US20170348347A1 - Agent for improving ocular subjective symptoms and method thereof - Google Patents

Agent for improving ocular subjective symptoms and method thereof Download PDF

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US20170348347A1
US20170348347A1 US15/539,771 US201515539771A US2017348347A1 US 20170348347 A1 US20170348347 A1 US 20170348347A1 US 201515539771 A US201515539771 A US 201515539771A US 2017348347 A1 US2017348347 A1 US 2017348347A1
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day
subjective symptoms
present
administration
group
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Masamichi Yamada
Chiyo Sakenaga
Keiichiro Arai
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Seikagaku Corp
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Seikagaku Corp
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    • 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
    • A61K31/70—Carbohydrates; Sugars; Derivatives thereof
    • A61K31/715—Polysaccharides, i.e. having more than five saccharide radicals attached to each other by glycosidic linkages; Derivatives thereof, e.g. ethers, esters
    • A61K31/726—Glycosaminoglycans, i.e. mucopolysaccharides
    • A61K31/728—Hyaluronic acid
    • 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
    • A61P27/00—Drugs for disorders of the senses
    • A61P27/02—Ophthalmic agents
    • A61P27/04—Artificial tears; Irrigation solutions

Definitions

  • the present invention relates to an agent for improving human ocular subjective symptoms and method thereof.
  • ophthalmic abnormalities has conventionally been assessed focusing primarily on external observation and evaluation (objective sign), while little emphasis has been placed on evaluation from the subjective viewpoint of the patient in the manner of ophthalmic discomfort or distress (subjective symptoms).
  • object sign primarily on external observation and evaluation
  • subjective symptoms primarily on subjective viewpoint of the patient in the manner of ophthalmic discomfort or distress.
  • objective sign such as normalization of tear fluid volume or decreases in the damaged areas of corneal and conjunctival epithelia.
  • hyaluronic acid having a hydrophobic residue bound thereto is known to be effective against ophthalmic abnormalities such as dry eye (see, for example, Patent Document 1)
  • the efficacy thereof is essentially based entirely on “objective sign” as described above, and it has yet to be evaluated from the viewpoints of improvement and/or treatment of subjective symptoms.
  • Patent Document 1 JP-T 2009-511423
  • Objective sign and subjective symptoms do not necessarily indicate similar tendencies, and subjective symptoms may be poor while objective sign are favorable, or conversely, objective sign may be poor while subjective symptoms are favorable.
  • existing ophthalmic solutions prescribed for dry eye require the patient to administer the ophthalmic solution over a long period of time until the efficacy thereof is demonstrated, resulting in the problem of patients with serious symptoms of dry eye losing the will and desire to continue to patiently administer the same ophthalmic solution over a long period of time, and thereby creating a desire for the providing of a drug capable of demonstrating its effect immediately after the start of administration.
  • An object of the present invention is to provide an agent and method for improving human ocular subjective symptoms and method thereof.
  • HA hyaluronic acid
  • the present invention provides an agent for improving human ocular subjective symptoms (hereinafter referred to as the “pharmaceutical preparation of the present invention”) containing HA having an aminoalkyl cinnamate covalently bonded thereto.
  • This preparation is in the form of a solution and the HA having an aminoalkyl cinnamate covalently bonded thereto is preferably contained at a concentration of 0.3% (w/v).
  • the human to whom this preparation is administered is preferably a person with dry eye.
  • the present invention provides a method for improving human ocular subjective symptoms that comprises a step for administering HA having an aminopropyl cinnamate covalently bonded thereto to a human eye (hereinafter referred to as the “method of the present invention”).
  • This HA having an aminopropyl cinnamate covalently bonded thereto is preferably administered in the form of a solution having a concentration of 0.3% (w/v).
  • the human to whom this solution is administered is preferably a person with dry eye.
  • an HA-based preparation for improving human ocular subjective symptoms and a method for improving human ocular subjective symptoms using that HA-based compound are provided.
  • FIG. 1 indicates the degree of fluorescein staining in the case of having administered a preparation to the eye of a model animal once a day.
  • FIG. 2 indicates the degree of fluorescein staining in the case of having administered a preparation to the eye of a model animal six times a day.
  • FIG. 3 indicates changes in a subjective symptom (ocular discomfort) in the case of having administered a preparation to the eye of a human patient.
  • FIG. 4 indicates changes in a subjective symptom (dryness) in the case of having administered a preparation to the eye of a human patient.
  • FIG. 5 indicates changes in a subjective symptom (grittiness) in the case of having administered a preparation to the eye of a human patient.
  • FIG. 6 indicates changes in the worst of various subjective symptoms in the case of having administered a preparation to the eye of a human patient.
  • FIG. 7 indicates changes in the average value of all subjective symptoms in the case of having administered a preparation to the eye of a human patient.
  • FIG. 8 indicates changes in the average value of subjective symptoms (ocular discomfort and dryness) in the case of having administered a preparation to the eye of a human patient.
  • FIG. 9 indicates the degree of fluorescein staining in the case of having administered a preparation to the eye of a human patient.
  • the term “step” not only refers to an independent step, but also includes a step that cannot be clearly distinguished from another step provided the intended objective of that step is achieved.
  • the content of each component of a composition refers to the total amount of a plurality of those substances present in the composition in the case a plurality of types of the substances are present for each component in the composition.
  • the pharmaceutical preparation of the present invention is an agent and/or pharmaceutical for improving human ocular subjective symptoms that contains HA having an aminoalkyl cinnamate covalently bonded thereto (hereinafter referred to as the “present compound”).
  • the present compound that is an active ingredient of the pharmaceutical preparation of the present invention is a compound in which an aminoalkyl cinnamate and HA are covalently bonded (hyaluronic acid derivative).
  • aminoalkyl cinnamate examples include aminoethyl cinnamate and aminopropyl cinnamate. Among these, 2-aminoethyl cinnamate and 3-aminopropyl cinnamate are preferable, while 3-aminopropyl cinnamate is particularly preferable.
  • aminoalkyl cinnamate includes and can be interchanged with these specific and/or preferable cinnamic acid esters.
  • HA having this “aminoalkyl cinnamate” covalently bonded thereto as far as it is a glycosaminoglycan which contains disaccharide units comprising N-acetyl-D-glucosamine attached to D-glucuronic acid in ⁇ 1,3-linkage and the disaccharide units are connected each other repeatedly by ⁇ 1,4-linkage.
  • it may be in a free state without forming a salt or may be in the form of a pharmaceutically acceptable salt.
  • Examples of pharmaceutically acceptable salts of HA include alkaline metal ion salts such as sodium salts or potassium salts, alkaline earth metal salts such as magnesium salts or calcium salts, salts of inorganic bases such as ammonium salts, and salts of organic bases such as diethanolamine, dicyclohexylamine or amino acids.
  • the HA salt is preferably a salt formed with an alkaline metal ion and particularly a salt formed with a sodium ion.
  • the HA may be any of that derived from a natural substance obtained by extracting from a portion of a living organism such as cockscomb, umbilical cord, cartilage or skin, that which has been chemically synthesized, and that which has been produced by microbial culturing or genetic engineering techniques. Furthermore, since the present compound is administered to a living organism, in addition to the present compound per se, the HA serving as the raw material thereof is preferably also of high purity and substantially free of contaminants for which the presence thereof is not acceptable for pharmaceutical use.
  • weight-average molecular weight of the HA there are no particular limitations on the weight-average molecular weight of the HA, and may be, for example, 10,000 to 5,000,000.
  • the weight-average molecular weight of the HA is preferably 200,000 to 3,000,000 and more preferably 500,000 to 2,500,000.
  • the weight-average molecular weight of the HA can be measured by the limiting viscosity method.
  • the present compound can be produced by covalently bonding this HA with an aminoalkyl cinnamate.
  • an aminoalkyl cinnamate There are no particular limitations on the mode of this covalent bonding, and preferably the amino group of the aminoalkyl cinnamate is linked with the carboxyl group of HA through an amide linkage.
  • the following provides an explanation using the present compound in which the covalent bond consists of an amide linkage as an example.
  • DS degree of substitution
  • the DS of an HA derivative in which one aminoalkyl cinnamate residue is introduced per constituent disaccharide unit is 100%, while the DS of an HA derivative in which one aminoalkyl cinnamate residue is introduced per 200 sugars (100 constituent disaccharide units) is 1%.
  • the value of DS in the present compound is preferably 3-30%, more preferably 10-20% and even more preferably 12-18%.
  • the present compound can be produced by linking an amino group derived from an aminoalkanol that composes the aminoalkyl cinnamate (in the manner of, for example, an aminoethanol (such as 2-aminoethanol) or an aminopropanol (such as 3-aminopropanol)) with the carboxyl group of HA.
  • an aminoethanol such as 2-aminoethanol
  • an aminopropanol such as 3-aminopropanol
  • the aminoalkyl cinnamate is an ester compound in which the carboxyl group of cinnamic acid and the hydroxyl group of the aminoalkanol are bonded through an ester linkage. Furthermore, the cinnamic acid that composes the aminoalkyl cinnamate may be a substituted cinnamic acid having a substituent.
