Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K49/00—Preparations for testing in vivo
  • A61K49/04—X-ray contrast preparations
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K49/00—Preparations for testing in vivo
  • A61K49/04—X-ray contrast preparations
  • A61K49/0433—X-ray contrast preparations containing an organic halogenated X-ray contrast-enhancing agent
  • A61K49/0438—Organic X-ray contrast-enhancing agent comprising an iodinated group or an iodine atom, e.g. iopamidol
• • 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 present invention generally relates to contrast media formulations and, more particularly, to nonionic x-ray contrast media formulations, radiological compositions containing such formulations and methods for x-ray visualization utilizing such compositions.
• the search for ideal contrast media for X-ray radiodiagnostic studies has extended over many decades. Bismuth subnitrate was the first radiocontrast agent used for visualization of the alimentary tract. Later, barium sulfate, a safer agent, was introduced. Barium sulfate has remained the most widely used radiographic agent for the alimentary tract (W.H. Strain, International Encyclopedia of Pharmacology and Therapeutics, Section 76, Vol. 1 , Radiocontrast Agents, Chapter 1 , Historical Development of Radiocontrast
• inorganic, insoluble oral agents like bismuth subnitrate and barium sulfate serve as valuable tools for gastrointestinal radiodiagnosis.
• urographic and angiographic X-ray procedures require intravascular administration of a safe, water-soluble, radiopaque contrast medium. Since the introduction of the water-soluble ionic triiodobenzoic acid derivatives, such as diatrizoic acid and iothalamic acid, in the early 1960's, radiographic visualization of the vascular system has become the most important application of X-ray contrast media.
• Such properties include the following to various degrees: (1) maximum x-ray opacity; (2) biological safety; (3) high water solubility; (4) chemical stability; (5) low osmolality; and (6) low viscosity.
• high osmolality can be correlated with undesirable physiologic adverse reactions to x-ray contrast media, e.g., nausea, vomiting, heat and pain.
• a significant advancement in the area of triiodobenzene based X-ray contrast media has been the development of non-ionic triiodobenzoic acid derivatives such as iopamidol, iohexol and ioversol.
• aqueous solutions of these non-ionic agents have less osmolality than previous agents and hence, provide greater patient comfort when injected.
• Adverse reactions, especially in the sensation of pain, warmth, and hemodynamic effects are greatly reduced as compared to the ionic triiodobenzoic acid derivatives.
• the viscosity values of these non-ionic formulations are higher than for formulations of ionic triiodobenzoic acid based contrast agents.
• Sovak describes a separate class of dimeric non-ionic X-ray contrast media with at least one primary carboxamide group as a substituent, an example of this class of dimers being losmin.
• the presence of primary carboxamide group conferred higher iodine content and sterically exposed the hydrophobic character of the neighboring iodine molecules ensuring the formation of aggregates and thus lowering the osmolality.
• Another attempt to optimize formulations involves combining a monomer with low viscosity value with a dimer of low osmolality value wherein the substituents on the iodinated aromatic groups are similar.
• 5,695,742 discloses injectable aqueous compositions comprising mixtures of nonionic iodinated aromatic monomers and non-ionic iodinated aromatic dimers having an intermediate osmolality value compared to the pure solutions wherein the mixtures are also disclosed as having a lower viscosity than expected.
• German Patent Application DE 19627309 discloses mixtures comprising monomers and dimers of ionic and non-ionic triiodoaromatic compounds as well as gadolinium complex compounds.
• the osmolality of such a mixture would be higher than the osmolality value for the pure nonionic dimer contrast agent.
• the present invention is directed to mixtures comprising at least one monomer and at least one dimer both derived from triiodinated benzene derivatives.
• the monomer corresponds to Formula I and the dimer corresponds to Formula II;
• A-,, Bi, and Di are independently -CON(R 3 )R 1 or -N(R)C(O)R 2 ;
• a 2 , A 3 , B 3 , and D 2 are independently -CON(R)R 1 or -N(R)C(O)R 2 provided, however, at least one of A 2 and A 3 is -CONH 2 ;
• E 2 and E 3 are independently selected from the group consisting of -CON(R)-, -N(R)C(O)- and -N(COR 2 )-; each R is independently H, a linear or branched (Ci - C 3 ) alkyl residue optionally substituted with one or more hydroxy, alkoxy or hydroxyalkoxy groups or combinations thereof, or a member of a (C 3 - C 7 ) cyclic residue, said cyclic residue being optionally interrupted by -0-, -S- or -NR -, and/or optionally substituted with one or more hydroxy,
• the present invention is further directed to mixtures comprising a monomer, a dimer, and at least one imaging agent other than the monomer and the dimer wherein the monomer corresponds to Formula I and the dimer corresponds to Formula II.
• the present invention is further directed to a method of diagnostic imaging, the method comprising administering to an individual a contrast agent comprising a mixture of at least one monomer and at least one dimer, the monomer corresponding to Formula I and the dimer corresponding to Formula II, and carrying out an imaging procedure on such individual.
• a contrast agent comprising a mixture of at least one monomer and at least one dimer, the monomer corresponding to Formula I and the dimer corresponding to Formula II, and carrying out an imaging procedure on such individual.
• contrast media compositions corresponding to mixtures of at least one monomer of Formula I and at least one dimer of Formulae II, wherein the dimers of Formula II contain at least one primary carboxamide substituent and the monomers of Formula I do not contain any primary carboxamide substituents, have unexpectedly and favorably lower osmolality and viscosity values than would be predicted based solely upon the contribution of the monomer and dimer in the mixture.
• the contrast media composition corresponds to a mixture of a monomer of Formula I and a dimer of Formula II.
• X-ray contrast media comprising a mixture of at least one monomer and at least one dimer of the present invention may be prepared with both improved viscosity and osmolality characteristics.
• mixtures of the present invention preferably comprise monomer and dimer in a weight ratio of iodine in the monomer and dimer, respectively, based on the iodine concentration in the mixture (e.g. in mg l/mL formulation).
• the weight ratio of iodine in the monomer to iodine in the dimer is about 1:20 to about 20:1.
• the mixture comprises the monomer and dimer in a weight ratio of about 1 :9 to about 9:1.
• the mixture comprises the monomer and dimer in a weight ratio of about 1 :5.7 to about 5.7:1.
• the mixture comprises the monomer and dimer in a weight ratio of about 1 :9 to about 1:1.
• the mixture comprises the monomer and dimer in a weight ratio of about 1 :3 to about 1 :1.
• Ai, Bi and Di are as previously defined.
• Ai and Bi are each -C(O)N(R 3 )R ⁇ and Di is -N(R)C(O)R 2 with each Ri, R 2 and R 3 of Ai, Bi and Di, being independently selected from the range, of substituents originally identified in connection with Formula I.
• Ai and Bi may be -CONHR 3 wherein each R 3 of Ai and B ⁇ is independently methyl, hydroxymethyl (-CH 2 OH), ethyl, hydroxyethyl (-CH 2 CH 2 OH or - CH(OH)CH 3 ), propyl, hydroxypropyl (-CH 2 CH 2 CH 2 OH) or d ⁇ hydroxypropyl (-
• each R 3 of Ai and Bi is independently hydroxyethyl (-CH 2 CH 2 OH or -CH(OH)CH 3 ), hydroxypropyl (- CH 2 CH 2 CH 2 OH) or dihydroxypropyl (-CH 2 CH(OH)CH 2 OH).
• the R and R 2 substituents of Di may independently be hydrogen, methyl, hydroxymethyl (-CH 2 OH), ethyl, hydroxyethyl (-CH 2 CH 2 OH or -CH(OH)CH 3 ), propyl, hydroxypropyl (-CH 2 CH 2 CH 2 OH), 2-methoxyethyl (- CH 2 CH 2 OCH 3 ), 1-methoxy-2-hydroxypropyl (-CH 2 CH(OH)C H 2 OCH 3 ), or dihydroxypropyl (-CH 2 CH(OH)CH 2 OH); more preferably, in this embodiment, the R and R 2 substituents of Di are preferably selected from methyl, hydroxymethyl (-CH 2 OH), hydroxyethyl (-CH 2 CH 2 OH), 2-methoxyethyl (-CH2CH2OCH3), and dihydroxypropyl (-CH 2 CH(OH)CH 2 OH).
