This is an interesting interplay between regulation and therapy. I think 3 people have died. I need to hunt up more about this issue.

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I have added this following bit. I think gene therapy is one of the more complex areas of regulation.

The story now is about Sarepta having USD 1B in debt that will need refinancing.

It is a really good story for looking at conflicts of interest and managing risk.

I find this an interesting story as it demonstrates the complexity of regulation in the health sphere. A further piece has been written by Endpoints News which I copy below. I don’t personally think gene therapy is necessary to handle the aging pathways, but I also know at least one person in their 30s has been harmed by a longevity gene therapy.

Drew Armstrong Executive Editor, Endpoints News
What the Sarepta mess says about the agency

In the last two weeks, Sarepta has been asked by the FDA to pull its Duchenne gene therapy, refused to do so, capitulated, and then won a reversal.

If the biotech industry was hoping that the Trump administration’s FDA would be faster and more flexible, I’m not sure this is what they meant.
The FDA’s July 18 action to pause the use of Sarepta’s gene therapy Elevidys seems reasonable. There had been two deaths among slightly older patients, and a third death in an experimental therapy that used the same viral vector. Even Peter Marks, who helped push through Elevidys and has been criticized by the new leaders at the FDA for doing so, agreed.

But what followed raises significant questions about what type of FDA this will be.

Last week an FDA official emphatically told Endpoints News that there was little chance Elevidys could make it back to market. And then, on Monday, the agency suddenly reversed course. It will let Sarepta resume selling Elevidys to ambulatory patients (who are younger and earlier in their disease).

So what changed?

The FDA said Monday that it determined that another death — an 8-year-old boy in Brazil — was unrelated to Elevidys. But that case got no mention in the agency’s initial action two weeks prior. (On Monday, the agency also cited the “patient community,” which has been whipsawed by the last few weeks.)

The other thing that happened in the last few days — and that’s not in the FDA’s statement yesterday — is an aggressive, conservative-led political campaign against the agency and Vinay Prasad, the head of the Center for Biologics Evaluation and Research.
Prasad has been a longtime critic of Sarepta and of the decision to approve Elevidys. The political attacks on him started before last week, but gained steam when Laura Loomer, an online provocateur who is close to President Trump, went after Prasad this month. On Sunday, a Wall Street Journal opinion columnist called Prasad a “Bernie Sanders acolyte in MAHA drag” who had used the recent deaths as a “pretext” to pull a drug he disliked. The same day, the Journal’s editorial board published a piece calling the FDA’s action “a bad turn that will chill investment in new drugs.”

It’s hard to read that series of events as anything other than the FDA caving to outside politics. (The agency didn’t respond to questions from Endpoints yesterday about whether that pressure was a factor.)
For months, I’ve spoken with biotech CEOs, investors and analysts who have been trying to figure out exactly what this FDA stands for. Will it take a deregulatory approach and speed up innovation, help the US compete with China, and appease libertarians? Or will it roll back access to some therapies, putting in place higher standards for drugs where new leaders believe evidence is lacking?

After the Sarepta mess, the worry isn’t that the FDA will stand for one or the other of those philosophies. It’s that when the decisions are hard and high-pressure, it won’t stand for anything.

A live piece on this at 1pm ET, 6pm BST

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I watched this live. I thought it was interesting in the sense that there remains a question as to whether the evidence of any benefit from Elevidys is strong enough for people to have an expectation of a positive result - ignoring the question of risk.

The live discussion predicted this:

https://www.reuters.com/business/healthcare-pharmaceuticals/us-fdas-chief-medical-science-officer-prasad-departs-agency-2025-07-30/

I find this edge case a really interesting regulatory question. That’s because of the low level of evidence for the intervention

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I don’t think this has been posted yet.

https://www.fiercepharma.com/pharma/sarepta-records-second-death-after-dmd-gene-therapy-elevidys-stops-dosing-half-patients
“The Massachusetts biotech aims to amend the trial protocol to add the prophylactic use of sirolimus, CEO Doug Ingram said on a conference call Monday.”

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The EMA CHMP last week refused the Elevidys MAA due to the lack of efficacy:

https://www.ema.europa.eu/en/medicines/human/EPAR/elevidys

The study failed to show that Elevidys had an effect on movement abilities after 12 months. Improvements in NSAA scores were observed both in patients who received Elevidys and in those who received placebo. The difference in the change in NSAA scores between the two groups was 0.65 on a 34-point scale and was not statistically significant, meaning that it may be due to chance. In addition, although many patients treated with Elevidys were shown to produce a shorter form of the dystrophin protein, the levels of dystrophin could not be linked to an improvement in movement abilities.

The company also presented data for a sub-group of patients who seemed to respond better to Elevidys; however, even in this group, effectiveness of treatment was not demonstrated.

The company had applied for a conditional marketing authorisation; as the Agency’s opinion was that the benefits of Elevidys have not been demonstrated, it recommended refusing conditional marketing authorisation.

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I think not only the scientific/regulatory assessment of those orphan drugs influence the outcome of an authorisation. Also patient representatives have an impact. I imagine that it can be hard to decide against approval of an (ultra)orphan drug.

I think that is true.

The difficulty with certain diseases is that taking no action has guaranteed harm and people want some hope.

In many ways that is why this is a good edge case to look at the regulatory process. It is quite obvious that the evidence as to its effectiveness is weak and possibly non-existent.

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Sadly this

Is behind a paywall, but it does include this free to air:

He sent off an email, obtained by STAT, to his team on Saturday evening, attempting to control the backlash. The agency’s recent crackdown on the gene therapy product was driven by a scientific consensus, he said. Not just him.

https://www.science.org/content/blog-post/vinay-prasad-was-fast

So you might be asking yourself, “Just what the hell is going on at the FDA?” Good question, even though it’s one of those multitool all-purpose questions that can be reasonably applied to almost any part of the federal government you point it at these days.

