EP2709447A1 - Zusammensetzungen, verfahren und systeme für die verabreichung von zwei oder mehr wirkstoffen über die atemwege - Google Patents

Zusammensetzungen, verfahren und systeme für die verabreichung von zwei oder mehr wirkstoffen über die atemwege

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Publication number
EP2709447A1
EP2709447A1 EP11865780.8A EP11865780A EP2709447A1 EP 2709447 A1 EP2709447 A1 EP 2709447A1 EP 11865780 A EP11865780 A EP 11865780A EP 2709447 A1 EP2709447 A1 EP 2709447A1
Authority
EP
European Patent Office
Prior art keywords
active agent
suspension
less
fevi
particles
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Withdrawn
Application number
EP11865780.8A
Other languages
English (en)
French (fr)
Other versions
EP2709447A4 (de
Inventor
Reinhard Vehring
Michael Steven Hartman
David Lechuga-Ballesteros
Adrian Edward Smith
Vidya B. Joshi
Sarvajna Kumar Dwivedi
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Pearl Therapeutics Inc
Original Assignee
Pearl Therapeutics Inc
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Pearl Therapeutics Inc filed Critical Pearl Therapeutics Inc
Publication of EP2709447A1 publication Critical patent/EP2709447A1/de
Publication of EP2709447A4 publication Critical patent/EP2709447A4/de
Withdrawn legal-status Critical Current

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00—Medicinal preparations characterised by special physical form
    • A61K9/10—Dispersions; Emulsions
    • A61K9/12—Aerosols; Foams
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00—Medicinal preparations characterised by special physical form
    • A61K9/0012—Galenical forms characterised by the site of application
    • A61K9/007—Pulmonary tract; Aromatherapy
    • A61K9/0073—Sprays or powders for inhalation; Aerolised or nebulised preparations generated by other means than thermal energy
    • A61K9/008—Sprays or powders for inhalation; Aerolised or nebulised preparations generated by other means than thermal energy comprising drug dissolved or suspended in liquid propellant for inhalation via a pressurized metered dose inhaler [MDI]
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/16—Amides, e.g. hydroxamic acids
    • A61K31/165—Amides, e.g. hydroxamic acids having aromatic rings, e.g. colchicine, atenolol, progabide
    • A61K31/167—Amides, e.g. hydroxamic acids having aromatic rings, e.g. colchicine, atenolol, progabide having the nitrogen of a carboxamide group directly attached to the aromatic ring, e.g. lidocaine, paracetamol
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/40—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with one nitrogen as the only ring hetero atom, e.g. sulpiride, succinimide, tolmetin, buflomedil
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00—Medicinal preparations characterised by special physical form
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00—Medicinal preparations characterised by special physical form
    • A61K9/14—Particulate form, e.g. powders, Processes for size reducing of pure drugs or the resulting products, Pure drug nanoparticles
    • A61K9/16—Agglomerates; Granulates; Microbeadlets ; Microspheres; Pellets; Solid products obtained by spray drying, spray freeze drying, spray congealing,(multiple) emulsion solvent evaporation or extraction
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
    • A61L9/00—Disinfection, sterilisation or deodorisation of air
    • A61L9/015—Disinfection, sterilisation or deodorisation of air using gaseous or vaporous substances, e.g. ozone
    • A61L9/02—Disinfection, sterilisation or deodorisation of air using gaseous or vaporous substances, e.g. ozone using substances evaporated in the air by heating or combustion
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P11/00—Drugs for disorders of the respiratory system
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P11/00—Drugs for disorders of the respiratory system
    • A61P11/02—Nasal agents, e.g. decongestants
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P11/00—Drugs for disorders of the respiratory system
    • A61P11/06—Antiasthmatics
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P11/00—Drugs for disorders of the respiratory system
    • A61P11/08—Bronchodilators
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P11/00—Drugs for disorders of the respiratory system
    • A61P11/14—Antitussive agents
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P29/00—Non-central analgesic, antipyretic or antiinflammatory agents, e.g. antirheumatic agents; Non-steroidal antiinflammatory drugs [NSAID]
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P37/00—Drugs for immunological or allergic disorders
    • A61P37/08—Antiallergic agents
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P43/00—Drugs for specific purposes, not provided for in groups A61P1/00-A61P41/00
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P9/00—Drugs for disorders of the cardiovascular system
    • A61P9/10—Drugs for disorders of the cardiovascular system for treating ischaemic or atherosclerotic diseases, e.g. antianginal drugs, coronary vasodilators, drugs for myocardial infarction, retinopathy, cerebrovascula insufficiency, renal arteriosclerosis
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P9/00—Drugs for disorders of the cardiovascular system
    • A61P9/12—Antihypertensives
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00—Medicinal preparations characterised by special physical form
    • A61K9/10—Dispersions; Emulsions

Definitions

  • the present disclosure relates generally to compositions, methods and systems for respiratory delivery of two or more active agents.
  • the present disclosure relates to compositions, methods, and systems for respiratory delivery of two or more active agents, wherein at least one of the active agents is selected from long-acting muscarinic antagonist ("LAMA”), long- acting ⁇ 2 adrenergic agonist (“LABA”), and corticosteroid active agents.
  • LAMA long-acting muscarinic antagonist
  • LAA long- acting ⁇ 2 adrenergic agonist
  • corticosteroid active agents corticosteroid active agents.
  • inhalers are well known devices for administering an active agent to a subject's respiratory tract, and several different inhaler systems are currently commercially available. Three common inhaler systems include dry powder inhalers, nebulizers and metered dose inhalers (MDIs).
  • MDIs metered dose inhalers
  • MDIs may be used to deliver medicaments in a solubilized form or as a suspension.
  • MDIs use a relatively high vapor pressure propellant to expel aerosolized droplets containing an active agent into the respiratory tract when the MDI is activated.
  • Dry powder inhalers generally rely on the patient's inspiratory efforts to introduce a medicament in a dry powder form to the respiratory tract.
  • nebulizers form a medicament aerosol to be inhaled by imparting energy to a liquid solution or suspension.
  • MDIs are active delivery devices that utilize the pressure generated by a propellant.
  • CFCs chlorofluorocarbons
  • traditional CFC propellants are understood to have a negative environmental impact, which has led to the development of alternative propellants that are believed to be more environmentally-friendly, such as perfluorinated compounds (PFCs) and hydrofluoroalkanes (HFAs).
  • PFCs perfluorinated compounds
  • HFAs hydrofluoroalkanes
  • the active agent to be delivered by a suspension MDI is typically provided as a fine particulate dispersed within a propellant or combination of two or more propellants (i.e., a propellant "system").
  • a propellant "system” In order to form the fine particulates, the active agent is typically micronized. Fine particles of active agent suspended in a propellant or propellant system tend to aggregate or flocculate rapidly. This is particularly true of active agents present in micronized form. In turn, aggregation or flocculation of these fine particles may complicate the delivery of the active agent. For example, aggregation or flocculation can lead to mechanical failures, such as those that might be caused by obstruction of the valve orifice of the aerosol container.
  • Unwanted aggregation or flocculation of drug particles may also lead to rapid sedimentation or creaming of drug particles, and such behavior may result in inconsistent dose delivery, which can be particularly troublesome with highly potent, low dose medicaments.
  • Another problem associated with such suspension MDI formulations relates to crystal growth of the drug during storage, resulting in a decrease over time of aerosol properties and delivered dose uniformity of such MDIs. More recently, solution approaches, such as those disclosed in U.S. Patent No. 6,964,759, have been proposed for MDI formulations containing anticholinergics.
  • FIG. 1 is a graph, which depicts the delivered dose uniformity of a co- suspension formulation containing glycopyrrolate and formoterol fumarate prepared according to the present description.
  • FIG. 2 is a graph, which depicts the delivered dose ratio of the co- suspension formulation of FIG. 1 .
  • FIG. 3 is a graph, which depicts the delivered dose uniformity of a second co-suspension formulation prepared according to the present description
  • FIG. 4 is a graph, which depicts the delivered dose ratio of the second co- suspension formulation of FIG. 3.
  • FIG. 5 is a graph, which depicts the delivered dose uniformity of glycopyrrolate and formoterol fumarate in a co-suspension formulation prepared according to the present description upon storage under different conditions as indicated.
  • FIG. 6 is a graph, which depicts the particle size distributions of exemplary co-suspension formulations prepared according to the present description upon storage under different conditions, as indicated.
  • FIG. 7 provides graphs illustrating the particle size distributions achieved by an exemplary co-suspension including a combination of glycopyrrolate and formoterol fumarate, upon storage at indicated conditions.
  • FIG. 8 provides graphs illustrating the particle size distribution achieved by an exemplary co-suspension including a combination of glycopyrrolate and formoterol fumarate compared to particle size distributions achieved by formulations including either glycopyrrolate or formoterol fumarate alone.
  • FIG. 9 is a graph, which depicts the serum glycopyrrolate and formoterol concentration levels over time achieved after delivery of an exemplary co- suspension including glycopyrrolate and formoterol fumarate prepared according to the present description.
  • the serum concentration time profile of glycopyrrolate and formoterol fumarate delivered from the exemplary combination formulation is compared to that achieved by compositions containing and delivering glycopyrrolate or formoterol fumarate alone.
  • FIG. 10 is a graph that depicts the formoterol particle size distribution achieved by a dual co-suspension prepared according to the present description, which included microcyrstaNine formoterol fumarate and glycopyrrolate active agent particles compared to a co-suspension only containing crystalline formoterol fumarate.
  • FIG. 1 1 is a graph that depicts the glycopyrrolate particle size distribution achieved by a dual co-suspension prepared according to the present description, which included microcrystalline glycopyrrolate active agent particles and microcrystalline formoterol fumarate active agent particles with two different particle size distributions (denoted “fine” and “coarse”) or spray dried formoterol fumarate.
  • FIG. 12 is a graph that depicts the formoterol fumarate particle size distribution achieved by a second dual co-suspension prepared according to the present description, which included microcrystalline formoterol fumarate and microcrystalline glycopyrrolate active agent particles compared to one that contained microcrystalline glycopyrrolate active agent particles and spray dried formoterol fumarate particles.
  • FIG. 13 is a graph, which depicts the delivered dose uniformity of glycopyrrolate and formoterol fumarate in an exemplary dual co-suspension formulation prepared according to the present description.
  • FIG. 14 depicts the delivered dose uniformity for each active agent included in an exemplary triple co-suspension composition, which included microcrystalline glycopyrrolate, formoterol fumarate and mometasone furoate active agent particles.
  • FIG. 15 is a graph depicting the formoterol fumarate aerodynamic particle size distributions achieved in a triple co-suspension prepared according to the present description, which included microcystalline glycopyrrolate, formoterol fumarate and mometasone furoate active agent particles, compared to that achieved in a dual co-suspension which included glycopyrrolate and formoterol fumarate.
  • FIG. 16 is a graph depicting the glycopyrrolate aerodynamic particle size distributions achieved in a triple co-suspension prepared according to the present description, which included microcystalline glycopyrrolate, formoterol fumarate and mometasone furoate active agent particles, compared to that achieved in a dual co- suspension which included glycopyrrolate and formoterol fumarate.
  • FIG. 17 is a graph depicting the glycopyrrolate and tiotropium bromide aerodynamic particle size distributions achieved by a triple co-suspension prepared according to the present description, which, in addition to either glycopyrrolate or tiotropium bromide active agent particles, included formoterol fumarate and mometasone furoate microcrystalline active agent particles.
  • FIG. 18 is a graph depicting the glycopyrrolate aerodynamic size distribution achieved by a two dual and one single component co-suspension prepared according to the present description. The dose proportionality between the two dual co-suspensions as well as the equivalency between the dual and the single component co-suspension is displayed.
  • FIG. 19 is a graph depicting the formoterol fumarate aerodynamic size distribution achieved by a two dual and two single component co-suspensions prepared according to the present description. The dose proportionality between the two dual and two single component co-suspensions as well as the equivalency between the dual and the single component co-suspension is displayed.
  • FIG. 20 is a graph depicting the dose delivered uniformity of ultra low formoterol fumarate single component co-suspensions prepared according to the present description.
  • FIG. 21 is a graph depicting the cumulative response over time on the first day of administration of two treatments using combination co-suspension compositions as described herein (GP/FF 72/9.6 and GP/FF 36/9.6) compared to two different delivering a single active agent (one delivering only glycopyrrolate - GP 36, and a second delivering only tiotropium bromide - Spiriva).
  • GP/FF 72/9.6 and GP/FF 36/9.6 two different delivering a single active agent
  • the graph illustrates the percent of patients achieving >12% improvement in FEVi and the time at which such percentages were achieved.
  • FIG. 22 - FIG. 24 provide graphs illustrating the mean change from baseline in FEVi AUC 0- 12 on treatment day 7 (Day 7) for various study compositions administered to patients as part of the clinical study described in Example 12.
  • Two treatments using combination co-suspension compositions as described herein are compared to a placebo and various different active compositions delivering a single active agent (one delivering only glycopyrrolate - GP 36, a second delivering only tiotropium bromide - Spiriva, and three delivering only formoterol fumarate - FF 7.2, FF 9.6, and Foradil).
  • FIG. 25 is a graph illustrating the FEVi AUC 0- 12 on Day 7 for each of the active study compositions administered to patients as part of the clinical study described in Example 12. The improvement in FEW ⁇ AUC 0- 12 provided by each of the active study compositions relative to placebo is shown.
  • FIG. 26 is a graph illustrating the difference between the FEVi AUCo-12 achieved by the GP/FF 36/9.6 treatment on Day 7 relative to the GP 36, FF 9.6, Spiriva and Foradil active comparators.
  • the GP/FF 36/9.6 treatment provided significantly better improvements in
  • FIG. 27 is a graph showing the Peak FEVi on treatment day 1 (Day 1 ) and Day 7 achieved by various study compositions administered to patients as part of the clinical study described in Example 12.
  • the Peak FEVi shown represents the peak change in FEVi from baseline provided by each of the active study composition relative to placebo on the study day indicated.
  • FIG. 28 is a graph illustrating the difference between the Peak FEVi achieved by the GP/FF 36/9.6 treatment on Day 1 and Day 7 relative to the Spiriva and Foradil active comparators. As can be easily appreciated by reference to FIG. 28, the GP/FF 36/9.6 treatment provided significantly better improvements in Peak FEVi compared to the active comparators.
  • FIG. 29 is a graph illustrating the improvements in Morning Trough FEVi achieved by various study compositions administered to patients as part of the clinical study described in Example 12. The graph illustrates the improvement in Morning Trough FEVi values provided by each of the active study compositions relative to placebo.
  • FIG. 30 is a graph showing the difference between the increase in pre- dose FEVi on Day 7 of the clinical study described in Example 12 provided by two treatments using combination co-suspension compositions as described herein (GP/FF 72/9.6 and GP/FF 36/9.6) relative to the different single active agent comparators and to each other.
  • GP/FF 72/9.6 and GP/FF 36/9.6 treatments provided significantly better improvements in pre-dose FEVi compared to the single active agent comparators, but did not differ significantly from each other.
  • FIG. 31 provides a graph illustrating the Day 1 and 7 peak, and Day 7 pre- dose improvements in inspiratory capacity (IC) relative to placebo provided by the two treatments using combination co-suspension compositions (GP/FF 72/9.6 and GP/FF 36/9.6) and the Spiriva active comparator composition administered as part of the clinical trial described in Example 12.
  • FIG. 32 provides a graph illustrating the consistent patient response achieved in the clinical study described in Example 12 regardless of the severity of the chronic obstructive pulmonary disease suffered by the patients.
  • the present disclosure provides compositions, methods, and systems for respiratory delivery of two or more active agents.
  • the present disclosure includes pharmaceutical compositions, systems and methods for respiratory delivery of two or more active agents via an MDI, and in particular embodiments at least one of the active agents is selected from long-acting muscarinic antagonist ("LAMA"), long-acting ⁇ 2 adrenergic agonist ("LABA”), and corticosteroid active agents.
  • LAMA long-acting muscarinic antagonist
  • LAA long-acting ⁇ 2 adrenergic agonist
  • corticosteroid active agents corticosteroid active agents.
  • the compositions described herein may be formulated for pulmonary or nasal delivery via an MDI.
  • the methods described herein include methods of stabilizing formulations including two or more active agents for respiratory delivery, as well as methods for pulmonary delivery of two or more active agents for treating a pulmonary disease or disorder via an MDI.
  • MDI systems for delivery of two or more active agents, as well as methods for preparing such
  • Formulating pharmaceutical compositions incorporating two or more active agents is often challenging due to unpredictable or unexpected interactions between the active agents or changes to the formulations resulting from the incorporation of multiple active agents. Such interactions are generally known as a "combination effect," and in the context of suspension formulations delivered from an MDI, a combination effect may be manifest by, for example, a deviation from similarity between a formulation including a single active agent and a formulation including a combination of two or more active agents in one or more of the following areas: the aerosol and particle size distribution characteristics provided by the formulation; delivered dose uniformity for one or more of the active agents; deliverability or absorption of one or more of the active agents; or the dose proportionality observed for one or more of the active agents.
  • the co- suspension compositions described herein avoid combination effects associated with combination formulations.
  • a composition avoids combination affects where, for a selected active agent, the aerosol properties, particle size distribution characteristics, and delivered dose uniformity achieved by a combination formulation do not deviate from those achieved by a comparable formulation wherein the only active agent is the selected active agent.
  • the lack of a combination effect is evidenced for a selected active agent where the plasma concentration over time for a targeted dose of the selected active agent delivered from a combination formulation does not deviate from the plasma concentration over time achieved when the selected active agent is delivered at the same dose from a comparable formulation wherein the only active agent is the selected active agent.
  • the phrases “do not deviate” or “does not deviate” signify that, for a given parameter, the performance achieved by a combination formulation is ⁇ 20% of that achieved by a comparable formulation including only one of the active agents included in the combination formulation. In certain embodiments, the performance achieved by a combination formulation does not vary from that achieved by a comparable formulation including only one of the active agents included in the combination.
  • a co-suspension as described herein, including two or more active agents is considered to exhibit no combination effect when, with respect to each such active agent at a given dose, one or more of the aerosol properties, the particle size distribution characteristics, the delivered dose uniformity, and the plasma concentration over time achieved by the combination co- suspension are within ⁇ 20% of those achieved by a comparable formulation including only a single active agent.
  • one or more of the aerosol properties, the particle size distribution characteristics, the delivered dose uniformity, and the plasma concentration over time achieved by the combination co-suspension compositions described herein are within ⁇ 15% of those achieved by a comparable formulation including only a single active agent.
  • one or more of the aerosol properties, the particle size distribution characteristics, the delivered dose uniformity, and the plasma concentration over time achieved by the combination co-suspension compositions described herein are within ⁇ 10% of those achieved by a comparable formulation including only a single active agent.
  • the combination co-suspension compositions as described herein exhibit no difference to comparable formulations including only one of the active agents included in the combination in one or more of the following areas: aerosol properties for the formulation; the particle size distribution characteristics; delivered dose uniformity for; and the plasma concentration over time.
  • the combination of two or more active agents included in the compositions provided herein may, in some embodiments, provide advantages over pharmaceutical formulations including only a single active agent. For instance, when a combination of two or more active agents is delivered simultaneously, the therapeutically effective dose of both active agents may be relatively less than when any of the combined active agents is delivered alone, thereby avoiding or reducing possible side effects. Moreover, combinations of two or more active agents may achieve a more rapid onset or longer duration of therapeutic benefit than can be achieved by delivering one of the combined active agents alone.