• Ai and Bi may be -CON(CH 3 )R 3 wherein each R 3 of Ai and Bi is independently methyl, hydroxymethyl (-CH 2 OH), ethyl, hydroxyethyl (-CH 2 CH 2 OH or -CH(OH)CH 3 ), propyl, hydroxypropyl (-CH 2 CH 2 CH 2 OH) or dihydroxypropyl (- CH 2 CH(OH)CH 2 OH); more preferably, in this embodiment, each R 3 of A and Bi is independently hydroxyethyl (-CH 2 CH 2 OH or -CH(OH)CH 3 ), hydroxypropyl (- CH 2 CH 2 CH 2 OH) or dihydroxypropyl (-CH 2 CH(OH)CH 2 OH).
• the R and R 2 substituents of Di may independently be, hydrogen, methyl, hydroxymethyl (-CH 2 OH), ethyl, hydroxyethyl (-CH 2 CH 2 OH or -CH(OH)CH 3 ), propyl, hydroxypropyl (-CH 2 CH 2 CH 2 OH), 2-methoxyethyl (- CH 2 CH 2 OCH 3 ), 1-methoxy-2-hydroxypropyl (-CH 2 CH(OH)CH 2 OCH 3 ), or dihydroxypropyl (-CH 2 CH(OH)CH 2 OH); more preferably, in this embodiment, the R and R 2 substituents of Di are preferably selected from methyl, hydroxymethyl (-CH2OH)- hydroxyethyl (-CH 2 CH 2 OH), 2-methoxyethyl (-CH2CH2OCH3), and dihydroxypropyl (-CH 2 CH(OH)CH 2 OH).
• the contrast media comprises a monomer selected from the group consisting of: iomeprol ⁇ C ⁇ H 22 l 3 N 3 O 8 ; N,N'-bis(2,3-dihydroxypropyl)-5- [(hydroxyacetyl)methylamino]-2,4,6-triiodo-1 ,3-benzenedicarboxamide; CAS [RN] [78649-41-9] ⁇ ,
• Contrast media of the present invention also contain a dimer corresponding to Formula II
• Formula (II) wherein A 2 , A 3 , B 3 , D 2 , E 2 , E 3 and X are as previously defined.
• X is methylene (-CH 2 -) or ethylene (-CH 2 CH 2 -), preferably methylene, and A 2 , A 3 , B 3 , D 2 , E 2 and E 3 are as originally defined in connection with Formulae I and II.
• each of A 2 and A 3 is -C(O)NH 2
• each of B 3 and D 2 is -C(O)N(R)R ⁇
• E 2 , E 3 , and X and each R and Ri are as originally defined in connection with Formulae I and II.
• each of A 2 and A 3 is -C(O)NH 2
• each of B 3 and D 2 is -CONHR
• E 2 , E 3 , and X and each R are as originally defined in connection with Formulae I and II.
• each of A 2 and A 3 is -C(O)NH
• each of B 3 and D 2 is -C(O)NHR ⁇
• -E 2 -X-E 3 - is -N(R)C(O)CH 2 C(O)N(R)- and each R and R ⁇ is as originally defined in connection with Formulae I and II.
• each of A 2 and A 3 is -C(O)NH 2
• each of B 3 and D 2 is -CONHR
• -E 2 -X-E 3 - is -N(R)C(O)CH 2 C(O)N(R)-
• each R and Ri is independently selected from hydrogen, methyl, hydroxymethyl (-CH 2 OH), ethyl, hydroxyethyl (-CH 2 CH 2 OH or -CH(OH)CH 3 ), propyl, hydroxypropyl (-CH 2 CH 2 CH 2 OH) or dihydroxypropyl (-CH 2 CH(OH)CH 2 OH); more preferably, in this embodiment, each R and Ri is independently hydroxyethyl, hydroxypropyl, or dihydroxypropyl.
• the contrast media comprises iosmin (also known as iosimenol) ⁇ C 3 ⁇ H 36 l 6 N 6 ⁇ 4 ; 5,5'-[(1 ,3-dioxo-1 ,3-propanediyl) bis[(2,3-dihydroxypropyl) imino]]bis[N-(2,3-dihydroxy propyl)-2,4,6-triiodo-1 ,3-benzenedicarboxamide; CAS [RN] [181872-90-2] ⁇ as the dimer:
• the contrast media comprises the dimer of Formula II, preferably iosmin, together with one or more monomers selected from the group consisting of iomeprol, ioversol, iohexol, iopamidol, iopromide, iobitridol and iopentol, preferably ioversol, iohexol, and iopamidol, and more preferably ioversol.
