On 26 November 2010, orphan designation (EU/3/10/810) 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 post-essential thrombocythaemia 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 post-essential thrombocythaemia 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.
Myelofibrosis is a disease 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. It can develop as a reaction to essential thrombocythaemia (overproduction of platelets, components that help the blood to clot). 'Essential' means that the thrombocythaemia is not caused by any known condition.
In myelofibrosis, 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 myelofibrosis can develop several symptoms, including pain in the bones, fever, tiredness, weakness, weight loss, infections and bleeding.
Post-essential thrombocythaemia myelofibrosis is a debilitating disease that is long-lasting and may be life-threatening because it can lead to severe anaemia (low red-blood-cell counts) and infections, and can result in leukaemia (cancer of the white blood cells).
At the time of designation, post-essential thrombocythaemia myelofibrosis affected less than 0.15 in 10,000 people in the European Union (EU). This was equivalent to a total of fewer than 7,600 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, although hydroxyurea and busulfan were authorised in the EU for primary myelofibrosis (myelofibrosis of unknown cause), there were no treatments authorised specifically for post-essential thrombocythaemia myelofibrosis.
Treatments for this disease were aimed at relieving symptoms. They 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 or radiation to remove or shrink the enlarged spleen. In some patients, allogeneic 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.
This medicine is thought to work by blocking an enzyme known as Janus kinase 2 (JAK2), which can be found in some receptors on the surface of cells and is involved in the production 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 this medicine have been evaluated in experimental models.
At the time of submission of the application for orphan designation, clinical trials with the medicine including patients with post-essential thrombocythaemia myelofibrosis were ongoing.
At the time of submission, this medicine was not authorised anywhere in the EU for post-essential thrombocythaemia 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 9 September 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: