The U.S. Food and Drug Administration has authorized two expanded access programs utilizing Jaguar Health's novel crofelemer powder for oral solution to treat pediatric patients with microvillus inclusion disease (MVID), a devastating ultrarare intestinal condition. The programs are being conducted under separate Single-Patient Investigational New Drug (sIND) applications, marking a significant development for patients with this debilitating disorder.
Napo Pharmaceuticals, a Jaguar Health family company, is providing the investigational crofelemer formulation for these compassionate use programs. "Napo is committed to providing the novel crofelemer formulation as an investigational drug as deemed medically necessary by the physician caregiver for these two patients, intended for mitigating the sequela from MVID disease progression," said Pravin Chaturvedi, PhD, Napo's and Jaguar's Chief Scientific Officer and Chair of the Scientific Advisory Board.
Promising Early Clinical Results
The expanded access authorization comes following encouraging preliminary data from ongoing investigator-initiated trials. Initial proof-of-concept results presented at the Annual ELITE PED-GI Congress on April 26, 2025, demonstrated that crofelemer reduced required total parenteral nutrition (TPN) and supplementary intravenous fluids in the first participating MVID patient by up to 27% and in the first participating short bowel syndrome with intestinal failure (SBS-IF) patient by up to 12.5%.
These findings represent potentially significant clinical improvements for patients who typically require TPN for as long as 20 hours a day, seven days a week. An abstract describing these initial results has been accepted for presentation at the upcoming North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) Annual Meeting taking place November 5-8, 2025 in Chicago.
Addressing Critical Unmet Medical Need
MVID represents one of the most challenging pediatric gastrointestinal conditions, with an estimated prevalence of only about 200 patients worldwide. There are currently no approved drug treatments for this ultrarare disease. Patients with MVID and SBS-IF suffer from devastating diarrhea and dehydration, with TPN carrying significant risks including morbidity, infections, metabolic complications, liver and kidney problems, and neurodevelopmental delay.
Short bowel syndrome affects approximately 10,000 to 20,000 people in the U.S., according to the Crohn's & Colitis Foundation, with an estimated similar population size in Europe.
Comprehensive Clinical Development Program
Jaguar Health, through its family companies Napo and Napo Therapeutics, is currently supporting two independent proof-of-concept investigator-initiated trials and conducting two placebo-controlled clinical studies of crofelemer in patients with intestinal failure due to MVID and SBS-IF across the United States, European Union, and Middle East/North Africa regions.
Additional proof-of-concept results from investigator-initiated trials are expected later in 2025, with data from placebo-controlled clinical studies anticipated in 2026. The company expects that published clinical data could potentially support reimbursed early patient access to crofelemer in European Union countries in 2026 while pursuing regulatory approval from the European Medicines Agency (EMA) and FDA.
Potential for Expedited Regulatory Pathways
The company anticipates that positive results from even a small number of MVID patients could potentially qualify crofelemer for expedited regulatory pathways, including participation in the EMA's PRIME program, which provides enhanced interaction with drug developers of novel medicines targeting unmet medical needs, and the FDA's Breakthrough Therapies program.
Botanical Drug with Sustainable Sourcing
Crofelemer is a botanical drug extracted and purified from the red bark sap, also referred to as "dragon's blood," of the medicinal Croton lechleri tree in the Amazon Rainforest. Napo Pharmaceuticals has established a sustainable harvesting program under fair trade practices to ensure quality, ecological integrity, and support for indigenous communities.
The development represents a significant step forward in addressing the critical needs of patients with rare intestinal failure conditions, offering hope for improved quality of life and reduced dependence on intensive nutritional support.
