TW201605432A - Novel dosage and formulation - Google Patents
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Abstract
Description
本發明係關於一種用於沙美特羅與丙酸氟替卡松之固定劑量組合的新穎劑量,及使用該固定劑量組合用於治療尤其氣喘及慢性阻塞性肺病(COPD)之呼吸道疾病的新穎方法及調配物。 The present invention relates to a novel dosage for a fixed dose combination of salmeterol and fluticasone propionate, and a novel method and formulation for treating respiratory diseases, particularly asthma and chronic obstructive pulmonary disease (COPD), using the fixed dose combination .
氣喘為一種特徵在於支氣管收縮、發炎及重塑之慢性氣道疾病。估計該疾病在全世界影響3億所有年齡段的人,對健康照護系統造成相當大的負擔。治療選擇包括舒解(亦即根據需要使用而具有快速起始作用)及控制(亦即每日服用以維持對氣喘的控制)藥物療法。目前可用之最有效的控制藥物療法為吸入皮質類固醇(ICS)(諸如丙酸氟替卡松),其主要經由抗炎效應達成控制。若未達成足夠的控制,則指示其他控制藥物療法,包括長效2-腎上腺素受體激動劑(LABA)與ICS之組合。 Asthma is a chronic airway disease characterized by bronchoconstriction, inflammation and remodeling. It is estimated that the disease affects 300 million people of all ages worldwide, placing a considerable burden on health care systems. Treatment options include soothing (i.e., having a rapid onset of action as needed) and control (i.e., daily administration to maintain control of asthma) drug therapy. The most effective controlled drug therapy currently available is inhaled corticosteroids (ICS) (such as fluticasone propionate), which are primarily controlled via anti-inflammatory effects. If adequate control is not achieved, other controlled drug therapies are indicated, including combinations of long-acting 2-adrenoreceptor agonists (LABA) and ICS.
沙美特羅(長效2-腎上腺素受體激動劑)與丙酸氟替卡松(吸入皮質類固醇)之固定劑量組合在歐洲及美國以粉末吸入劑或吸入氣霧劑形式市售可得用於治療氣喘與慢性阻塞性肺病(COPD)。 A fixed-dose combination of salmeterol (long-acting 2-adrenoreceptor agonist) and fluticasone propionate (inhaled corticosteroid) is commercially available in Europe and the United States as a powder inhaler or inhaled aerosol for the treatment of asthma. With chronic obstructive pulmonary disease (COPD).
乾粉調配物經由Accuhaler®/Diskus®吸入器 遞送且在大多數歐洲國家以商標名Seretide®且在美國以Advair®註冊。此固定劑量組合以三種不同劑量濃度(50/100、50/250及50/500,以定劑量表示)可用,分別含有50微克沙美特羅(呈羥萘甲酸沙美特羅形式)及100、250或500微克丙酸氟替卡松。應針對患者疾病嚴重程度給予他們含有適當丙酸氟替卡松劑量之濃度的Seretide®。 Dry powder formulation via Accuhaler®/Diskus® inhaler Delivered and registered under the trade name Seretide® in most European countries and Advair® in the United States. This fixed-dose combination is available in three different dose concentrations (50/100, 50/250, and 50/500, expressed as a fixed dose) containing 50 micrograms of salmeterol (sametrol hydroxynaphtholate) and 100, 250, respectively. Or 500 micrograms of fluticasone propionate. Seretide®, which is dosed with the appropriate dose of fluticasone propionate, should be given to the patient's disease severity.
根據氣喘指南,沙美特羅/丙酸氟替卡松組合之劑量應滴定至維持有效的症狀控制盡可能低之劑量。對於COPD,指示最高濃度(在歐洲為50/500微克且在美國為50/250微克)。 According to the asthma guidelines, the dose of salmeterol/fluticasone propionate combination should be titrated to maintain the effective dose control as low as possible. For COPD, the highest concentration is indicated (50/500 micrograms in Europe and 50/250 micrograms in the United States).
此固定劑量組合之臨床功效及安全性已在氣喘患者及COPD患者之臨床研究中進行廣泛探究。儘管此組合之益處超過相關之風險,然而由於與此等種類化合物相關之固有不良效應,一些安全問題依然存在。 The clinical efficacy and safety of this fixed-dose combination has been extensively explored in clinical studies of asthmatic patients and COPD patients. Although the benefits of this combination outweigh the associated risks, some safety issues remain due to the inherent adverse effects associated with these types of compounds.
沙美特羅為一種長效2-腎上腺素受體激動劑(LABA),其藉由直接作用導致氣道平滑肌鬆弛且抑制過敏性介體自肥大細胞釋放而引起支氣管擴張。一個與治療呼吸道疾病中使用2-腎上腺激導性激動劑相關之問題為關於全身腎上腺激導性受體激動作用之副作用的風險。此等風險可能包括例如心率增加(心跳過速)、心悸、失眠、焦慮、噁心及震顫。 Salmeterol is a long-acting 2-adrenoreceptor agonist (LABA) that causes airway smooth muscle relaxation by direct action and inhibits bronchiectasis by releasing allergic mediators from mast cells. One problem associated with the use of 2-adrenal agonist in the treatment of respiratory diseases is the risk of side effects on systemic adrenal agonist agonism. Such risks may include, for example, increased heart rate (tachycardia), palpitations, insomnia, anxiety, nausea, and tremors.
在2005年,食品與藥物管理局(the Food and Drug Administration)在沙美特羅多中心氣喘研究試驗(SMART)後提出可能的LABA危險,該試驗展示以沙美 特羅治療之個體的氣喘相關死亡之少但顯著性的增加。 In 2005, the Food and Drug Administration presented a possible LABA hazard after the Sameter Trodo Central Asthma Research Trial (SMART), which demonstrated There was little but significant increase in asthma-related death in individuals treated with tro.
丙酸氟替卡松為一種皮質類固醇。與所有此類化合物相同,其經由調節多個基因轉錄因子導致抑制多個發炎氣道從而來抑制慢性氣道發炎。此舉導致對發炎介體產生(或分泌)及發炎細胞募集及功能(例如嗜伊紅細胞、肥大細胞、淋巴細胞、嗜鹼細胞、巨噬細胞、噬中性細胞)的抑制。如關於吸入皮質類固醇所知,丙酸氟替卡松投藥與口腔、咽及喉中之局部不良效應以及肺炎風險增加有關。 Fluticasone propionate is a corticosteroid. As with all such compounds, it inhibits chronic airway inflammation by modulating multiple gene transcription factors resulting in inhibition of multiple inflammatory airways. This results in inhibition of the production (or secretion) of inflammatory mediators and the recruitment and function of inflammatory cells (eg eosinophils, mast cells, lymphocytes, basophils, macrophages, neutrophils). As known for inhaled corticosteroids, administration of fluticasone propionate is associated with local adverse effects in the mouth, pharynx and larynx, as well as an increased risk of pneumonia.
因此,對展示與市售Serertide®調配物相同之功效同時具有降低之副作用的新穎調配物仍然存在需要。 Thus, there remains a need for novel formulations that exhibit the same efficacy as commercially available Serertide® formulations while having reduced side effects.
現令人驚訝地發現一種用於吸入之乾粉醫藥組成物具有與市售Serertide®組合相同之功效同時展示降低之副作用,該乾粉醫藥組成物包含沙美特羅或其醫藥上可接受之鹽及丙酸氟替卡松以及醫藥上可接受之乾粉載劑(例如乳糖),分別提供等於約16微克之遞送劑量的沙美特羅及等於約280或140微克之遞送劑量的丙酸氟替卡松,該市售Serertide®組合具有分別等於47/460微克或47/231微克之遞送劑量的沙美特羅/氟替卡松。 It has now surprisingly been found that a dry powder pharmaceutical composition for inhalation has the same efficacy as the commercially available Serertide® combination, which exhibits reduced side effects, and the dry powder pharmaceutical composition comprises salmeterol or a pharmaceutically acceptable salt thereof and C. Fluticasone ketone and a pharmaceutically acceptable dry powder carrier (e.g., lactose) provide salmeterol at a delivery dose equal to about 16 micrograms and fluticasone propionate at a delivery dose equal to about 280 or 140 micrograms, respectively, of the commercially available Serertide® combination. There is salmeterol/fluticasone at a delivery dose equal to 47/460 micrograms or 47/231 micrograms, respectively.
本發明提供一種用於吸入之乾粉醫藥組成物,其包含沙美特羅或其醫藥上可接受之鹽及丙酸氟替卡松以及醫藥上可接受之乾粉載劑,提供等於約16/280微克 之遞送劑量的沙美特羅/丙酸氟替卡松。 The present invention provides a dry powder pharmaceutical composition for inhalation comprising salmeterol or a pharmaceutically acceptable salt thereof and fluticasone propionate and a pharmaceutically acceptable dry powder carrier providing an equivalent of about 16/280 micrograms The delivered dose of salmeterol / fluticasone propionate.
本發明提供一種用於吸入之乾粉醫藥組成物,其包含沙美特羅或其醫藥上可接受之鹽及丙酸氟替卡松以及醫藥上可接受之乾粉載劑,提供等於約16/140微克之遞送劑量的沙美特羅/丙酸氟替卡松。 The present invention provides a dry powder pharmaceutical composition for inhalation comprising salmeterol or a pharmaceutically acceptable salt thereof and fluticasone propionate and a pharmaceutically acceptable dry powder carrier to provide a delivery dose equal to about 16/140 micrograms. Salmeterol / fluticasone propionate.
亦提供一種治療需要該治療之患者的呼吸道病症的方法,該呼吸道病症特定言之為氣喘及COPD,該方法包含投與一般為每日兩次劑量之劑量的此沙美特羅/丙酸氟替卡松組合,提供等於約16/280微克或16/140微克之遞送劑量。 Also provided is a method of treating a respiratory condition in a patient in need of such treatment, which is specifically referred to as asthma and COPD, the method comprising administering a combination of the salmeterol/fluticasone propionate at a dose that is generally twice daily. A delivery dose equal to about 16/280 micrograms or 16/140 micrograms is provided.
本發明進一步提供一種此等沙美特羅/丙酸氟替卡松組合之用途,其用於製造用於該方法中之藥劑,例如如前一段中所述。 The invention further provides the use of such a combination of salmeterol/fluticasone propionate for the manufacture of a medicament for use in the method, for example as described in the preceding paragraph.
亦提供如上所述用於治療選自氣喘及慢性阻塞性肺病之呼吸道病症的醫藥組成物。 A pharmaceutical composition for treating a respiratory disorder selected from the group consisting of asthma and chronic obstructive pulmonary disease as described above is also provided.
本發明之沙美特羅/丙酸氟替卡松調配物可能以兩種活性成分之組合或以與一種例如毒蕈鹼拮抗劑、PDE4抑制劑、JAK抑制劑及/或PI3K抑制劑之額外抗炎劑及/或支氣管擴張劑的三成分之組合形式投與。 The salmeterol/fluticasone propionate formulation of the present invention may be in combination with two active ingredients or with an additional anti-inflammatory agent such as a muscarinic antagonist, a PDE4 inhibitor, a JAK inhibitor, and/or a PI3K inhibitor. / or a combination of the three components of the bronchodilator.
沙美特羅為(±)-2-(羥甲基)-4-[1-羥基-2-[6-(4-苯基丁氧基)己基胺基]乙基]苯酚之國際非專利名 稱(INN)。通常,沙美特羅以羥萘甲酸沙美特羅形式投與,其化學式如下顯示。 Salmeterol is an international non-proprietary name for (±)-2-(hydroxymethyl)-4-[1-hydroxy-2-[6-(4-phenylbutoxy)hexylamino]ethyl]phenol Weighing (INN). Usually, salmeterol is administered in the form of salmeterol hydroxynaphthoate, and its chemical formula is shown below.
本申請案中,沙美特羅之遞送劑量表示為16微克。此量對應於23微克羥萘甲酸沙美特羅。 In the present application, the delivered dose of salmeterol is expressed as 16 micrograms. This amount corresponds to 23 micrograms of salmeterol hydroxynaphthoate.
丙酸氟替卡松之化學名稱為6,9-二氟-11β,17-二羥基-16-甲基-3-側氧基雄固-1,4-二烯-17-硫代甲酸S-(氟甲基)酯17-丙酸酯且具有如下所示之化學式。 The chemical name of fluticasone propionate is 6,9-difluoro-11β, 17-dihydroxy-16-methyl-3-oxo-androst-1,4-diene-17-thioformic acid S- (fluorocarbon) The ester 17-propionate has the chemical formula shown below.
沙美特羅/氟替卡松組合較佳以乾粉形式與適於吸入之例如乳糖粉末(亦即乳糖顆粒)之適當載劑一起投與。在一較佳實施例中,乳糖為α-乳糖單水合物,較佳為結晶α-乳糖單水合物形式。 The salmeterol/fluticasone combination is preferably administered in dry powder form with a suitable carrier such as lactose powder (i.e., lactose granules) suitable for inhalation. In a preferred embodiment, the lactose is alpha-lactose monohydrate, preferably in the form of crystalline alpha-lactose monohydrate.
待要以本發明之調配物及方法治療的呼吸道疾病或病症一般為氣喘、慢性阻塞性肺病(COPD),包括急性或慢性支氣管炎和肺氣腫、支氣管高反應性、支氣管擴張症或鼻炎,尤其為氣喘及/或慢性阻塞性肺病(COPD)。 Respiratory diseases or conditions to be treated by the formulations and methods of the invention are generally asthma, chronic obstructive pulmonary disease (COPD), including acute or chronic bronchitis and emphysema, bronchial hyperreactivity, bronchiectasis or rhinitis, Especially asthma and/or chronic obstructive pulmonary disease (COPD).
根據Seretide®產品特性之綜述,因為此產品 含有沙美特羅與丙酸氟替卡松,所以可以預期與該等化合物中每一者相關之相同類型及嚴重程度的不良反應。與沙美特羅/丙酸氟替卡松相關之不良事件提供於表1中,按照系統器官種類及頻率列出。頻率定義為:很常見(1/10)、常見(1/100及<1/10)、不常見(1/1000及<1/100)、罕見(1/10000至<1/1000)及未知(自可用資料不可估計)。 Based on a review of the characteristics of Seretide® products, since this product contains salmeterol and fluticasone propionate, the same type and severity of adverse effects associated with each of these compounds can be expected. Adverse events associated with salmeterol/fluticasone propionate are provided in Table 1, listed by system organ type and frequency. Frequency is defined as: very common ( 1/10), common ( 1/100 and <1/10), not common ( 1/1000 and <1/100), rare ( 1/10000 to <1/1000) and unknown (uncommended from available data).
由於本發明之醫藥組成物之較低遞送劑量,以下不良事件有可能減少: Due to the lower delivery dose of the pharmaceutical composition of the present invention, the following adverse events are likely to decrease:
●口及喉之念珠菌病 ● mouth and throat candidiasis
●低鉀血症 ● hypokalemia
●高血糖症 ●hyperglycemia
●震顫 ●tremor
●心臟病症(諸如心悸、心跳過速、心律失常、心房震顫及心絞痛) ● Heart conditions (such as palpitations, tachycardia, arrhythmia, atrial tremor and angina)
●喉部刺激 ● throat stimulation
●聲音嘶啞/發音困難 ● hoarse voice / difficulty in pronunciation
為避免疑問,遞送劑量意謂可在口腔用於吸入之藥物量(每次致動自吸入器裝置之吹嘴發出的劑量)。遞送劑量可以使用熟習此項技術者所知的標準技術量測。 For the avoidance of doubt, the delivered dose means the amount of drug that can be used in the mouth for inhalation (the dose that is ejected from the mouthpiece of the inhaler device each time). The delivered dose can be measured using standard techniques known to those skilled in the art.
在活性劑之劑量的上下文中,如本文所使用之「約」意謂在由歐洲及美國藥典所定義之+/-35%的可接受變化的正常限度內。較佳地,術語「約」意謂在由US FDA指南草案針對MDI及DPI藥品所定義之+/-25%的可接受變化的正常限度內。更佳地,術語「約」意謂根據關於吸入及鼻產品之醫藥品質的CHMP指南在+/-15%的可接受變化的正常限度內,且最佳地對於施配系統在例如+/-10%的定劑量精度內。 In the context of a dose of the active agent, "about" as used herein means within the normal limits of an acceptable change of +/- 35% as defined by the European and US Pharmacopoeia. Preferably, the term "about" means within the normal limits of +/- 25% of the acceptable change defined by the US FDA Guideline for MDI and DPI drugs. More preferably, the term "about" means within a normal limit of +/- 15% acceptable change according to the CHMP guidelines for the medical quality of inhaled and nasal products, and optimally for a dispensing system such as +/- 10% within the fixed dose accuracy.
因此,「約16μg沙美特羅」之遞送劑量意謂16μg沙美特羅之目標劑量在對於施配系統之正常接受限度內有變化,例如10.4-21.6μg沙美特羅(+/-35%)或較佳12-20μg沙美特羅(+/-25%),或更佳13.6-18.4μg沙美特羅(+/-15%)或最佳14.4-17.6μg沙美特羅(+/-10%)。 Thus, the delivery dose of "about 16 μg salmeterol" means that the target dose of 16 μg salmeterol varies within the normal acceptance limits for the dispensing system, such as 10.4-21.6 μg salmeterol (+/- 35%) or Preferably 12-20 μg salmeterol (+/- 25%), or better 13.6-18.4 μg salmeterol (+/- 15%) or optimal 14.4-17.6 μg salmeterol (+/- 10%) .
「約280μg丙酸氟替卡松」之遞送劑量意謂280μg丙酸氟替卡松之目標劑量在對於施配系統之正常接受限度內有變化,例如182-378μg丙酸氟替卡松(+/-35%)或較佳210-350μg丙酸氟替卡松(+/-25%),或更佳238-322μg丙酸氟替卡松(+/-15%)或最佳252-308μg丙酸氟替卡松(+/-10%)。 The delivery dose of "about 280 μg fluticasone propionate" means that the target dose of 280 μg fluticasone propionate varies within the normal acceptance limits for the dispensing system, for example 182-378 μg fluticasone propionate (+/- 35%) or preferably 210 - 350 μg fluticasone propionate (+/- 25%), or better 238-322 μg fluticasone propionate (+/- 15%) or optimal 252-308 μg fluticasone propionate (+/- 10%).
「約140μg丙酸氟替卡松」之遞送劑量意謂140μg丙酸氟替卡松之目標劑量在對於施配系統之正常接 受限度內有變化,例如91-189μg丙酸氟替卡松(+/-35%)或較佳105-175μg丙酸氟替卡松(+/-25%),或更佳119-161μg丙酸氟替卡松(+/-15%)或最佳126-154μg丙酸氟替卡松(+/-10%)。 The delivery dose of "about 140 μg of fluticasone propionate" means that the target dose of 140 μg of fluticasone propionate is in the normal connection to the dispensing system. Subject to variations, such as 91-189 μg fluticasone propionate (+/-35%) or preferably 105-175 μg fluticasone propionate (+/-25%), or better 119-161 μg fluticasone propionate (+/-) 15%) or optimal 126-154 μg fluticasone propionate (+/- 10%).
在一較佳實施例中,本發明針對一種用於吸入之乾粉醫藥組成物,其包含沙美特羅或其醫藥上可接受之鹽,較佳羥萘甲酸沙美特羅,及丙酸氟替卡松以及乳糖粉末,較佳α-乳糖單水合物,提供等於約16/280微克之遞送劑量的沙美特羅/氟替卡松。 In a preferred embodiment, the present invention is directed to a dry powder pharmaceutical composition for inhalation comprising salmeterol or a pharmaceutically acceptable salt thereof, preferably salmeterol hydroxynaphthoate, and fluticasone propionate and lactose A powder, preferably alpha-lactose monohydrate, provides salmeterol/fluticasone equal to a delivery dose of about 16/280 micrograms.
在另一較佳實施例中,本發明針對一種用於吸入之乾粉醫藥組成物,其包含沙美特羅或其醫藥上可接受之鹽,較佳羥萘甲酸沙美特羅,及丙酸氟替卡松以及乳糖粉末,較佳α-乳糖單水合物,提供等於約16/140微克之遞送劑量的沙美特羅/氟替卡松。 In another preferred embodiment, the present invention is directed to a dry powder pharmaceutical composition for inhalation comprising salmeterol or a pharmaceutically acceptable salt thereof, preferably salmeterol hydroxynaphthoate, and fluticasone propionate and A lactose powder, preferably alpha-lactose monohydrate, provides salmeterol/fluticasone at a delivery dose equal to about 16/140 micrograms.
調配物之包裝可以適於單次單位劑量、多單位劑量(施配由製造商預先計量至泡殼、盤狀物、凹坑、管狀物及條狀物中之個別劑量)或多劑量遞送(量測來自粉末儲集器之劑量),較佳藉由多劑量遞送。因此將乾粉吸入器分為三組:(a)單次劑量、(b)多單位劑量及(c)多劑量裝置。 The package of the formulation may be adapted for a single unit dose, multiple unit doses (administered by the manufacturer to pre-measure to individual doses in the blister, disc, pit, tube and strip) or multiple dose delivery ( The dose from the powder reservoir is measured, preferably by multiple dose delivery. Dry powder inhalers are therefore divided into three groups: (a) single dose, (b) multiple unit doses, and (c) multiple dose devices.
調配物通常含有本發明化合物與適當粉末基質(載劑物質,諸如乳糖)之用於吸入之粉末混合物。每個膠囊或藥筒通常可以含有2μg至500μg每一治療活性成分。或者,活性成分可在無賦形劑之情況下呈現。 Formulations typically contain a powder mixture of the compound of the present invention and a suitable powder base (carrier material such as lactose) for inhalation. Each capsule or cartridge may typically contain from 2 [mu]g to 500 [mu]g of each therapeutic active ingredient. Alternatively, the active ingredient can be presented without excipients.
對於單次劑量吸入器,單次劑量已經由製造商稱重至小的容器中,該等容器為小的儲集器、藥筒或多半為硬明膠膠囊。必須自獨立盒或容器取出膠囊且插入吸入器之接受區域。其次,必須用針或切削刀片打開膠囊或者使其開孔以允許一部分呼吸之氣流通過膠囊以夾帶粉末或在吸入期間藉助於離心力使粉末自膠囊排放通過此等開孔。吸入之後,必須再次自吸入器移除空的膠囊。最主要地,必須拆卸吸入器以插入且移除膠囊,此操作對於一些患者而言可能較為困難且造成負擔。關於使用用於吸入粉末之硬明膠膠囊之其他缺點為(a)防止自周圍空氣吸收水分不佳,(b)具有開口或開孔之問題,在膠囊已經事先暴露於極端相對濕度之後會造成破碎或凹痕及(c)可能吸入膠囊碎片。此外,對於許多膠囊吸入器而言,已經報導不完全排出。 For single dose inhalers, a single dose has been weighed by the manufacturer into small containers that are small reservoirs, cartridges or mostly hard gelatin capsules. The capsule must be removed from the separate box or container and inserted into the receiving area of the inhaler. Secondly, the capsule must be opened or opened with a needle or cutting blade to allow a portion of the breathing gas stream to pass through the capsule to entrain the powder or to vent the powder from the capsule through the apertures during inhalation by means of centrifugal force. After inhalation, empty capsules must be removed from the inhaler again. Most of all, the inhaler must be disassembled to insert and remove the capsule, which may be difficult and burdensome for some patients. Other disadvantages associated with the use of hard gelatin capsules for inhalation of powders are (a) prevention of poor moisture absorption from ambient air, (b) problems with openings or openings that can cause breakage after the capsule has been previously exposed to extreme relative humidity. Or dents and (c) may inhale capsule fragments. Furthermore, for many capsule inhalers, incomplete drainage has been reported.
如WO 92/03175中所述,一些膠囊吸入器具有槽,個別膠囊可以自該槽轉移至接納室,其中發生開孔及排空。其他膠囊吸入器具有帶有膠囊室之旋轉的槽,該等膠囊室與用於劑量排出之空氣管道排成一行(例如WO91/02558及GB 2242134)。該等膠囊吸入器包含該類型之多單位劑量吸入器以及泡殼吸入器,其在盤狀物或條狀物上具有有限數目的單位供應劑量。泡殼吸入器提供比膠囊吸入器更好的藥物防潮。藉由使罩蓋以及泡殼箔開孔,或者剝離罩蓋箔獲得到達粉末之通路。當使用泡殼條狀物代替盤狀物時,可以增加劑量數目,但是患者替換空的條 狀物不便。因此具有併入之劑量系統之該等裝置通常為拋棄式的,包括用於傳送條狀物且打開泡殼袋之技術。 As described in WO 92/03175, some capsule inhalers have slots from which individual capsules can be transferred to a receiving chamber where opening and emptying occurs. Other capsule inhalers have a rotating slot with a capsule chamber that is lined up with an air duct for dose discharge (e.g., WO 91/02558 and GB 2242134). The capsule inhalers comprise a multi-unit dose inhaler of this type and a blister inhaler having a limited number of unit supply doses on the disc or strip. The blister inhaler provides better moisture protection than the capsule inhaler. The passage to the powder is obtained by opening the cover and the blister foil, or by peeling off the cover foil. When a blister strip is used instead of a disc, the number of doses can be increased, but the patient replaces the empty strip Inconvenient. Thus such devices having incorporated dosage systems are generally disposable, including techniques for transporting the strips and opening the blister pockets.
多劑量吸入器不含有預先量測量之粉末調配物。其由相對較大的容器及必須由患者操作之劑量量測原理組成。容器帶有多次劑量,該等劑量根據體積排量個別地與大多數粉末分開。存在多種劑量量測原理,包括可旋轉膜(例如EP0069715)或盤(例如GB 2041763;EP 0424790;DE 4239402及EP 0674533)、可旋轉圓筒(例如EP 0166294;GB 2165159及WO 92/09322)及可旋轉錐台(例如WO 92/00771),所有都具有必須填充有來自容器之粉末的空腔。其他多劑量裝置具有量測滑塊(例如US 5201308及WO 97/00703)或量測柱塞,其具有局部或圓周凹座以將一定體積之來自容器的粉末移至遞送室或空氣管道,例如EP 0505321、WO 92/04068及WO 92/04928。可重現之劑量量測為關於多劑量吸入器裝置主要關注的問題之一。因為填充劑量量測杯或腔主要是在重力的影響下,所以粉末調配物必須展現良好且穩定的流動性。另一方面,多劑量吸入器可以含有高得多數目之劑量,而裝填劑量之處理數通常較低。 Multi-dose inhalers do not contain pre-measured powder formulations. It consists of a relatively large container and a dose measurement principle that must be operated by the patient. The container is provided with multiple doses which are individually separated from most of the powder depending on the volumetric displacement. There are a variety of dosimetry principles, including rotatable membranes (eg, EP0069715) or discs (eg, GB 2041763; EP 0424790; DE 4239402 and EP 0674533), rotatable cylinders (eg, EP 0166294; GB 2165159 and WO 92/09322) and Rotatable frustums (eg WO 92/00771), all with cavities that must be filled with powder from the container. Other multi-dose devices have measuring sliders (for example US 5201308 and WO 97/00703) or measuring plungers having partial or circumferential recesses to move a volume of powder from the container to a delivery chamber or air duct, for example EP 0505321, WO 92/04068 and WO 92/04928. Reproducible dose measurements are one of the primary concerns regarding multi-dose inhaler devices. Since the filled dose measuring cup or chamber is primarily under the influence of gravity, the powder formulation must exhibit good and stable flow. Multi-dose inhalers, on the other hand, can contain a much higher number of doses, while the number of treatments for the loading dose is generally lower.
因為多劑量裝置中呼吸之氣流通常直接穿過劑量量測腔,且因為多劑量吸入器之大體積及剛性劑量量測系統不能由此呼吸之氣流攪動,所以僅自腔室夾帶粉末物質且在排出期間獲得極少去黏聚作用。 Because the flow of breathing in a multi-dose device typically passes directly through the dose measurement chamber, and because the large volume and rigid dose measurement system of the multi-dose inhaler cannot be agitated by the flow of breath, only the powder material is entrained from the chamber and Very little deagglomeration is obtained during discharge.
因此,需要獨立的崩解構件。然而,實際上, 其為吸入器設計之一部分。因為多劑量裝置中高的劑量數目,必須使粉末對空氣管道之內壁的黏附降至最低,及/或必須可能在不影響裝置中殘餘劑量的情況下定期清潔此等部件。一些多劑量吸入器的拋棄式藥物容器可以在已經取出規定數目劑量之後替換(例如WO 97/000703)。對於具有拋棄式藥物容器之該等半永久多劑量吸入器甚至更嚴格地要求阻止藥物積聚。 Therefore, a separate disintegration member is required. However, actually, It is part of the design of the inhaler. Because of the high number of doses in a multi-dose device, the adhesion of the powder to the inner wall of the air tube must be minimized, and/or such components must be cleaned periodically without affecting the residual dose in the device. Some disposable drug containers for multi-dose inhalers can be replaced after a prescribed number of doses have been taken (e.g., WO 97/000703). These semi-permanent multi-dose inhalers with disposable drug containers are even more rigorously required to prevent drug accumulation.
在一較佳實施例中,本發明之沙美特羅/丙酸氟替卡松組合係經由呼吸致動之多劑量乾粉吸入器投與,其自不可移動之藥筒遞送高達200次定劑量。用於此目的之一個尤佳多劑量吸入器裝置為Genuair®,(以前稱為Novolizer SD2FL),或如WO 97/00703、WO 03/000325或WO 2006/008027中所述,該等申請案之內容以引用的方式併入本文中。Genuair®亦描述於H.Chrystyn等人Int J Clin Pract(2012)66,3,309-317;及H.Magnussen等人Respiratory Medicine(2009)103,1832-1837中。另一適於投與本發明之沙美特羅/丙酸氟替卡松組合的呼吸致動之多劑量乾粉吸入器為Novolizer®,其描述於C.Fenton等人,Drugs(2003);63,22,:2437-2445;及D.Kohler,Respiratory Medicine(2004)增刊A,S17-S21中。 In a preferred embodiment, the salmeterol/fluticasone propionate combination of the present invention is administered via a breath-actuated multi-dose dry powder inhaler that delivers up to 200 doses from a non-movable cartridge. A particularly preferred multi-dose inhaler device for this purpose is Genuair®, (formerly known as Novolizer SD2FL), or as described in WO 97/00703, WO 03/000325 or WO 2006/008027, The content is incorporated herein by reference. Genuair® is also described in H. Chrystyn et al. Int J Clin Pract (2012) 66, 3, 309-317; and H. Magnussen et al. Respiratory Medicine (2009) 103, 1832-1837. Another breath-actuated multi-dose dry powder inhaler suitable for administration in combination with the salmeterol/fluticasone propionate of the present invention is Novolizer®, described in C. Fenton et al, Drugs (2003); 63, 22,: 2437-2445; and D. Kohler, Respiratory Medicine (2004) Supplement A, S17-S21.
在另一實施例中,本發明之沙美特羅/丙酸氟替卡松組合亦可經由單次劑量乾粉吸入器投與,諸如描述於WO 2005/113042或EP1270034中之裝置。 In another embodiment, the salmeterol/fluticasone propionate combination of the invention may also be administered via a single dose dry powder inhaler, such as the device described in WO 2005/113042 or EP 1270034.
用於藉由吸入投與之藥劑需要具有控制之顆 粒尺寸。用於吸入支氣管系統中之最佳顆粒尺寸通常為1-10μm,較佳2-5μm。尺寸大於20μm之顆粒在吸入時通常太大而不能到達小的氣道。為達成此等顆粒尺寸,如此產生之活性成分之顆粒可以藉由習知手段,例如藉由微粉化(micronisation)或超臨界流體技術減小尺寸。可以藉由風力分級或篩分分離出所需之部分。較佳地,該等顆粒將為結晶的。 The agent used for injecting by inhalation requires control Grain size. The optimum particle size for inhalation into the bronchial system is usually from 1 to 10 μm, preferably from 2 to 5 μm. Particles larger than 20 μm are usually too large to reach a small air passage when inhaled. To achieve such particle sizes, the particles of the active ingredient so produced can be reduced in size by conventional means, for example by micronisation or supercritical fluid techniques. The desired portion can be separated by wind grading or sieving. Preferably, the particles will be crystalline.
因為微粉化粉末之較差之流動性及極端黏聚之趨勢,難以以該等粉末實現高劑量重現性。為改良乾粉組成物之效率,顆粒在吸入器中時應為大的,但當排至呼吸道中時應為小的。因此,通常採用例如乳糖之賦形劑。賦形劑之顆粒尺寸通常比本發明內之吸入之藥劑大得多。當賦形劑為乳糖時,其一般以乳糖顆粒,較佳結晶α-乳糖單水合物形式存在,其例如具有20-1000μm之平均顆粒尺寸範圍,較佳在90-150μm範圍內。中值顆粒尺寸大致對應於平均值且為50質量%顆粒具有較大當量直徑且其他50質量%具有較小當量直徑的直徑。因此,平均顆粒尺寸在此項技術中通常係指當量d50。周圍的顆粒尺寸分佈可以影響流動性、體密度等等。由於要表徵顆粒尺寸直徑,可以使用除d50之外的其他當量直徑,諸如d10及d90。d10為10質量%顆粒具有較小直徑(且因此其餘90質量%更粗)的當量直徑。d90為90質量%顆粒具有較小直徑的當量直徑。在一個實施例中,用於本發明之調配物的乳糖顆粒之d10為90-160μm,d50為170-270μm且d90為 290-400μm。 Because of the poor flowability and extreme cohesion of micronized powders, it is difficult to achieve high dose reproducibility with such powders. To improve the efficiency of the dry powder composition, the particles should be large in the inhaler but should be small when discharged into the respiratory tract. Therefore, excipients such as lactose are usually employed. The particle size of the excipient is generally much greater than the inhaled medicament of the present invention. When the excipient is lactose, it is generally present in the form of lactose particles, preferably crystalline alpha-lactose monohydrate, which has, for example, an average particle size range of from 20 to 1000 μm, preferably from 90 to 150 μm. The median particle size roughly corresponds to the average value and is 50% by mass of the particles having a larger equivalent diameter and the other 50% by mass having a smaller equivalent diameter. Thus, the average particle size is generally referred to in the art as the equivalent d50. The surrounding particle size distribution can affect fluidity, bulk density, and the like. Since the particle size diameter is to be characterized, other equivalent diameters other than d50, such as d10 and d90, can be used. D10 is an equivalent diameter of 10% by mass of the particles having a smaller diameter (and thus the remaining 90% by mass is thicker). The d90 is 90% by mass of the particles having an equivalent diameter of a smaller diameter. In one embodiment, the lactose particles used in the formulation of the invention have a d10 of from 90 to 160 μm, a d50 of from 170 to 270 μm and a d90 of 290-400 μm.
用於本發明之適當的乳糖材料為市售可得的,例如來自DFE Pharma(Respitose® ML001、Respitose® ML006、Respitose® SV003、Respitose® SV010、Lactohale® 100、Lactohale® 200、Lactohale® 201、Lactohale® 300)或Meggle(Inhalac® 70、Inhalac® 120、Inhalac® 230、Inhalac® 250、Inhalac® 400、PrismaLac® 40、Capsulac® 60、Capsulac® 60 INH、SacheLac® 80、SpheroLac® 100)或Sheffield Bio-Science(單水合物吸入劑120M、單水合物吸入劑80M、單水合物吸入劑40M、無水吸入劑40M、單水合物吸入劑120MS、無水吸入劑120MS)。 Suitable lactose materials for use in the present invention are commercially available, for example, from DFE Pharma (Respitose® ML001, Respitose® ML006, Respitose® SV003, Respitose® SV010, Lactohale® 100, Lactohale® 200, Lactohale® 201, Lactohale ® 300) or Meggle (Inhalac® 70, Inhalac® 120, Inhalac® 230, Inhalac® 250, Inhalac® 400, PrismaLac® 40, Capsulac® 60, Capsulac® 60 INH, SacheLac® 80, SpheroLac® 100) or Sheffield Bio -Science (monohydrate inhaler 120M, monohydrate inhaler 80M, monohydrate inhalant 40M, anhydrous inhalant 40M, monohydrate inhaler 120MS, anhydrous inhalant 120MS).
乳糖顆粒與丙酸氟替卡松之間的重量比視所用之吸入器裝置而定,但通常為例如5:1至100:1,例如25:1至75:1,較佳30:1至60:1,更佳35:1至45:1。 The weight ratio between the lactose particles and fluticasone propionate depends on the inhaler device used, but is typically, for example, from 5:1 to 100:1, such as from 25:1 to 75:1, preferably from 30:1 to 60:1. Better 35:1 to 45:1.
乳糖顆粒與羥萘甲酸沙美特羅之間的重量比視所用之吸入器裝置而定,但通常為例如100:1至1000:1,例如250:1至750:1,較佳350:1至650:1,更佳450:1至550:1。 The weight ratio between the lactose particles and salmeterol hydroxynaphtholate depends on the inhaler device used, but is typically, for example, from 100:1 to 1000:1, such as from 250:1 to 750:1, preferably from 350:1 to 650:1, better 450:1 to 550:1.
在一更佳實施例中,本發明之沙美特羅/丙酸氟替卡松調配物以沙美特羅/丙酸氟替卡松與乳糖,較佳α-乳糖單水合物之乾粉調配物形式投與,適於經由乾粉吸入器投與之丙酸氟替卡松與乳糖之重量比為1:30至1:60,較佳1:35至1:45及/或羥萘甲酸沙美特羅與乳糖之重量比為1:350至1:650,較佳1:450至1:550,其中丙酸氟替卡松及 羥萘甲酸沙美特羅顆粒具有直徑為2至5μm之平均顆粒尺寸,例如直徑小於3μm,且乳糖顆粒之d10為90-160μm,d50為170-270μm且d90為290-400μm。 In a more preferred embodiment, the salmeterol/fluticasone propionate formulation of the present invention is administered as a dry powder formulation of salmeterol/fluticasone propionate and lactose, preferably alpha-lactose monohydrate, suitable for administration via a dry powder formulation of lactose, preferably alpha-lactose monohydrate The weight ratio of fluticasone propionate to lactose administered by a dry powder inhaler is from 1:30 to 1:60, preferably from 1:35 to 1:45 and/or the weight ratio of salmeterol to lactose is 1:350. To 1:650, preferably 1:450 to 1:550, wherein fluticasone propionate and The salmeterol hydroxynaphthoate particles have an average particle size of 2 to 5 μm in diameter, for example, a diameter of less than 3 μm, and the d10 of the lactose particles is 90-160 μm, the d50 is 170-270 μm, and the d90 is 290-400 μm.
諸如M3毒蕈鹼拮抗劑、PDE4抑制劑、白三烯D4拮抗劑、egfr-激酶抑制劑、p38激酶抑制劑、JAK抑制劑、PI3K抑制劑或NK1受體激動劑之額外活性劑可用於本發明之方法及調配物中。舉例而言,本發明提供如本文所述之沙美特羅/丙酸氟替卡松調配物,其進一步包含有效量之一或多種該等額外活性劑,例如進一步包含有效量之M3毒蕈鹼拮抗劑、PDE4抑制劑、JAK抑制劑及/或PI3K抑制劑。本發明亦提供用於治療如前文所述例如氣喘或COPD之呼吸道病症的方法,其包含投與如本文所述之沙美特羅/丙酸氟替卡松調配物,且進一步包含同時投與有效量之一或多種該等額外活性劑,例如進一步包含有效量之M3毒蕈鹼拮抗劑、PDE4抑制劑、JAK抑制劑及/或PI3K抑制劑。 Additional active agents such as M3 muscarinic antagonists, PDE4 inhibitors, leukotriene D4 antagonists, egfr-kinase inhibitors, p38 kinase inhibitors, JAK inhibitors, PI3K inhibitors or NK1 receptor agonists can be used in this Inventive methods and formulations. For example, the invention provides a salmeterol/fluticasone propionate formulation as described herein, further comprising an effective amount of one or more of such additional active agents, for example further comprising an effective amount of an M3 muscarinic antagonist, PDE4 inhibitor, JAK inhibitor and/or PI3K inhibitor. The invention also provides a method for treating a respiratory condition, such as asthma or COPD, as described above, comprising administering a salmeterol/fluticasone propionate formulation as described herein, and further comprising one of the concurrently effective amounts Or a plurality of such additional active agents, for example, further comprising an effective amount of an M3 muscarinic antagonist, a PDE4 inhibitor, a JAK inhibitor, and/or a PI3K inhibitor.
本發明亦提供一種包含如上所定義之沙美特羅及氟替卡松及M3毒蕈鹼拮抗劑的醫藥組成物。最佳M3毒蕈鹼拮抗劑係選自阿地尼亞、噻托溴銨、格隆溴銨、蕪地溴銨及GSK-1160724,較佳阿地尼亞且最佳為阿地溴銨。 The invention also provides a pharmaceutical composition comprising salmeterol and fluticasone and an M3 muscarinic antagonist as defined above. The most preferred M3 muscarinic antagonist is selected from the group consisting of adenia, tiotropium bromide, glycopyrrolate, indole bromide and GSK-1160724, preferably adenia and most preferably adiponium bromide.
本發明亦提供一種包含如上所定義之沙美特羅及氟替卡松及PDE4抑制劑的醫藥組成物。最佳PDE4抑制劑係選自羅氟司特、替托司特、艾比司特、雷瓦司特、RPL-554及CHF-6001,較佳為羅氟司特。 The invention also provides a pharmaceutical composition comprising salmeterol and fluticasone and a PDE4 inhibitor as defined above. The preferred PDE4 inhibitor is selected from the group consisting of roflumilast, tetomilast, ibistast, revastat, RPL-554 and CHF-6001, preferably roflumilast.
此等三成分之組合適於每日投與一次或兩次。 Combinations of these three components are suitable for one or two daily doses.
提供以下實例以使熟習此項技術者足夠清楚及完全地解釋本發明,但不應理解為限制如此說明書之先前部分中所陳述之其標的之基本態樣。 The following examples are provided to enable those skilled in the art to clarify the invention in a sufficiently clear and complete manner, but are not to be construed as limiting the basic aspects of the subject matter set forth in the foregoing part of the specification.
實例 Instance
實例1Example 1
包含羥萘甲酸沙美特羅與丙酸氟替卡松之用於吸入之醫藥組成物Medicinal composition for inhalation comprising salmeterol hydroxynaphtholate and fluticasone propionate
製備批次大小為8kg之醫藥組成物,其包含羥萘甲酸沙美特羅、丙酸氟替卡松及d10為90-160μm、d50為170-270μm且d90為290-400μm之α-乳糖單水合物。 A pharmaceutical composition having a batch size of 8 kg was prepared, which contained salmeterol hydroxynaphtholate, fluticasone propionate, and α-lactose monohydrate having a d10 of 90-160 μm, a d50 of 170-270 μm, and a d90 of 290-400 μm.
丙酸氟替卡松(186.7g)及α-乳糖單水合物(7798g)在Bohle摻合機中摻合,混合物經由篩分機Bohle BTS篩分且最終,混合物在Bohle摻合機中摻合。 Fluticasone propionate (186.7 g) and alpha-lactose monohydrate (7798 g) were blended in a Bohle blender, the mixture was sieved through a sieve Bohle BTS and finally the mixture was blended in a Bohle blender.
將羥萘甲酸沙美特羅(15.33g)添加至混合物中且在Bohle混合機中摻合,此混合物經由篩分機Bohle BTS篩分且最終,混合物在Bohle摻合機中摻合。 Salmeterol hydroxynaphtholate (15.33 g) was added to the mixture and blended in a Bohle mixer, this mixture was sieved through a sieve Bohle BTS and finally, the mixture was blended in a Bohle blender.
藉由交替摻合及篩分步驟製備羥萘甲酸沙美特羅及丙酸氟替卡松與-乳糖單水合物之混合物以保證均勻度且粉碎可能之黏聚物。 A mixture of salmeterol hydroxynaphthylate and fluticasone propionate and lactose monohydrate was prepared by alternate blending and sieving steps to ensure uniformity and to comminute possible cohesive mass.
