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
  • A61K31/66—Phosphorus compounds
  • A61K31/664—Amides of phosphorus acids
• • 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
  • A61K31/66—Phosphorus compounds
  • A61K31/675—Phosphorus compounds having nitrogen as a ring hetero atom, e.g. pyridoxal phosphate
• • 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
  • A61K47/20—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite containing sulfur, e.g. dimethyl sulfoxide [DMSO], docusate, sodium lauryl sulfate or aminosulfonic acids
• • 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
  • A61K9/0019—Injectable compositions; Intramuscular, intravenous, arterial, subcutaneous administration; Compositions to be administered through the skin in an invasive manner
• • 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
  • A61P35/00—Antineoplastic agents

Definitions

• the present invention is directed to improved cyclophosphamide formulations and methods of making the same.
• Cyclophosphamide is the generic name for 2-[bis(2-chloroethyl)amino]-tetrahydro-2H-1,3,2-oxazaphosphorine-2-oxide monohydrate, a widely used antineoplastic drug chemically related to the nitrogen mustards.
• Cyclophosphamide is one example of a group of cyclic phosphoric acid ester amides which were disclosed and claimed in U.S. Pat. No. 3,018,302 granted Jan. 23, 1962 to H. Arnold et al. Cyclophosphamide is sold under the proprietary name CYTOXAN. ENDOXAN and NEOSAR are other proprietary names for similar pharmaceutical formulations of cyclophosphamide.
• the commercial cyclophosphamide product is a sterile dry mixture of cyclophosphamide monohydrate.
• cyclophosphamide refers generically to the drug substance regardless of the crystal form
• cyclophosphamide monohydrate refers specifically to the monohydrate
• anhydrous cyclophosphamide refers to the anhydrous form.
• the monohydrate form is preferred for pharmaceutical processing, since the anhydrous form readily picks up water to form the monohydrate when exposed to a relative humidity of about 20-30% or higher at about 25° C. While the monohydrate is stable, nonetheless, under dry conditions (e.g.
• a relative humidity of about 20% or less the monohydrate begins to lose this water of hydration which can reduce stability during manufacturing. Because of stability limitations which may be due in part to ready inter-conversion between the anhydrous and monohydrate forms, it is recommended that storage temperatures for cyclophosphamide products not exceed 30° C. (86° F.), and preferably be stored at or below about 25° C. (77° F.).
• the parenteral dosage formulations of cyclophosphamide consist of sterile packaged dry powder fill of cyclophosphamide monohydrate.
• the sterile powder is dissolved in water or normal saline prior to administration, which can be oral as well as parenteral. It is intended that the solution itself be administered promptly after being prepared but it is satisfactory for use up to several hours after preparation.
• the product can acquire a glassy and/or sticky nature resulting in an undesirable material with prolonged dissolution times and decreased potency. This deterioration is more pronounced as storage time is extended or if the upper limit of the storage temperature range is exceeded.
• a common practice used with constitution of sterile solids by a suitable aqueous vehicle consists of warming the solution in the container to expedite the dissolution process, especially when the solids dissolve slowly.
• a study examining the effect of briefly heating cyclophosphamide solutions was reported by D. Brooke, et al. in American Journal of Hospital Pharmacy, 32:44-45 (1975). This study concluded that warming vials of cyclophosphamide in order to facilitate dissolution after adding an aqueous vehicle could decrease the potency of the final injectable product.
• these stability limitations and dissolution difficulties can often result in clinical usage of sub-potent cyclophosphamide solutions.
• an object of the present invention is to provide liquid cyclophosphamide containing compositions which have improved solubility characteristics and enhanced appearance, while maintaining a potency appropriate for a pharmaceutical dosage form.
• the invention includes cyclophosphamide-containing compositions such as pharmaceutically acceptable cyclophosphamide containing solutions having extended stability.
• the compositions include: a) cyclophosphamide; b) ethanol; and c) an ethanol soluble acidifying agent.
• solvent systems include those which contain ethanol and further excipients such as citric acid, calcium chloride dihydrate or a combination thereof.
• the invention includes pharmaceutically acceptable cyclophosphamide containing compositions, preferably in liquid form having extended stability.
• Some broad aspects of the invention include cyclophosphamide containing compositions which comprise cyclophosphamide, ethanol and an ethanol soluble acidifying agent.
• the cyclophosphamide containing compositions are in the form of a substantially non-aqueous, ethanolic solution which is ready for dilution and administration to a patient in need thereof.
• the cyclophosphamide included in the compositions of the present invention is one of the pharmaceutically acceptable forms of the molecule such as cyclophosphamide monohydrate, USP or cyclophosphamide anhydrate.
• the ethanol included in the compositions of the present invention can be any ethanol, preferably an ethanol which meets the requirements of the U.S. or European Pharmacopoeia. In certain aspects of the invention the ethanol is anhydrous.
• the ethanol soluble acidifying agents included in the compositions described herein can, in some embodiments, have pKa value less than 5.0.
