The Orphan Drug Development Guidebook is a patient focused guidebook that describes the available tools, incentives, resources and practices specific for developing traditional and innovative drugs/therapies for rare disease indications and how to best use them. It can be used by academic, non-profit organizations, small and larger (innovative) biotechs and patient-driven drug developers. The Guidebook currently has two chapters: the chapter dedicated to orphan drug development (ODDG) focused on small molecules or innovative therapies, and a chapter dedicated to drug repurposing (DRG).
More information can also be found in the papers published on the Orphan Drug Development Guidebook, the Drug Repurposing Guidebook and START checklist.
Basic case of development of a traditional, well-understood pharmaceutical (such as a small molecule or a protein) targeting a 'sufficiently well understood' rare disease to be registered in EU, US and Japan
Case of development of a highly innovative technology (i.e. advanced therapy medicinal products) targeting a 'sufficiently well understood' rare disease to be registered in EU, US and Japan
Case of development of a traditional, well-understood pharmaceutical (such as a small molecule or a protein) targeting a 'less understood' rare disease [i.e., extremely rare, extremely low prevalence, neglected (i.e., complete unmet medical need), scattered diseases knowledge, and no recognized endpoints or biomarkers, pediatric only indication] to be registered in EU, US and Japan
Case of development of a highly innovative technology (i.e. advanced therapy medicinal products) targeting a 'less understood' rare disease (i.e., extremely low prevalence, scattered diseases knowledge, and no recognized endpoints or biomarkers)
Repurposing of an active substance that is well-understood (a small molecule) targeting a 'sufficiently well understood' rare disease to be registered for the new indication in EU, US and Japan
Based on a systematic review of websites, literature search and the expertise of the Taskforce members, we have created fact sheets describing each BB by including key information on its use, duration, pros and cons, and among other aspects the TF’s advice on the best time to use the BB. All fact sheets can be found below. You can access to the BB forms by type or by geographical scope, or by type of development (i.e. orphan drug development or drug repurposing).
For both orphan drug development and drug repurposing, several milestones are used throughout the development. These milestones include Target and Product Milestone; Nonclinical POP milestone; First-in-human ready milestone; Human POC milestone; Pivotal Data milestone; and MAA- NDA/BLA milestone. Please note that there is no First-in-human milestone for drug repurposing.
There are different checklists available for each milestone, to assure that all the steps are validated in order to move forward. While all checklists are relevant for the milestones of orphan drug development and repurposing (except the first-in-human checklist), a specific checklist for repurposing has been developed, and is included at the bottom of the page. Please note that there is no First-in-human milestone for drug repurposing, as the drug is repurposed and therefore already tested in humans.
A checklist with questions that can assist you in your repurposing drug development program
Typically, researchers discover new drugs through:
To select the best drug, researchers engage in an often long phase of work to deepen the understanding of the molecular/ cellular mechanisms to be targeted and its impact on the disease processes, as well as building virtual, cellular, and animal models that reliably reproduce the role of such mechanism. This phase is called Target Validation and enables researchers and developers to create the basic knowledge and tools that will be needed inn the following phases. At this stage in the process, thousands of compounds may be potential candidates for development as a medical treatment. After early testing, however, only a small number of compounds look promising and call for further study. Once researchers identify a promising compound for development, they conduct experiments to gather information on:
This fishing and selection phase is called Drug Discovery: its scope is to produce a single (or limited number) of best candidate products responding to all the characteristics that can make them (in theory and experimentally in the lab) a suitable drug for patients.
Typically, researchers discover new drugs through:
To select the best drug, researchers engage in an often long phase of work to deepen the understanding of the molecular/ cellular mechanisms to be targeted and its impact on the disease processes, as well as building virtual, cellular, and animal models that reliably reproduce the role of such mechanism. This phase is called Target Validation and enables researchers and developers to create the basic knowledge and tools that will be needed inn the following phases. At this stage in the process, thousands of compounds may be potential candidates for development as a medical treatment. After early testing, however, only a small number of compounds look promising and call for further study. Once researchers identify a promising compound for development, they conduct experiments to gather information on:
This fishing and selection phase is called Drug Discovery: its scope is to produce a single (or limited number) of best candidate products responding to all the characteristics that can make them (in theory and experimentally in the lab) a suitable drug for patients.
