CN1946383A - 基于天然雌激素的多段式避孕制剂 - Google Patents

基于天然雌激素的多段式避孕制剂 Download PDF

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CN1946383A
CN1946383A CNA2005800125561A CN200580012556A CN1946383A CN 1946383 A CN1946383 A CN 1946383A CN A2005800125561 A CNA2005800125561 A CN A2005800125561A CN 200580012556 A CN200580012556 A CN 200580012556A CN 1946383 A CN1946383 A CN 1946383A
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扬·昂德里卡
贝恩德·迪斯特伯格
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    • AHUMAN NECESSITIES
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    • A61KPREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00Medicinal preparations containing organic active ingredients
    • A61K31/56Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids
    • A61K31/565Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids not substituted in position 17 beta by a carbon atom, e.g. estrane, estradiol
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61KPREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00Medicinal preparations containing organic active ingredients
    • A61K31/56Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids
    • A61K31/57Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids substituted in position 17 beta by a chain of two carbon atoms, e.g. pregnane or progesterone
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61PSPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P15/00Drugs for genital or sexual disorders; Contraceptives
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61PSPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P15/00Drugs for genital or sexual disorders; Contraceptives
    • A61P15/18Feminine contraceptives
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61PSPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
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    • A61P5/24Drugs for disorders of the endocrine system of the sex hormones

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Abstract

本发明涉及一种基于天然雌激素和合成孕激素的多段式避孕制剂。与经过长期和广泛的使用已被证明为可靠和安全的排卵抑制剂相比,本发明的多段式制剂避孕在整个周期持续时间内可靠性更高,改善了周期性出血,同时使副作用如乳房触痛、头痛、情绪低落和性欲改变等最小化或消除。

Description

基于天然雌激素的多段式避孕制剂
技术领域
本发明涉及一种基于天然雌激素和合成孕激素的多段式避孕制剂。
与经过长期和广泛的使用已被证明为可靠和安全的通过抑制排卵进行避孕的常规产品相比,本发明的多段式制剂避孕在整个周期持续时间内可靠性更高,改善了周期性出血,同时使副作用如乳房触痛、头痛、情绪低落和性欲改变等最小化或消除。
背景技术
专利文献中公开了基于天然雌激素和孕激素之组合的多段式避孕产品。
EP 0 770 388 B1中描述了一种多段式避孕产品,其中第一阶段由2至4个日剂量单元组成,并且每个日剂量单元中含有的活性成分全部为天然雌激素。该多段式产品的第二阶段由两组含有至少一种天然雌激素和至少一种合成孕激素的日剂量单元组成。在此,所述第一组由5至3个日剂量单元组成,而第二组由17至13个日剂量单元组成。第三阶段由2至4个日剂量单元组成,并且每个日剂量单元中含有的活性成分全部是天然雌激素。各阶段中天然雌激素的日剂量保持不变,但从第1至第3阶段依次递减。第二阶段中,第二组中合成或天然孕激素的比例大于第一组的比例。最后一个阶段由2至4个日剂量单元组成,并且每个日剂量单元中的活性成分是药学可接受的安慰剂。
在实施例5中列出了一种戊酸雌二醇和地诺孕素的组合。在此情况下,第一阶段为3个含有3mg戊酸雌二醇的日剂量单元,在第二阶段中,第一组为4个含有2mg戊酸雌二醇和1mg地诺孕素的日剂量单元,第二组为16个含有2mg戊酸雌二醇和2mg地诺孕素的日剂量单元,而第三阶段为2个含有1mg戊酸雌二醇的日剂量单元。最后一个阶段为3个含有药学可接受的安慰剂的日剂量单元。
为获得避孕可靠性的信息,采用放射免疫方法测定黄体酮的血清浓度。该专利所报道的黄体酮浓度为4.0ng/ml。从第一个给药周期至最后一个给药周期,不规则出血(突破性出血和点滴出血)的平均比例下降45至53%。
此外,现已查明组合制剂的避孕可靠性源自雌激素和孕激素这两种成分的作用。
现已查明抑制排卵需要每天使用1mg地诺孕素(Dienogest:Prklinikund Klinik eines neuen Gestagens,edited by A.T.Teichmann,Walter deGruyter Berlin/New York(1995),p.101)和2.0-3.0mg屈螺酮(Rosenbaum P,Schmidt W,Helmerhorst F M et a1.,Inhibition of ovulationby a novel progestogen(drospirenone)…,Eur contracept.Reprod.HealthCare 5:16-24(2000))。
此外,TAUBERT,H.D.和KUHL,H.(Kontrazeption mit Hormonen,editors Taubert,H.-D.et al.,Georg Thieme Verlag Stuttgart/New York(1995),p.160)指出不规则出血的发生率与雌激素,如炔雌醇或孕激素的血清浓度低之间没有必然的联系。
发明内容
因此,本发明的目的是提供一种基于天然雌激素的激素类避孕组合物,与常规通过抑制排卵进行避孕的产品相比,在整个周期的持续时间内本发明的多段式制剂的避孕可靠性更高,改善了周期性出血,同时使副作用如乳房触痛、头痛、情绪低落和性欲改变等最小化或消除。采用一种多段式避孕产品可以达到这一目的,在该多段式避孕产品中,第一阶段由2个含有3mg天然雌激素戊酸雌二醇的日剂量单元组成。第二阶段由两组日剂量单元组成,其中第一组包含5个含有2mg戊酸雌二醇和一种合成孕激素之组合的日剂量单元,其中该孕激素的剂量是抑制排卵剂量的至少2倍或3倍。该第二阶段的第二组由17个含有2mg戊酸雌二醇和一种合成孕激素之组合的日剂量单元组成,其中该孕激素的剂量是抑制排卵剂量的至少3倍或4倍。第三阶段包含2个含有1mg戊酸雌二醇的日剂量单元。最后一阶段为2个含有药学可接受的安慰剂的日剂量单元。
优选地,合成孕激素活性的成分,如地诺孕素、屈螺酮或某种孕激素的剂量至少是已知排卵抑制剂量的2倍。
本发明的多段式避孕产品特别适用于口服给药,但也可以采用阴道内给药、非肠道给药,包括局部给药、直肠给药、经鼻给药、口内给药或舌下给药等形式。
通过已知的方法,采用与所需给药形式相适应的制药技术中常规使用的固体或液体载体或稀释剂以及辅料,按所需剂量制备多段式避孕产品。
片、薄膜衣片、糖衣片或明胶硬胶囊优选用于口服给药。
具体实施方式
以下通过实施例对本发明进行说明。在本节中重点讨论避孕可靠性,周期性出血以及给药耐受性等问题。
避孕可靠性
避孕可靠性主要通过Hoogland评分加以确定,根据卵泡大小、雌二醇水平以及孕激素浓度给出Hoogland评分。在本发明中,采用放射免疫方法测定月经周期中指定时间点的黄体酮血清浓度,并且测定排卯数目(Hoogland评分为6)以及黄体化未破裂卵泡数目(Hoogland评分为5)。
周期稳定性
根据每个周期中记录的出血特性评价周期稳定性。重点是记录不规则出血的发生率(突破性出血和点滴出血)。对记录的方式进行标准化。数据被描述性地进行分析。
耐受性
根据主官感受如头痛、情绪低落、乳房触痛、胃部不适(恶心/呕吐)、水肿以及性欲改变评价耐受性。
实施例1
用药方案如下:
第1至2天:每日3mg戊酸雌二醇;
第3至7天:每日2mg戊酸雌二醇+2mg地诺孕素;
第8至24天:每日2mg戊酸雌二醇+3mg地诺孕素;
第25至26天:每日1mg戊酸雌二醇;
第27至28天:安慰剂。
93名女性参与了本项研究,年龄段为18至35岁。每人参与3次给药周期,对第2和第3个给药周期进行观察。
在第2个周期中(主实验期),93名妇女中有3人排卵(3.23%),在第3个给药周期中,93名妇女中有2人排卵。
因此,本发明给药方案抑制排卵的可靠性为96.77%。
同时,本发明的给药方案也表现出了良好的耐受性。
实施例2
用药方案如下:
第1至2天:每日3mg戊酸雌二醇;
第3至7天:每日2mg戊酸雌二醇+3mg地诺孕素;
第8至24天:每日2mg戊酸雌二醇+4mg地诺孕素;
第25至26天:每日1mg戊酸雌二醇;
第27至28天:安慰剂。
93名女性参与了本项研究,年龄段为18至35岁。每人参与3次给药周期,对第2和第3个给药周期进行观察。
在第2个给药周期中(主实验期),93名妇女中有2人排卵(2.15%),在第3个给药周期中,92名妇女中有2人排卵。
因此,本发明给药方案抑制排卵的可靠性为97.85%。
同时,本发明的给药方案也表现出了良好的耐受性。
两个实施例所观察到的有效排卵抑制率分别为97.85%和96.77%。在近期的有关常规排卵抑制剂的研究中(Pierson R A et al.,“OrthoEvra/Evra versus oral contraceptives:follicular development…”,Fertil.Steril.80(1),pp.34-42(2003)),实验结果证明即使是经过长期和广泛使用后被证明是可靠和安全的产品,排卵也占有一定的百分比。在第2个给药周期中,采用含有左炔诺孕酮的三段式口服避孕产品的排卵率为14%(22名实验对象中有3人排卵),采用含有左炔诺孕酮的一段式口服避孕产品时,25名实验对象中有6人排卵,而采用含有诺孕酯的三段式口服避孕产品的排卵率为16%(25名实验对象中有4人排卵)。这些数值与以上本发明产品所获得的效果明显不同,说明本发明产品的可靠性要高于Pierson等人所论述的避孕可靠性。

Claims (2)

1、基于天然雌激素和合成孕激素之组合的多段式避孕产品,其特征在于
第一阶段由2个含有3mg天然雌激素戊酸雌二醇的日剂量单元组成,
第二阶段由两组日剂量单元组成,其中第一组由5个含有2mg戊酸雌二醇和一种合成孕激素之组合的日剂量单元组成,其中该孕激素的剂量是抑制排卵剂量的至少2倍或3倍,而第二组由17个含有2mg戊酸雌二醇和一种合成孕激素之组合的日剂量单元组成,其中该孕激素的剂量是抑制排卵剂量的至少3倍或4倍,
第三阶段由2个含有1mg戊酸雌二醇的日剂量单元组成,以及
另外一个阶段由2个含有药学可接受的安慰剂的日剂量单元组成。
2、如权利要求1所述的多段式避孕产品,其特征在于所述合成孕激素活性成分为地诺孕素、屈螺酮或某种孕激素,其剂量至少是已知排卵抑制剂量的2倍。
CN2005800125561A 2004-04-20 2005-04-15 基于天然雌激素的多段式避孕制剂 Active CN1946383B (zh)

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DE102004019743A DE102004019743B4 (de) 2004-04-20 2004-04-20 Mehrphasenpräparat zur Kontrazeption auf der Basis eines natürlichen Estrogens
PCT/EP2005/004022 WO2005102247A2 (de) 2004-04-20 2005-04-15 Mehrphasenpräparat zur kontrazeption auf der basis eines natürlichen estrogens

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US20100173877A1 (en) 2010-07-08
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