Fosdenopterin

Fosdenopterin
Clinical data
Trade names	Nulibry
Other names	Precursor Z, ALXN1101
License data	US DailyMed: Fosdenopterin;
Routes of; administration	Intravenous
ATC code	A16AX19 (WHO) ;
Legal status
Legal status	US: ℞-only; EU: Rx-only;
Identifiers
	IUPAC name 5-amino-11,11,14-trihydroxy-14-oxo-13,15,18-trioxa-2,4,6,9-tetraza-14λ5-phosphatetracyclo[8.8.0.03,8.012,17]octadeca-3(8),4-dien-7-one;
CAS Number	150829-29-1;
PubChem CID	135894389;
DrugBank	DB16628;
ChemSpider	17221217;
UNII	4X7K2681Y7;
KEGG	D11779;
ChEMBL	ChEMBL2338675;
CompTox Dashboard (EPA)	DTXSID90934067 ;
Chemical and physical data
Formula	C10H14N5O8P
Molar mass	363.223 g·mol−1
3D model (JSmol)	Interactive image;
	SMILES NC1=NC(=O)C2=C(N[C@@H]3O[C@@H]4COP(=O)(O)O[C@@H]4C(O)(O)[C@@H]3N2)N1;
	InChI InChI=1S/C10H14N5O8P/c11-9-14-6-3(7(16)15-9)12-4-8(13-6)22-2-1-21-24(19,20)23-5(2)10(4,17)18/h2,4-5,8,12,17-18H,1H2,(H,19,20)(H4,11,13,14,15,16)/t2-,4-,5+,8-/m1/s1; Key:CZAKJJUNKNPTTO-AJFJRRQVSA-N;

Fosdenopterin (or cyclic pyranopterin monophosphate, cPMP), sold under the brand name Nulibry, is a medication used to reduce the risk of death due to a rare genetic disease known as molybdenum cofactor deficiency type A.^[2]

The most common side effects include complications related to the intravenous line, fever, respiratory infections, vomiting, gastroenteritis, and diarrhea.^[2]

Fosdenopterin was approved for medical use in the United States in February 2021,^[4] It is the first medication approved by the U.S. Food and Drug Administration (FDA) for the treatment of molybdenum cofactor deficiency type A.^[2] and in the European Union in September 2022.^[3] The US Food and Drug Administration considers it to be a first-in-class medication.^[5]

Medical uses

Fosdenopterin is indicated to reduce the risk of mortality in people with molybdenum cofactor deficiency (MoCD) type A.^[1]^[2]

Mechanism of action

People with molybdenum cofactor deficiency type A cannot produce cyclic pyranopterin monophosphate (cPMP) in their body.^[2] Fosdenopterin is an intravenous medication that replaces the missing cPMP.^[2]^[6] cPMP is a precursor to molybdopterin, which is required for the enzyme activity of sulfite oxidase, xanthine dehydrogenase/oxidase and aldehyde oxidase.^[7]

History

Fosdenopterin was developed at the German universities TU Braunschweig and the University of Cologne.^[8]^[9]

The effectiveness of fosdenopterin for the treatment of MoCD-A was demonstrated in thirteen treated participants compared to eighteen matched, untreated participants.^[2]^[10] The participants treated with fosdenopterin had a survival rate of 84% at three years, compared to 55% for the untreated participants.^[2]

The U.S. Food and Drug Administration (FDA) granted the application for fosdenopterin priority review, breakthrough therapy, and orphan drug designations along with a rare pediatric disease priority review voucher.^[2]^[5] The FDA granted the approval of Nulibry to Origin Biosciences, Inc., in February 2021.^[2]

Society and culture

Legal status

On 21 July 2022, the Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency (EMA) adopted a positive opinion, recommending the granting of a marketing authorization under exceptional circumstances for the medicinal product Nulibry, intended for the treatment of patients with molybdenum cofactor deficiency (MoCD) Type A.^[11] The applicant for this medicinal product is Comharsa Life Sciences Ltd.^[11] Fosdenopterin was approved for medical use in the European Union in September 2022.^[3]^[12]

