SMA ve Kas Hastalıklarında Güncel Tedaviler

Yazarlar

Yavuz Sayar
https://orcid.org/0000-0002-2503-4819

Özet

Spinal müsküler atrofi (SMA) ve Duchenne müsküler distrofi (DMD) gibi hastalıklarda hedefe yönelik genetik ve farmakolojik tedaviler, klinik süreçleri kökten değiştirmiştir. SMA özelinde Spinraza, Zolgensma ve Risdiplam gibi yöntemler protein sentezini düzenleyerek yaşam kalitesini artırırken, DMD'de kortikosteroidler standart tedavinin temelini oluşturmaya devam etmektedir. Yeni geliştirilen genetik yaklaşımlar ve ekzon atlama stratejileri onay süreçlerini geçse de, hastaların uzun dönemli takibi ve yan etki yönetimi kritik önemini korumaktadır. Erken tanı ve müdahale, her iki hastalık grubunda da tedavi başarısını belirleyen en temel faktör olmayı sürdürmektedir.

 

Targeted genetic and pharmacological therapies have fundamentally transformed the clinical management of Spinal Muscular Atrophy (SMA) and Duchenne Muscular Dystrophy (DMD). While treatments like Spinraza, Zolgensma, and Risdiplam effectively regulate protein production for SMA, corticosteroids remain the cornerstone of standard care for DMD. Despite the emergence of new genetic interventions and exon-skipping strategies, patient outcomes continue to rely heavily on early intervention and strict monitoring of side effects. Long-term clinical data is still being gathered to fully determine the durability and overall impact of these modern therapeutic approaches.

Referanslar

Matesanz SE, Curry C, Gross B, et al. Clinical Course in a Patient With Spinal Muscular Atrophy Type 0 Treated With Nusinersen and Onasemnogene Abeparvovec. J Child Neurol 2020; 35:717.

Chiriboga CA, Swoboda KJ, Darras BT, et al. Results from a phase 1 study of nusinersen (ISIS-SMN(Rx)) in children with spinal muscular atrophy. Neurology 2016; 86:890.

Finkel RS, Chiriboga CA, Vajsar J, et al. Treatment of infantile-onset spinal muscular atrophy with nusinersen: a phase 2, open-label, dose-escalation study. Lancet 2016; 388:3017.

FDA approves first drug for spinal muscular atrophy. U.S. Food & Drug Administration. www.fda.gov/newsevents/newsroom/pressannouncements/ucm534611.htm (Accessed on January 03, 2017).

European Medicines Agency. First medicine for spinal muscular atrophy. http://www.ema.europa.eu/ema/index.jsp?curl=pages/news_and_events/news/2017/04/news_detail_002735.jsp&mid=WC0b01ac058004d5c1 (Accessed on November 06, 2017).

Finkel RS, Mercuri E, Darras BT, et al. Nusinersen versus Sham Control in Infantile-Onset Spinal Muscular Atrophy. N Engl J Med 2017; 377:1723.

Mercuri E, Darras BT, Chiriboga CA, et al. Nusinersen versus Sham Control in Later-Onset Spinal Muscular Atrophy. N Engl J Med 2018; 378:625.

Hagenacker T, Wurster CD, Günther R, et al. Nusinersen in adults with 5q spinal muscular atrophy: a non-interventional, multicentre, observational cohort study. Lancet Neurol 2020; 19:317.

Prescribing information, SPINRAZA (nusinersen) injection, for intrathecal use. www.accessdata.fda.gov/drugsatfda_docs/label/2016/209531lbl.pdf (Accessed on January 03, 2017).

FDA approves innovative gene therapy to treat pediatric patients with spinal muscular atrophy, a rare disease and leading genetic cause of infant mortality. https://www.fda.gov/news-events/press-announcements/fda-approves-innovative-gene-therapy-treat-pediatric-patients-spinal-muscular-atrophy-rare-disease (Accessed on August 12, 2019).

Mendell JR, Al-Zaidy S, Shell R, et al. Single-Dose Gene-Replacement Therapy for Spinal Muscular Atrophy. N Engl J Med 2017; 377:1713.

Mendell JR, Al-Zaidy SA, Lehman KJ, et al. Five-Year Extension Results of the Phase 1 START Trial of Onasemnogene Abeparvovec in Spinal Muscular Atrophy. JAMA Neurol 2021; 78:834.

