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Orphan designation

On 10 March 2005, orphan designation (EU/3/05/265) was granted by the European Commission to Chiron Corporation Ltd, United Kingdom, for ciclosporin for inhalation use for the treatment of graft rejection after lung transplantation.
The sponsorship was transferred to Right Track Regulatory Limited, United Kingdom, in September 2007.

What is graft rejection in lung transplantation?

Lung transplantation is performed when, because of underlying conditions, the lungs are so damaged that one or both need to be replaced. It is most commonly performed in pulmonary emphysema, idiopathic pulmonary fibrosis, pulmonary hypertension and cystic fibrosis.
Rejection is the process by which the organ recipient's defence (immune) system recognises, becomes sensitised against, and attempts to eliminate the foreign donor organ.
It has been observed that at least one episode of rejection is common within the first year after a transplant. More than 80% of people who receive a lung transplant develop some symptoms of rejection within a month of transplantation. Symptoms include fever, shortness of breath, and weakness due to the non-optimal functioning of the transplanted lungs. Scar tissue may form in the small airways and gradually block them, possibly indicating gradual rejection.
The condition can be chronically debilitating and life threatening due to the high incidence of severe infections and graft rejection.

What are the methods of treatment available?

In order to preserve the new lung(s) in the recipient’s body, a suppression of the patient’s defence potential (immunosuppression) is induced after lung transplantation. The immunosuppressive agents already authorized for the use in the treatment of graft rejection are ciclosporin (intravenous administration) and corticosteroids. Other therapies that can be used are other immunosuppressive drugs such as methotrexate, or other methods that decrease the number of immune cells of the recipient, such as photopheresis and antilymphocyte antibodies.
Inhaled ciclosporin might be of potential significant benefit for the treatment of graft rejection after lung transplantation due to its new route of administration. The assumption will have to be confirmed at the time of marketing authorisation. This will be necessary to maintain the orphan status.

What is the estimated number of patients affected by the condition*?

According to the information provided by the sponsor, graft rejection after lung transplantation was considered to affect about 2,300 persons in the European Union.

* Disclaimer: For the purpose of the designation, the number of patients affected by the condition is estimated and assessed based on data from the European Union (EU 25), Norway, Iceland and Lichtenstein. This represents a population of 459,700,000 (Eurostat 2004). This estimate is based on available information and calculations presented by the sponsor at the time of the application.

How is this medicinal product expected to act?

Ciclosporin for inhalation use is an immunosuppressive drug used to prevent the body from rejecting transplanted organs, as it suppresses the body’s natural reaction to the transplanted organ and is a component of most of the post transplant regimens.
Ciclosporin acts by inhibiting some special defence cells called lymphocyte T cells. It inhibits also the production of some special substances called lymphokines, which play a role in the defence reactions of the body. Ciclosporin for inhalation is meant to be used to treat patients who develop a rejection against their lung transplants by delivering the medicinal product directly to the lungs. 

What is the stage of development of this medicinal product?

The effects of ciclosporin for inhalation use was evaluated in experimental models. At the time of submission of the application for orphan designation, clinical trials in patients with graft rejection in lung transplantation were completed.
Ciclosporin for inhalation use was not marketed anywhere worldwide for graft rejection in lung transplantation at the time of submission.
Orphan designation of ciclosporin for inhalation use was granted in the United States for prophylaxis of acute rejection in patients requiring allogenic lung transplant and for treatment of refractory acute graft rejection in patients requiring allogenic lung transplant.
According to Regulation (EC) No 141/2000 of 16 December 1999, the Committee for Orphan Medicinal Products (COMP) adopted on 3 February 2005 positive opinion recommending the grant of the above-mentioned designation.

Opinions on orphan medicinal products designations are based on the following cumulative criteria:
  • the seriousness of the condition, 
  • the existence or not of alternative methods of diagnosis, prevention or treatment and 
  • either the rarity of the condition (considered to affect not more than five in ten thousand persons in the Community) or the insufficient return of development investments.

Designated orphan medicinal products are still investigational products which were considered for designation on the basis of potential activity. An orphan designation is not a marketing authorisation. As a consequence, demonstration of the quality, safety and efficacy will be necessary before this product can be granted a marketing authorisation.

Key facts

Product details for <p>Ciclosporin (inhalation use)</p>
Active substanceCiclosporin (inhalation use)
Medicine Name
Disease/conditionTreatment of graft rejection after lung transplantation
Date of decision09/03/2005
Orphan decision numberEU/3/05/265

Review of designation

Sponsor’s contact details:

Right Track Regulatory Limited
44 Mymms Drive
Brookmans Park
Hertfordshire AL9 7AF
United Kingdom
Telephone: +44 1707 649053

Patients’ associations contact poins:

Pulmonary hypertention

Pulmonale Hypertonie (PH) e.V
Wormser Strasse 20
D – 76287 Rheinstetten
Telephone: +49 72 13 52 83 81
Telefax: +49 72 13 52 88 80

The Pulmonary Hypertension Association (UK)
PO Box 2760
United Kingdom
Telephone: +44 87 03 21 37 51
Telefax: +44 70 10 71 57 23

Association Française d'aide aux patients souffrant d'Hypertension Artérielle Pulmonaire
31 Rue Jacques Cellier
Telephone: +33 3 26 36 93 32

Cistic fibrosis

Mukoviszidose e.V.
In den Dauen 6
Telephone : +49 22 89 87 800
Telefax: +49 22 89 87 80 77

Vaincre la Mucoviscidose
181 rue de Tolbiac
Telephone : +33 1 40 78 91 91
Telefax : +33 1 45 80 86 44

Cystic Fibrosis Association of Ireland
CF House,
24 Lower Rathmines Road
6 Dublin
Telephone: +353 14 96 24 33
Telefax: +353 14 96 24 33