References

^ ^a ^b "Nulibry- fosdenopterin hydrobromide injection, powder, for solution". DailyMed. Archived from the original on 20 June 2021. Retrieved 31 March 2021.
^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j ^k "FDA Approves First Treatment for Molybdenum Cofactor Deficiency Type A". U.S. Food and Drug Administration (FDA) (Press release). 26 February 2021. Archived from the original on 27 February 2021. Retrieved 26 February 2021. This article incorporates text from this source, which is in the public domain.
^ ^a ^b ^c "Nulibry EPAR". European Medicines Agency (EMA). 18 July 2022. Retrieved 14 October 2022. Text was copied from this source which is copyright European Medicines Agency. Reproduction is authorized provided the source is acknowledged.
^ "Drug Approval Package: Nulibry". U.S. Food and Drug Administration (FDA). 26 March 2021. Archived from the original on 14 September 2021. Retrieved 13 September 2021.
^ ^a ^b Advancing Health Through Innovation: New Drug Therapy Approvals 2021 (PDF). U.S. Food and Drug Administration (FDA) (Report). 13 May 2022. Archived from the original on 6 December 2022. Retrieved 22 January 2023. This article incorporates text from this source, which is in the public domain.
^ DrugBank DB16628 . Accessed 5 March 2021.
^ Santamaria-Araujo JA, Fischer B, Otte T, Nimtz M, Mendel RR, Wray V, Schwarz G (April 2004). "The tetrahydropyranopterin structure of the sulfur-free and metal-free molybdenum cofactor precursor". The Journal of Biological Chemistry. 279 (16): 15994–9. doi:10.1074/jbc.M311815200. PMID 14761975.
^ Schwarz G, Santamaria-Araujo JA, Wolf S, Lee HJ, Adham IM, Gröne HJ, et al. (June 2004). "Rescue of lethal molybdenum cofactor deficiency by a biosynthetic precursor from Escherichia coli". Human Molecular Genetics. 13 (12): 1249–55. doi:10.1093/hmg/ddh136. PMID 15115759.
^ Tedmanson S (5 November 2009). "Doctors risk untried drug to stop baby's brain dissolving". TimesOnline. Archived from the original on 22 June 2021. Retrieved 6 March 2021.
^ Schwahn BC, Van Spronsen FJ, Belaidi AA, Bowhay S, Christodoulou J, Derks TG, et al. (November 2015). "Efficacy and safety of cyclic pyranopterin monophosphate substitution in severe molybdenum cofactor deficiency type A: a prospective cohort study". Lancet. 386 (10007): 1955–63. doi:10.1016/S0140-6736(15)00124-5. PMID 26343839. S2CID 21954888.
^ ^a ^b "Nulibry: Pending EC decision". European Medicines Agency. 22 July 2022. Archived from the original on 28 July 2022. Retrieved 30 July 2022. Text was copied from this source which is copyright European Medicines Agency. Reproduction is authorized provided the source is acknowledged.
^ "Nulibry Product information". Union Register of medicinal products. Retrieved 3 March 2023.

External links

"Fosdenopterin". Drug Information Portal. U.S. National Library of Medicine.

[Nulibry_FDA_label-1] "Nulibry- fosdenopterin hydrobromide injection, powder, for solution". DailyMed. Archived from the original on 20 June 2021. Retrieved 31 March 2021.

[FDA_PR_20210226-2] ^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j ^k "FDA Approves First Treatment for Molybdenum Cofactor Deficiency Type A". U.S. Food and Drug Administration (FDA) (Press release). 26 February 2021. Archived from the original on 27 February 2021. Retrieved 26 February 2021. This article incorporates text from this source, which is in the public domain.

[Nulibry_EPAR-3] "Nulibry EPAR". European Medicines Agency (EMA). 18 July 2022. Retrieved 14 October 2022. Text was copied from this source which is copyright European Medicines Agency. Reproduction is authorized provided the source is acknowledged.

[4] "Drug Approval Package: Nulibry". U.S. Food and Drug Administration (FDA). 26 March 2021. Archived from the original on 14 September 2021. Retrieved 13 September 2021.

[New_Drug_Therapy_Approvals_2021-5] Advancing Health Through Innovation: New Drug Therapy Approvals 2021 (PDF). U.S. Food and Drug Administration (FDA) (Report). 13 May 2022. Archived from the original on 6 December 2022. Retrieved 22 January 2023. This article incorporates text from this source, which is in the public domain.

[6] DrugBank DB16628 . Accessed 5 March 2021.

[7] Santamaria-Araujo JA, Fischer B, Otte T, Nimtz M, Mendel RR, Wray V, Schwarz G (April 2004). "The tetrahydropyranopterin structure of the sulfur-free and metal-free molybdenum cofactor precursor". The Journal of Biological Chemistry. 279 (16): 15994–9. doi:10.1074/jbc.M311815200. PMID 14761975.

[8] Schwarz G, Santamaria-Araujo JA, Wolf S, Lee HJ, Adham IM, Gröne HJ, et al. (June 2004). "Rescue of lethal molybdenum cofactor deficiency by a biosynthetic precursor from Escherichia coli". Human Molecular Genetics. 13 (12): 1249–55. doi:10.1093/hmg/ddh136. PMID 15115759.

[9] Tedmanson S (5 November 2009). "Doctors risk untried drug to stop baby's brain dissolving". TimesOnline. Archived from the original on 22 June 2021. Retrieved 6 March 2021.

[10] Schwahn BC, Van Spronsen FJ, Belaidi AA, Bowhay S, Christodoulou J, Derks TG, et al. (November 2015). "Efficacy and safety of cyclic pyranopterin monophosphate substitution in severe molybdenum cofactor deficiency type A: a prospective cohort study". Lancet. 386 (10007): 1955–63. doi:10.1016/S0140-6736(15)00124-5. PMID 26343839. S2CID 21954888.

[Nulibry:_Pending_EC_decision-11] "Nulibry: Pending EC decision". European Medicines Agency. 22 July 2022. Archived from the original on 28 July 2022. Retrieved 30 July 2022. Text was copied from this source which is copyright European Medicines Agency. Reproduction is authorized provided the source is acknowledged.

[12] "Nulibry Product information". Union Register of medicinal products. Retrieved 3 March 2023.

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