It comes up because of the departure of Vinay Prasad, who says that he’s leaving because he doesn’t want to be a distraction to the President’s agenda. This is bit over two months after he joined the agency as Chief Medical and Scientific Office and direct of CBER, the Center for Biologics Evaluation and Research. I wasn’t happy to hear about that appointment, but when have I been happy about any of these appointments in the Trump administration? They’re pretty much all been different degrees of God-awful. In truth, I have had points of agreement with Prasad in the past, but (as with many other people) I very much parted company with his views during the coronavirus pandemic. Those views, of course, are one of the reasons he was likely picked to join the current administration in the first place, after they had forced out Peter Marks.

If you had any idea that this was the beginning of a sensible process at the agency, though, think again. As the first link above from the AP makes clear, Prasad seems to have been forced out in turn because he was not quite Trumpy enough. He was behind the hold placed on Sarepta’s Elevidys gene therapy, which was rescinded (at least for ambulatory patients) after a few days and after objections by Sarepta themselves. There was an uproar in the Trump-friendly editorial world about that halt, because most of them are in the “the FDA is a dumb roadblock” camp and would much rather approve things than not (freedom, freedom, stupid egghead experts, etc.) That, coupled with some rejections of other gene therapy applications and especially some insufficiently pro-Trump and insufficiently pro-right-wing statements in the past (as waved under Trump’s nose by the utterly reprehensible Laura Loomer) seems to have done for him.

So no, it looks like we’ll be getting someone louder and less competent to replace him. If that lamprey that RFK Jr. had stuck on his arm the other day (I am not making this up) were able to tweet and give sound bites, he, she, or it might have been a front-runner for the job. But look for some idiotic quick-take artist with good hair to move in; that seems to be what the higher-ups are looking for.

As for me, I didn’t think that Sarepta’s gene therapy should have been approved at all. Nor should their previous submission have been approved until they showed that they actually benefitted patients, which they have completely failed to demonstrate over the years. I am old-fashioned enough to demand both safety and efficacy data rather than just handwaving past those issues for the sake of good press releases. Hell, I thought Peter Marks was too lenient - I didn’t know how good we had it! No, I wouldn’t last ten seconds in the current FDA, but we’re never going to put that theory to the test, because if anyone calls me I’m going to hang up on them anyway.

https://www.fiercepharma.com/pharma/vinay-prasad-back-fda-after-surprise-ouster-will-he-stay-time

inay Prasad, M.D., has rejoined the FDA, the latest turn in a monthslong stretch of leadership turnover at the agency.

“At the FDA’s request, Dr. Vinay Prasad is resuming leadership of the Center for Biologics Evaluation and Research,” a Department of Health and Human Services spokesperson told Fierce Pharma.

Prasad is returning to the position overseeing vaccines and cell/gene therapy regulation at the agency less than two weeks after being pushed out of the role.

Prasad’s earlier exit came as the FDA bowed to pressure from patient advocates in a regulatory showdown with Sarepta Therapeutics and after a barrage of criticism from conservatives.

President Donald Trump ordered the removal of Prasad despite opposition from Health Secretary Robert F. Kennedy Jr. and FDA Commissioner Marty Makary, M.D., Politico reported at the end of last month, citing four people with knowledge of the decision. The HHS spokesperson did not respond to Fierce’s question about whether the President is aware of Prasad’s return.

“Neither the White House nor HHS will allow the fake news media to distract from the critical work the FDA is carrying out under the Trump administration,” the spokesperson added.

During a news conference on Monday, Makary expressed his desire to hire Prasad back. He said that reports that Prasad was fired after intervention from the White House are “simply untrue.”

Relacionado

Vinay Prasad departs FDA amid conservative criticism, controversy over Sarepta gene therapy

Now, the question becomes how long Prasad will be able to stay at the FDA. The hematologist-oncologist lasted less than three months during his first tenure.

Prasad left the FDA after landing in the crosshairs of conservatives, including right-wing activist Laura Loomer, who reportedly has access to Trump and was responsible for the firing of several other former senior officials in the administration.

Loomer has called Prasad a “progressive leftist saboteur” and called his appointment a “catastrophic vetting failure” within the administration. She pointed to Prasad’s past comments criticizing Trump’s “right-to-try” policies, saying that his regulatory philosophy is “fundamentally anti-Trump.”

After Makary publicly revealed that he was trying to hire Prasad back, Loomer doubled down.

“I genuinely want to know if @DrMakaryFDA thinks the White House appreciates his comments that insinuate Vinay Prasad is still welcomed in the Trump admin if he decides he wants his job back,” Loomer wrote in an X post on Aug. 5.

“Too many officials in the Trump admin have gone rogue to make themselves stars instead of serving AT THE PLEASURE of the President,” she continued. “It’s going to end terribly someday.”

Similarly, after Prasad’s departure, the editorial board of The Wall Street Journal called the move “welcome news.” Even though Prasad has criticized the FDA in the past, he has done so “from the left,” the editorial said before taking a shot at Makary and his pick for an interim CBER director, George Tidmarsh, M.D., Ph.D., who just recently became director of the Center for Drug Evaluation and Research.

Tidmarsh, like Prasad, has criticized the previous FDA leadership’s approval of Sarepta’s Duchenne muscular dystrophy gene therapy Elevidys. Therefore, his appointment “won’t buoy confidence in the agency,” the WSJ editorial board argued.

News of Prasad’s sudden departure broke late Tuesday, July 29. The day prior, the FDA had made a surprise move to recommend that Sarepta could resume treating ambulatory patients with Duchenne muscular dystrophy with its gene therapy Elevidys.