NICE issues draft guidance recommending sapropterin for PKU in children

pharmafile | February 25, 2021 | News story | |  BioMarin, NICE, PKU 

NICE has issued draft guidance which recommends BioMarin’s Kuvan (sapropterin) at a dose of up to 10 mg/kg for treating phenylketonuria (PKU) in children aged up to 18.

The draft guidance, issued for public consultation, does not recommend sapropterin for adults.

PKU is a rare, inherited, chronic, and life-long metabolic condition usually diagnosed in children. It is caused by the deficiency of an enzyme which breaks down phenylalanine, a compound which occurs naturally in protein-rich foods such as milk, eggs, and meat. In high concentrations, phenylalanine is toxic to the central nervous system. If the condition isn’t managed, phenylalanine accumulates in the blood and can cause irreversible brain damage in babies and children, and affect brain function in adults.

Current treatment for PKU is a lifetime adherence to a severely protein-restricted diet which cuts out most natural proteins, together with dietary supplementation. Sapropterin is offered alongside this diet, and the aim of the treatment is to reduce blood phenylalanine levels and relax the dietary restrictions as much as possible.

Clinical trial findings show that sapropterin reduces blood phenylalanine levels in people with PKU, but as there is only short-term evidence available, its effectiveness is unclear.

The committee acknowledged that sapropterin could prevent long-term irreversible brain damage in children, because childhood is most critical period for brain development, but were uncertain to what extent the medicine reduces reliance on a protein-restricted diet.

NICE said that limitations with the economic analyses presented made it difficult to estimate the cost effectiveness of the drug. However, taking into account the benefits and cost of the treatment, the committee concluded that sapropterin in children is likely to be within the range NICE considers an effective use of NHS resources.

Meindert Boysen, Deputy Chief Executive and Director of the Centre for Health Technology Assessment at NICE, said: “We know that high blood phenylalanine levels can lead to irreversible damage to the developing brain and reversible neurological changes in adults. To date, the only option for people with PKU has been a lifelong protein-restricted diet, which is challenging to stick to and difficult to manage.

“Sapropterin allows patients to manage their condition more easily, reduces symptoms, and provides peace of mind about blood phenylalanine levels. Even though the evidence for a substantial reduction in the protein-restricted diet is lacking, when combined with concerns for long-term irreversible brain damage and impact on quality of life, it can be recommended as an option in children, alongside a protein-restricted diet.”

Darcy Jimenez

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