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
  • A61K31/075—Ethers or acetals
  • A61K31/08—Ethers or acetals acyclic, e.g. paraformaldehyde
• • 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
  • A61K31/4353—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 ortho- or peri-condensed with heterocyclic ring systems
  • A61K31/436—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 ortho- or peri-condensed with heterocyclic ring systems the heterocyclic ring system containing a six-membered ring having oxygen as a ring hetero atom, e.g. rapamycin
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P17/00—Drugs for dermatological disorders
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P17/00—Drugs for dermatological disorders
  • A61P17/02—Drugs for dermatological disorders for treating wounds, ulcers, burns, scars, keloids, or the like
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P17/00—Drugs for dermatological disorders
  • A61P17/04—Antipruritics
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P17/00—Drugs for dermatological disorders
  • A61P17/06—Antipsoriatics
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P17/00—Drugs for dermatological disorders
  • A61P17/08—Antiseborrheics
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P17/00—Drugs for dermatological disorders
  • A61P17/10—Anti-acne agents
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P23/00—Anaesthetics
  • A61P23/02—Local anaesthetics
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P37/00—Drugs for immunological or allergic disorders
  • A61P37/02—Immunomodulators
  • A61P37/06—Immunosuppressants, e.g. drugs for graft rejection
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P37/00—Drugs for immunological or allergic disorders
  • A61P37/08—Antiallergic agents
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P43/00—Drugs for specific purposes, not provided for in groups A61P1/00-A61P41/00

Definitions

• the invention relates to pharmaceutical compositions, for use in particular in the treatment of skin diseases. It concerns a pharmaceutical composition comprising a macrolide T-cell immunomodulator or immunosuppressant and a local anaesthetic.
• macrolide T-cell immunomodulators and immunosuppressants when used in combination with local anaesthetics, act synergistically, resulting in a potentiation of pharmacological activity, such that effective beneficial, especially anti-dermatitis activity and pain relief is seen upon co-administration at dosages which would be well below the effective dosages administered individually.
• compositions of the invention thus concerns novel pharmaceutical compositions comprising a macrolide T-cell immunomodulator or immunosuppressant in association or combination with a local anaesthetic, hereinafter briefly named "the compositions of the invention".
• a macrolide T-cell immunomodulator or immunosuppressant is to be understood herein as being a T-cell immunomodulator or T-cell immunosuppressant which has a macrocyclic compound structure including a lactone or lactam moiety. While it preferably has at least some T-cell immunomodulating or immunosuppressant activity, it may also exhibit concomitantly or predominantly further pharmaceutical properties, such as anti-inflammatory activity.
• a local anaesthetic is to be understood herein as being a compound other than benzyl alcohol which induces a locally limited, reversible condition of peripheral, pain- transmitting nerves or nerve endings which is associated with partial or complete lack of excitability or conducibility.
• compositions of the invention maybe adapted for systemic use as regards the immunomodulator or immunosuppressant component, e.g. oral or intravenous, or for topical use for both components; however, they are preferably both adapted for topical use. They are useful for the known indications of the particular active agents incorporated therein. They are particularly indicated for use in dermatological diseases, e.g. dermatological diseases which have an inflammatory component or involve inflammatory complications, such as atopic, contact or seborrhoeic dermatitis, psoriasis, acne, rosacea, post-peel, pruritus, skin burning, or itching; and associated pain.
• dermatological diseases e.g. dermatological diseases which have an inflammatory component or involve inflammatory complications, such as atopic, contact or seborrhoeic dermatitis, psoriasis, acne, rosacea, post-peel, pruritus, skin burning, or itching; and associated pain.
• a suitable macrolide T-cell immunomodulator or immunosuppressant is for example an FKBP12-binding calcineurin inhibitor or mitogen-activated kinase modulator or inhibitor, in particular an asco- or rapamycin. It preferably is an ascomycin. While the macrolide preferably has at least some calcineurin- or mitogen-activated kinase modulating or inhibiting activity, it may also exhibit concomitantly or predominantly further pharmaceutical properties, such as antiinflammatory activity. It preferably is a compound, e.g. an ascomycin, having rather long-acting activity relatively to other members of the same structural class, e.g. it is metabolically degraded slowly to inactive products.
• an asco- or rapamycin is to be understood as asco- or rapamycin as such, or a derivative thereof.
• An asco- or rapamycin derivative is to be understood as being an antagonist, agonist or analogue of the parent compound which retains the basic structure and modulates at least one of the biological, for example immunological properties of the parent compound.
• an "anti-inflammatory ascomycin derivative” is defined herein as an ascomycin derivative that exhibits pronounced anti-inflammatory activity in e.g. animal models of allergic contact dermatitis but has only low potency in suppressing systemic immune response, namely, which has a minimum effective dose (MED) of up to a concentration of about 0.04 % w/v in the murine model of allergic contact dermatitis upon topical administration, while its potency is at least 10 times lower than for tacrolimus (MED 14 mg/kg) in the rat model of allogeneic kidney transplantation upon oral administration (Meingassner, J.G. et al., Br. J. Dermatol. 137 [1997] 568-579; Stuetz, A. Seminars in Cutaneous Medicine and Surgery 20 ⁇ OOll 233-241).
• Such compounds are preferably lipophilic.
• Suitable ascomycins are e.g. as described in EP 184162, EP 315978, EP 323042, EP 423714, EP 427680, EP 465426, EP 474126, WO 91/13889, WO 91/19495, EP 484936, EP 523088, EP 532089, EP 569337, EP 626385, WO 93/5059 and WO 97/8182; in particular:
• Suitable anti-inflammatory ascomycin derivatives are e.g.: (32-desoxy-32-epi-Nl-tetrazolyl)ascomycin (ABT-281); 5,6-dehydroascomycin; ASD 732; and pimecrolimus.
• rapamycins are e.g. as described in USP 3'929'992, WO 94/9010 and USP 5'258'389, preferably sirolimus (rapamycin; Rapamune R ) and everolimus (RADOOl; Certican R ).
• a suitable local anaesthetic is for example an aminoester or aminoamide; it is e.g.:
• dibucaine hydrochloride (cinchocaine; 2-butoxy-N-[2-(diethylamino)ethyl]- 4-quinolinecarboxamide monohydrochloride);
• lidocaine lignocaine; Xylocaine R ; ⁇ -diethylamino-2,6-dimethylacetanilide
• - prilocaine (propitocaine; ⁇ -propylamino-2-methylpropionanilide);
• - tetracaine p-butylaminobenzoyl-2-dimethylaminoethanol hydrochloride
• polidocanol and prilocaine especially lidocaine
• compositions of the invention comprise a macrolide T-cell immunomodulator or immunosuppressant, preferably an anti-inflammatory ascomycin derivative as defined above, especially pimecrolimus, in combination or association with a local anaesthetic other than prilocaine and/or lidocaine.
• the macrolide T-cell immunomodulator or immunosuppressant is other than tacrolimus.
• it is other than tacrolimus and sirolimus.
• it is other than tacrolimus, sirolimus and ascomycin.
• a particularly preferred composition of the invention is pimecrolimus in association or combination with lidocaine.
• the local anaesthetic maybe e.g. an injectable or, preferably, a compound indicated for topical use.
• compositions of the invention wherein one or both components possess some degree of inherent anti-inflammatory activity.
• compositions comprising an ascomycin in combination with a local anaesthetic, especially 33-epichloro-33-desoxy- ascomycin in combination with polidocanol, lidocaine or prilocaine.
• the inflammatory condition is e.g. atopic, contact or seborrhoeic dermatitis, psoriasis, acne, rosacea, post-peel, pruritus, skin burning, or itching; and associated pain.
• Treatment as used herein includes prevention, namely prophylactic as well as curative treatment.
• the local anaesthetic component is administered normally topically; the macrolide T-cell immunomodulator or immunosuppressant may be administered together with the local anaesthetic, normally topically, or separately, either topically or systemically. Preferred is topical administration of both components.
• Synergy is e.g. calculated as in Berenbaum, Clin. Exp. Immunol. 28 (1977) 1, using an interaction term to correct for differences in mechanism between the two drugs, as described in Chou et al., Transpl. Proc. 26 (1994) 3043.
• the index of synergy is calculated as: dose of A + dose of B + (dose of A) x (dose of B
• synergistic ratio expressed in terms of the ratio by weight of the two compositions at synergistic amounts along the isobologram, especially at or near the point of maximum synergy, can then be used to determine formulations containing an optimally synergistic ratio of the two compounds.
• Activity may e.g. be determined in known assay models for testing the pharmacological activity of the individual components of the compositions.
• the invention also provides products and methods for co-administration of a macrolide T-cell immunomodulator or immunosuppressant, e.g. 33-epichloro-33-desoxy- ascomycin or 5,6-dehydroascomycin, and a local anaesthetic, e.g. polidocanol, lidocaine or prilocaine, at synergistically effective dosages, e.g.:
• a macrolide T-cell immunomodulator or immunosuppressant e.g. 33-epichloro-33-desoxy- ascomycin or 5,6-dehydroascomycin
• a local anaesthetic e.g. polidocanol, lidocaine or prilocaine
• a method of treatment or prevention of a dermatological disease such as atopic, contact or seborrhoeic dermatitis, psoriasis, acne, rosacea, post-peel, pruritus, skin burning, or itching, and associated pain, in a subject suffering from or at risk for such condition, comprising co-administering synergistically effective amounts of a composition of the invention;
• kits of parts comprising a macrolide T-cell immunomodulator or immunosuppressant and a local anaesthetic in separate unit dosage forms, preferably wherein the unit dosage forms are suitable for administration of the component compounds in synergistically effective amounts, together with instruction for use, optionally with further means for facilitating compliance with the administration of the component compounds, e.g. a label or drawings;
• a local anaesthetic in the manufacture of a pharmaceutical kit which is to be used for facilitating co-administration with a macrolide T-cell immunomodulator or immunosuppressant; - a macrolide T-cell immunomodulator or immunosuppressant and a local anaesthetic as a combined pharmaceutical preparation for simultaneous, separate or sequential use, preferably in synergistically effective amounts, e.g. for the treatment or prevention of a dermatological disease such as atopic, contact or seborrhoeic dermatitis, psoriasis, acne, rosacea, post-peel, pruritus, skin burning, or itching; and associated pain;
• a dermatological disease such as atopic, contact or seborrhoeic dermatitis, psoriasis, acne, rosacea, post-peel, pruritus, skin burning, or itching; and associated pain;
• compositions comprising a macrolide T-cell immunomodulator or immunosuppressant in combination or association with a local anaesthetic, e.g. in synergistically effective amounts, together with at least one pharmaceutically acceptable diluent or carrier, e.g. for use in treatment or prevention of a dermatological disease such as atopic, contact or seborrhoeic dermatitis, psoriasis, acne, rosacea, post-peel, pruritus, skin burning, or itching; and associated pain; and
• composition of the invention comprising mixing a macrolide T-cell immunomodulator or immunosuppressant and a local anaesthetic, in combination or association with at least one pharmaceutically acceptable diluent or carrier.
• “synergistically effective amounts” is meant an amount of macrolide T-cell immunomodulator or immunosuppressant and an amount of local anaesthetic which are individually below their respective effective dosages for a relevant indication, but which are pharmaceutically active on co-administration, e.g. in a synergistic ratio, for example as calculated above.
• “synergistically effective amounts” may mean an amount of macrolide T-cell immunomodulator or immunosuppressant and an amount of local anaesthetic which are individually equal to their respective effective dosages for a relevant indication, and which result in a more than additive effect.
• the molar amount of macrolide T-cell immunomodulator or immunosuppressant present is from roughly similar to, to significantly less than the amount of local anaesthetic, preferably half as much or less.
• Synergistic ratios of macrolide T-cell immunomodulator or immunosuppressant to local anaesthetic by weight are thus suitably from about 10: 1 to about 1 :50, preferably from about 5: 1 to about 1 :20, most preferably from about 1 : 1 to about 1:15, e.g. about 1:12.
• the compositions of the invention can be administered as a free combination, e.g. for separate systemic and topical administration of the two components, or can be formulated into a fixed combination, preferably for topical administration of both components, which greatly enhances the convenience for the patient.
• Absolute dosages of the compounds will vary depending on a number of factors, e.g. the individual, the route of administration, the desired duration, the rate of release of the active agent and the nature and severity of the condition to be treated.
• the amount of active agents required and the release rate thereof may be determined on the basis of known in vitro and in vivo techniques, determining how long a particular active agent concentration in the blood plasma remains at an acceptable level for a therapeutic effect.
• an initial dosage of about 2-3 times the maintenance dosage is suitably administered, followed by a daily dosage of about 2-3 times the maintenance dosage for a period of from one to two weeks, and subsequently the dose is gradually tapered down at a rate of about 5 % per week to reach the maintenance dosage.