  • the methods described herein include methods for treating a pulmonary disease or disorder amenable to treatment by respiratory delivery of a co-suspension composition as described herein.
  • the compositions, methods and systems described herein can be used to treat inflammatory or obstructive pulmonary diseases or conditions.
  • compositions, methods and systems described herein can be used to treat patients suffering from a disease or disorder selected from asthma, chronic obstructive pulmonary disease (COPD), exacerbation of airways hyper reactivity consequent to other drug therapy, allergic rhinitis, sinusitis, pulmonary vasoconstriction, inflammation, allergies, impeded respiration, respiratory distress syndrome, pulmonary hypertension, pulmonary vasoconstriction, and any other respiratory disease, condition, trait, genotype or phenotype that can respond to the administration of, for example, a LAMA, LABA, corticosteroid, or other active agent as described herein, whether alone or in combination with other therapies.
  • COPD chronic obstructive pulmonary disease
  • compositions, systems and methods described herein can be used to treat pulmonary inflammation and obstruction associated with cystic fibrosis.
  • COPD chronic obstructive lung disease
  • COAD chronic obstructive airway disease
  • CAL chronic airflow limitation
  • CORD chronic obstructive respiratory disease
  • asthma refers to asthma of whatever type or genesis, including intrinsic (non-allergic) asthma and extrinsic (allergic) asthma, mild asthma, moderate asthma, severe asthma, bronchitic asthma, exercise-induced asthma, occupational asthma and asthma induced following bacterial infection. Asthma is also to be understood as embracing whez-infant syndrome.
  • embodiments of the co-suspension compositions described herein provide a significant increase in one or more measures of lung function or capacity when compared to compositions delivering only a single active agent.
  • the delivery of a co-suspension composition as described herein including two or more active agents results in a significant increase in one or both of FEVi and inspiratory capacity (IC) relative to composition containing only a single active agent.
  • active agent is used herein to include any agent, drug, compound, composition or other substance that may be used on, or administered to a human or animal for any purpose, including therapeutic, pharmaceutical, pharmacological, diagnostic, cosmetic and prophylactic agents and immunomodulators.
  • active agent may be used interchangeably with the terms, “drug,” “pharmaceutical,” “medicament,” “drug substance,” or “therapeutic.”
  • drug may also encompass natural or homeopathic products that are not generally considered therapeutic.
  • association refers to an interaction or relationship between a chemical entity, composition, or structure in a condition of proximity to a surface, such as the surface of another chemical entity, composition, or structure.
  • the association includes, for example, adsorption, adhesion, covalent bonding, hydrogen bonding, ionic bonding and electrostatic attraction, Lifshitz-van der Waals interactions and polar interactions.
  • adhesion or “adhesion” is a form of association and is used as a generic term for all forces tending to cause a particle or mass to be attracted to a surface.
  • Adhere also refers to bringing and keeping particles in contact with each other, such that there is substantially no visible separation between particles due to their different buoyancies in a propellant under normal conditions.
  • a particle that attaches to or binds to a surface is encompassed by the term "adhere.”
  • Normal conditions may include storage at room temperature or under an accelerative force due to gravity.
  • active agent particles may associate with suspending particles to form a co-suspension, where there is substantially no visible separation between the suspending particles and the active agent particles or flocculates thereof due to differences in buoyancy within a propellant.
  • Suspending particles refer to a material or combination of materials that is acceptable for respiratory delivery, and acts as a vehicle for active agent particles. Suspending particles interact with the active agent particles to facilitate repeatable dosing, delivery or transport of active agent to the target site of delivery, i.e., the respiratory tract.
  • the suspending particles described herein are dispersed within a suspension medium including a propellant or propellant system, and can be configured according to any shape, size or surface characteristic suited to achieving a desired suspension stability or active agent delivery performance.
  • Exemplary suspending particles include particles that exhibit a particle size that facilitates respiratory delivery of active agent and have physical configurations suited to formulation and delivery of the stabilized suspensions as described herein.
  • co-suspension refers to a suspension of two or more types of particles having different compositions within a suspension medium, wherein one type of particle associates at least partially with one or more of the other particle types.
  • the association leads to an observable change in one or more characteristics of at least one of the individual particle types suspended in the suspension medium. Characteristics modified by the association may include, for example, one or more of the rate of aggregation or flocculation, the rate and nature of separation, i.e. sedimentation or creaming, density of a cream or sediment layer, adhesion to container walls, adhesion to valve components, and rate and the level of dispersion upon agitation.
  • Exemplary methods for assessing whether a co-suspension is present can include the following: If one particle type has a pycnometric density greater than the propellant and another particle type has a pycnometric density lower than the propellant, a visual observation of the creaming or sedimentation behavior can be employed to determine the presence of a co-suspension.
  • the term "pycnometric density" refers to the density of a material that makes up a particle, excluding voids within the particle.
  • the materials can be formulated or transferred into a transparent vial, typically a glass vial, for visual observation.
  • co-suspension includes partial co-suspensions, where a majority of the at least two particle types associate with each other, however, some separation (i.e., less than a majority) of the at least two particle types may be observed.
  • the exemplary co-suspension test may be performed at different propellant temperatures to accentuate the sedimentation or creaming behavior of particle types with a density close to the propellant density at room temperature. If the different particle types have the same nature of separation, i.e. all sediment or all cream, the presence of a co-suspension can be determined by measuring other characteristics of the suspension, such as rate of aggregation or flocculation, rate of separation, density of cream or sediment layer, adhesion to container walls, adhesion to valve components, and rate and level of dispersion upon agitation, and comparing them to the respective characteristics of the similarly suspended individual particle types. Various analytical methods generally known to those skilled in the art can be employed to measure these characteristics.
  • the term "fine particle dose” or “FPD” refers to the dose, either in total mass or fraction of the nominal dose or metered dose, that is within a respirable range.
  • the dose that is within the respirable range is measured in vitro to be the dose that deposits beyond the throat stage of a cascade impactor, i.e., the sum of dose delivered at stages 3 through filter in a Next Generation Impactor operated at a flow rate of 30 l/min.
  • the term "fine particle fraction” or “FPF” refers to the proportion of the delivered material relative to the delivered dose (i.e., the amount that exits the actuator of a delivery device, such as an MDI) that is within a respirable range.
  • the amount of delivered material within the respirable range is measured in vitro as the amount of material that deposits beyond the throat stage of a cascade impactor, e.g., the sum of the material delivered at stages 3 through filter in a Next Generation Impactor operated at a flow rate of 30 l/min.
  • the term “inhibit” refers to a measurable lessening of the tendency of a phenomenon, symptom or condition to occur or the degree to which that phenomenon, symptom or condition occurs.
  • the term “inhibit” or any form thereof, is used in its broadest sense and includes minimize, prevent, reduce, repress, suppress, curb, constrain, restrict, slow progress of and the like.
  • Mass median aerodynamic diameter refers to the aerodynamic diameter of an aerosol below which 50% of the mass of the aerosol consists of particles with an aerodynamic diameter smaller than the MMAD, with the MMAD being calculated according to monograph 601 of the United States Pharmacopeia (“USP").
  • optical diameter indicates the size of a particle as measured by the Fraunhofer diffraction mode using a laser diffraction particle size analyzer equipped with a dry powder dispenser (e.g., Sympatec GmbH, Clausthal-Zellerfeld, Germany).
  • solution mediated transformation refers to the phenomenon in which a more soluble form of a solid material (i.e. particles with small radius of curvature (a driving force for Ostwald ripening), or amorphous material) dissolves and recrystallizes into the more stable crystal form that can coexist in equilibrium with its saturated propellant solution.
  • a "patient” refers to an animal in which a combination of active agents as described herein will have a therapeutic effect. In one embodiment, the patient is a human being.
  • Perforated microstructures refer to suspending particles that include a structural matrix that exhibits, defines or comprises voids, pores, defects, hollows, spaces, interstitial spaces, apertures, perforations or holes that allow the surrounding suspension medium to permeate, fill or pervade the microstructure, such as those materials and preparations described in U.S. Patent No. 6,309,623 to Weers, et al.
  • the primary form of the perforated microstructure is, generally, not essential, and any overall configuration that provides the desired formulation characteristics is contemplated herein. Accordingly, in one embodiment, the perforated microstructures may comprise approximately spherical shapes, such as hollow, suspending, spray-dried microspheres. However, collapsed, corrugated, deformed or fractured particulates of any primary form or aspect ratio may also be compatible.
  • perforated microstructures may be formed of any biocompatible material that does not substantially degrade or dissolve in the selected suspension medium. While a wide variety of materials may be used to form the particles, in some embodiments, the structural matrix is associated with, or includes, a surfactant such as, a phospholipid or fluorinated surfactant. Although not required, the incorporation of a compatible surfactant in the perforated microstructure or, more generally, the suspending particles, can improve the stability of the respiratory dispersions, increase pulmonary deposition and facilitate the preparation of the suspension.
  • a surfactant such as, a phospholipid or fluorinated surfactant
  • suspension medium refers to a substance providing a continuous phase within which active agent particles and suspending particles can be dispersed to provide a co-suspension formulation.
  • the suspension medium used in co-suspension formulations described herein includes propellant.
  • propellant refers to one or more pharmacologically inert substances which exert a sufficiently high vapor pressure at normal room temperature to propel a medicament from the canister of an MDI to a patient on actuation of the MDI's metering valve.
  • propellant refers to both a single propellant and to a combination of two or more different propellants forming a “propellant system.”
  • respirable generally refers to particles, aggregates, drops, etc. sized such that they can be inhaled and reach the airways of the lung.
  • the terms “physical stability” and “physically stable” refer to a composition that is resistant to one or more of aggregation, flocculation, and particle size changes due to solution mediated transformations and is capable of substantially maintaining the MMAD of suspending particles and the fine particle dose.
  • physical stability may be evaluated through subjecting compositions to accelerated degradation conditions, such as by temperature cycling as described herein.
  • potent indicates active agents that are therapeutically effective at or below doses ranging from about 0.01 mg/kg to about 1 mg/kg. Typical doses of potent active agents generally range from about 100 pg to about 100 mg.
  • the term “highly potent” indicates active agents that are therapeutically effective at or below doses of about 10 pg/kg. Typical doses of highly potent active agents generally range up to about 100 pg.
  • suspension stability and “stable suspension” refer to suspension formulations capable of maintaining the properties of a co-suspension of active agent particles and suspending particles over a period of time.
  • suspension stability may be measured through delivered dose uniformity achieved by co-suspension compositions described herein.
  • substantially insoluble means that a composition is either totally insoluble in a particular solvent or it is poorly soluble in that particular solvent.
  • the term “substantially insoluble” means that a particular solute has a solubility of less than one part per 100 parts solvent.
  • the term “substantially insoluble” includes the definitions of "slightly soluble” (from 100 to 1000 parts solvent per 1 part solute), “very slightly soluble” (from 1000 to 10,000 parts solvent per 1 part solute) and “practically insoluble” (more than 10,000 parts solvent per 1 part solute) as given in Table 16-1 of Remington: The Science and Practice of Pharmacy, 21 st ed. Lippincott, Williams & Wilkins, 2006, p. 212.
  • surfactant refers to any agent which preferentially adsorbs to an interface between two immiscible phases, such as the interface between water and an organic polymer solution, a water/air interface or organic solvent/air interface.
  • Surfactants generally possess a hydrophilic moiety and a lipophilic moiety, such that, upon adsorbing to microparticles, they tend to present moieties to the continuous phase that do not attract similarly-coated particles, thus reducing particle agglomeration.
  • surfactants may also promote adsorption of a drug and increase bioavailability of the drug.
  • a "therapeutically effective amount” is the amount of compound which achieves a therapeutic effect by inhibiting a disease or disorder in a patient or by prophylactically inhibiting or preventing the onset of a disease or disorder.
  • a therapeutically effective amount may be an amount which relieves to some extent one or more symptoms of a disease or disorder in a patient; returns to normal either partially or completely one or more physiological or biochemical parameters associated with or causative of the disease or disorder; and/or reduces the likelihood of the onset of the disease of disorder.
  • chemically stable and “chemical stability” refer to co- suspension formulations wherein the individual degradation products of active agent remain below the limits specified by regulatory requirements during the shelf life of the product for human use (e.g., 1 % of total chromatographic peak area per ICH guidance Q3B(R2)) and there is acceptable mass balance (e.g., as defined in ICH guidance Q1 E) between active agent assay and total degradation products.
  • compositions described herein are co-suspensions that include two or more active agents and include a suspension medium, one or more species of active agent particles, and one or more species of suspending particles.
  • the compositions described herein may include one or more additional constituents.
  • variations and combinations of components of the compositions described herein may be used.
  • compositions described herein include a first active agent provided in active agent particles that are co-suspended with at least one species of suspending particles that incorporate a second active agent.
  • compositions described herein include two or more active agents provided in two or more different species of active agent particles co-suspended with at least one species of suspending particles that incorporate an active agent different from that contained in any of the active agent particles.
  • compositions described herein include two or more active agents provided in two or more different species of active agent particles co-suspended with at least one species of suspending particles that incorporate an active agent that may be the same as or different from that contained in any of the active agent particles.
  • compositions described herein include two or more active agents provided in two or more different species of active agent particles co-suspended with one or more species of suspending particles that are free of active agent. Where the compositions described herein include two or more species of active agent particles, such compositions may be referred to as "multi" co-suspensions.
  • compositions including two species of active agent particles co-suspended with one or more species of suspending particles may be referred to as a dual co-suspension
  • a composition including three species of active agent particles co-suspended with one or more species of suspending particles may be referred to as a triple co- suspension, etc.
  • the active agent particles exhibit an association with the suspending particles such that the active agent particles and suspending particles co-locate within the suspension medium.
  • the medium within which they are suspended e.g., a propellant or propellant system
  • buoyancy forces cause creaming of particles with lower density than the propellant and sedimentation of particles with higher density than the propellant. Therefore, in suspensions that consist of a mixture of different types of particles with different density or different tendencies to flocculate, sedimentation or creaming behavior is expected to be specific to each of the different particle types and expected to lead to separation of the different particle types within the suspension medium.
  • the combinations of propellant, active agent particles, and suspending particles described herein provide co-suspensions including combinations of two or more active agents wherein the active agent particles and suspending particles co-locate within the propellant (i.e., the active agent particles associate with the suspending particles such that suspending particles and active agent particles do not exhibit substantial separation relative to each other, such as by differential sedimentation or creaming, even after a time sufficient for the formation of a cream or sediment layer).
  • the compositions described herein form co-suspensions wherein the suspending particles remain associated with active agent particles when subjected to buoyancy forces amplified by temperature fluctuations and/or centrifugation at accelerations up to and over, for example, 1 g, 10 g, 35 g, 50 g, and 100 g.
  • the co- suspensions described herein need not be defined by a specific threshold force of association.
  • a co-suspension as contemplated herein may be successfully achieved where the active agent particles associate with the suspending particles such that there is no substantial separation of active agent particles and suspending particles within the continuous phase formed by the suspension medium under typical patient use conditions.
  • Co-suspensions of active agent particles and suspending particles provide desirable chemical stability, suspension stability and active agent delivery characteristics.
  • co-suspensions as described herein can inhibit one or more of the following: flocculation of active agent material; differential sedimentation or creaming of active agent particles and suspending particles; solution mediated transformation of active agent material; chemical degradation of a component of the formulation, including of active agent material or a surfactant; and loss of active agent to the surfaces of the container closure system, in particular the metering valve components.
  • co-suspensions can provide a physically and chemically stable formulation that provides consistent dosing characteristics for two or more active agents, even where such active agents are delivered at significantly different doses, while utilizing a relatively simple HFA suspension medium that does not require modification by the addition of, for example, cosolvents, antisolvents, solubilizing agents or adjuvants.
  • compositions prepared as described herein when delivered from an MDI, eliminate or substantially avoid the pharmaceutical effects often experienced with formulations including multiple active agents.
  • the combination formulations described herein provide delivery characteristics for each of the active agents contained therein comparable to delivery characteristics of the same active agents when formulated and delivered separately.
  • Providing a co-suspension according to the present description may also simplify formulation, delivery and dosing of the desired active agents. Without being bound by a particular theory, it is thought that by achieving a co-suspension of active agent particles and suspending particles, the delivery, physical stability, and dosing of an active agent contained within such a dispersion may be substantially controlled through control of the size, composition, morphology and relative amount of the suspending particles, and is less dependent upon the size and morphology of the particles of active agent.
  • the pharmaceutical compositions described herein can be formulated with a non-CFC propellant or propellant system substantially free of antisolvents, solubilizing agents, cosolvents, or adjuvants.
  • Co-suspension compositions formulated according to the present teachings can inhibit physical and chemical degradation of the active agents included therein.
  • the compositions described herein may inhibit one or more of chemical degradation, flocculation, aggregation and solution mediated transformation of the active agents included in the compositions.
  • the chemical and suspension stability provided by the co-suspension compositions described herein allows the compositions to be dispensed in a manner that achieves desirable delivered dose uniformity throughout emptying of an MDI canister ("DDU") for multiple active agents, even where at least one of the active agents to be delivered may be highly potent and the delivered doses of each of the active agents vary considerably.
  • DDU MDI canister
  • Co-suspension compositions as described herein which include two or more active agents, can achieve a DDU of ⁇ 30%, or better for each of the active agents included therein. In one such embodiment, compositions described herein achieve a DDU of ⁇ 25%, or better, for each of the active agents included therein. In another such embodiment, compositions described herein achieve a DDU of ⁇ 20%, or better, for each of the active agents included therein.
  • co-suspension compositions according to the present description serve to substantially preserve FPF and FPD performance throughout emptying of an MDI canister, even after being subjected to accelerated degradation conditions. For instance, compositions according to the present description maintain as much as 80%, 90%, 95%, or more, of the original FPF or FPD performance, even after being subjected to accelerated degradation conditions.
  • Co-suspension compositions described herein provide the added benefit of achieving such performance while being formulated using non-CFC propellants.
  • the compositions described herein achieve one or more of a targeted DDU, FPF or FPD, while being formulated with suspension medium including only one or more non-CFC propellants and without the need to modify the characteristics of the non-CFC propellant, such as by the addition of, for example, one or more cosolvent, antisolvent, solubilizing agent, adjuvant or other propellant modifying material.
  • the suspension medium included in a composition described herein includes one or more propellants.
  • suitable propellants for use as suspension mediums are those propellant gases that can be liquefied under pressure at room temperature, and upon inhalation or topical use, are safe and toxicologically innocuous. Additionally, it is desirable that the selected propellant be relatively non-reactive with the suspending particles and active agent particles.
  • Exemplary compatible propellants include hydrofluoroalkanes (HFAs), perfluorinated compounds (PFCs), and chlorofluorocarbons (CFCs).
  • propellants that may be used to form the suspension medium of the co-suspensions disclosed herein include 1 ,1 ,1 ,2-tetrafluoroethane (CF3CH2F) (HFA-134a), 1 ,1 ,1 ,2,3,3,3-heptafluoro-n-propane (CF3CHFCF3) (HFA- 227), perfluoroethane, monochloro-fluoromethane, 1 ,1 difluoroethane, and combinations thereof.
  • CF3CH2F 1-tetrafluoroethane
  • CF3CHFCF3 1 ,1 ,1 ,2,3,3,3-heptafluoro-n-propane
  • perfluoroethane monochloro-fluoromethane
  • 1 ,1 difluoroethane and combinations thereof.
  • suitable propellants include, for example: short chain hydrocarbons; Ci -4 hydrogen-containing chlorofluorocarbons such as CH 2 CIF, CCI2FCHCIF, CF3CHCIF, CHF2CCIF2, CHCIFCHF2, CF3CH2CI, and CCIF2CH3; CM hydrogen-containing fluorocarbons (e.g., HFAs) such as CHF 2 CHF 2 , CF 3 CH 2 F, CHF2CH3, and CF3CHFCF3; and perfluorocarbons such as CF3CF3 and CF 3 CF 2 CF 3 .
  • short chain hydrocarbons Ci -4 hydrogen-containing chlorofluorocarbons such as CH 2 CIF, CCI2FCHCIF, CF3CHCIF, CHF2CCIF2, CHCIFCHF2, CF3CH2CI, and CCIF2CH3
  • CM hydrogen-containing fluorocarbons e.g., HFAs
  • perfluorocarbons such as CF3CF3
  • Specific fluorocarbons, or classes of fluorinated compounds, that may be used as suspension media include, but are not limited to, fluoroheptane, fluorocycloheptane, fluoromethylcycloheptane, fluorohexane, fluorocyclohexane, fluoropentane, fluorocyclopentane, fluoromethylcyclopentane, fluorodimethyl- cyclopentanes, fluoromethylcyclobutane, fluorodimethylcyclobutane, fluorotrimethyl- cyclobutane, fluorobutane, fluorocyclobutane, fluoropropane, fluoroethers, fluoropolyethers and fluorotriethylamines. These compounds may be used alone or in combination with more volatile propellants.
  • FC-1 1 (CCI 3 F), FC-1 1 B1 (CBrCI 2 F), FC-1 1 B2 (CBr 2 CIF), FC12B2 (CF 2 Br 2 ), FC21 (CHCI 2 F), FC21 B1 (CHBrCIF), FC-21 B2 (CHBr 2 F), FC-31 B1 (CH 2 BrF), FC1 13A (CCI3CF3), FC-122 (CCIF 2 CHCI 2 ), FC-123 (CF 3 CHCI 2 ), FC-132 (CHCIFCHCIF), FC-133 (CHCIFCHF 2 ), FC-141 (CH 2 CICHCIF), FC-141 B (CCI 2 FCH 3 ), FC-142 (CHF 2 CH 2 CI), FC-151 (CH 2 FCH 2 CI), FC-152 (CH 2 FCH 2
  • the suspension medium may be formed of a single propellant. In other embodiments, a combination of propellants may be used to form the suspension medium. In some embodiments, relatively volatile compounds may be mixed with lower vapor pressure components to provide suspension media having specified physical characteristics selected to improve stability or enhance the bioavailability of the dispersed active agents. In some embodiments, the lower vapor pressure compounds will comprise fluorinated compounds (e.g. fluorocarbons) having a boiling point greater than about 25°C.
  • fluorinated compounds e.g. fluorocarbons
  • lower vapor pressure fluorinated compounds for use in the suspension medium may include perfluorooctylbromide CsFi 7 Br (PFOB or perflubron), dichlorofluorooctane C8Fi 6 CI 2 , perfluorooctylethane C8Fi 7 C 2 H 5 (PFOE), perfluorodecylbromide CioF 2 iBr (PFDB) or perfluorobutylethane C F 9 C 2 H 5 .
  • these lower vapor pressure compounds are present in a relatively low level. Such compounds may be added directly to the suspension medium or may be associated with the suspending particles.
  • the suspension medium included in compositions as described herein may be formed of a propellant or propellant system that is substantially free of additional materials, including, for example, antisolvents, solubilizing agents, cosolvents or adjuvants.
  • the suspension medium may be formed of a non-CFC propellant or propellant system, such as an HFA propellant or propellant system, that is substantially free of additional materials.
  • Such embodiments simplify the formulation and manufacture of pharmaceutical compositions suited for respiratory delivery of the active agents included in the co- suspension compositions.
  • the suspension medium utilized may include materials in addition to the propellant or propellant system.
  • additional materials may include, for example, one or more of an appropriate antisolvent, solubilizing agent, cosolvent or adjuvant to adjust, for example, the vapor pressure of the formulation or the stability, or solubility of suspended particles.
  • propane, ethanol, isopropyl alcohol, butane, isobutane, pentane, isopentane or a dialkyl ether, such as dimethyl ether may be incorporated with the propellant in the suspension medium.
  • the suspension medium may contain a volatile fluorocarbon.
  • a volatile fluorocarbon such as polyvinylpyrrolidone (“PVP”) or polyethylene glycol (“PEG”) may be added to the suspension medium.
  • PVP or PEG may be added to the suspension medium as a crystal growth inhibitor.
  • a volatile cosolvent or adjuvant such an adjuvant or cosolvent may be selected from known hydrocarbon or fluorocarbon materials and may account for up to about 1 % w/w of the suspension medium.
  • the cosolvent or adjuvant may comprise less than about 0.01 %, 0.1 %, or 0.5% w/w of the suspension medium.
  • the cosolvent or adjuvant may comprise less than about 0.01 %, 0.1 %, or 0.5% w/w of the suspension medium.
  • PVP or PEG are included in the suspension medium, such constituents may be included at up to about 1 % w/w, or they may comprise less than about 0.01 %, 0.1 %, or 0.5% w/w of the suspension medium.
  • the active agent particles included in the co-suspensions described herein are formed of a material capable of being dispersed and suspended within the suspension medium and are sized to facilitate delivery of respirable particles from the co-suspension.
  • the active agent particles are provided as a micronized material wherein at least 90% of the active agent particles by volume exhibit an optical diameter of about 7 ⁇ or less.
  • the active agent particles are provided as a micronized material wherein at least 90% of the active agent particles by volume exhibit an optical diameter selected from a range of about 7 ⁇ to about 1 ⁇ , about 5 ⁇ to about 2 ⁇ , and about 3 ⁇ to about 2 ⁇ .
  • the active agent particles are provided as a micronized material wherein at least 90% of the active agent particles by volume exhibit an optical diameter selected from 6 ⁇ or less, 5 ⁇ or less, 4 ⁇ or less, or 3 ⁇ or less. In another embodiment, the active agent particles are provided as a micronized material wherein at least 50% of the active agent particle material by volume exhibits an optical diameter of about 4 ⁇ or less. In further embodiments, the active agent particles are provided as a micronized material wherein at least 50% of the active agent particle material by volume exhibits an optical diameter selected from about 3 ⁇ or less, about 2 ⁇ or less, about 1 .5 ⁇ or less, and about 1 ⁇ or less.
  • the active agent particles are provided as a micronized material wherein at least 50% of the active agent particles by volume exhibit an optical diameter selected from a range of about 4 ⁇ to about 1 ⁇ , about 3 ⁇ to about 1 ⁇ , about 2 ⁇ to about 1 ⁇ , about 1 .3 ⁇ , and about 1 .9 ⁇ .
  • the active agent particles may be formed entirely of active agent or they may be formulated to include one or more active agents in combination with one or more excipients or adjuvants.
  • an active agent present in the active agent particles may be entirely or substantially crystalline, i.e., a majority of the active agent molecules are arranged in a regularly repeating pattern, over a long range of external face planes.
  • the active agent particles may include an active agent present in both crystal and amorphous states.
  • the active agent particles may include an active agent present in substantially an amorphous state, i.e., the active agent molecules are overall noncrystalline in nature and do not have a regularly repeating arrangement maintained over a long range.
  • active agents may be present in crystalline or substantially crystalline form.
  • at least one such active agent may be present in crystalline or substantially crystalline form and at least another active agent may be present in an amorphous state.
  • the active agent particles described herein include two or more active agents in combination with one or more excipients or adjuvants
  • the excipients and adjuvants can be selected based on the chemical and physical properties of the active agents used.
  • suitable excipients for the formulation of active agent particles include those described herein in association with the suspending particles.
  • active agent particles may be formulated with one or more of the lipid, phospholipid, carbohydrate, amino acid, organic salt, peptide, protein, alditols, synthetic or natural polymer, or surfactant materials as described, for example, in association with the suspending particles.
  • an active agent may be added to a solution of one or more of the lipid, phospholipid, carbohydrate, amino acid, metal salt, organic salt, peptide, protein, alditols, synthetic or natural polymer, or surfactant materials and spray-dried into a suspending particle that contains the active agent within the material forming the suspending particle.
  • any suitable process may be employed to achieve micronized active agent material for use as or inclusion in active agent particles or suspending particles as described herein.
  • Such processes include, but are not limited to, micronization by milling or grinding processes, crystallization or recrystallization processes, and processes using precipitation from supercritical or near-supercritical solvents, spray drying, spray freeze-drying, or lyophilization.
  • Patent references teaching suitable methods for obtaining micronized active agent particles are described, for example, in U.S. Patent No. 6,063,138, U.S. Patent No. 5,858,410, U.S. Patent No. 5,851 ,453, U.S. Patent No. 5,833,891 , U.S. Patent No. 5, 707,634, and International Patent Publication No.
  • the active agent particles include active agent material formulated with one or more excipient or adjuvant
  • micronized active agent particles can be formed using one or more of the preceding processes and such processes can be utilized to achieve active agent particles having a desired size distribution and particle configuration.
  • the active agent particles may be provided in any suitable concentration within the suspension medium.
  • the active agent particles may be present in concentrations between about 0.01 mg/ml and about 20 mg/ml.
  • the active agent particles may be present in a concentration selected from about 0.05 mg/ml to about 20 mg/ml, about 0.05 mg/ml to about 10 mg/ml, and from about 0.05 mg/ml to about 5 mg/ml.
  • a variety of therapeutic or prophylactic agents can be utilized as active in the co-suspension compositions disclosed herein.
  • Exemplary active agents include those that may be administered in the form of aerosolized medicaments, and active agents suitable for use in the compositions described herein include those that may be presented in a form or formulated in a manner which is dispersible within the selected suspension medium (e.g., is substantially insoluble or exhibits a solubility in the suspension medium that substantially maintains a co-suspension formulation), is capable of forming a co-suspension with the suspending particles, and is subject to respirable uptake in physiologically effective amounts.
  • the active agents that may be utilized in forming the active agent particles described herein can have a variety of biological activities.
  • Examples of specific active agents that may be included in a composition according to the present description may for example, short-acting beta agonists, e.g., bitolterol, carbuterol, fenoterol, hexoprenaline, isoprenaline (isoproterenol), levosalbutamol, orciprenaline (metaproterenol), pirbuterol, procaterol, rimiterol, salbutamol (albuterol), terbutaline, tulobuterol, reproterol, ipratropium and epinephrine; long-acting ⁇ 2 adrenergic receptor agonist ("LABA"), e.g., bambuterol, clenbuterol, formoterol, salmeterol; ultra long-acting ⁇ 2 adrenergic receptor agonists, e.g., carmoterol, milveterol, indacaterol, and
  • fluticasone propionate beclomethasone dipropionate, flunisolide, budesonide, tripedane, cortisone, prednisone, prednisilone, dexamethasone, betamethasone, or triamcinolone acetonide; antitussives, e.g., noscapine; bronchodilators, e.g., ephedrine, adrenaline, fenoterol, formoterol, isoprenaline, metaproterenol, salbutamol, albuterol, salmeterol, terbutaline; and muscarinic antagonists, including long-acting muscarinic antagonists ("LAMA"), e.g., glycopyrrolate, dexipirronium, scopolamine, tropicamide, pirenzepine, dimenhydrinate, tiotropium, darotropium, aclidinium, trospium, ipatropium, at
  • the active agents provided in the composition may be used in the form of salts (e.g., alkali metal or amine salts or as acid addition salts) or as esters, solvates (hydrates), derivatives, or a free base.
  • the active agents may be in any crystalline form or isomeric form or mixture of isomeric forms, for example, as pure enantiomers, a mixture of enantiomers, as racemates or as mixtures thereof.
  • the form of the active agents may be selected to optimize the activity and/or stability of the active agent and/or to minimize the solubility of the active agent in the suspension medium.
  • the active agents included in the compositions described herein may be selected from one or more potent or highly potent active agents.
  • the compositions described herein may include one or more potent active agents that are to be delivered at a dose selected from between about 100 g and about 100 mg per dose, about 100 g and about 10 mg per dose, and about 100 g and 1 mg per dose.
  • compositions described herein may include a combination of two or more potent or highly potent active agents that are to be delivered at a dose selected from up to about 80 g per dose, up to about 40 g per dose, up to about 20 g per dose, up to about 10 g per dose or between about 10 g and about 100 g per dose. Additionally, in certain embodiments, the compositions described herein may include a combination of two or more highly potent active agents that are to be delivered at a dose selected from between about 0.1 and about 2 g per dose, about 0.1 and about 1 g per dose, and about 0.1 and about 0.5 ig per dose.
  • the compositions described herein include a LABA active agent.
  • the composition includes a LABA active agent in combination with a LAMA active agent or a corticosteroid active agent.
  • the composition includes a LAMA active agent in combination with a LABA active agent and a corticosteroid.
  • a LABA active agent can be selected from, for example, bambuterol, clenbuterol, formoterol, salmeterol, carmoterol, milveterol, indacaterol, and saligenin- or indole- containing and adamantyl-derived ⁇ 2 agonists, and any pharmaceutically acceptable salts, esters, isomers or solvates thereof.
  • the active agent is selected from formoterol and its pharmaceutically acceptable salts, esters, isomers or solvates thereof.
  • Formoterol can be used to treat inflammatory or obstructive pulmonary diseases and disorders such as, for example, those described herein.
  • Formoterol has the chemical name ( ⁇ )-2-hydroxy-5-[(1 RS)-1 -hydroxy-2-[[(1 RS)-2-(4- methoxyphenyl)-1 -methylethyl]-amino]ethyl] formanilide, and is commonly used in pharmaceutical compositions as the racemic fumarate dihydrate salt.
  • formoterol may be used in the form of salts (e.g. alkali metal or amine salts or as acid addition salts) or as esters or as solvates (hydrates).
  • the formoterol may be in any crystalline form or isomeric form or mixture of isomeric forms, for example a pure enantiomer, a mixture of enantiomers, a racemate or a mixture thereof.
  • the form of formoterol may be selected to optimize the activity and/or stability of formoterol and/or to minimize the solubility of formoterol in the suspension medium.
  • salts of formoterol include, for example, salts of inorganic acids such as hydrochloric, hydrobromic, sulfuric and phosphoric acids, and organic acids such as fumaric, maleic, acetic, lactic, citric, tartaric, ascorbic, succinic, glutaric, gluconic, tricarballylic, oleic, benzoic, p- methoxybenzoic, salicylic, o- and p-hydroxybenzoic, p-chlorobenzoic, methanesulfonic, p-toluenesulfonic and 3-hydroxy-2-naphthalene carboxylic acids. Hydrates of formoterol are described, for example, in U.S. Pat. No.
  • the formoterol material utilized to form the formoterol particles is formoterol fumarate, and in one such embodiment, the formoterol fumarate is present in the dihydrate form.
  • the compositions described herein include formoterol
  • the compositions described herein may include formoterol at a concentration that achieves a delivered dose selected from between about 0.5 g and about 30 g, 0.5 g and about 1 g, about 1 ig and about 10 g, about 2 g and 5 g, about 2 g and about 10 g, about 5 ig and about 10 g, and 3 g and about 30 g per actuation of an MDI.
  • compositions described herein may include formoterol in an amount sufficient to provide a delivered dose selected from up to about 30 ⁇ ig, up to about 10 [ig, up to about 5 [ig, up to about 2.5 [ig, up to about 2 pg, or up to about 1 .5 pg per actuation of an MDI.
  • compositions described herein include formoterol as the active agent
  • the amount of formoterol included in the compositions may be selected from, for example, between about 0.01 mg/ml and about 1 mg/ml, between about 0.01 mg/ml and about 0.5 mg/ml, and between about 0.03 mg/ml and about 0.4 mg/ml.
  • the pharmaceutical co-suspension compositions described herein include a LABA active agent
  • the active agent is selected from salmeterol, including any pharmaceutically acceptable salts, esters, isomers or solvates thereof.
  • Salmeterol can be used to treat inflammatory or obstructive pulmonary diseases and disorders such as, for example, those described herein.
  • the compositions may also include a LAMA or corticosteroid active agent.
  • the compositions include salmeterol in combination with a LAMA active agent and a corticosteroid.
  • Salmeterol pharmaceutically acceptable salts of salmeterol, and methods for producing the same are described, for example, in U.S. Patent No. 4,992,474, U.S. Patent No. 5,126,375, and U.S. patent 5,225,445.
  • compositions described herein may include salmeterol at a concentration that achieves a delivered dose selected from between about 2 [ ⁇ g and about 120 [ig, about 4 g and about 40 [ig, about 8 [ig and 20 [ig, about 8 [ig and about 40 [ig, about 20 [ig and about 40 [ig, and about 12 g and about 120 [ig per actuation of an MDI.
  • compositions described herein may include salmeterol in an amount sufficient to provide a delivered dose selected from up to about 120 ⁇ ig, up to about 40 ⁇ ig, up to about 20 ⁇ ig, up to about 10 ⁇ ig, up to about 8 [ig, or up to about 6 [ig per actuation of an MDI.
  • the amount of salmeterol included in the compositions may be selected from, for example, between about 0.04 mg/ml and about 4 mg/ml, between about 0.04 mg/ml and about 2.0 mg/ml, and between about 0.12 mg/ml and about 0.8 mg/ml.
  • the compositions described herein may include sufficient salmeterol to provide a target delivered dose selected from between about 4 g and about 120 g, about 20 g and about 100 g, and between about 40 g and about 120 g per actuation of an MDI.
  • the compositions described herein may include sufficient salmeterol to provide a targeted delivered dose selected from up to about 100 g, up to about 40ig, or up to about 15 g per actuation of an MDI.
  • the compositions described herein include a long- acting muscarinic antagonist (LAMA) active agent.
  • LAMA active agents that may be used in the compositions described herein include, glycopyrrolate, dexipirronium, tiotropium, trospium, aclidinium and darotropium, including any pharmaceutically acceptable salts, esters, isomers or solvates thereof.
  • the compositions described herein include a LAMA active agent in combination with a LABA active agent or a corticosteroid.
  • the compositions described herein include a LAMA active agent in combination with both LABA and corticosteroid active agents.
  • glycopyrrolate including any pharmaceutically acceptable salts, esters, isomers or solvates thereof, may be selected.
  • Glycopyrrolate can be used to treat inflammatory or obstructive pulmonary diseases and disorders such as, for example, those described herein.
  • glycopyrrolate provides an antisecretory effect, which is a benefit for use in the therapy of pulmonary diseases and disorders characterized by increased mucus secretions.
  • Glycopyrrolate is a quaternary ammonium salt.
  • glycopyrrolate may be used in the form of salts (e.g. alkali metal or amine salts, or as acid addition salts), esters, solvates (hydrates), or selected isomers.
  • glycopyrrolate may be in any crystalline form or isomeric form or mixture of isomeric forms, for example a pure enantiomer, a mixture of enantiomers, a racemate or a mixture thereof.
  • the form of glycopyrrolate may be selected to optimize the activity and/or stability of glycopyrrolate and/or to minimize the solubility of glycopyrrolate in the suspension medium.
  • Suitable counter ions are pharmaceutically acceptable counter ions including, for example, fluoride, chloride, bromide, iodide, nitrate, sulfate, phosphate, formate, acetate, trifluoroacetate, propionate, butyrate, lactate, citrate, tartrate, malate, maleate, succinate, benzoate, p-chlorobenzoate, diphenyl-acetate or triphenylacetate, o-hydroxybenzoate, p-hydroxybenzoate, 1 -hydroxynaphthalene-2- carboxylate, 3-hydroxynaphthalene-2-carboxylate, methanesulfonate and benzenesulfonate.
  • the bromide salt of glycopyrrolate namely 3-[(cyclopentyl-hydroxyphenylacetyl)oxy]- 1 ,1 -dimethylpyrrolidinium bromide, is used and can be prepared according to the procedures set out in U.S. Pat. No. 2,956,062.
  • compositions described herein include glycopyrrolate
  • the compositions may include sufficient glycopyrrolate to provide a delivered dose selected from between about 10 g and about 100 g, about 15 g and about 100 g, about 15 g and about 80 g, and about 10 g and about 80 g per actuation of an MDI.
  • the formulations include sufficient glycopyrrolate to provide a delivered dose selected from up to about 100ig, up to about 80 g, up to about 40 g, up to about 20 g, or up to about 10 g per actuation of an MDI.
  • the formulations include sufficient glycopyrrolate to provide a delivered dose selected from about 9 g, 18 g, 36 g and 72 g per actuation of the MDI.
  • the amount of glycopyrrolate included in the compositions may be selected from, for example, between about 0.04 mg/ml and about 2.25 mg/ml.
  • tiotropium including any pharmaceutically acceptable salts, esters, isomers or solvates thereof, may be selected as a LAMA active agent for inclusion in a composition as described herein.
  • Tiotropium is a known, long-acting anticholinergic drug suitable for use in treating diseases or disorders associated with pulmonary inflammation or obstruction, such as those described herein.
  • Tiotropium, including crystal and pharmaceutically acceptable salt forms of tiotropium is described, for example, in U.S. Patent No. 5,610,163, U.S. Patent No. RE39820, U.S. Patent No. 6,777,423, and U.S. Patent No. 6.908,928.
  • the compositions described herein include tiotropium
  • the compositions may include sufficient tiotropium to provide a delivered dose selected from between about 2.5 g and about 25 g, about 4 g and about 25 [ig, about 2.5 g and about 20 g, and about 10 g and about 20 g per actuation of an MDI.
  • the formulations include sufficient tiotropium to provide a delivered dose selected from up to about 25 g, up to about 20 [ig, up to about 10 [ig, up to about 5 [ig, or up to about 2.5 [ig per actuation of an MDI.
  • the formulations include sufficient tiotropium to provide a delivered dose selected from about 3 ⁇ ig, 6 ⁇ ig, 9 ⁇ ig, and 18 ⁇ ig per actuation of the MDI.
  • the amount of tiotropium included in the compositions may be selected from, for example, between about 0.01 mg/ml and about 0.5 mg/ml.
  • compositions described herein include a corticosteroid.
  • active agents may be selected from, for example, beclomethasone, budesonide, ciclesonide, flunisolide, fluticasone, methyl- prednisolone, mometasone, prednisone and trimacinolone, including any pharmaceutically acceptable salts, esters, isomers or solvates thereof.
  • such compositions include a corticosteroid active agent in combination with a LAMA or LABA active agent.
  • the compositions include a corticosteroid active agent in combination with a LAMA and a LABA active agent.
  • mometasone may be selected from, for example, beclomethasone, budesonide, ciclesonide, flunisolide, fluticasone, methyl- prednisolone, mometasone, prednisone and trimacinolone, including any pharmaceutically acceptable salts, esters, isomers or solvates thereof.
  • Mometasone pharmaceutically acceptable salts of mometasone, such as mometasone furoate, and preparation of such materials are known, and described, for example, in U.S. Pat. No. 4,472,393, U.S. Pat. No. 5,886,200, and U.S. Pat. No. 6,177,560.
  • Mometasone is suitable for use in treating diseases or disorders associated with pulmonary inflammation or obstruction, such as those described herein (see, e.g., U.S. Pat. No. 5,889,015, U.S. Pat. No. 6,057,307, U.S. Pat. No. 6,057,581 , U.S. Pat. No. 6,677,322, U.S. Pat. No. 6,677,323 and U.S. Pat. No. 6,365,581 ).
  • compositions described herein include mometasone
  • the compositions include mometasone, including any pharmaceutically acceptable salts, esters, isomers or solvates thereof, in an amount sufficient to provide a target delivered dose selected from between about 20 [ ⁇ g and about 400 [ig, about 20 [ig and about 200 [ig, about 50 [ig and about 200 [ig, about 100 and about 200 ⁇ ig, about 20 ⁇ ig and about 100 ⁇ ig, and about 50 ⁇ ig and about 100 [ ⁇ g, per actuation of an MDI.
  • compositions described herein may include mometasone, including any pharmaceutically acceptable salts, esters, isomers or solvates thereof, in an amount sufficient to provide a targeted delivered dose selected from up to about 400 ⁇ ig, up to about 200 [ig, or up to about 100 [ig per actuation of an MDI.
  • compositions described herein include a corticosteroid selected from fluticasone and budesonide. Both fluticasone and budesonide are suitable for use in treatment of conditions associated with pulmonary inflammation or obstruction, such as those described herein.
  • Fluticasone, pharmaceutically acceptable salts of fluticasone, such as fluticasone propionate, and preparation of such materials are known, and described, for example, in U.S. Pat. No. 4,335,121 , U.S. Pat. No. 4,187,301 , and U.S. Pat. Pub. No. US2008125407.
  • Budesonide is also well known and described, for example, in U.S. Pat. No. 3,929,768.
  • compositions described herein may include fluticasone, including any pharmaceutically acceptable salts, esters, isomers or solvates thereof, in an amount sufficient to provide a target delivered dose selected from between about 20 [ig and about 200 [ig, about 50 [ig and about 175 [ig, and between about 80 [ ⁇ g and about 160 [ ⁇ g per actuation of an MDI.
  • compositions described herein may include fluticasone, including any pharmaceutically acceptable salts, esters, isomers or solvates thereof, in an amount sufficient to provide a targeted delivered dose selected from up to about 175 [ig, up to about 160 ⁇ ig, up to about 100 ⁇ ig, or up to about 80 ⁇ ig per actuation of an MDI.
  • compositions described herein may include budesonide, including any pharmaceutically acceptable salts, esters, isomers or solvates thereof, in an amount sufficient to provide target delivered dose selected from between about 30 [ig and about 240 [ig, about 30 [ig and about 120 [ig, and between about 30 [ ⁇ g and about 50 [ ⁇ g per actuation of an MDI.
  • the compositions described herein may include budesonide, including any pharmaceutically acceptable salts, esters, isomers or solvates thereof, in an amount sufficient to provide a targeted delivered dose selected from up to about 240 up to about 120 [ig, or up to about 50 [ig per actuation of an MDI.
  • compositions as described herein includes two or more active agents.
  • the compositions include a combination of two or more species of active agent particles which may be co-suspended with a single species of suspending particles.
  • a composition may include two or more species of active agent particles co-suspended with two or more different species of suspending particles.
  • compositions as described herein may include a single species of active agent particles suspended with a single species of suspending particles, wherein the single species of active agent particles incorporates one or more active agents and the single species of suspending particles incorporates one or more active agents.
  • a composition as described herein may include two or more active agents combined within a single species of active agent particle. For example, where the active agent particles are formulated using one or more excipients or adjuvants in addition to the active agent material, such active agent particles may include individual particles that include two or more different active agents.
  • the suspending particles included in the co-suspension compositions described herein work to facilitate stabilization and delivery of the active agent included in the compositions.
  • the suspending particles are typically formed from pharmacologically inert material that is acceptable for inhalation and is substantially insoluble in the propellant selected.
  • the majority of suspending particles are sized within a respirable range. In particular embodiments, therefore, the MMAD of the suspending particles will not exceed about 10 ⁇ but is not lower than about 500 nm.
  • the MMAD of the suspending particles is between about 5 ⁇ and about 750 nm.
  • the MMAD of the suspending particles is between about 1 ⁇ and about 3 ⁇ .
  • the MMAD of the suspending particles is between 10 ⁇ and 50 ⁇ .
  • the suspending particles will typically exhibit a volume median optical diameter between about 0.2 ⁇ and about 50 ⁇ . In one embodiment, the suspending particles exhibit a volume median optical diameter that does not exceed about 25 ⁇ . In another embodiment, the suspending particles exhibit a volume median optical diameter selected from between about 0.5 ⁇ and about 15 ⁇ , between about 1 .5 ⁇ and about 10 ⁇ , and between about 2 ⁇ and about 5 ⁇ .
  • the concentration of suspending particles included in a composition according to the present description can be adjusted, depending on, for example, the amount of active agent particles and suspension medium used.
  • the suspending particles are included in the suspension medium at a concentration selected from about 1 mg/ml to about 15 mg/ml, about 3 mg/ml to about 10 mg/ml, 5 mg/ml to about 8 mg/ml, and about 6 mg/ml.
  • the suspending particles are included in the suspension medium at a concentration of up to about 30 mg/ml.
  • the suspending particles are included in the suspension medium at a concentration of up to about 25 mg/ml.
  • the relative amount of suspending particles to active agent particles is selected to achieve a co-suspension as contemplated herein.
  • a co-suspension composition may be achieved where the amount of suspending particles, as measured by mass, exceeds that of the active agent particles.
  • the ratio of the total mass of the suspending particles to the total mass of active agent particles may be between about 3:1 and about 15:1 , or alternatively from about 2:1 and 8:1 .
  • the ratio of the total mass of the suspending particles to the total mass of active agent particles may be above about 1 , such as up to about 1 .5, up to about 5, up to about 10, up to about 15, up to about 17, up to about 20, up to about 30, up to about 40, up to about 50, up to about 60, up to about 75, up to about 100, up to about 150, and up to about 200, depending on the nature of the suspending particles and active agent particles used.
  • the ratio of the total mass of the suspending particles to the total mass of the active agent particles may be selected from between about 10 and about 200, between about 60 and about 200, between about 15 and about 60, between about 15 and about 170, between about 15 and about 60, about 16, about 60, and about 170.
  • the amount of suspending particles is less than that of the active agent particles.
  • the mass of the suspending particles may be as low as 20% of the total mass of the active agent particles.
  • the total mass of the suspending particles may also approximate or equal the total mass of the active agent particles.
  • Suspending particles suitable for use in the compositions described herein may be formed of one or more pharmaceutically acceptable materials or excipients that are suitable for inhaled delivery and do not substantially degrade or dissolve in the suspension medium.
  • perforated microstructures, as defined herein may be used as the suspending particles.
  • excipients that may be used in the formulation of suspending particles described herein include but are not limited to (a) carbohydrates, e.g., monosaccharides such as fructose, galactose, glucose, D-mannose, sorbose, and the like; disaccharides, such as sucrose, lactose, trehalose, cellobiose, and the like; cyclodextrins, such as 2-hydroxypropyl- - cyclodextrin; and polysaccharides, such as raffinose, maltodextrins, dextrans, starches, chitin, chitosan, inulin, and the like; (b) amino acids, such as alanine, glycine, arginine, aspartic acid, glutamic acid, cysteine, lysine, leucine, isoleucine, valine, and the like; (c) metal and organic salts prepared from organic acids and bases, such as
  • phospholipids from both natural and synthetic sources may be used in preparing suspending particles suitable for use in the compositions described herein.
  • the phospholipid chosen will have a gel to liquid crystal phase transition of greater than about 40°C.
  • Exemplary phospholipids are relatively long chain (i.e., C16-C22) saturated lipids and may comprise saturated phospholipids, such as saturated phosphatidylcholines having acyl chain lengths of 16 C or 18 C (palmitoyl and stearoyl).
  • Exemplary phospholipids include phosphoglycerides such as dipalmitoylphosphatidylcholine, disteroylphosphatidylcholine, diarachidoylphosphatidylcholine, dibehenoylphosphatidylcholine, diphosphatidyl glycerol, short-chain phosphatidylcholines, long-chain saturated phosphatidylethanolamines, long-chain saturated phosphatidylserines, long-chain saturated phosphatidylglycerols, and long- chain saturated phosphatidylinositols. Additional excipients are disclosed in International Patent Publication No. WO 96/32149 and U.S. Patent Nos. 6,358,530, 6,372,258 and 6,518,239.
  • the suspending particles may be formed using one or more lipids, phospholipids or saccharides, as described herein.
  • suspending particles include one or more surfactants.
  • the use of suspending particles formed of or incorporating one or more surfactants may promote absorption of the selected active agent, thereby increasing bioavailability.
  • the suspending particles described herein, such as, for example, suspending particles formed using one or more lipids can be formed to exhibit a desired surface rugosity (roughness), which can further reduce inter-particle interactions and improve aerosol ization by reducing the surface area available for particle-particle interaction.
  • a lipid that is naturally occurring in the lung could be used in forming the suspending particles, as such suspending particles that have the potential to reduce opsonization (and thereby reducing phagocytosis by alveolar macrophages), thus providing a longer-lived controlled release particle in the lung.
  • the suspending particles utilized in the compositions described herein may be selected to increase storage stability of the selected active agent, similar to that disclosed in International Patent Publication No WO 2005/000267.
  • the suspending particles my include pharmaceutically acceptable glass stabilization excipients having a Tg of at least 55 °C, at least 75 °C, or at least 100 °C.
  • Glass formers suitable for use in compositions described herein include, but are not limited to, one or more of trileucine, sodium citrate, sodium phosphate, ascorbic acid, inulin, cyclodextrin, polyvinyl pyrrolidone, mannitol, sucrose, trehalose, lactose, and, proline.
  • additional glass-forming excipients are disclosed in U. S. Patent Nos. RE 37,872, 5,928,469, 6,258,341 , and 6,309,671 .
  • the suspending particles may be designed, sized and shaped as desired to provide desirable stability and active agent delivery characteristics.
  • the suspending particles comprise perforated microstructures as described herein.
  • perforated microstructures may be used as suspending particles in the compositions described herein, they may be formed using one or more excipients as described herein.
  • perforated microstructures may include at least one of the following: lipids, phospholipids, nonionic detergents, nonionic block copolymers, ionic surfactants, biocompatible fluorinated surfactants and combinations thereof, particularly those approved for pulmonary use.
  • perforated microstructures include poloxamer 188, poloxamer 407 and poloxamer 338.
  • Other specific surfactants include oleic acid or its alkali salts.
  • the perforated microstructures include greater than about 10% w/w surfactant.
  • suspending particles may be prepared by forming an oil-in-water emulsion, using a fluorocarbon oil (e.g., perfluorooctyl bromide, perfluorodecalin) which may be emulsified using a surfactant such as a long chain saturated phospholipid.
  • a fluorocarbon oil e.g., perfluorooctyl bromide, perfluorodecalin
  • the resulting perfluorocarbon in water emulsion may be then processed using a high pressure homogenizer to reduce the oil droplet size.
  • the perfluorocarbon emulsion may be fed into a spray dryer, optionally with an active agent solution, if it is desirable to include active agent within the matrix of the perforated microstructures.
  • Spray drying is a one-step process that converts a liquid feed to a dried particulate form.
  • Spray drying has been used to provide powdered pharmaceutical material for various administrative routes, including inhalation.
  • Operating conditions of the spray dryer (such as inlet and outlet temperature, feed rate, atomization pressure, flow rate of the drying air and nozzle configuration) can be adjusted to produce the desired particle size producing a yield of the resulting dry microstructures.
  • Such methods of producing exemplary perforated microstructures are disclosed in U.S. Patent No. 6,309,623 to Weers et al.
  • Perforated microstructures as described herein may also be formed through lyophilization and subsequent milling or micronization.
  • Lyophilization is a freeze-drying process in which water is sublimed from the composition after it is frozen. This process allows drying without elevated temperatures.
  • the suspending particles may be produced using a spray freeze drying process, such as is disclosed in U.S. Patent 5,727,333.
  • suspending particles as described herein may include bulking agents, such as polymeric particles.
  • Polymeric polymers may be formed from biocompatible and/or biodegradable polymers, copolymers or blends.
  • polymers capable of forming aerodynamically light particles may be used, such as functionalized polyester graft copolymers and biodegradable polyanhydrides.
  • bulk eroding polymers based on polyesters including poly(hydroxy acids) can be used.
  • Polyglycolic acid (PGA), polyactic acid (PLA) or copolymers thereof may be used to form suspending particles.
  • the polyester may include a charged or functionalizable group, such as an amino acid.
  • suspending particles may be formed of poly(D,i_-lactic acid) and/or poly(D,i_-lactic-co- glycolic acid) (PLGA), which incorporate a surfactant such as DPPC.
  • polystyrene resin examples include polyamides, polycarbonates, polyalkylenes such as polyethylene, polypropylene, poly(ethylene glycol), poly(ethylene oxide), poly(ethylene terephthalate), poly vinyl compounds such as polyvinyl alcohols, polyvinyl ethers, and polyvinyl esters, polymers of acrylic and methacrylic acids, celluloses and other polysaccharides, and peptides or proteins, or copolymers or blends thereof. Polymers may be selected with or modified to have the appropriate stability and degradation rates in vivo for different controlled drug delivery applications.
  • compositions described herein may include two or more species of suspending particles. Even further, compositions according to the present description can include suspending particles that include one or more active agents incorporated into the suspending particles. Where active agent is incorporated into suspending particles, the suspending particles will be of a respirable size and can be formulated and produced using, for example, the methods and materials described herein.
  • compositions formulated according to the present teachings can inhibit degradation of active agent included therein.
  • the compositions described herein inhibit one or more of flocculation, aggregation and the solution mediated transformation of active agent material included in the compositions.
  • the pharmaceutical compositions described herein are suited for respiratory delivery via and MDI in a manner that achieves desirable delivered dose uniformity ("DDU") of each active agent included in a combination of two or more active agents, even with combinations including potent and highly potent actives.
  • DDU delivered dose uniformity
  • compositions described herein can achieve a DDU of ⁇ 30%, or better, for each active agent throughout emptying of an MDI canister.
  • compositions described herein achieve a DDU of ⁇ 25%, or better, for each active agent throughout emptying of an MDI canister. In yet another such embodiment, compositions described herein achieve a DDU for the active agent of ⁇ 20%, or better, for each active agent throughout emptying of an MDI canister.
  • compositions described herein also serve to substantially preserve FPF and FPD performance throughout emptying of an MDI canister, even after being subjected to accelerated degradation conditions. For instance, compositions according to the present description maintain as much as 80%, 90%, 95%, or more, of the original FPF and FPD performance throughout emptying of an MDI canister, even after being subjected to accelerated degradation conditions. Compositions described herein provide the added benefit of achieving such performance while being formulated using non-CFC propellants and eliminating or substantially avoiding pharmaceutical effects often experienced with compositions incorporating multiple active agents.
  • compositions described herein achieve desired one or all of a targeted DDU, FPF and FPD performance while being formulated with suspension medium including only one or more non-CFC propellants and without the need to modify the characteristics of the non-CFC propellant, such as by the addition of, for example, one or more cosolvent, antisolvent, solubilizing agent, adjuvant or other propellant modifying material.
