CSL Behring and GKV-Spitzenverband Agree on Reimbursement Price for HEMGENIX® – Europe's First Gene Therapy for Haemophilia B

Marburg, Germany, 2 April 2025 – CSL Behring and the GKV-Spitzenverband (National Association of Statutory Health Insurance Funds) have successfully concluded negotiations on the reimbursement price of HEMGENIX^®. This agreement marks the availability of the first gene therapy approved in Europe for haemophilia B under an innovative, national, success-based reimbursement model, being implemented for the first time in Germany.

HEMGENIX^® represents significant progress in the treatment of haemophilia B. The aim of this one-time gene therapy is to eliminate the need for regular factor IX infusions, thereby offering patients the possibility of more freedom from prophylaxis and significantly improving their quality of life.^1-4 This development not only provides substantial relief for those affected but also has the potential to reduce long-term costs for the healthcare system.

‘The performance-based payment model at national level which was agreed with the GKV-Spitzenverband is unique in Germany. It addresses key reimbursement challenges, such as the question of long-term efficacy, which is inherent for any one-time therapy.  Reimbursement is linked to treatment success of the individual patient,’ explains Stefan Neudoerfer, CSL Behring's chief negotiator in Germany.

Moreover, this reimbursement model reflects the high therapeutic and innovative value of HEMGENIX^® and sets new standards for integrating innovative gene therapies into the German healthcare system.

‘The agreement on the reimbursement price of HEMGENIX^® is a decisive step for the care of people with haemophilia B in Germany. It enables access to a groundbreaking therapy and recognises the long-term medical and economic benefits of gene therapy,’ explains Christian Wieszner, Managing Director of CSL Behring Germany.

With this agreement, CSL Behring is underlining its commitment to innovative therapies that sustainably improve the lives of patients. At the same time, the agreement is a new step for reimbursement models that consider both individual therapeutic success and societal benefits.

HEMGENIX^® was granted conditional marketing authorisation by the European Commission (EC) for the European Union and European Economic Area in February 2023, following approval from the U.S. Food and Drug Administration (FDA) in November 2022. HEMGENIX^® has also received regulatory approval in Canada, the UK, Switzerland, Australia, Saudi Arabia, Taiwan, South Korea and Hong Kong.

Following these approvals, CSL Behring is working with relevant stakeholders to ensure eligible patients have access to HEMGENIX^® across Europe and beyond, building on milestone access decisions in Denmark, Switzerland, Spain, the UK (including Scotland) and Austria. Patients in France and Denmark have already experienced successful treatment with HEMGENIX^®.

Additionally, new four-year data from the HOPE-B study presented at the Annual Congress of the European Association for Haemophilia and Allied Disorders 2025 showed that a one-time infusion of HEMGENIX^® continues to offer long-term durability, safety and greater bleed protection versus prophylactic treatment in people living with haemophilia B.¹⁰

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About Haemophilia B

Haemophilia B is a life-threatening rare disease. People with the condition are particularly vulnerable to bleeds in their joints, muscles, and internal organs, leading to pain, swelling, and joint damage.² The constant worry of a bleed means that their daily activities can be restricted, even for things as simple as going up and down stairs.^2,3,11 Current treatments for moderate to severe haemophilia B include life-long prophylactic infusions of Factor IX to temporarily replace or supplement low levels of the blood-clotting factor.² Many people with haemophilia find themselves continually confronted with the mental and emotional impact of managing their condition, and rarely have their minds free of haemophilia.¹¹

About HEMGENIX^®

HEMGENIX^® (etranacogene dezaparvovec) is an in vivo gene therapy that reduces the rate of abnormal bleeding in eligible people with haemophilia B by enabling the body to continuously produce Factor IX, the protein that is deficient in people with the disease.¹² It uses a non-infectious viral vector derived from an adeno-associated virus (AAV5).¹² The AAV5 vector carries the Padua gene variant of Factor IX to the target cells in the liver, generating Factor IX proteins that are 5–8x more active than normal.¹³ These genetic instructions remain in the target cells, but generally do not become a part of a person’s own DNA.¹² Once delivered, the new genetic instructions allow the cellular machinery to produce stable levels of Factor IX.¹⁴

