Achondroplasia treatments in children aged 5 and older.

Achondroplasia, the most prevalent skeletal dysplasia, is a genetic disorder caused by activating mutations in the FGFR3 gene impairing endochondral ossification of long bones. Clinical manifestations include disproportionate short stature and multisystem complications. Management has been limited to supportive care, surgical limb lengthening, and recombinant human growth hormone. The latter two carry significant risks and provide modest benefits, respectively. Recently, targeted molecular therapies have emerged as promising alternatives. This review highlights three investigational agents: Vosoritide, Infigratinib, and Navepegritide. Vosoritide, an injectable C-type natriuretic peptide analog, reduces MAPK pathway overactivation; Infigratinib, an oral FGFR1-3 inhibitor, directly suppresses downstream signaling; and Navepegritide, a long-acting CNP prodrug, sustains MAPK inhibition. Clinical trials in children aged 5 years and older demonstrate improved annualized growth velocity compared to baseline: 1.7 cm/year with Vosoritide, 6.0 cm/year with Infigratinib, and 5.4 cm/year with Navepegritide. Safety profiles are favorable with few to no significant treatment-related adverse events reported in the trials reviewed; radius fracture, adenoidal hypertrophy, and sleep apnea were reported for Vosoritide, injection site reactions were reported for Navepegritide, and nasopharyngitis was reported for Infigratinib. Direct comparisons across trials are limited, but available data suggest all three therapies bring growth trajectories of children with achondroplasia closer to unaffected peers. Long-term outcomes, particularly regarding comorbidities such as foramen magnum stenosis, spinal stenosis, and sleep apnea, remain under investigation. These emerging treatments represent a paradigm shift in achondroplasia management, underscoring the need for head-to-head studies and evaluation of combination strategies to optimize efficacy and durability.