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• • 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
  • A61K9/107—Emulsions ; Emulsion preconcentrates; Micelles
• • 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
  • A61K31/56—Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids
  • A61K31/57—Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids substituted in position 17 beta by a chain of two carbon atoms, e.g. pregnane or progesterone
  • A61K31/573—Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids substituted in position 17 beta by a chain of two carbon atoms, e.g. pregnane or progesterone substituted in position 21, e.g. cortisone, dexamethasone, prednisone or aldosterone
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
  • A61K47/02—Inorganic compounds
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
  • A61K47/06—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite
  • A61K47/08—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite containing oxygen, e.g. ethers, acetals, ketones, quinones, aldehydes, peroxides
  • A61K47/10—Alcohols; Phenols; Salts thereof, e.g. glycerol; Polyethylene glycols [PEG]; Poloxamers; PEG/POE alkyl ethers
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
  • A61K47/06—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite
  • A61K47/08—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite containing oxygen, e.g. ethers, acetals, ketones, quinones, aldehydes, peroxides
  • A61K47/12—Carboxylic acids; Salts or anhydrides thereof
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
  • A61K47/06—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite
  • A61K47/16—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite containing nitrogen, e.g. nitro-, nitroso-, azo-compounds, nitriles, cyanates
  • A61K47/18—Amines; Amides; Ureas; Quaternary ammonium compounds; Amino acids; Oligopeptides having up to five amino acids
  • A61K47/183—Amino acids, e.g. glycine, EDTA or aspartame
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
  • A61K47/06—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite
  • A61K47/22—Heterocyclic compounds, e.g. ascorbic acid, tocopherol or pyrrolidones
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
  • A61K47/06—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite
  • A61K47/24—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite containing atoms other than carbon, hydrogen, oxygen, halogen, nitrogen or sulfur, e.g. cyclomethicone or phospholipids
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
  • A61K47/46—Ingredients of undetermined constitution or reaction products thereof, e.g. skin, bone, milk, cotton fibre, eggshell, oxgall or plant extracts
• • 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
  • A61K9/0048—Eye, e.g. artificial tears
• • 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
  • A61K9/08—Solutions
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P27/00—Drugs for disorders of the senses
  • A61P27/02—Ophthalmic 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]

Definitions

• the present invention relates to an eye drop containing difluprednate as an active ingredient for treating macular edema.
• Macular edema is swelling of retinal macula, and the edema occurs due to a liquid diapedesis from the retinal blood vessels.
• the blood leaks from weak blood vessel walls and enters into extremely small regions of retinal macula rich in retina cone which is a nerve terminal that detects color and the vision during the day relies on.
• images become blurred in the center of the central field or right beside the center.
• the visual acuity decreases progressively for months.
• Diabetic retinopathy, retinal blood vessel obstruction, ocular inflammation and age-related macular degeneration are all associated with the macular edema.
• Retinal macula is sometimes damaged by maculatumentia after removal of crystalline lens for the treatment of cataract.
• intravitreal administration can solve some problems associated with systemic administration
• intravitreal administration of existing ophthalmic compositions can cause ocular hypertension, steroid glaucoma and posterior subcapsular cataract when steroid is administered.
• intravitreal administration of steroid sometimes causes post-surgery complications.
• sub-Tenon administration is often used in clinical practice to decrease the tissue-invasive potential of intravitreal administration and burden on patients. While administration of steroid decreases the tissue-invasive potential as compared to vitreous surgery, it is still associated with the problems of post-surgery complications.
• Administration by instillation is an administration method with high merit since it has low tissue-invasive potential.
• Examples of the treatment of ophthalmic diseases by instillation of steroid include use of a 0.1% betamethasone ophthalmic solution for anti-inflammatory diseases (blepharitis, conjunctivitis, keratitis, scleritis, episcleritis, anterior ocular segmentuveitis, postoperative inflammation) in the external eye and the anterior ocular segment.
• WO 2007/025275 describes the possibility of application of instillation and the like of various steroids and corticosteroid antagonists to the treatment of various ophthalmic diseases such as macular degeneration, glaucoma, macular edema, age-related macular degeneration, retina angiogenesis, diabetic retinopathy, ulceris, posterior eye segmentuveitis and the like, while decreasing the side effects of steroid.
• various ophthalmic diseases such as macular degeneration, glaucoma, macular edema, age-related macular degeneration, retina angiogenesis, diabetic retinopathy, ulceris, posterior eye segmentuveitis and the like, while decreasing the side effects of steroid.
• the present invention aims to provide an eye drop for the treatment of macular edema.
• the present inventors have conducted intensive studies in an attempt to solve the aforementioned problems and found that administration of an eye drop containing difluprednate as an active ingredient improves the symptoms of decreased visual acuity, increased foveal retinal thickness and the like due to macular edema, which resulted in the completion of the present invention.
• the present invention provides the following.
• (21) An eye drop containing difluprednate for use in the treatment of macular edema.
• (22) The eye drop of (21), wherein the macular edema is refractory macular edema.
• (23) The eye drop of (21) or (22), which is an emulsion eye drop.
• (24) The eye drop of any of (21) to (23), wherein the concentration of difluprednate is 0.005-0.1% (w/v).
• (25) The eye drop of any of (21) to (24), comprising 0.005-0.1% (w/v) of difluprednate, and castor oil, polysorbate 80, concentrated glycerin, sodium acetate, boric acid, sodium edetate and sorbic acid.
• macular edema can be treated with an eye drop.
• the eye drop of the present invention is useful for treating refractory macular edema.
• the present invention relates to an eye drop for treating macular edema, which contains difluprednate as an active ingredient.
• Difluprednate (6 ⁇ ,9 ⁇ -difluoroprednisolone 17-butyrate 21-acetate) is a steroidal anti-inflammatory drug like betamethasone phosphate and triamcinolone, and is known to show a superior anti-inflammatory action by transdermal administration and the like.
• an eye drop thereof is used for the prophylaxis or treatment of inflammation after surgery and for the prophylaxis or treatment of ocular pain after surgery.
• Macular edema is swelling of retinal macula, and the edema occurs due to a liquid leakage from the retinal blood vessels. Macular edema is observed as increased foveal retinal thickness of macula. While the foveal retinal thickness of healthy human varies depending on the individual differences and age, the average value thereof is reported to be 178 ⁇ m (Br J Ophthalmol. 1998 September; 82(9): 1003-6).
• photocoagulation by laser irradiation, vitreous surgery, systemic administration of steroid, intravitreal administration and sub-Tenon administration have conventionally been employed as mentioned above, and a certain level of therapeutic effect is found by these treatment methods in some macular edema.
• refractory macular edema refers to macular edema for which a sufficient effect cannot be afforded by the conventionally-employed treatments (e.g., any one or more of photocoagulation by irradiation, vitreous surgery, systemic administration of steroid, intravitreal administration and sub-Tenon administration).
• a sufficient treatment effect means that the foveal retinal thickness decreases by not less than 20%.
• improvement of log MAR value by not less than 0.2 unit is also considered a sufficient effect. This is a general diagnostic criterium in ophthalmic treatments (FDA/NEI protocol (NEI/FDA Ophthalmic Clinical Trial Design and Endpoints Meeting, 2006)).
• the log MAR (the log of the minimum angle of resolution) value shows the ability of the eye (visual acuity) to distinguish the minimum separable acuity, which can be determined by logarithmically converting the values measured using a decimal visual acuity chart.
• the foveal retinal thickness is a value from the internal limiting membrane to the visual cell inner segment-outer segment junction in the fovea, and can be measured by Cirrus OCT (registered trade mark, Carl Zeiss), 3D OCT-1000 (registered trade mark, TOPCON CORPORATION) and the like.
• the eye drop containing difluprednate as an active ingredient relating to the present invention may take any form of emulsion or suspension.
• an emulsion eye drop in the form of an emulsion particularly preferred is an emulsion eye drop in the form of an emulsion.
• emulsion eye drop include Durezol (registered trade mark, Sirion Therapeutics, USA).
• Durezol is a preparation obtained by emulsifying a mixture of difluprednate and predetermined sub-components for the purpose of enabling difluprednate, the active ingredient, to appropriately penetrate into the eyeball and act on the affected part.
• the eye drop of the present invention is an emulsion
• it can be prepared according to, for example, U.S. Pat. No. 6,114,319 (JP-B-3410364).
• the eye drop of the present invention is a suspension
• it can be prepared according to, for example, U.S. Pat. No. 5,556,848 (JP-B-3781792).
• the concentration of difluprednate contained in the eye drop of the present invention is preferably 0.005-0.1% (w/v), more preferably 0.025-0.1% (w/v), particularly preferably 0.05% (w/v).
• the eye drop of the present invention can be used after mixing with various known pharmaceutically acceptable substances appropriately selected with the aim of adjusting the tissue transitivity upon instillation and the like.
• oils e.g., castor oil, peanuts oil, cottonseed oil, soybean oil, olive oil, medium-chain triglyceride etc.
• solvents e.g., saline, sterilization purified water etc.
• stabilizers e.g., sodium edetate, citric acid etc.
• emulsifiers e.g., polyvinylpyrrolidone etc.
• suspending agents e.g., hydroxypropylmethylcellulose, methylcellulose, hydroxymethylcellulose etc.
• surfactants e.g., polysorbate 80, polyoxyethylene hydrogenated castor oil etc.
• preservatives e.g., benzalkonium chloride, parabens, chlorobutanol etc.
• buffers e.g., boric acid, borax (sodium borate), sodium acetate, citrate buffer, phosphate buffer etc.
• isotonicity agents e.g., sodium chloride, glyce
• the eye drop of the present invention when used as an emulsion, it desirably contains a surfactant as an emulsifier.
• a surfactant a nonionic surfactant and the like can be added.
• the nonionic surfactant include polyoxyethylene hydrogenated castor oils or polyoxyethylene sorbitan fatty acid ester, preferably sorbitan polyoxyethylene monooleates, polyoxyethylene sorbitan monolaurates, sorbitan polyoxyethylene monopalmitates, sorbitan polyoxyethylene monostearates and the like.
• castor oil and polysorbate 80 are preferably contained.
• Examples of other components that can be contained include concentrated glycerin, sodium acetate, boric acid, sodium edetate and sorbic acid. Particularly preferred are concentrated glycerin, sodium acetate, boric acid, sodium edetate and sorbic acid, which are preferably contained as necessary.
• the eye drop of the present invention can be safely administered to mammals (human, dog, rabbit, bovine, horse, monkey, cat, sheep etc.).
• an eye drop containing 0.005-0.1% (w/v) of difluprednate is preferably administered to an adult about 2-4 times per day by instillation of 1-2 drops (preferably 1 drop: about 30-50 ⁇ L) per administration.
• the dosing period of the eye drop of the present invention varies depending on the level of condition and the like, for example, it is at least about 1 week, preferably about 1-4 weeks, more preferably about not less than 4 weeks, more preferably not longer than about 12 weeks. Depending on the level of condition and the like, however, administration exceeding 12 weeks may be performed.
• the dosing period of the eye drop of the present invention with a difluprednate concentration of 0.005-0.1% (w/v) is at least 1 week, the administration frequency is 4 times per day, and the dose is about 30-50 ⁇ L per administration.
• the dosing period of the eye drop of the present invention with a difluprednate concentration of 0.005-0.1% (w/v) is 1-4 weeks, the administration frequency is 4 times per day, and the dose is about 30-50 ⁇ L per administration.
• the administration frequency of the eye drop of the present invention with a difluprednate concentration of 0.005-0.1% (w/v) is 4 times per day for 4 weeks from the start of the administration, twice per day after 4 weeks, and the dose is about 30-50 ⁇ L per administration.
• the dosing period of the eye drop of the present invention with a difluprednate concentration of 0.005-0.1% (w/v) is not longer than 12 weeks, the administration frequency is 4 times per day for 4 weeks from the start of the administration, twice per day after 4 weeks, and the dose is about 30-50 ⁇ L per administration.
• the dosing period of the eye drop of the present invention with a difluprednate concentration of 0.005-0.1% (w/v) is at least 12 weeks, the administration frequency is 4 times per day for 4 weeks from the start of the administration, twice per day after 4 weeks, and the dose is about 30-50 ⁇ L per administration.
• the eyes of 11 patients with macular edema (16 eyes) were treated by instillation of 0.05% (w/v) difluprednate emulsion eye drop (Durezol).
• photocoagulation was applied to 12 eyes, and an intraocular lens was implanted in 11 eyes.
• the patients subjected to the treatment were those who had underwent conventionally-known treatments of macular edema, and were in various conditions particularly due to vitreous surgery and intraocular lens implant. They were patients diagnosed with refractory macular edema who resist improvement of retinal edema near fovea even by these treatments and still have a greater foveal retinal thickness than healthy human.
• the clinical test was performed by instillation of Durezol to all patients after lapse of not less than 3 months from the previous treatment. The instillation of Durezol was performed 4 times per day for the first 1 month, twice per day for 2 months thereafter. In addition, the dose per administration was 1 drop (about 30-50 ⁇ l).
• the formulation of Durezol is as follows.
• the control group As a control group, 17 eyes of 9 patients from among patients with the onset of diabetic macular edema were adopted, who were comparable to the Durezol administration group in the age, sex, duration of diabetes and the level of retinopathy.
• the control group consists of patients before undergoing treatments of macular edema, such as sub-Tenon administration of steroid, intravitreal administration of steroid, vitreous surgery and the like.
• This control group was administered with a 0.1% (w/v) ophthalmic solution of betamethasone sodium phosphate (Rinderon A, registered trade mark) 6 times per day for 1 month.
• the betamethasone phosphate eye drop is a steroid preparation generally used as an anti-inflammatory agent for anterior ocular segment in the same manner as an eye drop containing difluprednate.
• the above-mentioned administration conditions of Rinderon A are those for the administration of Rinderon A in a test (steroid responder test) previously confirming the level of intraocular pressure increase caused by sub-Tenon administration or intravitreal administration of steroid such as triamcinolone and the like for the treatment of macular edema.
• the steroid responder test aims to test the sensitivity of individual patient to steroid by measuring the level of intraocular pressure increase resulting from the action, inside the eyeball, of betamethasone phosphate administered by instillation, and it clarifies whether or not macular edema can be treated by intravitreal administration and the like of steroid.
• the patients in the Examples of the present invention and the patients in the control group were subjected to the visual acuity test and measurement of decrease rate of the foveal retina thickness using Cirrus OCT (Carl Zeiss), according to the FDA/NEI protocol (NEI/FDA Ophthalmic Clinical Trial Design and Endpoints Meeting, 2006).
• improvement of not less than 0.2 unit in the log MAR value by instillation was judged to be effective for improvement of visual acuity, or not less than 20% of decrease rate of the foveal retinal thickness was judged to be effective.
• the effectiveness rate was calculated as a proportion (%) of the number of cases effective for the improvement of visual acuity and foveal retinal thickness decrease rate to the total number of cases.
• Table 1 shows the effects of the Durezol instillation and Rinderon A instillation on the foveal retinal thickness decrease rate in macular edema.
• the effectiveness rate of the foveal retinal thickness decrease is 37.5% in the Durezol administration group at the time point of 1 month from the start of the administration, which clearly shows that the symptom of macular edema is improved.
• the Rinderon A administration group control group
• Rinderon A is used as an anti-inflammatory agent for the anterior ocular segment like Durezol
• the eye drop of difluprednate of the present invention shows efficacy not obtainable by a betamethasone phosphate eye drop, which is a similar steroid preparation.
• the difluprednate eye drop is also effective for refractory macular edema, which is difficult to treat by conventional treatment methods.
• Table 2 shows time-course changes in the effect of Durezol instillation on the foveal retinal thickness decrease rate.
• Continuous instillation of Durezol to macular edema patients provides continuous increase in the effectiveness rate, continuous decrease in the average retina thickness of the patients, and administration for 3 months can afford an extremely high effectiveness rate of 61.5%.
• the patients of the Durezol administration group had experience of various conventionally-known treatments before the Durezol instillation treatment, similar effectiveness was achieved by the Durezol administration regardless of the treatment history such as vitreous surgery and the like. This indicates that the instilled difluprednate preparation directly acts on the edema site of the macula part.
• the effect of the eye drop of the present invention is not limited for refractory macular edema, and a similar edema-improving effect is also expected in general patients with macular edema, whose conditions can be improved more easily.
• Table 3 shows the effect of Durezol for improvement of visual acuity in macular edema.
• Table 4 shows time course changes of the effectiveness rate by the Durezol administration in the improvement of visual acuity.
• Improvement of visual acuity by the treatment of macular edema requires a comparatively long time after improvement of edema in the macula part, and therefore, it is generally difficult to confirm improvement of visual acuity during a short-term treatment.
• apparent improvement of visual acuity was found in a short time in a part of the Durezol administration group, thus showing the effectiveness of the difluprednate eye drop as a method for treating macular edema.
• Rinderon A is a steroid used by instillation as an anti-inflammatory agent for the anterior ocular segment, as well as for a steroid responder test in patients with macular edema, as mentioned above, and the results are consistent with the absence of improvement of visual acuity in the steroid responder test.
• An eye drop containing difluprednate of the present invention as an active ingredient has enabled improvement of edema in macular edema patients by instillation, which is an administration method with low tissue invasiveness as compared to conventional methods employed in clinical practice.
• the effects on foveal retinal thickness and visual acuity are superior to those of a betamethasone phosphate eye drop, for which experimental example of instillation administration has been reported.
• effective results can also be obtained in patients with recurrent refractory macular edema, who received sub-Tenon administration or intravitreal administration of triamcinolone, vitreous surgery or intravitreal administration of bevacizumab in the past.
• the present invention is based on JP 2009-165924 (filing date: Jul. 14, 2009) filed in Japan, the contents of which are hereby incorporated by reference.

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