• the contrast media of the present invention further comprisesan imaging agent of a class not corresponding to either of Formulae I and II.
• the contrast media may additionally comprise X-ray contrast imaging agents not corresponding to Formula I or II.
• the contrast media may comprise other types of imaging agents such as ultrasound, magnetic resonance (MR), radionuclide, and optical imaging agents and may be used for other imaging applications.
• imaging agents such as ultrasound, magnetic resonance (MR), radionuclide, and optical imaging agents and may be used for other imaging applications.
• Other types of imaging agents are described in H.S Thomsen, R.N. Muller and R.F. Mattrey, Editors, Trends in Contrast Media, (Berlin: Springer-Verlag, 1999); and E.M. Sevick-Muraca, et al., Near-Infrared Imaging with Fluorescent Contrast Agents, In: M.-A. Mycek and B.W.
• Radiological compositions may be prepared containing the above mentioned mixtures of iodinated nonionic compounds as an x-ray contrast agent together with a pharmaceutically acceptable radiological vehicle by following established methods used to manufacture such injectable formulations.
• Radiological vehicles include those that are suitable for injection such as aqueous buffer solutions; e.g., tris(hydroxymethyl) amino methane (and its salts), phosphate, citrate, bicarbonate, etc., sterile water for injection, physiological saline, and balanced ionic solutions containing chloride and/or bicarbonate salts of normal blood plasma cations such as Ca, Na, K and Mg, and other halides, carbonates, sulphates, phosphates of Na, K, Mg, Ca.
• buffer solutions are described in Remington's Practice of Pharmacy, Eleventh Edition, for example on page 170.
• the vehicles may advantageously contain a small amount (e.g., from about 0.01 to about 15.0 mole %) of a chelating agent such as ethylenediamine tetraacetic acid (EDTA), calcium disodium EDTA, or other pharmaceutically acceptable chelating agents such as calcium monosodium DTPA-BMEA (Versetamide; Mallinckrodt Inc.).
• a chelating agent such as ethylenediamine tetraacetic acid (EDTA), calcium disodium EDTA, or other pharmaceutically acceptable chelating agents such as calcium monosodium DTPA-BMEA (Versetamide; Mallinckrodt Inc.).
• the composition further comprises non-radiographic additives selected from the group consisting of excipients, such as, for example, glycerol, polyethylene glycol or dextran, and anticlotting agents, such as, for example, heparin or hirudin.
• the concentration of the x-ray contrast agent of the present invention in the pharmaceutically acceptable vehicle, e.g., water, will vary with the particular field of use. A sufficient amount is present to provide satisfactory x-ray visualization.
• the concentration of iodine is broadly about 100 to about 500 mg/ml, preferably about 140 to about 400 mg/ml, and the dose is in the range of 25-300 ml.
• the radiological composition is administered so that the contrast agent remains in the living animal body for about 0.5 to 3 hours, although shorter or longer residence periods are acceptable as needed.
• the mixture disclosed herein and analogous mixtures may be formulated conveniently in vials, bottles, ampules or prefilled syringes containing 10 to 2000 ml of an aqueous solution. These containers may be made of glass, plastic or other materials suitable for pharmaceutical products.
• the mixtures of this invention may be formulated as micelles, liposomes and micro/nano particles. These formulations may enhance delivery and localization of the inventive compositions to/at the desired organ or site.
• the target specificity of these formulations can be enhanced by incorporating suitable targeting molecules such as peptides, saccharides, fatty acids, and the like. Preparation and uses of these formulations are well known in the art.
• the diagnostic compositions of the invention are used in the conventional manner.
• the compositions may be administered to a patient, typically a warm-blooded animal, either systemically or locally to the organ or tissue to be imaged, optimally using a power injector when appropriate, and the patient then subjected to the imaging procedure.
• a power injector when appropriate, and the patient then subjected to the imaging procedure.
• an amount of the radiological composition sufficient to provide adequate visualization, is injected into the coronary system and the system is scanned with a suitable device such as a fluoroscope.
• the agent may be used in various other radiographic procedures e.g., in cardiography, coronary arteriography, aortography, cerebral and peripheral angiography, orthography, intravenous pyelography and urography.
