Classifications

• • 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
  • A61K31/58—Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids containing heterocyclic rings, e.g. danazol, stanozolol, pancuronium or digitogenin
• • 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
  • A61K31/13—Amines
  • A61K31/135—Amines having aromatic rings, e.g. ketamine, nortriptyline
  • A61K31/137—Arylalkylamines, e.g. amphetamine, epinephrine, salbutamol, ephedrine or methadone
• • 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
  • A61K31/13—Amines
  • A61K31/135—Amines having aromatic rings, e.g. ketamine, nortriptyline
  • A61K31/138—Aryloxyalkylamines, e.g. propranolol, tamoxifen, phenoxybenzamine
• • 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
  • A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
  • A61K31/439—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom the ring forming part of a bridged ring system, e.g. quinuclidine
• • 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
  • A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
  • A61K31/46—8-Azabicyclo [3.2.1] octane; Derivatives thereof, e.g. atropine, cocaine
• • 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
  • A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
  • A61K31/47—Quinolines; Isoquinolines
  • A61K31/4704—2-Quinolinones, e.g. carbostyril
• • 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
  • A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
  • A61K31/47—Quinolines; Isoquinolines
  • A61K31/4709—Non-condensed quinolines and containing further heterocyclic rings
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K45/00—Medicinal preparations containing active ingredients not provided for in groups A61K31/00 - A61K41/00
  • A61K45/06—Mixtures of active ingredients without chemical characterisation, e.g. antiphlogistics and cardiaca
• • 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
  • A61K9/0075—Sprays or powders for inhalation; Aerolised or nebulised preparations generated by other means than thermal energy for inhalation via a dry powder inhaler [DPI], e.g. comprising micronized drug mixed with lactose carrier particles
• • 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
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P11/00—Drugs for disorders of the respiratory system
• • A—HUMAN NECESSITIES
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  • 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
  • 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
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K2300/00—Mixtures or combinations of active ingredients, wherein at least one active ingredient is fully defined in groups A61K31/00 - A61K41/00

Definitions

• the present invention relates to pharmaceutical products and formulations comprising R(+) budesonide. More particularly the present invention relates to pharmaceutical products and formulations comprising R(+) budesonide, which products and formulations are useful for the treatment and/or prevention of respiratory, inflammatory or obstructive airway disease.
• the present invention also relates to a process for preparing the formulation according to the present invention, therapeutic uses thereof and methods of treatment employing the same.
• Asthma and chronic obstructive pulmonary disease (COPD) are the most prevailing conditions which affect most people. Airflow obstruction is the main characteristic feature in each of these airway diseases and the medications utilized in the treatment are also often similar.
• the pathophysiology of asthma and related disorders involves various symptoms, including bronchoconstriction, inflammation of the airways, and increased mucous secretion, which results in wheezing, coughing and shortness of breath.
• a persistent or recurrent cough may exacerbate the problem by causing further irritation and inflammation of the airways.
• Bronchoconstriction occurs due to bronchial smooth muscle spasm and airway inflammation with mucosal edema.
• COPD chronic pulmonary disease
• COPD ulcerative colitis
• airflow limitation that is not fully reversible.
• the airflow obstruction is usually progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases, primarily caused by cigarette smoking.
• COPD affects the lungs it also produces significant systemic consequences.
• COPD is associated with mucus hyper secretion, emphysema and bronchiolitis.
• bronchodilators such as beta 2 -agonists, anticholinergics and steroids.
• Inhaled bronchodilators are the foundation of pharmacotherapy for COPD because of their capacity to alleviate symptoms, decrease exacerbations of disease and improve quality of life. These drugs also improve airflow limitation and hyperinflation, thereby improving exercise tolerance. In addition bronchodilators may reduce respiratory muscle fatigue (controversial) and improve mucociliary clearance.
• Long acting beta 2 -agonists improve lung function, reduce symptoms and protect against exercise-induced dyspnea in patients with asthma and COPD.
• Long acting beta 2 -agonists induce bronchodilation by causing prolonged relaxation of airway smooth muscle.
• long acting beta 2 -agonists (LABAs) exert other effects such as inhibition of airway smooth-muscle cell proliferation and inflammatory mediator release, as well as non smooth-muscle effects, such as stimulation of mucociliary transport, cytoprotection of the respiratory mucosa and attenuation of neutrophil recruitment and activation.
• Beta 2 -agonists reduce the symptoms that occur in the night or the early morning which normally affect sleep patterns and reduce a patient's overall quality of life.
• beta 2 -agonist reduces the frequency of drug administration.
• Anticholinergic agents are also a first choice for the symptomatic treatment of patients with COPD.
• Anticholinergic agents inhibit the muscarinic action of acetylcholine on structure innervated by postganglionic cholinergic nerves. These agents typically inhibit bronchoconstriction by relaxing the smooth muscles and causing considerable bronchodilation.
• beta 2 -agonists and anticholinergics provide a symptomatic relief in bronchoconstriction
• another component of asthma which is inflammation, requires separate treatment such as with a steroid.
• Most of these inhaled corticosteroids need to be administered in multiple dosage regimens.
• corticosteroid/glucocorticoid Treatment with a corticosteroid/glucocorticoid is considered to be one of the most potent and effective therapies currently available for persistent asthma.
• Corticosteroids exhibit inhibitory effects on inflammatory cells and inflammatory mediators involved in the pathogenesis of respiratory disorders.
• Corticosteroids are used in several forms, to treat many different conditions. Because they reduce itching, swelling, redness, and allergic reactions, they are often used in treating skin problems, severe allergies, asthma, and arthritis.
• corticosteroids include beclomethasone, budesonide, fluticasone, mometasone and triamcinolone.
• Combination therapy of a long-acting beta 2 -agonist, an anticholinergic and an inhaled corticosteroid improves pulmonary efficiency, reduces inflammatory response and provides symptomatic relief as compared to higher doses of inhaled corticosteroid alone in patients affected by respiratory disorders such as asthma and COPD.
• the selection of a specific long-acting beta 2 -agonist, a specific anticholinergic and a specific inhaled corticosteroid plays a very important role in formulation of a fixed dose combination.
• Combination therapy also simplifies treatment of respiratory disorders, reduces the cost of treatment and provides control of the respiratory disorders. Reducing the dose frequency to the minimum is a main step in simplifying COPD and asthma management for improving patient adherence to the therapy.
• US2009088408 discloses pharmaceutical compositions of anticholinergics, corticosteroids and betamimetics and their use in the treatment of respiratory diseases.
• US20050042174 discloses combined doses of asthma medicaments such as a combination of doses of a beta 2 -agonist, an anticholinergic agent and an anti-inflammatory steroid.
• WO2006105401 discloses combination of an anticholinergic, a corticosteroid and a long acting beta 2 -agonist for simultaneous and sequential administration in the prevention or treatment of a respiratory, inflammatory or obstructive airway disease.
• WO2004028545 discloses a combination of a long-acting beta 2 -agonist and a glucocorticosteroid in the treatment of fibrotic diseases.
• corticosteroids especially in children, have been limited due to potential side effects. In children and teenagers, these medicines can stop or slow growth and affect the function of the adrenal glands (small glands located above each kidney, which secrete natural corticosteroids). Another possible problem for children is that corticosteroids may make infections such as chickenpox and measles more serious.
• corticosteroids include suppression of the Hypothalamic-Pituitary-Adrenal (HPA) axis, effects on bone growth in children and on bone density in the elderly, ocular complications (cataract formation and glaucoma) and skin atrophy.
• HPA Hypothalamic-Pituitary-Adrenal
• corticosteroids may increase the risk of high blood pressure and bone disease. Bone problems from corticosteroids are especially likely in older women.
• Enantiomers are structurally identical compounds which differ only in that, one isomer is a mirror image of the other and the mirror images cannot be superimposed. This phenomenon is known as chirality.
• structurally identical, enantiomers can have profoundly different effects in biological systems; one enantiomer may have a specific biological activity while the other enantiomer may have no biological activity at all, or may have an entirely different form of biological activity.
• Budesonide a corticosteroid
• the form in which budesonide is presently used is a racemic mixture. That is, it is a mixture of optical isomers, called enantiomers R(+) and S( ⁇ ), which are characterized by different strength and pharmacokinetic properties.
• Budesonide is chemically a mixture of two epimers 22R(+) and 22S( ⁇ ) having a different configuration at the acetal 22-carbon atom.
• R(+) budesonide which consists mainly of epimer 22R, is found to be clinically superior over the preparations consisting of a 1:1 mixture of the epimers.
• R(+) isomer The anti-inflammatory properties of R(+) isomer are nearly three times as strong as compared to that of S( ⁇ ) isomer.
• R(+) budesonide also shows greater volume of distribution and plasma clearance.
• R(+) budesonide is very well tolerated and does not cause any serious adverse effects.
• the systemic action of R(+) budesonide is weaker as compared to that of S( ⁇ ) budesonide.
• Budesonide is the mainstay in the treatment of respiratory and inflammatory or obstructive airway diseases. However most of the formulations containing budesonide available in the prior art contain the racemic mixture of budesonide.
• the object of the present invention is to provide novel pharmaceutical compositions for inhalation comprising R(+) budesonide and one or more bronchodilators for administration in the prevention or treatment of respiratory, inflammatory or obstructive airway disease.
• Another object of the present invention is to provide novel pharmaceutical compositions for inhalation comprising R(+) budesonide and one or more bronchodilators for inhalation having reduced side effects in the prevention or treatment of respiratory, inflammatory or obstructive airway disease.
• compositions according to the invention may, of course, include one or more pharmaceutically acceptable excipients.
• Yet another object of the present invention is to provide a process for preparing novel pharmaceutical compositions comprising R (+) budesonide and one or more bronchodilators for administration in the prevention or treatment of respiratory, inflammatory or obstructive airway disease.
• a further object of the present invention is to provide pharmaceutical compositions comprising R(+) budesonide and one or more bronchodilator for use in the prophylaxis or treatment of respiratory, inflammatory or obstructive airway disease.
• a pharmaceutical composition comprising R(+) budesonide and one or more bronchodilators.
• a process for preparing a pharmaceutical composition comprising R(+) budesonide and one or more bronchodilators.
• a pharmaceutical composition comprising R(+) budesonide and one or more bronchodilators for use in treating disorders or conditions that respond to, or are prevented, ameliorated or eliminated by, the administration of R(+) budesonide, and one or more bronchodilators.
• R(+) enantiomer of budesonide provides relief from bronchial disorders, while simultaneously reducing undesirable side effects commonly experienced by corticosteroid users. Further since the active enantiomer is used, the dose required is also reduced as compared to that of racemic budesonide, which reduced dose also contributes to the reduction in undesirable side effects.
• the present invention thus provides novel pharmaceutical compositions for inhalation comprising R(+) budesonide and one or more bronchodilators for administration in the prevention or treatment of respiratory, inflammatory or obstructive airway disease while simultaneously reducing undesirable side effects commonly experienced by corticosteroid users.
• the optically pure R(+) isomer of budesonide may be administered alone, or in combination with one or more bronchodilators or other drug(s) for the treatment and/or prevention of respiratory, inflammatory or obstructive airway disease.
• the other drugs may be selected from various classes of drugs commonly used for respiratory diseases for example bronchodilators.
• the present invention provides a pharmaceutical composition
• a pharmaceutical composition comprising R(+) budesonide and one or more bronchodilators.
• Bronchodilators used according to the present invention may be beta 2 -agonists and/or anticholinergics. As discussed, the selection of a specific long-acting beta 2 -agonist, an anticholinergic and inhaled corticosteroid plays a very important role in formulation of fixed dose combination.
• beta 2 -agonist agent or “beta 2 -agonist” or “anticholinergic agent” or “corticosteroids” are used in broad sense to include not only the beta 2 -agonist or anticholinergic agent per se but also their pharmaceutically acceptable salts, pharmaceutically acceptable solvates, pharmaceutically acceptable hydrates, pharmaceutically acceptable enantiomers, pharmaceutically acceptable derivatives, pharmaceutically acceptable enantiomers, pharmaceutically acceptable polymorphs, pharmaceutically acceptable prodrugs, etc.
• the present invention also provides a pharmaceutical composition comprising R(+) budesonide and one or more beta 2 -agonists.
• beta 2 -agonists may comprise, one or more, short acting beta 2 -agonists, long acting beta 2 -agonists or ultra long acting beta 2 -agonists.
• the beta 2 -agonists that can be used, according to the present invention include albuterol, levoalbuterol, terbutaline, pirbuterol, procaterol, metaproterenol, fenoterol, bitolterol mesylate, ritodrine, salmeterol, formoterol, arformoterol, carmoterol, bambuterol, clenbuterol, indacaterol, milveterol, vilanterol, olodaterol.
• the pharmaceutical composition may comprise R(+) budesonide and formoterol with one or more pharmaceutically acceptable excipients, R(+) budesonide and arformoterol with one or more pharmaceutically acceptable excipients, R(+) budesonide and salmeterol with one or more pharmaceutically acceptable excipients.
• the pharmaceutical composition may comprise R(+) budesonide, and carmoterol with one or more pharmaceutically acceptable excipients.
• the pharmaceutical composition may comprise R(+) budesonide, and indacaterol with one or more pharmaceutically acceptable excipients.
• the present invention also provides a pharmaceutical composition comprising R(+) budesonide and one or more anticholinergic agent.
• Suitable anticholinergic agents include tiotropium, ipratropium and oxitropium.
• the pharmaceutical composition may comprise R(+) budesonide and tiotropium with one or more pharmaceutically acceptable excipients, or R(+) budesonide and ipratropium with one or more pharmaceutically acceptable excipients, or R(+) budesonide and oxitropium with one or more pharmaceutically acceptable excipients.
• the present invention also provides a pharmaceutical composition
• a pharmaceutical composition comprising R(+) budesonide and one or more beta-agonist and one or more anticholinergic agents.
• the pharmaceutical composition may comprise R(+) budesonide, arformoterol and tiotropium with one or more pharmaceutically acceptable excipients, or R(+) budesonide, arformoterol and tiotropium with one or more pharmaceutically acceptable excipients or R(+) budesonide, tiotropium and carmoterol with one or more pharmaceutically acceptable excipients, or R(+) budesonide, tiotropium and indacaterol with one or more pharmaceutically acceptable excipients.
• a preferred beta 2 -agonist for use in the present invention is carmoterol.
• Carmoterol chemically known as 8-hydroxy-5-(1-hydroxy-2-(N-(2-(4-methoxy phenyl)-1-methyl ethyl)amino)ethyl)-2(1H)-quinolinone hydrochloride salt is a long acting beta 2 -agonist characterized by having a rapid onset of action s, prolonged duration of action and also having a high selectivity towards the beta 2 adrenoreceptor. Furthermore carmoterol is more potent than other long acting beta 2 -agonists.
• Another preferred beta 2 -agonist for use in the present invention is indacaterol.
• Indacaterol is chemically known as (R)-5-[2-[(5,6-diethyl-2,3-dihydro-1H-inden-2-yl)amino]-1-hydroxy ethyl]-8-hydroxy quinolin-2(1H)-one is a ultra long acting beta 2 -agonist. Furthermore indacaterol exhibits a longer duration of action as well as having a greater cardiovascular safety margin.
• a preferred anticholinergic agent for use in the present invention is tiotropium.
• Tiotropium is chemically known as (1 ⁇ , 2 ⁇ , 4 ⁇ , 5 ⁇ , 7 ⁇ )-7-[(hydroxy di-2-thienyl acetyl) oxy]-9, 9-di methyl-3-oxa-9-azonia tricyclo [3.3.1.0 2,4 ] nonane bromide monohydrate. Tiotropium has duration of action of up to 32 hours. Also tiotropium causes an improvement in dyspnea and a reduction in the need for rescue therapy.
• Tiotropium in combination with pulmonary rehabilitation (PR) is associated with an increased exercise endurance time and produces clinically meaningful improvements in dyspnea and health status as compared to PR alone in COPD patients.
• tiotropium is more potent than ipratropium in the treatment of patients with COPD in terms of the effect of lung function, dyspnea, exacerbation rates and health status.
• “carmoterol”, “indacaterol” and “tiotropium” are used in broad sense to include not only “carmoterol”, “indacaterol” and “tiotropium” per se but also their pharmaceutically acceptable salts, pharmaceutically acceptable solvates, pharmaceutically acceptable hydrates, pharmaceutically acceptable esters, pharmaceutically acceptable enantiomers, pharmaceutically acceptable derivatives, pharmaceutically acceptable polymorphs, pharmaceutically acceptable prodrugs, etc.
• R(+) budesonide is used in broad sense to include not only “R(+) budesonide” per se but also its pharmaceutically acceptable salts, pharmaceutically acceptable solvates, pharmaceutically acceptable hydrates, pharmaceutically acceptable esters, pharmaceutically acceptable derivatives, pharmaceutically acceptable polymorphs, pharmaceutically acceptable prodrugs, etc.
• the preferred beta 2 -agonists are: carmoterol, indacaterol, formoterol, arformoterol, salmeterol.
• anticholinergics are: tiotropium, oxitropium, ipratropium
• compositions according to the invention are pharmaceutical compositions in which the beta 2 -agonist comprises or consists of carmoterol, indacaterol, formoterol, aformoterol, salmeterol, and the anticholinergic comprise or consists of tiotropium.
• compositions comprise:
• R(+) budesonide may be present in the composition in the amount of about 80 mcg to about 640 mcg.
• carmoterol may be present in the composition in the amount of about 1 mcg to about 4 mcg.
• indacaterol may be present in the composition in the amount of about 50 mcg to about 800 mcg.
• tiotropium may be present in the composition in the amount of about 9 mcg to about 18 mcg.
• R(+) budesonide, tiotropium and carmoterol and the combination of R(+) budesonide, tiotropium and indacaterol provide a rapid onset of action and improved control of obstructive or inflammatory airway diseases, or reduction in the exacerbations of the diseases.
• Another advantage of the combinations is that they facilitate the treatment of an obstructive and inflammatory airway disease with a single medicament.
• this combination therapy provides for administration of the combination by use of a single inhaler for patients with severe COPD who currently have to make use of multiple inhalers. This is particularly important since COPD is a disease of the elderly who may get confused between the inhalers and who also suffer from several combined conditions such as heart disease, arthritis etc. and are receiving other medications.
• compositions of the present invention may be administered by any suitable method used for delivery of drugs to the respiratory tract.
• the composition of the present invention may thus be administered using metered dose inhalers (MDI), dry powder inhalers (DPI), nebulisers, nasal sprays, nasal drops, insufflation powders, sprays and spray patches.
• MDI metered dose inhalers
• DPI dry powder inhalers
• nebulisers nasal sprays, nasal drops, insufflation powders, sprays and spray patches.
• compositions comprising R(+) budesonide and one or more bronchodilators, which compositions are used in the form of nebulisers, dry powder inhalers (DPI), nasal sprays, nasal drops, insufflation powders, sprays and spray patches; in a particularly preferred embodiment, compositions are used in the form of metered dose inhalers (MDI).
• DPI dry powder inhalers
• MDI metered dose inhalers
• the various dosage forms according to the present invention may comprise carriers/excipients suitable for formulating the same.
• the metered dose inhalation formulations may comprise one or more pharmaceutically acceptable excipients, such as HFC/HFA propellants, co-solvents, bulking agents, non volatile component, buffers/pH adjusting agents, surface active agents, preservatives, complexing agents, lubricants, antioxidants or combinations thereof.
• pharmaceutically acceptable excipients such as HFC/HFA propellants, co-solvents, bulking agents, non volatile component, buffers/pH adjusting agents, surface active agents, preservatives, complexing agents, lubricants, antioxidants or combinations thereof.
• propellants are those substances which, when mixed with the co-solvent(s), form a homogeneous propellant system in which a therapeutically effective amount of a medicament can be dissolved.
• the HFC/HFA propellant must be toxicologically safe and must have a vapor pressure which is suitable to enable the medicament to be administered via a pressurized MDI.
• the HFC/HFA propellants may comprise, one or more of 1,1,1,2-tetrafluoroethane (HFA-134(a)), 1,1,1,2,3,3,3,-heptafluoropropane (HFA-227), HFC-(difluoromethane), HFC-143(a) (1,1,1-trifluoroethane), HFC-134 (1,1,2,2-tetrafluoroethane), HFC-152a (1,1-difluoroethane) and such other propellants which may be known to the person having a skill in the art.
• HFA-134(a) 1,1,1,2-tetrafluoroethanethane
• HFA-227 1,1,1,2,3,3,3,3,-heptafluoropropane
• HFC-(difluoromethane) HFC-143(a) (1,1,1-trifluoroethane
• HFC-134 1,1,2,2-tetrafluoroethane
• the co-solvent is any solvent which is miscible in a formulation in the amount desired and which, when added, provides a formulation in which the medicament can be dissolved.
• the function of the co-solvent is to increase the solubility of the medicament and the excipients in the formulation.
• the co-solvent may comprise one or more of C 2 -C 6 aliphatic alcohols, such as but not limited to ethyl alcohol and isopropyl alcohol; glycols such as but not limited to propylene glycol, polyethylene glycols, polypropylene glycols, glycol ethers, and block copolymers of oxyethylene and oxypropylene; and other substances, such as but not limited to glycerol, polyoxyethylene alcohols, and polyoxyethylene fatty acid esters; hydrocarbons such as but not limited to n-propane, n-butane, isobutane, n-pentane, iso-pentane, neo-pentane, and n-hexane; and ethers such as but not limited to diethyl ether.
• C 2 -C 6 aliphatic alcohols such as but not limited to ethyl alcohol and isopropyl alcohol
• glycols such as but not limited to prop
• Suitable surfactants may be employed in the aerosol solution formulation of the present invention, which surfactants may serve to stabilize the solution formulation and improve the performance of valve systems within a metered dose inhaler.
• the surfactant may comprise one or more ionic and I or non-ionic surfactant, but not limited to oleic acid, sorbitan trioleate, lecithin, isopropylmyristate, tyloxapol, polyvinylpyrrolidone polysorbates such as polysorbate 80, vitamin E-TPGS, and macrogol hydroxystearates such as macrogol-15-hydroxystearate.
• the non-volatile component is all the suspended or dissolved constituents that would be left after evaporation of the solvent.
• the non-volatile component may comprise one or more of monosaccharides such as but not limited to glucose, arabinose; disaccharides such as lactose, maltose; oligosaccharides and polysaccharides such as but not limited to dextrans; polyalcohol such as but not limited to glycerol, sorbitol, mannitol, xylitol; salts such as but not limited to potassium chloride, magnesium chloride, magnesium sulphate, sodium chloride, sodium citrate, sodium phosphate, sodium hydrogen phosphate, sodium hydrogen carbonate, potassium citrate, potassium phosphate, potassium hydrogen phosphate, potassium hydrogen carbonate, calcium carbonate and calcium chloride.
• monosaccharides such as but not limited to glucose, arabinose
• disaccharides such as lactose, maltose
• oligosaccharides and polysaccharides such as but not limited to dextrans
• polyalcohol such as but not limited to glycerol
• Suitable bulking agents may be employed in the metered dose inhalation formulations of the present invention.
• the bulking agent may comprise one or more saccharides, including monosaccharides, disaccharides, polysaccharides and sugar alcohols such as arabinose, glucose, fructose, ribose, mannose, sucrose, terhalose, lactose, maltose, starches, dextran or mannitol.
• saccharides including monosaccharides, disaccharides, polysaccharides and sugar alcohols such as arabinose, glucose, fructose, ribose, mannose, sucrose, terhalose, lactose, maltose, starches, dextran or mannitol.
• Suitable buffers or pH adjusting agents may be employed in the metered dose inhalation formulations of the present invention.
• the buffer or the pH adjusting agent may comprise one or more of organic or inorganic acids such as but not limited to citric acid, ascorbic acid, hydrochloric acid, sulfuric acid, nitric acid, or phosphoric acid.
• Suitable preservatives may be employed in aerosol solution formulations of the present invention to protect such formulations from contamination with pathogenic bacteria.
• the preservative may comprise one or more of benzalkonium chloride, benzoic acid, benzoates such as sodium benzoate and such other preservatives which may be known to the person having a skill in the art.
• Suitable complexing agents may be employed in aerosol solution formulations of the present invention, which complexing agents are capable of forming complex bonds.
• the complexing agent may comprise one or more of but not limited to sodium EDTA or disodium EDTA.
• a further preferred embodiment of the present invention can be where the composition is in the form of insufflatable powder.
• R(+) budesonide in combination with one or more bronchodilator may be mixed with inert carrier substances or drawn up onto inert carrier substances to form insufflatable powders.
• a dry powder insufflation composition according to the present invention can be administered by the use of an insufflator, which can produce a finely divided cloud of the dry powder.
• the insufflator preferably is provided with means to ensure administration of a substantially pre-determined amount of a formulation or product as provided by the present invention.
• the powder may be used directly with an insufflator, which is provided with a bottle or container for the powder, or the powder may be filled into a capsule or cartridge, such as a gelatin capsule, or other single dose device adapted for administration.
• the insufflator preferably has means to open the capsule or other dose device.
• a further preferred embodiment of the present invention can be where the composition is in the form of dry powder inhaler (DPI).
• DPI dry powder inhaler
• R(+) budesonide in combination with one or more bronchodilator may be mixed with inert carrier substances or drawn up onto inert carrier substances to form dry powder inhalation formulations.
• Carrier substances suitable for forming the insufflation powders or dry powder inhalation formulations of the present invention include but are not limited to sugars/sugar alcohols such as glucose, saccharose, lactose and fructose, starches or starch derivatives, oligosaccharides such as dextrins, cyclodextrins and their derivatives, polyvinylpyrrolidone, alginic acid, tylose, silicic acid, cellulose, cellulose derivatives (for example cellulose ether), sugar alcohols such as mannitol or sorbitol, calcium carbonate, calcium phosphate, lactose, lactitol, dextrates, dextrose, maltodextrin, saccharides including monosaccharides, disaccharides, polysaccharides; sugar alcohols such as arabinose, ribose, mannose, sucrose, trehalose, maltose and dextran.
• composition may be in the form of a nebuliser formulation.
• Nebulisation therapy has an advantage over other inhalation therapy, since it is easy to use and does not require co-ordination or much effort. It also works much more rapidly than medicines taken by mouth.
• the composition according to the present invention may comprise suitable excipients such as osmotic agents, pH regulators buffering agent, wetting agent and complexing agents in a suitable vehicle.
• suitable excipients such as osmotic agents, pH regulators buffering agent, wetting agent and complexing agents in a suitable vehicle.
• Osmotic agents which may be used in nebuliser formulations according to the present invention include sodium chloride, potassium chloride, zinc chloride, calcium chloride and mixtures thereof.
• Other suitable osmotic agents include, but are not limited to, mannitol, glycerol, dextrose and mixtures thereof.
• the pH of a nebuliser formulation may be adjusted by the addition of pharmacologically acceptable acids.
• Pharmacologically acceptable inorganic acids or organic acids may be used for this purpose.
• preferred inorganic acids are selected from the group consisting of hydrochloric acid, hydrobromic acid, nitric acid, sulphuric acid and phosphoric acid and mixtures thereof.
• particularly suitable organic acids are selected from the group consisting of ascorbic acid, citric acid, malic acid, tartaric acid, maleic acid, succinic acid, fumaric acid, acetic acid, formic acid and propionic acid and mixtures thereof.
• Complexing agents that may be used in nebuliser formulations according to the present invention include editic acid (EDTA) or one of the known salts thereof, e.g. sodium EDTA or disodium EDTA dihydrate (sodium edetate).
• EDTA editic acid
• salts thereof e.g. sodium EDTA or disodium EDTA dihydrate (sodium edetate).
• Wetting agents that may be used in nebuliser formulations according to the present invention include sodiumdioctylsulfosuccinate; polysorbates such as polysorbate 20, polysorbate 40, polysorbate 60, polysorbate 80, polysorbate 65, polysorbate 85; sorbitan fatty acid esters such as Span 20, Span 40, Span 60 Span 80, Span 120; sodium lauryl sulfate; polyethoxylated castor oil; polyethoxylated hydrogenated castor oil and mixtures thereof.
• Anti-microbial preservative agent may also be added for multi-dose packages.
• the formulation according to the present invention may be included in suitable containers provided with means enabling the application of the contained formulation to the respiratory tract.
• the dry powder inhalation formulations of the present invention may either be encapsulated in capsules of gelatin or HPMC, or in blisters. Alternatively, the dry powder inhalation formulations may be contained in a reservoir either in a single dose or multi-dose dry powder inhalation device.
• dry powder inhalation formulations may be suspended in a suitable liquid vehicle and packed in an aerosol container along with suitable propellants or mixtures thereof.
• dry powder inhalation formulations may also be dispersed in a suitable gas stream to form an aerosol composition.
• the metered dose inhalation formulations of the present invention may be packed in plain aluminium cans or in SS (stainless steel) cans.
• Some aerosol drugs tend to adhere to the inner surfaces, i.e. walls, of the cans and valves. This can lead to the patient getting significantly less than the prescribed amount of the active agent upon each activation of a metered dose inhaler.
• Coating the inner surface of the container with a suitable polymer can reduce this adhesion problem.
• Suitable coatings include fluorocarbon copolymers such as FEP-PES (fluorinated ethylene propylene and poly ether sulphone) and PFA-PES (perfluoro alkoxy alkane and poly ether sulphone), epoxy and ethylene.
• the inner surfaces of the cans may be anodized, plasma treated or plasma coated.
• the pharmaceutical composition may further comprise (i.e. in addition to the bronchodilator, i.e., the beta 2 -agonist and/or the anticholinergic) one or more active(s) selected from antihistamines, antiallergics or leukotriene antagonist or their pharmaceutically acceptable salts, solvates, tautomers, derivatives, enantiomers, isomers, hydrates, prodrugs or polymorphs thereof.