• synergistically effective amounts of 33-epichloro-33-desoxyascomycin on oral administration for use in prevention and treatment of atopic, contact or seborrhoeic dermatitis, psoriasis, acne, rosacea, post-peel, pruritus, skin burning, or itching, and associated pain, in larger animals, e.g. man, are amounts of 33-epichloro-33-desoxyascomycin of up to about 2 mg/kg/day, e.g.
• compositions of the invention administration of the components of the compositions of the invention together or at substantially the same time, e.g. within fifteen minutes or less, either in the same vehicle or in separate vehicles.
• compositions of the invention include compositions suitable for administration by any conventional route, in particular compositions suitable for administration either enterally, for example, orally, e.g. in the form of solutions for drinking, tablets or capsules, or parenterally, e.g. in the form of injectable solutions or suspensions; or topically, e.g. for the treatment of inflammatory conditions of the skin or mucosae, e.g. in the form of a dermal cream, ointment, ear drops, mousse, shampoo, solution, lotion, gel, emulgel or like preparation, e.g.
• each component in a concentration of from about 0.1 % to about 5 % by weight of each component, especially in combination or association with penetration enhancing agents, as well as for application to the eye, e.g. in the form of an ocular cream, gel or eye-drop preparation, for treatment of inflammatory conditions of the lungs and airways, e.g. in the form of inhalable compositions, and for mucosal application, e.g. in the form of vaginal tablets.
• compositions of the invention are suitably emulsions, microemulsions, emulsion preconcentrates or microemulsion preconcentrates, or solid dispersions, especially water-in-oil microemulsion preconcentrates or oil-in-water microemulsions, comprising the macrolide T-cell immunomodulator or immunosuppressant and the local anaesthetic in a synergistic ratio.
• compositions of the invention can be prepared in conventional manner, e.g. by mixing a macrolide T-cell immunomodulator or immunosuppressant and a local anaesthetic, in combination or association with at least one pharmaceutically acceptable diluent or carrier.
• the active agent components may be in free form or pharmaceutically acceptable salt form as appropriate.
• Example 1 Cream
• the preparation follows the conventional manufacturing procedures for an emulsion.
• 33-Epichloro-33-desoxyascomycin is added to the heated homogeneous oily phase which contains triglycerides medium chain, oleyl alcohol, sodium cetylstearyl sulfate, cetyl alcohol , stearyl alcohol and glyceryl monostearate.
• the water phase containing lidocaine hydrochloride, the Parabens, propylene glycol, citric acid and sodium hydroxide is heated at the same temperature as the oily phase.
• the oily phase is added to the water phase and homogeneisation is performed.
• the resultant cream is cooled to room temperature.
• composition and its preparation are as for Example 1, except that benzyl alcohol 1.00 g is used in place of the Parabens.

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• Health & Medical Sciences (AREA)
• Pharmacology & Pharmacy (AREA)
• Veterinary Medicine (AREA)
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• Animal Behavior & Ethology (AREA)
• Chemical & Material Sciences (AREA)
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• Anesthesiology (AREA)
• Pain & Pain Management (AREA)
• Pulmonology (AREA)
• Transplantation (AREA)
• Pharmaceuticals Containing Other Organic And Inorganic Compounds (AREA)
• Acyclic And Carbocyclic Compounds In Medicinal Compositions (AREA)

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Citations (9)

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• 2003
  • 2003-04-04 GB GBGB0307869.8A patent/GB0307869D0/en not_active Ceased
• 2004
  • 2004-02-04 US US10/550,360 patent/US20060110448A1/en not_active Abandoned
  • 2004-04-02 WO PCT/EP2004/003515 patent/WO2004087144A1/en not_active Ceased
  • 2004-04-02 MX MXPA05010709A patent/MXPA05010709A/es not_active Application Discontinuation
  • 2004-04-02 BR BRPI0409207-4A patent/BRPI0409207A/pt not_active IP Right Cessation
  • 2004-04-02 RS YUP-2005/0752A patent/RS20050752A/sr unknown
  • 2004-04-02 AU AU2004226823A patent/AU2004226823A1/en not_active Abandoned
  • 2004-04-02 EP EP04725354A patent/EP1613317A1/en not_active Withdrawn
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