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Biogen receives European marketing authorization for Qalsody to treat a rare, genetic form of ALS

Cambridge, Massachusetts
Saturday, June 1, 2024, 10:00 Hrs  [IST]

Biogen Inc. announced the European Commission (EC) has granted marketing authorization under exceptional circumstances and maintained orphan designation for Qalsody (tofersen) for the treatment of adults with amyotrophic lateral sclerosis (ALS) associated with a mutation in the superoxide dismutase 1 gene (SOD1-ALS). Qalsody is the first treatment approved in the European Union to target a genetic cause of ALS, also known as motor neuron disease (MND).

“The European Commission’s approval of Qalsody is a testament to the unwavering dedication of the ALS community – people living with ALS and their loved ones, scientists, clinicians, and advocates – who have worked together over the past two decades to bring forward this important new treatment for the SOD1-ALS community,” said Stephanie Fradette, Pharm.D., head of the neuromuscular development unit at Biogen. “We are working with the medical community and local authorities to bring Qalsody to people living with SOD1-ALS across the region as quickly as possible.”

The marketing authorization for Qalsody is granted under exceptional circumstances, which is recommended when the benefit/risk assessment of a treatment is determined to be positive but due to the rarity of the disease, it is unlikely that comprehensive data can be obtained under normal conditions of use. The European Medicines Agency (EMA) recommended Qalsody’s designation as an orphan medicinal product be maintained.

“Qalsody’s approval represents a paradigm shift in the treatment of SOD1-ALS, offering hope to patients and loved ones who have long awaited a breakthrough,” said Philip Van Damme, M.D., Ph.D., Professor of Neurology and Director of the Neuromuscular Reference Center at the University Hospital Leuven in Belgium. “The European Academy of Neurology has confirmed new treatment guidelines for ALS that recognize Qalsody should be offered as first-line treatment for patients with SOD1-ALS.”

The approval of Qalsody is based on the totality of evidence, including the targeted mechanism of action, biomarker, and clinical data. In the randomized, double-blind, placebo-controlled phase 3 VALOR study (n=108), patients were randomized 2:1 to receive treatment with either Qalsody 100 mg (n=72) or placebo (n=36) for 24 weeks. The primary efficacy endpoint was the change from baseline to Week 28 in the ALS Functional Ratings Scale-Revised total score. The results numerically favoured tofersen, but were not statistically significant (ITT population: tofersen-placebo adjusted mean difference [95% CI]: 1.4 [-1.3, 4.1]). At Week 28, mean plasma neurofilament light chain (NfL), a marker of axonal injury and neurodegeneration, was reduced by 55% (geometric mean ratio to baseline) in the tofersen-treated participants (ITT), compared to a 12% increase with placebo (difference in geometric mean ratios for tofersen to placebo: 60% (95% CI: 51%, 67%)). Very common adverse reactions (may affect more than 1 in 10 people) reported in Qalsody-treated participants were pain (back pain, pain in arms or legs), feeling tired, muscle and joint pain, fever, and an increase in protein and/or white blood cell count occurring in the fluid that surrounds the brain and spinal cord.

“At EUpALS, we are excited that people with SOD1-ALS in Europe will have access to Qalsody, the first treatment targeting a genetic cause of ALS. This is a major milestone for the ALS community, showing that ALS is a treatable disease,” said Evy Reviers, Chairwoman of the European Organisation for Professionals and People living with ALS (EUpALS). “As a representative of the European ALS community, I am excited to enter a new evolution in the common fight against ALS. We thank Biogen for the many years of scientific and clinical pioneering efforts that led to this medical success.”

Biogen is committed to working closely with all stakeholders to enable access to this treatment for eligible European patients. Through the Biogen early access program, about 330 people with SOD1-ALS have received Qalsody across 18 EU countries. Qalsody is also approved for use in the United States and Biogen is engaging with regulatory authorities in other regions.

Qalsody (tofersen) is an antisense oligonucleotide (ASO) designed to bind to SOD1 mRNA to reduce SOD1 protein production. The US Food and Drug Administration granted accelerated approval for Qalsody to treat amyotrophic lateral sclerosis (ALS) in adults who have a mutation in the superoxide dismutase 1 (SOD1) gene. This indication is approved under accelerated approval based on reduction in plasma neurofilament light chain (NfL) observed in patients treated with Qalsody. Continued approval for this indication may be contingent upon verification of clinical benefit in confirmatory trial(s). The European Commission granted marketing authorization under exceptional circumstances and orphan designation for Qalsody.

Biogen licensed Qalsody from Ionis Pharmaceuticals, Inc. under a collaborative development and license agreement. Qalsody was discovered by Ionis.

In addition to the ongoing open label extension (OLE) of the phase 3 VALOR study, Qalsody is being studied in the Phase 3, randomized, placebo-controlled ATLAS study to evaluate whether Qalsody can delay clinical onset when initiated in presymptomatic individuals with a SOD1 genetic mutation and biomarker evidence of disease activity (elevated plasma NfL).

Amyotrophic lateral sclerosis (ALS) is a rare, progressive and fatal neurodegenerative disease that results in the loss of motor neurons in the brain and the spinal cord that are responsible for controlling voluntary muscle movement. People with ALS experience muscle weakness and atrophy, causing them to lose independence as they steadily lose the ability to move, speak, eat, and eventually breathe. Average life expectancy for people with ALS is three to five years from time of symptom onset.

Multiple genes have been implicated in ALS. Genetic testing helps determine if a person’s ALS is associated with a genetic mutation, even in individuals without a known family history of the disease. Mutations in the SOD1 gene are responsible for approximately 2% of the estimated 168,000 people who have ALS globally (SOD1-ALS). More than 15% of people with ALS are thought to have a genetic form of the disease; 4 however, they may not have a known family history of the disease.

In people with SOD1-ALS, mutations in their SOD1 gene cause their bodies to create a toxic misfolded form of SOD1 protein. This toxic protein causes motor neurons to degenerate, resulting in progressive muscle weakness, loss of function, and eventually, death.

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