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Ibuprofen for the treatment of patent ductus arteriosus

Pre-authorisation Evaluation of Medicines for Human Use Document Date: London, 9 February 2009
COMMITTEE FOR ORPHAN MEDICINAL PRODUCTS
PUBLIC SUMMARY OF
POSITIVE OPINION FOR ORPHAN DESIGNATION
ibuprofen
for the treatment of patent ductus arteriosus

On 14 February 2001, orphan designation (EU/3/01/020) was granted by the European Commission to
Orphan Europe, France, for ibuprofen for the treatment of patent ductus arteriosus.

What is patent ductus arteriosus?
Patent ductus arteriosus (PDA) is a heart disease where the ductus arteriosus fails to close at birth. The
pulmonary artery is a blood vessel that transports blood from the heart to the lungs. The aorta is a
blood vessel that transports blood from the heart out to the rest of the body. In the womb, the baby
gets its oxygen from the mother across the placenta (organ joining the mother and baby during
pregnancy). The ductus arteriosus is the passageway that helps the distribution of oxygen from the
mother to the baby’s organs and allows blood flow to avoid the lungs.
In most babies, the ductus arteriosus closes within a few hours of birth. When the ductus arteriosus
stays open (patent) after birth, blood travels in the wrong direction between the aorta and pulmonary
artery. The abnormal blood flow patterns across the ductus may lead to heart failure, pulmonary (lung)
hypertension (high blood pressure) and an increased risk of bacterial infection of the heart and ductus
itself. The infection, or rupture of the ductus, may be life threatening.
Symptoms vary with the size of the ductus and the amount of blood that flows through it. If the ductus
is small, there may be no symptoms. When symptoms occur they include; rapid breathing, increased
work to breathe, getting tired quickly, poor growth, respiratory infection (e.g. cold).
What is the estimated number of patients affected by the condition?
At the time of designation patent ductus arteriosus affected approximately 2.13 in 10,000 people in the
European Union (EU)*. This is based on the information provided by the sponsor and knowledge of
the Committee for Orphan Medicinal Products (COMP). This is below the threshold for orphan
designation which is 5 in 10,000. This is equivalent to a total of around 80,000 people.
What treatments are available?
Current treatment of patent ductus arteriosus comprises two steps. The first is medicinal treatment with
an anti-inflammatory drug administered intravenously. The second step is surgical ligation
(connection) of the ductus, if the medicinal treatment has failed. One product with anti-inflammatory
activity was authorised for the condition in several Member States of the Community at the time of
submission of the application for orphan drug designation.
Satisfactory argumentation has been submitted by the sponsor to justify the assumption that ibuprofen
might be of potential significant benefit for the treatment of patent ductus arteriosus. The assumption
will have to be confirmed at the time of marketing authorisation. This will be necessary to maintain
the orphan status.
* Disclaimer: The number of patients affected by the condition is estimated and assessed for the purpose of the designation, for a European Community population of 377,000,000 (Eurostat 2001) and may differ from the true number of patients affected by the condition. 7 Westferry Circus, Canary Wharf, London, E14 4HB, UK Tel. (44-20) 74 18 84 00 Fax (44-20) 75 23 70 40 E-mail: orphandrugs@emea.europa.eu http://www.emea.europa.eu European Medicines Agency, 2009. Reproduction is authorised provided the source is acknowledged How is this medicinal product expected to act?
Ibuprofen is an anti-inflammatory drug which closes the ductus by inhibiting the production of
prostaglandin. Prostaglandins are a class of hormone-like (chemical messenger) lipids (fats) present in
tissues and bodily fluids. They may be involved in processes such as pain, inflammation and kidney
function and affect blood pressure and smooth muscle (muscle that performs automatic tasks such as
opening/closing blood vessels) activity.

What is the stage of development of this medicinal product?
The evaluation of the effects of ibuprofen in experimental models was ongoing.
At the time of submission of the application for orphan designation, no clinical trials in patients with
patent ductus arteriosus were initiated.
Ibuprofen for intravenous formulation was not marketed anywhere worldwide for patent ductus arteriosus, at the time of submission. Orphan designation of ibuprofen was granted in the United States in 1996 for patent ductus arteriosus. According to Regulation (EC) No 141/2000 of 16 December 1999, the Committee for Orphan Medicinal Products (COMP) adopted on 19 December 2000 a positive opinion recommending the grant of the above-mentioned designation. Update: Ibuprofen (Pedea) has been authorised in the EU since 29 July 2004 for treatment of a haemodynamically significant patent ductus arteriosus in preterm newborn infants less than 34 weeks of gestational age. For more information: www.emea.europa.eu/htms/human/epar/a.htm __________________________ 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; • and either the rarity of the condition (affecting not more than five in 10,000 people in the Community) or the 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 the quality, safety and efficacy is necessary before a product can be granted a marketing authorisation. For more information:
Sponsor’s contact details: Sponsor’s contact details: Orphan Europe Immeuble Le Wilson 70 Avenue du Général de Gaulle F-92800 Puteaux France Telephone: +33 1 47 73 64 58 Telefax: +33 1 49 00 18 00 E-mail: Patients’ association contact points: Pending Translations of the active ingredient and indication in all EU languages
Language Active
Ingredient
Indication
Traitement du canal artériel persistant Θεραπεία του Ανοικτού Αρτηριακού Πόρου Tratamento de ductus arteriosus persistente

Source: http://video.eurordis.org/summerschool/orphan_drug_cases/data/resources/ESS_FILES/Pedea%20PSO.pdf

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