美国孤儿药开发的政策、策略与实践

简述了罕见病及孤儿药的定义和研发意义,重点介绍了美国针对孤儿药开发的现有制度法规、激励政策及管理经验,并以实例 分析从研发、注册和上市等角度探讨了美国孤儿药开发的策略,旨在为从事孤儿药开发工作的人士提供参考。     

“首届中国孤儿药研发论坛”专家观点（续）

对 2015 年 4 月 25 日召开的“首届中国孤儿药研发论坛”与会专家对话内容进行归纳总结,旨在为从事罕见病诊断和孤儿药研发工作的人士提供信息参考。来自产、学、研领域的专家从研发、临床、审评、投资、媒体等角度探讨了中国孤儿药研发策略。     

“首届中国孤儿药研发论坛”专家观点

对2015 年4 月25 日召开的“首届中国孤儿药研发论坛”的专家报告内容进行归纳总结,旨在为从事罕见病诊断和孤儿药研发工 作的人士提供信息参考。报告内容涉及国内外孤儿药研发现状和前景、中国孤儿药政策和审评状况、罕见病诊断以及中国孤儿药研发的机 会等。     

日本制药企业加大对孤儿药的投入

制药企业纷纷表示,对孤儿药的投入不够。然而,在过去的几年里,出现了以罕见疾病治疗药作为研发重点的制药企业。日本政府也推出多项举措支持孤儿药尽快实用化。     

罕见病基因治疗与孤儿药

孤儿药因面向的罕见病患者群小、市场需求低、研发成本高、缺乏政策支持等,其发展面临困境。随着精准医疗概念的提出,基 因治疗因能够从根本出发,给患者提供 “一劳永逸”的治疗,备受关注。基因治疗以单基因罕见病的治疗作为极佳切入点,为孤儿药的 研发带来了新的希望。概述基因治疗针对的疾病对象、实施策略和属性以及基因药物的结构及基因治疗的载体,以血友病的基因治疗为 例回顾罕见病基因治疗的发展,并分析罕见病基因治疗药物研发现状。     

“孤儿药”激励机制亟待设立

在治疗罕见病的"孤儿药"的研发领域,一直活跃着许多新兴的中小型生物技术企业。而现在,随着越来越多的大型制药企业将研发重心转向孤儿药,这个领域呈现出群雄逐鹿的态势(见本期"产经"栏目)。对于我国的制药行业来说,这个领域也充满的着机会,因为在一定意义上来说,大家都处于同一起跑线上。但相比于发达国家日益健全的针对"孤儿药"研发的法规,我国在相关政策和立法上还处于起步阶段,如果不尽快推进相关法规和激励机制的设立,那必将制约中国     

各国孤儿药政策对比分析

据统计，医学上明确诊断的罕见病有5 000~8 000 种。虽然因患病人数少而得名罕见病，但考虑到疾病种类之多，罕见病仍是 各国不可忽视的公共卫生挑战。协助和激励医疗行业开发治疗罕见病的孤儿药，是各国政府一项重要的公共卫生政策。重点介绍了美国、 日本和欧盟的孤儿药立法，激励政策以及对病患、医药行业的积极影响。     

2013 年全球新药研发报告——第一部分:新药及生物制品（Ⅲ）

该年度报告涉及2013 年最新上市的56 种新药及生物制品,包括20 种新孤儿药和10 种全新药物,以及获得美国FDA“新突破药物”称号的前3 名药物。此外,该年度报告还讨论了30 种重要的延伸性新药（新适应证、新剂型和现有药物的新复方）,以及19 种年内首次获批但在该报告结束时尚未上市的新药。     

2013 年全球新药研发报告——第一部分:新药及生物制品（Ⅱ）

该年度报告涉及2013 年最新上市的56 种新药及生物制品,包括20 种新孤儿药和10 种全新药物,以及获得美国FDA“新突破药物”称号的前3 名药物。此外,该年度报告还讨论了30 种重要的延伸性新药（新适应证、新剂型和现有药物的新复方）,以及19 种年内首次获批但在该报告结束时尚未上市的新药。     

2013 年全球新药研发报告——第一部分:新药及生物制品（Ⅰ）

该年度报告涉及2013 年最新上市的56 种新药及生物制品,包括20 种新孤儿药和10 种全新药物,以及获得美国FDA“新突破药物”称号的前3 名药物。此外,该年度报告还讨论了30 种重要的延伸性新药（新适应证、新剂型和现有药物的新复方）,以及19 种年内首次获批但在该报告结束时尚未上市的新药。     

eRepo-ORP: Exploring the Opportunity Space to Combat Orphan Diseases with Existing Drugs

About 7000 rare, or orphan, diseases affect more than 350 million people worldwide. Although these conditions collectively pose significant health care problems, drug companies seldom develop drugs for orphan diseases due to extremely limited individual markets. Consequently, developing new treatments for often life-threatening orphan diseases is primarily contingent on financial incentives from governments, special research grants, and private philanthropy. Computer-aided drug repositioning is a cheaper and faster alternative to traditional drug discovery offering a promising venue for orphan drug research. Here, we present eRepo-ORP, a comprehensive resource constructed by a large-scale repositioning of existing drugs to orphan diseases with a collection of structural bioinformatics tools, including eThread, eFindSite, and eMatchSite. Specifically, a systematic exploration of 320,856 possible links between known drugs in DrugBank and orphan proteins obtained from Orphanet reveals as many as 18,145 candidates for repurposing. In order to illustrate how potential therapeutics for rare diseases can be identified with eRepo-ORP, we discuss the repositioning of a kinase inhibitor for Ras-associated autoimmune leukoproliferative disease. The eRepo-ORP data set is available through the Open Science Framework at https://osf.io/qdjup/.     

