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FDA Approves Leucovorin for Ultra-Rare FOLR1 Folate Disorder, Declines Autism Indication

The decision follows an agency review that judged the autism evidence insufficient.

Overview

  • Approval covers adults and children with cerebral folate deficiency caused by FOLR1 variants and extends to generic products as well as an updated Wellcovorin label.
  • The agency relied on a systematic review of published reports and mechanistic data because randomized trials were not feasible for a condition estimated at roughly 1 in 1 million.
  • Senior officials said efficacy for autism could not be established, highlighting the January retraction of one of the largest positive trials.
  • Leucovorin prescriptions for children rose about 71% after a September White House briefing that had promoted potential autism benefits, creating access problems.
  • To address supply pressures, regulators are urging manufacturers to increase production and are allowing imports, while off-label prescribing for autism remains unsupported by robust data.