On 1 October 2010, orphan designation (EU/3/10/794) was granted by the European Commission to Dr Ulrich Granzer, Germany, for N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyrimidin-4-yl)amino] benzenesulfonamide dihydrochloride monohydrate for the treatment of primary myelofibrosis.
The sponsorship was transferred to Sanofi Aventis, France, in February 2011. In October 2012, Sanofi Aventis changed name to Sanofi-Aventis Groupe.
The sponsorship was transferred to SynteractHCR Deutschland GmbH, Germany, in May 2017.
The sponsorship was transferred to Celgene Europe B.V., the Netherlands, in June 2018.
N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyrimidin-4-yl)amino] benzenesulfonamide dihydrochloride monohydrate for treatment of primary myelofibrosis has been authorised in the EU as Inrebic since 8 February 2021.
This medicine is now known as fedratinib.
The sponsorship was transferred to Bristol-Myers Squibb Pharma EEIG, Ireland in September 2021.
Primary myelofibrosis is a disease of unknown cause in which the bone marrow (the spongy tissue inside the large bones) becomes dense and fibrous, and starts producing abnormal immature blood cells that replace the normal blood cells.
In this disease, some immature blood cells migrate from the bone marrow to other organs, such as the spleen and liver, where they mature. This causes the organs to become enlarged. Patients with primary myelofibrosis can develop several symptoms, including pain in the bones, tiredness, weakness, infections and bleeding.
Primary myelofibrosis is a debilitating disease that is long lasting and may be life threatening because it results in severe anaemia (low red-blood-cell counts) and infections, and can lead to leukaemia (cancer of the white blood cells).
At the time of designation, primary myelofibrosis affected approximately 0.3 in 10,000 people in the European Union (EU). This was equivalent to a total of around 15,000 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).
At the time of designation, hydroxyurea and busulfan (which are also used to treat cancer) were authorised in the EU for primary myelofibrosis. In addition, treatments aimed at relieving the symptoms of the disease were used. These included androgens (male hormones), glucocorticoids (a type of steroid) and erythropoietin (a hormone that stimulates the production of red blood cells) to treat anaemia, and surgery to remove the enlarged spleen. In some patients, haematopoietic (blood) stem-cell transplantation was used. This is a complex procedure where the patient receives stem cells from a matched donor to help restore the bone marrow.
The sponsor has provided sufficient information to show that this medicine might be of significant benefit for patients with primary myelofibrosis because it works in a different way to existing treatments and may represent an alternative treatment for patients with this condition. This assumption will need to be confirmed at the time of marketing authorisation, in order to maintain the orphan status.
This medicine is thought to work by blocking an enzyme known as Janus kinase 2 (JAK2). This enzyme can be found in some receptors on the surface of cells and is involved in the reproduction and growth of blood cells. In myelofibrosis, JAK2 is overactivated. By blocking this enzyme, the medicine is expected to slow down the abnormal growth of blood cells, reducing the symptoms of the disease.
The effects of N-tert-butyl-3-[(5-methyl-2-{[4-(2-pyrrolidin-1-ylethoxy)phenyl]amino}pyrimidin-4-yl)amino] benzenesulfonamide dihydrochloride monohydrate have been evaluated in experimental models.
At the time of submission of the application for orphan designation, clinical trials with this medicine in patients with primary myelofibrosis were ongoing.
At the time of submission, this medicine was not authorised anywhere in the EU for primary myelofibrosis. Orphan designation of the medicine had been granted in the United States for the treatment of secondary and primary myelofibrosis.
In accordance with Regulation (EC) No 141/2000 of 16 December 1999, the COMP adopted a positive opinion on 16 July 2010 recommending the granting of this designation.
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.
Bristol-Myers Squibb Pharma EEIG
The Committee for Orphan Medicinal Products reviewed the orphan designation of Inrebic at the time of marketing authorisation, and confirmed that the orphan designation should be maintained.
More information is available in the Inrebic : Orphan maintenance assessment report (initial authorisation).
EMA publishes information on orphan medicinal product designation adopted by the Committee for Orphan Medicinal Products (COMP) on the IRIS online platform:
For contact details of patients’ organisations whose activities are targeted at rare diseases, see:
European Organisation for Rare Diseases (EURORDIS), a non-governmental alliance of patient organisations and individuals active in the field of rare diseases.
Orphanet, a database containing information on rare diseases, which includes a directory of patients’ organisations registered in Europe.
The list of medicines that have received an orphan designation in the EU is available on the European Commission's website: