AU726283B2 - Pharmaceutical combined preparations, kit and method for hormonal contraception - Google Patents

Description

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AUSTRALIA

Patents Act 1990

ORIGINAL

COMPLETE SPECIFICATION STANDARD PATENT .u

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5 S Applicant(s): Address for Service: Schering Aktiengesellschaft Mullerstrasse 178 D-13353 Berlin Germany DAVIES COLLISON CAVE Patent Trade Mark Attorneys Level 10, 10 Barrack Street SYDNEY NSW 2000 Invention Title: Pharmaceutical combined preparations, kit and method for hormonal contraception The following statement is a full description of this invention, including the best method of performing it known to me:- 5020 1 Pharmaceutical combined preparation, kit and method for hormonal contraception Description The present invention relates to a two-stage pharmaceutical combined preparation for hormonal contraception containing at least 30 daily unit doses, which preparation, in its first stage, comprises as hormonal active ingredient a combination of an oestrogen preparation and, in a dose that is at least sufficient to inhibit ovulation, a gestagen preparation, in single stage form and, in the second stage comprises as hormonal active ingredient an oestrogen preparation only, wherein the first stage comprises a minimum of 25 and a maximum of 77 daily discrete or continuous unit doses and the second eee: .stage comprises 5, 6 or 7 daily discrete or continuous unit doses, and wherein the total number of daily units is equal to the total number of days of the desired cycle of a minimum of 30 and a maximum of 84 days, and relates also to a corresponding pack (contraceptive kit) containing that combined preparation, o and to a contraceptive method that uses the above contraceptive preparation.

oo Oral contraceptives in the form of combined preparations have been known since 1960 as so-called monophase preparations. Those preparations consist of 21 unit doses that comprise active ingredient and 7 tablets or drag6es that are active ingredient-free. The daily unit dose is composed of an oestrogen and gestagen. In monophase preparations the dose of active ingredient to be administered daily is the same in each unit dose. If the dose that is to be administered daily of the active components in the individual unit doses is different in individual sections over the administration cycle, then 2 the preparation is referred to as a so-called multi-phase preparation. Triquilarw may be mentioned as an especially well-known example (DE-AS 23 65 103) As a result of the development of new, more active gestagens than those contained in the first oral contraceptives, a continuous reduction of the daily dose of gestagen has been possible. It has also been possible for the daily dose of oestrogen to be reduced although, as before, the oestrogen contained in hormonal contraceptives is usually ethynyloestradiol.

In the development of new, improved oral contraceptives, the following three factors have been (and are) dominant: contraceptive reliability good cycle control, that is to say a low incidence of intermediate bleeding and a minimum of undesired side effects should be ensured.

The contraceptive reliability is effected in particular by the gestagenic component. The daily dosage amount of that component corresponds at least to the threshold dose considered necessary for the gestagen in question to inhibit ovulation. The ethynyloestradiol usually used as

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the oestrogen in combined preparations should increase the ovulation-inhibiting effect of the gestagen and in particular ensure stability of the cycle. In the case of administration of ethynyloestradiol alone, the daily dose that has to be used in order to inhibit ovulation is 100 pg.

Combined preparations with the most recent generation of gestagens are, for example, the monophase preparations Femovan (DE-PS 2 546 062) and Marvelon (DE-OS 2 361 120) MilvaneV may be mentioned as an example of a multi-phase preparation in which the unit doses contain a gestagen of the most recent generation, namely gestodene 3 (EP-0 148 724). In those three-phase preparations, usually 4-6 drag6es are administered in the first phase, each dragee comprising a low dose of oestrogen and a low dose of gestagen. In the second phase of 4-6 dragees, each unit dose comprises an oestrogen in the same dose or a dose that is slightly increased (up to a maximum of twice) and a gestagen in the same dose or a in a dose that is slightly increased (up to a maximum of times). In a third phase of 9-11 units, each drag6e comprises an oestrogen in the same dose or a dose that is slightly reduced, at most reduced to the initial amount, and a gestagen in a dose that is further increased, to a maximum of 3 times the initial amount. 7 pill-free days then follow.

Recently, multi-phase combined preparations have been proposed that may provide an extended administration of active ingredient-containing unit doses, that is to say S• of up to 24 days in the 28-day cycle. In those preparations the daily dose of gestagen either increases from the first, over the second, up to the third phase (EP-A 0 491 415) or decreases (EP-A 0 491 438). In order to complete the 28-day cycle, in the first case there follow 4 blind pill days, 4 placebos or 4 unit doses that contain gestagen only, and in the second case from 4 to 7 blind pill days or from 4 to 7 placebos.

The aim of the development of new oral contraceptives having a reduced daily hormone dose is to minimize the side effects described in epidemiological studies. More recent epidemiological data point towards a trend for the improved tolerability of low-dose preparations in respect of cardiovascular side effects [Thorogood M, Oral Contraceptives and Cardiovascular Disease: an Epidemiologic Overview; Pharmacoepidemiology and Drug Safety, Vol. 2: 3-16 (1993); Gerstman B. Piper J. M., Tomita D. Ferguson W. Stadel Lundin F. E.; 4 Oral Contraceptive Estrogen Dose and the Risk of Deep Venous Thromboembolic Disease, Am. J. Vol.133, No. 1, 32-36 (1991); Lidegaard Oral contraception and the risk of a cerebral thromboembolic attack: results of a case-control study; BMJ Vol. 306, 956-63 (1993); Vessey Mant Smith Yeates Oral contraceptives and venous thromboembolism: findings in a large prospective study; BMJ, Vol. 292 (1986); Mishell Oral Contraception: Past, Present and Future Perspectives; Int. J. Fertil., 36 Suppl., 7-18 (1991)].

A connection between the level of the daily oestrogen dose and the frequency of cardiovascular complications is accepted.

The preparation currently having the lowest dose of oestrogen is marketed as MercilonR and contains 20 4g of ethynyloestradiol in combination with 150 Mg of descgestrel in each daily unit dose over a period of 21 days with a following pill-free period of 7 days. As is to be expected, the cycle control of that preparation by comparison with preparationshaving a higher dose of oestrogen is somewhat poorer. A further clinically significant problem is the observation, which has been made in several studies, of a lower ovarian suppression of the preparation containing 20 ,g of ethynyloestradiol.

Clearly, below that very low dose of oestrogen, ripening of follicles occurs in many women, which could be detected by ultrasound examinations and hormone tests [Lunell N. Carlstrom Zador Ovulation inhibition with a combined oral contraceptive containing 20 pg ethynyloestradiol and 250 pg levonorgestrel; Acta Obstet. Gynecol. Scand. Suppl. 88: 17-21 (1979); Mall- Haefeli Werner-Zodrow Huber P. Klinische Erfahrungen mit Mercilon und Marvelon unter besonderer Berucksichtigung der Ovar-Funktion (Clinical experiences 5 with Mercilon and Marvelonwith special considera--on given to ovary function); Geburtsh. and Frauenheil 51, 35-38, Georg Thieme Verlag, Stuttgart-New York (1991); Strobel Behandlung mit-oralen Kontrazeptiva (T-reatment with oral contraceptives); Fortschr Med. 11C Jg.

No 20 (1992); Letter to Editor, Contraception 45: 519- 521 (1992); Teichmann Brill Can Dose Reduction of Ethynylestradiol in OCs Jeopardize Ovarian Supp e e ssion and Cycle Control? Abstract Book, VIIIth World Conress on Human Reproduction, Bali, Indonesia (1993)].

Until recently, several days' interruption of the administration of drages containing active ingredient *-was considered necessary in order to trigger withdrawal bleeding and ensure adequate cycle control.

Other preparations have been described that contai an o estrogenic and gestagenic active ingredient and th a re generally administered in constant amounts in each Sindividual unit dose over a period of 21 days, the administration of those unit doses containing an oestrogenic and gestagenic active ingredient preceding the Sadministration of unit doses containing oestrogen only (Ijzerman US-A 3 502 772; Pasquale, US-A 4 921 843; Kuhl et al. EP-A 0 499 348) With those preparations, at h b

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i t h t h o s e p r e p a ratons at the beginning of administration, either already on the first day of the cycle (Kuhl) or at the earliest on che second day of the cycle (Pasquale), the administration is begun of unit doses that contain an oestrogenic active ingredient only, at a dose that is below the ovulationinhibiting dose of the oestrogenic component so that, developmentcially in the first cycle of administration follicle development may occur. Follicle development is con sidered responsible for breakthrough ovulation (Chowdt et al "Escape" ovulation in women due to the missing of low dose combination oral contraceptive pills, Contr,iaep- 6 tion, 22: 241-247, 1980; Molloy B.G. et al., "Missed pill" conception: fact or fiction? Brit. Med. J. 290, 1474-1475, 1985). The contraceptive protection is consequently placed in question. The risk of a pregnancy is therefore high especially in the case of mistakes in administration among the 20 pg ethynyloestradiol preparations.

DE-OS 43 13 926 describes a pharmaceutical preparation for contraception having a minimum of four phases, which preparation consists of a fixed or sequential combination, consisting of a minimum of three phases, of ethynyloestradiol or mestranol or another synthetic o. estrogen, and also a gestagen, and an oestrogen preparation that is to be administered at least in the fourth phase of the cycle and that contains ethynyloestradiol or mestranol and/or another synthetic and/or endogenous oestrogen. That preparation is to be administered over the entire cycle of the woman and is limited to a 28-day administration.

9 Common to all preparations for hormonal contraception on the market so far is that the pack unit is set to a 28day cycle of administration (4-week rhythm). For a prevention period of one year, that is to say 12 months, administration of the contents of 13 pack units is therefore necessary.

It has, of course, already been known for a long time that the onset of menstruation, when taking an oral contraceptive where there is a continuous daily administration of both oestrogen-containing and especially gestagen-containing unit doses, can be deferred until completion of the administration of the gestagen-containing unit doses [Hamerlynck J.V. Th. H. et al., Contraception 35,3: 199-205 (1987); Luodon IPPF Med. Bull.

7 13,1: 2-3 (1979); Luodon N.B. et al., Brit. Med. J.

60085: 487-490 (1977/2)] After stopping the gestagencontaining unit doses withdrawal bleeding commences.

Although the ovulation-inhibiting agent according to EP-A 0 499 348 is not limited to a desired administration cycle of 28 days, the number of hormone day units containing both oestrogen and gestagen is restricted to an upper limit of 23 day units.

The aim of the present invention is to provide a combined preparation having as low as possible an oestrogen content in each individual unit dose but at the same time also a low total hormone content per cycle of administration, with which, with a high degree of contraceptive reliability, as low as possible an incidence of follicle development even in the first cycle of administration, and satisfactory cycle control with reliable prevention of intermediate bleeding, such as breakthrough bleeding and spotting, are achieved and with which undesired side e' effects are avoided.

a This aim is achieved by the provision of the two-stage combined preparation described at the outset and also a corresponding pack containing that combined preparation (contraceptive kit) and a contraceptive method that uses the described contraceptive preparation.

Preferred arrangements of the present invention concern a pharmaceutical combined preparation of the type mentioned at the outset in which the first stage comprises 25 or 26 daily unit doses, the first stage comprises a minimum of 28 and a maximum of 84 daily unit doses, the first stage comprises 28 daily unit doses, the first stage comprises 28 plus 7, or 28 plus a multiple of 7, daily unit doses, 8 the second stage comprises 7 daily unit doses, the first stage comprises 25 or 26 daily unit doses and the second stage comprises 5 or 6 daily unit doses, so that the combined preparation has a total of 30 or 31 daily unit-doses.

The present invention relates furthermore to a contraceptive kit containing a minimum of 30 and a maximum of 84 daily unit doses each comprising at least one hormonal active ingredient, which kit has a first and a second stage, wherein, in its first stage, the kit comprises as hormonal active ingredient a combination of an oestrogen "*'*"preparation and, in a dose at least sufficient to inhibit ovulation, a gestagen preparation, in a single stage form, and, in the second stage, comprises as o o hormonal active ingredient an oestrogen preparation only, *o*the first stage comprising a minimum of 25 and a maximum of 77 daily discrete or continuous unit doses and the second stage comprising 5, 6 or 7 daily discrete or continuous unit doses, and the total number of daily units being equal to the total number of days of the desired cycle of a minimum of 30 and a maximum of 84 r oe days.

