Compassionate Use Program

Requirements for Compassionate Use

​​CUP is an arrangement manufacturers can use to make a medicinal product without granted marketing authorization (MA) available for a group of patients. Before a CUP can be initiated, NoMA has to assess and approve the application. The applicant is the manufacturer of the medicinal product in question.

For a CUP application to be approved, the following requirements must be met:

• CUP is only for patients with chronic, life-threatening, long-lasting or serious disabling diseases
• CUP is only for patients that cannot be included in ongoing clinical trials and that do not benefit from the use of medicinal products with MA
• The benefit-risk ratio for the patient population of interest must be positive, supported by sufficient evidence on the effect and safety of the medicinal product
• The applicant has submitted an application for MA and/or has ongoing clinical trials with the medicinal product in question

Overview of current and discontinued programs

NoMA publishes information regarding which medicinal products are covered by CUP. The following information about the product is provided: active substance, trade name, indication and the name of the manufacturer.

CUP available for patients

CUP available for patients

Active substance	Indication	Date of approval	Responsible for the CUP
Belantamab mafodotin (GSK2857916) 2.5 mg/kg / 1.9 mg/kg solution for IV infusion	Multiple myeloma	2025-01-28	GSK Norway Contact person: Janne Beheim Mobile: +47 99 27 24 89 E-mail: janne.x.beheim@gsk.com
Sipavibart (AZD3151) 150 mg/mL solution for injection	Pre-exposure prophylaxis of COVID-19 for immunocompromised individuals	2024-04-10	AstraZeneca Nordic Contact person: Kristin Janett Løseth Phone: +47 21 00 64 00 Mobile phone: +47 90 08 11 65 E-mail: kristin.loseth@astrazeneca.com
Nimorazole tablets, 500 mg	Squamous cell Cancer of the Head and Neck (SCCHN)	2016-12-01	Inphena ApS Name: Søren Anker Nielsen Email: san@inphena.com Phone: (+45) 40 200 200

CUP no longer available for new patients

CUP no longer available for new patients

Active substance	Indication	Date of approval	Responsible for the CUP
Elranatamab (PF-06863135) 40mg/ml	Multiple Myeloma (MM)	02.02.2023 Ended: January 2024	Pfizer AS
Glofitamab (AG42296) 5 mg/ml solution for iv infusion	Relapsed / refractory Diffuse Large B-Cell Lymphoma (r/r DLBCL), transformed Follicular Lymphoma (tFL) or Primary Mediastinal B-Cell Lymphoma (PMBCL)	20.05.2021	Roche Norge AS
Tebentafusp (IMCgp100) 0.2mg/mL solution for infusion	HLA-A*02:01 positive patients with unresectable or metastatic uveal melanoma	16.01.2022 Ended: May 2023	Immunocore, Ltd.
Mosunetuzumab (AG42295) 1 mg/1 mL, 10 mg/10 mL og 30 mg/30 mL	Relapsed / Refractory Follicular Lymphoma (R/R FL)	14.10.2021. Ended: 2022-	Roche Norge AS
Pevonedistat (TAK-924/MLN4924 10 mg/ml consentrate for solution for iv infusion)	Higher risk myelodysplastic syndromes (HR-MDS), or low blast acute myelogenous leukemia (LB- AML)	25.08.2020	Takeda
Risdiplam (RO7034067)  60mg, mixture	Spinal muscular atrophy (SMA)	08.05.2020	Roche Norge AS
Zanamivir 10mg/ml Infusion bag.	Hospitalised patients severely ill with influenza infection	25.02.2011	GlaxoSmithKline Research & Development Limited, United Kingdom
Polatuzumabvedotin, 140mg concentrate for infusjon	Relapsed or refractory Diffuse Large B-Cell Lymphoma (r/r DLBCL)	01.02.2019	Roche Norge AS
Entrectinib capsules, 100mg, 200mg	Solid Tumors harboring a NTRK Gene Fusion or Patients with Non-Small Cell Lung Cancer (NSCLC) harboring a ROS1 Gene Fusion (AG40852)	07.03.2019	Roche Norge AS
Quizartinib tablets, 20mg and 30mg	Relapsed or Refractory Acute Myeloid Leukemia (AML) with FLT3-ITD mutations	12.03.2019	Daiichi Sankyo Inc.
Lorlatinib tablets, 5mg, 25mg, and 100mg acetate solvate tablets or as 25mg or 50mg free base tablets	Advanced non-small cell lung cancer (NSCLC) with an ALK or ROS1 gene rearrangement	05.09.2018	Pfizer Norge AS
Brigatinib tablets, 90 mg and 180 mg	ALK positive Non-Small Cell Lung Cancer	20.04.2018	Takeda Pharmaceuticals AS,
Emicizumab, 150 mg/1 ml	Hemophilia A and FVIII Inhibitors	01.11.2017	Roche Norge AS
Orcrelizumab, 300 mg intravenous infusion	Primary Progressive Multiple Sclerosis (PPMS)	07.06.2017	Roche Norge AS
Pembrolizumab, intravenous infusjon 2 mg/kg	Metastatic Melanoma	09.09.2014	MSD Norge AS
Ibrutinib capsules, 140mg	Relapsed or Refractory Chronic Lymphocytic Leukaemia/Small Lymphocytic Lymphoma with Deletion 17p	06.05.2014	Janssen-Cilag AB
Cobimetinib (GDC- 0973) 20 mg	advanced/metastatic BRAFV600 mutation-positive melanoma	25.06.2015	Roche Norge AS
Combination regimen of trametinib and dabrafenib. Dabrafenib 150 mg Trametinib 2 mg	BRAF activating mutation- positive metastatic melanoma	22.08.2015	GlaxoSmithKline (GSK) AS, Oslo
Daclatasvir, 60 mg	Chronic hepatitis C	23.06.2014	Bristol-Mayers Squibb AS
Boceprevir	Hepatitis C	05.05.2011	MSD
Abiratrone	Metastatic Advanced Prostate Cancer	19.11.2011	Jansen Cilag
Crizotinib (PF- 02341066)	Cancer (Positive ALK- fusion)	13.10.2011	Pfizer
Aflibercept	Metastatic Colorectal Cancer (mCRC)	28.09.2011	Sanofi