Access to Orphan Drugs: A Comprehensive Review of Legislations,Regulations and Policies in 35 Countries

ObjectiveTo review existing regulations and policies utilised by countries to enable patient access to orphan drugs.MethodsA review of the literature (1998 to 2014) was performed to identify relevant, peer-reviewed articles. Using content analysis, we synthesised regulations and policies for access to orphan drugs by type and by country.ResultsFifty seven articles and 35 countries were included in this review. Six broad categories of regulation and policy instruments were identified: national orphan drug policies, orphan drug designation, marketing authorization, incentives, marketing exclusivity, and pricing and reimbursement. The availability of orphan drugs depends on individual country’s legislation and regulations including national orphan drug policies, orphan drug designation, marketing authorization, marketing exclusivity and incentives such as tax credits to ensure research, development and marketing. The majority of countries (27/35) had in place orphan drug legislation. Access to orphan drugs depends on individual country’s pricing and reimbursement policies, which varied widely between countries. High prices and insufficient evidence often limit orphan drugs from meeting the traditional health technology assessment criteria, especially cost-effectiveness, which may influence access.ConclusionsOverall many countries have implemented a combination of legislations, regulations and policies for orphan drugs in the last two decades. While these may enable the availability and access to orphan drugs, there are critical differences between countries in terms of range and types of legislations, regulations and policies implemented. Importantly, China and India, two of the largest countries by population size, both lack national legislation for orphan medicines and rare diseases, which could have substantial negative impacts on their patient populations with rare diseases.     

Drug repositioning for orphan diseases

The need and opportunity to discover therapeutics for rare or orphan diseases are enormous. Due to limited prevalence and/or commercial potential, of the approximately 6000 orphan diseases (defined by the FDA Orphan Drug Act as <200 000 US prevalence), only a small fraction (5%) is of interest to the biopharmaceutical industry. The fact that drug development is complicated, time-consuming and expensive with extremely low success rates only adds to the low rate of therapeutics available for orphan diseases. An alternative and efficient strategy to boost the discovery of orphan disease therapeutics is to find connections between an existing drug product and orphan disease. Drug Repositioning or Drug Repurposing--finding a new indication for a drug--is one way to maximize the potential of a drug. The advantages of this approach are manifold, but rational drug repositioning for orphan diseases is not trivial and poses several formidable challenges--pharmacologically and computationally. Most of the repositioned drugs currently in the market are the result of serendipity. One reason the connection between drug candidates and their potential new applications are not identified in an earlier or more systematic fashion is that the underlying mechanism 'connecting' them is either very intricate and unknown or indirect or dispersed and buried in an ever-increasing sea of information, much of which is emerging only recently and therefore is not well organized. In this study, we will review some of these issues and the current methodologies adopted or proposed to overcome them and translate chemical and biological discoveries into safe and effective orphan disease therapeutics.     

Orphan nuclear receptor RORγ confers doxorubicin resistance in prostate cancer

Prostate cancer (PCa) is a malignant tumor with an extremely high prevalence. Doxorubicin is the first‐line clinical treatment for castration‐resistant PCa. Clinically, relapse is almost inevitable due to the cancer cells' increasing resistance to doxorubicin. Our previous studies have revealed that retinoic acid‐related orphan nuclear receptor γ (RORγ) is a key protein for cancer progression and a promising target for PCa therapy. Though, RORγ's role and mechanism in doxorubicin‐resistant PCa remain unclear. To study the mechanism of doxorubicin resistance, we generated a doxorubicin‐resistant PCa cell line C4‐2B (C4‐2B DoxR) in this study, by culturing cells in an increasing doxorubicin concentration. Here, we show that RORγ expression was upregulated in C4‐2B DoxR cells compared with that in normal C4‐2B cells. The RORγ‐stably‐overexpressing PCa cell line constructed by lentiviral transfection showed an obvious improvement in doxorubicin resistance and a trend toward castration resistance. Furthermore, RORγ‐specific small molecule inhibitors XY018, GSK805, and SR2211 can significantly inhibit the proliferation of C4‐2B DoxR cells and promote their apoptosis. Collectively, these results have demonstrated the correlation between the upregulation of RORγ and the development of PCa's doxorubicin resistance, thus providing new ideas for solving the problem of chemotherapy drug resistance in PCa.     

Finding Sequences for over 270 Orphan Enzymes

Despite advances in sequencing technology, there are still significant numbers of well-characterized enzymatic activities for which there are no known associated sequences. These ‘orphan enzymes’ represent glaring holes in our biological understanding, and it is a top priority to reunite them with their coding sequences. Here we report a methodology for resolving orphan enzymes through a combination of database search and literature review. Using this method we were able to reconnect over 270 orphan enzymes with their corresponding sequence. This success points toward how we can systematically eliminate the remaining orphan enzymes and prevent the introduction of future orphan enzymes.