FDA Approves New Topical GENE Tx – Vyjuvek

The FDA just approved a new rare, GENE therapy, Vyjuvek (beremagene geperpavec-svdt) from Krystal Biotech, indicated for the treatment of patients six months of age or older with dystrophic epidermolysis bullosa (DEB).  Vyjuvek is the first-ever redosable gene therapy and the first and only medicine approved by the FDA for the treatment of DEB, both recessive and dominant, that can be administered by a healthcare professional in either a healthcare professional setting or in the home. It is a biological suspension mixed with excipient gel for topical application.

DEB is a rare and serious disease that affects the skin and mucosal tissues caused by one or more mutations in the COL7A1 gene. Vyjuvek delivers two copies of the COL7A1 gene when applied directly to DEB wounds The COL7A1 gene is responsible for the production of functional COL7 protein that forms anchoring fibrils necessary to bind the dermis (inner layer of the skin) to the epidermis (outer layer of the skin).

The new topical stops blisters and wounds from developing on DEB patient skin. Prior to this approval there was no treatment other than simply applying bandages. Vyjuvek both heals wounds and prevents skin from re-blistering while correcting the underlying skin defect of DEB. Further, Vyjuvek doesn’t require supporting technology or specialized expertise making it accessible even to patients who live far away from specialized centers. 

Pricing for Vyjuvek was announced at a list price of $24,250 per vial, which translates to an estimated steady state cost of $631,000 per patient per year.  The label for Vyjuvek specifies that the therapy should be applied by a health care professional.  However, the company also stated that it can be administered in the home.

Administration is a bit complicated requiring atypical syringe filling steps using a syringe with a needle. However, the therapy is applied without penetrating the skin in a droplet pattern. The amount of therapy used depends on the number of wounds to be treated and their size. Assuming a patient or care giver can follow the filling process, the application of droplets on the wound not seem to require a health care professional (people with hemophilia routinely dose intravenously for example). That being said, the package insert does state that a health care professional should apply the therapy IN THE HOME as well.

Distribution details were not disclosed. As Vyjuvek is designated a rare therapy, the small number of patients and its ultra-high cost would lend towards a distribution plan via specialty pharmacy distribution.

Click Here to access the package insert

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Krystal Biotech Receives FDA Approval for the First-Ever Redosable Gene Therapy, Vyjuvek

May 19, 2023

  • Dystrophic Epidermolysis Bullosa (DEB) is a serious rare genetic disease that affects the skin and mucosal tissues and is caused by one or more mutations in the COL7A1 gene, resulting in lack of production of functional type VII collagen (COL7) protein
  • Vyjuvek is a topical gel that addresses the genetic cause of DEB by restoring functional copies of the COL7A1 gene to patients and is the only medicine available for patients in the US
  • Vyjuvek is approved for the treatment of patients six months of age or older with either recessive or dominant DEB
  • Vyjuvek is approved to be administered by a healthcare professional either in a healthcare professional setting (e.g., clinic) or a home setting.

Krystal Biotech, Inc.Pittsburgh, May 19, 2023 (GLOBE NEWSWIRE) — Krystal Biotech, Inc. (the Company) (NASDAQ: KRYS), a biotechnology company focused on developing and commercializing genetic medicines for patients with rare diseases, today announced the US Food and Drug Administration (FDA) has approved Vyjuvek (beremagene geperpavec-svdt) for the treatment of patients six months of age or older with dystrophic epidermolysis bullosa (DEB). Vyjuvek is designed to address the genetic root cause of DEB by delivering functional copies of the human COL7A1 gene to provide wound healing and sustained functional COL7 protein expression with redosing. Vyjuvek is the first-ever redosable gene therapy and the first and only medicine approved by the FDA for the treatment of DEB, both recessive and dominant, that can be administered by a healthcare professional in either a healthcare professional setting or in the home.