  • a co-suspension composition deliverable from a metered dose inhaler includes the following: a suspension medium comprising a pharmaceutically acceptable HFA propellant; a first species of active agent particles comprising glycopyrrolate, including any pharmaceutically acceptable salts, esters, isomers or solvates thereof, suspended in the suspension medium at a concentration sufficient to provide a delivered dose of glycopyrrolate of between about 15 g and about 80 g per actuation of the metered dose inhaler; a second species of active agent particles comprising formoterol, including any pharmaceutically acceptable salts, esters, isomers or solvates thereof, suspended in the suspension medium at a concentration sufficient to provide a delivered dose of formoterol of between about 2 g and about 10 g per actuation of the metered dose inhaler; and a plurality of respirable suspending particles comprising perforated microstructures exhibiting a volume median optical diameter of between about 1 .5 ⁇ and about 10 ⁇ ,
  • a co-suspension composition deliverable from a metered dose inhaler includes the following: a suspension medium comprising a pharmaceutically acceptable HFA propellant; a first species of active agent particles comprising tiotropium, including any pharmaceutically acceptable salts, esters, isomers or solvates thereof, suspended in the suspension medium at a concentration sufficient to provide a delivered dose of tiotropium of between about 5 g and about 20 g per actuation of the metered dose inhaler; a second species of active agent particles comprising formoterol, including any pharmaceutically acceptable salts, esters, isomers or solvates thereof, suspended in the suspension medium at a concentration sufficient to provide a delivered dose of formoterol of between about 2 g and about 10 g per actuation of the metered dose inhaler; and a plurality of respirable suspending particles comprising perforated microstructures exhibiting a volume median optical diameter of between about 1 .5 ⁇ and about
  • a co-suspension composition deliverable from a metered dose inhaler includes the following: a suspension medium comprising a pharmaceutically acceptable HFA propellant; a plurality of active agent particles comprising glycopyrrolate, including any pharmaceutically acceptable salts, esters, isomers or solvates thereof, suspended in the suspension medium at a concentration sufficient to provide a delivered dose of glycopyrrolate of between about 15 g and about 80 g per actuation of the metered dose inhaler; and a plurality of respirable suspending particles comprising formoterol, including any pharmaceutically acceptable salts, esters, isomers or solvates thereof, wherein the plurality of suspending particles exhibit a volume median optical diameter of between about 1 .5 ⁇ and about 10 ⁇ , are included in the suspension medium at a concentration sufficient to provide a delivered dose of formoterol of between about 2 g and about 10 g per actuation of the metered dose inhaler, and associate with the plurality of
  • a co-suspension composition deliverable from a metered dose inhaler includes the following: a suspension medium comprising a pharmaceutically acceptable HFA propellant; a plurality of active agent particles comprising tiotropium, including any pharmaceutically acceptable salts, esters, isomers or solvates thereof, suspended in the suspension medium at a concentration sufficient to provide a delivered dose of tiotropium of between about 5 g and about 20 g per actuation of the metered dose inhaler; and a plurality of respirable suspending particles comprising formoterol, including any pharmaceutically acceptable salts, esters, isomers or solvates thereof, wherein the plurality of suspending particles exhibit a volume median optical diameter of between about 1 .5 ⁇ and about 10 ⁇ , are included in the suspension medium at a concentration sufficient to provide a delivered dose of formoterol of between about 2 g and about 10 g per actuation of the metered dose inhaler, and associate with
  • a co-suspension composition deliverable from a metered dose inhaler includes the following: a suspension medium comprising a pharmaceutically acceptable HFA propellant; a first species of active agent particles comprising glycopyrrolate, including any pharmaceutically acceptable salts, esters, isomers or solvates thereof, suspended in the suspension medium at a concentration sufficient to provide a delivered dose of glycopyrrolate of between about 15 g and about 80 g per actuation of the metered dose inhaler; a second species of active agent particles comprising formoterol, including any pharmaceutically acceptable salts, esters, isomers or solvates thereof, suspended in the suspension medium at a concentration sufficient to provide a delivered dose of formoterol of between about 2 g and about 10 g per actuation of the metered dose inhaler; a third species of active agent particles comprising a corticosteroid selected from beclomethasone, budesonide, ciclesonide, flunisolide,
  • At least 90% of the first, second, and third species of active agent particles by volume exhibit an optical diameter of less than 7 ⁇ , and the ratio of the total mass of the suspending particles to the total mass of the first, second, and third species of active agent particles is selected from between about 3:1 and about 15:1 and between about 2:1 and 8:1 .
  • a co-suspension composition deliverable from a metered dose inhaler includes the following: a suspension medium comprising a pharmaceutically acceptable HFA propellant; a first species of active agent particles comprising glycopyrrolate, including any pharmaceutically acceptable salts, esters, isomers or solvates thereof, suspended in the suspension medium at a concentration sufficient to provide a delivered dose of glycopyrrolate of between about 15 ⁇ g and about 80 ⁇ g per actuation of the metered dose inhaler; a second species of active agent particles comprising formoterol, including any pharmaceutically acceptable salts, esters, isomers or solvates thereof, suspended in the suspension medium at a concentration sufficient to provide a delivered dose of formoterol of between about 2 ⁇ g and about 10 ⁇ g per actuation of the metered dose inhaler; a third species of active agent particles comprising budesonide, including any pharmaceutically acceptable salts, esters, isomers or solvates thereof, suspended in
  • At least 90% of the first, second, and third species of active agent particles by volume exhibit an optical diameter of less than 7 ⁇ , and the ratio of the total mass of the suspending particles to the total mass of the first, second, and third species of active agent particles is selected from between about 3:1 and about 15:1 and between about 2:1 and 8:1 .
  • a co-suspension composition deliverable from a metered dose inhaler includes the following: a suspension medium comprising a pharmaceutically acceptable HFA propellant; a first species of active agent particles comprising tiotropium, including any pharmaceutically acceptable salts, esters, isomers or solvates thereof, suspended in the suspension medium at a concentration sufficient to provide a delivered dose of tiotropium of between about 5 g and about 20 g per actuation of the metered dose inhaler; a second species of active agent particles comprising formoterol, including any pharmaceutically acceptable salts, esters, isomers or solvates thereof, suspended in the suspension medium at a concentration sufficient to provide a delivered dose of formoterol of between about 2 g and about 10 g per actuation of the metered dose inhaler; a third species of active agent particles comprising budesonide, including any pharmaceutically acceptable salts, esters, isomers or solvates thereof suspended in the
  • At least 90% of the first, second, and third species of active agent particles by volume exhibit an optical diameter of less than 7 ⁇ , and the ratio of the total mass of the suspending particles to the total mass of the first, second, and third species of active agent particles is selected from between about 3:1 and about 15:1 and between about 2:1 and 8:1 .
  • a co-suspension composition deliverable from a metered dose inhaler includes the following: a suspension medium comprising a pharmaceutically acceptable HFA propellant; a first species of active agent particles comprising glycopyrrolate, including any pharmaceutically acceptable salts, esters, isomers or solvates thereof, suspended in the suspension medium at a concentration sufficient to provide a delivered dose of glycopyrrolate of between about 15 g and about 80 g per actuation of the metered dose inhaler; a second species of active agent particles comprising fornnoterol, including any pharmaceutically acceptable salts, esters, isomers or solvates thereof, suspended in the suspension medium at a concentration sufficient to provide a delivered dose of formoterol of between about 2 g and about 10 g per actuation of the metered dose inhaler; a third species of active agent particles comprising mometasone, including any pharmaceutically acceptable salts, esters, isomers or solvates thereof, suspended in the suspension medium
  • At least 90% of the first, second, and third species of active agent particles by volume exhibit an optical diameter of less 7 ⁇ , and the ratio of the total mass of the suspending particles to the total mass of the first, second, and third species of active agent particles is selected from between about 3:1 and about 15:1 and between about 2:1 and 8:1 .
  • a co-suspension composition deliverable from a metered dose inhaler includes the following: a suspension medium comprising a pharmaceutically acceptable HFA propellant; a first species of active agent particles comprising tiotropium, including any pharmaceutically acceptable salts, esters, isomers or solvates thereof, suspended in the suspension medium at a concentration sufficient to provide a delivered dose of tiotropium of between about 5 g and about 20 g per actuation of the metered dose inhaler; a second species of active agent particles comprising formoterol, including any pharmaceutically acceptable salts, esters, isomers or solvates thereof, suspended in the suspension medium at a concentration sufficient to provide a delivered dose of formoterol of between about 2 g and about 10 g per actuation of the metered dose inhaler; a third species of active agent particles comprising mometasone, including any pharmaceutically acceptable salts, esters, isomers or solvates thereof suspended in
  • At least 90% of the first, second, and third species of agent particles by volume exhibit an optical diameter of less than 7 ⁇ , and the ratio of the total mass of the suspending particles to the total mass of the first, second, and third species of active agent particles is selected from between about 3:1 and about 15:1 and between about 2:1 and 8:1 .
  • a co-suspension composition deliverable from a metered dose inhaler includes the following: a suspension medium comprising a pharmaceutically acceptable HFA propellant; a first species of active agent particles comprising glycopyrrolate, including any pharmaceutically acceptable salts, esters, isomers or solvates thereof, suspended in the suspension medium at a concentration sufficient to provide a delivered dose of glycopyrrolate of between about 15 ⁇ g and about 80 ⁇ g per actuation of the metered dose inhaler; a second species of active agent particles comprising formoterol, including any pharmaceutically acceptable salts, esters, isomers or solvates thereof, suspended in the suspension medium at a concentration sufficient to provide a delivered dose of formoterol of between about 2 ⁇ g and about 10 ⁇ g per actuation of the metered dose inhaler; and a plurality of respirable suspending particles comprising perforated microstructures incorporating a corticosteroid selected from beclomethasone, bud
  • At least 90% of the first and second species of active agent particles by volume exhibit an optical diameter of less than 7 ⁇ , and the ratio of the total mass of the suspending particles to the total mass of the first and second species of active agent particles is selected from between about 3:1 and about 15:1 and between about 2:1 and 8:1 .
  • a co-suspension composition deliverable from a metered dose inhaler includes the following: a suspension medium comprising a pharmaceutically acceptable HFA propellant; a first species of active agent particles comprising glycopyrrolate, including any pharmaceutically acceptable salts, esters, isomers or solvates thereof, suspended in the suspension medium at a concentration sufficient to provide a delivered dose of glycopyrrolate of between about 15 g and about 80 g per actuation of the metered dose inhaler; a second species of active agent particles comprising formoterol, including any pharmaceutically acceptable salts, esters, isomers or solvates thereof, suspended in the suspension medium at a concentration sufficient to provide a delivered dose of formoterol of between about 2 g and about 10 g per actuation of the metered dose inhaler; and a plurality of respirable suspending particles comprising perforated microstructures incorporating budesonide, including any pharmaceutically acceptable salts, esters, isomers or
  • At least 90% of the first and second species of active agent particles by volume exhibit an optical diameter of less than 7 ⁇ , and the ratio of the total mass of the suspending particles to the total mass of the first and second species of active agent particles is selected from between about 3:1 and about 15:1 and between about 2:1 and 8:1 .
  • a co-suspension composition deliverable from a metered dose inhaler includes the following: a suspension medium comprising a pharmaceutically acceptable HFA propellant; a first species of active agent particles comprising glycopyrrolate, including any pharmaceutically acceptable salts, esters, isomers or solvates thereof, suspended in the suspension medium at a concentration sufficient to provide a delivered dose of glycopyrrolate of between about 15 g and about 80 g per actuation of the metered dose inhaler; a second species of active agent particles comprising formoterol, including any pharmaceutically acceptable salts, esters, isomers or solvates thereof suspended in the suspension medium at a concentration sufficient to provide a delivered dose of formoterol of between about 2 g and about 10 g per actuation of the metered dose inhaler; and a plurality of respirable suspending particles comprising perforated microstructures incorporating mometasone, including any pharmaceutically acceptable salts, esters, isomers or
  • At least 90% of the first and second species of active agent particles by volume exhibit an optical diameter of less than 7 ⁇ , and the ratio of the total mass of the suspending particles to the total mass of the first and second species of active agent particles is selected from between about 3:1 and about 15:1 and between about 2:1 and 8:1 .
  • a co-suspension composition deliverable from a metered dose inhaler includes the following: a suspension medium comprising a pharmaceutically acceptable HFA propellant; a first species of active agent particles comprising tiotropium, including any pharmaceutically acceptable salts, esters, isomers or solvates thereof, suspended in the suspension medium at a concentration sufficient to provide a delivered dose of tiotropium of between about 5 g and about 20 g per actuation of the metered dose inhaler; a second species of active agent particles comprising formoterol, including any pharmaceutically acceptable salts, esters, isomers or solvates thereof, suspended in the suspension medium at a concentration sufficient to provide a delivered dose of formoterol of between about 2 g and about 10 g per actuation of the metered dose inhaler; and a plurality of respirable suspending particles comprising perforated microstructures incorporating a corticosteroid selected from beclomethasone, bud
  • At least 90% of the first and second species of active agent particles by volume exhibit an optical diameter of less than 7 ⁇ , and the ratio of the total mass of the suspending particles to the total mass of the first and second species of active agent particles is selected from between about 3:1 and about 15:1 and between about 2:1 and 8:1 .
  • a co-suspension composition deliverable from a metered dose inhaler includes the following: a suspension medium comprising a pharmaceutically acceptable HFA propellant; a first species of active agent particles comprising tiotropium, including any pharmaceutically acceptable salts, esters, isomers or solvates thereof, suspended in the suspension medium at a concentration sufficient to provide a delivered dose of tiotropium of between about 5 g and about 20 g per actuation of the metered dose inhaler; a second species of active agent particles comprising formoterol, including any pharmaceutically acceptable salts, esters, isomers or solvates thereof, suspended in the suspension medium at a concentration sufficient to provide a delivered dose of formoterol of between about 2 g and about 10 g per actuation of the metered dose inhaler; and a plurality of respirable suspending particles comprising perforated microstructures incorporating budesonide, including any pharmaceutically acceptable salts, esters,
  • At least 90% of the first and second species of active agent particles by volume exhibit an optical diameter of less than 7 ⁇ , and the ratio of the total mass of the suspending particles to the total mass of the first and second species of active agent particles is selected from between about 3:1 and about 15:1 and between about 2:1 and 8:1 .
  • a co-suspension composition deliverable from a metered dose inhaler includes the following: a suspension medium comprising a pharmaceutically acceptable HFA propellant; a first species of active agent particles comprising tiotropium, including any pharmaceutically acceptable salts, esters, isomers or solvates thereof, suspended in the suspension medium at a concentration sufficient to provide a delivered dose of tiotropium of between about 5 g and about 20 g per actuation of the metered dose inhaler; a second species of active agent particles comprising formoterol, including any pharmaceutically acceptable salts, esters, isomers or solvates thereof, suspended in the suspension medium at a concentration sufficient to provide a delivered dose of formoterol of between about 2 g and about 10 g per actuation of the metered dose inhaler; and a plurality of respirable suspending particles comprising perforated microstructures incorporating mometasone, including any pharmaceutically acceptable salts, esters
  • At least 90% of the first and second species of active agent particles by volume exhibit an optical diameter of less than 7 ⁇ , and the ratio of the total mass of the suspending particles to the total mass of the first and second species of active agent particles is selected from between about 3:1 and about 15:1 and between about 2:1 and 8:1 .
  • an MDI system includes a pressurized, liquid phase formulation-filled canister disposed in an actuator formed with a mouthpiece.
  • the MDI system may include the formulations described herein, which include a suspension medium, at least one species of active agent particles and at least one species of suspending particles.
  • the canister used in the MDI may be of any suitable configuration, and in one exemplary embodiment, the canister may have a volume ranging from about 5 ml_ to about 25 ml_, such as, for example a canister having a 19 ml_ volume.
  • a metering valve including a metering chamber capable of holding a defined volume of the formulation (e.g., 63 ⁇ or any other suitable volume available in commercially available metering valves), which is released into an expansion chamber at the distal end of the valve stem when actuated.
  • the actuator retains the canister and may also include a port with an actuator nozzle for receiving the valve stem of the metering valve.
  • the specified volume of formulation travels to the expansion chamber, out the actuator nozzle and into a high-velocity spray that is drawn into the lungs of a patient.
  • Methods of formulating a pharmaceutical composition for respiratory delivery of at least two active agents involve the steps of providing a suspension medium, one or more species of active agent particles and one or more species of suspending particles, and combining such constituents to form a composition wherein the active agent particles associate with the suspending particles and co-locate with the suspending particles within the suspension medium such that a co-suspension as described herein is formed.
  • the association of the active agent particles and the suspending particles is such that they do not separate due to their different buoyancies in a propellant.
  • a method of formulating a pharmaceutical composition as described herein can include providing two or more species of active agent particles in combination with one or more species of suspending particles.
  • the method may include providing two or more species of suspending particles in combination with two or more species of active agent particles in a manner which results in a co-suspension.
  • one or more species of active agent particles may be combined with one or more species of suspending particles, as described herein.
  • the active agent material included in the active agent particles is selected from one or more of LABA, LAMA or corticosteroid active agents.
  • the active agent particles consist essentially of active agent material, and are free of additional excipients, adjuvants, stabilizers, etc.
  • a suspension medium as described herein such as a suspension medium formed by an HFA propellant
  • Suspending particles are also obtained or prepared as described herein.
  • Active agent particles are also obtained, and the suspension medium, suspending particles and active agent particles are combined to form a co- suspension wherein the active agent particles associate with suspending particles and co-locate with the suspending particles within the continuous phase formed by the suspension medium.
  • co-suspensions according to the present description When compared to active agent particles contained in the same suspension medium in the absence of suspending particles, co-suspensions according to the present description have been found to exhibit a higher tolerance to solution mediated phase transformation that leads to irreversible crystal aggregation, and thus may lead to improved stability and dosing uniformity.
  • methods for forming stabilized compositions including two or more active agents for pulmonary delivery include preserving the FPF and/or FPD of the composition throughout emptying of an MDI canister.
  • a respirable co-suspension as described herein is provided which is capable of maintaining the FPD and/or the FPF to within ⁇ 20%, ⁇ 10%, or even ⁇ 5% the initial FPD and/or FPF, respectively, throughout emptying of an MDI canister.
  • Such performance can be achieved where two or more active agents are incorporated into the co-suspension and even after the co-suspension is subjected to accelerated degradation conditions.
  • a suspension medium as described herein such as a suspension medium formed by an HFA propellant
  • Suspending particles are also obtained or prepared as described herein.
  • Active agent particles are also obtained, and the suspension medium, suspending particles and active agent particles are combined to form a co-suspension wherein the active agent particles associate with suspending particles and co-locate with the suspending particles within the suspension medium.
  • the co-suspension maintains an FPD or FPF within ⁇ 20%, ⁇ 10%, or even ⁇ 5% of the respective values measured prior to exposure of the composition to multiple temperature cycling events.
  • Methods for preparing an MDI for respiratory delivery of two or more active agents are disclosed.
  • a method may include loading a canister, as described herein, with active agent particles and suspending particles.
  • An actuator valve can be attached to an end of the canister and the canister sealed.
