190507 VIG BASISTRAMIEN MEDICIJNMONITOR...Advanced Therapy Medicinal Products. This is a new...

OPPORTUNITIES AND BOTTLENECKS FOR A NEW GENERATION OF MEDICINES

CELL AND GENE THERAPY

54

CELL AND GENE THERAPY 2019 CELL AND GENE THERAPY 2019

INHOUD

Foreword 5Summary 7‘I can see again thanks to stem cell transplantation!’ 9Patient as supplier and recipient 13Advanced therapies: ATMPs 15Cells and genes 15‘Now my daughter has the opportunity to go to school’ 17Rapid development 20Authorised procedures in europe 21Opportunities for new therapies 23Success is not guaranteed 24Bottlenecks 26Conclusion 30

FOREWORDYou are an artist, repairing a fresco. Lime accidentally falls into one eye. Slowly but surely, the light dims in the affected eye. It is easy to imagine the despair. What will it mean for your work, for travel, for your quality of life? It happened to Anne-Mieke. A stem cell transplant provided the solution. Her eyesight has improved and she can lead a normal life.

Thankfully, this kind of treatment is no longer science fiction. The European Medicines Agency EMA has already approved fourteen cell and gene therapies. For example CAR T cells. A treatment in which the patient’s immune cells are processed so that they can defeat cancer. Such therapies are now available for blood conditions, blindness and joint complaints.

Another example. Little eight month old Louisa has a rare form of leukaemia. She is being treated with chemotherapy, but the side-effects are severe. The disease is briefly defeated, but comes back again. Louisa is given an experimental treatment with CAR T cells, which is successful. Louisa is now almost four years old. She has recovered and is going to school.

The stories of Anne-Mieke and Louisa can be found in this brochure. They illustrate the exceptional possibilities offered by cell and gene therapy. However, these treatments are – unfortunately – only rarely used in our country.

Why is that? Current legislation is not designed to deal with them. There is a great deal of discussion about the relationship between costs and benefits. Practical adjustments are also required, for example in manufacturing, transportation and training. Of course, there are also ethical questions. What interventions in the human body do we consider justified?

It is high time to consider the matter. There are already over one thousand cell and gene therapies under development, so the future is bright. The revolutionary aspect for many of these treatments is that they truly can provide a cure, or at least improve quality of life significantly and enduringly. They are game changers.

In order to achieve breakthroughs, the government, doctors, insurers, patients and pharmaceutical companies must work together. Only then can we quickly and responsibly bring the innovations of the twenty first century to the patient. Let’s see how far we can go together! That’s the challenge this brochure wants to promote.

Gerard Schouw,Director, Dutch Association Innovative Medicines

7

CELL AND GENE THERAPY 2019

SUMMARYHundreds of clinical trials are currently investigating cell and gene therapies. Also referred to as: Advanced Therapy Medicinal Products. This is a new generation of medical therapies based on cells, genes, tissues or a combination thereof. For example, new cancer therapies have recently become available that use the patient’s own immune cells as a weapon against tumours.

The patient is often both starting point and destination in these therapies: their own cells are transported to a special facility and processed in a number of ways. The resulting medical product – for example immune cells, stem cells or a cornea – is then returned to the hospital. It is given to the patient there. This is a medical and logistical operation that demands a great deal from all involved.

Cell and gene therapies are often designed as a cure or aim to achieve lasting improvements in symptoms or quality of life in a wide range of conditions, including cancer, eye injury, Blood clotting diseases or immune deficiencies. The term ATMP encompasses a number of different technologies, such as gene therapy products, somatic cell therapy products and tissue therapy products.

Since 2009, fourteen cell and gene therapies have received marketing authorisation in Europe. These market launches have been a mixed success. They illustrate the new possibilities offered by these therapies, but also highlight a number of the bottlenecks. For example slow uptake in medical practice, and long debates about costs and reimbursement.

Cell and gene therapies are so innovative and different from traditional medicines that they run into the limitations of existing routines and regulations. This brochure hopes to disseminate knowledge about these therapies and the specific requirements for their production and application.

Raising awareness about cell and gene therapies among all involved parties (researchers, policy makers, companies, doctors and insurers) is a requirement for ensuring these new applications successfully reach the patient in the coming years.

6


9


‘I CAN SEE AGAIN THANKS TO STEM CELL TRANSPLANTATION!’

While restoring a fresco, some lime falls into artist Anne-Mieke’s eye. At that moment in time, she isn’t worried – but one year later, she is completely blind in one eye. A stem cell transplant restored her sight, and she is back at work full-time.

‘I was on a scaffold preparing a ceiling fresco, when a drop of lime slid past my safety glasses. It hurt a lot, and I was focused on making the pain stop. After an hour of rinsing under running water, a friend took me to the emergency room. That’s when the alarm bells started ringing. I had suffered severe eye trauma; lime continues to burn for a long time. The damage was going deeper and deeper. In a year, I was blind.’

Two eyes‘At the beginning I still had a little light in the eye, but eventually it all goes away. No light, no darkness – nothing. It’s a very strange sensation. Your body also needs to adjust. It literally made me ill. I was often nauseated due to balance problems. Your brain sends out signals that aren’t quite right anymore.’

‘Fortunately, I have two eyes, and I was determined to continue living my life. I had just completed my training in Old Painting Techniques, so I was highly motivated. But I was also afraid that my one-sided blindness would affect my work.’

No more treatment optionsAfter an intensive period during which Anne-Mieke visited the hospital every day, she was told that treatment is only possible once the eye has fully rested. ‘That took a year! However, when I saw my ophthalmologist again, I was told the damage was so severe that there were no more treatment options. I had expected there to be some options, for example a cornea transplant. I was ready for the challenge of tackling that eye.’ Anne-Mieke’s doctor then told her about a clinical trial for treatment of eye burns. She qualified for participation.

Stem cellsAfter an extensive series of tests, Anne-Mieke is included in the clinical trial: a stem cell treatment. ‘This did require harvesting stem cells from my healthy eye. That was a difficult decision. There are risks associated with surgery. If something goes wrong, you lose sight in both eyes. I must have made a list of the risks and benefits a thousand times. But ultimately I decided to grasp the opportunity.’

8


Anne-Mieke at work

1110


MiracleSome stem cells are collected from Anne-Mieke’s eye, and over the course of six months, they grew into a membrane in a lab. In December 2017, the surgery in which the membrane is replaced was performed. ‘Initially I wore an eye patch, but finally the day arrived that it could be removed. I gradually regained more and more of my sight. First you see a wall. Then you see the wall is made of stones. It was a miracle!’

Back to work‘I’m still in follow-up. I will remain involved in this study for the rest of my life. I believe this is important for other patients who have suffered chemical or physical burns to their eyes.’

‘My eyesight is not 100% of what it was – the damage was too great – but I can read large letters and my depth perception is back.’

‘Actually, I don’t really think about it anymore. People around me don’t notice either. That feels great. I’m back at work full-time, I have exhibitions and I travel a lot. I enjoy that even more now. What I’ll never do again is work on a ceiling fresco. I’ve learned my lesson.’

11


11

Combating diseases with the

patient’s own cells is the ultimate

example of personalised medicine

1312


1

32

84

56

7

PATIENT AS SUPPLIER AND RECIPIENTOur immune system does not only protect us against pathogens such as viruses and bacteria. Parts of the human immune system can also recognise and clean up cancer cells. This type of immune reaction can often clear tumour growth in an early stage. Unfortunately, there are also tumour cells that our immune system cannot tackle.

That the body’s own immune system can fight off cancer was discovered in the late 1980s, knowledge that inspired new studies. In brief, the idea was to remove immune cells (T-cells) from the patient’s tumour and multiply them in the lab, and then return them a few days later. In a small number of cancer patients, this treatment resulted in the shrinking of metastasised tumours. In the subsequent decades, the technology was developed further into CAR T-cell immunotherapy.

This therapy is built around the patient’s immune cells (figure 1). The first step is the isolation of T cells from human blood, using a blood cell separator. The cells are transported to a special processing facility. An extra piece of DNA is built into the cells, allowing them to better recognise and clean up tumours. Subsequently, the modified cells are given some time to multiply, until there are millions of them. The live cells are transported back to the hospital and given back to the patient via an infusion.

Combatting diseases with the patient’s own cells is the ultimate example of personalised medicine: a single person is the supplier of the starting material for the manufacturing process and the recipient for the final product. This process is significantly different from common manufacturing and logistics processes for pharmaceutical products, where a medicine is made for thousands of patients.

Figure 1 The various steps of CAR T cell therapy: (1) White blood cells are taken from the patient. T cells are isolated from these white blood cells. (2) The T cells are transported (3) to a facility where they are genetically modified. They are given an additional piece of DNA coded for CAR (chimeric antigen receptor), which will later be able to detect cancer cells (4). Then millions of T cells are cultivated at the

facility (5) until they are sufficient in number for a treatment. The cells are then transported to the hospital (6), where they are administered to the patient by infusion (7). Thanks to the integrated CAR gene, the newly formed CAR T cells are able to detect certain proteins on the exterior of the cancer cell (antigens). The CAR T cells then bind to the cancer cell and kill it (8).

1514


ADVANCED THERAPIES: ATMPSIn the autumn of 2018, two CAR T-cell therapies were authorised in Europe for the treatment of specific blood tumours that do not respond to other medicines. These CAR Ts are classified as ATMP: Advanced Therapy Medicinal Products, a new generation of medical therapies based on cells, genes, tissues or a combination thereof. The patient’s own cells or tissues are often the starting point. ATMPs are interventions at the gene, cell or tissue level that aim to provide a permanent solution to a wide range of conditions, such as cancer, eye conditions, blood coagulation disorders or joint complaints.

CELLS AND GENESA characteristic of cell and gene therapy is that they can add (for example missing) genetic properties to cells that have a direct effect in the patient’s body. They can add additional properties, or block existing properties.

In gene therapy, the patient’s genetic code is modified. This allows errors in the DNA to be repaired (figure 2). Errors in the DNA can lead to incorrect or blocked protein creation in a cell. If this protein plays an important role, lack thereof can lead to severe, sometimes even lethal conditions. The technology can also be used to give cells a boost. This is used to treat cancer, where gene therapy is used to strengthen the patient’s immune system.

Cell therapy is the administration of viable, often purified cells in a patient’s body in order to grow, replace or repair damaged tissue. These cells may be obtained from the patient, or from a donor. Many cell therapies are being developed with the use of stem cells. These are cells that can divide and specialise into specific cell types.

Tissue technology attempts to repair, maintain, improve or replace damaged organs and tissues.

Figure 2 Gene therapy can make a cell work normally again.

THROUGH GENE THERAPY PATIENTS RECEIVE A GOOD VERSION OF

A DEFECTIVE GENE

A cell has a defective gene

A properly working

version of the gene

is introduced

The cell functionsnormally again

1716


16

‘NOW MY DAUGHTER HAS THE OPPORTUNITY TO GO TO SCHOOL’

In the summer of 2016, Norman and his family return to the Netherlands after a long stay abroad. Their youngest daughter Louisa, eight months old, suddenly becomes very sick. First they think it’s a flu, but doctors in the Sophia Children’s Hospital quickly make a different diagnosis: Louisa has acute lymphatic leukaemia (ALL).

Norman: ‘To make matters even worse, Louisa had a very rare form of the disease. Children under the age of one year have a higher chance of abnormalities in the so-called MLL gene. This makes treatment more difficult, and significantly reduces the odds of a cure.’

Moving train‘It feels like you’ve jumped onto a moving train. Everything is defined in protocols. Louisa qualified for a two-year treatment program with a fairly intensive chemotherapy regimen; she needed to stay in the hospital for the first two months of that. After the diagnosis, she received her first dose of chemotherapy. Only a few months later did the realisation strike: this is a long lasting disease, it’s not going away easily. The process is gruelling.’

Side-effects‘In general, things went fairly well. But there were complications. She responded very poorly to some cytostatic medicines; others she did better with. But she also suffered indirectly due to the chemo, in the form of serious infections. Here immune system was minimal, so her body could not deal with bacterial and viral infections properly. There was a phase during which she was quarantined fully.’

Surviving‘Your life comes to a standstill. The only thing that matters is caring for your child. But we also had two other daughters, three and five years old. They had also just returned from England, and were building new lives here. We made the conscious decision to make sure their lives were as normal as possible – school, swimming lessons, visiting friends. During the first period, my wife spent every day in the hospital, and I was there after work whenever I could be.’

16


The girl in the photograph is not Louisa

1918


Recurrence‘In September, Louisa was put on less intensive treatment. The signs were hopeful; no more leukemia cells could be detected. But in December, we received the news we were all dreading. A bone marrow and lumbar puncture showed that the leukemia was back. The fact it recurred during treatment was considered a bad omen. Unfortunately, it also showed that there were leukemia cells in the brain fluid.’

Tailored treatment‘You’re suddenly thrust into uncertainty, into a domain without protocols or manuals. The only option we had in the Netherlands was a bone marrow transplant. The question remained whether the treatment would be effective for Louisa, since she was so severely weakened and due to the leukaemia cells in the brain fluid. The chances of success in her case were also very poor. We talked to doctors about this, but we did not have a good feeling.’

Immunotherapy‘Our doctor then pointed us towards an experimental treatment at the Children’s Hospital of Philadelphia: CAR T therapy. Children with ALL receive treatment with CAR T-cells. This is a one-time treatment, in which specific immune cells belonging to the patient – the T-cells – are collected and modified genetically in a laboratory so that they can recognize and destroy CD19-positive leukaemia cells. We were lucky – Louisa was given a spot in an ongoing clinical trial. Things moved very quickly, and before we knew it we were in an airplane heading for an intake meeting.

Philadelphia‘The treating team decided that Louisa’s T-cells could be collected in the Netherlands, in the Wilhelmina Children’s Hospital in Utrecht. The cells were then shipped to the USA. The lab at the Children’s Hospital of Philadelphia then worked to modify her T-cells for six to eight weeks. Finally, in May 2018, the big moment arrived – the administration of the modified T-cells. The whole family temporarily moved to Philadelphia for her treatment. Fortunately, her condition had not worsened significantly in the meanwhile.’

Suspense‘Of course, the moment her processed T-cells were returned is tense, but the treatment itself is no big deal. For Louisa, it consisted of a single injection. Fortunately for her, other than a bit of fever, there were no side-effects. I’m still amazed at how easily it went. If you see what chemo-therapy does to your body, and if there is an alternative that appears to work for my daughter, that’s great news. We also realised that Louisa was extremely lucky; the treatment does not work well for half of patients.’

Going to school‘We have recently returned from a follow-up visit in Philadelphia. Louisa has had a clean bill of health for a year and three months now. She has a full head of hair, is growing quickly and enjoying life to the fullest. In March 2020 she will start kindergarten. That’s something we never dared to? dream. CAR T therapy literally opened up a new world for her. Before, she led a very sheltered life due to the risk of infections. It’s the first time she can visit the supermarket or a restaurant now. Her mental and physical development is moving in leaps and bounds.’

Future‘Only now are we really processing everything that has happened. We are trying to start living a normal life as a family again. But the uncertainty remains. I’m afraid that’s just part of life as a parent of a child with cancer. You can never be sure it’s completely gone. But every quarter we receive good news, means a longer ‘clean’ bill of health. We are thankful every day for the opportunity we were given. We never dared to? dream she would respond so well to treatment.’


Per mid-2019, fourteen cell and

gene therapies have received

marketing authorisation in Europe

2120


Figure 3 Over 1,000 clinical trials with cell and gene therapies are being conducted worldwide.

618

60

67

4438 36 36 35

2115 14

10

3 3 2 20

10

20

30

40

50

60

70

80

90

100+

67

Age

-rel

ated

dis

ease

s

Ear d

isor

ders

Lym

phat

ic s

yste

mdi

sord

ers

Surg

ery

Resp

irato

ry d

isor

ders

Kid

ney

and

repr

oduc

tived

isor

ders

Gas

troi

ntes

tinal

dise

ases

Infe

ctio

us d

isea

ses

Hae

mat

olog

y

Skin

dis

orde

rs

Imm

unol

ogy

and

infla

mm

ator

y di

sord

ers

Eye

diso

rder

s

Met

abol

ic d

isor

ders

Mus

cula

r dis

orde

rs

Ner

vous

sys

tem

Car

diov

ascu

lar

dise

ases

Canc

er

NUMBER OF TRIALS (Q1 2019)

Source: Alliance for Regenerative Medicine, 2019

RAPID DEVELOPMENTOver 900 companies worldwide are working on new cell or gene therapies, over 200 of which are located in Europe. Together, they are running over one thousand clinical trials. In mid-2019, 93 of these studies were in the final phase prior to marketing authorisation. The main goal is finding applications for various forms of cancer, cardiovascular diseases and nervous system disorders (figure 3).

AUTHORISED PROCEDURES IN EUROPEThrough mid-2019, fourteen cell and gene therapies have received marketing authorisation in Europe for a variety of conditions. These include a gene therapy product that is injected into the eye, intended for patients that gradually go blind due to an inherited condition. The therapy includes a virus-like particle containing a gene that can add missing properties to cells. After injection in the back of the eye, the crippled virus penetrates the light-sensitive cells and helps them work better. Eyesight is not completely restored, but patients can distinguish objects in their environment more easily and their mobility is improved.

A second example of an authorised new therapy is a tissue therapy product for repair to damaged knee cartilage. This development is particularly useful for younger people who have had an accident or an athletic injury. Treatment begins with an arthroscopy, during which a small cartilage sample is collected and then cultured in a laboratory. Next, a mixture of balls of cartilage cells are injected into the damaged area during a second arthroscopy. The cells grow in place and over the next months contribute to the repair of the cartilage.

Cell and gene therapy often results

in a long-term improvement in

quality of life, and sometimes even

cures diseases

2322


A similar technique is used to treat patients with a damaged cornea, the transparent layer on the outside of the eye (figure 4). Normally, stem cells repair the cornea continuously, but if the damage is too great – for example due to burns or accidents with caustic substances – they can no longer manage. This affects eyesight. During treatment, a square millimetre of cornea is removed from the patient’s eye and grown in the laboratory. The cells are then placed on a transparent protein membrane and sent back to the hospital. Once returned to the eye, the cells continue to multiply and grow into a new cornea.

As of a few years ago, children who are highly susceptible to simple infections due to a deficient immune system (ADA-SCID) can be treated with a gene therapy product. Stem cells are collected from a patient’s bone marrow and modified genetically in the laboratory. This corrects the errors present in the body’s own bone marrow stem cells. Once they are placed back, patients develop a normally functioning immune system and are less prone to severe infections.

Limbal stem cells are implanted in the diseased cornea.

Limbal stem cellsare grown in the laboratory.

Limbus(border around the iris) Iris

(coloured part of the eye)

Cornea

Figure 4 Stem cell treatment for eyes damaged by fire or chemicals. The cornea of these patients is damaged or sick.

OPPORTUNITIES FOR NEW THERAPIESThe recent new applications will be joined by a growing arsenal of advanced therapies in the coming years. There is a great deal of focused scientific interest, which is only expected to grow further. A review performed in early 2019 revealed over one thousand studies involving cell and gene therapy, most of which were in early stages of development, with over ninety studies in the final phases.

New cancer therapies are at the top of the list, with over six hundred clinical trials, followed by cardiovascular disease and nervous system conditions. Many of the conditions are rare, but research is also being performed into cell and gene therapies to cure HIV, or common hereditary conditions such as the blood disease thalassemia.

Most of these applications are being developed for life-threatening and disabling conditions, for which there is currently no good treatment, or which require regular hospital admissions. Cell and gene therapy often cures diseases, or at least results in a long-term improvement in quality of life. These properties are also reflected by the proportion of these new therapies in the PRIME list of the European Medicines Agency (EMA). PRIMA is an EMA programme designed to stimulate the development of innovative medicines. In mid-2019, the list included eighteen cell and gene therapies, including multiple products for hereditary blood conditions (haemophilia) and novel treatments for cancer.

With PRIME, the EMA wants to improve the chances for marketing authorisation for these new medicines, by consulting with the developers and cell and gene therapies at an early stage. This gives the EMA the opportunity to advise on the design of clinical trials, to ensure the correct data is provided and thus improve the chances of marketing authorisation. Clinical trial data also play a crucial role after marketing in discussions of added value and the cost of a new therapy.

24


25


25

SUCCESS IS NOT GUARANTEEDWhile medical prospects of this new technology are often promising, introducing these therapies into everyday care for patients has proven difficult. There are various reasons for this, varying from manufacturing difficulties for the medicine, to organisational hurdles within the hospital and long debates about coverage for these therapies by insurance. This has even led to the withdrawal of marketing authorisation for four cell and gene therapies. These medicines are no longer available to patients.

This illustrates that innovative therapies do not necessarily become success stories following successful marketing authorisation. Acceptance and inclusion in daily practice, gradual growth in market share and turnover, and societal acceptance are not self-evident.

This is caused in part by the radical innovation represented by cell and gene therapies, which deviates strongly from traditional medicines. It has proved difficult to integrate these new applications within the

traditional pharmaceutical frameworks which have been developed over the course of decades. There is a major difference between formulating a medicine based on an active substance, or transforming a patient’s cells into a medicine. There is little experience with previous authorisations.

The challenges not only lie in cell and gene therapies themselves, but also in the processes surrounding them, involving cells, viruses or a combination thereof. The starting point for these medicines are cells that are transported for a long stay in a laboratory or factory, and then finally returned to the hospital. Activities are performed at different locations, and logistics require good planning, training, checks and communication. Designing and certifying such a facility with strict requirements (in accordance with Good Manufacturing Practice, GMP procedures) and all processes inside and outside the laboratory is complex.

One idea is to spread the costs of

cell and gene therapy over several

years, based on the effect of the

treatment for the patient

2726


26

BOTTLENECKS Cell and gene therapies demand a different perspective on procedures from all involved – from diagnosis to treatment. With these new medicines, drug developers and academic centres are wandering off the beaten track. This means they run into new obstacles.

Valuation and reimbursementCurrently, there are no cell and gene therapies available on the market that have a long track record based on which easy lessons can be learned about factors for success or failure. Discussions about costs and benefits and the level of reimbursement by insurance companies are a recurrent topic. This is due to the relatively high cost of many of these therapies, which is paid at a time when the benefits are still unclear, combined with the long development process, complex manufacturing and logistics, and often relative limited markets.

Clinical data for these innovative medicines currently fuel additional debate. Market access is often based on small, innovative trials involving only a few dozen patients. This means there is uncertainty about the medical and economic impact of routine clinical use of cell and gene therapy. The demand for more clinical data may prolong the debate surrounding reimbursement.

Finally, there is a current lack of evidence regarding the long-term efficacy of these novel technologies. The therapy is often intended as a cure, but it remains uncertain whether the effect will remain in fifteen years or longer. Insurers and companies are considering creating new regulations for payments. The idea is to spread the costs of such medicine over several years, based on the effect of the treatment for the patient.

Manufacturing, logistics and legislationCell and gene therapies are significantly different from traditional medicines based on small chemical substances (such as statins or pain medication) and proteins (such as antibodies and enzymes). Traditional pharmaceutical products are often manufactured at a central location at a large scale and prescribed to groups of patients worldwide. They often have a long shelf-life and are easily transported.

In contrast, medication based on patient cell materials in particular are products of which a single batch is made per person, which can only be used for a few days. This requires short lines of communication between hospitals and manufacturing facilities. This manufacturing site must comply with the strict requirements of Good Manufacturing Practice (GMP). Transportation to a central manufacturing facility across national borders places even greater demands on logistics, refrigeration, customs forms and labelling. Therefore, transporting the patient to a central treatment facility in order to avoid complex logistics is often considered.

The development, design and certification of a GMP facility for the manufacture of cell and gene therapies is a long, specialised process. Once the facility is up and running, operating a GMP facility is a significant cost item, as many procedures are performed manually. Additionally, GMP procedures require a range of unique checks and quality controls. Contamination and misidentification are particularly important to rule out for therapies that involve the patient’s own cells. Per item production and delivery of such medicines has a significant impact on the cost of therapy.

Finally, many of these new medicines are covered by regulations on working with genetically modified organisms (GMOs). An immune cell with an extra piece of DNA is seen as a GMO. This also applies to a gene therapy product with a virus-like particle. It means the hospital and the manufacturing facility must have a special permit before patients can receive such treatments. In the Netherlands in 2019, it often takes a year for such permits to be issued, while this process usually takes a few months in other developed countries. This is due to the strict Dutch interpretation of the European legislation.

