Nusinersen

Identification

Summary

Nusinersen is a medication used to treat spinal muscular atrophy.

Brand Names
Spinraza
Generic Name
Nusinersen
DrugBank Accession Number
DB13161
Background

An antisense oligonucleotide that induces survival motor neuron (SMN) protein expression, it was approved by the U.S. FDA in December, 2016 as Spinraza for the treatment of children and adults with spinal muscular atrophy (SMA). It is adminstrated as direct intrathecal injection.

Type
Biotech
Groups
Approved, Investigational
Biologic Classification
Gene Therapies
Antisense oligonucleotides
Synonyms
  • Nusinersen
External IDs
  • ASO-10-27
  • ISIS 396443
  • ISIS SMNRx
  • ISIS-396443
  • ISIS-SMNRx

Pharmacology

Indication

Indicated for the treatment of spinal muscular atrophy (SMA) in pediatric and adult patients.

Pharmacology
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Associated Conditions
Contraindications & Blackbox Warnings
Contraindications
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Pharmacodynamics

Autopsy samples from patients (n=3) had higher levels of SMN2 messenger ribonucleic acid (mRNA) containing exon 7 in the thoracic spinal cord compared to untreated SMA infants. Cardiac Electrophysiology: In 121 patients with spinal muscular atrophy who received either nusinersen or sham-control, QTcF values >500 ms and change from baseline values >60 ms were observed in 5% of patients receiving nusinersen. Compared to the sham-control, there was no increase in the incidence of cardiac adverse reactions associated with delayed ventricular repolarization in patients treated with nusinersen.

Mechanism of action

Nusinersen is a survival motor neuron-2 (SMN2)-directed antisense oligonucleotide (ASO) designed to treat SMA caused by mutations in chromosome 5q that lead to SMN protein deficiency. Using in vitro assays and studies in transgenic animal models of SMA, nusinersen was shown to increase exon 7 inclusion in SMN2 messenger ribonucleic acid (mRNA) transcripts and production of full-length SMN protein. Nusinersen acts to replace the SMN protein deficit which causes SMA, by increasing the splicing efficiency of the SMN2 pre- mRNA. More specifically, nusinersen in an 18-mer 2’-MOE phosphorothioate antisense oligonucleotide that acts as a splice-altering oligonucleotide. Nusinersen was designed to pair with a specific target sequence on the SMN2 pre-mRNA to displace heterogeneous ribonucleoproteins (hnRNPs) at the intronic splice silencing site-1 (ISS-1) between exons 7 and 8 to allow for more complete translation of SMN protein from the paralogous gene SMN2. Further reinforcing this concept, SMA phenotype is closely tied to SMN2 copy number. SMN2 serves to produce SMN protein, however at a greatly reduced rate because of differential splicing caused by the binding of the hnRNPs at the ISS-1.

TargetActionsOrganism
ASurvival motor neuron protein
antisense oligonucleotide
Humans
Absorption

Intrathecal injection of nusinersen into the cerebrospinal fluid (CSF) allows it to be distributed from the CSF to the target central nervous system (CNS) tissues. Following intrathecal administration, trough plasma concentrations of nusinersen were relatively low, compared to the trough CSF concentration. Median plasma Tmax values ranged from 1.7 to 6.0 hours. Mean plasma Cmax and AUC values increased approximately dose-proportionally up to a dose of 12 mg.

Volume of distribution

CSF: 0.4 L Plasma: 29 L

Protein binding

CSF: < 25% Plasma: >94%

Metabolism

Nusinersen is metabolized via exonuclease (3’- and 5’)-mediated hydrolysis primarily at the 3' end of the oligonucleotide. It is not a substrate for, or inhibitor or inducer of CYP450 enzymes. N-1 metabolites of the drug can be detected in the cerebrospinal fluid while N-1,2,3 metabolites can be predominantly detected in the plasma 2.

Route of elimination

Excreted by the kidney as chain-shortened oligonucleotides, which are not considered pharmacologically active.

Half-life

The mean terminal elimination half-life is estimated to be 135 to 177 days in CSF, and 63 to 87 days in plasma Label.

Clearance

Slow clearance is observed

Adverse Effects
Medicalerrors
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Toxicity

Single injection to adult monkeys produced apparent acute neurological impairment.

Pathways
Not Available
Pharmacogenomic Effects/ADRs
Not Available

Interactions

Drug Interactions
This information should not be interpreted without the help of a healthcare provider. If you believe you are experiencing an interaction, contact a healthcare provider immediately. The absence of an interaction does not necessarily mean no interactions exist.
Not Available
Food Interactions
No interactions found.

