Families of children with Duchenne Muscular Dystrophy (DMD) are intensifying their advocacy efforts as a promising new treatment gains regulatory traction but remains inaccessible in many regions. Givinostat, a drug that blocks histone deacetylase activity to improve muscle repair, has received conditional approval from European regulators but faces implementation challenges across healthcare systems.
Mechanism and Clinical Impact
Givinostat works by reducing inflammation and the buildup of scar tissues, ultimately slowing disease progression in DMD patients. The drug has received a positive recommendation from the Committee for Medicinal Products for Human Use (CHMP) for conditional approval, with a formal decision expected from the European Commission by July.
According to patient advocates, the medication can significantly extend periods of physical stability. Bianca Benson, mother of two boys with DMD, explained that "the use of Givinostat will lengthen six months of physical deterioration out to a two-year period." She cited awareness of a 21-year-old DMD patient who was still walking and driving as a result of the drug's positive impact.
Patient Stories Drive Advocacy
The urgency surrounding access to givinostat is exemplified by families like the Bensons, whose sons Noah (11) and Rowan (9) were diagnosed with DMD in January 2020. Bianca Benson described the daily challenges: "The body is not producing significant amounts of the protein dystrophin that helps keep muscle cells intact restricting movement and causing chronic fatigue. Imagine trying to walk around with 10lb weights strapped to your limbs and back."
Noah now requires a wheelchair for school transport and has become "understandably frustrated with his situation," often asking his Special Needs Assistant "why is he getting worse?" Meanwhile, Rowan uses a wheelchair for long-distance travel but maintains mobility for shorter periods.
Access Barriers and Costs
Despite regulatory progress, access remains limited. In Ireland, neither the European Medicines Agency (EMA) nor the Health Products Regulatory Authority (HPRA) have granted marketing authorization for givinostat. The HSE stated that "a national assessment and decision process cannot commence in the absence of a marketing authorisation."
The financial burden is substantial. A one milligram dose costs €33.80, and typical patients require 31 milligrams twice daily, totaling €4,191.20 monthly. The drug is indicated for boys aged six years and older who retain walking ability.
Regional Disparities in Access
Access varies significantly by location. In the UK, givinostat was conditionally approved in December but initially only available in Leicestershire and Swansea due to local NHS budget arrangements. The Newcastle Hospitals Trust, which treats DMD patients across the North East and Cumbria, recently announced it was "finalising arrangements" to make the drug available for eligible patients.
Twelve-year-old Alfie Pentony from Newry, Co Down, exemplifies these geographic disparities. Despite the drug's availability in other parts of the UK, it remains unavailable in Northern Ireland, forcing him to travel to Newcastle-upon-Tyne for treatment while taking steroid medication to slow muscle weakness.
Political Engagement and Next Steps
Advocacy efforts are intensifying at the political level. Bianca Benson planned to travel to Leinster House to meet with Minister for Health Jennifer Carroll McNeill, representing not only her sons but "the 110 boys in Ireland who have been diagnosed with DMD."
The condition affects approximately 110 boys in Ireland currently, with no cure available. While specialist gene therapy exists in countries like the US, treatment costs start at €3 million, making it financially prohibitive for most families.
As regulatory decisions approach, families emphasize the time-sensitive nature of treatment. "Timing is of the essence," noted one parent, "the sooner Archie goes on something like this the better chance he has of survival." The drug is specifically designed for ambulatory patients, making early intervention crucial before mobility is lost to disease progression.