Prolonged debates about

reimbursement, but also

requirements for additional clinical

trials slow implementation in

medical practice

28


29


29

Long-term and expensive researchIn general, the development of new medicines is a long-term, expensive endeavour. Cell and gene therapies are no exception. Additionally, some of these types of medicines are being developed by academic centres and smaller companies, with less experience and operational possibilities than larger companies when it comes to meeting the requirements for marketing authorisation. This frequently means that the final phase of clinical research and dossier building for marketing authorisation is too great a challenge. This slows development significantly.

If marketing authorisation is successfully obtained for cell and gene therapies, it often remains unclear whether the product will succeed when competing with other, existing treatments and other medical innovations. The prolonged debates surrounding reimbursement or requirements for further clinical research may slow down the uptake of these new technologies in medical practice. As a result, poor

turnover may strain operations so far that certain therapies may be withdrawn from the market. This places significant demands on the endurance of such companies.

30


Different from traditional medicines:

Medical potential. Cell and gene therapies treat the underlying genetic cause of medical conditions. This means they can have a long-term, positive effect on patient health, and in some cases even provide a cure.

Single treatment. Cell and gene therapies are often only administered once or a few times within a short period of time. this is in contrast with many medicines for chronic conditions which often need to be taken daily, for the rest of the person’s life.

High costs in advance. Because the therapy is administered once, all treatment costs occur at the beginning, at a point in time when the long-term effects of treatment are still unclear.

Complex manufacturing. Cell and gene therapies are manufactured via complex processes. Some cell therapies use the patient’s own cells. This means the treatment is unique for each patient, requiring its own manufacturing process. Specialised centres

and highly trained staff are required to ensure this manufacturing process is performed properly. Because live cells are often used, manufacturing is susceptible to disruptions and errors.

Storage. Some cell and gene therapies contain live cells that have specific storage and transportation requirements. The limited time that cells can survive outside the body must also be taken into account.

Specific rules for marketing authorisation and pharmacovigilance. The EMA has defined a specific set of regulations and legislation for the marketing authorisation of cell and gene therapies, and for post-marketing pharmacovigilance. Among other reasons, this is because many are composed of biological materials. In some cases, this material is modified genetically. This means the therapy is classified as ‘genetically modified’. Pharmacovigilance rules taken into account the specific risks of cell and gene therapies.

PublisherAssociation of Innovative Medicines (Vereniging Innovatieve Geneesmiddelen)

Final editingPeter Bertens, Anton van Tuyl

EditingDesiree Haneveld, Arno van ’t Hoog, Elise Kalkhoven,Carolien Terlien, Anton van Tuyl

Layoutaz grafisch serviceburo bv, www.az-gsb.nl

DesignStudioDam, Amsterdam

PhotographyPeter Boer

PrintingWilco, Amersfoort

All rights reserved. No part of this publication may bereproduced, saved in an automated data file or published, in any form whatsoever, either electronically, by means of photocopy, recording or in any other manner without the prior permission of the publisher.

This publication was compiled with the greatest possible care. This publication was verified for accuracy and is current at the time of publishing. However, the text, as well as the figures included in the publication, are of a time-specific nature. The publisher assumes no liability for any inaccuracies in this publication.

© 2019Association of Innovative Medicines (Vereniging Innovatieve Geneesmiddelen)

CONCLUSIONCell and gene therapies are at the forefront of a series of medical innovations that provide new opportunities for the treatment of severe, life-threatening conditions. In some cases, a single treatment can lead to a cure. However, due to its innovative nature, this new category of medicines is being faced with the limitations of existing legislation and regulations, and of daily practices in healthcare. In short, this technology is not business as usual.

Raising awareness about the specific requirements for the development, manufacture and application of cell and gene therapies among all involved parties (researchers, policy makers, companies, doctors and insurers) is a requirement for ensuring these new applications reach the patient more rapidly in the coming years.

https://www.vereniginginnovatievegeneesmiddelen.nl/homepage

http://www.az-gsb.nl

32


190507 VIG BASISTRAMIEN MEDICIJNMONITOR...Advanced Therapy Medicinal Products. This is a new...

Documents

Transcript of 190507 VIG BASISTRAMIEN MEDICIJNMONITOR...Advanced Therapy Medicinal Products. This is a new...