Combined therapy of valproic acid and an SMN2 splicing modifier for an adult patient with SMA type II

Keiko Koterazawa , Shinji Kitayama , Hisahide Nishio
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Abstract

Background

Spinal muscular atrophy (SMA) is a lower motor neuron disease caused by Survival of Motor Neuron 1 gene (SMN1) deletions or other mutations. SMA is characterized by the progressive deterioration of motor and respiratory functions. New drugs that increase the gene product (SMN protein) levels, such as nusinersen, onasemnogene abeparvovec, and risdiplam, have been reported to ameliorate the symptoms and improve the prognosis of infants with SMA. Among these, nusinersen and risdiplam are SMN2 splicing modifiers suitable for patients of all ages. However, these drugs have limited efficacy in older children and adults with SMA. Therefore, there is a need for more effective therapies for these patients.

Case presentation

Here, we report an adult patient with SMA type II. The patient was treated with valproic acid (VPA, a histone deacetylase inhibitor) and an SMN2 splicing modifier, risdiplam. With the combined therapy of VPA and risdiplam over a period of more than 2 years, the patient’s clinical course was uneventful, without requiring hospitalization for acute illness such as pneumonia. In addition, motor function in the upper extremities improved during this period.

Conclusion

Combined treatment with VPA and risdiplam resulted in a stable disease course in our adult SMA patient. Thus, combined therapy consisting of drugs with different mechanisms of action might be effective for adult SMA.

丙戊酸和 SMN2 剪接修饰剂联合治疗一名 II 型 SMA 成年患者
背景脊髓性肌萎缩症(SMA)是一种下运动神经元疾病,由运动神经元生存1基因(SMN1)缺失或其他突变引起。SMA 的特征是运动和呼吸功能逐渐退化。据报道,提高基因产物(SMN 蛋白)水平的新药,如 nusinersen、onasemnogene abeparvovec 和 risdiplam,可改善 SMA 婴儿的症状和预后。其中,nusinersen 和 risdiplam 是 SMN2 剪接调节剂,适用于所有年龄段的患者。然而,这些药物对年长儿童和成人 SMA 患者的疗效有限。在此,我们报告了一名患有 SMA II 型的成人患者。该患者接受了丙戊酸(VPA,一种组蛋白去乙酰化酶抑制剂)和SMN2剪接修饰剂risdiplam的治疗。在长达两年多的时间里,患者接受了丙戊酸和利地普仑的联合治疗,临床病程平稳,未因肺炎等急性病住院治疗。此外,在此期间,患者上肢的运动功能也有所改善。因此,由不同作用机制的药物组成的联合疗法对成人 SMA 可能有效。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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