Products

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Product Ingredients
IngredientUNIICASInChI Key
Nusinersen sodium4CHB7QQU1QNot AvailableNot applicable
Brand Name Prescription Products
NameDosageStrengthRouteLabellerMarketing StartMarketing EndRegionImage
SpinrazaSolution2.4 mg / mLIntrathecalBiogen2017-08-29Not applicableCanada flag
SpinrazaInjection, solution2.4 mg/1mLIntrathecalBiogen2016-12-23Not applicableUS flag
SpinrazaInjection, solution12 mgIntrathecalBiogen Netherlands B.V.2020-12-16Not applicableEU flag

Categories

ATC Codes
M09AX07 — Nusinersen
Drug Categories
Classification
Not classified
Affected organisms
  • Humans and other mammals

Chemical Identifiers

UNII
5Z9SP3X666
CAS number
1258984-36-9

References

General References
  1. Hache M, Swoboda KJ, Sethna N, Farrow-Gillespie A, Khandji A, Xia S, Bishop KM: Intrathecal Injections in Children With Spinal Muscular Atrophy: Nusinersen Clinical Trial Experience. J Child Neurol. 2016 Jun;31(7):899-906. doi: 10.1177/0883073815627882. Epub 2016 Jan 27. [Article]
  2. CENTER FOR DRUG EVALUATION AND RESEARCH [Link]
  3. FDA Approved Drug Products: Spinraza (nusinersen) for intrathecal injection [Link]
PubChem Substance
347911437
RxNav
1863556
Wikipedia
Nusinersen
AHFS Codes
  • 92:18.00 — Antisense Oligonucleotides
FDA label
Download (531 KB)

Clinical Trials

Clinical Trials
PhaseStatusPurposeConditionsCount
4RecruitingTreatmentMuscular Atrophy, Spinal1
3Active Not RecruitingTreatmentSpinal Muscular Atrophy (SMA)1
3CompletedTreatmentSpinal Muscular Atrophy (SMA)1
3Enrolling by InvitationTreatmentMuscular Atrophy, Spinal1
3TerminatedTreatmentSpinal Muscular Atrophy (SMA)1
2Active Not RecruitingPreventionSpinal Muscular Atrophy (SMA)1
2CompletedTreatmentSpinal Muscular Atrophy (SMA)1
2TerminatedTreatmentSpinal Muscular Atrophy (SMA)1
2, 3RecruitingTreatmentMuscular Atrophy, Spinal1
1CompletedTreatmentSpinal Muscular Atrophy (SMA)3

Pharmacoeconomics

Manufacturers
Not Available
Packagers
Not Available
Dosage Forms
FormRouteStrength
Injection, solutionIntrathecal12 mg
Injection, solutionIntrathecal2.4 mg/1mL
Injection, solutionIntrathecal; Parenteral
SolutionIntrathecal2.4 mg / mL
SolutionIntrathecal2.4 mg
Prices
Not Available
Patents
Patent NumberPediatric ExtensionApprovedExpires (estimated)Region
US6166197No2000-12-262017-12-26US flag
US7101993No2006-09-052023-09-05US flag
US8361977No2013-01-292030-05-27US flag
US7838657No2010-11-232027-07-11US flag
US8110560No2012-02-072025-12-05US flag
US6210892No2001-04-032018-10-07US flag
US8980853No2015-03-172030-11-24US flag
US9717750No2017-08-012030-06-17US flag
US9926559No2018-03-272034-01-09US flag
US10266822No2019-04-232025-12-05US flag
US10436802No2019-10-082035-09-11US flag

Properties

State
Solid
Experimental Properties
Not Available

Targets

Drugtargets
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Kind
Protein
Organism
Humans
Pharmacological action
Yes
Actions
Antisense oligonucleotide
General Function
Not Available
Specific Function
Rna binding
Gene Name
SMN2
Uniprot ID
B4DP61
Uniprot Name
Survival motor neuron protein
Molecular Weight
24380.21 Da

Enzymes

Kind
Protein
Organism
Enterobacteria phage lambda
Pharmacological action
Yes
Actions
Substrate
General Function
Metal ion binding
Specific Function
Facilitates phage DNA recombination through the double-strand break repair (DSBR) and single-strand annealing pathways. Also important for the late, rolling-circle mode of lambda DNA replication.
Gene Name
exo
Uniprot ID
P03697
Uniprot Name
Exonuclease
Molecular Weight
25908.385 Da

Drug created on December 30, 2016 17:53 / Updated on June 13, 2021 16:25