On 3 December 2008, orphan designation (EU/3/08/594) was granted by the European Commission to Europa Rx Limited, United Kingdom, for recombinant human tissue non-specific alkaline phosphatase - Fc - deca-aspartate fusion protein for the treatment of hypophosphatasia.
The sponsorship was transferred to Dr Ulrich Granzer, Germany, in September 2010 and Alexion Europe SAS, France, in September 2012.
Update: recombinant human tissue non-specific alkaline phosphatase - Fc - deca-aspartate fusion protein, asfotase alfa (Strensiq) has been authorised in the EU since 28 August 2015 for long-term enzyme replacement therapy in patients with paediatric-onset hypophosphatasia to treat the bone manifestations of the disease.
- What is hypophosphatasia?
Hypophosphatasia is a rare inherited metabolic disorder. It is caused by defects in the gene for tissue non-specific alkaline phosphatase (TNSALP), an enzyme that is involved in the development of bone, particularly the hardening of the bones. Patients with hypophosphatasia have symptoms such as early loss of teeth, malformed (unusually shaped) bones and frequent bone fractures (breaks).
There are five forms of the disease. Perinatal and infantile hypophosphatasia affect unborn babies and children, and are life-threatening either in the womb or in early infancy because of the incomplete development of the bones and lungs. The other three forms (childhood and adult hypophosphatasia, and odontohypophosphatasia) are generally not lethal but are debilitating and long-lasting.
- What is the estimated number of patients affected by the condition?
At the time of designation, hypophosphatasia affected less than 0.01 in 10,000 people in the European Union (EU). This was equivalent to a total of fewer than 500 people*, and is below the threshold for orphan designation, which is 5 people in 10,000. This isbased on the information provided by the sponsor and the knowledge of the Committee for Orphan Medicinal Products (COMP).
*Disclaimer: For the purpose of the designation, the number of patients affected by the condition is estimated and assessed on the basis of data from the European Union (EU 27), Norway, Iceland and Liechtenstein. At the time of designation, this represented a population of 502,800,000 (Eurostat 2008).
- What treatments are available?
At the time of submission of the application for orphan drug designation, there were no satisfactory methods authorised for the treatment of hypophosphatasia. Treatment has been aimed at relieving the symptoms of the disease such as setting fractures in plaster casts, controlling pain and controlling the levels of calcium in the blood. Patients are sometimes treated with surgery, and dental hygiene is carefully monitored.
- How is this medicine expected to work?
Recombinant human tissue non-specific alkaline phosphatase - Fc - deca-aspartate fusion protein contains TNSALP, the enzyme that is missing in patients with hypophosphatasia. The enzyme is produced by a method known as ‘recombinant DNA technology’: it is made by a cell that has received a gene (DNA), which makes it able to produce TNSALP. In this medicine, the TNSALP is attached to a protein called deca-aspartate, which guides the TNSALP to the bones. Providing TNSALP is expected to replace the missing enzyme in the bones, improving their development and making them harder.
- What is the stage of development of this medicinal product?
The evaluation of the effects of recombinant human tissue non-specific alkaline phosphatase - Fc - deca-aspartate fusion protein in experimental models is ongoing.
At the time of submission of the application for orphan designation, no clinical trials in patients with hypophosphatasia had been started.
At the time of submission, recombinant human tissue non-specific alkaline phosphatase - Fc - deca-aspartate fusion protein was not authorised anywhere in the world for hypophosphatasia. Orphan designation of the product had been granted in the United States for hypophosphatasia.
In accordance with Regulation (EC) No 141/2000 of 16 December 1999, the COMP adopted a positive opinion on 8 October 2008 recommending the granting of this designation.
- Opinions on orphan medicinal product designations are based on the following three criteria:
- the seriousness of the condition;
- the existence of alternative methods of diagnosis, prevention or treatment;
- either the rarity of the condition (affecting not more than five in 10,000 people in the Community) or insufficient returns on investment.