Preferred contraceptive kits according to the present invention are characterised as follows the first stage comprises 25 or 26 daily unit doses, the first stage comprises a minimum of 28 and a maximum of 84 daily unit doses, the first stage comprises 28 daily unit doses, the first stage comprises 28 plus 7, or 28 plus a multiple of 7, daily unit doses, the second stage comprises 7 daily unit doses, the first stage comprises 25 or 26 daily unit doses and the second stage comprises 5 or 6 daily unit -9doses, so that the kit has a total of 30 or 31 daily unit doses.

In a further embodiment of the contraceptive kit according to the invention, some of the unit doses of the first stage are arranged in periodically repeating sub-units that are separated from one another spatially and/or by other markings.

Preferably, the unit doses are arranged in sub-units at the earliest from the 26th daily unit dose, the individual sub-units can be separated from one another by perforations or other means suitable for separation, 7 unit doses are contained in each of the separate sub-units, the first stage comprises 28 plus 7, or 28 plus a multiple of 7, daily unit doses, and/or the second stage comprises 7 daily unit doses.

In yet a further embodiment of the invention there is provided the use of hormonal active ingredients in the manufacture of a medicament for mammalian female contraception, wherein the medicament is a two-stage pharmaceutical combined preparation for hormonal contraception containing at least 30 daily unit doses, which preparation, in its first stage, comprises as hormonal active ingredient a combination of an oestrogen preparation and, in a dose that is at least sufficient to inhibit ovulation, a gestagen preparation, in single stage form and, in the second stage comprises as hormonal active ingredient an oestrogen preparation only, wherein the first stage comprises a minimum of 25 and a maximum of 77 daily discrete or continuous unit doses and the second stage comprises 5, 6 or 7 daily discrete or continuous unit doses, and wherein the total number of daily units is equal to the total number of days of the desired cycle of a minimum of 30 and a maximum of 84 days.

In the case of the contraceptive method according to the invention, which employs the described combined preparation, in the first stage, commencing with the first day of the cycle, a unit dose comprising an oestrogen in combination with a gestagenic component is administered daily over a minimum period of 25 and a maximum period of 77 days. There then follows the second stage in which over the remaining period of the cycle, which cycle comprises a minimum of 30 and a maximum of 84 days, an oestrogen is administered over 5, 6 or 7 days.

i Thus a unit dose comprising a hormonal active ingredient is administered on every day of the cycle.

.oo o S With administration of the combined preparation according to the invention, recruitment of the dominant follicle, which in the spontaneous cycle occurs during the first 6 days of the menstrual cycle, is efficiently suppressed. Thus, with the combined preparation of the present invention follicle development can be suppressed and consequently breakthrough ovulations avoided, thereby increasing contraceptive reliability.

This is of great importance especially where mistakes are made in administration, particularly in the case of hormonal contraceptives having a low daily dose of ethynyloestradiol. Since 25 of women who take the pill are known to make mistakes (omitting unit doses or extending the interval between the daily administration of two unit doses to more than 24 hours) (Finlay

I.G.,

Scott Patterns of contraceptive pill-taking in an inner city practice. Br. Med. J. 1986, 293: 601-602), the combined preparation according to the invention, when Sused as an ovulation-inhibiting agent, increases contraceptive reliability. This is true in particular in the case of the lowest-dose preparations.

In particular, however, this higher number of daily unit doses comprising both oestrogen and gestagen results in an extension of the cycle and a reduced frequency of withdrawal bleeding.

The subsequent stage, in which unit doses that comprise Sas hormonal active ingredient an oestrogenic component only are administered daily over 5, 6 or 7 days, ensures a withdrawal bleeding and causes a stimulation of progesterone receptors in the endometrium, as a result of which a reduced rate of intermediate bleeding compared with conventional low-dose preparations is achieved in the subsequent administration cycle.

In conjunction with the extended phase of administration of oestrogen- and gestagen-containing unit doses, for example an extension of the menstrual cycles to 30 or 31 days (monthly pack) is thus possible.

