The US Food and Drug Administration (FDA) has granted approval for two groundbreaking gene therapies aimed at treating sickle cell disease (SCD). This decision marks a significant milestone, with one of the therapies, Casgevy (exagamglogene autotemcel), developed by Vertex Pharmaceuticals and CRISPR Therapeutics, being the first-ever drug to gain approval utilizing CRISPR gene-editing technology. Casgevy involves editing patients’ own CD34-positive hematopoietic stem cells using CRISPR-Cas9 technology outside the body to modify the BCL11A gene. This alteration increases the production of fetal hemoglobin, addressing the dysfunction observed in SCD patients. The other approved therapy, Lyfgenia (lovotibeglogene autotemcel), developed by Bluebird Bio, entails genetically modifying patients’ own hematopoietic stem cells using lentiviral vectors. This modification delivers a functional copy of a modified beta-globin gene, enabling the production of anti-sickling hemoglobin (HbAT87Q), functioning similarly to normal adult hemoglobin.
Both therapies are one-time infusions made from the patient’s own blood stem cells and are authorized for individuals aged 12 years and older with a history of vaso-occlusive crises. The FDA highlighted the rigorous evaluation of scientific and clinical data supporting the approval, emphasizing its commitment to advancing safe and effective treatments for severe health conditions. In addition to the approval, the FDA included a black box warning for Lyfgenia, emphasizing the need for life-long monitoring due to hematologic malignancies observed in some treated patients. Both Casgevy and Lyfgenia will undergo long-term studies to assess their safety and effectiveness. Common side effects reported for Casgevy included low platelet and white blood cell levels, mouth sores, nausea, and musculoskeletal pain, while Lyfgenia exhibited side effects such as stomatitis, febrile neutropenia, and low blood cell counts. Both therapies had previously received orphan drug, fasttrack, and regenerative medicine advanced therapy designations from the FDA