Applying the international rare disease research consortium (IRDiRC) N-of-1 therapy task force eligibility criteria for individualised therapies use case: Duchenne muscular dystrophy.

The nucleic acid therapy field is making progress in rare diseases, with multiple regulatory approved therapeutic modalities. As these therapeutic approaches are programmable, they also provide an opportunity for individualized therapy development. Indeed, currently over 30 individuals are being treated with such N-of-1 antisense oligonucleotides. The International Rare Disease Research Consortium (IRDiRC) Task Force of N-of-1 treatments published a roadmap to outline the different steps that are involved, among others, in establishing whether an individual is eligible for N-of-1 treatment development. We have tested these principles, using Duchenne muscular dystrophy as a use case. Our analysis shows that while assessing some eligibility aspects, such as genetic eligibility, is relatively straightforward, assessing other criteria, such as unmet medical need and extrapolation from approved treatments, was more difficult.