FDA CDC News
FDA Approves First Topical Gene Therapy for Treatment of Wounds in Patients with Dystrophic Epidermolysis Bullosa
Today, the U.S. Food and Drug Administration approved Vyjuvek, a herpes-simplex virus type 1 (HSV-1) vector-based gene therapy, for the treatment of wounds in patients 6 months of age and older with dystrophic epidermolysis bullosa (DEB) with mutation(s) in the collagen type VII alpha 1 chain (COL7A1) gene.
“Vyjuvek is the first FDA-approved gene therapy treatment for DEB, a rare and serious genetic skin disorder,” said Peter Marks, M.D., Ph.D., director of the FDA’s Center for Biologics Evaluation and Research. “Today’s action demonstrates the FDA’s ongoing commitment to supporting the development and evaluation of new treatments that address unmet needs for rare diseases or conditions.”
DEB is a genetic disorder that affects the connective tissue in the skin and nails and results from mutation(s) in the COL7A1 gene. This gene encodes type VII collagen (COL7), which is an essential protein that helps strengthen and stabilize the outer and middle layers of the skin. When COL7A1 is deficient, skin layers can separate, causing painful and debilitating blisters and wounds. DEB usually presents itself at birth and is divided into two major types depending on the inheritance pattern: recessive dystrophic epidermolysis bullosa (RDEB) and dominant dystrophic epidermolysis bullosa (DDEB).
Symptoms can vary widely among affected people. Individuals with DDEB typically have mild cases with blistering primarily affecting the hands, feet, knees, and elbows. RDEB cases can be painful and debilitating, often involving widespread blistering that can lead to vision loss, disfigurement, and other serious medical complications, which could be fatal.
Vyjuvek is a genetically modified (engineered in a laboratory) herpes-simplex virus used to deliver normal copies of the COL7A1 gene to the wounds. COL7 molecules arrange themselves into long, thin bundles that form anchoring fibrils that hold the epidermis (skin) and dermis together, which is essential for maintaining the integrity of the skin. Vyjuvek has also been modified to eliminate its ability to replicate in normal cells. Vyjuvek is mixed into an excipient (non-active ingredient) gel prior to topical application. A healthcare professional evenly applies Vyjuvek gel in droplets to a patient’s wounds once a week.
The safety and effectiveness of Vyjuvek was established primarily in a randomized, double-blinded, placebo-controlled study involving a total of 31 subjects with DEB, including 30 subjects with RDEB and one subject with DDEB. In the study, two DEB wounds of comparable size on each patient were identified and randomized to receive either topical administration of Vyjuvek or the placebo on a weekly basis. The age of the subjects ranged from 1 year to 44 years (mean age 17 years). Efficacy was established by improved wound healing, defined as the difference in the proportion of confirmed complete (100%) wound closure between the Vyjuvek-treated and the placebo-treated wounds at 24 weeks. Sixty-five percent of the Vyjuvek-treated wounds completely closed while only 26% of the placebo-treated wound completely closed.
In addition, in a different clinical study, two young patients with RDEB (6 and 7 months of age, respectively) received topical Vyjuvek weekly without any new safety findings.
The most common adverse reactions associated with Vyjuvek included itching, chills, redness, rash, cough and runny nose.
Patients or caregivers should take the following precautions during treatment with Vyjuvek:
- Avoid direct contact with treated wounds (e.g., touching and scratching) and dressings of treated wounds for approximately 24 hours following Vyjuvek application. In the event of accidental exposure, patients and exposed individuals should clean the affected area.
- Wash hands and wear protective gloves when changing wound dressings.
- Disinfect bandages from the first dressing change following Vyjuvek treatment with a virucidal agent, such as 70% isopropyl alcohol, 6% hydrogen peroxide, or <0.4% ammonium chloride, and dispose of the disinfected bandages in a separate sealed plastic bag in household waste. Dispose of the subsequent used dressings and cleaning materials into a sealed plastic bag and dispose in household waste.
This application received Orphan Drug and Fast Track designations. Vyjuvek also received Regenerative Medicine Advanced Therapy and Priority Review designations and a Rare Pediatric Disease Priority Review Voucher. The FDA’s rare pediatric disease priority review voucher program is intended to encourage development of new drugs and biologics to prevent and/or treat rare diseases in children.
