WO2004089375A1 - Implantable polymeric device for sustained release of dopamine agonist - Google Patents

Implantable polymeric device for sustained release of dopamine agonist Download PDF

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Publication number
WO2004089375A1
WO2004089375A1 PCT/US2004/010270 US2004010270W WO2004089375A1 WO 2004089375 A1 WO2004089375 A1 WO 2004089375A1 US 2004010270 W US2004010270 W US 2004010270W WO 2004089375 A1 WO2004089375 A1 WO 2004089375A1
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WO
WIPO (PCT)
Prior art keywords
dopamine agonist
implantable device
implantable
matrix
dopamine
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Ceased
Application number
PCT/US2004/010270
Other languages
English (en)
French (fr)
Inventor
Rajesh A. Patel
Louis R. Bucalo
Lauren Costantini
Sofie Kleppner
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Titan Pharmaceuticals Inc
Original Assignee
Titan Pharmaceuticals Inc
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Priority to JP2006509657A priority Critical patent/JP5064794B2/ja
Priority to AU2004228017A priority patent/AU2004228017C1/en
Priority to DE602004031512T priority patent/DE602004031512D1/de
Priority to PL04758809T priority patent/PL1610791T3/pl
Priority to EP04758809A priority patent/EP1610791B1/en
Priority to DK04758809.0T priority patent/DK1610791T3/da
Priority to HK06104808.8A priority patent/HK1083682B/en
Priority to SI200431641T priority patent/SI1610791T1/sl
Priority to CA2520613A priority patent/CA2520613C/en
Application filed by Titan Pharmaceuticals Inc filed Critical Titan Pharmaceuticals Inc
Priority to AT04758809T priority patent/ATE499100T1/de
Priority to MXPA05010450A priority patent/MXPA05010450A/es
Priority to NZ542548A priority patent/NZ542548A/en
Priority to KR1020057018582A priority patent/KR101152183B1/ko
Publication of WO2004089375A1 publication Critical patent/WO2004089375A1/en
Priority to IL171115A priority patent/IL171115A/en
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

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    • A61K31/195—Carboxylic acids, e.g. valproic acid having an amino group
    • A61K31/197—Carboxylic acids, e.g. valproic acid having an amino group the amino and the carboxyl groups being attached to the same acyclic carbon chain, e.g. gamma-aminobutyric acid [GABA], beta-alanine, epsilon-aminocaproic acid or pantothenic acid
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Definitions

  • the invention provides a nonbioerodible, polymeric device for subcutaneous implantation and sustained release of dopamine agonist for treatment of Parkinson's disease and other conditions for which administration of a dopamine agonist is therapeutically beneficial.
  • Parkinson's disease a progressive neurodegenerative disorder, is characterized by loss of neurons that synthesize and release dopamine. This loss of dopaminergic neurons manifests itself in symptoms such as rigidity, resting tremors (shaking), poverty of movement (akinesia), slowness of movement (bradykinesis), and changes in gait and posture.
  • Treatment of Parkinson's disease generally is based on therapeutic administration of substances that can compensate for the lack of dopaminergic neurotransmission due to the loss of dopamine-secreting neurons.
  • a classic treatment regime includes chronic oral administration of levodopa, which is decarboxylated in the brain to form dopamine.
  • Apomo ⁇ hine an effective agonist at both dopamine receptors in the nervous system, has been used for treatment of Parkinson's disease in patients that have become resistant to or have developed adverse side effects with associated with chronic levodopa therapy.
  • apomo ⁇ hine is administered by repeated subcutaneous injections or continuous parenteral infusion via a pump.
  • Apomo ⁇ hine may also be administered transdermally (U.S. Pat. No. 5,562,917), intranasally (U.S. Pat. 5,756,483), as a topically-applied gel (U.S. Pat. No. 5,939,094), or sublingually (U.S. Pat. No. 5,994,363). None of these methods permits continuous administration over long periods of time.
  • Dopamine agonists have also been used for treatment of parkinsonism which results from central nervous system injury by toxin exposure or a disease condition such as encephalitis, erectile dysfunction, restless leg syndrome, and hype ⁇ rolactinemia.
  • the invention provides compositions (i. e. , implantable polymeric devices), methods, and kits for administration of one or more dopamine agonists to a mammal in need thereof.
  • the invention provides an implantable device for administration of a dopamine agonist to a mammal in need thereof.
  • the implantable device includes at least one dopamine agonist encapsulated in a biocompatible, nonerodible polymeric matrix.
  • an implantable device of the invention releases dopamine agonist continuously in vivo through pores that open to the surface of the matrix at a rate that results in a plasma level of at least about 0.001, 0.005, 0.01, 0.02, 0.03,0.04, 0.05, 0.06, 0.07, 0.08, 0.09, 0.1, 0.2, 0.3, 0.4, 0.5, 0.6, 0.7, 0.8, 0.9, 1, 5, or 10 ng/ml in various embodiments.
  • an implantable device of the invention includes ethylene vinyl acetate (EVA) as a biocompatible, nonerodible polymer for formation of the polymeric matrix.
  • EVA ethylene vinyl acetate
  • the vinyl acetate content of EVA used for preparation of the polymeric matrix is often about 2 to about 40, more often about 10 to about 35, most often about 30 to about 35 %. In some embodiments, the vinyl acetate content is about 33%.
  • An implantable device of the invention includes about 10 to about 85% dopamine agonist.
  • the dopamine agonist is apomo ⁇ hine, lisuride, pergolide, bromocriptine, pramipexole, ropinerole, or rotigotine. In one embodiment, the dopamine agonist is apomo ⁇ hine.
  • the dopamine agonist is generally at least a dopamine D2 receptor agonist, but may also be an agonist for the Dl and/or D3 dopamine receptors.
  • Implantable devices often release dopamine agonist continuously in vivo for at least about 3, 6, 9, 12, 15, 18, 21, or 24 months.
  • implantable devices of the invention are produced using an extrusion process, sometimes producing devices with dimensions of about 2 to about 3 mm in diameter and about 2 to about 3 cm in length, although other shapes and sizes are contemplated and are within the skill of the art.
  • an implantable device of the invention releases dopamine agonist at a rate of at least about 0.1 to about 10 mg/day at steady state in vitro or in vivo.
  • the implantable devices release dopamine agonist at a rate of at least about 0.01, 0.05, 0.1, 0.5, 1, 2, 3, 4, 5, 6, 7, 8, 9, or 10 mg/day in vitro or in vivo.
  • a dopamine-containing implantable device may further include an anti- inflammatory agent, for example a steroid, a nonsteroidal anti-inflammatory drug ("NSAID"), or an antihistamine, and/or an antioxidant within the polymeric matrix.
  • an anti- inflammatory agent for example a steroid, a nonsteroidal anti-inflammatory drug ("NSAID"), or an antihistamine, and/or an antioxidant within the polymeric matrix.
  • NSAID nonsteroidal anti-inflammatory drug
  • the invention provides a method for administration of a dopamine agonist to a mammal in need thereof. Metiiods of the invention include subcutaneous administration of at least one implantable device as described above.
  • the methods include subcutaneous implantation of a multiplicity of the devices.
  • the device or devices release dopamine agonist at a steady state level that is therapeutically effective for treatment of a condition for which administration of a dopamine agonist is therapeutically beneficial, for example, Parkinson's disease, toxin- or disease-induced parkinsonism, erectile dysfunction, restless leg syndrome, or hype ⁇ rolactinemia.
  • the dopamine agonist is apomo ⁇ hine, lisuride, pregolide, bromocriptine, pramipexole, ropinerole, or rotigotine.
  • the dopamine agonist is apomo ⁇ hine.
  • each device continuously releases at least about 0.001, 0.005, 0.01, 0.02, 0.03, 0.04, 0.05, 0.06, 0.07, 0.08, 0.09, 0.1, 0.2, 0.3, 0.4, 0.5, 0.6, 0.7, 0.8, 0.9, 1, 5, 10, 25, 50, or 100 ng of dopamine agonist per ml of plasma at steady state.
  • each device releases at least about 0.1 mg of dopamine agonist per day in vitro.
  • one or a multiplicity of devices is subcutaneously implanted in an individual, for example, on the upper arm, the back, and/or the abdomen.
  • one or more anti-inflammatory agents are coadministered along with dopamine agonist.
  • the anti-inflammatory agent may be encapsulated within the same polymeric device as dopamine agonist or in a separate polymeric device that does not contain dopamine agonist, or may be administered via a different route, such as orally or via injection, either simultaneously with implantation of the dopamine agonist-containing devices or at a different time, or on a different schedule such as for example multiple dosing of an oral or injectable formulation.
  • the anti-inflammatory agent may be a steroid, a NSAID, and/or an antihistamine.
  • an antioxidant is inco ⁇ orated into the dopamine agonist-containing polymeric device and is coadministered along with dopamine agonist.
  • the methods of the invention include administration of another substance in conjunction with administration of dopamine agonist via an implanted polymeric device of the invention.
  • Such substances include, but are not limited to, levodopa, dopamine agonists, catechol-O-methyltranserase inhibitors, or monoamine oxidase inhibitors, administered orally or intravenously.
  • kits of the invention provide a kit for use in a method of administration of a dopamine agonist to a mammal in need thereof.
  • Kits of the invention include at least one implantable device that includes dopamine agonist encapsulated in a biocompatible, nonerodible polymeric matrix, as described above, and instructions for use.
  • kits of the invention include a multiplicity of individual dopamine agonist-containing implantable devices.
  • Fig. 1 depicts in vitro release of apomo ⁇ hine over time.
  • Fig. 1 shows the average cumulative release of apomo ⁇ hine HCl ("ApoH") from implants loaded with 50%, 60%, or 70% ApoH and washed for 30 minutes (Fig. 1A), 60 minutes (Fig. IB), or 120 minutes (Fig. 1C) in ethanol.
  • ApoH apomo ⁇ hine HCl
  • Fig. 2 depicts in vitro release of ApoH and loratidine ("LA”) over time from an implant loaded with 49% ApoH and 21% LA.
  • LA ApoH and loratidine
  • the invention provides a biocompatible, nonerodible polymeric device, wliich permits controlled, sustained release of one or more dopamine agonists over extended periods of time when implanted subcutaneously in an individual in need of treatment.
  • Continuous release of a compound in vivo over an extended duration may be achieved via implantation of a device containing the compound encapsulated, i.e., dispersed, in a nonerodible polymeric matrix.
  • a device containing the compound encapsulated, i.e., dispersed, in a nonerodible polymeric matrix examples include implantable, nonerodible polymeric devices for continuous drug release are described in, e.g., U.S. Pat. Nos. 4,883,666, 5,114,719, and 5,601,835.
  • Implantation of the device and extended release of dopamine agonist improves compliance with dosing regimens, eliminating the need for repeated injections, ingestion of pills or tablets, or manipulations associated with a mechanical diffusion pump.
  • An implantable, sustained-release device also permits achievement of more constant blood levels of dopamine agonist than injectable or oral dosage forms, thereby permitting lower dosing levels than conventional means of administration, minimizing side effects, and improving therapeutic effectiveness.
  • Devices of the invention include one or more non-bioerodible polymers. Such polymers release compounds at linear rates for extended time periods of several months or longer, in contrast to bioerodible polymers, which do not exhibit linear release kinetics due to formation of channels in the matrix as it erodes, resulting in increased release rates over time.
  • the present invention includes a biocompatible, nonerodible polymer that exhibits generally linear release kinetics for dopamine agonist in vivo, after an initial burst.
  • the invention includes implantable devices for treatment of
  • Devices of the invention include one or more dopamine agonists encapsulated in a polymeric, nonerodible matrix.
  • Dopamine agonist refers to a compound which is capable of binding to one or more dopamine receptor subgroups, resulting in beneficial therapeutic effect in an individual treated with the agonist.
  • the dopamine agonists described herein typically are agonists for at least the D2 subgroup of dopamine receptors, and may also be agonists for Dl and/or D3 receptors.
  • an implantable device of the invention includes apomo ⁇ hine, lisuride, pergolide, bromocriptine, pramipexole, ropinerole, or rotigotine, or a combination or two or more of these dopamine agonists.
  • the implantable device includes apomo ⁇ hine.
  • “Apomo ⁇ hine” refers to apomo ⁇ hine and pharmaceutically acceptable salts thereof, such as for example, apomo ⁇ hine HCl ("ApoH").
  • Inco ⁇ oration of dopamine agonist into the polymeric matrix causes the formation of a series of interconnecting channels and pores that are accessible to the surface for release of the drug.
  • devices of the invention When implanted subcutaneously, devices of the invention continuously release dopamine agonist for an extended period of time with a pseudo or near zero order release rate. After an initial burst following implantation, release rates are typically within about 10-20% of the steady state average.
  • “nonerodible matrix” refers to a polymeric carrier that is sufficiently resistant to chemical and/or physical destruction by the environment of use such that the matrix remains essentially intact throughout the release period.
  • the polymer is generally hydrophobic so that it retains its integrity for a suitable period of time when placed in an aqueous environment, such as the body of a mammal, and stable enough to be stored for an extended period before use.
  • the ideal polymer must also be strong, yet flexible enough so that it does not crumble or fragment during use. Nonerodible matrices remain intact in vivo for extended periods of time, typically months or years. Drug molecules encapsulated in the matrix are released over time via diffusion through channels and pores in a sustained and predictable manner. The release rate can be altered by modifying the percent drug loading, porosity of the matrix, structure of the implantable device, or hydrophobicity of the matrix, or by adding a hydrophobic coating to the exterior of the implantable device. [0021] Where appropriate, a coating that is impermeable to the drug is placed over at least a portion of the device to further regulate the rate of release.
  • a coating of a nonerodible polymeric material e.g., EVA, or a coating of a nonerodible polymeric material with a lower drug loading than the remainder of the implantable device, may be used.
  • a coating may be formed, for example, by co- extrusion with the device.
  • ethylene vinyl acetate copolymer is used as the polymeric matrix, but other nonerodible materials may be used.
  • suitable materials include silicone, hydrogels such as crosslinked poly(vinyl alcohol) and poly(hydroxy ethylmethacrylate), acyl substituted cellulose acetates and alkyl derivatives thereof, partially and completely hydrolyzed alkylene- vinyl acetate copolymers, unplasticized polyvinyl chloride, crosslinked homo- and copolymers of polyvinyl acetate, crosslinked polyesters of acrylic acid and/or methacrylic acid, polyvinyl alkyl ethers, polyvinyl fluoride, polycarbonate, polyurethane, polyamide, polysulphones, styrene acrylonitrile copolymers, crosslinked poly(ethylene oxide), poly(alkylenes), poly(vinyl imidazole), poly(esters), poly(ethylene terephthalate), polyphosphazene
  • silicone such as crosslinked poly(viny
  • Implantable devices of the invention are typically formulated with dopamine agonist loading of about 10% to about 85%.
  • Devices are often formulated as compositions that include a polymeric matrix that includes EVA (33% acetate) and any of at least about 10, 20, 30, 40, 50, 55, 60, 65, 70, 75, or 80 to about 85%, or any of about 10 to about 20, about 20 to about 30, about 30 to about 40, about 40 to about 50, about 50 to about 60, about 60 to about 70, about 70 to about 80, or about 80 to about 85% dopamine agonist by weight.
  • Devices may be produced using an extrusion process, wherein ground EVA is blended with dopamine agonist, melted, and extruded into rod-shaped structures.
  • Rods are cut into individual implantable devices of the desired length, packaged, and sterilized prior to use.
  • Other methods for encapsulating therapeutic compounds in implantable polymeric, nonerodible matrices are well known to those of skill in the art. Such methods include, for example, solvent casting (see, e.g., U.S. Pat. Nos. 4,883,666, 5,114,719, and 5,601,835). A skilled artisan would be able to readily determine an appropriate method of preparing such an implantable device, depending on the shape, size, drug loading, and release kinetics desired for a particular type of patient or clinical indication.
  • Devices of the invention are suitable for sustained release of dopamine agonist for treatment of idiopathic Parkinson's disease or another condition for which administration of dopamine agonist is therapeutically beneficial, such as, for example, toxin- or disease-induced parkinsonism, erectile dysfunction, restless leg syndrome, or hype ⁇ rolactinemia.
  • sustained release refers to the release of dopamine agonist such that the blood concentration remains within the therapeutic range but below toxic levels for an extended duration.
  • Devices of the invention generally exhibit near zero-order pharmacokinetics in vivo, similar to kinetics achieved with an IV drip, but without the need for external medical equipment and personnel associated with intravenous methods. Generally, after implantation, the devices release therapeutically effective amounts of dopamine for periods of several months up to one year or longer.
  • Implantable devices may be used, or the size and shape of the devices may be modified, to achieve a desired overall dosage.
  • Implantable devices are often about 0.5 to about 10, more often about 1.5 to about 5, often about 2 to about 6, most often about 2 to about 3 cm in length, and are often about 0.5 to about 7, more often about 1.5 to about 5, most often about 2 to about 3 mm in diameter.
