EU/3/19/2160: Orphan designation for the treatment of epidermolysis bullosa

Epidermolysis bullosa is a group of inherited diseases in which the skin is very fragile and forms severe blisters after even minor friction (rubbing) or injury. In most cases, symptoms of epidermolysis bullosa appear from birth, but for some forms, symptoms may not occur until adulthood. The diseases are caused by mutations (changes) in the genes responsible for the production of certain proteins that make the skin strong and elastic, such as collagen or keratins.

Epidermolysis bullosa is a long-term debilitating and life-threatening condition because the severe blistering and associated scarring and deformities result in poor quality of life and may reduce life expectancy.
 

At the time of designation, epidermolysis bullosa affected approximately 0.70 in 10,000 people in the European Union (EU). This was equivalent to a total of around 36,000 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 28), Norway, Iceland and Liechtenstein. This represents a population of 518,400,000 (Eurostat 2019).

At the time of designation, no satisfactory methods were authorised in the EU to treat epidermolysis bullosa. Good personal hygiene and skincare were recommended to help blisters heal, to avoid infections and to protect the skin from damage. Painkillers were also used. Surgery was sometimes necessary for complications such as deformed hands. 

This medicine is made up of ‘mesenchymal stem cells’ that are extracted from the skin of a donor and grown in the laboratory. Although the way these stem cells work in epidermolysis bullosa is not fully known, when injected into the patient they are expected to send signals that reduce inflammation. By reducing inflammation, the medicine is expected to help the blisters in the skin of patients with epidermolysis bullosa to heal.

The effects of allogeneic skin-derived ABCB5-positive mesenchymal stem cells have been evaluated in experimental models.

At the time of submission of the application for orphan designation, no clinical trials with the medicine in patients with epidermolysis bullosa had been started.

At the time of submission, the medicine was not authorised anywhere in the EU for the treatment of epidermolysis bullosa or designated as an orphan medicinal product elsewhere for this condition.

In accordance with Regulation (EC) No 141/2000, the COMP adopted a positive opinion on 17 April 2019, 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.