RNAi therapeutic 'Amvuttra' enters reimb review

Scheduled to be considered for the Health Insurance Review and Assessment Service (HIRA)'s Drug Reimbursement Evaluation Committee (DREC)

After receiving orphan drug designation in 2023, Amvuttra received final approval last year

'Amvuttra,' an RNA interference (RNAi) therapeutic, has been put on a test stand for insurance reimbursement entry. 

According to sources, Amvuttra (vutrisiran), a new drug for the treatment of hereditary transthyretin amyloidosis (hATTR) with polyneuropathy (hATTR-PN), will be considered for the Health Insurance Review and Assessment Service (HIRA)'s Drug Reimbursement Evaluation Committee (DREC) today (December 4). Amvuttra was developed by Alnylam Pharmaceuticals and introduced to South Korea by Medison Pharma Korea.

Amvuttra obtained an orphan drug designation from the Ministry of Food and Drug Safety (MFDS) in November 2023 and received final approval last year.

Amvuttra is administered once every 3 months and is designed to target and silence messenger RNA, thereby blocking the production of wild-type and mutant transthyretin (TTR).

The efficacy of Amvuttra was demonstrated through the Phase 3 HELIOS-A study. In the Phase 3 trial, 164 patients with hATTR-PN and accompanying polyneuropathy from 22 countries participated. Participants were randomly assigned to either a subcutaneous injection group receiving Amvuttra 25 mg once every 3 months (Amvuttra group, 122 patients) or an intravenous injection group receiving 'Onpattro (patisiran)' 0.3mg/kg once every 3 weeks (Onpattro group, 42 patients).

Furthermore, the effectiveness of Amvuttra was evaluated by comparison with the placebo group in the APOLLO study, which evaluated the efficacy and safety of Onpattro in a patient group similar to that in the HELIOS-A trial.

As a result, during the 9-month treatment period, the Amvuttra group experienced less severe neurological damage than the placebo group, and had improved quality of life. Additionally, the 10 Meter Walk Test, which evaluates patients' walking speed and exercise capacity, showed that patients treated with vutrisiran had no change in time. NT-proBNP, a biomarker of heart function, improved.

Meanwhile, hATTR-PN, which affects approximately 1 in 100,000 people, is caused by a genetic mutation in the TTR gene. It is characterized by systemic multiple autonomic neuropathy, including symptoms related to the heart, digestive system, and ocular manifestations. Vyndaqel stabilizes the TTR protein.

Symptoms typically begin in the lower extremity nerves, where the abnormal protein readily accumulates, presenting as pain, paresthesia, and paralysis before progressing to involve the upper limbs. Complications spread to other organs, including the heart, kidneys, and eyes. The average life expectancy after symptom onset is approximately 7 to 12 years.