  • the present compound can be produced in compliance with the method described in, for example, Japanese Patent Application Laid-Open (JP-A) No. 2002-249501 or International Publication No. WO 2008/069348.
  • production methods include a method that uses a water-soluble condensing agent such as a water-soluble carbodiimide (such as 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide hydrochloride (EDCI.HCl) or 1-cyclohexyl-3-(2-morpholinoethyl) carbodiimide-metho-p-toluenesulfonate), a method that uses the aforementioned condensing agent and a condensation assistant such as N-hydroxysuccinimide (HOSu) or N-hydroxybenzotriazole (HOBt), a method that uses a condensing agent such as 4-(4,6-dimethoxy-1,3,5-triazin-2-yl)-4-methylmorpholinium chloride (DMT-MM), an active esterification
  • a water-soluble condensing agent such as a water-soluble carbodiimide (such as 1-ethyl-3-(3-di
  • the present compound may be prepared by preliminarily reacting cinnamic acid with an aminoalkanol (such as 3-aminopropanol, to apply similarly hereinafter) to prepare an aminoalkyl cinnamate (such as 3-aminopropyl cinnamate, to apply similarly hereinafter) followed by allowing the amino group of the aminoalkyl cinnamate to bond with the carboxyl group of HA through an amide linkage, or by allowing the amino group of an aminoalkanol to bond with the carboxyl group of HA through an amide linkage to prepare HA having an aminoalkanol introduced therein, followed by allowing the carboxyl group of cinnamic acid to bond with a hydroxyl group derived from the aminoalkanol present in the aforementioned HA having an aminoalkanol introduced therein through an ester linkage.
  • an aminoalkanol such as 3-aminopropanol, to apply similarly hereinafter
  • the pharmaceutical preparation of the present invention can be produced by incorporating HA having an aminoalkyl cinnamate covalently bonded thereto and formulating into a preparation.
  • the preparation can be made to be in the form of a preparation and/or pharmaceutical administered to the human eye, it is preferably in the form of a solution.
  • This solution is preferably an ocular solution or ophthalmic solution.
  • the pharmaceutical preparation of the present invention is preferably in the form of a solution and contains the present compound at a concentration of 0.3% (w/v) as will be subsequently described.
  • a buffering agent such as sodium phosphate, sodium hydrogen phosphate, sodium dihydrogen phosphate, sodium acetate or E-aminocaproic acid, an isotonic agent such as sodium chloride, potassium chloride or concentrated glycerin, a surfactant such as polyoxyethylene sorbitan monooleate, polyoxyl 40 stearate or polyoxyethylene hydrogenated castor oil, or a preservative such as benzalkonium chloride, as necessary.
  • a buffering agent such as sodium phosphate, sodium hydrogen phosphate, sodium dihydrogen phosphate, sodium acetate or E-aminocaproic acid
  • an isotonic agent such as sodium chloride, potassium chloride or concentrated glycerin
  • a surfactant such as polyoxyethylene sorbitan monooleate, polyoxyl 40 stearate or polyoxyethylene hydrogenated castor oil
  • a preservative such as benzalkonium chloride
  • the pH of the pharmaceutical preparation of the present invention is preferably within the range of pH 5 to 6.
  • the pharmaceutical preparation of the present invention can be used by administering to a human eye.
  • Administration of the pharmaceutical preparation of the present invention to a human eye may be carried out by a method that is medically acceptable for administration to a human eye, and there are no particular limitations thereon provided the effects of the present invention can be demonstrated.
  • preferable examples thereof include administering 1 to 6 times per day, administering about 4 times per day, administering everyday, continuously administering daily for 14 days or longer and continuously administering daily for 28 days or longer, while a combination thereof, (such as administering about 4 times per day every day, continuously administering about 4 times per day for 14 days or more, or continuously administering about 4 times per day for 28 days or more) is more preferable.
  • examples of the daily dosage include administration of 1, 2 or 3 drops per administration.
  • Human ocular subjective symptoms can be improved by administering the pharmaceutical preparation of the present invention to a human eye.
  • the person targeted for administration of the pharmaceutical preparation of the present invention provided he or she is a person exhibiting ocular subjective symptoms.
  • the purpose of administration provided it is for improving human ocular subjective symptoms.