About the Pivotal HOPE-B Trial

The pivotal Phase III HOPE-B trial is an ongoing, multinational, open-label, single-arm study to evaluate the safety and efficacy of etranacogene dezaparvovec.¹⁵ A total of 54 adult patients with haemophilia B, classified as having moderately severe to severe haemophilia B and requiring prophylactic Factor IX replacement therapy, were enrolled in a prospective, 6-month or longer observational period. During this period, patients continued to use their current standard of care therapy to establish a baseline annual bleeding rate (ABR).¹⁵ After the 6-month lead-in period, patients received a single intravenous administration of etranacogene dezaparvovec at the 2x10¹³ gc/kg dose. Patients were not excluded from the trial based on pre-existing neutralising antibodies (NAbs) to AAV5.¹⁵

Etranacogene dezaparvovec was generally well-tolerated, with a total of 96 treatment-related adverse events (AEs) 4 years post-infusion, 92 (96%) of which occurred in the first six months post-treatment.¹⁰ No serious treatment-related adverse reactions were reported.^1,10,12 One death resulting from urosepsis and cardiogenic shock in a 77-year-old patient at 65 weeks following dosing was considered unrelated to treatment by investigators and the company sponsor.¹⁷ Three previously reported serious adverse events (hepatocellular carcinoma, schwannoma and myelodysplastic syndrome) were determined to be unrelated to treatment with etranacogene dezaparvovec by independent molecular tumour characterisation and vector integration analysis.¹⁷ No inhibitors to Factor IX were reported.¹⁰

Additional trial data

CSL220 (formerly AMT-060) has a similar structure to etranacogene dezaparvovec, differing only in a single amino acid substitution in the F9 gene.¹⁸ In a Phase I/II study, the durability of CSL220 was assessed in two cohorts of adult patients with severe/moderately severe haemophilia B receiving different single-infusion doses.¹⁸ Mean Factor IX activity remained stable in both cohorts at 8 years (Cohort 1: n=3, Year 8: 4.9 IU/dL; Cohort 2: n=5, Year 8: 5.6 IU/dL), mean ABR was maintained at Year 8 (Cohort 1: 2.2; Cohort 2: 1.0) with no new safety events identified were identified during Year 8 and no patients returning to continuous Factor IX prophylaxis.¹⁸

In a Phase IIb study of adults (n=3) with haemophilia B receiving a single dose of etranacogene dezaparvovec, mean aPTT-based actor IX activity remained stable from Year 1 (40.7%) up to Year 5 (46.7%) and mean ABR for the cumulative follow-up was 0.14 (Years 0-5) for all bleeds. A favourable safety profile was maintained over 5 years.¹⁹ Despite the limited population size, these data provide further evidence of the long-term effects of etranacogene dezaparvovec.^18,19

About CSL
CSL (ASX:CSL; USOTC:CSLLY) is a global biotechnology company with a dynamic portfolio of lifesaving medicines, including those that treat haemophilia and immune deficiencies, vaccines to prevent influenza, and therapies in iron deficiency and nephrology. Since our start in 1916, we have been driven by our promise to save lives using the latest technologies. Today, CSL—including our three businesses: CSL Behring, CSL Seqirus and CSL Vifor—provides lifesaving products to patients in more than 100 countries and employs 32,000 people. Our unique combination of commercial strength, R&D focus and operational excellence enables us to identify, develop and deliver innovations so our patients can live life to the fullest. For inspiring stories about the promise of biotechnology, visit CSL.com/Vita. For more information about CSL, visit CSL.com.

