FDA Advisory Committee Supports Elamipretide for Ultra-Rare Barth Syndrome Amid Data Challenges

The FDA Advisory Committee voted 10-6 in favor of elamipretide, a therapy developed by Stealth BioTherapeutics for the ultra-rare Barth syndrome, despite significant challenges in the data presented[1][2]. The committee recognized the urgent need for treatment options, even though the efficacy data from the trials did not meet statistical significance and were subject to variability[1][2]. Several members, including Carole Tucker, emphasized positive trends and patient testimonies as key in their decision to support the therapy[1]. However, the FDA remains skeptical about the drug's approvability due to concerns over trial results, with a final decision expected by January 29, 2025[2].
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What are the specific reasons for the FDA's skepticism about the efficacy of elamipretide despite the advisory committee's support?
How might patient testimonies affect the FDA's final decision regarding the approval of elamipretide for Barth syndrome?
What are the main challenges in conducting well-controlled trials for ultra-rare diseases like Barth syndrome?
How could this case influence future regulatory processes and flexibility for ultra-rare disease treatments?
What alternative strategies could be employed to address data variability in trials for rare genetic disorders?