• the ethanol soluble acidifying agents are organic or inorganic acids which are suitable for inclusion in parenteral compositions.
• suitable acids include without limitation organic acids such as succinic, acetic, lactic and tartaric acids and inorganic acids such as phosphoric, sulphuric, hydrochloric and nitric acids . . . .
• the acidifying agent included in the compositions is in anhydrous form.
• One particularly preferable acidifying agent is citric acid anhydrous.
• the acidifying agents can include a buffering agent such as pharmaceutically acceptable buffers which include, without limitation, buffers such as citrate, phosphate, acetate, sulfate and HCl based buffers.
• a buffering agent such as pharmaceutically acceptable buffers which include, without limitation, buffers such as citrate, phosphate, acetate, sulfate and HCl based buffers.
• the amount of ethanol soluble acidifying agent included in the compositions is an amount which is sufficient to keep the pH of the solution when diluted in IV fluids at 20 mg/ml cyclophosphamide concentration is between about 3 to about 4.
• the amount of ethanol soluble acidifying agent which is sufficient in some aspects of the invention will range from about 0.2 to about 2% W/V of the composition prior to dilution to the volume as administered to a patient.
• the amount of acidifying agent is between 1.0 and 1.8% W/V with about 1.6 being preferred.
• Alternative aspects include amounts of from about 0.4 to about 0.8% % W/V and amounts from about 0.4 to about 0.6% % W/V.
• this can be equivalent to concentrations of from about 1 to about 8 mg/ml, from about 2 to about 6 or from about 2 to about 4 mg/ml of the ethanol soluble acidifying agent in the composition (prior to dilution for patient administration).
• a composition containing 200 mg/ml cyclophosphamide can contain about 4 mg/ml citric acid while a composition containing 400 mg/ml cyclophosphamide can contain about 8 mg/ml citric acid.
• a suitable ratio of drug to acidifying agent in the ethanol composition can be 50 mg of drug:1 mg acidifying agent. It will be understood by those of ordinary skill that the amount of the ethanol soluble acidifying agent which is sufficient can vary somewhat depending upon the acidifying agent(s) selected. While the amount required will typically be within the above-mentioned ranges, specific amounts for any acidifying agent will be readily determined by those of ordinary skill.
• the concentration of the cyclophosphamide in the inventive solutions prior to dilution and administration to patients is in many aspects from about 100 to about 600 mg/ml, or from about 250 to about 550 mg/ml. In other preferable embodiments, the cyclophosphamide concentration is about 200, 400 or 500 mg/ml. Such aspects of the invention are for storage purposes typically. As will be understood by those of ordinary skill, the highly concentrated alcohol-based compositions will typically undergo significant dilution prior to IV or parenteral administration to a patient in need thereof.
• the inventive cyclophosphamide containing solutions include a source of chloride ions either in addition to or in place of the ethanol soluble stabilizing agent.
• the amount of included is an amount which is sufficient to achieve the desired long term storage stabilizing effect on the cyclophosphamide.
• the amount of stabilizing agent is from about 1 to about 5 mg/ml of the ready to dilute composition.
• Suitable sources of chloride ions are those which include chloride containing salts, such as calcium chloride dihydrate.
• Alternatives include without limitation, choline chloride and magnesium chloride hexahydrate. Alternatives will be apparent to those of ordinary skill.
• the pharmaceutically acceptable cyclophosphamide containing solutions can also include an anti-oxidizing agent such as, for example, thioglycerol, propyl gallate, methionine, cysteine and combinations thereof.
• an anti-oxidizing agent such as, for example, thioglycerol, propyl gallate, methionine, cysteine and combinations thereof.
• Thioglycerol is a preferred antioxidant.
• Useful concentrations of the anti-oxidant in the inventive compositions can be range from about 1 to about 8 mg/ml.
• compositions i.e. solutions described herein have significantly improved shelf lives.
• the cyclophosphamide-containing solutions maintain at least about 90% or about 95%, and alternatively, at least about 97% cyclophosphamide content after about 18 months at a temperature of about 5° C.
• the compositions claimed herein are distinguishable from currently marketed products because the inventive liquid formulations do not require 30 minute constitution time and can be diluted directly in the vial containing the cyclophosphamide to a concentration of 20 mg/ml or into an infusion bag.
• compositions of the present invention in some alternative aspects of the invention can include supplemental solubilizing agents such as propylene glycol in amounts from about 5 to about 30% v/v.
• the amount of ethanol in the ready to dilute composition would be at least about 70% v/v or about 80% v/v.
• One suitable solvent system in accordance with this aspect of the invention provides cyclophosphamide compositions which contain about 70% ethanol, about 30% propylene glycol, and about 0.5% thioglycerol.
• the invention further includes pharmaceutically acceptable containers containing the pharmaceutically acceptable cyclophosphamide containing solutions described herein.
• the containers can be single use or multiple use vials containing one or more typical doses of the drug.
• the containers will include cyclophosphamide solutions containing from about 0.1 g to about 4 g of the drug.
• Some other aspects of the invention include containers in which there are about 500 mg, about 1 gram or about 2 grams of cyclophosphamide in ethanol that are ready to dilute with an IV infusion fluid in the vial containing the drug.
• a container or vial containing 500 mg of cyclophosphamide can include about 2.5 ml of the composition at a concentration for the cyclophosphamide of 200 mg/ml and include room therein for the diluent.
• containers designed to hold 1 or 2 grams of cyclophosphamide will contain about 5 ml or 10 ml of a 200 mg/ml cyclophosphamide composition described herein and proportionally less volume when the concentrations are 400 or 500 mg/ml, i.e., a container holding 2 grams of cyclophosphamide can also be prepared using 5 ml of a 400 mg/ml cyclophosphamide composition described herein.
• containers with 1, 2 or 4 ml of a 500 mg/ml composition, optionally with space therein for dilution are also contemplated.
• the containers either allow for a diluent to be added thereto or be designed to allow the needed dose to be drawn up and placed into a suitable larger volume bag or other container. In either case, the containers will allow dilution of the highly concentrated solutions described herein.
• Suitable diluents include those well-known to those of ordinary skill such as normal saline (0.9% NaCl in water), water for injection (WFI), half-normal saline (0.45% NaCl in water), D 5 W and D 5 W/normal saline, etc.
• the cyclophosphamide concentrate can be filled into 25 or 30 cc vials for 500 mg strength, 50 cc vial for 1 g strength and 100 cc vial for 1 g strength.
• Appropriate amount of diluent or infusion fluid can be added thereto to obtain a final cyclophosphamide concentration of 20 mg/ml for direct infusion.
• the following table summarizes the fill volumes and the diluent required to make 20 mg/ml cyclophosphamide form various concentrates.
• This solution can be further diluted in IV bags to obtain 2 mg/ml solution for slow IV infusion.
• the concentration of the cyclophosphamide in liquid when administered to a patient will vary according to the needs of the patient. Some suitable concentrations for administration to patients include 20 mg/ml or 2 mg ml.
• the ratio of drug to liquid diluent can be from about 1:1 to about 1:100.
• the invention also includes methods of treating a cyclophosphamide responsive conditions in mammals.
• the methods include administering an effective amount of a pharmaceutically acceptable composition containing the pharmaceutically acceptable cyclophosphamide containing solutions described herein to a mammal in need thereof.
• the amounts of drug and frequency of administration will be apparent to those of ordinary skill. Applicants incorporate herein by reference the FDA-approved package insert documents for cyclophosphamide products.
• maintenance of cyclophosphamide content in the solutions shall be understood to mean the amount of cyclophosphamide content as compared to the initial amount as determined by high performance liquid chromatography (“HPLC”), such as after a period of about 18 months at a temperature of from about 5° C.
• HPLC high performance liquid chromatography
• Formulations 1 to 8 contained varying amounts of water. The data indicated that the degradation levels increased in the presence of water.
• Formulations 9-11 like the prior art '286 patent formulations, are totally organic solvent based formulations, and showed significant degradation when stored at room temperature. The degradation was observed even under the refrigerated conditions. For example formulation 11 showed about 2.7% potency loss when stored at 4° C. for 9 weeks, which means more than 10% potency loss will be observed at the end of one year storage at 4° C. Such levels of degradation are not acceptable as commercial products.
• cyclophosphamide administered at a concentration of 20 mg/mL such as in formulations 9-11 is highly hypertonic and will cause hemolysis or other blood incompatibilities such as phlebitis in the patients. Thus, these formulations are not suitable as parenteral product.
• citric acid improved the drug stability to the extent that a maximum of 97.3% of the drug content was retained after 3 months at 25° C. compared to 93.5% observed after only 2 months at 25° C. without citric acid.

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• 2015
  • 2015-05-01 US US14/702,320 patent/US9662342B2/en active Active
  • 2015-05-01 CN CN201580023235.5A patent/CN106456654A/zh active Pending
  • 2015-05-01 WO PCT/US2015/028862 patent/WO2015171460A2/en not_active Ceased
  • 2015-05-01 RU RU2016147362A patent/RU2016147362A/ru unknown
  • 2015-05-01 CA CA2948148A patent/CA2948148C/en active Active
  • 2015-05-01 EP EP15789798.4A patent/EP3139929A4/en not_active Withdrawn
  • 2015-05-01 KR KR1020167034447A patent/KR20170008252A/ko not_active Ceased
  • 2015-05-01 US US14/702,287 patent/US20150320774A1/en not_active Abandoned
  • 2015-05-01 BR BR112016026140A patent/BR112016026140A2/pt active Search and Examination
  • 2015-05-01 JP JP2017511153A patent/JP6516831B2/ja not_active Expired - Fee Related
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• 2017
  • 2017-04-28 US US15/581,134 patent/US20170232015A1/en not_active Abandoned

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