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European ad-hoc consensus statement on gene replacement therapy for spinal muscular atrophy

Authors:

Jodi M. Wolffa ∙ Nora Capoccib ∙ Evrim Atasb ∙ Diana X. Bharucha-Goebelc ∙ John F. Brandsemad ∙ Russell J. Butterfielde ∙ Christina B. Chadwickf ∙ Manuela Cortif,g ∙ Thomas O. Crawfordh ∙ Linda Cripei ∙ John W. Dayj ∙ Tina Duongj ∙ Mai K. ElMallahk ∙ Kevin M. Flanigani,l ∙ Lindsey A. Georgem ∙ Natalie L. Goedekern ∙ Erica Goudeo ∙ Sharon Hesterleeb ∙ Brian Linb ∙ Natalie K. Katzk ∙ Susan E. Matesanzd ∙ Craig McDonaldo ∙ Elizabeth M. McNallyp ∙ Claudia Mercado-Rodriguezf,g ∙ Deipanjan Nandiq ∙ Julie A. Parsonsr ∙ Crystal Prouds ∙ Leigh Ramos-Plattt ∙ Angela Lekb ∙ Stephanie M. Salabarriaf,g ∙ Eric Caminoa ∙ Rachel Schradera ∙ Erin Sheak ∙ Richard Shelli ∙ Perry B. Shiehu ∙ Jonathan H. Soslowv ∙ Jane B. Taylorw ∙ Aravindhan Veerapandiyanx ∙ Chet Villay ∙ Michele L. Yangx ∙ Craig M. Zaidmann ∙ Carmen Leon-Astudillof,g ∙ Barry J. Byrnef,g Barry.byrne@ufl.edu Show less
Affiliations & Notes
a
Parent Project Muscular Dystrophy, USA
b
Muscular Dystrophy Association, USA
c
Neuromuscular and Neurogenetic Disorders of Childhood, NINDS/NIH, Bethesda, MD, USA, Division of Neurology, Children’s National Hospital, WA, DC, USA
d
Division of Neurology, Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, PA, USA
e
Department of Pediatric Neurology, University of Utah, Salt Lake City, UT, USA
f
Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL, USA
g
Powell Gene Therapy Center, University of Florida College of Medicine, Gainesville, FL, USA
h
Department of Pediatrics, Johns Hopkins University, Baltimore, MD, USA
i
Department of Pediatrics and Neurology, Nationwide Children’s Hopsital, Columbus, OH, USA
j
Department of Neurology, Stanford University, Stanford, CA, USA
k
Department of Pediatrics, School of Medicine, Duke University, Durham, NC, USA
l
Center for Gene Therapy, Nationwide Children’s Hospital, Columbus, OH, USA
m
Department of Pediatrics, Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia PA, USA
n
Department of Neurology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
o
Department of Physical Medicine and Rehabilitation, University of California Davis School of Medicine, Sacramento, CA, USA
p
Center for Genetic Medicine, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
q
The Heart Center, Nationwide Children’s Hospital, Columbus, OH, USA
r
Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
s
Children’s Hospital of the King’s Daughters, Norfolk, VA, USA
t
Department of Pediatrics, Keck School of Medicine, University of Southern California and Children’s Hospital of Los Angeles, Los Angeles, CA, USA
u
Department of Pediatrics, University of California, Los Angeles, CA USA
v
Division of Pediatric Cardiology, Vanderbilt University Medical Center, Nashville, TN, USA
w
Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
x
Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children’s Hospital, Little Rock, AR, USA
y
The Heart Institute, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

Gene transfer therapy represents a major advancement in the treatment of patients with Duchenne muscular dystrophy (DMD). As clinical use expands, there is an urgent need for standardized, evidence and practice-informed guidelines to ensure safe and equitable delivery of this and similar products. A group of clinicians and researchers, coordinated by the Muscular Dystrophy Association and Parent Project Muscular Dystrophy, developed these consensus guidelines to outline recommendations for patient selection, institutional readiness, monitoring, and adverse event management, particularly in the first three months after treatment. This document emphasizes the importance of experienced multidisciplinary teams, real-time safety surveillance, and transparent reporting to support patient safety and clinician decision-making after treatment.
While the Food and Drug Administration has approved only one gene therapy product for the treatment of patients with DMD, these recommendations may potentially apply to other products in clinical development. Currently, significant knowledge gaps remain regarding long-term safety, durability, and optimal timing of dosing, particularly for patients with advanced disease. Researchers do not fully understand how combination therapies and genetic background may impact the response to gene therapy. To address these gaps, ongoing real-world data collection, cross-center collaboration, and flexible adaptation of clinical protocols are essential. While these guidelines are based primarily on clinical expertise rather than well-established evidence, the guideline provides a foundation to support administration of gene therapy for patients with DMD. As the field evolves, continued refinement will be essential to maximize benefit, reduce risk, and inform future standards of care.

01 Sep 2025

Neuromuscular Disord, volume 54, issue 106208, pages

MND/SMA