RNAi 'Amvuttra' to enter the final reimb process soon

The Ministry of Health and Welfare (MOHW) ordered a drug price negotiation to the National Health Insurance Service (NHIS)

Designated as an orphan drug in 2023, and passed the Drug Reimbursement Evaluation Committee in December

The RNAi therapeutic 'Amvuttra' is facing its final hurdle in insurance reimbursement listing process.

According to sources, the Ministry of Health and Welfare (MOHW) recently ordered a drug price negotiation to the National Health Insurance Service (NHIS) for Amvutra (vutrisiran). Amvutra is a new treatment for hereditary transthyretin-mediated amyloidosis with polyneuropathy (hATTR-PN), developed by Alnylam Pharmaceuticals and introduced to the Korean market by Medison Pharma Korea.

Accordingly, discussions are expected to begin once the NHIS negotiation team is formed. Amvutra previously passed the Health Insurance Review and Assessment Service's (HIRA) Drug Reimbursement Evaluation Committee in December last year.

Amvutra was designated as an orphan drug by the Ministry of Food and Drug Safety (MFDS) in November 2023 and received final approval in November last year.

Amvutra is administered by subcutaneous injection once every 3 months. This drug targets and silences specific messenger RNA (mRNA) to block the production of both wild-type and mutant transthyretin (TTR) protein.

The efficacy of Amvutra was demonstrated through the HELIOS-A Phase 3 study. The Phase 3 trial enrolled 164 hATTR-PN patients with polyneuropathy across 22 countries. These patients were randomly assigned to either the Amvutra group (122 patients), receiving 25mg via subcutaneous injection every three months, or the 'Onpattro (patisiran)' group (42 patients), receiving 0.3mg/kg via intravenous injection every three weeks.

Amvutra's efficacy was assessed by comparing its data with placebo data from the APOLLO study, which evaluated the efficacy and safety of Onpattro in a patient population similar to that in HELIOS-A.

As a result, during the 9-month treatment period, the Amvutra group experienced less severe neurological impairment and showed improved quality of life compared to the placebo group. In the 10-meter walk test, which assesses a patient's walking speed and motor ability, the time taken by the vutrisiran group showed almost no change. NT-proBNP, a biomarker used to evaluate cardiac function, also showed improvement.

Meanwhile, hATTR-PN, which affects approximately 1 in 100,000 people, is a disease caused by mutations in the transthyretin gene. It is characterized by systemic multiple autonomic neuropathies, including cardiac, gastrointestinal, and ophthalmic. Vyndaqel stabilizes the transthyretin protein.

Generally, symptoms such as pain, paresthesia, and paralysis begin in the lower extremity nerves, where abnormal proteins tend to accumulate, eventually spreading to the upper body and affecting other organs, such as the heart, kidneys, and eyes. Life expectancy is 7 to 12 years on average from the onset of symptoms.