Roy Swearingen, a 65-year-old Marine Corps veteran from Cypress, Texas, made medical history this week as the first veteran in the United States to receive Qalsody (tofersen), a groundbreaking FDA-approved medication for treating a rare genetic form of amyotrophic lateral sclerosis (ALS). The treatment was administered at the Michael E. DeBakey VA Medical Center in Houston, marking a significant milestone in personalized ALS therapy.
Targeting Genetic ALS with Precision Medicine
Qalsody, approved by the FDA in April 2023, represents the first treatment specifically designed to target a genetic cause of ALS. The medication is indicated for adults with ALS who carry mutations in the superoxide dismutase 1 (SOD1) gene, a subset representing approximately 1-2% of all ALS patients.
"This is the first approved treatment to target a genetic cause of ALS and we are thrilled to offer it to Mr. Swearingen and other eligible Veterans," said Dr. James Orengo, Director of the Houston VA ALS Center. The precision medicine approach marks a paradigm shift from symptomatic management to addressing underlying genetic mechanisms of disease progression.
Patient Experience and Family Impact
Swearingen, diagnosed with ALS just over a year ago, expressed gratitude for the VA's rapid response to making the new therapy available. "I am hoping for the best and grateful to be able to get this new medication," he said. "My VA doctors told me about the research into this drug and when it became FDA-approved they were right on top of getting me started on it as soon as possible."
The personal stakes are particularly high for the Swearingen family. His wife Sally, an Iraq-born immigrant who has lived through three wars, emphasized the emotional significance of the treatment. "We are very hopeful that we will see an improvement or at least a slowing of the ALS symptoms as a result of the new medication," she said. "We have a three year old son who wants to know his father."
ALS Disease Burden and Veteran Risk
ALS, also known as Lou Gehrig's disease, affects over 5,000 newly diagnosed patients annually in the United States, with most cases occurring between ages 40-70. The progressive neurological disease causes degeneration of nerve cells in the brain and spinal cord, leading to muscle weakness, atrophy, and ultimately loss of motor function including the ability to walk, talk, eat, and breathe.
Research indicates that veterans face an elevated risk of developing ALS compared to the general population, though the exact mechanisms underlying this increased susceptibility remain under investigation. "Research tells us that Veterans are at greater risk of being diagnosed with ALS than those with no history of military service," Orengo noted.
Multidisciplinary Care Approach
The Houston VA has established a specialized ALS Center employing a comprehensive, multidisciplinary team approach to patient care. The team includes Dr. Kasra Rahbar, a neurointerventionalist, and Richel Aliboso, NP, working alongside Orengo to provide state-of-the-art treatment options.
Dr. Pitchaiah Mandava, Chief of Neurology at Houston VA, emphasized the significance of offering cutting-edge therapies to veterans. "This is an exceptional example of personalized medicine that showcases the VA's agility in offering cutting edge therapy to Veterans in a timely manner," he said.
Clinical Significance and Future Outlook
While ALS currently has no cure, early detection and expert clinical management can significantly impact quality of life through comprehensive symptom management. "Although there currently is no cure, early detection and expert clinical care can provide optimal quality of life through a total body and wholistic management of symptoms," Orengo explained.
The successful implementation of Qalsody at the Houston VA represents broader efforts within the VA system to ensure veterans have access to the latest therapeutic advances. For families like the Swearingens, the availability of targeted genetic therapies provides renewed hope in the face of a devastating diagnosis.
"Getting an ALS diagnosis has been devastating but in my gut I know the right thing to do is to try and fight it with the latest medications and the best medical care," Sally Swearingen said. "This new medication and the VA is offering us hope and that's what keeps us going."
