On 22 May 2006, orphan designation (EU/3/06/368) was granted by the European Commission to Amicus Therapeutics UK Limited, United Kingdom, for 1-deoxygalactonojirimycin hydrochloride for the treatment of Fabry disease.
The sponsorship was transferred as follows:
- to Shire Pharmaceutical Development Limited, United Kingdom, in June 2008;
- to Amicus Therapeutics UK Ltd, United Kingdom, in February 2010;
- to Glaxo Group Limited, United Kingdom, in June 2011;
- and finally to Amicus Therapeutics UK Ltd, United Kingdom, in March 2014.
Update: 1-deoxygalactonojirimycin hydrochloride has been authorised in the EU as Galafold since 26 May 2016.
More information on Galafold can be found in the European public assessment report (EPAR) on the Agency’s website.
- What is Fabry disease?
Fabry disease comprises a group of inherited lysosomal storage disorders. Lysosomes are small vesicles within cells containing enzymes that are able to destroy or transform different substances of the cell, such as proteins, fat, nucleic acids (components of the genetic material) and sugars. Any change of the lysosomal enzymes causes abnormal accumulation of the substance (also known as substrate) normally transformed by it. Cells are unable to destroy or eliminate accumulated substrates, and high levels of them can be toxic leading to damage and malfunction of the organ where accumulation occurs. In Fabry disease, the activity of the lysosomal enzyme α-galactosidase A is impaired or absent. Fabry disease is a heterogenous disorder with variable onset of symptoms that affect several organs. Glycosphingolipids (biological molecules composed of a type of sugar and lipid) is the substrate that accumulates in Fabry disease, and severity of the disease depends on the level of accumulation. Fabry disease affects the nervous system, kidneys, heart, skin and gastrointestinal system. Some of the most common pathological symptoms are skin lesions and burning pain of the extremities. This pain can become very intense, especially when one has a fever. Fabry disease is chronically debilitating and life threatening.
- What is the estimated number of patients affected by the condition*?
At the time of designation, Fabry disease affected approximately 1 in 10,000 people in the European Union (EU). This was equivalent to a total of around 47,000 people*, and is below the ceiling for orphan designation, which is 5 people in 10,000. This is based 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 25), Norway, Iceland and Liechtenstein. At the time of designation, this represented a population of 468,900,000 (Eurostat 2006).
- What treatments are available?
Several products were authorised for the condition in the Community at the time of submission of the application for orphan drug designation. In particular, enzymes replacing the missing enzyme were used to treat Fabry disease.
1-deoxygalactonojirimycin hydrochloride might be of potential significant benefit for the treatment of Fabry disease, as it may act in a different way which is hoped to improve the long-term outcome of the patients. This assumption will have to be confirmed at the time of marketing authorisation. This will be necessary to maintain the orphan status.
- How is this medicine expected to work?
1-deoxygalactonojirimycin hydrochloride is expected to bind to the abnormal α-galactosidase A enzyme and to correct its transport into the lysosome where its action is needed. This way, it is expected that the α-galactosidase A activity is restored. The abnormally high levels of glycosphingolipids are decreased and the extent of Fabry disease and its clinical consequences are limited.
- What is the stage of development of this medicine?
The effects of 1-deoxygalactonojirimycin hydrochloride were evaluated in experimental models.
At the time of submission of the application for orphan designation, clinical trials in patients with Fabry disease were ongoing.
1-deoxygalactonojirimycin hydrochloride was not authorised anywhere worldwide for Fabry disease, at the time of submission. Orphan designation of 1-deoxygalactonojirimycin hydrochloride was granted in the United States for treatment of Fabry disease.
In accordance with Regulation (EC) No 141/2000 of 16 December 1999, the COMP adopted a positive opinion on 5 April 2006 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;
- and either the rarity of the condition (affecting not more than five in 10,000 people in the Community) or the 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 the quality, safety and efficacy is necessary before a product can be granted a marketing authorisation.
|Name||Language||First published||Last updated|
|EU/3/06/368: Public summary of positive opinion for orphan designation of 1-deoxygalactonojirimycin hydrochloride for the treatment of Fabry disease||(English only)||15/05/2009||08/05/2014|
|Active substance||1-Deoxygalactonojirimycin hydrochloride|
|Disease/condition||Treatment of Fabry disease|
|Date of decision||22/05/2006|
|Orphan decision number||EU/3/06/368|
Review of designation
On 8 April 2016, the Committee for Orphan Medicinal Products (COMP) completed its review of the designation EU/3/06/368 for Galafold (migalastat1) as an orphan medicinal product for the treatment of Fabry disease. 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. As other methods of treatment are authorised in the European Union (EU), the COMP also considered whether the medicine is of significant benefit to patients with Fabry disease. The COMP recommended that the orphan designation of the medicine be maintained2.
1Previously known as 1-deoxygalactonojirimycin hydrochloride.
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 the same 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 Galafold for the ‘long-term treatment of adults and adolescents aged 16 years and older with a confirmed diagnosis of Fabry disease (α-galactosidase A deficiency) and who have an amenable mutation’.
This falls within the scope of the product’s designated orphan indication, which is: ‘treatment of Fabry disease’.
The COMP concluded that there had been no change in the seriousness of the condition since the orphan designation in 2006. Fabry disease remains a condition that is debilitating in the long term particularly due to recurrent episodes of severe pain not responding to standard analgesics. The condition can also be life threatening because of kidney failure and complications affecting the heart and the nervous system.
- Prevalence of the condition
The sponsor provided updated information on the prevalence of Fabry disease based on data from the published literature.
On the basis of the information provided by the sponsor and the knowledge of the COMP, the COMP concluded that the prevalence of Fabry disease 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 estimated to be less than 2.3 people in 10,000. This is equivalent to a total of fewer than 118,000 people in the EU.
- Existence of other methods of treatment
At the time of the review of the orphan designation, Fabrazyme and Replagal were authorised in the EU for the treatment of Fabry disease. These are two injectable medicines containing the enzyme α‑galactosidase A, which is lacking in patients with Fabry disease.
- Significant benefit of Galafold
The COMP concluded that the claim of a significant benefit of Galafold in the treatment of Fabry disease is justified because this medicine is available as capsules to be taken by mouth whereas existing treatment are given by infusion (drip) into a vein. This is considered a major contribution to patient care.
Therefore, although other methods for the treatment of this condition have been authorised in the EU, the COMP concluded that Galafold is of significant benefit to patients affected by Fabry disease.
Based on the data submitted and the scientific discussion within the COMP, the COMP considered that Galafold still meets the criteria for designation as an orphan medicinal product and that Galafold 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: Galafold (migalastat) for the treatment of Fabry disease||(English only)||10/06/2016|
Sponsor’s contact details
Amicus Therapeutics UK Ltd
30A Upper High Street
Oxon OX9 3EX
Tel. + 44 (0)1844 211669
Fax + 44 (0)1844 211081
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.