According to the preferred variants an optional postpone- 11 ment of the withdrawal bleeding up to day 77 is possible, the bleeding commencing after the unit doses comprising oestrogen and gestagen have been stopped.

A variable manipulation of the initiation of the withdrawal bleeding is possible with the contraceptive kit according to the present invention, in which the unit doses of the first stage, at the earliest from the 26th daily unit dose, are arranged in sub-units that can be separated from one another by perforations or some other suitable means of separation.

The contraceptive kit according to the invention is constructed, for example, in the form of a blister in which each individual segment, each of which preferably contains 7 unit doses of the first stage, can conveniently and easily be separated by means of perforations made in the base plate of the blister.

It is, however, also possible for the sub-units each to be in the form of individual separate blisters or for the, for example, 28 unit doses of the first stage to be in a first blister and for the following unit doses of the first stage to be in a second blister in which subunits can be separated from one another by perforations in the described manner.

Preferably, in all embodiments of the invention the oestrogen of the first hormone component is selected from the group of compounds 179-oestradiol, ethynyloestradiol and 179-oestradiol valerate and the gestagen is selected from the group of compounds 12 dienogest gestodene, levonorgestrel, desogestrel, 3-ketodesogestrel, drospironenone, cyproterone acetate, norgestimate and norethisterone and also the oestrogen of the second hormone component is selected from the group of compounds 17S-oestradiol, ethynyloestradiol and 171-oestradiol valerate.

Preferably, in the present invention the oestrogen of the first hormone component is contained in each daily unit e dose in a dose of from 1.0 to 6.0 mg of 179-oestradiol, from 0.015 to 0.025 mg of ethynyloestradiol, from 1.0 to 4.0 mg of 17S-oestradiol valerate Sand the gestagen is contained in each daily unit dose in a dose of from 1.0 to 3.0 mg of dienogest from 0.05 to 0.075 mg of gestodene, from 0.05 to 0.125 mg of levonorgestrel, from 0.06 to 0.15 mg of desogestrel, from 0.06 to 0.15 mg of 3-ketodesogestrel, from 1.0 to 3.0 mg of drospironenone, from 1.0 to 2.0 mg of cyproterone acetate, from 0.2 mg to 0.3 mg of norgestimate 13 from 0.35 to 0.75 mg of norethisterone.

The second hormone component comprises the oestrogen in each daily unit dose preferably in an amount of from 1.0 to 6.0 mg of 179-oestradiol, from 0.002 to 0.04 mg of ethynyloestradiol, from 1.0 to 4.0 mg of 179-oestradiol valerate.

According to an especially preferred embodiment the second hormone component contains as oestrogen ethynyloestradiol in an amount of from 0.01 to 0.015 mg in each daily unit dose.

There come into consideration as oestrogen for the first and for the second hormone component especially ethynyloestradiol or the natural oestradiol.

Of the gestagens mentioned for the second hormone component attention is drawn to gestodene; levonorgestrel is also preferred.

Ss.. 179-oestradiol valerate, which may be contained as the teoo oestrogen both in the first and in the second hormone component, is mentioned only as a possible representative of those 178-oestradiol esters; other homologous esters of that kind may also be used as the oestrogen component within the scope of the present invention.

The following Examples serve to illustrate the present invention in more detail Example 1: Day 1 2 3 4 5 6 7 Composition C C C C C C C 14 0S

