Tobramycin VVB and associated names - referral

Current status

European Commission final decision

Overview

On 28 January 2015, the European Medicines Agency completed an arbitration procedure following a disagreement among Member States of the European Union (EU) regarding the authorisation of the medicine Tobramycin VVB. The Agency's Committee for Medicinal Products for Human Use (CHMP) concluded that Tobramycin VVB can be granted marketing authorisation in Lithuania and in the following Member States of the EU: Bulgaria, Estonia, Hungary, Latvia, Poland and Romania.

What is Tobramycin VVB?

Tobramycin VVB is an antibiotic for treating long-term lung infection caused by the bacteria Pseudomonas aeruginosa in patients aged 6 years and older who have cystic fibrosis. Cystic fibrosis is an inherited disease in which there is an accumulation of thick mucus in the lungs that allows bacteria to grow more easily and cause infections. P. aeruginosa is a frequent cause of infections in cystic fibrosis patients.

Tobramycin VVB is to be available as a nebuliser solution (300 mg/5 ml) to be inhaled. The active substance in Tobramycin VVB, tobramycin, belongs to the group of antibiotics known as 'aminoglycosides'. It works by disrupting the production of proteins that P. aeruginosa needs to build its cell walls, resulting in damage to the bacteria which eventually kills them.

Tobramycin VVB is a 'hybrid medicine' that has been developed to be comparable to a 'reference medicine' containing tobramycin called Tobi (300 mg/5 ml nebuliser solution).

Why was Tobramycin VVB reviewed?

UAB VVB submitted Tobramycin VVB to the Lithuanian medicines regulatory agency for a decentralised procedure. This is a procedure where one Member State (the 'reference Member State', in this instance Lithuania) assesses a medicine with a view to granting a marketing authorisation that will be valid in this country as well as in other Member States (the 'concerned Member States', in this instance Bulgaria, Estonia, Hungary, Latvia, Poland and Romania).

However, the Member States were not able to reach an agreement and the Lithuanian medicines regulatory agency referred the matter to the CHMP for arbitration on 14 October 2015.

The reason for the referral was a disagreement over whether Tobramycin VVB is clinically superior to Tobi Podhaler, another medicine containing tobramycin. Demonstration of clinical superiority is required because Tobi Podhaler is an orphan medicine and was granted market exclusivity in the EU at the time of its market authorisation in July 2011. This means that during the period of market exclusivity similar products, such as Tobramycin VVB, cannot be placed on the market; there are, however, exceptions such as where clinically superiority over Tobi Podhaler can be shown.

What are the conclusions of the CHMP?

Based on the evaluation of the currently available data and the scientific discussion within the Committee, the CHMP concluded that Tobramycin VVB is clinically superior to Tobi Podhaler because a substantial proportion of patients are intolerant to Tobi Podhaler but can be treated with Tobramycin VVB. The CHMP therefore recommended that Tobramycin VVB be granted marketing authorisation in Lithuania as well as in the other concerned Member States.

The European Commission issued a decision on this opinion on 04 April 2016.

Questions and answers on Tobramycin VVB and associated names (tobramycin, 300 mg/5 ml nebuliser solution)

Key facts

About this medicine

• Approved name:
  Tobramycin VVB and associated names
• International non-proprietary name (INN) or common name:
  tobramycin

About this procedure

• Current status:
  European Commission final decision
• Reference number:
  EMEA/H/A-29/1428
• Type:
  Article 29(4) referrals

  This type of referral is triggered when there is a disagreement between Member States regarding a marketing authorisation application being evaluated in a mutual-recognition or decentralised procedure, on the grounds of a potential serious risk to public health.

Key dates and outcomes

• CHMP opinion date:
  28/01/2015
• EC decision date:
  04/04/2016

All documents

Opinion provided by Committee for Medicinal Products for human Use

Questions and answers on Tobramycin VVB and associated names (tobramycin, 300 mg/5 ml nebuliser solution)

Reference Number: EMA/55653/2016

Tobramycin VVB and associated names Article-29(4) referral - Annex III

Reference Number: EMA/55653/2016

European Commission final decision

Tobramycin VVB and associated names Article-29(4) referral - CHMP assessment report

Reference Number: EMA/139057/2016

Tobramycin VVB and associated names Article-29(4) referral - Annex I

Tobramycin VVB and associated names Article-29(4) referral - Annex II

Tobramycin VVB and associated names Article-29(4) referral - Annex III

Questions and answers on Tobramycin VVB and associated names (tobramycin, 300 mg/5 ml nebuliser solution)

Description of documents published

Please note that some of the listed documents apply only to certain procedures.

• Overview - lay-language summary of the stage of the procedure
• Notification – a letter from a Member State, the European Commission or the marketing authorisation holder requesting the initiation of the procedure
• Scientific background – further background information from the triggering Member State on the issues leading to the initiation of the procedure (if applicable)
• List of questions – questions agreed by the Committee requesting further information from the marketing authorisation holder(s) / applicant(s) to evaluate the issues identified
• Timetable for the procedure – agreed timeframe to respond to the list of questions, to assess the issues and to adopt a conclusion
• List of medicines concerned by the procedure – medicine(s) / active substance(s) concerned, and marketing authorisation holder(s) / applicant(s)
• List of questions to be addressed by the stakeholders – call for data to be submitted by stakeholders (e.g. healthcare professionals, patient organisations, individual patients) (if applicable)
• Stakeholder submission form – form to be used by stakeholders to submit data (if applicable)
• Scientific conclusions – scientific conclusions of the PRAC and/or CHMP and/or CMDh
• Assessment report – PRAC or CHMP assessment and conclusions on the issues investigated, including divergent positions (if applicable)
• Divergent positions – divergent positions of the CHMP or CMDh members for pharmacovigilance procedures (if applicable)
• Changes to the summary of product characteristics, labelling and package leaflet (amended sections or fully revised version) (if applicable)
• Condition(s) to the marketing authorisation(s) – condition(s) for the safe and effective use of the medicine(s) (if applicable)
• Condition for lifting the suspension – condition to be fulfilled for the suspension of the marketing authorisation(s) to be lifted (if applicable)
• Timetable for implementation of CMDh position – agreed timeframe to submit and finalise the variation(s) implementing the outcome of the procedure (if applicable)

Note that older documents may have different titles.