• the bronchodilator i.e., the beta 2 -agonist and/or the anticholinergic
• active(s) selected from antihistamines, antiallergics or leukotriene antagonist or their pharmaceutically acceptable salts, solvates, tautomers, derivatives, enantiomers, isomers, hydrates, prodrugs or polymorphs thereof.
• the present invention also provides a process to manufacture the compositions according to the present invention.
• the present invention provides a process of preparing a metered dose inhalation formulation which process comprises admixing more or more pharmaceutically acceptable carriers and/or excipients with the actives (e.g. R(+) budesonide and one or more bronchodilators) and the propellant, and optionally providing the formulation in precrimped cans.
• the actives e.g. R(+) budesonide and one or more bronchodilators
• the present invention also provides a process of preparing a dry powder inhalation formulation which process comprises admixing of one or more pharmaceutically acceptable carriers and/or excipients with the actives (e.g. R(+) budesonide and one or more bronchodilator) and providing the formulation as a dry powder inhaler.
• the actives e.g. R(+) budesonide and one or more bronchodilator
• the present invention also provides a process of preparing an inhalation solution which process comprises dissolving the drugs, optionally chelating agents, osmotic agents and any other suitable ingredients in the vehicle and adjusting the pH using a suitable pH adjusting agent.
• the present invention further provides a method for the treatment in a mammal, such as a human, for treating respiratory, inflammatory or obstructive airway disease such as COPD and asthma, which method comprises administration of a therapeutically effective amount of a pharmaceutical composition according to the present invention.
• the method of treatment may be characterized in that R(+) budesonide and one or more bronchodilators are administered once a day in therapeutically effective amounts, e.g. R(+) budesonide, tiotropium and carmoterol or R(+) budesonide, tiotropium and indacaterol are administered once a day in therapeutically effective amounts.
• compositions comprising R(+) budesonide and one or more bronchodilators for use in the prophylaxis or treatment of respiratory, inflammatory or obstructive airway disease.
• step (2) The suspension obtained in step (1) was filled in precrimped cans.
• Lecithin was dispersed in ethanol.
• step (3) The suspension obtained in step (3) was filled in precrimped cans.
• step (2) The suspension obtained in step (1) was filled in precrimped cans.
• PVP was dispersed in PEG.
• step (3) The suspension obtained in step (3) was filled in precrimped cans.
• step (2) The suspension obtained in step (1) was filled in precrimped cans.
• Lecithin was dispersed in ethanol.
• step (3) The suspension obtained in step (3) was filled in precrimped cans.
• step (2) The suspension obtained in step (1) was filled in precrimped cans.
• PVP was dispersed in PEG.
• step (3) The suspension obtained in step (3) was filled in precrimped cans.
• step (2) The suspension obtained in step (1) was transferred to the mixing vessel where the remaining quantity of HFA was added.
• step (2) The suspension obtained in step (1) was transferred to the mixing vessel where the remaining quantity of HFA was added.
• step (2) The solution obtained in step (1) was transferred to a mixing vessel.
• step (3) The suspension obtained in step (3) was transferred to the mixing vessel where remaining quantity of HFA was added.
• step (4) The suspension obtained in step (4) was transferred to the mixing vessel where the remaining quantity of HFA was added.
• step (4) The suspension obtained in step (4) was transferred to the mixing vessel where remaining quantity of HFA was added.
• step (1) The cosift of step (1) was then sifted with the remaining quantity of lactose and blended.
• step (3) The blend of step (2) was then filled in capsules.
• step (1) The cosift of step (1) was then sifted with the remaining quantity of lactose and blended.
• step (3) The blend of step (2) was then filled in capsules.
• step 2 The suspension obtained in step 1 was transferred to the mixing vessel where the remaining quantity of HFA was added.
• step 2 The suspension obtained in step 1 was transferred to the mixing vessel where the remaining quantity of HFA was added.
• Step 2 The solution obtained in Step 1 was transferred to a mixing vessel.
• step 3 The suspension obtained in step 3 was transferred to the mixing vessel where remaining quantity of HFA was added.
• step (4) The suspension obtained in step (4) was transferred to the mixing vessel where remaining quantity of HFA was added.
• step (4) The suspension obtained in step (4) was transferred to the mixing vessel where the remaining quantity of HFA was added.
• step (1) The cosift of step (1) was then sifted with the remaining quantity of lactose and blended.
• step (3) The blend of step (2) was then filled in capsules.
• step 2 The cosift of step 1 was then sifted with the remaining quantity of lactose and blended.
• step 2 was then filled in capsules.

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