Media Contacts

Stephanie Fuchs

Mobile: +49 151 584 388 60

Email: Stephanie.Fuchs@cslbehring.com

References

1. Genezen MA, Inc. CSL Behring GmbH. Hemgenix® (etranacogene dezaparvovec): Summary of Product Characteristics [online]. Available at: https://www.ema.europa.eu/en/documents/product-information/hemgenix-epar-product-information_en.pdf [Last accessed: April 2025].
2. Srivastava A, Santagostino E, Dougall A, et al. WFH Guidelines for the Management of Hemophilia, 3rd edition. Haemophilia 2020; 26 Suppl 6: 1-158.
3. Hermans C, Pierce GF. Towards achieving a haemophilia-free mind. Haemophilia 2023; 29: 951-953.
4. Itzler R, Buckner TW, Leebeek FWG, et al. Effect of etranacogene dezaparvovec on quality of life for severe and moderately severe haemophilia B participants: Results from the phase III HOPE-B trial 2 years after gene therapy. Haemophilia 2024; 30: 709-719.
5. CSL Behring. CSL Behring Signs First Commercial Agreement in Austria to Fund Haemophilia B Gene Therapy HEMGENIX®. Available at: https://www.cslbehring.de/en-us/news/2024/pm-hemgenix-agreement-austria. [Last accessed April 2025].
6. Medicinrådet. The Medical Council recommends the gene therapy Hemgenix following a new effect-based price agreement. Available at: https://medicinraadet.dk/nyheder/2024/medicinradet-anbefaler-genterapien-hemgenix-efter-ny-effektbaseret-prisaftale. [Last accessed April 2025].
7. National Institute for Health and Care Excellence. Final draft guidance: Etranacogene dezaparvovec for treating moderately severe or severe haemophilia B. Available at: https://www.nice.org.uk/guidance/gid-ta10699/documents/674. [Last accessed April 2025].
8. Scottish Medicines Consortium. Etranacogene dezaparvovec (Hemgenix). Available at: https://scottishmedicines.org.uk/medicines-advice/etranacogene-dezaparvovec-hemgenix-full-smc2649/. [Last accessed April 2025].
9. Ministerio De Sanidad. Puntos destacados de la reunión de la Comisión Interministerial de Precios de los Medicamentos 26 de septiembre de 2024. Available at: https://www.sanidad.gob.es/areas/farmacia/precios/comisionInteministerial/acuerdosNotasInformativas/ docs/NOTAINFORMATIVACIPM_SEPTIEMBRE2024.pdf [Last Accessed: April 2025].
10. Leebeek FWG, von Drygalski A, et al. The phase 3 HOPE-B trial shows 4-year durability of sustained near-normal FIX activity, bleed protection and favourable safety in adults with severe or moderately severe haemophilia B. EAHAD 2025. EAHAD25-ABS-1255.
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13. Spronck EA, Liu YP, Lubelski J, et al. Enhanced Factor IX Activity following Administration of AAV5-R338L "Padua" Factor IX versus AAV5 WT Human Factor IX in NHPs. Mol Ther Methods Clin Dev 2019; 15: 221-231.
14. Thornburg CD. Etranacogene dezaparvovec for hemophilia B gene therapy. Ther Adv Rare Dis 2021; 2: 26330040211058896.
15. Pipe S, van der Valk P, Verhamme P, et al. Long-Term bleeding protection, sustained FIX activity, reduction of FIX consumption and safety of hemophilia B gene therapy: results from the HOPE-B Trial 3 years after administration of a single dose of etranacogene dezaparvovec in adult patients with severe or moderately severe hemophilia B. Blood 2023; 142: 1055.
16. Klamroth R, Van der Valk P, Quon D, et al. Four- year results of etranacogene dezaparvovec in haemophilia B patients with pre-existing AAV5 neutralising antibodies: Phase 3 HOPE-B trial [EAHAD 2025 Abstract PO037] Haemophilia. 2025; 31(Suppl. 1):49.
17. Pipe SW, van der Valk P, Verhamme P, et al. Etranacogene dezaparvovec shows sustained efficacy and safety in adult patients with severe or moderately severe haemophilia B 3 years after administration in the hope-B Trial [EAHAD 2024 Oral Abstract OR09]. Haemophilia. 2024; 30: 25.
18. Leebeek FWG, Meijer K, Coppens M, et al. Stable Factor IX Expression and Sustained Reductions in Factor IX Use 8 Years after Gene Therapy with CSL220 (Formerly AMT-060) in Adults with Hemophilia B. Blood 2024; 144: 3578-3578.
19. von Drygalski A, Giermasz A, Gomez E, et al. OC 02.3 Etranacogene dezaparvovec hemophilia B gene therapy phase 2b trial final Results: stable and durable FIX level expression over 5 years. ISTH 2024 Oral Communication Abstracts. Research and Practice in Thrombosis and Haemostasis 2024; 8: 116.

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