Recent Orphan Drug companies Experience with CUP, in...
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Recent Orphan Drug companies
Experience with CUP, in Europe
François HouÿezDirector of Health Policy
6th ECRD, 23-25 May 2012, Brussels
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Regulation EC 726/2004 Title V, article 83.2
2
with a chronically or seriously debilitating disease
or whose disease is considered to be life-threatening
and who cannot be treated satisfactorily by an authorised medicinal product
Running a Compassionate Use Programme (CUP) consists in making a medicinal
product available for compassionate reasons to a group of patients:
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History
� US: Aids activists urged FDA to accelerate regulatory process– March on Wall Street (24 March 1987)
– FDA adopted the compassionate use scheme
� France 1988– French patients’ advocates negotiated early access with
health authorities
– 1991: ATU in Code de la Santé Publique
� Denmark: 1995
� Germany: 2005
� Italy: 2006
� Spain: 2009
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� A clinical trial nor an experiment:
– intention is to treat
� A substitute to product development:
– does not replace CT, should not even start if no CT
� A financial help programme nor a humanitarian
programme
� A way to place a product on the market prior to the
marketing authorisation
� A “favour” or a “gift” to clinicians who achieve their
objectives in recruiting for clinical trials
Compassionate use is not
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1st trimester 1995 – 3rd trimester 1998
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q31995 1996 1997 1998
0
100
200
300
400
500
600
700
0
10000
20000
30000
40000
50000# hospitalisations
ATU IP IDV, RTV, SQV
ATU NRTI
Results as salvage
ATU 3TC
ATU d4T
MA
2Q96 to 2Q97: - 56%
A success story: hospitalisation rates for
1000 AIDS patients, France 1995-1998
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Some national schemes better than others
Afssaps annual report 2009
Afssaps annual report 2009
72% OD that were subsequently authorised
benefited from an ATU
72% OD that were subsequently authorised
benefited from an ATU
in average 34 months prior authorisation
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Equity guaranteed
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RECENT ORPHAN DRUG COMPANIES
EXPERIENCE WITH CUP, IN EUROPE
Eurordis Survey with industry
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Methods (1)
� EURORDIS invitation letter sent in coordination with
EBE/EuropaBio
� Written questionnaire to person in charge of CUP in
64 companies• that obtained a MA for a designated OD within the last 3 years
(CUP in progress or closed)
• And/or are EBE/EuropaBio members or ERTC members
� Target: to obtain information on 15-20 products
� Survey period:
– November 2010 – January 2011
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Responses from 17 companies on 19 products
Company Product Indication CUP in Europe?
Eusa Pharma Inolimomab Graft versus host disease yes
Genzyme Mozobil® Treatment to mobilise progenitor cells prior to stem cell transplantation yes
AstraZeneca Vandetanib Medullary thyroid carcinoma Yes
Merck Serono Kuvan®Hyperphenylalaninaemia (HPA) in adult and paediatric patients of 4 years +
with (PKU)yes
Orphan Europe Carglumic acidNAGS deficiency, isovaleric acidaemia, methylmalonic acidaemia, propionic
acidaemiayes
Pharma Mar Yondelis® Soft Tissue Sarcoma yes
Shire Pharmaceuticals velaglucerase alpha (Vpriv) Gaucher type 1 Yes
Johnson&Johnson Decitabine MDS Yes
UCB Xyrem® Treatment of narcolepsy Yes
Swedish Orphan BioVitrum Kiobrina Prevention of growth restriction in preterm infants No
Chiesi Pharmaceutici
human corneal epithelium
containing stem cells Corneal lesions, with associated corneal (limbal) stem cell deficiency, due to
ocular burnsNo
Nymusa® Primary apnoea of premature newborns No
NovimmuneNI-0801 haemophagocytic lymphohistiocytosis No
NI-0501 haemophagocytic lymphohistiocytosis No
Talecris Biother. Gmbh Alpha-1-proteinase inhibitor Congenital alpha-1 antitrypsin deficiency No
Rare Partners sarl No
Baxter No
Dompé No
FoldRx No
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In case “no”, why?
� Could not apply before due to the lack of GMP certificate for
production facilities.
