On 20 September 2010, orphan designation (EU/3/10/784) was granted by the European Commission to Inspiration Biopharmaceuticals EU Limited, Ireland, for recombinant porcine factor VIII (B-domain-deleted) for the treatment of haemophilia A.
The sponsorship was transferred to Baxter Innovations GmbH, Austria, in July 2013.
For a list of the administrative updates to this public summary of opinion please refer to the PDF document below.
- What is haemophilia A?
Haemophilia A is an inherited bleeding disorder that is caused by the lack of a substance called factor VIII. Factor VIII is one of the proteins involved in the blood coagulation (clotting) process. Patients with haemophilia A are more prone to bleeding than normal and have poor wound healing after injury or surgery. Bleeding can also happen within muscles or the spaces in the joints, such as the elbows, knees and ankles. This can lead to permanent injury if it happens repeatedly.
Haemophilia A is a debilitating disease that is life-long and may be life-threatening because bleeding can also happen in the brain, the spinal cord, the throat or the gut.
- What is the estimated number of patients affected by the condition?
At the time of designation, haemophilia A affected approximately 0.6 in 10,000 people in the European Union (EU). This was equivalent to a total of around 30,000 people*, and is below the threshold 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 27), Norway, Iceland and Liechtenstein. At the time of designation, this represented a population of 506,300,000 (Eurostat 2010).
- What treatments are available?
At the time of submission of the application for orphan-drug designation, medicines containing factor VIII were authorised in the EU for the treatment of haemophilia A, to replace the missing protein. However, some patients with haemophilia A could not benefit from these medicines because their immune system (the body’s natural defences) had reacted by producing ‘inhibitors’ (antibodies) against factor VIII. These inhibitors can stop the medicine from working. In these cases, other treatments were used, including treatments to try and remove the inhibitors from the blood or medicines containing other coagulation factors such as factor VIIa, which attempted to control bleeding by ‘by-passing’ the use of factor VIII. These methods were not effective in all patients.
The sponsor has provided sufficient information to show that recombinant porcine factor VIII (B-domain-deleted) might be of significant benefit for patients with haemophilia A because it might improve the treatment of patients who have developed inhibitors against human factor VIII. Early studies indicate that this medicine might be able to control bleeding episodes in these patients by restoring blood factor-VIII levels. This assumption will need to be confirmed at the time of marketing authorisation, in order to maintain the orphan status.
- How is this medicine expected to work?
Recombinant porcine factor VIII (B-domain-deleted) is a type of factor VIII that is expected to work in the same way as human factor VIII. It is produced by a method known as ‘recombinant DNA technology’: it is made by a cell that has received a gene (DNA). This makes the cell able to produce a form of factor VIII that is similar to the factor VIII normally produced by pigs.
In the body, the medicine is expected to replace the missing human factor VIII, making the patient less prone to bleeding. The medicine is therefore expected to work even in patients who have developed inhibitors against human factor VIII. This is because the pig factor VIII has a slightly different shape to human factor VIII and will not be as easily recognised by the inhibitors against the human protein.
- What is the stage of development of this medicine?
The effects of recombinant porcine factor VIII (B-domain-deleted) have been evaluated in experimental models.
At the time of submission of the application for orphan designation, clinical trials with recombinant porcine factor VIII (B-domain-deleted) in patients with haemophilia A were ongoing.
At the time of submission, recombinant porcine factor VIII (B-domain-deleted) was not authorised anywhere in the EU for haemophilia A. Orphan designation of this medicine had been granted in the United States for the treatment and prevention of episodic bleeding in patients with inhibitor antibodies to human coagulation factor VIII.
In accordance with Regulation (EC) No 141/2000 of 16 December 1999, the COMP adopted a positive opinion on 2 June 2010 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 5 in 10,000 people in the EU) 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/3/10/784: Public summary of opinion on orphan designation: Recombinant porcine factor VIII (B-domain-deleted) for the treatment of haemophilia A||(English only)||18/10/2010||31/07/2013|
|Active substance||Recombinant porcine factor VIII (B-domain-deleted)|
|Disease/condition||Treatment of haemophilia A|
|Date of decision||20/09/2010|
|Orphan decision number||EU/3/10/784|
Review of designation
During its meeting of 6 to 8 October 2015, the Committee for Orphan Medicinal Products (COMP) reviewed the designation EU/3/10/784 for Obizur (susoctocog alfa1) as an orphan medicinal product in the treatment of haemophilia A. 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 haemophilia A. As one of the criteria for orphan designation is no longer met (i.e. the significant benefit), the COMP recommended that the orphan designation of the product should not be maintained2.
1Previously known as recombinant porcine factor VIII (B-domain-deleted).
2The removal of the orphan designation at time of marketing authorisation means that the product cannot benefit from 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 can be placed on the market.
- Life-threatening or chronically debilitating nature of the condition
The Committee for Medicinal Products for Human Use (CHMP) recommended the authorisation of Obizur for: ‘treatment of bleeding episodes in patients with acquired haemophilia caused by antibodies to factor VIII. Obizur is indicated in adults’.
Acquired haemophilia is considered a type of haemophilia A (an inherited bleeding disorder that is caused by the lack of the protein factor VIII). Acquired haemophilia is caused by the spontaneous development of antibodies that inactivate factor VIII. Therefore the approved indication for Obizur is considered to fall within the scope of the product’s designated orphan indication, which is: ‘treatment of haemophilia A’.
The COMP concluded that there had been no change in the seriousness of the condition since the orphan designation in 2010. Haemophilia A remains a condition that is debilitating in the long term and may be life-threatening because bleeding can occur in the brain, the spinal cord, the throat or the gut.
- Prevalence of the condition
The sponsor provided updated information on the prevalence of haemophilia A based on data from the World Federation of Haemophilia Annual Global Survey of 2011.
On the basis of the information provided by the sponsor and the knowledge of the COMP, the COMP concluded that the prevalence of haemophilia A 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 approximately 0.7 people in 10,000. This is equivalent to a total of around 36,000 people in the EU.
- Existence of other methods of treatment
At the time of the review of the orphan designation, several medicines were authorised in the EU for the treatment of haemophilia A, including plasma-derived and recombinant factor VIII, to replace the missing factor VIII. However, these medicines do not work in patients who develop antibodies against factor VIII, such as patients with acquired haemophilia. In these cases, other treatments were used, including treatments to try and remove the antibodies from the blood or medicines containing other coagulation factors such as factor VIIa, which attempted to control bleeding by ‘by-passing’ the use of factor VIII.
- Significant benefit of Obizur
The COMP concluded that the claim of a significant benefit of Obizur in the treatment of haemophilia A is no longer justified because the sponsor has not provided sufficient data to confirm that Obizur will offer a clinically relevant advantage or a major contribution to patient care in patients with haemophilia A.
The sponsor compared data obtained with Obizur with data from published studies for other authorised products for this indication, which did not confirm improved efficacy or safety of Obizur. The sponsor had also claimed that response to treatment could be monitored after injection of Obizur by measuring factor VIII levels, and the dose could be adjusted accordingly. However the COMP concluded that data provided did not support that such dose adjustment would lead to improved bleeding control versus authorised products.
Therefore, the COMP concluded that the assumption that Obizur may be of significant benefit for patients affected by haemophilia A is no longer valid.
Based on the data submitted and the scientific discussion within the COMP, the COMP concluded that Obizur no longer meets one of the criteria for designation as an orphan medicinal product. Therefore, the COMP recommended that the product should be removed from the Community Register of Orphan Medicinal Products.
|Name||Language||First published||Last updated|
|Recommendation for removal of orphan designation at the time of marketing authorisation: Obizur (susoctocog alfa) for the treatment of haemophilia A||(English only)||24/11/2015|
Sponsor’s contact details
Baxter Innovations GmbH
Tel. +43 1201 002542
Fax +43 1201 00771
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.