TWI419691B - 藥劑組成物(一) - Google Patents
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Description
本發明係有關一種阿地尼亞(aclidinium)之新穎劑量以及使用阿地尼亞以治療呼吸系統疾病(尤其是氣喘以及慢性阻塞性肺病)之方法與配方。
阿地溴銨(aclidinium bromide)係為(3R)-(2-羥基-2,2-二噻吩-2-基乙酰氧基)-1-(3-苯氧丙基)-1-氮雜雙環[2.2.2]辛烷溴化物(即敘述於例如WO0104118號專利案中者)。雖然該化合物已知為長效性抗膽鹼藥物,且對於治療呼吸系統疾病有所助益,然而其最適當的劑量仍尚未被揭露。
於現今研究結果中意外發現,在治療成人的呼吸系統疾病-尤其是氣喘以及慢性阻塞性肺病-方面,最有效使用阿地尼亞之方式係利用吸入方式於一次用藥中,投予每一定量標稱劑量(metered nominal dose)約200微克之阿地尼亞;通常於單一用藥中,投予每日定量標稱劑量約200微克之阿地尼亞;例如約180微克之吸入器發出劑量(emitted dose),以及約60微克之微粒劑量(Fine Particle dose)(相對應於阿地溴銨之重量)。
因此,本發明於第一實施例中提供一種供吸入之藥劑組成物,包含乾粉型態之阿地尼亞(aclidinium)於藥理學上可接受的鹽(例如阿地溴銨),並與一藥理學上可接受之乾粉載體(例如乳糖顆粒)相混合;其(i)包括一相當於約200微克阿地溴銨(aclidinium bromide)之阿地尼亞單一定量標稱劑量,或(ii)於多劑量乾粉吸入裝置中,以計量提供一相當於約200微克阿地溴銨的阿地尼亞定量標稱劑量。此組成物可每日投予一次或多次,較佳每日投予一次或二次。
於第二實施例中,本發明提供一種治療呼吸系統疾病的方法,適用於有需要之病患,其中該呼吸系統疾病係選自於例如氣喘或慢性阻塞性肺病;該方法包括投予一劑量,通常為每日投予一次或每日投予二次之阿地尼亞劑量,例如投予阿地溴銨(相當於約200微克定量標稱劑量之阿地溴銨),例如包括投予如前文中所述之藥劑組成物。本發明亦提供於製造藥劑過程中阿地尼亞之使用,例如於前述方法中之使用。
阿地尼亞可當作單一治療藥物而加以投予,亦可與一種或多種附加的抗發炎以及/或氣管擴張藥物合併使用(例如皮質類固醇、PDE IV抑制劑以及β2促效劑),例如佛莫特洛(formoterol)、沙美特洛(salmeterol)、布地奈德(budesonide)以及莫美他松(mometasone)。本發明亦提供有如前文所述之方法以及藥劑組成物;該方法更包括投予有效量的前述附加藥物,該藥劑組成物則更包括前述之附加藥物。
為對於本發明之特點與作用能有更深入之瞭解,茲藉實施例詳述於後。
一般而言,阿地尼亞係與一陰離子X相結合,而以鹽的形式投予,其中X係為藥學上可接受之單價或多價酸之陰離子。X通常係取自於一無機酸(例如鹽酸、氫溴酸、硫酸以及磷酸)或一有機酸(例如甲磺酸、醋酸、反丁烯二酸、琥珀酸、乳酸、檸檬酸或順丁烯二酸)。前述阿地尼亞較佳為阿地溴銨之形式。
阿地尼亞較佳以乾粉形式投予,並與一適當之載體(例如乳糖粉末)相結合,以適於吸入。
舉例而言,於一實施例中,阿地尼亞係為阿地溴銨,並與乳糖粉末相混合。
可使用本發明所述之配方與方法治療之呼吸系統疾病或病症通常為氣喘、急性或慢性支氣管炎、肺氣腫、慢性阻塞性肺病(COPD)、支氣管性過度敏感或鼻炎,尤其是氣喘或慢性阻塞性肺病,且主要為慢性阻塞性肺病。
關於活性藥物之劑量方面,本文中所使用之『約』係指落入如歐洲與美國藥典所定義之加/減35%之可接受變異之正常限值內;或指落入由現今最嚴格要求所定義之較佳的可接受變異之正常限值內(即美國食品及藥物管理局之指南草案中關於吸入器之規定之加/減25%之範圍);或係特別指落入用於配送系統中定量劑量準確度之範圍內(例如加/減10%)。因此,『約200微克』之定量標稱劑量,係指為200微克之一目標劑量標的,該目標劑量之變異係落入配送系統中可接受之限值內(例如美國與歐洲藥典所定義之可接受變異加/減35%);或較佳係指為150至250微克之目標劑量(如現今最嚴格要求所定義之較佳的可接受變異,即美國食品及藥物管理局之指南草案中關於吸入器之規定);或最佳係指為170至230微克之目標劑量(於吸入器之定量劑量準確度之範圍內)。