• X-ray contrast Imaging Procedures are found in Albert A. Moss, M. D., Gordon Gamsu, M. D., and Harry K. Genant, M. D., Computed Tomography of the Body, (Philadelphia, PA: W. B. Saunders Company, 1992) and M. Sovak, Editor, Radiocontrast Agents, ( Berlin: Springer-Verlag, 1984 ).
• the following examples illustrate the invention and are not limiting.
• osmolality is determined at 37°C using the Wescor 5500 Vapor Pressure Osmometer. Viscosity is determined at 25°C and 37°C using Brookfield Analog Micro Viscometer Model LVT or Digital Model DV-II+ Cone/Plate Viscometer.
• Example 1 r0028]1A 320 mgl/ml losimenol Injection formulation: 62.13 grams of losimenol, 0.224 grams of Tromethamine, 0.1 grams of Edetate calcium disodium and 0.22 grams of NaCI were mixed in 75 ml of water for injection (WFI) at room temperature (RT) until completely dissolved. The pH was adjusted to ⁇ 6.8 using 1 N hydrochloric acid solution or 1N sodium hydroxide solution and the formulation was brought up to the final volume of 100 ml with WFI. A 50 ml aliquot of the above formulation in a bottle was autoclaved at 121°C for 20 minutes.
• OPTIRAY-320 contains 678 mg of ioversol with 3.6 mg of tromethamine as a buffer, 0.2 mg of edetate calcium disodium as a stabilizer with pH adjusted between 6 and 7.4 with hydrochloric acid or sodium hydroxide. A portion of this mixed formulation was autoclaved at 121°C for 20 minutes. [0030] Autoclaved and unautoclaved samples were tested for osmolality (at 37°C) and viscosity (at 25°C and 37°C) values using established methods and the values are tabulated (Table 1 ).
• Table 1 summarizes the osmolality and viscosity of the losimenol for Injection, Experiment 1A, before and after autoclave (Nos. 1 and 2 respectively), and of the mixed MRCM formulation, Experiment 1B, before and after autoclave (Nos. 3 and 4 respectively).
• the osmolality and viscosity values for the autoclaved and unautoclaved samples are comparable. Therefore, subsequent samples were not autoclaved.
• Example 2 [0031] A 320 mgl/ml losimenol formulation was prepared following the procedure defined in Example 1A, except no NaCI was added. The formulation was not autoclaved. [0032]An Ioversol 320 mgl/ml formulation (OPTIRAY-320) was mixed with the above losimenol formulation in different ratios. Osmolality (at 37°C) and viscosity (at 25°C and 37°C) were measured for the starting samples and the unautoclaved, mixed samples following established methods. The results are summarized in Table 2. For sample set Nos. 1 , 3 and 4, the individual (losimenol and Ioversol) and the mixed samples were tested on the same day. For sample set No.
• Example 3 The autoclaved losimenol Injection formulation (IF) sample from Example 1A was diluted to a concentration of 300 mgl/ml with WFI.
• IF autoclaved losimenol Injection formulation
• Each milliliter of OPTIRAY-300 contains 636 mg of ioversol with 3.6 mg of tromethamine as a buffer, 0.2 mg of edetate calcium disodium as a stabilizer and the pH was adjusted between 6 and 7.4 with hydrochloric acid or sodium hydroxide.
• Each milliliter of ISOVUE-300 contains 612 mg of iopamidol with 1 mg tromethamine as a buffer, 0.39 mg edetate calcium disodium as a stabilizer and the pH adjusted between 6.5 and 7.5 with hydrochloric acid or sodium hydroxide.
• OMNIPAQUE-300 contains 647 mg of iohexol, 1.21 mg tromethamine, 0.1 mg edetate calcium disodium and the pH adjusted between 6.8 and 7.7 with hydrochloric acid or sodium hydroxide.
• Example 4 A 320 mgl/ml losimenol Injection formulation was made as described in Example 1A. To 10 ml of the losimenol formulation was mixed with 1.059 grams of Ioversol powder to give 370 mgl/ml of mixed formulation (13.5% iodine from monomer/86.5% iodine from dimer). The osmolality at 37°C was determined to be 277 mOsm/kg. The viscosity value at 37°C was determined to be 9.1 centipoise (cps).

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