The approval of Vyjuvek was granted to Krystal Biotech, Inc.
FDA CDC News
FDA Authorizes First At-Home COVID-19 Test Using Traditional Review Process
U.S. Food and Drug Administration granted marketing authorization for the Cue COVID-19 Molecular Test.
The U.S. Food and Drug Administration has granted marketing authorization to the Cue COVID-19 Molecular Test, which is a nucleic acid amplification test designed to detect genetic material from the SARS-CoV-2 virus present in nasal swabs from adults with signs and symptoms of upper respiratory infection. This is the first-ever at-home test authorized by the FDA using a traditional premarket review pathway for any respiratory illness, and it is also the first at-home COVID-19 test granted marketing authorization outside of emergency use authorities.
The Cue COVID-19 Molecular Test is a molecular nucleic acid amplification test, consisting of a single-use Cue COVID-19 test cartridge, a single-use Cue sample wand, and the Cue cartridge reader. It uses the Cue Health app to display results when the test is complete, and the reusable, battery-operated Cue Cartridge Reader runs the Cue Test Cartridge and communicates results directly to the app in about 20 minutes. In a study reviewed by the FDA, the test correctly identified 98.7% of negative and 92.9% of positive samples in individuals with signs and symptoms of upper respiratory infection.
There is a risk of false positive and false negative results, and individuals who test positive should avoid spreading the virus and should seek follow-up care with their physician or healthcare provider as additional testing may be necessary. Negative results should be confirmed by a lab-based molecular test if necessary for patient management.
The FDA has established criteria called special controls that define the requirements related to labeling and performance testing, and they have created a new regulatory classification, which means that subsequent devices of the same type with the same intended use may go through the FDA’s 510(k) pathway. The FDA has granted the marketing authorization to Cue Health Inc.
For more information, please read the press release: https://www.fda.gov/news-events/press-announcements/fda-permits-marketing-first-covid-19-home-test-using-traditional-premarket-review-process
More news on the topic: https://www.labpulse.com/business-insights/policy-and-regulation/regulatory-approval/article/15540028/cue-health-granted-first-traditional-fda-authorization-for-athome-test-to-detect-respiratory-illness
FDA CDC News
“FDA Modernizes Clinical Trials with New Guidelines for Efficiency and Diversity”
FDA releases draft recommendations to modernize clinical trials, incorporating RWE, technology, and increasing diversity.
The United States Food and Drug Administration (FDA) has announced additional steps to modernize clinical trials in an effort to increase efficiency and improve patient outcomes. The agency has released draft recommendations and is seeking feedback on how they should be applied to increasingly diverse trial types and data sources.
The new guidelines aim to address challenges in clinical trial design and execution, including the use of real-world evidence (RWE) and increasing diversity in clinical trial populations. The FDA recognizes the importance of incorporating RWE in clinical trials to provide a more comprehensive understanding of a drug’s safety and efficacy in real-world settings. The agency is also committed to increasing diversity in clinical trials to ensure that all patient populations receive equal access to potentially life-saving treatments.
The draft recommendations suggest new approaches to trial design, such as the use of adaptive designs and master protocols, to increase efficiency and reduce costs. Adaptive designs allow for changes to be made during the trial based on emerging data, while master protocols enable multiple drugs to be tested simultaneously in a single trial. The FDA also recommends the use of innovative trial designs, such as basket and umbrella trials, which allow for the testing of multiple drugs in a single trial on patients with similar genetic profiles or disease types.
The FDA is also exploring the use of decentralized clinical trials, which rely on technology to enable patients to participate in trials from their homes. This approach has the potential to increase participation in clinical trials and reduce the burden on patients who may have difficulty traveling to study sites. The FDA acknowledges that the use of technology in clinical trials has the potential to improve efficiency and reduce costs while maintaining the integrity of the data.
Finally, the FDA is committed to increasing diversity in clinical trials by encouraging the inclusion of underrepresented populations, such as women, racial and ethnic minorities, and the elderly. The agency is exploring ways to incentivize the inclusion of these populations in clinical trials and is partnering with patient advocacy groups to increase awareness and understanding of the importance of clinical trial diversity.