Documentation to be submitted

Cover letter

The cover letter must contain information regarding previous and/or ongoing clinical trials with the medicinal product in question. If there has been, or is ongoing, clinical trials in Norway please refer to the respective EudraCT-number(s) and/or EU CT number(s), as well as NoMA reference number(s).

 

Information on application for Marketing Authorisation (MA)

If an application for MA has been submitted, NoMA must be notified. If so, the application must include the refe​rence number for the MA application and the date of submission. This information can be provided in the cover letter.

Justification

The need of a CUP must be justified, reasoning why the patients cannot be satisfactorily treated with approved medicinal products. In addition, it must be justified why the patients cannot be included in an ongoing clinical trial.

Safety monitoring

The application must contain a description on how adverse reactions will be registered and reported.

Protocol (project plan)

There are no formal requirements on the content of a CUP protocol. For guidance, chapter 6 in ICH GCP and chapter 4 (page 10 and 11) in the Guidance on the Norwegian Regulation on Clinical Trials may be used.

Informing the patients

There are no formal requirements on the content of the patient information. For guidance, the template published by Regional Ethics Committee on clinical trials may be used.

Labelling

A label suggestion must be submitted with the application.

Benefit/risk assessment

Unless described in the protocol, a benefit/risk assessment has to be submitted with the application. The assessment must address the risks of using the medicinal product with respect to the potential benefits for the intended patient population. The benefit/risk assessment must contain a summary of the results from clinical trials where patients with the indication in question have been included.

 

Documentation of the medicinal products

If the application involves the use of a new active substance, or a new formulation of an already authorized substance, pharmaceutical documentation must be submitted. The investigator’s brochure must be submitted.

A list of all previous and/or ongoing clinical trials must be submitted. A reference to the corresponding EudraCT-number(s) and/or EU CT number(s) should be made, if available, as well as the NoMA reference numbers if any trials has been performed in Norway.

Contact information

The name and contact details ​for the person who can be contacted regarding the CUP must be provided in the application. This information will be publicly available on NoMAs website, please see Overview of CUPs​.

 

List of included patients

The responsible physician must have a list of all patients in the program. The list must be continuously updated while patients are included in the program. The applicant must once a year submit an update to NoMA regarding the number of patients included in the program.

 

Financing the medicinal product

The medicinal product must be free of charge for the patients included in the CUP. It is up to the manufacturer, the responsible institution and potentially the pharmacy to agree on the cost of the medicinal product.

Authorisations import and manufacturing

The regulation of import of medicinal products to be used within a CUP is the same as for import of other medicinal products. Medicinal products can be imported by businesses or hospital pharmacies with import authorisations. Within EEA, only import authorisation is required, whereas outside EEA (third countries) it is necessary with manufacturing authorisation in addition.

Authorisation for manufacturing is granted by NoMA. Amongst others, a manufacturing authorisation implies that there must be a Qualified Person (QP) to import the medicinal product. The QP has to make sure that all formal requirements to both the medicinal product and the transportation (from countries outside EEA) are met.

Approval

• Decisions taken by NoMA are made in accordance with § 2-8 in the Norwegian Regulation on Medicinal Products.
• The application must meet all the requirements for the Compassionate Use Program. All documentation described must be submitted for the evaluation of the application to begin (see step 2).
• NoMA can approve CUP for a limited period or grant a conditional approval. If an extension is necessary, a substantial amendment must be submitted for approval.
• There are no fees for CUP applications.

Application Processing Times

NoMA aims to respond to all applications for Compassionate Use within 35 days. Please note however, there are no legal requirements for processing times for CUP applications​.

Follow-up

Reporting of adverse reactions is as for products with MA, described in Regulation (EC) 726/2004, article 24(1) and article 25.

Substantial changes to the protocol must be submitted for approval as a substantial amendment. Substantial amendments include changes that can have a substantial influence on the safety of the patients, their physical/psychical integrity or the quality and safety of the medicinal product itself. The substantial amendments are assessed according to the same guidelines as for clinical trials. If NoMA has not commented on the substantial amendment within 35 days, the amendment is considered approved.

The applicant has to submit an annual report to NoMA. The report must include the number of patients included in the program, an updated risk/benefit assessment of the product and a line listing of all serious adverse events.

When a medicinal product used in a CUP is granted MA and the price is set, the proprietor of the MA must submit updated information to NoMA regarding the CUP within 30 days.

Patients already included in the CUP can continue in the program after the medicinal product has been granted MA and the price has been set, and the assessment of reimbursement is finalized, if the responsible physician deems it necessary. 

​New patients can be included until the price has been set, ​and the product is commercially available in Norway​.  Please, also see web page "Nye Metoder" (in Norwegian).

Termination

NoMA can terminate a CUP if it is deemed necessary, e.g. due to safety issues.