Leavitt, Andrew DAndrew DLeavittMahlangu, JohnnyJohnnyMahlanguRaheja, PriyankaPriyankaRahejaSymington, EmilyEmilySymingtonQuon, Doris VDoris VQuonGiermasz, AdamAdamGiermaszLópez Fernández, Maria FernandaMaria FernandaLópez FernándezKenet, GiliGiliKenetLowe, GillianGillianLoweKey, Nigel SNigel SKeyMillar, Carolyn MCarolyn MMillarPipe, Steven WSteven WPipeMadan, BellaBellaMadanSHENG-CHIEH CHOUKlamroth, RobertRobertKlamrothMason, JaneJaneMasonChambost, HervéHervéChambostPeyvandi, FloraFloraPeyvandiMajerus, ElaineElaineMajerusPepperell, DominicDominicPepperellRivat, ChristineChristineRivatYu, HuaHuaYuRobinson, Tara MTara MRobinsonOzelo, Margareth CMargareth COzelo2025-05-212025-05-212024-11https://scholars.lib.ntu.edu.tw/handle/123456789/729566Valoctocogene roxaparvovec, an adeno-associated virus-mediated gene therapy for severe hemophilia A, enables endogenous factor (F)VIII expression and provides bleed protection. Determine valoctocogene roxaparvovec durability, efficacy, and safety 4 years after treatment. In the phase 3 GENEr8-1 trial, 134 adult male persons with severe hemophilia A without inhibitors and previously using FVIII prophylaxis received a 6 × 10 vg/kg infusion of valoctocogene roxaparvovec. Efficacy endpoints included annualized bleed rate, annualized FVIII infusion rate, FVIII activity, and the Haemophilia-Specific Quality of Life Questionnaire for Adults. Adverse events and immunosuppressant use were assessed. Change from baseline was assessed after participants discontinued prophylaxis (scheduled for week 4). Median follow-up was 214.3 weeks; 2 participants discontinued since the previous data cutoff. Declines from baseline in mean treated annualized bleed rate (-82.6%;  < .0001) and annualized FVIII infusion rate (-95.5%;  < .0001) were maintained from previous years in the primary analysis population of 112 participants who enrolled from a noninterventional study. During year 4, 81 of 110 rollover participants experienced 0 treated bleeds. Week 208 mean and median chromogenic FVIII activity were 16.1 IU/dL and 6.7 IU/dL, respectively, in 130 modified intention-to-treat participants. Seven participants resumed prophylaxis since the previous data cutoff. Mean change from baseline to week 208 in Haemophilia-Specific Quality of Life Questionnaire for Adults Total Score ( < .0001) remained clinically meaningful for modified intention-to-treat participants. Alanine aminotransferase elevation was the most common adverse event during year 4 (56/131 participants); none required immunosuppressants. Valoctocogene roxaparvovec provides persistent FVIII expression, hemostatic control, and health-related quality of life improvements with no new safety signals.enadeno-associated virusclinical trialgene therapyhemophilia Aquality of life[SDGs]SDG3journal article10.1016/j.rpth.2024.10261539687929