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00 3 *0 90 S

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00

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Day Composition Day Composition Day Composition Day Composition Example 2: Day Composition Day Composition Day Composition Day Composition Day Composition Example 3: Day Composition Day Composition 18 19 C C 22 23 C C 20 21 C C 15 16 C C 19 20 21 C C C 25 26 C C 13 14 C C Day Composition Day Composition Day Composition Example 4: Day Composition Day Composition Day Composition Day Composition Day Composition Day Composition Day Composition Day Composition 15 16 17 18 19 20 21 C C C C C C C 22 23 24 C C C C 26 27 28 29 30 31 E E E E E E 1 2 3 4 5 6 7 C C C C C C C 8 9 10 11 12 13 14 C C C C C C C 15 16 17 18 19 20 21 C C C C C C C 22 23 24 25 26 27 28 C C C C C C C 29 30 31 32 33 34 C C C C C C C 45 46 C C 52 53 C C 50 51 C C Day Composition Example Day Composition Day Composition Day Composition Day Composition Day Composition Day Composition Day Composition Day Composition Day Composition Day Compos it ion 10 11 C C 17 18 C C 24 25 C C 31 32 C C 59 E E 27 28 C C 34 C C 41 42 C C 0 0 38 49 40 C C C 46 47 C C 53 54 C C 50 51 C C 58 59 C C C 65 66 67 68 C C C C Day 71 Composition C 72 73 74 75 76 C C C C C 17 78 79 80 81 82 83 84 E E E E E E E Day Composition Example 6: Day Composition Day Composition Day Composition Day Composition 1 2 3 4 5 6 7 C C C C C C C 8 9 10 11 12 13 -14 C C C C C C C 15 16 17 18 19 20 21 C C C C C C C 22 23 24 25 26 27 28 C C C C C C C 29 30 31 32 33 34 C C C C C C C Day Composition Day Composition Day Composition Day Composition 36 37 38 49 40 41 42 C C C C C C C 43 44 45 46 47 48 49 C C C C C C C 50 51 52 53 54 55 56 E E E E E E E Day day of the menstrual cycle, day 1 is of bleeding the first day 18 C combination of oestrogen and gestagen first hormone component) E oestrogen second hormone component) P perforation The formulation of the unit doses is effected in conventional manner with the use of auxiliaries known for the preparation of oestrogen-/gestagen-containing and exclusively oestrogen-containing tablets, pills, dragees etc.

The combined preparation according to the invention serves to prevent conception in women by the administration of daily unit doses of the first hormone component over a minimum of 25 and a maximum of 77 days, commencing on day 1 of the menstrual cycle (first day of menstrual bleeding) followed by 5, 6 or 7 daily unit doses of the second hormone component, which contains exclusively an oestrogen for a total of a minimum of 30 and a maximum of 84 days in the administration cycle. In the second (next) menstrual cycle, administration of the first unit dose of the first hormone component of a new pack unit (kit) of the pharmaceutical combined preparation according to the invention is commenced on day one o *of that cycle, without any pause in administration.

I'ith that combined preparation, pronounced ovarian suppression without frequent follicle ripening, and also excellent cycle control, can be achieved with a low daily oestrogen dose, a low total amount of oestrogen and a low total amount of hormone per administration cycle.

The advantages of that combined preparation-according to the invention (ovulation-inhibiting agent) administered over a minimum of 30 and a maximum of 84 days per cycle compared with the preparations described hitherto, 19 especially those having a daily ethynyloestradiol dose of less that 30 Ag and those with a pill-free period, may be characterised as follows: 1. A significantly lower frequency of follicle development in the user. This means a lower risk of breakthrough ovulation and consequently a greater contraceptive reliability especially where mistakes are made in administration.

2. The recruitment of the dominant follicle is effectively suppressed by the extension of the administra- .*.tion of the combination.

3. The administration of 5, 6 or 7 daily oestrogen unit doses following the administration of the combination dose of the first stage results in a clearly improved cycle control and in a lower incidence of side effects, suchas headaches within the framework o of premenstrual syndrome.

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4. Other clinical symptoms that are attributable to [.strongly fluctuating endogenous levels of oestrogen, such as, for example, tenderness of the breasts, are likewise distinctly reduced on account of the *significantly stronger ovarian suppression.

As a result of the freedom from bleeding (amenorrhoea) for a longer period, there is an increased acceptance by the user; this is true especially as the number of. unit doses in the first stage increases.

6. The negative effects that occur with or as a result of bleeding, such as, for example, anaemia, cramp, queasiness etc. occur less frequently.

7. Constant low oestrogen and gestagen levels; consequent avoidance of metabolic variations and as a result improvement of tolerability.

8. A possible pregnancy as a result of mistakes in administration is recognisable by the absence of withdrawal bleeding after stopping the oestrogenand gestagen-containing unit doses.

