title: Pressure for drug development in lysosomal storage disorders – a quantitative analysis thirty years beyond the US orphan drug act
creator: Mechler, Konstantin
creator: Mountford, William K.
creator: Hoffmann, Georg Friedrich
creator: Ries, Markus
subject: ddc-610
subject: 610 Medical sciences Medicine
description: Background: Lysosomal storage disorders are a heterogeneous group of approximately 50 monogenically inherited orphan conditions. A defect leads to the storage of complex molecules in the lysosome, and patients develop a complex multisystemic phenotype of high morbidity often associated with premature death. More than 30 years ago the Orphan Drug Act of 1983 passed the United States legislation intended to facilitate the development of drugs for rare disorders. We directed our efforts in assessing which lysosomal diseases had drug development pressure and what distinguished those with successful development and approvals from diseases not treated or without orphan drug designation.   Methods: Analysis of the FDA database for orphan drug designations through descriptive and comparative statistics.   Results: Between 1983 and 2013, fourteen drugs for seven conditions received FDA approval. Overall, orphan drug status was designated 70 times for 20 conditions. Approved therapies were enzyme replacement therapies (N = 10), substrate reduction therapies (N = 1), small molecules facilitating lysosomal substrate transportation (N = 3). FDA approval was significantly associated with a disease prevalence higher than 0.5/100,000 (p = 0.00742) and clinical development programs that did not require a primary neurological endpoint (p = 0.00059). Orphan drug status was designated for enzymes, modified enzymes, fusion proteins, chemical chaperones, small molecules leading to substrate reduction, or facilitating subcellular substrate transport, stem cells as well as gene therapies.   Conclusions: Drug development focused on more common diseases. Primarily neurological diseases were neglected. Small clinical trials with either somatic or biomarker endpoints were successful. Enzyme replacement therapy was the most successful technology. Four factors played a key role in successful orphan drug development or orphan drug designations: 1) prevalence of disease 2) endpoints 3) regulatory precedent, and 4) technology platform. Successful development seeded further innovation.  
publisher: BioMed Central
date: 2015
type: Article
type: info:eu-repo/semantics/article
type: NonPeerReviewed
format: application/pdf
identifier: https://archiv.ub.uni-heidelberg.de/volltextserverhttps://archiv.ub.uni-heidelberg.de/volltextserver/19407/1/13023_2015_Article_262.pdf
identifier: DOI:
identifier: urn:nbn:de:bsz:16-heidok-194078
identifier:   Mechler, Konstantin ; Mountford, William K. ; Hoffmann, Georg Friedrich ; Ries, Markus  (2015) Pressure for drug development in lysosomal storage disorders – a quantitative analysis thirty years beyond the US orphan drug act.  Orphanet Journal of Rare Diseases, 10 (46).  pp. 1-9.  ISSN 1750-1172     
relation: https://archiv.ub.uni-heidelberg.de/volltextserver/19407/
rights: info:eu-repo/semantics/openAccess
rights: Please see front page of the work (Sorry, Dublin Core plugin does not recognise license id)
language: eng