– Certificate granted recently though Administrative obstacle and lack of
experience for some countries
� Proof of concept studies for 2 orphan indications not started
� The development stage of compounds has not reached yet a stage
where a CUP may have been envisioned
� Expanded access programs will be discussed once preliminary
efficacy has been demonstrated
� Final decisions have not been made on initiating a program
� New for the company, bureaucracy
� Company was founded in March 2010, not yet involved in a CUP
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11/14 products marketed within the last 3 years
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9 products, 42 countries, 74 programmes
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74/378 = 19,6%
of the potential was
achieved
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23/42 countries: 1-2 programmes
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More than 3034 patients total
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Detailed figures/country only for 3
Johnson & J, Pharma Mar Genzyme
Austria 0 6 36
Belgium 2 232 46
Croatia 0 0 13
Czech
Republic1 0 67
Cyprus 4 0 0
Denmark 0 0 15
Estonia 10 0 3
France 0 452 60
Finland 0 0 9
Germany 2 135 166
Greece 0 7 12
Hungary 0 0 55
Iceland 0 0 1
Ireland 0 1 4
Italy 22 266 180
Latvia 1 0 10
Lithuania 21 0 13
Luxembourg 0 0 1
Netherlands 9 5 18
Norway 0 4 4
Poland 12 1 75
Portugal 0 5 26
Romania 1 0 0
Russia 0 0 4
Slovakia 0 0 3
Slovenia 0 0 0
Spain 16 290 125
Sweden 0 0 13
Switzerland 1 42 37
UK 23 123 253
total 125 1569 1249
Johnson & Johnson: decitabine
Pharma Mar: Yondelis®
Genzyme: Mozobil®
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Other companies in other
diseases areas provide
patients’ organisations
with weekly data, country
by country, and hospital by
hospital.
Transparency matters.
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Not much discussion with POs
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Were data collected via CUPs?
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Which type?
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Impact on information gained
Exposed in
pivotal studies
Exposed in CUP
and safety data
collected**
Eusa Pharma vandetanib 288* 442
Pharma Mar Yondelis® 266 1569
Johnson &
JohnsonDecitabine 303* 125
Genzyme Mozobil® 298 1249
Total 856 3385 (+320%)
* estimates from phase III trials recruitment goals
** not all prior to benefit/risk evaluation
NB: for Carbaglu®, no pivotal studies.
All data from clinical files obtained via compassionate use programme
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For what use?
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Completed programmes (1)
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Completed programmes (2)
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Completed programmes (3)
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Completed programmes (4)
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Completed programmes (5)
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More thinking needed on:
� When to start a CUP
– End proof of concept? Even before?
– By the Go/No Go decision?
– With or without preliminary efficacy data?
– When agreement signed with the MAA if different from initial
developer?
� In short: when is a compound becoming a potential medicine?
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Thank you to
Karel Verkoelen Genzyme
Lode Dewulf UCB
Anne De Bock AstraZeneca
Paolo De Angeli Chiese Pharmaceutici
Federico Fucetola Dompé
Emmanuelle Lecomte-Brisset Eusa Pharma
Bill Aliski FoldRx Pharmaceuticals
Paolo Morgese Merck Serono
Olivia Maurel Novimmune
Marie-Christine Fortun Orphan Europe
Virginia Cuervo Pharma Mar
Germano Carganico RarePartners Srl
Peter Myrenfors Swedish Orphan Biovitrum
And Baxter, Talecris Biopharmaceuticals
Fabrizia Bignami Eurordis
Blanca Vera Gargallo Eurordis
Emmanuel Chantelot EBE/Europabio
supported by
The responsibility of
the content of this
report lays with
EURORDIS. The
Executive Agency is
not responsible for
any use that may be
made of the
information
contained therein.
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Thank you.
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(C) Roll-over study(A) Clinical trials: experimental drug
(B) Clinical trials: placebo or control
CT recruitment
terminates
(E) Open label study, named patient basis, cohort…
(D) Parallel access / track
Patients representing an unmet
medical need or with no suitable
alternative available, and/or not
eligible for CT
Patients eligible
for clinical trials
(CT)
All patients with
same disease in
countries with CT
All patients with
same disease in countries with
no CT
Patients representing
an unmet medical
need or with no
suitable alternative
available
(F) Open label study, named patient basis, cohort…
(G) Patients treated
via marketing
authorisation
(H) Financial
Assistance
Programme
(I) Import
authorisation
When a marketing
authorisation is granted
When there is no marketing
authorisation
(J) Humanitarian
access
(K) Compulsory
licensing
(M) No treatment
Compassionate Use
Programme = (C) +
(E) + (F)
Expanded Access
Programme =
CUP + (D) + (I) + (J) +
(K) +…
(L) Off-label use
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