In a world awash with billion-dollar profits for drugs to treat the most common ailments ─ hypertension, acid reflux, diabetes, high cholesterol, and so on ─ patients with FSH muscular dystrophy may believe that rare conditions like theirs will never get the time of day from the pharmaceutical industry.
In fact, this is no longer true. With the passage of the Orphan Drug Act (ODA) in 1983, new incentives were created to attract companies to take on rare diseases (defined as having fewer than 200,000 patients in the US). These include tax breaks, market exclusivity, and millions of dollars in waived fees.
In many respects, the law has been a resounding success. Prior to the Act’s passage, the Food and Drug Administration (FDA) had approved only 34 drugs for orphan diseases. Since then, more than 600 orphan disease indications have been approved.
Apart from a few trials of drugs intended to increase muscle size, however, drug developers showed little interest in FSHD, even in the decades following the ODA. This changed dramatically with the publication in 2010 of a “unified model” for the genetic basis of FSHD. This hypothesis, from an international research team led by Silvère van der Maarel (the first recipient of an FSH Society grant), proposed that the genetic alteration in FSHD activated a gene called DUX4 to damage muscles.
About the same time, researchers equipped with better genetic tests and patient data began to realize that FSHD is more common than previously thought. Estimates of its prevalence rose from one in 20,000 to as high as one in 5,000. Once believed to be ultra-rare, FSHD is now viewed as one of the most common forms of muscular dystrophy.
As researchers unraveled how DUX4 expression leads to FSHD, they began to think about ways to intervene. The drug industry took notice. Our phones at the FSH Society started receiving calls from companies asking, What are the symptoms, and what is the impact on people’s lives? How many have it? Where are they? Are there doctors who see many patients? How hard would it be to conduct a clinical trial? If a treatment was developed, would people want to take it?
Fortunately, we could tell companies what they needed to know, thanks to years of work by the pioneering researchers and leaders at the FSH Society. We have a good understanding of the disease and the variable ways in which it affects people. The Society had funded research to develop “FSHD in a dish” cell-based and animal models, early-stage drug and gene therapy work, and clinical measurement tools. We had compiled the largest global database of patients and families, and are able to contact them on behalf of researchers and companies seeking volunteers for their studies.
It is remarkable to see all of this painstaking work converging around a collective goal ─ to get a treatment onto the market by the year 2025. This March 12, the FSH Society convened industry researchers, academic leaders, advocacy groups, and FDA representatives to assess how ready the FSHD field is for clinical trials. We discussed gaps in the data and tools ─ natural history studies, biomarkers, imaging methods, clinical measurements ─ and developed a plan to fill those gaps as quickly and efficiently as possible.
We call this enterprise our Therapeutic Accelerator Project. Our goal is to complete the work over the next three years. We will do so by acting as the “general contractor” to coordinate all of the stakeholders to collaborate on these projects. We intend to enlist the most capable labs, eliminate redundancy, and shorten the timelines to get the work done.
Substantial funds ─ $15 million over three years ─ are needed to complete this monumental task on schedule. This February, the FSH Society launched a campaign to raise the needed funds from a combination of industry partners and philanthropists.
In addition to funding, we will need a substantial investment of something equally valuable and even scarcer ─ the time and effort of patients willing to volunteer for the pivotal Therapeutic Accelerator studies. Did you know that across all medical research, 85 percent of trials face delays and 30 percent never get off the ground due to a lack of volunteers? We cannot let this happen in FSHD.
Our patients and families are waiting.
I believe there are many who want to volunteer but they put to many restrictions and traveling isn’t easy for many of us. Having places closer to people would help and stop repeating the same test on all these new drugs or ideas for a cure. I read that two studies are doing the same tests on people but are for different trials. They know what causes this so get a cure and stop repeating everything that’s all ready been done and wasting money on the same thing. It should not take 3 or 5 years to find a cure with all that they know, the volunteers they have had and the technology that is out there now days. This is so frustrating. It really looks like they are dragging their feet because if there is a cure than they ALL may or will loose their jobs. I am not the only one who feels this way either. I’ve talked to thousands that feel the same way. And you can ask for money from the millionaires like everyone else does they will either help or they won’t but till they are asked you don’t know.
Hello I have lived with fshd my entire life, I was diagnosed at the age of 5. My father had it and all 4 of his kids got it also. It’s hard living when everyone in your family is to weak to carry anything. Please find a treatment. If a volunteer is what you need then I volunteer. My life is hard watching people live while I can’t really live I just exist.
Hi Bryan, our hearts go out to you and your family. Kudos to you for wanting to volunteer. One of our most important jobs at the FSH Society is to make sure patients and families have the information they need to live stronger and know about advances in research and opportunities to volunteer for studies. We urge you to join our member database and provide your email and address to us. We keep your information confidential, and use your contact information to alert you about clinical studies and trials in your area. I would encourage your siblings to also sign up.
https://www.fshdsociety.org/become-member/
My daughter discovered FSHD in 2014 up to now we got no channel to joint to drug test volunteer because we are not the USA citizen. I check the FDA clinical trail every week, and send many requests no reply. Hopefully they can review the condition open for volunteers from all of the world.
Andrew Shum
Hong Kong
We wish you and your daughter well. Please remember that a clinical trial is not the same as a drug approval. This is an experiment to see if a drug even works. Clinical trials are carried out in a very limited number of locations that can meet all the requirements to ensure a scientifically rigorous experiment. As a community, we should support getting volunteers enrolled as quickly as possible and getting impeccable data so that the trial can be concluded in a timely way. Strong data is the best outcome. Muddy, weak data is the worst. If a drug is effective, the FDA should approve quickly so that the treatment will be available to every patient.