PoP: Proof of Principle Pre-clinical research is a preliminary phase that involves testing the drug in lab models (in-vitro) and on animals, including basic testing for safety flags. Before testing a drug in humans, researchers must find out whether it has the potential to cause serious harm, also called toxicity. The two types of preclinical research are:
PoP is achieved when a sufficient evidence of biological activity in vitro and in vivo is demonstrated, an adequate understanding of the pharmaco-kinetics and pharmaco-dynamics of the drug is gathered, and some initial toxicology and safety information is generated. With these data, researchers can plan the following phase of extensive testing of toxicology and biodistribution, which is required to move into clinical studies.
PoP: Proof of Principle Pre-clinical research is a preliminary phase that involves testing the drug in lab models (in-vitro) and on animals, including basic testing for safety flags. Before testing a drug in humans, researchers must find out whether it has the potential to cause serious harm, also called toxicity. The two types of preclinical research are:
PoP is achieved when a sufficient evidence of biological activity in vitro and in vivo is demonstrated, an adequate understanding of the pharmaco-kinetics and pharmaco-dynamics of the drug is gathered, and some initial toxicology and safety information is generated. With these data, researchers can plan the following phase of extensive testing of toxicology and biodistribution, which is required to move into clinical studies.
Purpose: Safety and dosage In order to enable starting human testing of pharmaceuticals, Regulatory Authorities require researchers to test product’s safety in animals (in vivo toxicology) at doses higher than the corresponding future human doses in highly controlled experiments. the Good Laboratory Practices (GLP) for Nonclinical Laboratory Studies set the minimum basic requirements for conducting “clinical study enabling” toxicology experiments regarding:
Usually, preclinical studies are not very large. However, these studies must provide detailed information on dosing and toxicity levels. After preclinical testing, researchers review their findings and decide whether the drug should be tested in humans.
Purpose: Safety and dosage In order to enable starting human testing of pharmaceuticals, Regulatory Authorities require researchers to test product’s safety in animals (in vivo toxicology) at doses higher than the corresponding future human doses in highly controlled experiments. the Good Laboratory Practices (GLP) for Nonclinical Laboratory Studies set the minimum basic requirements for conducting “clinical study enabling” toxicology experiments regarding:
Usually, preclinical studies are not very large. However, these studies must provide detailed information on dosing and toxicity levels. After preclinical testing, researchers review their findings and decide whether the drug should be tested in humans.
PoC: Proof of Concept Purpose: Efficacy and side effects While preclinical research answers basic questions about a drug’s safety, it is not a substitute for studies of ways the drug will interact with the human body. “Clinical research” refers to studies, or trials, that are done in people. As the developers design the clinical study, they will consider what they want to accomplish for each of the different Clinical Research Phases and begin the Investigational New Drug Process (IND) / Clinical Trial Application (CTA) / national regulatory applications, a process they must go through before clinical research begins. The First in Human (FIH) is the first clinical trial where the drug tested previously in animal is for the first time tested in normal volunteers (healthy people). In most cases, 20 to 80 healthy volunteers or people with the disease/condition participate in this first study (or set of studies) aiming at providing initial safety and tolerability information. This set of studies in healthy volunteers is collectively called “phase I”. However, if a new drug is intended for use in cancer patients or if the administration of the drug poses risks to the healthy volunteers (e.g. in the case of most biotechnology products), researchers conduct phase I studies in patients with that type of cancer/rare-disease/etc. Phase I studies are closely monitored and gather information about how a drug interacts with the human body. Researchers adjust dosing schemes based on animal data to find out how much of a drug the body can tolerate and what its acute side effects are. As a phase I trials continue, researchers answer research questions related to how it works in the body, the side effects associated with increased dosage, and early information about how effective it is to determine how best to administer the drug to limit risks and maximize possible benefits. This is important to the design of phase II studies. In some cases, the phase I and II may be condensed.
In phase II studies, researchers administer the drug to a (small) group of patients with the disease or condition for which the drug is being developed. The scope of phase II studies is to provide the first evidence of biological activity, efficacy and safety in the intended patient population, as well as to selected the best dose(s) to be further studied in phase III. Typically involving a few hundred patients, these studies aren't large enough to formally demonstrate whether the drug will be beneficial, or to accurately predict product’s safety. In rare diseases, phase II (or combined phase I-II) studies might be much smaller, sometimes only a few dozens of patients or even less. Researchers use data gathered in phase II to refine research questions, develop research methods, and design phase III research protocols.
