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CADTH ISSUES IN EMERGING HEALTH TECHNOLOGIES Informing Decisions About New Health Technologies Issue Mar 171 2018 Gene Therapy: An Overview of Approved and Pipeline Technologies CADTH ISSUES IN EMERGING HEALTH TECHNOLOGIES 1 Authors: Alison Sinclair, Saadul Islam, Sarah Jones Cite as: Gene therapy: an overview of approved and pipeline technologies. Ottawa: CADTH; 2018 Mar. (CADTH issues in emerging health technologies; issue 171). Acknowledgments: Louis de Léséleuc, Jeff Mason, Teo Quay, Joanne Kim, Lesley Dunfield, Eftyhia Helis, Iryna Magega, Jane Hurge ISSN: 1488-6324 (online) Disclaimer: The information in this document is intended to help Canadian health care decision-makers, health care professionals, health systems leaders, and policy- makers make well-informed decisions and thereby improve the quality of health care services. While patients and others may access this document, the document is made available for informational purposes only and no representations or warranties are made with respect to its fitness for any particular purpose. The information in this document should not be used as a substitute for professional medical advice or as a substitute for the application of clinical judgment in respect of the care of a particular patient or other professional judgment in any decision-making process. The Canadian Agency for Drugs and Technologies in Health (CADTH) does not endorse any information, drugs, therapies, treatments, products, processes, or services. While CADTH has taken care to ensure that the information prepared by it in this document is accurate, complete, and up-to-date as at the applicable date the material was first published by CADTH, CADTH does not make any guarantees to that effect. CADTH does not guarantee and is not responsible for the quality, currency, propriety, accuracy, or reasonableness of any statements, information, or conclusions contained in any third-party materials used in preparing this document. The views and opinions of third parties published in this document do not necessarily state or reflect those of CADTH. CADTH is not responsible for any errors, omissions, injury, loss, or damage arising from or relating to the use (or misuse) of any information, statements, or conclusions contained in or implied by the contents of this document or any of the source materials. This document may contain links to third-party websites. CADTH does not have control over the content of such sites. Use of third-party sites is governed by the third-party website owners’ own terms and conditions set out for such sites. CADTH does not make any guarantee with respect to any information contained on such third-party sites and CADTH is not responsible for any injury, loss, or damage suffered as a result of using such third-party sites. CADTH has no responsibility for the collection, use, and disclosure of personal information by third-party sites. Subject to the aforementioned limitations, the views expressed herein are those of CADTH and do not necessarily represent the views of Canada’s federal, provincial, or territorial governments. This document is prepared and intended for use in the context of the Canadian health care system. The use of this document outside of Canada is done so at the user’s own risk. This disclaimer and any questions or matters of any nature arising from or relating to the content or use (or misuse) of this document will be governed by and interpreted in accordance with the laws of the Province of Ontario and the laws of Canada applicable therein, and all proceedings shall be subject to the exclusive jurisdiction of the courts of the Province of Ontario, Canada. The copyright and other intellectual property rights in this document are owned by CADTH and its licensors. These rights are protected by the Canadian Copyright Act and other national and international laws and agreements. You are permitted to make copies of this document for non-commercial purposes only, provided it is not modified when reproduced and appropriate credit is given to CADTH and its licensors. About CADTH: CADTH is an independent, not-for-profit organization responsible for providing Canada’s health care decision-makers with objective evidence to help make informed decisions about the optimal use of drugs, medical devices, diagnostics, and procedures in our health care system. Funding: CADTH receives funding from Canada’s federal, provincial, and territorial governments, with the exception of Quebec. Contact [email protected] with inquiries about this notice or legal matters relating to CADTH services. CADTH ISSUES IN EMERGING HEALTH TECHNOLOGIES 2 Summary • Gene therapy is an area of therapeutics aimed at curing, or significantly improving the management of, diseases with few or no treatment alternatives. • A large proportion of the candidates for gene therapy include advanced-stage cancer or hematological conditions. In addition, rare or inherited disorders are also frequent targets of gene therapy. • While gene therapy developments are still largely in the research stage, companies are increasingly investing in these technologies. Recently, a number of products have been approved outside of Canada or are in the advanced stage of clinical research. • The upfront current cost of gene therapy is generally very high. Multi-stakeholder dialogues around management of cost and reimbursement of these products are necessary. • Specialized manufacturing facilities, care centres, and clinicians trained to conduct customized procedures for such therapies are vital to ensure accessibility and quality of care. Scope Methods This bulletin summarizes information on gene therapies that These bulletins are not systematic reviews of the literature and have been marketed in at least one country or are currently at do not involve a detailed critical appraisal of identified studies. an advanced or priority stage of development and are therefore They are not intended to provide recommendations for or most likely to appear on the market in the next two to three against a particular technology. years. General aspects of adoption and implementation are considered, but clinical and cost-effectiveness of individual Literature Search therapies are not reviewed. Details on mechanisms, processes A limited literature search was conducted on key resources, related to manufacturing and administration, and regulatory including PubMed, the Cochrane Library, University of York aspects are not within the scope of this bulletin. Centre for Reviews and Dissemination databases, and Canadian and major international health technology agencies. As well, a A comprehensive list of ongoing clinical trials on gene therapy focused Internet search was conducted. Methodological filters around the world or in Canada is also not within the scope of were applied to limit retrieval to randomized controlled trials, this bulletin. This information may be found at ClinicalTrials.gov, controlled clinical trials, and clinical studies. Where possible, 1 maintained by the US National Library of Medicine, and Health retrieval was limited to the human population. The search was 2 Canada’s Clinical Trials Database. also limited to English-language documents published between CADTH ISSUES IN EMERGING HEALTH TECHNOLOGIES 3 January 1, 2016, and December 8, 2017. Regular alerts updated the search until project completion; only citations retrieved Background before January 30, 2018, were incorporated into the report. What is Gene Therapy? According to the FDA, gene therapy is “the administration of Study Selection genetic material to modify or manipulate the expression of The search results were divided between two authors by topic a gene product or to alter the biological properties of living area. No duplicate screening was completed. In addition to cells for therapeutic use.”3 In Canada, gene therapies are the studies identified by the literature search, publications of included in the definition of “drug” under theFood and Drugs interest cited by identified sources were also included in the Act and are regulated under the Food and Drug Regulations.4-6 report. As the report was intended to focus on the therapies Both the US and Canada regulate gene therapies as biologic most likely to appear on the market in the next two to three drug therapies.3-5,7 Other jurisdictions, such as Europe, have a years, journal articles, database entries, or Web pages were separate regulatory pathway for gene therapies.7,8 considered for inclusion if they provided information on a Gene therapy involves the administration of specific genetic gene therapy that has been approved for marketing anywhere material (i.e., DNA or RNA) via a carrier, known as a “vector,” that in the world or was in active development, either in phase III enables the foreign genetic material to enter the target cells.9 or in earlier phases with a special regulatory designation. All Most gene therapies use modified versions of natural viruses indications were eligible. as vectors, as they are an efficient way of introducing DNA or RNA into a cell.8-10 The gene therapy agent can be injected Stakeholder Review into the body (in vivo gene therapy) or used to modify cells A draft version of this bulletin was posted publicly for taken from the body, which are then re-infused (ex vivo gene stakeholder review. therapy; Figure 1). Replacement gene therapy aims to provide a working copy of the damaged gene(s), boost the availability Figure 1: Schematic of Approaches to Gene Therapy Applicable to Both Gene Editing and
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