Eurand N.V., a specialty pharma company, announced US FDA approval of its NDA for Zenpep (pancrelipase) delayed-release capsules for the treatment of exocrine pancreatic insufficiency (EPI) in patients with cystic fibrosis (CF) or other conditions.
Zenpep is the only FDA-approved pancreatic enzyme product (PEP) that has been evaluated in clinical studies in adults and children - including children from one to 12 years old - and will offer four dosage strengths to meet the varied needs of infants, toddlers, adolescents and adults with EPI.
"The availability of clinical evidence in a paediatric population is particularly important for EPI patients with CF and their caregivers, as early improvements in BMI (Body Mass Index) significantly affect long-term survivability," said Jamie Wooldridge, assistant professor, Department of Paediatrics, Division of Pulmonary Medicine at Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, and a principal investigator in the Zenpep paediatric trial. Zenpep capsules were formulated to allow the contents to be sprinkled on food where necessary, which is a key attribute to support the developmental needs of very young children as well as older patients.
EPI is the inability to properly digest food due to a lack of digestive enzymes made by the pancreas. Loss of digestive enzymes leads to maldigestion and malabsorption of nutrients. This is a common disorder for those suffering from cystic fibrosis and other conditions compromising the exocrine function of the pancreas, such as pancreatic cancer, gastrointestinal surgery and chronic pancreatitis. EPI results in malnutrition and, especially in CF patients, impaired growth in children, compromised immune response and shortened life expectancy. Zenpep replaces these missing enzymes and improves digestion and absorption. In addition, Zenpep's stability and precise range of dosage strengths will allow health care professionals to dose a patient's treatment regimen for optimal symptom control and potentially reduce their pill burden.
Zenpep was developed specifically to meet the FDA's guidelines on PEPs. Historically, PEPs have not been regulated and approved by the FDA. In 2004, due to inconsistent quality that affected the safety and efficacy of PEPs, the FDA determined it was necessary to better control these products. All manufacturers of EPI drug products were required to file NDAs and receive marketing approvals by April 2010.
"For years, patients with EPI taking unapproved PEPs have lived with far too much variability in the control of their gastrointestinal symptoms as a result of product instability and dosing inconsistency," said Gearoid Faherty, chairman and chief executive officer. "The approval of Zenpep is a major milestone for patients suffering from EPI and for Eurand. In preparation for our US launch we have built and continue to expand a first-rate commercial organization to help Zenpep reach its full market potential." According to IMS Health, the market for PEPs was an estimated $1.13 billion worldwide in 2008.
The US commercial launch of Zenpep is planned for the fourth quarter of 2009. Eurand will market Zenpep for the approved indication through its own sales force to the different physician groups that treat EPI within each of the target CF and non-CF patient populations.
"Eurand is committed to a successful launch of Zenpep and intends to deploy a sales force of sufficient size and scope to address these distinct market segments. To accelerate adoption, we will also have an extensive sampling and patient support program for a period of time following the launch," Faherty said.
"The Cystic Fibrosis Foundation encouraged the FDA to mandate the NDA process for pancreatic enzymes in order to ensure that all of these products are of the highest quality," said Robert J. Beall, president and CEO of the Cystic Fibrosis Foundation, a leading patient advocacy group. "Pancreatic enzymes approved through this process will help ensure that CF patients receive products that are documented to be safe and effective. The approved formulations will allow for more precise dosing, which will help ensure patients receive the proper nutrients to support growth and development and may reduce their treatment burden. We are pleased that people with CF will have the option of using Eurand's newly approved pancreatic enzyme, Zenpep, and are grateful to all those who participated in the clinical trials that made this approval possible."
Zenpep was shown to be safe and effective for the treatment of EPI in two Phase III multicenter clinical trials -- one in older children, adolescents and adults, and one in young children (ages 1 through 6). Both studies established efficacy and safety of Zenpep in CF patients with EPI. In the placebo-controlled, randomized, double-blind pivotal study in older children and adult patients, ages 7-23 years, the primary efficacy endpoint was mean Coefficient of Fat Absorption (CFA), the gold standard for assessing the severity of EPI. CFA was statistically higher with Zenpep treatment (88.3%) than placebo (62.8%)(p less than 0.001).
In the open-label, single-arm study in young patients, patients maintained symptom control when switched from their usual PEP regimen to Zenpep at similar doses. The safety and efficacy in padiatric patients evaluated in this study were similar to adult patients.
Zenpep was not associated with any serious drug-related adverse events in any of the clinical trials. The most common adverse events were gastrointestinal complaints, which were similar in type and frequency across all age ranges in the two studies. The most commonly reported adverse events occurring in at least two patients (greater than or equal to 6% of patients) included: abdominal pain, flatulence, headache, cough, decreased weight, early satiety, and contusion. The type and incidence of adverse events were similar in children and adults.
Zenpep is the sixth Eurand-developed product to be approved by the FDA since 2001 and the second this year following the May 8th approval of Lamictal ODT.
Exocrine Pancreatic Insufficiency (EPI) is the inability to properly digest food due to a lack of digestive enzymes made by the pancreas. EPI can result from a number of diseases, including cystic fibrosis, pancreatic cancer, gastrointestinal surgery, and chronic pancreatitis. The FDA estimates that more than 200,000 Americans suffer from EPI. If left untreated, EPI causes malnutrition and, especially in CF patients, impaired growth in children, compromised immune response and shortened life expectancy. EPI is treated by porcine-derived pancreatic enzyme products, which have been marketed in the US without FDA approval for more than 70 years.
Zenpep is an innovatively formulated pancreatic enzyme product for the treatment of exocrine pancreatic insufficiency. The product was developed in response to the 2004 FDA initial guidance on pancreatic enzyme products, which outlined the need to reduce the variability in enzyme levels, address stability issues associated with unapproved enzyme therapies and regulate them under NDAs. Zenpep is a highly stable formulation of a porcine pancreatic extract that is biologically similar to the endogenous human pancreatic secretions necessary for proper human digestion.