PoC: Proof of Concept Purpose: Efficacy and side effects While preclinical research answers basic questions about a drug’s safety, it is not a substitute for studies of ways the drug will interact with the human body. “Clinical research” refers to studies, or trials, that are done in people. As the developers design the clinical study, they will consider what they want to accomplish for each of the different Clinical Research Phases and begin the Investigational New Drug Process (IND) / Clinical Trial Application (CTA) / national regulatory applications, a process they must go through before clinical research begins. The First in Human (FIH) is the first clinical trial where the drug tested previously in animal is for the first time tested in normal volunteers (healthy people). In most cases, 20 to 80 healthy volunteers or people with the disease/condition participate in this first study (or set of studies) aiming at providing initial safety and tolerability information. This set of studies in healthy volunteers is collectively called “phase I”. However, if a new drug is intended for use in cancer patients or if the administration of the drug poses risks to the healthy volunteers (e.g. in the case of most biotechnology products), researchers conduct phase I studies in patients with that type of cancer/rare-disease/etc. Phase I studies are closely monitored and gather information about how a drug interacts with the human body. Researchers adjust dosing schemes based on animal data to find out how much of a drug the body can tolerate and what its acute side effects are. As a phase I trials continue, researchers answer research questions related to how it works in the body, the side effects associated with increased dosage, and early information about how effective it is to determine how best to administer the drug to limit risks and maximize possible benefits. This is important to the design of phase II studies. In some cases, the phase I and II may be condensed.
In phase II studies, researchers administer the drug to a (small) group of patients with the disease or condition for which the drug is being developed. The scope of phase II studies is to provide the first evidence of biological activity, efficacy and safety in the intended patient population, as well as to selected the best dose(s) to be further studied in phase III. Typically involving a few hundred patients, these studies aren't large enough to formally demonstrate whether the drug will be beneficial, or to accurately predict product’s safety. In rare diseases, phase II (or combined phase I-II) studies might be much smaller, sometimes only a few dozens of patients or even less. Researchers use data gathered in phase II to refine research questions, develop research methods, and design phase III research protocols.
Purpose: Efficacy and monitoring of adverse reactions Researchers design phase III studies to demonstrate whether or not a product offers a treatment benefit to a specific population, i.e. whether the benefit-risk ratio of the drug is positive. Sometimes known as pivotal studies, these studies may involve hundred to thousands of participants for large therapeutic indications and dozens to hundred for rare diseases. Data gathered in phase III studies determine the “label” of the product, i.e. the therapeutic indication, the posology and mode of administration, and the expected efficacy and potential risk as reported in the prescribing information leaflet. Phase III studies provide most of the safety data. In previous studies, it is possible that less common side effects might have gone undetected. Because these studies are larger and longer in duration, the results are more likely to show long-term or rare side effects.
Purpose: Efficacy and monitoring of adverse reactions Researchers design phase III studies to demonstrate whether or not a product offers a treatment benefit to a specific population, i.e. whether the benefit-risk ratio of the drug is positive. Sometimes known as pivotal studies, these studies may involve hundred to thousands of participants for large therapeutic indications and dozens to hundred for rare diseases. Data gathered in phase III studies determine the “label” of the product, i.e. the therapeutic indication, the posology and mode of administration, and the expected efficacy and potential risk as reported in the prescribing information leaflet. Phase III studies provide most of the safety data. In previous studies, it is possible that less common side effects might have gone undetected. Because these studies are larger and longer in duration, the results are more likely to show long-term or rare side effects.
If a drug developer has evidence from preclinical and clinical (phases I to III) research that a drug is safe and effective for its intended use, the applicant can file an application to market the drug to the relevant Regulatory Authority (i.e., FDA, EMA, MHLW/PMDA, etc). The relevant Regulatory Authority review team thoroughly examines all submitted data on the drug, decides if it is complete and makes a decision to approve or not to approve it. In cases where the Regulatory Authority determines that a drug has been shown to be safe and effective for its intended use, it is then necessary to work with the applicant to develop and refine prescribing information. This is referred to as “labeling.” Labeling accurately and objectively describes the basis for approval and how best to use the drug.
If a drug developer has evidence from preclinical and clinical (phases I to III) research that a drug is safe and effective for its intended use, the applicant can file an application to market the drug to the relevant Regulatory Authority (i.e., FDA, EMA, MHLW/PMDA, etc). The relevant Regulatory Authority review team thoroughly examines all submitted data on the drug, decides if it is complete and makes a decision to approve or not to approve it. In cases where the Regulatory Authority determines that a drug has been shown to be safe and effective for its intended use, it is then necessary to work with the applicant to develop and refine prescribing information. This is referred to as “labeling.” Labeling accurately and objectively describes the basis for approval and how best to use the drug.