  • An implantable device of the invention may release dopamine agonist in vitro or in vivo at a rate of about 0.01 to about 10, about 0.1 to about 10, about 0.25 to about 5, or about 1 to about 3 mg/day in vitro or in vivo.
  • the release rate of implantable devices may also be modified by changing the vinyl acetate content in the EVA polymer matrix.
  • the vinyl acetate content is often about 2 to about 40, more often about 10 to about 35, most often about 30 to about 35% by weight. In one embodiment, the vinyl acetate content is about 33% by weight.
  • devices of the invention may include other substances in addition to dopamine agonist to increase effectiveness of treatment and or reduce inflammation at the site of administration, or to prevent oxidation of dopamine agonist(s).
  • an anti-inflammatory agent such as for example, a steroid, examples of which include but are not limited to dexarnethasone, triamcinolone, betamethasone, clobetasol, cortisone, hydrocortisone, or a pharmaceutically acceptable salt thereof, or a nonsteroidal anti-inflammatory agent ("NSAID”), examples of which include but are not limited to diclofenac potassium diclofenac sodium, diclofenac sodium with misoprostol, diflunisal, etodolac, fenoprofen calcium, flurbiprofen, ibuprofen, indomethacin, ketoprofen, meclofenamate sodium, mefenamic acid, meloxicam, nabumetone
  • NSAID nonsteroidal anti-
  • any of these agents, or a combination may be included in the same implant(s) as dopamine agonist or alternatively, may be inco ⁇ orated into one or more separate implants that do not include dopamine agonist.
  • An antioxidant e.g., ascorbic acid, sodium metabisulfite, glutathione, may be included in the same implant as dopamine agonist to prevent or reduce oxidation of dopamine agonist during preparation, storage, and/or administration of the implant.
  • the invention provides methods for treatment of idiopathic
  • Parkinson's disease or toxin- or disease-induced parkinsonism or any other condition for which administration of a dopamine agonist is therapeutically beneficial, e.g., erectile dysfunction, restless leg syndrome, or hype ⁇ rolactinemia.
  • Parkinsonism includes conditions resulting from injury to the central nervous system that cause an individual to exhibit symptoms similar to those of Parkinson's disease. Parkinsonism may result, for example, from toxin exposure, for example, carbon monoxide or manganese poisoning or MPTP administration, or from a disease condition such as encephalitis.
  • Methods of the invention include subcutaneous administration of one or more polymeric implantable devices which each include one or more dopamine agonists encapsulated within a biocompatible, nonerodible polymeric matrix, e.g., EVA, and release of the dopamine agonist(s) in a controlled manner over an extended period of time through multiple pores that open to the surface of the implantable device(s).
  • implantable devices are produced via an extrusion process, as described above.
  • the method includes administration of apomo ⁇ hine, lisuride, pergolide, bromocriptine, pramipexole, ropinerole, or rotigotine, or a combination or two or more of these dopamine agonists.
  • a combination of dopamine agonists may be administered from the same implantable device(s) or may be administered from separate implantable devices.
  • the method includes administration of apomo ⁇ hine.
  • Implantable devices are administered by subcutaneous implantation to an individual in need of treatment with a dopamine agonist.
  • implantable devices are administered by subcutaneous implantation at sites including, but not limited to, the upper arm, back, or abdomen of an individual. Other suitable sites for adininistration may be readily determined by a medical professional. Multiple implantable devices may be administered to achieve a desired dosage for treatment.
  • an implantable device or a multiplicity of devices is administered that will release dopamine at a rate that will maintain a therapeutically effective plasma level for an extended period of time of at least about 3, 6, 9, 12, 15, 18, 21, or 24 months.
  • die duration of implantation, with continuous release of dopamine agonist is from about 3 months to about 2 years, about 3 months to about 1 year, about 3 months to about 9 months, or about 3 months to about 6 months.
  • the desired dosage rate will depend upon factors such as the underlying condition for which dopamine agonist is being administered, and the physiology of a particular patient, but will be readily ascertainable to physicians.
  • Dopamine agonist is desirably released from one or a multiplicity of implanted devices at a rate that maintains plasma levels of the drug(s) at a therapeutically effective level. Maintenance of dopamine agonist at a fairly constant plasma level often permits dosing at a lower level than with other therapies, such as oral administration.
  • therapeutically effective amount or “therapeutically effective level” refers to the amount of dopamine agonist that will render a desired therapeutic outcome, e.g.., a level or amount effective to reduce symptoms of Parkinson's disease and/or increase periods of therapeutic effectiveness ("on" periods) for a patient undergoing chronic dopaminergic therapy for idiopathic Parkinson's disease or toxin- or disease-induced parkinsonism, or beneficial treatment, t.e., reduction or alleviation of adverse or undesirable symptoms of a condition treatable with a dopamine agonist, such as erectile dysfunction, restless leg syndrome, or hype ⁇ rolactinemia.
  • Parkinson's disease or parkinsonism For treatment of Parkinson's disease or parkinsonism, effectiveness is often associated with reduction in "on'V'off ' fluctuations associated with a particular Parkinson's disease treatment regime, such as for example, chronic levodopa administration.
  • An amount that is "tiierapeutically effective" for a particular patient may depend upon such factors as a patient's age, weight, physiology, and/or the particular symptoms or condition to be treated, and will be ascertainable by a medical professional.
  • a desirable steady-state plasma level of dopamine agonist in methods of the invention is in the range of about 0.005 to about 100 ng/ml, about 0.01 to about 100 ng/ml, about 0.05 to about 0.65 ng/ml, about 0.2 to about 0.65 ng/ml, about 0.2 to about 45 ng/ml, or about 1 to about 20 ng/ml.
  • an implantable device of the invention may release dopamine agonist in vivo at a rate that results in a plasma level of at least about 0.001, 0.005, 0.01, 0.02, 0.03, 0.04, 0.05, 0.06, 0.07, 0.08, 0.09, 0.1, 0.2, 0.3, 0.4, 0.5, 0.6, 0.7, 0.8, 0.9, 1; 5, or 10 ng/ml at steady state.
  • a total release rate from one or a multiplicity of implanted devices that results in delivery of a therapeutically effective amount of dopamine agonist on a daily basis is typically about 0.01 to about 10 mg/day, often about 0.25 to about 5 mg/day, sometimes about 1 to about 3 mg/day, but may be modified depending upon the symptomology involved and the particular patient being treated.
  • one or more implantable devices may be used with a total release rate of about 0.01 to about 10 mg/day, about 0.25 to about 5 mg/day, or about 1 to about 3 mg/day apomo ⁇ hine.
  • implantable devices of the invention will alleviate compliance difficulties, as described above.
  • long term continuous release of dopamine agonist generally reduces or eliminates the peaks and troughs of blood concentration associated with other formulations such as oral or injectable dosage forms, which permits dosing at a lower level than traditional treatment regimens. This often reduces or alleviates adverse side effects associated with higher dosages, for example, nausea, vomiting, orthostatic hypotension, hallucinations, delirium, or dyskinesia.
  • dopamine is administered via an implantable device of the invention in conjunction with another therapy.
  • dopamine agonist may be administered via implantable devices of the invention in conjunction with levodopa, dopamine agonists, catechol-O-methyltransferase (COMT) inhibitors, or monoamine oxidase (MAO) inhibitors, administered orally or intravenously.
  • CCT catechol-O-methyltransferase
  • MAO monoamine oxidase
  • Some methods of the invention include coadministration of another substance or substances in conjunction with dopamine agonist.
  • an anti- inflammatory agent or agents such as a steroid, a NSAID, and/or an antihistamine
  • an implantable device may be administered via an implantable device, by local, systemic, or subcutaneous injection, or orally, in conjunction with administration of dopamine agonist in an implantable device of the invention, to reduce or prevent inflammation caused by the agonist(s) at the site of administration of the implant.
  • the anti-inflammatory agent(s) is administered via an implantable device, it may be included in the same implant as dopamine agonist or in a separate implantable device.
  • An implantable device may include one or more of the anti-inflammatory agents described above.
  • the amount of anti-inflammatory agent administered is an amount expected to be effective to reduce local inflammation associated with administration of dopamine agonist in an implanted device of the invention.
  • an antioxidant may be included in the dopamine agonist implant to prevent oxidation of the dopamine agonist(s) during preparation, storage, and/or administration of the implant.
  • the amount of antioxidant inco ⁇ orated into the implant is an amount sufficient to prevent oxidation of at least a portion, typically substantially all of the dopamine agonist in the implant.
  • Parkinson's disease patients including, for example, "de novo” patients, e.g, patients who have not previously received treatment, "early stage” patients, e.g., patients who have been treated for a short period of time with another therapy such as levodopa administration but who are not exhibiting adverse side effects from the other therapy, "late stage” patients, e.g., patients who are exhibiting side effects associated with chronic treatment with another therapeutic substance such as levodopa, and "fluctuators," e.g. , patients for whom treatment with another substance such as levodopa fluctuates in effectiveness in an "on'V'off manner.
  • Methods of the invention may be used, for example, to decrease motor fluctuations and dyskinesias for treatment of "late stage” patients with motor fluctuations.
  • Continuous dosing via an implantable device of the invention may decrease "off' time and decrease dyskinesias.
  • the methods may also be Used, for example, to prevent motor fluctuations and dyskinesias in "early stage” patients who are undergoing pharmacologic therapy for the first time. This group often received monotherapy with a dopamine agonist.
  • Administration via an implantable device of the invention may allow continuous dopamine agonist receptor stimulation, thus decreasing the risk of motor fluctuations and dyskinesias later in treatment.
  • the methods may also be used, for example, to prevent motor fluctuations and dyskinesias in patients on dopamine agonist monotherapy who require 1-dopa supplementation. Since it is difficult to administer 1-dopa with linear dosing kinetics, and motor complications often emerge when 1-dopa is administered, continuous dosing via the implantable devices of the invention may allow continuous dopamine agonist receptor stimulation and decrease the risk of motor fluctuations and dyskinesias at this point in treatment.
  • kits for use in treatment of Parkinson's disease or another condition for which dopamine agonist administration is therapeutically beneficial, as described above.
  • the kits contain at least one implantable, nonerodible device of the type herein described, capable of delivering long-term therapeutic levels of dopamine agonist, in suitable packaging, along with instructions providing information to the user and/or health care provider regarding subcutaneous implantation and use of the system for treating a condition for which dopamine agonist administration is therapeutically beneficial, such as, for example, Parkinson's disease, toxin- or disease-induced parkinsonism, erectile dysfunction, restless leg syndrome, or hype ⁇ rolactinemia. Kits may also include literature discussing performance of the implantable devices of the invention.
  • kits of the invention may include implantable devices that include apomo ⁇ hine, lisuride, pergolide, bromocriptine, pramipexole, ropinerole, or rotigotine, or combinations of any of these dopamine agonists in the same or separate polymeric implants.
  • a kit includes one or more implantable devices that include encapsulated apomo ⁇ hine.
  • Kits may include a delivery system, i. e.
  • one or a multiplicity of implantable devices capable of providing sustained release of therapeutic levels of dopamine agonist, e.g., about 0.005 to about 100 ng/ml, about 0.01 to about 100 ng/ml, about 0.05 to about 0.65 ng/ml, about 0.2 to about 0.65 ng/ml, about 0.2 to about 45 hg/ml, or about 1 to about 20 ng/ml, for at least about 3 months.
  • Kits of the invention may include implantable devices each capable of in vivo release of dopamine agonist such that a plasma level of at least about 0.001, 0.005, 0.01, 0.02, 0.03, 0.04, 0.05, 0.06, 0.07, 0.08, 0.09, 0.1, 0.2, 0.3, 0.4, 0.5, 0.6, 0.7, 0.8, 0.9, 1, 5, 10, 25, 45, or 100 ng/ml is achieved at steady state.
  • Kits of the invention may include a delivery system capable of releasing about 0.1 to about 10, about 0.25 to about 5, or about 1 to about 3 mg/day dopamine agonist in vitro or in vivo.
  • the device(s) in a kit may include one or more substances in addition to dopamine agonist, such as one or more an anti-inflammatory agents, such as a steroid, NSAID, or antihistamine, and/or an antioxidant.
  • an implantable device or devices may be preloaded into an apparatus or apparatuses suitable for subcutaneous implantation of the device(s) into a patient, such as, for example, syringes or trocars.
  • Trifluoro Acetic Acid 99%, Spectrochemical grade, supplied by Aldrich Chemicals, St. Louis, MO
  • Implantable devices were prepared using an extrusion process in a
  • Microtruder device (Rancastle, RC-025-CF-RF).
  • EVA was ground into smaller particle sizes prior to extrusion.
  • the extrusion process was performed under argon gas to prevent oxidation of apomo ⁇ hine.
  • All blends of copolymer and drug(s) were prepared by rolling in a 120 ml amber bottle for approximately 10 minutes. The blend was then fed through the Microtruder.
  • Parameters that were used for extrusion of ApoH/EVA implants are shown in Table 1, and parameters used for extrusion of implants that included triancinolone ("TA”), glutathione ("GSH”), and/or LA are shown in Table 2.
  • the implants were then washed by placing them on an aluminum screen and immersing them in ethanol (approximately 50 ml per implant). The implants were washed for approximately 30, 60, or 120 minutes in the ethanol bath. The washed implants were air dried for 10 minutes and oven dried at 40° C for 1 hour before drying in a vacuum over for 24 hours at 30° C. The implants were packaged into 20 ml glass vials in the presence of argon gas, sealed, and then sterilized by gamma irradiation.
  • Example 2 - In Vitro Characterization of Extruded Implantable Devices [0052] Extruded rods prepared as described above were characterized for total drug load and for rate of drug release.
  • Implants prepared with 70% ApoH:30% EVA were cut into 2 mm pieces, accurately weighed, and placed into 250 ml volumetric flasks. Approximately

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CA2520613A CA2520613C (en) 2003-03-31 2004-03-31 Implantable polymeric device for sustained release of dopamine agonist
DE602004031512T DE602004031512D1 (de) 2003-03-31 2004-03-31 Polymeres implantat zur verzögerten freisetzung von dopamin antagonisten
PL04758809T PL1610791T3 (pl) 2003-03-31 2004-03-31 Wszczepialne urządzenie polimerowe do przedłużonego uwalniania agonisty dopaminy
EP04758809A EP1610791B1 (en) 2003-03-31 2004-03-31 Implantable polymeric device for sustained release of dopamine agonist
DK04758809.0T DK1610791T3 (da) 2003-03-31 2004-03-31 Implanterbar polymer anordning for vedvarende frigivelse af dopamin-agonist
HK06104808.8A HK1083682B (en) 2003-03-31 2004-03-31 Implantable polymeric device for sustained release of dopamine agonist
SI200431641T SI1610791T1 (sl) 2003-03-31 2004-03-31 Implantibilna polimerna naprava za zadržano sproščanje dopaminskega agonista
JP2006509657A JP5064794B2 (ja) 2003-03-31 2004-03-31 ドパミンアゴニストの徐放のための移植可能なポリマーデバイス
AT04758809T ATE499100T1 (de) 2003-03-31 2004-03-31 Polymeres implantat zur verzögerten freisetzung von dopamin antagonisten
AU2004228017A AU2004228017C1 (en) 2003-03-31 2004-03-31 Implantable polymeric device for sustained release of dopamine agonist
MXPA05010450A MXPA05010450A (es) 2003-03-31 2004-03-31 Dispositivo polimerico implantable para la liberacion prolongada de agonistas de dopamina.
NZ542548A NZ542548A (en) 2003-03-31 2004-03-31 Implantable polymeric device for sustained release of dopamine agonist
KR1020057018582A KR101152183B1 (ko) 2003-03-31 2004-03-31 도파민 아고니스트의 지속 방출을 위한 이식가능한 폴리머디바이스
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WO2010010136A1 (en) * 2008-07-24 2010-01-28 Boehringer Ingelheim International Gmbh Pharmaceutical composition comprising pramipexole and an anti-inflammatory agent for the treatment of parkinson's disease
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WO2011012723A1 (en) 2009-07-31 2011-02-03 Ascendis Pharma As Injectable sustained release compositions comprising a pramipexole prodrug
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JP2006522149A (ja) 2006-09-28
CY1111465T1 (el) 2015-08-05
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US20150151029A1 (en) 2015-06-04
KR20060015491A (ko) 2006-02-17
MXPA05010450A (es) 2005-11-04
JP5608581B2 (ja) 2014-10-15
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US9278163B2 (en) 2016-03-08
ATE499100T1 (de) 2011-03-15
HK1177895A1 (en) 2013-08-30
EP1610791B1 (en) 2011-02-23
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US20090162412A1 (en) 2009-06-25
CN102772357B (zh) 2014-12-31
PT1610791E (pt) 2011-05-23
NZ542548A (en) 2009-04-30
DE602004031512D1 (de) 2011-04-07
PL1610791T3 (pl) 2011-07-29
AU2004228017C1 (en) 2010-06-03
CA2520613C (en) 2012-12-04
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US20050031667A1 (en) 2005-02-10
US20120258161A1 (en) 2012-10-11
US8852623B2 (en) 2014-10-07
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JP2011087986A (ja) 2011-05-06

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