RESUMO
Onasemnogene abeparvovec has been life-changing for children with spinal muscular atrophy (SMA), signifying the potential and progress occurring in gene- and cell-based therapies for rare genetic diseases. Hence, it is important that clinicians gain knowledge and understanding in gene therapy-based treatment strategies for SMA. In this review, we describe the development and translation of onasemnogene abeparvovec from clinical trials to healthcare practice and share knowledge on the facilitators and barriers to implementation. Rapid and accurate SMA diagnosis, awareness, and education to safely deliver gene therapy to eligible patients and access to expertise in multidisciplinary management for neuromuscular disorders are crucial for health system readiness. Early engagement and intersectoral collaboration are required to surmount complex logistical processes and develop policy, governance, and accountability. The collection and utilisation of real-world evidence are also an important part of clinical stewardship, informing ongoing improvements to care delivery and access. Additionally, a research-enabled clinical ecosystem can expand scientific knowledge and discovery to optimise future therapies and magnify health impacts. Important ethical, equity, economic, and sustainability issues are evident, for which we must connect globally.
RESUMO
BACKGROUND: New methods of detecting and treating spinal muscular atrophy (SMA) are now available, and the Australian SMA landscape is rapidly changing. These various interventions can be increasingly complex to navigate for both healthcare professionals and at-risk families. OBJECTIVE: The aim of this article is to describe how recent developments in SMA testing and treatment give rise to ethical considerations. DISCUSSION: Ethical issues in SMA detection and treatment arise for both individual interventions and how they integrate. A patient-centred approach can help general practitioners to navigate these issues.