Day JW, Finkel RS, Chiriboga CA, et al. Onasemnogene abeparvovec gene therapy for symptomatic infantile-onset spinal muscular atrophy in patients with two copies of SMN2 (STR1VE): an open-label, single-arm, multicentre, phase 3 trial. Lancet Neurol 2021; 20:284.

Mercuri E, Muntoni F, Baranello G, et al. Onasemnogene abeparvovec gene therapy for symptomatic infantile-onset spinal muscular atrophy type 1 (STR1VE-EU): an open-label, single-arm, multicentre, phase 3 trial. Lancet Neurol 2021; 20:832.

Zolgensma (onasemnogene abeparvovec-xioi) suspension prescribing information. Available at: https://www.fda.gov/media/126109/download (Accessed on December 22, 2021).

Zolgensma - one-time gene therapy for spinal muscular atrophy. Med Lett Drugs Ther 2019; 61:113.

FDA approves oral treatment for spinal muscular atrophy. https://www.fda.gov/news-events/press-announcements/fda-approves-oral-treatment-spinal-muscular-atrophy (Accessed on August 20, 2020).

Baranello G, Darras BT, Day JW, et al. Risdiplam in Type 1 Spinal Muscular Atrophy. N Engl J Med 2021; 384:915.

Darras BT, Masson R, Mazurkiewicz-Bełdzińska M, et al. Risdiplam-Treated Infants with Type 1 Spinal Muscular Atrophy versus Historical Controls. N Engl J Med 2021; 385:427.

Mercuri E, Deconinck N, Mazzone ES, et al. Safety and efficacy of once-daily risdiplam in type 2 and non-ambulant type 3 spinal muscular atrophy (SUNFISH part 2): a phase 3, double-blind, randomised, placebo-controlled trial. Lancet Neurol 2022; 21:42.

Evrysdi (risdiplam) prescribing information. https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/213535s000lbl.pdf (Accessed on August 20, 2020).

Matthews E, Brassington R, Kuntzer T, et al. Corticosteroids for the treatment of Duchenne muscular dystrophy. Cochrane Database Syst Rev 2016; :CD003725.

Birnkrant DJ, Bushby K, Bann CM, et al. Diagnosis and management of Duchenne muscular dystrophy, part 1: diagnosis, and neuromuscular, rehabilitation, endocrine, and gastrointestinal and nutritional management. Lancet Neurol 2018; 17:251.

Biggar WD, Politano L, Harris VA, et al. Deflazacort in Duchenne muscular dystrophy: a comparison of two different protocols. Neuromuscul Disord 2004; 14:476.

Griggs RC, Moxley RT 3rd, Mendell JR, et al. Prednisone in Duchenne dystrophy. A randomized, controlled trial defining the time course and dose response. Clinical Investigation of Duchenne Dystrophy Group. Arch Neurol 1991; 48:383.

Griggs RC, Moxley RT 3rd, Mendell JR, et al. Duchenne dystrophy: randomized, controlled trial of prednisone (18 months) and azathioprine (12 months). Neurology 1993; 43:520.

Angelini C, Pegoraro E, Turella E, et al. Deflazacort in Duchenne dystrophy: study of long-term effect. Muscle Nerve 1994; 17:386.

Biggar WD, Gingras M, Fehlings DL, et al. Deflazacort treatment of Duchenne muscular dystrophy. J Pediatr 2001; 138:45.

Alman BA, Raza SN, Biggar WD. Steroid treatment and the development of scoliosis in males with duchenne muscular dystrophy. J Bone Joint Surg Am 2004; 86-A:519.

McDonald CM, Henricson EK, Abresch RT, et al. Long-term effects of glucocorticoids on function, quality of life, and survival in patients with Duchenne muscular dystrophy: a prospective cohort study. Lancet 2018; 391:451.

Lebel DE, Corston JA, McAdam LC, et al. Glucocorticoid treatment for the prevention of scoliosis in children with Duchenne muscular dystrophy: long-term follow-up. J Bone Joint Surg Am 2013; 95:1057.

Henricson EK, Abresch RT, Cnaan A, et al. The cooperative international neuromuscular research group Duchenne natural history study: glucocorticoid treatment preserves clinically meaningful functional milestones and reduces rate of disease progression as measured by manual muscle testing and other commonly used clinical trial outcome measures. Muscle Nerve 2013; 48:55.

