The FDA has granted approval to eladocagene exuparvovec-tneq (Kebilidi, PTC Therapeutics), a novel adeno-associated virus vector-based gene therapy, for the treatment of aromatic L-amino acid decarboxylase (AADC) deficiency in both adult and pediatric patients. This marks a significant advancement as Kebilidi becomes the first FDA-approved gene therapy specifically indicated for this rare and debilitating genetic disorder.
AADC deficiency results from mutations in the DDC gene, impairing the synthesis of dopamine and leading to severe developmental delays and neurological abnormalities. Symptoms typically manifest within the first few months of life, including delays in motor function, hypotonia, and cognitive impairments. The newly approved gene therapy offers a potential avenue to address the underlying cause of the deficiency by delivering a functional copy of the DDC gene directly to the brain.
How Kebilidi Works
Kebilidi is administered through four infusions during a single surgical session directly into the putamen, a region of the brain crucial for motor control. This procedure requires specialized expertise in pediatric stereotactic neurosurgery. Once infused, the gene therapy promotes the expression of the AADC enzyme, subsequently increasing dopamine levels in the brain. Dopamine is a critical neurotransmitter involved in movement, attention, learning, and memory.
Clinical Trial Data
The safety and efficacy of eladocagene exuparvovec-tneq were evaluated in an open-label, single-arm clinical study involving 13 pediatric patients with confirmed AADC deficiency. All patients exhibited no gross motor function at the study's outset and had decreased AADC activity in plasma. When compared to untreated patients, those treated with eladocagene exuparvovec-tneq showed notable improvements in gross motor function. At week 48, eight out of 12 treated patients demonstrated improved motor skills, a result not observed in the untreated cohort with severe AADC deficiency.
Regulatory Context
Eladocagene exuparvovec-tneq received accelerated approval, priority review, orphan drug designation, and a rare pediatric disease priority review voucher from the FDA. Continued approval is contingent upon verification and description of clinical benefit, such as the durability of improved symptoms, in an ongoing confirmatory clinical trial.
Device Authorization
In conjunction with the gene therapy approval, the FDA also authorized the SmartFlow Neuro Cannula (ClearPoint Neuro), an infusion tube designed for precise delivery of eladocagene exuparvovec-tneq into the brain's parenchymal tissue. The SmartFlow Neuro Cannula is currently the only FDA-authorized device indicated for use in the administration of Kebilidi.