The formulation of an oestrogen and gestagen for the preparation of a combined preparation according to the invention is effected in a manner completely analogous to that already known for conventional oral contraceptives having a 21-day administration period of active ingredients, such as, for example, Femovart (ethynyloestra- .diol/gestodene) or Microgynonv (ethynyloestradiol/levonorgestrel). The formulation of the exclusively oestrogen-containing unit doses can also be carried out in a completely analogous manner to that known for oestrogencontaining agents designed for oral administration that are already available, for example ProgynonC®. The unit doses of the first stage of the preparation according to the invention may also be in the form of a plaster (transdermal application), an implant or another depot formulation and thus administered continuously.

As a form of packing for the combined preparation according to the invention, a blister pack constructed in the manner according to the invention is generally used; other forms of packing known for that purpose are, however, also possible.

In order to determine equivalently effective amounts of ethynyloestradiol and 178-oestradiol on the one hand and of different gestagens, such as gestodene, levonor- 21 gestrel, desogestrel and 3 -ketodesogestrel, on the other hand, reference is made to the data given in EP-A-0 253 607. Further details for determining dosage equivalents of different gestagenic active ingredients may be found, for example, in "Probleme der Dosisfindung: Sexualhormone" (Problems of dosage determination: sexual hormones); F. Neumann et al. in "Arzneimittelforschung" (Drug Research) 27, 2a, 296-318 (1977) and in "Aktuelle Entwicklungen in der hormonal Kontrazeption" (Current developments in hormonal contraception), H. Kuhl in "Gynacologe" 25: 231-240 (1992).

Throughout this specification and the claims which follow, unless the context requires otherwise, the word "comprise", or variations such as "comprises" or "comprising", will be understood to imply the inclusion of a stated integer or step or group of integers or steps but not the exclusion of any other integer or step or group of integers or steps.

S*

Claims (8)

1. Method of contraception in female mammals comprising a sequential administration for a minimum of 30 and a maximum of 84 days of daily unit doses of a minimum of 25 and a maximum of 77 daily discrete or continuous unit doses during a first stage and 5, 6 or 7 daily discrete or continuous unit doses during a second stage, compris- ing as hormonal active ingredient in the first stage a combination of an oestrogen preparation and, in a dose that is at least sufficient to inhibit ovulation, a gestagen preparation, in single stage form, and comprising as hormonal active ingredient in the second stage an oestrogen preparation only.

2. Method according to claim 1, characterised in that in the first stage 25 or 26 daily unit doses are administered.

3. Method according to claim 1, characterised in that in the first stage a minimum of 28 and a maximum of 77 daily unit doses are administered.

4. Method according to claim 3, characterised in that in the first stage 28 daily unit doses are administered. *i .o9 Method according to claim 3, characterised in that in the first stage 28 plus 7, or 28 plus a multiple of 7, daily unit doses are administered. ooo 9

6. Method according to any one of the preceding claims, characterised in that in the o ~second stage 7 daily unit doses are administered. 9 999*

7. Method according to claim 2, characterised in that in the second stage 5 or 6 daily unit doses are administered. 999*

8. Method according to any one of the preceding claims, characterised in that the oestrogen in the unit doses of the first stage is selected from the group of compounds