In conclusion, the FDA’s draft recommendations for modernizing clinical trials represent a significant step forward in improving patient outcomes and increasing efficiency in drug development. By incorporating RWE, innovative trial designs, and technology, while also increasing diversity in clinical trial populations, the agency is working to ensure that all patients have equal access to potentially life-saving treatments. The FDA is requesting feedback on these draft recommendations, and it is hoped that the final guidelines will reflect the input of a diverse range of stakeholders.
FDA CDC News
FDA Approves New Buprenorphine Treatment Option for Opioid Use Disorder
Today, the U.S. Food and Drug Administration approved Brixadi (buprenorphine) extended-release injection for subcutaneous use (under the skin) to treat moderate to severe opioid use disorder (OUD). Brixadi is available in two formulations, a weekly injection that can be used in patients who have started treatment with a single dose of a transmucosal buprenorphine product or who are already being treated with buprenorphine, and a monthly version for patients already being treated with buprenorphine.
“Buprenorphine is an important treatment option for opioid use disorder. Today’s approval expands dosing options and provides people with opioid use disorder a greater opportunity to sustain long-term recovery,” said FDA Commissioner Robert M. Califf, M.D. “The FDA will continue to take the critical steps necessary to pursue efforts that advance evidence-based treatments for substance use disorders, which is a strategic priority under the FDA’s Overdose Prevention Framework.”
Buprenorphine is a safe and effective medication for the treatment of OUD. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), patients receiving medication for their OUD cut their risk of death from all causes in half.
The FDA continues to implement a comprehensive approach to increase options to treat OUD. Earlier this month, the agency issued a joint letter with SAMHSA to clarify the importance of counseling and other services as part of a comprehensive treatment plan for OUD, and to also reiterate that supplying buprenorphine should not be made contingent upon participation in such services. The agency also held a virtual public workshop that highlighted the need for additional strengths and dosing regimens for extended-release formulations.
Brixadi is approved in both weekly and monthly subcutaneous injectable formulations at varying doses, including lower doses that may be appropriate for those who do not tolerate higher doses of extended-release buprenorphine that are currently available. The weekly doses are 8 milligrams (mg), 16 mg, 24 mg, 32 mg; and the monthly doses are 64 mg, 96 mg, 128 mg. The approved weekly formulation in various lower strengths offers a new option for people in recovery who may benefit from a weekly injection to maintain treatment adherence. Brixadi will be available through a Risk Evaluation and Mitigation Strategy (REMS) program and administered only by health care providers in a health care setting.
The most common adverse reactions (occurring in ≥5% of patients) with Brixadi include injection-site pain, headache, constipation, nausea, injection-site erythema, itchy skin at the injection site (injection-site pruritus), insomnia and urinary tract infections.
The safety and efficacy of Brixadi were evaluated in a behavioral pharmacology study assessing the ability of two weekly doses of Brixadi to block the subjective effects of opioids, and one randomized, double-blind, active-controlled clinical trial in 428 adults with a diagnosis of moderate-to-severe OUD. After an initial test dose of transmucosal buprenorphine, patients were randomized to treatment with Brixadi plus a sublingual placebo, or active sublingual buprenorphine plus placebo injections. After titration over the first week, patients were treated with weekly injections over 12 weeks and then transitioned to monthly injections for an additional 12 weeks. A response to treatment was measured by urine drug screening and self-reporting of illicit opioid use during the treatment period. Patients were considered responders if they had negative opioid assessments at the end of each of the two treatment phases. The proportion of patients meeting the responder definition was 16.9% in the Brixadi group and 14.0% in the sublingual buprenorphine group.
The FDA granted approval of Brixadi to Braeburn Inc.
The agency remains focused on responding to all facets of substance use, misuse, substance use disorders, overdose and death in the U.S. through its FDA Overdose Prevention Framework. The framework’s priorities include: supporting primary prevention by eliminating unnecessary initial prescription drug exposure and inappropriate prolonged prescribing; encouraging harm reduction through innovation and education; advancing development of evidence-based treatments for substance use disorders; and protecting the public from unapproved, diverted or counterfeit drugs presenting overdose risks.
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