Genuair®(H.Chrystyn等人(2009))藥筒裝有該組成物。該等藥筒經校準以提供60次定劑量。每次致 動Genuair®提供12mg定劑量之上述組成物。 Genuair® (H. Chrystyn et al. (2009)) cartridges contain this composition. The cartridges were calibrated to provide 60 dosing doses. Every time The Genuair® provides a 12 mg dose of the above composition.
遞送劑量之量測Delivery dose measurement
根據歐洲藥典第7版(7.0),第2.9.18章及美國藥典USP36-NF31,第601章;使用「收集管(Collection Tube)」設備(CT)量測實例1中所述之醫藥組成物之遞送劑量(用於在口腔吸入之藥物量)。為此,經由適配器將Genuair®吸入器裝配至收集管,按壓Genuair®吸入器之劑量銷(key)且釋放,接著吸進2L或4L空氣通過吸入器(流過吸入器之呼氣流速在4KPa之壓降下為約65L/min)及收集管。隨後,用溶劑萃取遞送至收集管之吸入粉末且使用高效液相層析設備(HPLC)分析。 According to the European Pharmacopoeia, 7th edition (7.0), Chapter 2.9.18 and the United States Pharmacopoeia USP36-NF31, Chapter 601; measuring the pharmaceutical composition described in Example 1 using the "Collection Tube" device (CT) The delivered dose (the amount of drug used for inhalation in the mouth). For this purpose, via the adapter Genuair® collection tube is fitted to the inhaler, the pressing pin Genuair® dose inhaler (key) and releases, 2L or 4L then sucked into the air through the inhaler (expiratory flow rate flowing through the inhaler in 4KPa The pressure drop is about 65 L/min) and the collection tube. Subsequently, the inhalation powder delivered to the collection tube was extracted with a solvent and analyzed using a high performance liquid chromatography apparatus (HPLC).
每次致動(每次吸入)之平均遞送劑量為16μg沙美特羅,其對應於23μg羥萘甲酸沙美特羅及280μg丙酸氟替卡松。 The average delivered dose per actuation (per inhalation) was 16 μg salmeterol, which corresponds to 23 μg salmeterol hydroxy naphthylate and 280 μg fluticasone propionate.
實例2Example 2
在I期、隨機、開放標籤、雙向完全交叉、單次劑量臨床試驗中,將沙美特羅(羥萘甲酸鹽形式)/丙酸氟替卡松固定劑量組合(FDC)經由Genuair®及ccuhalerTM投與健康志願者以評估兩種調配物之藥物代謝動力學。 In a Phase I, randomized, open-label, two-way, fully crossover, single-dose clinical trial, salmeterol (hydroxynaphthoate form) / fluticasone propionate fixed-dose combination (FDC) was administered via Genuair® and ccuhaler TM Healthy volunteers were evaluated for pharmacokinetics of the two formulations.
此研究展示經由Genuair®與Seretide® Accuhaler® 50/500μg投與之沙美特羅(羥萘甲酸鹽形式)/丙酸氟替卡松16/280μg固定劑量組合(FDC)的生體相等性。 This study demonstrates the bioequivalence of salmeterol (hydroxynaphthoate form)/fluticasone propionate 16/280 μg fixed dose combination (FDC) administered via Genuair® and Seretide® Accuhaler® 50/500 μg.
不影響、改變、變更或修改所述醫藥組成物之基本態樣的改良包括在本發明之範疇內。 Improvements that do not affect, alter, alter or modify the basic aspects of the pharmaceutical composition are included within the scope of the invention.
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IT7920688V0 (en) | 1979-02-05 | 1979-02-05 | Chiesi Paolo Parma | INHALER FOR PULVERULENT MEDICINAL SUBSTANCES, WITH COMBINED DOSER FUNCTION. |
CY1492A (en) | 1981-07-08 | 1990-02-16 | Draco Ab | Powder inhalator |
US4570630A (en) | 1983-08-03 | 1986-02-18 | Miles Laboratories, Inc. | Medicament inhalation device |
FI69963C (en) | 1984-10-04 | 1986-09-12 | Orion Yhtymae Oy | DOSERINGSANORDNING |
DE3927170A1 (en) | 1989-08-17 | 1991-02-21 | Boehringer Ingelheim Kg | INHALATOR |
US5270305A (en) * | 1989-09-08 | 1993-12-14 | Glaxo Group Limited | Medicaments |
IT1237118B (en) | 1989-10-27 | 1993-05-18 | Miat Spa | MULTI-DOSE INHALER FOR POWDER DRUGS. |
US5201308A (en) | 1990-02-14 | 1993-04-13 | Newhouse Michael T | Powder inhaler |
GB9004781D0 (en) | 1990-03-02 | 1990-04-25 | Glaxo Group Ltd | Device |
GB9015522D0 (en) | 1990-07-13 | 1990-08-29 | Braithwaite Philip W | Inhaler |
WO1992003175A1 (en) | 1990-08-11 | 1992-03-05 | Fisons Plc | Inhalation device |
DE4027391A1 (en) | 1990-08-30 | 1992-03-12 | Boehringer Ingelheim Kg | GAS-FREE INHALATION DEVICE |
DE69132850T2 (en) | 1990-09-26 | 2002-05-29 | Pharmachemie B.V., Haarlem | Cyclone powder inhaler |
GB9026025D0 (en) | 1990-11-29 | 1991-01-16 | Boehringer Ingelheim Kg | Inhalation device |
AU650953B2 (en) | 1991-03-21 | 1994-07-07 | Novartis Ag | Inhaler |
DE4239402A1 (en) | 1992-11-24 | 1994-05-26 | Bayer Ag | Multiple dosage powder inhaler - has acceleration channel and dwell chamber for uniformly high drug dispersion |
AU683036B2 (en) | 1992-12-18 | 1997-10-30 | Merck Sharp & Dohme Corp. | Inhaler for powdered medications |
PL182198B1 (en) | 1995-06-21 | 2001-11-30 | Asta Medica Ag | Pharmaceutic powder holding container with integrated measuring device and powdered |
DE10129703A1 (en) | 2001-06-22 | 2003-01-02 | Sofotec Gmbh & Co Kg | Atomizing system for a powder mixture and method for dry powder inhalers |
ITMI20010357U1 (en) | 2001-06-28 | 2002-12-30 | Plastiape Spa | INHALER DEVICE |
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TR201000681A2 (en) * | 2010-01-29 | 2011-08-22 | B�Lg�� Mahmut | Dry powder formulations inhaled. |
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