發出劑量以及微粒劑量(微粒劑量=發出劑量中低於5微米之截止氣動臨界值(cut off aerodynamic threshold)的阿地溴銨微克數)亦具有相同之變異值,且與定量劑量成比例;因此,對於發出劑量來說,舉例而言,約200微克之定量標稱劑量(加/減35%)相當於約180微克之發出劑量(加/減35%),且相當於60微克之微粒劑量(加/減35%)。
配方的包裝方式可為適用於單位劑量配送者或適用於多劑量配送者。於多劑量配送之情況下,該配方可預先定量或於使用時再定量。因此,乾粉吸入器可依此分成三種類型:(a)單一劑量裝置;(b)多單位劑量裝置;以及(c)多劑量裝置。
配方通常包括本發明中用於吸入之化合物的粉末混合物,以及一適當的粉末基底(載體物質)(例如乳糖或澱粉);其中該載體物質較佳使用乳糖。包含於每一膠囊或儲存匣中之每一種有療效的活性成份,通常係介於2微克至400微克之間。或,該活性成份亦可能以未使用賦形劑之方式呈現。
關於第一種類型之單一劑量吸入器,製造者秤出單一劑量後,將其置入小容器內;其中前述小容器大多為硬質膠囊。自一分離的盒體或容器內取出一顆膠囊,將膠囊插入吸入器之容納區域內。隨後,利用針體或切割刀片將該膠囊打開或穿孔,使部份的吸入蒸氣得以穿透膠囊而得以傳送粉末,或經由吸入時所產生之離心力而將粉末由膠囊內經該穿孔排出。於吸入後,必須再次將空膠囊自該吸入器移除。通常,膠囊的插入或移除皆必須拆解該吸入器,而此等操作方式對某些病患而言,是相當困難且麻煩的。此外,關於裝載吸入粉末硬質膠囊之使用方面,仍具有下述其他缺點:(a)、對於周邊空氣中濕氣之抵抗能力差;(b)、對於暴露於極端相對溼度下的膠囊而言,將膠囊打開以及穿孔皆會造成膠囊的碎裂或凹陷等問題;(c)、可能會吸入膠囊碎片。此外,對於為數不少的膠囊吸入器而言,亦有報告指出曾發生不完全排出之情況。
如WO92/03175專利案所述,一些膠囊吸入器係設有一匣體,個別的膠囊可自該匣體傳送至一容納室,並於該容納室內將膠囊加以穿孔並排空。其它膠囊吸入器則設置有具有膠囊室之旋轉式匣體,前述膠囊室可被帶至與氣道相對應的位置,而將藥劑釋放(例如WO91/02558以及GB2242134專利案)。這些膠囊吸入器包括多單位劑量吸入器以及泡囊吸入器,這些吸入器僅能於一盤體或條體上供給有限數量之單位劑量。
相較於膠囊吸入器而言,泡囊吸入器對於濕氣之防潮能力較佳。此外,藉由貫穿表面與泡箔或剝除表面泡箔,則可接觸到粉末。當使用泡條體以取代一盤體時,劑量數目雖可隨之增加,但對於病患而言,空條體之更換仍為不便。因此,該類裝置通常與整合於其內之劑量系統皆為可拋棄式者,其中整合於其中的劑量系統則包括有運輸條體以及打開泡囊的技術。
於多劑量吸入器中,並未包含有已預先測定數量之粉末配方。這些吸入器係由一較大的容器以及一必須由病患操作之劑量量測結構所組成。該容器所承載之多劑係藉由體積排量,從大的粉末團塊分離而得。前述劑量量測結構有多種類型,包括可旋轉膜(例如EP0069715專利案所述)或盤體(例如GB2041763、EP0424790、DE4239402以及EP0674533等專利案所述)、可旋轉圓筒(例如EP0166294、GB2165159以及WO92/09322等專利案所述)以及可旋轉之平截頭體(Frustum)(例如WO92/00771專利案所述);前述所有類型的結構皆具有空腔,且必須以容器內之粉末將該空腔加以填滿。其它多劑量裝置則具有測量用滑道(如US5201308或WO97/00703等專利案所述)或測量用活塞;其中該活塞具有局部或環繞周圍之凹陷,藉以將一定容積之粉末自該容器內移轉至一投藥腔或一空氣導管(例如EP0505321、WO92/04068以及WO92/04928等專利案所述)。
對於多劑量吸入式裝置而言,劑量測量之可重複性係為主要考量點之一。一般而言,由於劑量測量杯或空腔之填入過程主要係受到重力之影響,因此填裝的粉末配方必須能展現良好且穩定之流動性質。對於重新填裝的單一劑量以及多單位劑量吸入器而言,使用者可以確保劑量量測準確度以及可重複性。然而於另一方面,對於多劑量吸入器而言,由於可包含之劑量數目較高,因此較少於操作時僅裝填一劑量。
由於進入多劑量裝置內的吸入蒸氣通常係直接穿過劑量測量空腔,且由於為大體積剛性之多劑量吸入器之劑量量測系統無法被該吸入蒸氣所攪動,因此粉末團塊僅自該空腔內被帶出,而於排出時僅有少量粉末會自該團塊脫離。
因此,有必要具有單獨存在的分解裝置(disintegration means)。然而,於實施時,這些分解裝置並非總是被設計為吸入器之一部份。由於多劑量裝置內之劑量數目較多,因此在不影響到裝置內之剩餘劑量的情形下,必須將粉末附著於空氣導管與該解聚裝置(de-agglomeration means)之內壁上的情形降至最低,以及/或必須能定時清理這些部份。一些多劑量吸入器擁有可拋棄式藥品承載容器,當攫取預定數目的劑量後,該容器將可被更換(例如WO97/000703)。對於這些具有可拋棄式藥品承載容器之半永久的多劑量裝置而言,須更為嚴格地防止藥品之積聚。
於一較佳實施例中,阿地尼亞係經由一由呼吸致動、多劑量、乾粉吸入器加以投予,而計量投予200微克之阿地尼亞定量標稱劑量之每日劑量。為達此目的,所提供之更佳的吸入裝置為Genuair(原稱為Novolizer SD2FL),或提供有如敘述於WO97/000703、WO03/000325或WO03/061742等專利案中者;前述專利案之內容於此引入本文中參考。
除使用於乾粉吸入器外,本發明之組成物亦可以霧氣形式,利用推進氣體或使用所謂霧化器(atomizer)或噴霧器(nebulizer),將含有藥理學上具活性之藥物的溶液或懸浮液於高壓下噴灑,藉以產生含有可吸入顆粒之噴霧。
供以吸入方式投予之藥物的顆粒大小,較佳控制於一特定範圍內。供吸入氣管系統內之最佳顆粒大小通常為1至10微米,較佳為2至5微米。當吸入顆粒時,大小超過20微米之顆粒將難以到達小氣道內。為達到上述顆粒大小,可利用習知的方法(例如微粉化或超臨界流體技術),將所產生的活性成份顆粒加以縮小。此外,可利用氣流分級或篩選方式,分離出為所欲顆粒大小之部份顆粒。前述顆粒較佳為結晶狀。
由於被微粉化之粉末的流動性較差,且有極端聚積傾向,因此將難以使受到微粉化的粉末達到高劑量之可重複性。為增加乾粉組成物之效率,於吸入器內之顆粒大小應較大,但當進入呼吸道時的顆粒大小則應較小。因此,通常需要使用賦形劑(例如單、雙或多醣,或醣醇),其中一般被使用者包括有乳糖、甘露醇或葡萄糖。賦形劑的顆粒大小通常遠大於本發明中所述之吸入藥劑的顆粒大小。當使用乳糖作為賦形劑時,其通常為乳糖顆粒,較佳為結晶阿伐(alpha)乳糖單水合物,其平均顆粒大小例如介於20至1000微米之範圍內,較佳介於90至150微米之範圍內。中位顆粒大小(median particle size)與平均顆粒大小約略相等;前述中位顆粒大小係指一直徑值,其中50%顆粒具有較大的等效直徑(equivalent diameter),另外50%的顆粒則具有一較小的等效直徑。因此,於所屬技術領域內,平均顆粒大小通常係指等效d50。顆粒大小分佈對於流動性質以及塊體密度等皆可能造成影響。由此,為描述一顆粒大小直徑之特徵,除使用d50外,亦可使用其它等效直徑,例如d10以及d90。d10之等效直徑係指其中10%顆粒具有一較小的直徑,因此其餘90%的顆粒則較粗。d90之等效直徑則係指其中90%顆粒具有一較小的直徑。於一實施例中,使用於本發明配方中之乳糖顆粒,其d10為90至160微米,其d50為170至270微米,而其d90則為290至400微米。
適合使用於本發明中之乳糖物質於市面皆可購得,例如由DMW Internacional所購得者(Respitose GR-001、Respitose SV-001、Respitose SV-003);由Meggle所購得者(Capsulac 60、Inhalac 70、Capsulac 60 INH);以及由Borculo Domo所購得者(Lactohale 100-200、Lactohale 200-300以及Lactohale 100-300)。
乳糖顆粒與阿地尼亞之重量比率將視所使用的吸入裝置而定,但其比率通常為5:1至200:1,例如50:1至150:1,如60-70:1。
於一較佳實施例中,於投藥時,阿地尼亞係以阿地溴銨之乾粉配方形式存在,並與乳糖混合,其中阿地尼亞與乳糖之重量比率為1:100至1:150,藉此可適用於一乾粉吸入器而加以投藥。其中,前述阿地尼亞顆粒之平均顆粒直徑係為介於2至5微米,其直徑例如小於3微米;而乳糖顆粒之d10為90至160微米,d50為170至270微米,而d90則為290至400微米。
關於附加的活性藥物,例如β2促效劑、PDE IV抑制劑、皮質類固醇、白三烯D4拮抗劑、egfr-激酶抑制劑、p38激酶抑制劑或NK1受器促效劑等,皆可使用於本發明之方法與配方。舉例而言,於此文中所述之本發明所提供的阿地尼亞配方,更包括一種或多種具有有效量之附加的活性藥物;例如,更包括具有有效量之β2促效劑以及/或PDE IV抑制劑以及/或皮質類固醇。本發明亦提供如文中所提到的用於治療呼吸系統疾病(例如氣喘或慢性阻塞性肺病)的方法,該方法包括投予如文中所述的阿地尼亞配方,且更包括同時投予具有有效量之一種或多種附加的活性藥物,例如更包括具有有效量之β2促效劑以及/或PDE IV抑制劑以及/或皮質類固醇。
適合與本發明之阿地尼亞共同使用之β2促效劑包括以下物質:例如阿福特羅(arformoterol)、班布特羅(bambuterol)、比托特羅(bitolterol)、布澤特羅(broxaterol)、卡布特羅(carbuterol)、克倫特羅(clenbuterol)、多培沙明(dopexamine)、非諾特羅(fenoterol)、福莫特羅(formoterol)、海索那林(hexoprenaline)、異丁特羅(ibuterol)、異他林(isoetharine)、異丙腎上腺素(isoprenaline)、左沙丁胺醇(levosalbutamol)、瑪布特羅(mabuterol)、美洛君(meluadrine)、間羥異丙基腎上腺素(metaprotenerol)、諾洛米羅(nolomirole)、奧西那林(orciprenaline)、吡布特羅(pirbuterol)、丙卡特羅(procaterol)、瑞普特羅(reproterol)、利托君(ritodrine)、里模特羅(rimoterol)、沙丁胺醇(salbutamol)、沙甲胺醇(salmefamol)、沙美特羅(salmeterol)、sibenadet、sotenerot、磺酰特羅(sulfonterol)、特布他林(terbutaline)、噻拉米特(tiaramide)、妥洛特羅(tulobuterol)、GSK-597901、米維特羅(milveterol)、GSK-678007、GSK-642444、GSK-159802、LAS100977(5-(2-{[6-(2,2-二氟-2-苯基乙氧基)己基]氨基}-1(R)
-羥乙基)-8-羥基喹啉-2(1H
)-酮)、HOKU-81、KUL-1248、卡莫特羅(carmoterol)、茵達特羅(indacaterol)以及5-[2-(5,6-二乙基因達-2-基氨基)-1-羥乙基]-8-羥-1H-喹啉-2-酮、4-羥-7-[2-{[2-{[3-(2-苯基乙氧基)丙基]磺酰基}乙基]氨基}乙基]-2(3H)-苯駢噻唑酮、1-(2-氟-4-羥苯基)-2-[4-(1-苯并咪唑基)-2-甲基-2-丁氨基]乙醇、1-[3-(4-甲氧基芐胺基)-4-羥苯基]-2-[4-(1-苯并咪唑基)-2-甲基-2-丁氨基]乙醇、1-[2H-5-羥-3-側氧基-4H-1,4-苯并噁嗪-8-基]-2-[3-(4-N,N-二甲氨基苯基)-2-甲基-2-丙氨基]乙醇、1-[2H-5-羥-3-側氧基-4H-1,4-苯并噁嗪-8-基]-2-[3-(4-甲氧基苯基)-2-甲基-2-丙氨基]乙醇、1-[2H-5-羥-3-側氧基-4H-1,4-苯并噁嗪-8-基]-2-[3-(4-n-丁氧苯基)-2-甲基-2-丙氨基]乙醇、1-[2H-5-羥-3-側氧基-4H-1,4-苯并噁嗪-8-基]-2-{4-[3-(4-甲氧基苯基)-1,2,4-三唑-3-基]-2-甲基-2-丁氨基}乙醇、5-羥-8-(1-羥-2-異丙基氨基丁基)-2H-1,4-苯并噁嗪-3-(4H)-酮、1-(4-氨基-3-氯-5-三氟甲基苯基)-2-三級-丁氨基)乙醇以及1-(4-乙氧甲酰氨基-3-氰基-5-氟苯基)-2-(三級-丁氨基)乙醇等物質之消旋物、鏡像異構物、非鏡像異構物以及其混合物、以及上述物質於藥理學上相容之酸加成鹽。
與本發明一併使用之β2促效劑較佳包括以下藥物:例如阿福特羅、班布特羅、比托特羅、布澤特羅、卡布特羅、克倫特羅、多培沙明、非諾特羅、福莫特羅、海索那林、異丁特羅、異丙腎上腺素、左沙丁胺醇、瑪布特羅、美洛君、諾洛米羅、奧西那林、吡布特羅、丙卡特羅、(R,R)福莫特羅、瑞普特羅、利托君、里模特羅、沙丁胺醇、沙美特羅、sibenadet、磺酰特羅、特布他林、妥洛特羅、GSK-597901、米維特羅、LAS100977(5-(2-{[6-(2,2-二氟-2-苯基乙氧基)己基]氨基}-1(R)
-羥乙基)-8-羥基喹啉-2(1H
)-酮)、KUL-1248、卡莫特羅以及茵達特羅等物質之消旋物、鏡像異構物、非鏡像異構物以及其混合物、以及上述物質於藥理學上相容的酸加成鹽。
由於本發明之M3拮抗劑係為具有長效作用者,因此該M3拮抗劑較佳與長效型β2促效劑(亦被稱為LABA)共同使用。前述共同使用的藥物可毎日投予一次或二次。
前述LABA較佳為福莫特羅、沙美特羅以及GSK-597901、米維特羅、LAS100977(5-(2-{[6-(2,2-二氟-2-苯基乙氧基)己基]氨基}-1(R)
-羥乙基)-8-羥基喹啉-2(1H
)-酮)、KUL-1248、卡莫特羅以及茵達特羅等物質之消旋物、鏡像異構物、非鏡像異構物以及其混合物、以及上述物質於藥理學上相容的酸加成鹽。更佳為沙美特羅、福莫特羅、LAS100977(5-(2-{[6-(2,2-二氟-2-苯基乙氧基)己基]氨基}-1(R)
-羥乙基)-8-羥基喹啉-2(1H
)-酮)以及QAB-149。最佳為沙美特羅、福莫特羅以及LAS100977(5-(2-{[6-(2,2-二氟-2-苯基乙氧基)己基]氨基}-1(R)
-羥乙基)-8-羥基喹啉-2(1H
)-酮),尤其為沙美特羅羥萘甲酸鹽(salmeterol xinafoate)、富馬酸福莫特羅(formoterol fumarate)以及LAS100977(5-(2-{[6-(2,2-二氟-2-苯基乙氧基)己基]氨基}-1(R)
-羥乙基)-8-羥基喹啉-2(1H
)-酮)。
舉例來說,本發明提供有一供吸入之藥劑組成物,其包含乾粉型態阿地尼亞於藥理學上可接受的鹽(例如溴鹽),並與一藥理學上可接受之乾粉載體(例如乳糖顆粒)以及富馬酸福莫特羅相混合,(i)包括一相當於約200微克阿地溴銨之阿地尼亞單一定量標稱劑量以及約5至25微克(例如6、8.5、12、18或24微克,例如12微克)富馬酸福莫特羅之單一定量標稱劑量,或(ii)於一多劑量乾粉吸入裝置,以計量提供一相當於約200微克阿地溴銨的阿地尼亞定量標稱劑量以及約5至25微克(例如6、8.5、12、18或24微克,例如12微克)富馬酸福莫特羅之定量標稱劑量。
供吸入方式投予之藥劑組成物包括阿地尼亞以及一β2促效劑,毎日可投予一次或多次;其中該β2促效劑例如為福莫特羅或LAS100977(5-(2-{[6-(2,2-二氟-2-苯基乙氧基)己基]氨基}-1(R)
-羥乙基)-8-羥基喹啉-2(1H
)-酮)。較佳毎日投予一次或兩次。
適合與本發明之阿地尼亞共同使用之PDE4抑制劑包括以下物質:苯芳群二馬來酸鹽(benafentrine dimaleate)、依他唑酯(etazolate)、登布茶鹼(denbufylline)、洛利普南(rolipram)、西潘茶鹼(cipamfylline)、札達維林(zardaverine)、阿羅茶鹼(arofylline)、非明司特(filaminast)、泰魯斯特(tipelukast)、妥非司特(tofimilast)、吡拉米司特(piclamilast)、托拉芬群(tolafentrine)、美索普南(mesopram)、鹽酸屈他維林(drotaverine hydrochloride)、利米斯特(lirimilast)、羅氟司特(roflumilast)、西洛司特(cilomilast)、歐果米司特(oglemilast)、艾樸瑞米司特(apremilast)、6-[2-(3,4-二乙氧苯基)噻唑-4-基]砒啶-2-羧酸(替托米司特、Tetomilast)、(R)-(+)-4-[2-(3-環戊氧基-4-甲氧基苯基)-2-苯乙基]砒啶(CDP-840)、N-(3,5-二氯-4-砒啶基)-2-[1-(4-氟芐基)-5-羥基-1H-吲哚-3-基]-2-含氧乙酰胺(GSK-842470)、9-(2-氟芐基)-N6-甲基-2-(三氟甲基)腺嘌呤(NCS-613)、N-(3,5