Clinical trials have demonstrated a positive effect of nusinersen therapy on survival
of infants with SMA type 1. However, there is a lack of data outside clinical trials
on how the introduction of nusinersen has affected the survival of patients with SMA.
We therefore set out to analyse survival in patients diagnosed at less than 24 months
before, during and after the introduction of nusinersen in a nationwide population-based
SMA patients diagnosed before the age of 24 months in the time period between February
21, 2000 and December 19, 2019 were identified using ICD-codes, and medical procedures
for identification of treatment utilizing information from the public available National
Patient Registry held by the National Board of Health and Welfare. Data was divided
into 3 different calendar periods (before, during, and after introduction of nusinersen
treatment in Sweden).
Time to Event analysis was then applied.
A total of 155 patients were enrolled in the study, and median follow-up was 1.14
years (inter-quartile range (IQR): 0.27–8.37 years). Data did not provide conclusive
evidence that survival differed between the calendar periods (P-value from the log-rank test = 0.419) and while hazards were lower in the middle
period, HR 0.70 (95% CI: 0.34–1.47), and 3, HR 0.71 (95% CI: 0.28–1.77) compared to
the first period, all confidence intervals were wide., However, nusinersen treatment
was associated with a decreased mortality rate, HR 0.05 (95% CI: 0.01–0.37).
SMA patients receiving nusinersen therapy had a dramatically increased overall survival
compared to patients not receiving therapy. This indicates that nusinersen treatment
has an effect on survival, in patients diagnosed with SMA, in a nationwide real-world
setting. Larger studies are warranted.