HINE-2
  • Survival without the need for permanent ventilation

Safety: The most common side effects were lower respiratory infection (55%) and constipation (35%). Serious adverse reactions of atelectasis were more frequent in SPINRAZA-treated patients (18%) than in control patients (10%)

HINE-2=Hammersmith Infant Neurological
Examination Section 2.

SEE RESULTS

TRIAL FOR LATER-ONSET SMA

Pivotal trial: CHERISH2,6

Study: A phase 3, multicenter, randomized (2:1), double-blind, sham procedure–controlled clinical trial

Treatment duration: 15 months

Participants: 126 patients with later-onset SMA aged 2 to 9 years at screening

Primary endpoint: Least-squares mean change from baseline in HFMSE at 15 months of treatment

Select secondary endpoints: Clinically meaningful change in HFMSE ≥3 points and change in upper limb function as measured by RULM

Study limitations: Differences in dosing compared to the approved SPINRAZA schedule

Safety: The most common side effects were fever (43%), headache (29%), vomiting (29%), and back pain (25%)

HFMSE=Hammersmith Functional Motor Scale—Expanded; RULM=Revised Upper Limb Module.

SEE RESULTS

Review the warnings and precautions, including thrombocytopenia, coagulation abnormalities, and renal toxicity2

SEE SPINRAZA SAFETY
Start your patient on SPINRAZA

INDICATION

SPINRAZA is indicated for the treatment of spinal muscular atrophy (SMA) in pediatric and adult patients.

IMPORTANT SAFETY INFORMATION

Coagulation abnormalities and thrombocytopenia, including acute severe thrombocytopenia, have been observed after administration of some antisense oligonucleotides. Patients may be at increased risk of bleeding complications.

In the sham-controlled studies for patients with infantile-onset and later-onset SMA, 24 of 146 SPINRAZA-treated patients (16%) with high, normal, or unknown platelet count at baseline developed a platelet level below the lower limit of normal, compared to 10 of 72 sham-controlled patients (14%). Two SPINRAZA-treated patients developed platelet counts <50,000 cells per microliter, with the lowest level of 10,000 cells per microliter recorded on study day 28.

Renal toxicity, including potentially fatal glomerulonephritis, has been observed after administration of some antisense oligonucleotides. SPINRAZA is present in and excreted by the kidney. In the sham-controlled studies for patients with infantile-onset and later-onset SMA, 71 of 123 SPINRAZA-treated patients (58%) had elevated urine protein, compared to 22 of 65 sham-controlled patients (34%).

Laboratory testing and monitoring to assess safety should be conducted. Perform a platelet count, coagulation laboratory testing, and quantitative spot urine protein testing at baseline and prior to each dose of SPINRAZA and as clinically needed.

Severe hyponatremia was reported in an infant treated with SPINRAZA requiring salt supplementation for 14 months.

Cases of rash were reported in patients treated with SPINRAZA.

SPINRAZA may cause a reduction in growth as measured by height when administered to infants, as suggested by observations from the controlled study. It is unknown whether any effect of SPINRAZA on growth would be reversible with cessation of treatment.

The most common adverse reactions (≥20% of SPINRAZA-treated patients and ≥5% more frequently than in control patients) that occurred in the infantile-onset controlled study were lower respiratory infection and constipation. Serious adverse reactions of atelectasis were more frequent in SPINRAZA-treated patients (18%) than in control patients (10%). Because patients in this controlled study were infants, adverse reactions that are verbally reported could not be assessed. The most common adverse reactions that occurred in the later-onset controlled study were pyrexia, headache, vomiting, and back pain. Post-lumbar puncture syndrome has also been observed after the administration of SPINRAZA.

Please see full Prescribing Information.

As a courtesy, our full Prescribing Information is also available en Español. For prescribing decisions, please refer to official approved labeling.

References

1. Biogen Data on File [as of 9/21]. 2. SPINRAZA. Prescribing Information. Biogen; 2023. 3.Crawford TO, Kirschner J, Ryan MM, et al; NURTURE Study Group. Nusinersen effect in infants in the presymptomatic stage of SMA: 4.9-year interim of the NURTURE study. Presented at: Muscular Dystrophy Association (MDA) 4th Clinical and Scientific Conference. March 13–16, 2022; Nashville, TN. 4. De Vivo DC, Bertini E, Swoboda KJ, et al; NURTURE Study Group. Nusinersen initiated in infants during the presymptomatic stage of spinal muscular atrophy: interim efficacy and safety results from the Phase 2 NURTURE study. Neuromuscul Disord. 2019;29(11):842-856. 5. Finkel RS, Mercuri E, Darras BT, et al; ENDEAR Study Group. Nusinersen versus sham control in infantile-onset spinal muscular atrophy. N Eng J Med. 2017;377(18):1723-1732. 6. Mercuri E, Darras BT, Chiriboga CA, et al; CHERISH Study Group. Nusinersen versus sham control in later-onset spinal muscular atrophy. N Eng J Med. 2018;378(7):625-635.

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