  • the actuator valve may be adapted for dispensing a metered amount of the active agents included in the co-suspension composition per actuation of the MDI.
  • the canister can be charged with a pharmaceutically acceptable suspension medium, such as a propellant as described herein, whereupon the active agent particles and suspending particles yield a stable co-suspension in the suspension medium.
  • compositions may be delivered by an MDI. Therefore, in particular embodiments of such methods, an MDI loaded with a composition described herein is obtained, and two or more active agents are administered to a patient via respiratory delivery through actuation of the MDI.
  • an MDI loaded with a composition described herein is obtained, and two or more active agents are administered to a patient via respiratory delivery through actuation of the MDI.
  • the mouthpiece is inserted into a patient's mouth between the lips and teeth. The patient typically exhales deeply to empty the lungs and then takes a slow deep breath while actuating the cartridge of the MDI.
  • each active agent delivered throughout emptying of an MDI canister is not more than 30% greater than the mean delivered dose and is not less than 30% less than the mean delivered dose. Therefore, methods of achieving a desired DDU of two or more active agents delivered from an MDI are also provided.
  • the method may include achieving a DDU for each of the two or more active agents delivered from an MDI selected from, for example, a DDU of ⁇ 30%, or better, a DDU of ⁇ 25%, or better, and a DDU of ⁇ 20%, or better throughout emptying of the MDI canister from which the co-suspension composition is delivered.
  • Methods for treating patients suffering from an inflammatory or obstructive pulmonary disease or condition are provided herein.
  • such methods include pulmonary delivery of a pharmaceutical composition described herein, and in certain such embodiments, pulmonary administration of the pharmaceutical composition is accomplished by delivering the composition using an MDI.
  • the disease or condition to be treated can be selected from any inflammatory or obstructive pulmonary disease or condition that responds to the administration of, for example, the active agents described herein.
  • the combination of active agents includes at least one active agent selected from LAMA, LABA or corticosteroid active agents.
  • the pharmaceutical compositions described herein may be used in treating a disease or disorder selected from asthma, COPD, exacerbation of airways hyper reactivity consequent to other drug therapy, allergic rhinitis, sinusitis, pulmonary vasoconstriction, inflammation, allergies, impeded respiration, respiratory distress syndrome, pulmonary hypertension, pulmonary vasoconstriction, emphysema, and any other respiratory disease, condition, trait, genotype or phenotype that can respond to the administration of combinations of active agents described herein.
  • the pharmaceutical compositions described herein may be used in treating pulmonary inflammation and obstruction associated with cystic fibrosis.
  • compositions according to the present description delivered from an MDI provide desirable pharmacodynamic (PD) performance.
  • pulmonary delivery of the pharmaceutical compositions described herein results in rapid, significant improvement in the lung capacity, which can be characterized by an improvement in the patient's forced expiratory volume in one second (FEVi).
  • FEVi forced expiratory volume in one second
  • methods for achieving a clinically significant increase in FEVi include providing a co-suspension composition comprising two or more active agents, wherein at least one of those active agents is selected from a LABA, LAMA or corticosteroid active agents, as described herein, and administering such composition to a patient experiencing pulmonary inflammation or obstruction via an MDI.
  • the active agents included in the composition include a combination selected from one of a combination of LABA and LAMA active agents, a combination of LABA and corticosteroid active agents, a combination of LAMA and corticosteroid active agents, and a combination of LABA, LAMA and corticosteroid active agents.
  • a clinically significant increase in FEVi is any increase of 100 ml or greater, and in certain embodiments of the methods described herein, administration of compositions according to the present description to patient results in a clinically significant increase in FEVi within 1 hour or less.
  • methods for administering a composition as described herein to a patient via an MDI result in a clinically significant increase in FEV1 within 0.5 hours or less.
  • methods are provided for achieving an increase in FEVi greater than 100 ml.
  • the methods described herein include methods for achieving an FEVi of 150 ml or greater within a period of time selected from 0.5 hours or less, 1 hour or less, and 1 .5 hours or less.
  • the methods described herein include methods for achieving an FEVi of 200 ml or greater within a period of time selected from 0.5 hours or less, 1 hour or less, and 1 .5 hours or less, and 2 hours or less.
  • the methods described herein include methods for achieving an FEW ⁇ of 250 ml or greater within a period of time selected from 0.5 hours or less, 1 hour or less, and 1 .5 hours or less, and 2 hours or less.
  • the methods described herein include methods for achieving an FEVi of 300 ml or greater within a period of time selected from 0.5 hours or less, 1 hour or less, and 1 .5 hours or less, and 2 hours or less.
  • the methods described herein include methods for achieving an FEVi of 350 ml or greater within a period of time selected from 0.5 hours or less, 1 hour or less, and 1 .5 hours or less, and 2 hours or less.
  • the active agents included in the composition include a combination selected from one of a combination of LABA and LAMA active agents, a combination of LABA and corticosteroid active agents, a combination of LAMA and corticosteroid active agents, and a combination of LABA, LAMA and corticosteroid active agents, wherein the composition is delivered to the patient via an MDI.
  • methods for achieving and maintaining a clinically significant increase in FEVi are provided.
  • a clinically significant increase in FEVi is achieved in a period of time selected from 0.5 hours or less, 1 hour or less, and 1 .5 hours or less, and the clinically significant increase in FEVi is maintained for up 12 hours or more.
  • the increase in FEVi may be selected from an increase of 150 ml or greater, 200 ml or greater, 250 ml or greater, 300 ml or greater, and 350 ml or greater, and the increase in FEVi remains clinically significant for a time period selected from up to 4 hours, up to 6 hours, up to 8 hours, up to 10 hours, and up to 12 hours, or more.
  • the active agents included in the composition include a combination selected from one of a combination of LABA and LAMA active agents, a combination of LABA and corticosteroid active agents, a combination of LAMA and corticosteroid active agents, and a combination of LABA, LAMA and corticosteroid active agents, wherein the composition is delivered to the patient via an MDI.
  • compositions, systems and methods described herein are not only suited to achieving desirable pharmacodynamic performance in short periods of time, but will achieve such results in a high percentage of patients.
  • methods are provided herein for achieving a 10% or greater increase in FEVi in 50% or more of patients experiencing pulmonary inflammation or obstruction.
  • methods for achieving a 10% or greater increase in FEVi in a patient include providing a co-suspension composition comprising a combination of active agents, wherein at least one active agent is selected from LABA, LAMA, and corticosteroid active agents as described herein, and administering such composition via an MDI to a patient experiencing pulmonary inflammation or obstruction.
  • administration of the composition results in 10% or greater increase in FEVi within a period of time selected from 0.5 hours or less, 1 hour or less, 1 .5 hours or less, and 2 hours in 50% or more of patients. In other such embodiments, administration of the composition results in 10% or greater increase in FEVi within a period of time selected from 0.5 hours or less, 1 hour or less, 1 .5 hours or less, and 2 or less hours in 60% or more of patients. In still other such embodiments, administration of the composition results in 10% or greater increase in FEVi within a period of time selected from 0.5 hours or less, 1 hour or less, 1 .5 hours or less, and 2 hours or less in 70% or more of patients.
  • administration of the composition results in 10% or greater increase in FEVi within a period of time selected from 0.5 hours or less, 1 hour or less, 1 .5 hours or less, and 2 or less hours in 80% or more of patients.
  • the active agents included in the composition include a combination selected from one of a combination of LABA and LAMA active agents, a combination of LABA and corticosteroid active agents, a combination of LAMA and corticosteroid active agents, and a combination of LABA, LAMA and corticosteroid active agents, wherein the composition is delivered to the patient via an MDI.
  • the methods described herein facilitate treatment of patients experiencing pulmonary inflammation or obstruction, wherein such methods include providing a co-suspension composition comprising a combination of active agents as described herein and administering such composition to a patient experiencing pulmonary inflammation or obstruction via an MDI, and administration of the composition via an MDI results in patients experiencing either an increase from baseline in FEVi of at least 200 ml or a 12%, or greater, increase from baseline in FEVi coupled with total increase in FEVi of at least 150 ml.
  • administration of the composition results in either an increase from baseline in FEVi of at least 200 ml or a 12%, or greater, increase from baseline in FEVi coupled with total increase in FEVi of at least 150 ml within a period of time selected from 1 hour, or less, 1 .5 hours or less, 2 hours, or less, and 2.5 hours, or less, in 50% or more of patients.
  • administration of the composition results in an increase from baseline in FEVi of at least 200 ml or a 12%, or greater, increase from baseline in FEVi coupled with total increase in FEVi of at least 150 ml within a period of time selected from 1 hour, or less, 1 .5 hours, or less, 2 hours, or less, and 2.5 hours, or less, in 60% or more of patients.
  • administration of the composition results in either an increase from baseline in FEVi of at least 200 ml or a 12%, or greater, increase from baseline in FEVi coupled with total increase in FEVi of at least 150 ml within a period of time selected from 1 .5 hours, or less, 2 hours, or less, 2.5 hours, or less, and 3 hours, or less, in 70% or more of patients.
  • administration of the composition results in either an increase from baseline in FEVi of at least 200 ml or a 12%, or greater, increase from baseline in FEVi coupled with total increase in FEVi of at least 150 ml within a period of time selected from 1 .5 hours, or less, 2 hours, or less, 2.5 hours or less, and 3 hours, or less, in 80% or more of patients.
  • the active agents included in the composition include a combination selected from one of a combination of LABA and LAMA active agents, a combination of LABA and corticosteroid active agents, a combination of LAMA and corticosteroid active agents, and a combination of LABA, LAMA and corticosteroid active agents, wherein the composition is delivered to the patient via an MDI.
  • the methods for achieving and maintaining a clinically significant increase in FEVi described herein result in an increase in FEVi that represents a significant improvement in FEVi relative to the improvement provided by compositions delivering only a single active agent.
  • a significant improvement in FEVi is an improvement of 60 ml or greater.
  • methods for achieving a significant improvement in FEVi relative to the improvement provided by compositions delivering only a single active agent include providing a co- suspension composition as described herein comprising a combination of active agents, wherein at least one active agent is selected from LABA, LAMA, and corticosteroid active agents as described herein, and administering such composition via an MDI to a patient experiencing pulmonary inflammation or obstruction.
  • administration of the co-suspension composition results in an improvement in FEW ⁇ AUC 0- 12 of at least 70 ml when compared to the FEW ⁇ AUCo-12 achieved by a composition delivering a single active agent.
  • administration of the co-suspension composition results in an improvement in FEVi AUCo-12 of at least 80 ml when compared to the FEVi AUCo-12 achieved by a composition delivering a single active agent. In still other embodiments, administration of the co-suspension composition results in an improvement in FEVi AUCo-12 of at least 90 ml when compared to the FEVi AUCo-12 achieved by a composition delivering a single active agent.
  • methods for achieving a significant improvement in FEVi relative to the improvement provided by compositions delivering only a single active agent include providing a co-suspension composition as described herein comprising a combination of active agents, wherein at least one active agent is selected from LABA, LAMA, and corticosteroid active agents as described herein, administering such composition via an MDI to a patient experiencing pulmonary inflammation or obstruction, with such administration resulting in a significant improvement in the peak change in FEVi (Peak FEVi) when compared to the Peak FEVi achieved by a composition delivering a single active agent.
  • a co-suspension composition as described herein comprising a combination of active agents, wherein at least one active agent is selected from LABA, LAMA, and corticosteroid active agents as described herein
  • administration of the co-suspension composition as described herein results in an improvement in Peak FEVi of at least 70 ml when compared to the Peak FEVi achieved by a composition delivering a single active agent. In other such embodiments, administration of the co-suspension composition as described herein results in an improvement in Peak FEVi of at least 80 ml when compared to the Peak FEVi achieved by a composition delivering a single active agent. In further such embodiments, administration of the co-suspension composition as described herein results in an improvement in Peak FEVi of at least 90 ml when compared to the Peak FEVi achieved by a composition delivering a single active agent.
  • IC inspiratory capacity
  • methods for improving IC as described herein include providing a co-suspension composition as described herein comprising a combination of active agents, wherein at least one active agent is selected from LABA, LAMA, and corticosteroid active agents as described herein, and administering such composition via an MDI to a patient experiencing pulmonary inflammation or obstruction, wherein administration of the composition results in an increase in IC of 70 ml or greater.
  • administration of the composition according to the present description results in an increase in IC of 100 ml or greater.
  • administration of the composition according to the present description results in an increase in IC of 200 ml or greater.
  • administration of composition according to the present description results in an increase in IC of 300 ml or greater
  • administration of composition according to the present description results in an increase in IC of 350 ml or greater
  • the increase in IC is experienced rapidly.
  • a clinically significant increase in IC or an increase in IC selected from 100 ml or greater, 200 ml or greater, 300 ml or greater, or 350 ml or greater can be experienced in a patient within a time selected from 1 hour or less and 2 hours or less.
  • the methods for increasing IC described herein are not only useful for quickly achieving clinically significant increases in IC in a short period of time, but they are useful for maintaining a clinically significant increase in IC over time.
  • the clinically significant increases in IC provided by the methods described herein are experienced by patients quickly after administration, the increases in IC remain clinically significant for a period of up to 12 hours or more post-administration, and the increases in IC remain clinically significant even after chronic dosing (e.g., multiple consecutive dosing days).
  • compositions according to the present description provide increases in IC that are significantly greater than increases in IC provided by compositions delivering only a single active agent.
  • administration of a co-suspension composition as described herein provides an increase in IC that is at least 70 ml greater than the increase in IC provided by a composition delivering only a single active agent.
  • the increase in IC provided by administering a co-suspension composition described herein is at least 100 ml greater than the increase in IC provided by a composition delivering only a single active agent.
  • the increase in IC provided by administering a co-suspension composition described herein is at least 125 ml greater than the increase in IC provided by a composition delivering only a single active agent
  • the methods described herein for achieving desired pharmacodynamic effects are characterized by delivery of relatively low amounts of active agents.
  • the methods described herein for achieving clinically significant increases in FEVi include administering a co-suspension as described herein comprising a combination of glycopyrrolate and formoterol active agents, wherein the co-suspension is administered to a patient via a metered dose inhaler up to two times daily and with each administration a total delivered dose of glycopyrrolate of no more than 150 g and a total delivered dose of formoterol of no more than 12 ug are administered to the patient.
  • the methods described herein for achieving clinically significant increases in FEVi include administering a co-suspension as described herein comprising a combination of glycopyrrolate and formoterol active agents, wherein the co-suspension is administered to a patient via a metered dose inhaler up to two times daily and with each administration a total delivered dose of glycopyrrolate of no more than 100 g and a total delivered dose of formoterol of no more than 12 ug are administered to the patient.
  • the methods described herein for achieving clinically significant increases in FEVi include administering a co-suspension as described herein comprising a combination of glycopyrrolate and formoterol active agents, wherein the co-suspension is administered to a patient via a metered dose inhaler up to two times daily and with each administration a total delivered dose of glycopyrrolate of no more than 80 g and a total delivered dose of formoterol of no more than 12 ug are administered to the patient.
  • the methods described herein for achieving clinically significant increases in FEVi include administering a co-suspension as described herein comprising a combination of glycopyrrolate and formoterol active agents, wherein the co-suspension is administered to a patient via a metered dose inhaler up to two times daily and with each administration a total delivered dose of glycopyrrolate of no more than 50 g and a total delivered dose of formoterol of no more than 12 ug are administered to the patient.
  • the methods for achieving clinically significant increases in IC described herein include administering a co-suspension composition as described herein to a patient via a metered dose inhaler, wherein the co- suspension includes glycopyrrolate and formoterol active agents, the co-suspension is administered to a patient via a metered dose inhaler up to two times daily, and with each administration total delivered doses of no more than 150 g glycopyrrolate and 12 ug formoterol are administered to the patient.
  • the methods described herein for achieving clinically significant increases in IC include administering a co-suspension as described herein comprising a combination of glycopyrrolate and formoterol active agents, wherein the co-suspension is administered to a patient via a metered dose inhaler up to two times daily and with each administration a total delivered dose of glycopyrrolate of no more than 100 g and a total delivered dose of formoterol of no more than 12 ug are administered to the patient.
  • the methods described herein for achieving clinically significant increases in IC include administering a co- suspension as described herein comprising a combination of glycopyrrolate and formoterol active agents, wherein the co-suspension is administered to a patient via a metered dose inhaler up to two times daily and with each administration a total delivered dose of glycopyrrolate of no more than 80 g and a total delivered dose of formoterol of no more than 12 ug are administered to the patient.
  • the methods described herein for achieving clinically significant increases in IC include administering a co-suspension as described herein comprising a combination of glycopyrrolate and formoterol active agents, wherein the co-suspension is administered to a patient via a metered dose inhaler up to two times daily and with each administration a total delivered dose of glycopyrrolate of no more than 50 g and a total delivered dose of formoterol of no more than 12 ug are administered to the patient.
  • compositions provided and delivered in the methods described herein may include a co-suspension composition including any combination of active agents as described herein.
  • the methods described herein for achieving a clinically significant increase in FEVi or IC include providing a co-suspension composition comprising two or more active agents, wherein at least one of those active agents is selected from a LABA, LAMA or corticosteroid active agents as described herein, and administering such composition to a patient experiencing pulmonary inflammation or obstruction via an MDI.
  • the active agents included in the co-suspension composition include a combination selected from one of a combination of LABA and LAMA active agents, a combination of LABA and corticosteroid active agents, a combination of LAMA and corticosteroid active agents, and a combination of LABA, LAMA and corticosteroid active agents.
  • the co-suspension composition provided and administered can be any of the specific co-suspension compositions detailed herein.
  • An exemplary co-suspension composition as described herein was prepared and evaluated.
  • the composition included a combination of glycopyrrolate (GP) and formoterol fumarate (FF) active agents.
  • GP glycopyrrolate
  • FF formoterol fumarate
  • GP was present in the propellant as micronized, crystalline active agent particles. It was co-suspended with spray dried suspending particles that included FF disposed within the material forming the suspending particle. To achieve this, FF was dissolved in the feedstock used to manufacture the lipid-based suspending particles.
  • GP active agent particles were formed by micronizing glycopyrrolate using a jet mill.
  • the particle size distribution of the glycopyrrolate active agent particles was determined by laser diffraction using a laser diffraction particle size analyzer, Fraunhofer diffraction mode, equipped with a dry powder dispenser (e.g., Sympatec GmbH, Clausthal-Zellerfeld, Germany).
  • 50% by volume of the active agent particles exhibited an optical diameter smaller than 1 .7 ⁇ , and 90% by volume exhibited an optical diameter smaller than 3.5 ⁇ .
  • FF-containing suspending particles were manufactured as follows: 654 ml_ of a fluorocarbon-in-water emulsion of PFOB (perfluorooctyl bromide) stabilized by a phospholipid was prepared; 26.5 g of the phospholipid, DSPC (1 ,2-disteroyl-sn- glycero-3-phosphocholine), and 2.4 g of calcium chloride were homogenized in 276 ml_ of hot water (80°C) using a high shear mixer; and 142 ml_ of PFOB were added slowly during homogenization.
  • PFOB perfluorooctyl bromide
  • the resulting coarse emulsion was then further homogenized using a high pressure homogenizer (Model C3, Avestin, Ottawa, CA) at pressures of up to 170 MPa for 5 passes.
  • 552 mg FF was dissolved in 273 ml of warm water (50°C) and most of the solution was combined with the emulsion using a high shear mixer.
