Interest Form: Bitopertin Expanded Access Program

Disc Medicine’s Expanded Access Program (EAP) allows eligible people with EPP or XLP to be considered for access to bitopertin, an investigational medicine being studied for these conditions, outside of a clinical trial.

United Porphyrias Association helps connect interested patients with available sites. As new sites become active, UPA will reach out directly to interested patient, especially when a site opens in or near their region.

Please note that completing the form does not mean you are enrolled in the program or guaranteed access to bitopertin.

Bitopertin is an investigational medicine. It is not approved by any regulatory authority, and its safety and effectiveness have not been established.

Learn more about the EAP here.

Name

First NameLast Name

Email

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Have you been formally diagnosed with EPP or XLP?

Age

Are you currently participating in a clinical trial and/or taking any study drug(s)?

Are you currently taking any medication(s) for porphyria?

Which medication(s) are you currently taking for your porphyria

Other

Have you ever taken Bitopertin?

Other