171-oestradiol, ethynyloestradiol and 17B-oestradiol valerate and the gestagen is selected from the group of compounds dienogest gestodene, levonorgestrel, desogestrel, 3-ketodesogestrel, drospironenone, cyproterone acetate, norgestimate and norethisterone and also the oestrogen in the unit doses of the second hormone component is selected from the group of compounds .i 17B-oestradiol, ethynyloestradiol and 17B-oestradiol valerate. 9. Method according to any one of the preceding claims, characterised in that the oestrogen of the first stage is administered in each daily unit dose in a dose of *OWS from 1.0 to 6.0 mg of 17B-oestradiol, from 0.015 to 0.025 mg of ethynyloestradiol, o from 1.0 to 4.0 mg of 17B-oestradiol valerate and the gestagen is administered in each daily unit dose in a dose of -24- from 1.0 to 3.0 mg of dienogest from 0.05 to 0.075 mg of gestodene, from 0.05 to 0.125 mg of levonorgestrel, from 0.06 to 0.15 mg of desogestrel, from 0.06 to 0.15 mg of 3-ketodesogestrel, from 1.0 to 3.0 mg of drospironenone, from 1.0 to 2.0 mg of cyproterone acetate, from 0.2 mg to 0.3 mg of norgestimate from 0.35 to 0.75 mg of norethisterone. Method according to any one of the preceding claims, characterised in that there is administered in each daily unit dose in the second stage an amount of from 1.0 to 6.0 mg of 17B-oestradiol, from 0.002 to 0.04 mg of ethynyloestradiol, from 1.0 to 4.0 mg of 17B-oestradiol valerate. 11. Method according to any one of claims 1 to 10, in which the female mammals is a homo sapiens. 12. Use of hormonal active ingredients in the manufacture of a medicament for mammalian female contraception, wherein the medicament is a two-stage pharmaceutical combined preparation for hormonal contraception containing at least 30 daily unit doses, "which preparation, in its first stage, comprises as hormonal active ingredient a combination of an oestrogen preparation and, in a dose that is at least sufficient to inhibit ovulation, a gestagen preparation, in single stage form and, in the second stage comprises as hormonal active ingredient an oestrogen preparation only, wherein the first stage comprises a minimum of 25 and a maximum of 77 daily discrete or continuous unit doses and the second stage comprises 5, 6 or 7 daily discrete or continuous unit doses, and wherein the total number of daily units is equal to the total number of days of the desired cycle of a minimum of 30 and a maximum of 84 days. 13. Use of claim 12, characterised in that the first stage comprises 25 or 26 daily unit doses. 14. Use of claim 12, characterised in that the first stage comprises a minimum of 28 and a maximum of 84 daily unit doses. Use of claim 14, characterised in that the first stage comprises 28 daily unit doses. 16. Use of claim 14, characterised in that the first stage comprises 28 plus 7, or 28 plus a multiple of 7, daily unit doses. 17. Use of claim 12, characterised in that the second stage comprises 7 daily unit doses. 18. Use of claim 13, characterised in that the second stage comprises 5 or 6 daily unit doses, so that the combined preparation has a total of 30 or 31 daily unit doses. 19. Use of any one of claims 12 to 18, characterised in that the oestrogen of the first stage is selected from the group of compounds 17B-oestradiol, ethynyloestradiol and 17f-oestradiol valerate and the gestagen is selected from the group of compounds dienogest S. gestodene, aelevonorgestrel, desogestrel, drospironenone, .cyproterone acetate, -26- norgestimate and norethisterone and also the oestrogen of the second hormone component is selected from the group of compounds 17B-oestradiol, ethynyloestradiol and 17B-oestradiol valerate. Use of any one of claims 12 to 19, characterised in that the oestrogen of the first stage is contained in each daily unit dose in a dose of from 1.0 to 6.0 mg of 17B-oestradiol, from 0.015 to 0.025 mg of ethynyloestradiol, from 1.0 to 4.0 mg of 179-oestradiol valerate and the gestagen is contained in each daily unit dose in a dose of from 1.0 to 3.0 mg of dienogest from 0.05 to 0.075 mg of gestodene, from 0.05 to 0.125 mg of levonorgestrel, from 0.06 to 0.15 mg of desogestrel, from 0.06 to 0.15 mg of 3-ketodesogestrel, from 1.0 to 3.0 mg of drospironenone, from 1.0 to 2.0 mg of cyproterone acetate, from 0.2 mg to 0.3 mg of norgestimate from 0.35 to 0.75 mg of norethisterone. 21. Use of any one of claims 12 to 20, characterised in that there is contained in each daily unit dose in the second stage an amount of o• from 1.0 to 6.0 mg of 17B-oestradiol, -27- from 0.002 to 0.04 mg of ethynyloestradiol, from 1.0 to 4.0 mg of 17B-oestradiol valerate. 22. Methods of contraception and uses of hormonal active ingredients in the manufacture of medicaments for mammalian female contraception substantially as hereinbefore described especially with reference to the Examples. DATED this 27 th day of April 2000 SCHERING AG By their Patent Attorneys DAVIES COLLISON CAVE 0 0 o0*