EU/3/17/1828 - orphan designation for treatment of cystic fibrosis
ivacaftor
tezacaftor
OrphanHuman
Overview
On 27 February 2017, orphan designation (EU/3/17/1828) was granted by the European Commission to Vertex Pharmaceuticals (Europe) Limited, United Kingdom, for 1-(2,2-difluoro-2H-1,3-benzodioxol-5-yl)-N-{1-[(2R)-2,3-dihydroxypropyl]-6-fluoro-2-(1-hydroxy-2-methylpropan-2-yl)-1H-indol-5-yl}cyclopropane-1-carboxamide (also known as tezacaftor) and ivacaftor for the treatment of cystic fibrosis.
1-(2,2-difluoro-2H-1,3-benzodioxol-5-yl)-N-{1-[(2R)-2,3-dihydroxypropyl]-6-fluoro-2-(1-hydroxy-2-methylpropan-2-yl)-1H-indol-5-yl}cyclopropane-1-carboxamide and ivacaftor has been authorised in the EU as Symkevi since 31 October 2018.
The sponsorship was transferred to Vertex Pharmaceuticals (Ireland) Limited, Ireland, in December 2018.
This medicine is now known as tezacaftor and ivacaftor.
The sponsor’s address was updated in January 2022.
Cystic fibrosis is a hereditary disease that affects the secretion of fluids from cells in the lungs and from the glands in the gut and pancreas. In cystic fibrosis, these fluids become thick, blocking the airways in the lungs and the flow of digestive juices in the gut and pancreas. This leads to inflammation and long-term infection of the lungs because of the build-up of thick mucus, and to poor growth and nutrition because of problems with the digestion and absorption of food.
Cystic fibrosis is caused by changes (mutations) in a gene that makes a protein called 'cystic-fibrosis transmembrane conductance regulator' (CFTR), which is involved in regulating the production of mucus and digestive juices.
Cystic fibrosis is a long-term debilitating and life-threatening disease because it severely damages the lung tissue, leading to problems with breathing and to recurrent chest infections.
At the time of designation, cystic fibrosis affected less than 1 in 10,000 people in the European Union (EU). This was equivalent to a total of fewer than 52,000 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 515,700,000 (Eurostat 2017).
At the time of designation, Kalydeco (ivacaftor) and Orkambi (ivacaftor and lumacaftor) were authorised to treat patients with cystic fibrosis who have certain mutations in the gene for CFTR. Lung infection in cystic fibrosis was mainly treated with antibiotics. Other medicines used to treat the lung disease included anti-inflammatory medicines, bronchodilators (medicines that help to open up the airways in the lungs) and mucolytics (medicines that help break down mucus in the lungs). In addition, patients with cystic fibrosis were often given other types of medicines such as pancreatic enzymes (substances that help to digest and absorb food) and food supplements. They were also advised to exercise and to have physiotherapy.
The sponsor has provided sufficient information to show that this medicine might be of significant benefit for patients with cystic fibrosis. Early studies showed that this medicine improved lung function in patients with certain mutations in the CFTR gene that are currently not treated by the existing medicines. This assumption will need to be confirmed at the time of marketing authorisation, in order to maintain the orphan status.
This medicine is made up of two substances, tezacaftor and ivacaftor, that work by improving activity of CFTR in the lungs, which is necessary to produce thin, normal mucus.
Ivacaftor is thought to restore the ability of CFTR channels to transport chloride ions into and out of cells (a key function of the protein), while tezacaftor is expected to increase the amount of and stabilise CFTR on the cell surface. The combination of the two substances is expected to thin the abnormal secretions, reduce symptoms of the disease and improve lung function.
The effects of the combination of tezacaftor and ivacaftor have been evaluated in experimental models.
At the time of submission of the application for orphan designation, clinical trials with this combination in patients with cystic fibrosis were ongoing.
At the time of submission, the combination was not authorised anywhere in the EU for cystic fibrosis or designated as an orphan medicinal product elsewhere for this condition.
In accordance with Regulation (EC) No 141/2000 of 16 December 1999, the COMP adopted a positive opinion on 19 January 2017 recommending the granting of this designation.
- 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.
Key facts
- Active substance
- ivacaftor
- tezacaftor
- Intended use
- Treatment of cystic fibrosis
- Orphan designation status
- Positive
- EU designation number
- EU/3/17/1828
- Date of designation
- Sponsor
Vertex Pharmaceuticals (Ireland) Limited
Unit 49
Northwood Court
Block F2 Santry
Dublin 9
Ireland
E-mail: vertexmedicalinfo@vrtx.com
Review of designation
The Committee for Orphan Medicinal Products reviews the orphan designation of a product if it is approved for marketing authorisation.
The Committee for Orphan Medicinal Products reviewed the orphan designation of Symkevi at the time of marketing authorisation, and confirmed that the orphan designation should be maintained.
More information is available in the Symkevi : Orphan maintenance assessment report.
EMA list of opinions on orphan medicinal product designation
EMA publishes information on orphan medicinal product designation adopted by the Committee for Orphan Medicinal Products (COMP) on the IRIS online platform:
Patients' organisations
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.
EU register of orphan medicines
The list of medicines that have received an orphan designation in the EU is available on the European Commission's website: