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Spinal Muscular AtrophyApril 2021

What the STR1VE Trial Found — Onasemnogene Abeparvovec for Infant SMA

STR1VE tested onasemnogene abeparvovec (Zolgensma), a one-time IV gene therapy, in 22 infants with SMA type 1. At 14 months, 91% were alive without permanent ventilation, and most learned to sit independently — outcomes never seen in untreated infants.

What the trial was testing

The STR1VE enrolled 22 patients with spinal muscular atrophy. The study was sponsored by Novartis Gene Therapies and tracked outcomes across the full group of patients who matched the trial's eligibility profile.

It was a large trial designed to confirm whether the treatment works well enough for wider use. Trials at this stage are designed to produce evidence regulators and physicians can act on — not just observations to follow up later.

What the results showed

91% survived without permanent ventilation vs. 26% in untreated infants.

The Lancet Neurology · 2021 · NCT03306277

These findings — that survival without permanent ventilation at 14 months after one-time gene therapy — were published in the The Lancet Neurology and represent the headline result of the study.

Researchers tracked outcomes across 22 patients enrolled in the trial. The result was consistent enough across the group that the team felt confident reporting it.

What this means for patients

For patients with spinal muscular atrophy, this result changes the calculus on what to ask their care team about. Whether it changes day-to-day care depends on factors like disease subtype, prior treatments, and where the patient is in their care journey.

What you can do now

Onasemnogene abeparvovec (Zolgensma) is FDA-approved and available now for children under 2 with SMA. It is a one-time IV infusion that replaces the missing SMN1 gene. Liver inflammation is a notable side effect that requires steroid coverage. Ask a pediatric neurologist about newborn screening and treatment timing — earlier is better.

Eligibility for the treatments mentioned above depends on specific test results and clinical history. Bring this summary, the trial name, and your most recent labs or pathology report to your next visit.