  • ocular subjective symptoms include ocular discomfort (not including discomfort such as physical irritation caused by administration of a preparation to the eye per se, but including the discomfort normally felt by dry eye patients), dryness (feeling that the eyes are dry), burning (feeling that the eyes are hot and smarting), feeling of a foreign body (strange feeling that something is contacting the eye during blinking or eyes feeling gritty), grittiness (feeling that the surface of the eye is not smooth as if sand had entered the eyes), stinging (painful sensation as if pricked with a needle), bleariness, itchiness, sensitivity to light and blurry vision, and the pharmaceutical preparation of the present invention can be applied to one or two or more of these symptoms.
  • the pharmaceutical preparation of the present invention is particularly effective for one or two or more subjective symptoms selected from the group consisting of ocular discomfort, dryness, burning, grittiness and stinging, among these, for one or two or more subjective symptoms selected from the group consisting of ocular discomfort, dryness, burning and grittiness, and especially for one or two or more subjective symptoms selected from the group consisting of ocular discomfort, dryness and grittiness
  • the pharmaceutical preparation of the present invention is preferably administered to persons having these symptoms or is preferably administered for the purpose of improving these symptoms.
  • the pharmaceutical preparation of the present invention demonstrates effects that improve subjective symptoms, in particular immediately after the start of administration, and is effective for improving subjective symptoms at an early stage after the start of administration, it is preferably used for the purpose of improving subjective symptoms at an early stage after the start of administration.
  • “early stage after the start of administration” refers to a period of several weeks after the start of administration, preferably refers to a period up to and including about day 13, and more preferably refers to a period up to and including about day 6, when defining the day on which administration is started as day 0.
  • immediateately after the start of administration refers to the day following the start of administration.
  • the pharmaceutical preparation of the present invention is effective for improving the aforementioned subjective symptoms particularly in persons in which these symptoms are felt especially strongly (persons with severe subjective symptoms such as persons exhibiting an average score of 2.5 or higher for the worst subjective symptom), the pharmaceutical preparation of the present invention is administered to such persons for that purpose.
  • the “score” referred to here indicates a score of 0 (no subjective symptoms) to 5 (worst subjective symptoms) used to evaluate each of the aforementioned symptoms in accordance with that perceived by the person administered the pharmaceutical preparation of the present invention.
  • scores given for each of the subjective symptoms those persons having an average of 2.5 or higher for the highest score are considered to be “persons exhibiting an average score of 2.5 or higher for the worst subjective symptom”.
  • a person administered the pharmaceutical preparation of the present invention is preferably a person with dry eye (in the present specification, dry eye has same meaning with dry eye disease and dry eye syndrome).
  • the pharmaceutical preparation of the present invention is particularly effective for improving subjective symptoms before bedtime at which time subjective symptoms are thought to appear with the greatest severity as a result of having used the eyes throughout the day, the pharmaceutical preparation of the present invention can be used for the purpose of improving subjective symptoms before bedtime in this manner.
  • improvement of subjective symptoms in the present description refers to a decrease in subjective symptoms. Improvement of subjective symptoms can be evaluated quantitatively by a decrease in the subjective symptoms score.
  • the method of the present invention is a method for improving human ocular subjective symptoms that comprises a step for administering the present compound (which naturally includes that in the form of the pharmaceutical preparation of the present invention) to the eye of a human.
  • the method of the present invention can be carried out in the same manner as that in accordance with the explanation described in the aforementioned section (1) entitled “Pharmaceutical Preparation of Present Invention”.
  • administration of the present compound preferably being in the form of a 0.3% (w/v) solution and the person receiving administration preferably being a person with dry eye are the same as previously described.
  • the present invention includes the use of the present compound for improving human ocular subjective symptoms and the use of the pharmaceutical preparation of the present invention for improving human ocular subjective symptoms.
  • HA having an aminopropyl cinnamate covalently bonded thereto was prepared in compliance with the method described in Example 2 of JP-A 2002-249501 using HA having a weight-average molecular weight of 880,000 (as measured according to the limiting viscosity method).
  • this “HA having an aminopropyl cinnamate covalently bonded thereto” is abbreviated as “HA-3APC”.
  • HA-3APC As a result of analyzing the resulting HA-3APC according to the method described in the examples of JP-A 2002-249501, the degree of substitution of the aminopropyl cinnamate per HA repeating disaccharide unit was 15.3%.
  • HA-3APC test substance
  • HA-3APC test substance
  • the entire cornea was macroscopically divided from above into three sections while illuminated with a slit lamp (SL-D7, Topcon Corp.) and the degree of damage to the corneal epithelia was evaluated based on the following criteria for each section (maximum score of 9 per eye). The scores for each animal were indicated as the average of both eyes. In addition, the entire cornea of each animal scored was photographed using a digital photography unit.