DEB is a rare and serious disease that affects the skin and mucosal tissues caused by one or more mutations in the COL7A1 gene. The COL7A1 gene is responsible for the production of functional COL7 protein that forms anchoring fibrils necessary to bind the dermis (inner layer of the skin) to the epidermis (outer layer of the skin). The lack of functional anchoring fibrils in DEB patients leads to extremely fragile skin that blisters and tears with minor friction or trauma. DEB patients suffer from open wounds, which lead to recurrent skin infections and fibrosis that can cause fusion of fingers and toes, and ultimately increase the risk of developing an aggressive form of skin cancer.

“This is a devastating disease,” said M. Peter Marinkovich, M.D., primary investigator of the GEM-3 trial, Director of the Blistering Disease Clinic at Stanford Health Care and Associate Professor of Dermatology at the Stanford University School of Medicine. “Until now, doctors and nurses had no way to stop blisters and wounds from developing on dystrophic EB patient skin and all we could do was to give them bandages and helplessly watch as new blisters formed. Vyjuvek topical gene therapy changes all of this. Vyjuvek both heals patient wounds and prevents skin from re-blistering because it actually corrects the underlying skin defect of dystrophic EB.”

The FDA approval of Vyjuvek is based on two clinical studies. The GEM-1/2 trial was an intra-patient, open label, single center, randomized, placebo-controlled study showing that repeat topical applications of Vyjuvek were associated with durable wound closure, full-length cutaneous COL7 expression, and anchoring fibril assembly with minimal reported adverse events. The GEM-3 trial was an intra-patient, double-blinded, multi-center, randomized, placebo-controlled study that met both its primary endpoint of complete wound healing at six months and its key secondary endpoint of complete wound healing at three months. Vyjuvek was well tolerated with no drug-related serious adverse events or discontinuations due to treatment-related events.

“Data from our GEM-1/2 trial and our GEM-3 trial, published in Nature Medicine and the New England Journal of Medicine, respectively, demonstrated the strength of both studies showing that Vyjuvek safely and effectively improved wound healing,” said Suma Krishnan, President, Research & Development, Krystal Biotech, Inc. “For so many years, all we have been able to offer DEB patients was palliative care, but now, based on the strength of the Company’s clinical trial data, there is a safe and effective FDA approved treatment.”

“Today’s landmark approval of Vyjuvek as the first redosable gene therapy ushers in a whole new paradigm to treat genetic diseases and is an important milestone for patients affected by DEB as well as their families and caregivers,” said Krish S. Krishnan, Chairman and Chief Executive Officer of Krystal Biotech, Inc. “We offer our sincere gratitude to DEB patients, caregivers, investigators, US regulators, and our employees who made this approval possible. For Krystal, this is a transformative achievement that highlights our commitment to developing and commercializing novel therapies for patients with rare diseases and demonstrates Krystal’s capability as a fully-integrated company ready to launch and bring Vyjuvek to patients as quickly as possible and deliver additional transformative medicines to patients as we advance our pipeline.”

Vyjuvek is expected to be available in the United States in the third quarter of 2023, and the Company will begin the promotion of Vyjuvek immediately. To meet the needs of patients, caregivers, and families as they start and continue their Vyjuvek treatment journey, the Company has developed Krystal Connect, a personalized support program. The program includes resources that can answer questions about Vyjuvek, verify health benefits, support treatment planning and administration and provide information about financial assistance for eligible patients. For more information, patients, caregivers and healthcare professionals can call Krystal Connect at 1-844-5-KRYSTAL.

With this approval, the FDA issued the Company a Rare Pediatric Disease Priority Review Voucher (PRV), which confers priority review to a subsequent drug application that would not otherwise qualify for priority review. The PRV program is designed to encourage the development of new drugs for the prevention or treatment of rare diseases.

“With the FDA approval of Vyjuvek, the DEB population has reached a monumental milestone in the treatment of this horrible disorder. Our hopes have now been realized for a safe and effective treatment for one of the most devastating symptoms of the disorder,” said Brett Kopelan, Executive Director of debra of America, the national organization dedicated to improving the lives of all people living with EB in the US. Mr. Kopelan added, “we thank Krystal for their dedication and commitment to bringing Vyjuvek to fruition. People living with DEB will now have a significant chance of having an improved quality of life and debra will continue to work closely with Krystal to assure patients have ready access to Vyjuvek.”

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