Designated orphan medicinal products are products that are still under investigation and are considered for orphan designation on the basis of potential activity. An orphan designation is not a marketing authorisation. As a consequence, demonstration of quality, safety and efficacy is necessary before a product can be granted a marketing authorisation.
|Name||Language||First published||Last updated|
|EU/3/08/594: Public summary of positive opinion for orphan designation of recombinant human tissue non-specific alkaline phosphatase - Fc - deca-aspartate fusion protein for the treatment of hypophosphatasia||(English only)||24/04/2009||26/03/2015|
|Active substance||Recombinant human tissue non-specific alkaline phosphatase - Fc - deca-aspartate fusion protein|
|Disease/condition||Treatment of hypophosphatasia|
|Date of decision||03/12/2008|
|Orphan decision number||EU/3/08/594|
Review of designation
During its meeting of 14 to 16 July 2015, the Committee for Orphan Medicinal Products (COMP) reviewed the designation EU/3/08/594 for Strensiq (asfotase alfa1) as an orphan medicinal product for the treatment of hypophosphatasia. The COMP assessed whether, at the time of marketing authorisation, the medicinal product still met the criteria for orphan designation. The Committee looked at the seriousness and prevalence of the condition, and the existence of other methods of treatment. The COMP recommended that the orphan designation of the medicine be maintained2.
1Previously known as ‘recombinant human tissue non-specific alkaline phosphatase - Fc - deca-aspartate fusion protein’.
2The maintenance of the orphan designation at time of marketing authorisation would, except in specific situations, give an orphan medicinal product 10 years of market exclusivity in the EU. This means that in the 10 years after its authorisation similar products with a comparable therapeutic indication cannot be placed on the market.
- Life-threatening or long-term debilitating nature of the condition
The Committee for Medicinal Products for Human Use (CHMP) recommended the authorisation of Strensiq for:
‘long-term enzyme replacement therapy in patients with paediatric-onset hypophospatasia to treat the bone manifestations of the disease’.
This falls within the scope of the product’s designated orphan indication(s), which is: ‘treatment of hypophosphatasia’.
The COMP concluded that there had been no change in the seriousness of the condition since the orphan designation in 2008. Hypophosphatasia remains a condition that is debilitating in the long term and life threatening due incomplete development of the bones and respiratory problems.
- Prevalence of the condition
The sponsor performed a search of the scientific literature and concluded that no publications are available which suggest a change in prevalence of hypophosphatasia.
On the basis of the information provided by the sponsor and the knowledge of the COMP, the COMP concluded that the prevalence of hypophosphatasia remains below the ceiling for orphan designation, which is 5 people in 10,000. At the time of the review of the orphan designation, the prevalence was still estimated to be less than 0.01 people in 10,000. This is equivalent to a total of fewer than 500 people in the EU.
- Existence of other methods of treatment
The COMP noted that, at the time of the review of the orphan designation, no treatments were authorised in the EU for patients affected by this condition. Treatment aimed at relieving the symptoms of the disease such as plaster casts for broken bones, calcium supplements for maintaining the levels of calcium in the blood and painkillers.
Based on the data submitted and the scientific discussion within the COMP, the COMP considered that Strensiq still meets the criteria for designation as an orphan medicinal product and that it should remain in the Community Register of Orphan Medicinal Products.
|Name||Language||First published||Last updated|
|Recommendation for maintenance of orphan designation at the time of marketing authorisation: Strensiq (asfotase alfa) for the treatment of hypophosphatasia||(English only)||28/09/2015|
Sponsor’s contact details
Alexion Europe SAS
1-15, avenue Edouard Belin
Tel. +33 147323621
Fax +33 147102446
For contact details of patients’ organisations whose activities are targeted at rare diseases, see:
- Orphanet, a database containing information on rare diseases, which includes a directory of patients’ organisations registered in Europe;
- European Organisation for Rare Diseases (EURORDIS), a non-governmental alliance of patient organisations and individuals active in the field of rare diseases.