  • the model animals prepared in the manner described above were divided into the 9 groups shown in Table 1 after scoring so that the average scores were the same among the groups.
  • the test substance was administered to each group in accordance with Table 1.
  • the test substance was administered by instillation using a continuous dispenser (Multipette Plus, Eppendorf Co.). Furthermore, those groups that were dosed 6 times per day were dosed a total of 6 times at 1.5 hour intervals, those groups dosed once per day were dosed once per day at the time of the initial dosing of the groups dosed 6 times per day, and this was continued for 21 days (3 weeks).
  • the degree of damage to corneal epithelia was evaluated immediately after the start of administration (day 0), on day 3 and at the days after 1 week, 2 weeks and 3 weeks. Damage was evaluated in accordance with the aforementioned criteria and scored under blind conditions.
  • FIGS. 1 and 2 The results are shown in FIGS. 1 and 2 .
  • FIG. 1 According to the results of the dose-response relationship test as determined according to the Shirley-Williams test, among those groups dosed once per day ( FIG. 1 ), significant differences were observed versus the control group (once per day) for the group dosed at 0.5% at all evaluation times after day 3 and for the groups dosed at 0.1% and 0.3% at the days after the 1 week and 3 weeks.
  • FIG. 2 the results were observed versus the control group (6 times per day) for all groups dosed with the test substance at all evaluation times after day 3.
  • the Jonckherre statistic was significant on day 3 and at the days after the 2 week and 3 weeks, and among those groups dosed 6 times per day ( FIG. 2 ), the Jonckherre statistic was significant at all evaluation times.
  • a base (consisting of sodium chloride and potassium chloride as isotonic agents, sodium hydrogen phosphate and sodium dihydrogen phosphate as buffering agents, disodium edetate as stabilizer, and 0.003% benzalkonium chloride as preservative) was added to the HA-3APC prepared in Example 1, and after adjusting the pH to 5.0 to 6.0 to prepare 0.5 w/v % and 3.0 w/v % HA-3APC solutions, the solutions were subjected to filtration sterilization with a 0.22 um filter to obtain ophthalmic solutions. These solutions are referred to as a 0.5% ophthalmic solution and 0.3% ophthalmic solution, respectively.
  • HA-3APC was prepared for use as a placebo.
  • the subjects dropped a placebo into both eyes at 1 drop per administration 4 times per day (morning, noon, afternoon and before bedtime), and this was continued for 2 weeks as a run-in period.
  • the subjects were instructed to score ocular subjective symptoms (ocular discomfort, dryness, burning, grittiness and stinging) based on their own perception of those symptoms and record them in a daily diary at bedtime (prior to instillation before bedtime) every day during the run-in period.
  • the scores ranged from 0 (absence of subjective symptoms) to 5 (most severe (worst) subjective symptoms).
  • the subjects dropped in the 0.5% ophthalmic solution or 0.3% ophthalmic solution prepared in Example 3 or the placebo in both eyes at 1 drop per administration 4 times per day (morning, noon, afternoon and before bedtime), and this was continued for 4 weeks.
  • the subjects were instructed to score subjective symptoms and record them in a daily diary at bedtime (prior to instillation before bedtime) every day during the instillation period.
  • Subjects who strongly perceived subjective symptoms (subjects having an average score of 2.5 or higher for the most severe (highest) subjective symptom score (worst symptom score)) immediately before starting administration of ophthalmic solution (period of 7 days to 1 day before the start of administration of ophthalmic solution) were evaluated, and their time-based changes during the administration period were graphed.
  • the number of subjects in the 0.5% ophthalmic solution, 0.3% ophthalmic solution and placebo groups were 23, 26 and 26, respectively.
  • Results for ocular discomfort are shown in FIG. 3 .
  • statistically significant decreases in subjective symptoms versus the placebo group were observed in the 0.3% ophthalmic solution group during the time periods indicated below.
  • FIG. 6 indicates the results for the subjective symptom perceived by each patient (ocular discomfort, dryness, grittiness and stinging) to be the worst subjective symptom (highest symptom score).
  • FIG. 7 indicates the results of analyzing the average score of each patient for each subjective symptom (ocular discomfort, dryness, burning, grittiness and stinging).
  • FIG. 8 indicates the results of analyzing the average score of each patient for each subjective symptom (ocular discomfort and dryness).
  • the pharmaceutical preparation of the present invention can be applied industrially as a preparation for improving human ocular subjective symptoms, while the method of the present invention can be applied industrially as a method for improving human ocular subjective symptoms that uses an HA-based compound.

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