-二氯-4-砒啶基)-8-甲氧基喹啉-5-甲醯胺(D-4418)、N-[9-甲基-4-側氧基-1-苯基-3,4,6,7-四氫吡咯[3,2,1-jk][1,4]苯重氮基-3(R)-基]砒啶-4-甲醯胺、3-[3-(環戊氧基)-4-甲氧基苯基]-6-(乙氨基)-8-異丙基-3H-嘌呤氯化氫(V-11294A)、6-[3-(N,N-二甲基胺甲醯基)苯磺醯基]-4-(3-甲氧基苯氨基)-8-甲基喹啉-3-甲醯胺氯化氫(GSK-256066)、4-[6,7-二乙氧基-2,3-二(羥甲基)奈-1-基]-1-(2-甲氧基乙基)砒啶-2(1H)-酮(T-440)、(-)-反式-2-[3'-[3-(N-環丙基胺甲醯基)-4-側氧基-1,4-二氫-1,8-奈啶-1-基]-3-氟聯苯-4-基]環丙甲酸(MK-0873)、CDC-801、UK-500001、BLX-914、2-甲氧羰基-4-氰基-4-(3-環丙基甲氧基-4-二氟甲氧基苯基)環己烷1-酮、順
[4-氰基-4-(3-環丙基甲氧基-4-二氟甲氧基苯基)環己烷-1-醇、5(S)-[3-(環戊氧基)-4-甲氧基苯基]-3(S)-(3-甲基芐基)哌啶-2-酮(IPL-455903)、ONO-6126(Eur Respir J 2003,22(Suppl. 45):Abst 2557)以及於PCT專利申請案號為WO03/097613、WO2004/058729、WO 2005/049581、WO 2005/123693與WO 2005/123692之專利案中所主張的化合物。
適合與本發明之阿地尼亞共同使用之皮質類固醇以及糖質腎上腺皮質素包括以下物質:潑尼松龍(prednisolone)、甲基潑尼松龍(methylprednisolone)、德沙美松(dexamethasone)、西貝酸德沙美松(dexamethasone cipecilate)、奈非可特(naflocort)、地夫可特(deflazacort)、乙酸鹵潑尼松(halopredone acetate)、布地奈德(budesonide)、二丙酸貝克美松(beclomethasone dipropionate)、氫化可體松(hydrocortisone)、醋酸曲安縮松(triamcinolone acetonide)、醋酸氟輕松(fluocinolone acetonide)、氟輕松(fluocinonide)、新戊酸氯可托龍(clocortolone pivalate)、甲基潑尼松龍乙丙酸酯(methylprednisolone aceponate)、軟脂酸德沙美松(dexamethasone palmitoate)、替利坦松(tipredane)、氫化可體松醋丙酯(hydrocortisone aceponate)、波尼卡酯(prednicarbate)、二丙酸阿氯米松(alclometasone dipropionate)、丙酸布替可特酯(Butixocort propionate)、RPR-106541、鹵美他松(halometasone)、磺庚甲基潑尼松龍(methylprednisolone suleptanate)、莫美他松糠酸酯(mometasone furoate)、利美索龍(rimexolone)、法呢酸潑尼松龍酯(prednisolone farnesylate)、環索奈德(ciclesonide)、迪普羅酮丙酸酯(deprodone propionate)、丙酸氟替卡松(fluticasone propionate)、糖酸氟替卡松(fluticasone furoate)、鹵倍他索丙酸酯(halobetasol propionate)、氯替潑諾(loteprednol etabonate)、倍他米松丁酸丙酸酯(betamethasone butyrate propionate)、氟尼縮松(flunisolide)、潑尼松(prednisone)、德沙美松磷酸鈉(dexamethasone sodium phosphate)、曲安奈德(triamcinolone)、倍他米松戊酸酯(betamethasone 17-valerate)、倍他米松(betamethasone)、倍他米松二丙酸酯(betamethasone dipropionate)、21-氯-11貝他-羥-17阿爾發-[2-(甲基巰基)乙醯氧基]-4-孕烯-3,20-雙酮、去異丁酰基環所奈德(Desisobutyrylciclesonide)、醋酸氫化可體松(hydrocortisone acetate)、氫化可體松琥珀酸鈉(hydrocortisone sodium succinate)、NS-126、潑尼松龍磷酸鈉(prednisolone sodium phosphate)、普酸氫化可體松(hydrocortisone probutate)、潑尼松龍間磺基苯甲酸鈉(prednisolone sodium metasulfobenzoate)以及丙酸氯倍他索(clobetasol proprinate),尤其為布地奈德以及莫美他松。
舉例來說,本發明提供有一供吸入之藥劑組成物,其包含乾粉型態阿地尼亞於藥理學上可接受的鹽(例如溴鹽),並與一藥理學上可接受之乾粉載體(例如乳糖顆粒)以及富馬酸福莫特羅相混合,(i)包括一相當於約200微克阿地溴銨之阿地尼亞單一定量標稱劑量以及約100至900微克(例如100、110、200、220、300、330、400、440、800或880微克,例如200至450微克,如220或440微克)之莫美他松糠酸酯單一定量標稱劑量,或(ii)於一多劑量乾粉吸入裝置,以計量提供一相當於約200微克阿地溴銨的阿地尼亞定量標稱劑量以及約100至900微克(例如100、110、200、220、300、330、400、440、800或880微克,例如200至450微克,如220或440微克)之莫美他松糠酸酯定量標稱劑量。
供吸入方式投予之藥劑組成物包括阿地尼亞以及一皮質類固醇(例如莫美他松糠酸酯),每日可投予一次或多次。較佳毎日投予一次或兩次。
本發明亦提供有一藥劑組成物,包括阿地尼亞、如前文所定義之β2促效劑以及如前文所定義之皮質類固醇。其中,β2促效劑較佳為LAS100977(5-(2-{[6-(2,2-二氟-2-苯基乙氧基)己基]氨基}-1(R)
-羥乙基)-8-羥基喹啉-2(1H
)-酮)以及福莫特羅;而皮質類固醇則較佳為莫美他松糠酸酯。由此三者合併之組成物適於毎日投予一或二次。
方法:對於罹患有中度至重度之長期COPD之病患中,於四週內隨機接受雙盲試驗(double blind)、毎日投予一次阿地尼亞(25、50、100、200或400微克)加以治療、給予安慰劑或投予公開標識的噻托(tiotropium)18微克。肺功能測量(spirometric measurement)之實施如下:於第一次投藥後22至24小時以及隨後每週實施,以及於第1天投藥後0.5至6小時以及第四周(第29天)實施。
結果:ITT母體包括有460位病患。於第29日,於下表中列有與阿地尼亞劑量呈相關性增加的FEV1
谷值(trough FEV1
)。
與噻托不同處在於,阿地尼亞於第29日投藥後最初6小時內,仍具有可與第1日相比擬的的支氣管擴張效果(對所有劑量而言)。對於投予100至400微克的阿地尼亞而言,投藥後3小時可達到FEV1
之峰值(peak FEV1
)。阿地尼亞之耐受度良好,且對於ECG、實驗參數以及不良事件而言,阿地尼亞的使用並不會產生呈劑量相關性之影響。
結論:阿地尼亞可產生超過24小時的持續性支氣管擴張作用,且耐受度良好。相較於公開標識的18微克噻托,200微克以及400微克的阿地尼亞具有可與其相比擬的支氣管擴張效果。基於效能以及耐受度之數據,200微克的阿地尼亞將可選作為未來關於COPD長期臨床試驗的試驗劑量。
Claims (25)
- 一種供吸入之藥劑組成物,包含乾粉型態阿地尼亞(aclidinium),於藥理學上可接受的鹽,並與一藥理學上可接受之乾粉載體相混合,提供有(a)一相當於約200微克阿地溴銨(aclidinium bromide)之阿地尼亞定量標稱劑量;或(b)一相當於約180微克(加/減35%)阿地溴銨之阿地尼亞發出劑量;或(c)一相當於約60微克(加/減35%)阿地溴銨之阿地尼亞微粒劑量。
- 如申請專利範圍第1項所述之藥劑組成物,係為單一劑量乾粉配方樣態,包括有一相當於約200微克阿地溴銨之阿地尼亞單一定量標稱劑量。
- 如申請專利範圍第1項所述之藥劑組成物,係為多劑量乾粉配方樣態,供以一多劑量乾粉吸入裝置投藥,而計量提供一相當於約200微克阿地溴銨之阿地尼亞定量標稱劑量。
- 如申請專利範圍第1至3項中任一項所述之藥劑組成物,其中該阿地尼亞於藥理學上可接受之鹽係為阿地溴銨。
- 如申請專利範圍第1項所述之藥劑組成物,其中該藥理學上可接受之載體係為乳糖顆粒。
- 如申請專利範圍第1項所述之藥劑組成物,其中阿地尼亞與載體之重量比率係為1:50至1:150。
- 如申請專利範圍第6項所述之藥劑組成物,其中阿地尼亞與載體之重量比率係為1:100至1:150。
- 如申請專利範圍第1項所述之藥劑組成物,其中該阿地尼亞之均顆粒直徑係介於2至5微米。
- 如前申請專利範圍第1項所述之藥劑組成物,其中該載體顆粒之d10為90至160微米,d50為170至270微米,d90則為290400微米。
- 如申請專利範圍第1項所述之藥劑組成物,更包括具有一有效量之一種或多種附加的活性物質,該活性物質係選自於由以下物質所組成之群組:β2促效劑、PDE IV抑制劑以及皮質類固醇。
- 如申請專利範圍第10項所述之藥劑組成物,其中該附加的活性物質係選自於由以下物質所組成之群組:自由態或為藥理學上可接受之鹽的形態之佛莫特洛(formoterol)、沙美特洛(salmeterol)、布地奈德(budesonide)以及莫美他松(mometasone)。
- 如申請專利範圍第11項所述之藥劑組成物,其中該附加的活性物質係為富馬酸福莫特羅(formoterol fumarate),其於每一劑量中之含量約為5至25微克。
- 如申請專利範圍第12項所述之藥劑組成物,其中該附加的活性物質係為富馬酸福莫特羅,且其於每一劑量中之含量約為6微克。
- 如申請專利範圍第12項所述之藥劑組成物,其中該附加的活性物質係為富馬酸福莫特羅,且其於每一劑量中之含量約為12 微克。
- 如申請專利範圍第11項所述之藥劑組成物,其中該附加的活性物質係為莫美他松糠酸酯(mometasone furoate),其於每一定量標稱劑量中之含量約為100至900微克。
- 一種為自由態或為藥理學上可接受之鹽之形態的阿地尼亞於製造用於治療患有呼吸系統疾病且需要被治療的病患之藥劑的用途,其中呼吸系統疾病係為氣喘或慢性阻塞性肺病,該用途則係包括每日投予一次相當於約200微克阿地溴銨的阿地尼亞定量標稱劑量。
- 一種為自由態或為藥理學上可接受之鹽之形態的阿地尼亞於製造用於治療具有呼吸系統疾病且需要被治療的病患之藥劑的用途,其中呼吸系統疾病係為氣喘或慢性阻塞性肺病,該用途則包括每日投予二次相當於約200微克阿地溴銨的阿地尼亞定量標稱劑量。
- 如申請專利範圍第16或17項所述之用途,包括投予如申請專利範圍第1項所述之藥劑組成物。
- 如申請專利範圍第18項所述之用途,更包括投予具有一有效量之一種或多種附加的活性物質,該活性藥物係選自於由以下物質所組成之群組:β2促效劑、PDE IV抑制劑以及皮質類固醇。
- 如申請專利範圍第19項所述之用途,其中該附加的活性物質係選自於由以下物質所組成之群組:自由態或為藥理學上可接 受之鹽的形態之佛莫特洛(formoterol)、沙美特洛(salmeterol)、布地奈德(budesonide)以及莫美他松(mometasone)。
- 如申請專利範圍第20項所述之用途,其中該附加的活性物質係為富馬酸福莫特羅(formoterol fumarate),其於每一定量標稱劑量中之含量約為5至25微克。
- 如申請專利範圍第20項所述之用途,其中該附加的活性物質係為莫美他松糠酸酯(mometasone furoate),其於每一定量標稱劑量中之含量約為100至900微克。
- 一種為自由態或為藥理學上可接受之鹽的形態之阿地尼亞於製造用於治療具有呼吸系統疾病、如申請專利範圍第1項所述之藥劑組成物的用途,其中呼吸系統疾病係選自於氣喘以及慢性阻塞性肺病。
- 根據申請專利範圍第1項所述之藥劑組成物,供使用於治療選自於氣喘以及慢性阻塞性肺病之一的呼吸系統疾病。
- 一種多劑量乾粉吸入裝置,於致動時,供計量投予(a)一相當於約200微克阿地溴銨(aclidinium bromide)之阿地尼亞定量標稱劑量;或(b)一相當於約180微克(加/減35%)阿地溴銨之阿地尼亞發出劑量;或(c)一相當於約60微克(加/減35%)阿地溴銨之阿地尼亞微粒劑量。
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