Press Release: The Chion Foundation and TREND Community Partner to Identify Novel Treatment for Prader-Willi Syndrome
The Chion Foundation, an organization committed to improving the lives of individuals affected by Prader-Willi Syndrome (PWS) and other rare diseases, has partnered with Trend Community, an innovative patient experience and engagement platform, to launch the Pitolisant Health Initiative to explore the potential of pitolisant (sold under the brand name of Wakix™) to address the many unmet needs of patients with PWS. PWS is a rare, complex disease characterized by hunger, disturbances in the sleep/wake cycle, excessive daytime sleepiness, low muscle tone, and decreased cognition. Pitolisant is an inverse agonist of the histamine h3 receptor recently approved in Europe as a treatment for the rare sleep disorder of narcolepsy with or without cataplexy.
While pitolisant is currently only available in Europe, the Chion Foundation and TREND Community have worked with the US Food and Drug Administration (FDA) to help individuals personally import pitolisant from Europe based upon the FDA’s discretion. These families are documenting their experience with pitolisant on TREND Community via journaling and survey
questions. Thus far, the Chion Foundation has identified seven US families affected by PWS who have been prescribed and are now taking pitolisant via the FDA’s personal importation program. Caregiver reported data suggest that pitolisant is well-tolerated and has neurological benefits that extend beyond wakefulness to include mental clarity, increased processing speed, improved attention, and improved muscle tone. Early patient experience with pitolisant is encouraging.
Immunologist and co-founder of Chion Foundation, Lara C. Pullen, PhD identified pitolisant as an ideal drug to be repurposed to treat many of PWS’ clinical manifestations. The histamine h3 receptor is located in the brain and gut, and is known to regulate not only sleep/wake states, but also hunger, cognition, and movement, all of which are debilitating problems for patients with PWS.
Today Harmony Biosciences announced its licensing agreement with Bioprojet Pharma to bring Wakix to market in the United States (read press release). The Chion Foundation and Trend Community intend to continue its collection of patient experience data with pitolisant and work with Harmony Biosciences to secure an indication and label expansion for pitolisant for patients with PWS.
About Chion Foundation: https://www.chionfoundation.org/
About Trend Community: https://trend.community/
About FDA Personal Importation Program: https://www.fda.gov/ForIndustry/ImportProgram/ImportBasics/ucm432661.htm
About Harmony Biosciences: https://harmonybiosci.squarespace.com/
Note: The following viewpoint was written in collaboration with The Chion Foundation (chionfoundation.org).
Traditionally, drugs that are approved by the FDA must go through many layers of clinical trials in order to be approved. Typically, these trials must take place through an FDA-approved protocol in the United States or in another country. The gold standard trial is the phase III, randomized, double-blind study which is used to gather data on the safety and efficacy of medical products. Such phase III trials are very expensive and time consuming. They often occur in highly specific patient populations and in very controlled clinical settings. Unfortunately, in the rare disease world, such clinical trials are rare because patients are few and far between and may be difficult to recruit.
The United States government and the FDA have recognized this difficulty and are making efforts to remedy this problem. The 21st Century Cures Act was signed into law in December 2016. The Cures Act specifies that patient experience data may be submitted to the FDA for review. This data may include data on patients’ experience with a disease as well as patients’ preferences with respect to treatment.
The Cures Act also requires the FDA to develop a plan to collect and use patient experience data in drug development. The intention is for the FDA to use patient experience data in its benefit-risk assessment framework so that it can inform decision-making. The Cures Act also re-emphasizes the need to encourage treatments for rare pediatric diseases. Additionally, the Orphan Drug Act has been expanded to include not just clinical and preclinical studies in rare diseases, but “prospectively planned and designed observational studies and other natural history analysis.”
Many clinical researchers would like to be able to successfully integrate clinical research into real-world settings by accessing data from electronic health records, electronic devices, and social media. The Cures Act shepherds in a new emphasis on this real-world data, with the understanding that such data have the potential to complement data obtained from traditional clinical trials. Experts note that such real-world data have the potential advantages of helping researchers answer questions about drug treatment effects and outcomes in an efficient and cost-effective manner. There are challenges, of course, to using data that may be collected in less than scientifically rigorous settings and that is the reason why we believe that we must be as diligent as possible as we collect our patient experience data. The FDA is currently evaluating whether they can use real-world evidence to help support the approval of new indications for an approved drug.
The New England Journal of Medicine recently published an article written by leaders at the FDA that discussed some ideas on how this real-world evidence can be incorporated into drug approval. The authors wrote that, “We believe that real-world evidence can be used across a wide spectrum of research, ranging from observational studies to studies that incorporate planned interventions, whether with or without randomization at the point of care.” The article described the challenges and opportunities of real-world data. In particular, it emphasized the importance of having the data address defined populations using defined methodologies. TREND Community aims to systematically document patient experience data to inform regulatory decision making.