  • the emulsion was spray dried in nitrogen using the following spray drying conditions: inlet temperature 95°C; outlet temperature 68°C; emulsion feed rate 2.4 ml/min; and total gas flow 498 l/min.
  • the final mass fraction of formoterol in the spray dried powder was 2%.
  • a second lot of FF-containing suspending particles was manufactured in a similar fashion.
  • the mass fraction of FF in the spray dried powder was 1 % for this lot.
  • a third lot of suspending particles was manufactured without FF.
  • the particle size distribution of the suspending particles was determined by laser diffraction. For both lots of FF containing suspending particles, 50% by volume were smaller than 3.5 ⁇ and the Geometric Standard Deviation of the distribution was 1 .7. For the suspending particles without FF, 50% by volume were smaller than 3.2 ⁇ and the Geometric Standard Deviation of the distribution was 1 .8.
  • MDIs containing FF, GP or both were prepared by weighing the target masses of active agent particles and suspending particles into fluorinated ethylene polymer (FEP) coated aluminum canisters (Presspart, Blackburn, UK) with a 19 ml_ volume.
  • FEP fluorinated ethylene polymer
  • the canisters were crimp sealed with 63 ⁇ valves (# BK 357, Bespak, King's Lynn, UK) and filled with 12.4 g of HFA 134a (1 ,1 ,1 ,2-tetrafluoroethane) (Ineos Fluor, Lyndhurst, UK) by overpressure through the valve stem.
  • the filled MDIs were stored valve down at two different conditions: refrigerated at 5°C without overwrap and controlled room temperature at 25°C/60% RH with a foil overwrap. Aerosol performance and delivered dose uniformity tests were carried out at different time points. Aerosol performance was assessed after manufacturing in accordance with USP ⁇ 601 > (United States Pharmacopoeia Monograph 601 ). A Next Generation Impactor (NGI) operated at a flow rate of 30 l/min was used for determination of particle size distribution. Sample canisters were seated into an actuator with two waste actuations and two additional waste priming actuations. Five actuations were collected in the NGI with a USP throat attached.
  • NGI Next Generation Impactor
  • valve, actuator, throat, NGI cups, stages, and filter were rinsed with volumetrically dispensed solvent.
  • the sample solutions were assayed using a drug- specific chromatographic method.
  • the fine particle fraction was defined using the sum of stages 3 through filter.
  • Delivered dose uniformity through use testing was performed using a Dose Uniformity Sampling Apparatus as described by USP ⁇ 601 >. Inhalers were seated and primed as described before. Two actuations were collected and assayed at beginning, middle and end of use.
  • Table 1 b Average aerosol performance for co-suspensions in Example 1
  • FIGS 1 and 2 show the ex-actuator dose for configuration 1A and 1 B, respectively, normalized by the actual metered doses of the canister. Assuming an actuator deposition of 20% the target ex-actuator doses for both actives were 80%.
  • the individual FF and GP doses are represented by dots and triangles, respectively.
  • the closed line denotes the mean of the formoterol doses, and the broken line denotes the mean of the glycopyrrolate doses.
  • Figures 3 and 4 show the ratio of the normalized ex actuator doses for configuration 1A and 1 B, respectively. The result indicates that the dose ratio remained constant through canister life. Furthermore the variability of the dose ratio is much lower than that of the individual doses, indicating that a co-suspension with a consistent carrier to active ratio was formed and maintained through container life.
  • MDIs containing FF, GP or both were prepared at target concentrations of 2.4 and 18 g per actuation for FF and GP respectively.
  • GP active agent was micronized and had a dio, dso, dgo and span of 0.6, 1 .7, 3.6 and 1 .9 ⁇ respectively as measured by laser diffraction as described Example 1 .
  • FF was incorporated into spray dried suspending particles and prepared as described in Example 1 , with a composition of 2% FF, 91 .5% DSPC and 6.5% CaCI 2 .
  • the GP, FF and GP + FF MDIs were prepared by weighing the target masses of active agent particles and suspending particles into fluorinated ethylene polymer (FEP) coated aluminum canisters (Presspart, Blackburn, UK) with a 19 ml_ volume.
  • FEP fluorinated ethylene polymer
  • the canisters were crimp sealed with 50 ⁇ valves (# BK 357, Bespak, King's Lynn, UK) and filled with 10.2 g of HFA 134a (1 ,1 ,1 ,2-tetrafluoroethane) (Ineos Fluor, Lyndhurst, UK) by overpressure through the valve stem.
  • HFA 134a (1 ,1 ,1 ,2-tetrafluoroethane
  • the canisters were sonicated for 15 seconds and agitated on a wrist action shaker for 30 minutes.
  • the canisters were fitted with polypropylene actuators with a 0.3 mm orifice (# BK
  • the aerosol performance of the combination co-suspension composition including both GP and FF active agent was no different than the aerosol performance achieved by suspension compositions including either GP or FF alone demonstrating that the aerosol properties of the individual active agents are substantially the same when achieved from the single component or dual combination co-suspensions.
  • the GP + FF Inhalation Aerosol as well as the FF Inhalation Aerosol and GP Inhalation Aerosol were prepared as described in Example 2.
  • the GP+FF Inhalation Aerosol was also labeled the "fixed" combination of GP and FF, while the treatment calling for consecutive delivery of the GP Inhalation Aerosol followed immediately by delivery of the FF Inhalation Aerosol was labeled the "loose" combination of GP and FF.
  • Subjects were randomized in to the study and assigned one of four treatment sequences, with each treatment sequence including all four study treatments. Each subject received four single dose treatments separated by 7 to 21 days. Sixteen subjects were enrolled and analyzed for safety. Three subjects were excluded from the PK analysis as a result of not receiving one or more of the four treatments, and an additional two subjects were excluded from the PK analysis as non-evaluable due to dosing errors arising from poor inhalation technique.
  • the GP + FF Inhalation Aerosol was administered to provide each subject a 72 ig dose of GP and a 9.6 g dose of FF (four actuations, 18 g GP and 2.4 g FF per actuation).
  • the GP Inhalation Aerosol was administered to provide each subject a 72 g dose of GP (four actuations, 18 g GP per actuation).
  • the FF Inhalation Aerosol was administered to provide each subject a 9.6 g dose of FF (four actuations, 2.4 g FF per actuation).
  • placebo MDI placebo MDI.
  • An exemplary dual co-suspension composition according to the present description was produced and metered dose inhalers incorporating the composition were prepared.
  • the composition included a combination of glycopyrrolate (GP) and formoterol fumarate (FF), with each being provided as a micronized, crystalline material.
  • GP glycopyrrolate
  • FF formoterol fumarate
  • a combination crystalline co-suspension MDI was manufactured by semi- automated suspension filling.
  • the dual co-suspension consisted of a combination of two microcrystalline active pharmaceutical ingredients (also referred to as "APIs" or "API" in the singular), GP and FF, co-suspended with suspending particles in HFA 134a propellant.
  • the dual co-suspension was formulated to provide a delivered dose of 18 ig GP per actuation and 4.8 g FF per actuation.
  • the FF API material used was denoted as "coarse", while in other compositions, the FF API material used was denoted as "fine.”
  • the compositions were formulated to provide a delivered FF dose of 4.8 g per actuation.
  • the particle size characteristics for the course FF, fine FF and GP API materials used in formulation the co-suspension compositions described in this Example are detailed in Table 2.
  • a monotherapy co-suspension composition incorporating only FF active agent material was formulated.
  • the FF monotherapy co-suspension utilized coarse FF API.
  • a monotherapy MDI was manufactured using such FF monotherapy co- suspension, and the FF monotherapy MDI was formulated and manufactured provide a delivered dose of 4.8 g FF per actuation.
  • Suspending particles were manufactured via spray dried emulsion at a feed stock concentration of 80 mg/mL with a composition of 93.44% DSPC (1 ,2- Distearoyl-sn-Glycero-3-Phosphocholine) and 6.56% anhydrous calcium chloride (equivalent to a 2:1 DSPC:CaCl2 mole/mole ratio).
  • DSPC and CaCl2 was dispersed with a high shear mixer at 8000-10000 rpm in a vessel containing heated water (80 ⁇ 3 °C) with PFOB slowly added during the process.
  • the emulsion was then processed with 6 passes in a high pressure homogenizer (10000- 25000 psi).
  • the emulsion was then spray dried via a spray dryer fitted with a 0.42" atomizer nozzle with a set atomizer gas flow of 18 SCFM.
  • the drying gas flow rate was set to 72 SCFM with an inlet temperature of 135 °C, outlet temperature 70 °C, and an emulsion flow rate of 58 mL/min.
  • a drug addition vessel (DAV) was prepared for suspension filling in the following manner: first adding half of suspending particle quantity, next filling microcrystalline materials, and lastly adding the remaining half of suspending particles to the top. Materials were added to the vessel in a humidity controlled environment of ⁇ 10% RH. The DAV was then connected to a 4 L suspension vessel and flushed with HFA 134a propellant and then mixed with gently to form a slurry. The slurry is then transferred back to the suspension mixing vessel and diluted with additional HFA-134a to form the final suspension at target concentration stirring gently with an impeller. The temperature inside the vessel was maintained at 21 -23 °C throughout the entire batch production.
  • SX salmeterol xinafoate
  • FP fluticasone propionate
  • Micronized SX (4-hydroxy-a1 -[[[6-(4-phenylbutoxy)hexyl]amino] methyl]- 1 ,3-benzenedimethanol, 1 -hydroxy-2-naphthalenecarboxylate) was received by the manufacturer (Inke SA, Germany) and used as active agent particles. The particle size distribution of the SX was determined by laser diffraction. 50% by volume of the micronized particles exhibited an optical diameter smaller than 2 ⁇ , and 90% by volume exhibited an optical diameter smaller than 3.9 ⁇ .
  • Micronized FP (S-(fluoromethyl)6 a ,9-difluoro-1 1 p -17-dihydroxy-16 a -methyl- 3-oxoandrosta-1 ,4-diene-17 p -carbothioate, 17-propionate) was received as micronized by the manufacturer (Hovione FarmaCiencia SA, Loures Portugal) and used as active agent particles. The particle size distribution of the FP was determined by laser diffraction. 50% by volume of the micronized particles exhibited an optical diameter smaller than 2.6 ⁇ , and 90% by volume exhibited an optical diameter smaller than 6.6 ⁇ .
  • Suspending particles were manufactured as follows: 150 ml_ of a fluorocarbon-in-water emulsion of PFOB (perfluorooctyl bromide) stabilized by a phospholipid was prepared; 12.3 g of the phospholipid, DSPC (1 ,2-disteroyl-sn- glycero-3-phosphocholine) and 1 .2 g of calcium chloride were homogenized in 100 ml_ of hot water (70°C) using a high shear mixer; and 65 ml_ of PFOB were added slowly during homogenization. The resulting coarse emulsion was then further homogenized using a high pressure homogenizer (Model C3, Avestin, Ottawa, CA) at pressures of up to 140 MPa for 3 passes.
  • PFOB perfluorooctyl bromide
  • the emulsion was spray dried in nitrogen using the following spray drying conditions: Inlet temperature 90°C; outlet temperature 69°C; emulsion feed rate 2.4 ml/min; and total gas flow 498 l/min.
  • the particle size distribution of the suspending particles, VMD was determined by laser diffraction. 50% by volume of the suspending particles were smaller than 2.7 ⁇ , the Geometric Standard Deviation of the distribution was 2.0. Additionally, the aerodynamic particle size distribution of the suspending particles was determined with a time-of-flight particle sizer. 50% by volume of the suspending particles had an aerodynamic particle diameter smaller than 1 .6 ⁇ . The large difference between aerodynamic particle diameter and optical particle diameter indicates that the suspending particles had a low particle density ⁇ 0.5 kg/I. This was verified by electron microscopy, which confirmed that the suspending particles exhibited a hollow, thin-walled morphology.
  • MDIs were prepared by weighing the target masses of micronized FP, SX, and suspending particles into fluorinated ethylene polymer (FEP) coated aluminum canisters (Presspart, Blackburn, UK) with a 19 ml_ volume.
  • FEP fluorinated ethylene polymer
  • the canisters were crimp sealed with 63 ⁇ valves (# BK 357, Bespak, King's Lynn, UK) and filled with 10 ml of HFA 134a (1 ,1 ,1 ,2-tetrafluoroethane) (Ineos Fluor, Lyndhurst, UK) by overpressure through the valve stem.
  • HFA 134a (1 ,1 ,1 ,2-tetrafluoroethane
  • the canisters were fitted with polypropylene actuators with a 0.3 mm orifice (# BK 636, Bespak, King's Lynn, UK). Aerosol performance was assessed shortly after manufacturing in accordance with USP 601 , as described in Example 1 . Results are reported below in Table 4.
  • Table 4 Results for a co-suspension of Fluticasone Propionate (FP) and Salmeterol Xinafoate (SX) of Example 5 Suspending Target Target FP SX SX FP SX particle Delivered Delivered DDU DDU FPF MMAD MMAD cone. Dose FP Dose SX
  • SX salmeterol xinafoate
  • FP fluticasone propionate
  • FP-containing suspending particles were manufactured as follows: 200 mL of a fluorocarbon-in-water emulsion of PFOB stabilized by a phospholipid was prepared; 3.3g of the phospholipid (DSPC) and 0.8g of micronized FP were dispersed and 0.3g of calcium chloride dihydrate was dissolved in 100ml_ of warm water (70°C) using a high shear mixer; and 44mL of PFOB was added slowly during dispersion. The resulting coarse emulsion was then further homogenized using a high pressure homogenizer at 140 MPa for 3 passes. The homogenization reduced the particle size of the suspended FP crystals.
  • MDIs were prepared by weighing the target masses of micronized SX active agent particles and FP-containing suspending particles into fluorinated ethylene polymer (FEP) coated aluminum canisters (Presspart, Blackburn, UK) with a 19 ml_ volume.
  • FEP fluorinated ethylene polymer
  • the canisters were crimp sealed with 63 ⁇ valves (# BK 357, Bespak, King's Lynn, UK) and filled with 10 ml of HFA 134a (1 ,1 ,1 ,2- tetrafluoroethane) (Ineos Fluor, Lyndhurst, UK) by overpressure through the valve stem. After injecting the propellant, the canisters were sonicated for 15 seconds and agitated on a wrist action shaker for 30 minutes. The canisters were fitted with polypropylene actuators with a 0.3 mm orifice (# BK 636, Bespak, King's Lynn, UK). Aerosol performance was assessed shortly after manufacturing in accordance with USP 601 as previously described in Example 1 . Results are reported below in Table 5.
  • BD Budesonide
  • MF mometasone furoate
  • BD 16,17-(butylidenebis(oxy))-1 1 ,21 -dihydroxy-, (1 1 - ,16-a)-pregna-1 ,4- diene-3,20-dione
  • the particle size distribution of the BD was determined by laser diffraction. 50% by volume of the micronized particles exhibited an optical diameter smaller than 1 .9 ⁇ , and 90% by volume exhibited an optical diameter smaller than 4.3 ⁇ .
  • MF 9a,21 -dichloro-1 1 ⁇ ,17-di hydroxy- 16a-methylpregna-1 ,4-diene-3,20- dione 17-(2-furoate)
  • the particle size distribution of the MF was determined by laser diffraction. 50% by volume of the micronized particles exhibited an optical diameter smaller than 1 .6 ⁇ , and 90% by volume exhibited an optical diameter smaller than 3.5 ⁇ .
  • Suspending particles were manufactured as follows: 500 ml_ of a fluorocarbon-in-water emulsion of PFOB (perfluorooctyl bromide) stabilized by a phospholipid was prepared; 18.7 g of the phospholipid, DSPC (1 ,2-disteroyl-sn- glycero-3-phosphocholine) and 1 .3 g of calcium chloride were homogenized in 400 ml_ of hot water (75°C) using a high shear mixer; and 100 ml_ of PFOB were added slowly during homogenization.
  • PFOB perfluorooctyl bromide
  • the resulting coarse emulsion was then further homogenized using a high pressure homogenizer (Model C3, Avestin, Ottawa, CA) at pressures of up to 170 MPa for 5 passes.
  • the emulsion was spray dried in nitrogen using the following spray drying conditions: inlet temperature 95°C; outlet temperature 72°C; emulsion feed rate 2.4 ml/min; and total gas flow 498 l/min.
  • MDIs were prepared by weighing the target masses of micronized active and suspending particles into coated glass vials with a 15 ml_ volume.
  • the canisters were crimp sealed with 63 ⁇ valves (Valois, Les Vaudreuil, France) and filled with 9.2 g of HFA 134a (1 ,1 ,1 ,2-tetrafluoroethane) (Ineos Fluor, Lyndhurst, UK) by overpressure through the valve stem. After injecting the propellant, the canisters were sonicated for 15 seconds and agitated on a wrist action shaker for 30 minutes.
  • the suspension concentrations were 0.8 mg/ml for BD active agent particles, 1 .1 mg/ml for MF active agent particles, and 6 mg/ml for the suspending particles.
  • the suspending particle to active agent particle ratio was 7.5 for BD and 5.5 for MF.
  • Target ex actuator doses were 40 ⁇ g for BD and 55 ⁇ g for MF.
  • Dual co-suspension compositions were prepared with suspending particles including either mometasone furoate (MF) or budesonide (BD), and MDIs incorporating the composition were prepared.
  • the co-suspension composition included a combination of crystalline glycopyrrolate (GP) and formoterol fumarate (FF) active agent particles co-suspended with suspending particles including either MF or BD.
  • GP crystalline glycopyrrolate
  • FF formoterol fumarate
  • Each of the APIs were provided as a micronized, crystalline material.
  • Suspending particles containing 50% (w/w) of either BD or MF were manufactured as follows: high shear homogenization of a dispersion containing 2.8 g of DSPC (1 ,2-Distearoyl-sn-Glycero-3-Phosphocholine), and 0.26 g of calcium chloride in 400 ml_ of hot water (75 °C) using a high shear mixer was performed while 56.6 g of PFOB were added slowly.
  • Micronized MF or BD (in 1 :1 weight proportion to DSPC) was added to the resulting coarse emulsion, which was further homogenized using a high pressure homogenizer (Model C3, Avestin, Ottawa, CA) at pressures of up to 170 MPa for 3 to 5 passes.
  • the emulsion was spray dried using the following spray drying conditions: inlet temperature 90-95 °C; outlet temperature 95-72 °C; emulsion feed rate 2-8 mL/min; total dry nitrogen flow 525- 850 L/min.
  • the particle size distribution of the resulting powders was determined by laser diffraction, 50% by volume of the suspending particles were smaller than 1 .8 ⁇ , the span of the distribution was 1 .6 ⁇ .
  • Canisters containing either 50% (w/w) MF or BD containing suspending particles were filled with HFA 134a propellant, targeting a 50 or 100 g/actuation of MF or BD, respectively.
  • Their aerosol particle size distributions were determined according to the methods described in Example 1 , and results are shown in Table 6.
  • a comparable series of canisters containing MF or BD containing suspending particles in combination with GP and FF active agent particles were produced.
  • Sufficient micronized GP and FF API material was added to such canisters in amounts sufficient to provide targeted delivered doses of 36 g/actuation and 6 g/actuation for GP and FF, respectively.
