Medicine:Orphan device

Short description: Devices for rare disease patients

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An orphan device is a product or an equipment intended for the prevention, prediction, diagnosis, support, treatment or management of a life-threatening or chronically debilitating disease with a low prevalence/incidence, most notably for rare diseases. Orphan medical technology is then considered as both the medical device (tool or equipment) and the connectivity of the device. Many orphan devices provide essential functions for patients with rare diseases, their carers, and the healthcare professionals using them. Nevertheless, there are very few medical devices that are specifically developed for rare diseases (in contrast to orphan medicinal products). At the same time, many patients and carers express a substantial unmet need for new medical devices for their conditions.

Orphan devices constitute a very diverse group of products, reflecting the broad field of rare diseases. Device needs for rare diseases vary from noninvasive markers for monitoring disease activity, wearables and tests that allow home monitoring of disease by patients and treatment side effects, or imaging enhanced functional scans. Devices are also needed to support quality of life and activities ofdaily living as best as possible, helping, for example, with rehabilitation, muscle support, or nutrition support. As such, there is a high need to connect patients, carers, and healthcare professionals to technology that can address these requirements.

The development of medical technologies for rare diseases faces many of the same challenges as developing orphan medicinal products, including the small number of patients, the geographical spread of patients, the lack of expertise on specific diseases, and the fact that most diseases are paediatric-onset. Some geographies have developed supportive specific orphan-device legislation. However, there is no harmonization between different geographies, and joint applications between Europe, the United States and Japan do not exist. Examples of existing orphan device legislation are the United States Food and Drug Administration (FDA) Humanitarian use device program, which designates medical devices to benefit patients in treating or diagnosing rare diseases. In Japan, the PMD Act outlines regulations for reviewing medical device applications, except for medical software programs which are independently regulated. Europe has no legislation specifically for medical devices for rare diseases despite the implementation in 2021 of new regulations for in vitro diagnostics and medical devices.

The approval process provided by the FDA and the Japanese Pharmaceuticals and Medical Devices Agency allows a medical device to be marketed with several incentives and limited prove of effectiveness. Like orphan drugs, most orphan devices would not be profitable to develop and produce without government assistance and regulatory incentives due to the small number of patients affected by these conditions. The assignment of orphan status to a disease and to devices developed to diagnose and treat it is a matter of public policy that depends on the country's legislation if any exists.

Definitions

United States

The FDA currently does not have a definition of orphan devices or orphan medical technology. The closest resembling definition is that of a humanitarian use device, which is "a medical device intended to benefit patients in the treatment or diagnosis of a disease or condition that affects or is manifested in not more than 8,000 individuals in the United States per year".

Europe

In the EU no definition of orphan devices or orphan medical technology exists. Orphan devices follow the same procedure as devices for common diseases, and have to adhere to the Medical Device Regulation.

Japan

In Japan drugs and medical devices are given the designation as an orphan drug or device based on the Act of Securing Quality, Efficacy, Safety of Pharmaceuticals, Medical Devices, Regenerative or Cellular Therapy Products, Gene Therapy Products, and Cosmetics "if they are intended for use in less than 50,000 patients in Japan and for which there is a high medical need".

Support for orphan devices

Several initiatives are currently supporting both research and the development of policies and incentives for orphan devices. Most notably, the International Rare Diseases Research Consortium (IRDiRC) has set up a Working Group specifically for medical technologies for rare diseases. In the United States, the SHIP-MD consortium examining unmet needs of pediatric medical device development and develops solutions to address those needs. In Europe, the CORE-MD project, review methodologies for the clinical evaluation of high-risk medical devices, also specifically for rare diseases and recommend new designs to set an appropriate balance between innovation, safety, and clinical effectiveness.