The DEEP Project. Dr Evi MISSOURI- KHETAB MD, MBA. Medical and Public Health Services, Ministry of Health, Cyprus THE DEEP CONSORTIUM



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The DEEP Project Dr Evi MISSOURI- KHETAB MD, MBA Medical and Public Health Services, Ministry of Health, Cyprus THE DEEP CONSORTIUM

DEEP- Deferiprone EvaluaCon in Paediatrics DEEP is a 4 year Project funded by the European Commission within the 7 th Framework Program Paediatric populaeon from 1 month to less than 18 years DEEP studies are invesegator driven and mulecentric (European and non European countries) Partners: Research Centers, PaEents associaeons, no profit insetueons, pharmaceuecal industry

DEEP Primary ObjecCves To update Deferiprone SPC, providing data on pharmacokineecs Efficacy Safety in children aged between 1 month and less than 18 years To provide a new formulaeon specifically tested for children

The DEEP PROJECT Lead Partner: Partners : Italy (CVBF- ConsorEo per Volutazioni Biologiche 17 Centres e Farmacologiche- Bari) DuraCon: StarCng Date: 4 years 01/01/2011

The DEEP PROJECT- ParCcipaCng Centers 1. Azienda Ospedaliera Ospedali RiuniE Villa Sofia- Cervello, Palermo - Italy 2. Cairo University, Cairo - Egypt 3. NaEonal And Kapodistrian University Of Athens, Athens- Greece 4. Qendra Spitalore Universitare "Nene Tereza«, Tirane - Albania 5. Department of Medical and Public Health Services of the Ministry of Health, Nicosia - Cyprus 6. Azienda Ospedaliera di Rilievo Nazionale "Antonio Cardarelli", Napoli - Italy 7. Centre NaEonal de Greffe de Moelle Osseuse Tunis, Tunis - Tunisia 8. Azienda Ospedaliera di Padova, Padova - Italy 9. Azienda Ospedaliero Universitaria Consorziale Policlinico di Bari, Bari - Italy 10. U.O.C. Ematologia - EmoglobinopaEe, Azienda Ospedaliera G. Di CrisEna, Palermo - Italy 11. Presidio Ospedaliero "Annunziata", Centro di Studi della Microcitemia, Cosenza - Italy 12. Ospedale Civile di LenEni, Centro di Thalassemia, LenCni (SR) - Italy 13. Policlinico di Modena, Clinica Pediatrica, Modena - Italy 14. Clinica Pediatrica Università - ASL 1 D.H per Talassemia - Pediatria, Sassari - Italy 15. Azienda Ospedaliera di Rilievo Nazionale e di Alta Specializzazione Garibaldi, U.O.D. Talassemia, Catania - Italy 16. ASL Cagliari Ospedale Regionale per le Microcitemie, Cagliari - Italy 17. Azienda Ospedaliera Universitaria Meyer, Firenze- Italy

β- Thalassaemia Major Rare Disease: Prevalence in Europe 0.5 10,000 About 1.5% of the global populaeon is carrier of the disease About 200,000 paeents worldwide Geographical trend: widespread throughout Mediterranean Region, Middle East, Southeast Asia and Indonesia

β- Thalassaemia Major: The therapeucc approach 1. Frequent blood transfusions in order to suppress ineffeceve erythropoiesis to provide adequate oxygen carrying capacity and to decrease gastrointesenal absorpeon of iron 2. ChelaCon therapy to remove iron accumulaeon in Essues (liver, heart and endocrine organs), not otherwise removable through physiological mechanism

Available Chelators DEFEROXAMINE (MA 1962) Treatment of chronic iron overload DEFERIPRONE (MA 1999) Treatment of iron overload in paeents with thalassaemia major when deferoxamine therapy is CI or inadequate DEFERASIROX (MA 2006) Treatment of chronic iron overload due to frequent blood transfusions ( 7ml/kg/month of packed red blood cells) in paeents with β- thalassaemia major aged 6 years and older. Treatment of chronic iron overload due to blood transfusions when deferoxamine therapy is CI or inadequate in paeents aged 2 to 5 years.

8 Work Packages WP 1- WP 2- «CoordinaCon of the Project and General management of the proposed studies across countries» Specific ObjecCves: To provide the overall scienefic strategy and coordinaeon of the project To ensure the quality principles of the studies, in accordance with the European Good Clinical PracEces and in compliance with the EU Clinical Trials DirecEve (2001/20/EC) To ensure the respect of ethical rules and European and naeonal regulaeons «FormulaCon Study- Development of a Paediatric Oral SoluCon» ACCOMPLISHED Specific ObjecCves: Develop and prepare a drug product suitable for a paediatric populaeon with a small weight range and with appropriate dosage device Develop a 80mg/dl oral solueon that is more palatable than the one in the market to minimise the risk of non-adherence to therapy

WP3-8 Work Packages (2) «PharmacokineCc Study» Specific ObjecCves: to characterise DFP PK aoer single administraeon in male and female paediatric with hereditary haemoglobinopathies, <6 years of age to evaluate the effect of demographic factors on the PK of DFP in children paeents WP 4- «Paediatric Efficacy/Safety Study» Specific ObjecCves: compare the efficacy of DFP versus DFX in children affected by hereditary haemoglobinopathies to evaluate the treatment efficacy, the safety profiles and the paeent compliance START UP: OCTOBER 2013

WP 5-8 Work Packages (3) «Paediatric Long term Safety Study» Specific ObjecCves: to evaluate long- term safety of Deferiprone use in children by contaceng: - a RetrospecCve cohort study: will be recruited from exiseng paeents in register database who have received deferiprone before this study - a ProspecCve cohort study: paeents who receive deferiprone will be prospecevely recruited and monitored up to 3 years to produce a prescribing guideline which would include the safety data, in order to improve prescribing of deferiprone in paediatric paeents Recruitment ongoing WP 6- «Pharmacoeconomic Study» Specific ObjecCves: to evaluate the market and develop a budget impact model (predominantly in European countries) to provide an economic evaluaeon of Deferiprone compared to alternaeve treatment opeons Ongoing

WP 7- WP 8-8 Work Packages (4) «Project Management» Specific ObjecCves: to provide a management structure adequate to ensure the correct development of the work plan during the project to provide resource, procedures and tools aimed to ensure the project proper fulfilment and that all the expected results are delivered on Eme, within cost and with an adequate quality level «CommunicaCon Strategy and the Knowledge Management» to ensure efficient communicaeon with stakeholders outside the project in order to raise awareness about aceviees and results to use results of the project for a PUMA applicaeon or a Type II variaeon and for markeeng exploitaeon

DEEP website: www.deep.cvbf.net Dr Evi Missouri- Khetab E- mail: emissouri@mphs.moh.gov.cy Tel.: 00 357 99 625711

Thank you for your aiencon