Daftary AS, Crisanti M, Kalra M, et al. Effect of long-term steroids on cough efficiency and respiratory muscle strength in patients with Duchenne muscular dystrophy. Pediatrics 2007; 119:e320.

King WM, Ruttencutter R, Nagaraja HN, et al. Orthopedic outcomes of long-term daily corticosteroid treatment in Duchenne muscular dystrophy. Neurology 2007; 68:1607.

FDA grants accelerated approval to first targeted treatment for rare Duchenne muscular dystrophy mutation. https://www.fda.gov/news-events/press-announcements/fda-grants-accelerated-approval-first-targeted-treatment-rare-duchenne-muscular-dystrophy-mutation (Accessed on December 17, 2019).

FDA approves targeted treatment for rare Duchenne muscular dystrophy mutation. https://www.fda.gov/news-events/press-announcements/fda-approves-targeted-treatment-rare-duchenne-muscular-dystrophy-mutation (Accessed on August 19, 2020).

Dhillon S. Viltolarsen: First Approval. Drugs 2020; 80:1027.

Clemens PR, Rao VK, Connolly AM, et al. Safety, Tolerability, and Efficacy of Viltolarsen in Boys With Duchenne Muscular Dystrophy Amenable to Exon 53 Skipping: A Phase 2 Randomized Clinical Trial. JAMA Neurol 2020; 77:982.

Finkel RS. Read-through strategies for suppression of nonsense mutations in Duchenne/ Becker muscular dystrophy: aminoglycosides and ataluren (PTC124). J Child Neurol 2010; 25:1158.

Translarna: EPAR - Product information. http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Product_Information/human/002720/WC500171813.pdf (Accessed on March 27, 2018).

Konieczny P, Swiderski K, Chamberlain JS. Gene and cell-mediated therapies for muscular dystrophy. Muscle Nerve 2013; 47:649.

Mendell JR, Campbell K, Rodino-Klapac L, et al. Dystrophin immunity in Duchenne's muscular dystrophy. N Engl J Med 2010; 363:1429.

Klein CJ, Coovert DD, Bulman DE, et al. Somatic reversion/suppression in Duchenne muscular dystrophy (DMD): evidence supporting a frame-restoring mechanism in rare dystrophin-positive fibers. Am J Hum Genet 1992; 50:950.

Long C, Amoasii L, Mireault AA, et al. Postnatal genome editing partially restores dystrophin expression in a mouse model of muscular dystrophy. Science 2016; 351:400.

Nelson CE, Hakim CH, Ousterout DG, et al. In vivo genome editing improves muscle function in a mouse model of Duchenne muscular dystrophy. Science 2016; 351:403.

Tabebordbar M, Zhu K, Cheng JK, et al. In vivo gene editing in dystrophic mouse muscle and muscle stem cells. Science 2016; 351:407.

Calos MP. The CRISPR Way to Think about Duchenne's. N Engl J Med 2016; 374:1684.

Walter MC, Lochmüller H, Reilich P, et al. Creatine monohydrate in muscular dystrophies: A double-blind, placebo-controlled clinical study. Neurology 2000; 54:1848.

Escolar DM, Buyse G, Henricson E, et al. CINRG randomized controlled trial of creatine and glutamine in Duchenne muscular dystrophy. Ann Neurol 2005; 58:151.

Wagner KR, McPherron AC, Winik N, Lee SJ. Loss of myostatin attenuates severity of muscular dystrophy in mdx mice. Ann Neurol 2002; 52:832.

Bogdanovich S, Krag TO, Barton ER, et al. Functional improvement of dystrophic muscle by myostatin blockade. Nature 2002; 420:418.

Schuelke M, Wagner KR, Stolz LE, et al. Myostatin mutation associated with gross muscle hypertrophy in a child. N Engl J Med 2004; 350:2682.

McNally EM. Powerful genes--myostatin regulation of human muscle mass. N Engl J Med 2004; 350:2642.

Wagner KR. The elusive promise of myostatin inhibition for muscular dystrophy. Curr Opin Neurol 2020; 33:621.

Gussoni E, Blau HM, Kunkel LM. The fate of individual myoblasts after transplantation into muscles of DMD patients. Nat Med 1997; 3:970.

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