  • Additional placebo suspending particles prepared as described herein but free of any active agent also referred to as "placebo" suspending particles
  • the aerosol particle size distributions provided by the co-suspension compositions prepared according to this Example were determined as described in Example 1 , with the results are shown in Table 7.
  • the mass mean aerodynamic diameter of the corticosteroid in the single component suspensions is equivalent to the one obtained in the triple combination formulations prepared with two different species of active agent particles co-suspended with BD or MF containing suspending particles.
  • the triple co-suspension compositions prepared according to the present description avoided a combination effect.
  • Table 6 Suspension MDIs in HFA 134a propellant containing corticosteroid suspending particles. Aerosol properties, mass aerodynamic diameter and fine particle fraction determined by drug specific cascade impaction.
  • Table 7 Triple combination suspension MDIs in HFA 134a propellant including corticosteroid containing suspending particles (Mometasone Furoate or Budesonide), a LAMA (Glycopyrrolate) and a LABA (Formoterol Fumarate). Aerosol properties, mass mean aerodynamic diameter and fine particle fraction determined by drug specific cascade impaction. Triple A 2.3 Formoterol 3.96 44.4
  • a triple co-suspension composition according to the present description was produced and MDIs incorporating the composition were prepared.
  • the composition included a combination of glycopyrrolate (GP), formoterol fumarate (FF), and mometasone furoate (MF) active agent particles, with each being provided as a micronized, crystalline API material.
  • GP glycopyrrolate
  • FF formoterol fumarate
  • MF mometasone furoate
  • a triple co-suspension MDI was manufactured by semi-automated suspension filling.
  • the triple co-suspension consisted of a combination of three microcrystaNine active pharmaceutical ingredients forming three different species of active agent particles: MF (corticosteroid); GP (LAMA); and FF (LABA). These three different species of active agent particles were co-suspended with suspending particles in HFA 134a propellant.
  • the triple co-suspension was formulated to the following delivered dose targets: 50 g per actuation MF; 36 g per actuation GP; and 4.8 g per actuation FF.
  • a monotherapy co-suspension including only MF was produced.
  • the monotherapy MF co- suspension included MF active agent particles co-suspended in the propellant with suspending particles as described in this Example, and was formulated to provide a target delivered dose of 50 g per actuation MF.
  • Suspending particles were manufactured via spray dried emulsion at a feed stock concentration of 80 mg/mL with a composition of 93.44% DSPC (1 ,2- Distearoyl-sn-Glycero-3-Phosphocholine) and 6.56% anhydrous calcium chloride (equivalent to a 2:1 DSPC:CaCl2 mole/mole ratio).
  • DSPC and CaCl2 were dispersed with a high shear mixer at 8000-10000 rpm in a vessel containing heated water (80 ⁇ 3 °C) with PFOB slowly added during the process.
  • the emulsion was then processed with 5 passes in a high pressure homogenizer (10000- 25000 psi).
  • the emulsion was then spray dried via a spray dryer fitted with a 0.42" atomizer nozzle with a set atomizer gas flow of 18 SCFM.
  • the drying gas flow rate was set to 72 SCFM with an inlet temperature of 135 °C, outlet temperature 70 °C, and an emulsion flow rate of 58 mL/min.
  • a drug addition vessel (DAV) was prepared for suspension filling in the following manner: first adding half of suspending particle quantity, next filling microcrystalline materials, and lastly adding the remaining half of suspending particles to the top. Materials were added to the vessel in a humidity controlled environment of ⁇ 10% RH. The DAV was then connected to a 4 L suspension vessel and flushed with HFA 134a propellant and then mixed with a magnetic stir bar. The temperature inside the vessel was maintained at 21 -23 °C throughout the entire batch production. After recirculation of the batch for 30 min canisters were filled with the suspension mixture through 50 ⁇ _ EPDM valves. Sample canisters were the selected at random for Total Canister Analysis to ensure correct formulation quantities. The freshly manufactured triple co-suspension MDI batch was then placed on one week quarantine before initial product performance analysis. The mometasone furoate only MDI was manufactured by suspension filling in the same manner.
  • Table 9 Triple microcrystalline Co-Suspension in HFA 134a propellant MDI. Primary particle size distribution determined by laser diffraction (Sympatec).
  • Table 10 Triple co-suspension MDIs in HFA 134a propellant containing microcrystalline Corticosteroid (Mometasone Furoate), LABA (Formoterol Fumarate) and a LAMA (Glycopyrrolate). Aerosol properties, mass mean aerodynamic diameter and fine particle fraction were determined by drug specific cascade impaction (NGI).
  • NBI drug specific cascade impaction
  • Aerosol performance and delivered dose uniformity achieved by the triple co-suspensions prepared according to this Example were evaluated according to the description provided in Example 1 .
  • Figure 14 illustrates the GP, FF and MF DDU achieved from two canisters containing MF only and two canisters containing MF, GP and FF prepared according to this Example.
  • the DDU of MF delivered from the MF monotherapy configuration is equivalent to the one achieved with the triple co- suspension composition.
  • the aerosol performance of the triple co-suspension composition prepared according to this example was also assessed relative to formulations containing a combination of only two active agents, FF and GP.
  • the aerodynamic particle size distribution of FF and GP are equivalent whether delivered from the compositions containing two active agents or three active agents as shown in Figures 15 and 16, respectively.
  • triple co-suspension compositions were produced and metered dose inhalers incorporated in the composition were prepared.
  • the triple co-suspensions included glycopyrrolate (GP) or tiotropium bromide (TB) in combination with formoterol fumarate (FF), and mometasone furoate (MF) active agents, with each API being used as micronized, crystalline material.
  • GP glycopyrrolate
  • TB tiotropium bromide
  • FF formoterol fumarate
  • MF mometasone furoate
  • APIs active pharmaceutical ingredients
  • corticosteroid a corticosteroid
  • LAMA a LAMA
  • LABA a LABA
  • the APIs were provided as microcrystaNine materials that served as the active agent particles co-suspended with suspending particles prepared as described herein.
  • the triple co-suspension compositions prepared as described in this Example were prepared by adding the active agent particles and suspending particles to an HFA 134a propellant.
  • the first triple co-suspension batch (Triple GFM) was formulated to the following delivered dose targets: 40 g per actuation MF; 13 g per actuation GP; and 4.8 g per actuation FF.
  • the active agent particles were co-suspended with suspending particles manufactured using an emulsion composed of 93.46% DSPC (1 ,2-Distearoyl-sn-Glycero-3-Phosphocholine) and 6.54% anhydrous calcium chloride spray dried with an 80 mg/mL feed concentration.
  • the DSPC:CaCI 2 molar ratio of the suspending particles was 2:1 .
  • the suspending particles were combined with the active agent particles in propellant for a formulation target of 6 mg/ml suspending particle concentration.
  • the primary particle sizes of the microcrystaNine active agent particles determined by Sympatec laser diffraction measurements as described in Example 1 , are displayed below in Table 1 1 .
  • the second triple co-suspension batch was prepared using a different LAMA API, anhydrous tiotropium bromide (TB) to replace GP.
  • the second triple co-suspension was formulated to the following delivered dose targets: 50 g per actuation MF; 9 g per actuation TB; and 4.8 g per actuation FF.
  • the suspending particles were prepared as described in relation to the Triple GFM co- suspension, and the active agent particles were co-suspended with the suspending particles at a targeted suspension concentration of 6 mg/ml.
  • the primary particle sizes of the microcrystaNine active agent particles determined by Sympatec laser diffraction measurements as described in Example 1 , are displayed below in Table 12.
  • MDIs were prepared using the Triple GFM and Triple TFM co-suspension compositions, and the aerosol properties, fine particle fraction, and mass median aerodynamic diameter were determined as described in Example 1 .
  • Table 13 sets out the MMAD and FPF performance for Triple GFM and Triple TFM, while the desirable aerosol properties achieved by the Triple GFM and Triple TFM co- suspensions are shown in Figure 17 (showing the aerodynamic particle size distribution of GP and TB obtained from Triple GFM and Triple TFM, respectively).
  • Table 1 1 Triple GFM primary particle size distribution determined by laser diffraction (Sympatec).
  • Table 12 Triple TFM primary particle size distribution determined by laser diffraction (Sympatec).
  • Table 13 Triple GFM and Triple TFM aerosol properties, mass mean aerodynamic diameter and fine particle fraction determined by drug specific cascade impaction
  • Exemplary dual co-suspension compositions were produced and MDIs incorporating the dual co-suspension compositions were prepared.
  • the compositions included a combination of glycopyrrolate (GP) and formoterol fumarate (FF), with each being provided as a micronized, crystalline material with particle size distribution as shown in Table 14.
  • the microcrystalline GP and FF materials provided two species of active agent particles, while suspending particles were prepared as described in Example 4.
  • the GP active agent particles, FF active agent particles, and suspending particles were combined in an HFA 134a propellant.
  • the dual co-suspensions described in this example were prepared by first dispensing the appropriate quantities of GP and FF active agent particles and suspending particles into a drug addition vessel (DAV) inside a humidity controlled chamber (RH ⁇ 5%). The DAV is then sealed under a nitrogen atmosphere and connected to the suspension vessel containing 12 kg of HFA-134a. A slurry was then formed by adding 0.5-1 kg of HFA-134a into the DAV, which is then removed from the suspension vessel and gently swirled. The slurry is then transferred back to the suspension mixing vessel and diluted with additional HFA-134a to form the final suspension at target concentration stirring gently with an impeller.
  • DAV drug addition vessel
  • RH ⁇ 5% humidity controlled chamber
  • the suspension is then recirculated via a pump to the filling system for a minimum time prior to initiation of filling. Mixing and recirculation continue throughout the filling process. Valves are placed onto MDI canisters and then purged of air either by a vacuum crimping process, or an HFA-134a purging process, followed by valve crimping. The crimped canisters are then filled through-the-valve with the appropriate quantity of suspension, adjusted by the metering cylinder.
  • Table 14 Glycopyrrolate and Formoterol Fumarate particle size distributions.
  • the suspension for pressure filling is prepared by first dispensing the appropriate quantities of micronized glycopyrrolate and formoterol fumarate crystals and suspending particles to a drug addition vessel (DAV), inside a humidity controlled chamber (RH ⁇ 5%).
  • DAV drug addition vessel
  • RH ⁇ 5% a humidity controlled chamber
  • the suspending particle carrier was added in three equal portions intercalating the addition of GP and FF after the first and second addition respectively.
  • the DAV is then sealed under a nitrogen atmosphere and connected to the suspension vessel containing 12 kg of HFA-134a.
  • a slurry was then formed by adding 0.5-1 kg of HFA-134a into the DAV, which is then removed from the suspension vessel and gently swirled.
  • the slurry is then transferred back to the suspension mixing vessel and diluted with additional HFA-134a to form the final suspension at target concentration stirring gently with an impeller.
  • the suspension is then recirculated via a pump to the filling system for a minimum time prior to initiation of filling. Mixing and recirculation continue throughout the filling process. Valves are placed onto canisters and then purged of air either by a vacuum crimping process, or an HFA-134a purging process followed by valve crimping.
  • the crimped canisters are then filled through-the-valve with the appropriate quantity of suspension, adjusted by the metering cylinder.
  • MDIs containing the dual co-suspensions described in this Example were prepared to contain two different doses GP and FF. Specifically, a first run of dual co-suspension compositions were prepared to provide 18 g per actuation GP and 4.8 ig per actuation FF ("low dose"), and a second run of dual co-suspension compositions were prepared to provide 36 g per actuation GP and 4.8 g per actuation FF ("high dose"). In addition to the dual co-suspensions compositions, monotherapy FF and GP co-suspension compositions were prepared.
  • the monotherapy co-suspension compositions were prepared as described for the dual co-suspensions, except that they included only one species of active agent particles (either GP or FF).
  • the monotherapy co-suspensions were formulated and monotherapy MDIs prepared to provide the following targeted delivered doses: 18 g per actuation of GP, and 0.5, 1 .0, 3.6 or 4.8 g per actuation of FF.
  • the compositions and MDIs providing 0.5 g FF and 1 g FF per actuation are referred to as "ultra low" dose.
  • the delivered dose uniformity of the ultra low dose FF monotherapy MDIs was also measured as described in Example 1 .
  • the DDU for the 1 g/actuation and 0.5 g/actuation compositions and systems are shown in Figure 20. Desirable dose delivery uniformity is achieved even for ultralow doses.
  • combination co-suspension compositions as described herein delivered via a metered dose inhaler were evaluated in a clinical trial.
  • the combination co-suspension compositions contained both glycopyrrolate and formoterol fumarate.
  • the clinical trial was a randomized, double-blind, customized, unbalanced, incomplete block, crossover, multi-center study conducted in patients with moderate to very severe Chronic Obstructive Pulmonary Disease (COPD).
  • COPD Chronic Obstructive Pulmonary Disease
  • Two different combination co-suspension compositions as described herein were compared to a placebo and four active comparator compositions delivering only one of the two active agents included in the combination compositions.
  • the two combination co-suspension compositions administered in the clinical trial included both Glycopyrrolate (GP) and Formoterol Fumarate (FF) active agents delivered as a fixed combination.
  • the combination co-suspensions were prepared generally as described in Example 4, with the GP and FF active agent particles provided as micronized, crystalline GP and FF material, the suspending particles being spray dried particles comprising DSPC and CaC ⁇ , and the suspension medium being formed by HFA 134a.
  • the combination co-suspension compositions were prepared for delivery to patients via an MDI as described herein and were tailored to facilitate administration of two different doses of the GP and FF active agents.
  • the first co-suspension combination composition was formulated to deliver 36 g GP and 4.8 g FF to a patient per actuation of the MDI and was used to dose 72 g GP and 9.6 g FF to patients twice daily (two actuations of the MDI administered twice daily).
  • This first composition and treatment is also referred to in this example and the accompanying figures as "GP/FF 72/9.6" and the "GP/FF 72/9.6 treatment.”
  • the second co-suspension combination composition was formulated to deliver 18 g GP and 4.8 g FF to a patient per actuation of the MDI and was used to dose 36 g GP and 9.6 g FF to patients twice daily (two actuations of the MDI administered twice daily).
  • This second composition and treatment is also referred to in this example and the accompanying figures as "GP/FF 36/9.6” and the "GP/FF 36/9.6 treatment.”
  • the GP/FF 72/9.6 and GP/FF 36/9.6 treatments were compared against a placebo and five different active compositions containing one of FF, GP or tiotropium as a single active agent.
  • the first composition was an active control, Spiriva Handihaler (tiotropium bromide inhalation powder). Spiriva is a dry powder inhaler (DPI) product and was administered to patients once daily, with each DPI capsule including and 18 g dose of tiotropium.
  • DPI dry powder inhaler
  • Foradil is also a DPI product, but it was administered to patients twice daily, and each DPI capsule included a 12 g dose of FF.
  • the third composition was a co-suspension composition including only GP as the active agent.
  • the monotherapy GP co- suspension composition (GP 36) was manufactured for pulmonary delivery via an MDI and was administered twice daily, with each administration delivering a 36 g dose of GP to the patient.
  • the remaining two compositions were two different monotherapy co-suspension compositions including only FF as the active ingredient (FF 9.6 and FF 7.2).
  • the monotherapy FF co-suspension compositions were manufactured for pulmonary delivery via an MDI and were administered twice-daily, with each administration delivering either a 9.6 g dose of FF (FF 9.6) or a 7.2 g dose of FF (FF 7.2) to the patient.
  • the GP and FF monotherapy co-suspension compositions were formulated using micronized, crystalline GP or FF material as active agent particles, spray dried particles comprising DSPC and CaC as the suspending particles, and HFA 134a as the suspension medium.
  • Secondary endpoints included the peak change in FEVi post administration of each of the study compositions (Peak FEVi) on Day 1 and Day 7, the trough FEVi experienced by patients after chronic dosing for 7 days but prior to dosing on treatment Day 7 (Morning Trough FEVi) and safety assessments.
  • the two GP/FF co-suspension compositions were safe and well- tolerated.
  • Figure 25 shows the improvement in FEVi AUCo-12 on Day 7 achieved by GP/FF 72/9.6, GP/FF 36/9.6, and each of the active comparators relative to placebo.
  • GP/FF 72/9.6 and GP/FF 36/9.6 provided markedly better improvement in FEVi AUC 0- 12 on Day 7 relative to the comparator compositions, with the improvement in FEVi AUCo-12 on Day 7 provided by GP/FF 72/9.6 and GP/FF 36/9.6 being at least 80 ml greater than that provided by each of the comparator compositions.
  • FEVi AUCo-12 on Day 7 shown in Figure 26 further highlights, for example, the improvement in FEVi AUC 0- 12 on Day 7 provided by the GP/FF 36/9.6 composition relative to the GP 36, FF 9.6, Spiriva, and Foradil comparators.
  • Figure 32 presents the percent improvement in FEVi AUCo-12 on Day 7 provided by GP/FF 36/9.6 and each of the comparators in all patients, patients with moderate COPD, and patients with severe to very severe COPD. The results shown in Figure 32 illustrate that the response in patients was consistent regardless of the severity of COPD.
  • GP/FF 72/9.6 and GP/FF 36/9.6 were also superior to all other comparators for the secondary endpoints of the study.
  • the Peak FEVi shown in Figure 27 represents a change from baseline provided by each of the active study compositions relative to placebo on Day 1 and Day 7 of administration.
  • GP/FF 72/9.6 and GP/FF 36/9.6 provided superior Peak FEVi on both Day 1 and Day 7.
  • Figure 28 highlights the improvement in Peak FEVi relative to Spiriva and Foradil provided by GP/FF 72/9.6 and GP/FF 36/9.6 on Day 1 and Day 7.
  • Figure 29 illustrates the improvement in Morning Trough FEVi provided by GP/FF 72/9.6, GP/FF 36/9.6, and each of the active comparators relative to placebo.
  • Figure 30 shows the difference between the increase in pre-dose FEVi on Day 7 provided by GP/FF 72/9.6 and GP/FF 36/9.6 and the increase in pre-dose FEVi on Day 7 provided by the GP 36, FF 9.6, Spiriva and Foradil comparators.
  • the GP/FF 36/9.6 treatment provided significantly greater improvements in pre-dose FEVi on Day 7.
  • Figure 31 illustrates the peak improvement in IC experienced on Day 1 (Day 1 Peak), the improvement in IC retained in patients prior to administration of the specified test compositions on Day 7 (Day 7 Pre), and the peak improvement in IC experienced in patients on Day 7 after administration of the specified compositions (Day 7 Peak).

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EP11865780.8A 2011-05-17 2011-05-17 Zusammensetzungen, verfahren und systeme für die verabreichung von zwei oder mehr wirkstoffen über die atemwege Withdrawn EP2709447A4 (de)

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US8815258B2 (en) 2009-05-29 2014-08-26 Pearl Therapeutics, Inc. Compositions, methods and systems for respiratory delivery of two or more active agents
AU2014210942A1 (en) 2013-01-31 2015-08-20 Prosonix Limited Pharmaceutical compositions comprising multi-component crystalline particles suitable for use in inhalation therapy
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EP2999460A1 (de) * 2013-05-22 2016-03-30 Pearl Therapeutics, Inc. Zusammensetzungen, verfahren und systeme für die respiratorische verabreichung von drei oder mehr wirkstoffen
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CN106880636A (zh) * 2015-12-15 2017-06-23 天津金耀集团有限公司 一种环索奈德单方和复方干粉吸入剂组合物
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