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
  • A61K31/33—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
  • A61K31/47—Quinolines; Isoquinolines
  • A61K31/4738—Quinolines; Isoquinolines ortho- or peri-condensed with heterocyclic ring systems
  • A61K31/4745—Quinolines; Isoquinolines ortho- or peri-condensed with heterocyclic ring systems condensed with ring systems having nitrogen as a ring hetero atom, e.g. phenantrolines
• • 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
  • A61K9/0014—Skin, i.e. galenical aspects of topical compositions
• • 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
  • A61P35/00—Antineoplastic agents
• • 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
  • A61K9/06—Ointments; Bases therefor; Other semi-solid forms, e.g. creams, sticks, gels

Definitions

• the present invention relates to topical treatment of actinic keratosis lesions using immune response modifier compounds.
• Certain lH-imidazo[4,5-c]quinolin-4-amines and 1- and 2-substituted derivatives thereof were later found to be useful as antiviral agents, bronchodilators and immunomodulators. Subsequently, certain substituted lH-imidazo[4,5-c] pyridin-4-amine, quinolin-4-amine, tetrahydroquinolin-4-amine, naphthyridin-4-amine, and tetrahydronaphthyridin-4-amine compounds as well as certain analogous thiazolo and oxazolo compounds were synthesized and found to be useful as immune response modifiers, rendering them useful in the treatment of a variety of disorders.
• IRM compounds are disclosed in U.S. Patent Nos. 5,238,944; 5,939,090; and 6,425,776; European Patent 0 394 026; and U.S. Patent Publication 2003/0199538. Many such formulations include preservatives such as methylparaben, sorbic acid, propylene glycol, etc.
• preservatives such as methylparaben, sorbic acid, propylene glycol, etc.
• the mechanism for the antiviral and antitumor activity of these IRM compounds is thought to be due in substantial part to enhancement of the immune response by induction of various important cytokines (e.g., interferons, interleukins, tumor necrosis factor, etc.).
• Such compounds have been shown to stimulate a rapid release of certain monocyte/macrophage- derived cytokines and are also capable of stimulating B cells to secrete antibodies, which play an important role in these IRM compounds' antiviral and antitumor activities.
• One of the predominant immunostimulating responses to these compounds is the induction of interferon (IFN)- ⁇ production, which is believed to be very important in the acute antiviral and antitumor activities seen.
• IFN interferon
• up regulation of other cytokines such as, for example, tumor necrosis factor (TNF), Interleukin-1 (IL-I) and IL-6 also have potentially beneficial activities and are believed to contribute to the antiviral and antitumor properties of these compounds.
• TNF tumor necrosis factor
• IL-I Interleukin-1
• IL-6 also have potentially beneficial activities and are believed to contribute to the antiviral and antitumor properties of these compounds.
• IRMs the ability to provide therapeutic benefit via topical application of an IRM compound for treatment of a particular condition at a particular location may be hindered by a variety of factors. These factors include: irritation of the skin to which the formulation is applied; formulation wash away; insolubility and/or degradation of the IRM compound in the formulation; physical instability of the formulation (e.g., separation of components, thickening, precipitation/agglomerization of active ingredient, and the like); poor permeation; undesired systemic delivery of the topically applied IRM compound; concentration of the IRM compound applied; frequency of application; and duration of application.
• factors include: irritation of the skin to which the formulation is applied; formulation wash away; insolubility and/or degradation of the IRM compound in the formulation; physical instability of the formulation (e.g., separation of components, thickening, precipitation/agglomerization of active ingredient, and the like); poor permeation; undesired systemic delivery of the topically applied IRM compound; concentration of the IRM compound applied; frequency of
• the present invention provides methods of treating actinic keratosis (AK).
• Actinic keratoses are premalignant lesions considered biologically to be either carcinoma in-situ or squamous intraepidermal neoplasia.
• AK is the most frequent epidermal tumor and is induced by ultraviolet (UV) radiation, typically from sunlight. Because of its precancerous nature, AK may be considered the most important manifestation of sun-induced skin damage.
• the method includes applying topically to a surface (e.g., dermal or mucosal surface) of a patient in need thereof (i.e., a patient with actinic keratosis lesions) a pharmaceutical formulation that includes 2-methyl-l-(2-methylpropyl)-lH-imidazo[4,5-c][l,5]naphthyridin- 4-amine.
• a pharmaceutical formulation that includes 2-methyl-l-(2-methylpropyl)-lH-imidazo[4,5-c][l,5]naphthyridin- 4-amine.
• the amount of 2-methyl- 1 -(2-methylpropyl)- 1 H-imidazo [4,5-c] [ 1 ,5]naphthyridin-4- amine present in a topical formulation of the invention will be about 0.3 wt-%, based on the total weight of the formulation.
• the formulations can be prepared using the free base form or salts of l-(2-methylpropyl)-lH-imidazo[4,5-c][l,5]naphthyridin-4-amine.
• the salt form is used in an amount sufficient to provide the equivalent of about 0.3% by weight of the free base.
• formulations containing IRM compounds such as 2-methyl-l-(2-methylpropyl)-lH-imidazo[4,5-c][l,5]naphthyridin-4- amine in combination with sorbic acid may suffer impaired stability of both the IRM compound and the sorbic acid.
• addition of a pharmaceutically acceptable antioxidant compound to such formulations can reduce degradation of the IRM compound and sorbic acid, thereby providing improved stability.
• Sorbic acid and related salts and esters are often used as preservative systems and can be particularly suitable for use in a multi-dose dispenser formulation (see, for example, U.S. Patent No. 6,245,776 (Skwierczynski et al.)), but stability is an important issue for formulations and can reduce shelf life of a product or even jeopardize regulatory approvability. It has been discovered that stability can be improved through the addition of a compound acting as an antioxidant. The antioxidant may beneficialally have hydrogen atom donating functionality. Moreover, when an antioxidant compound is included with the IRM compound and sorbic acid, stability of the formulation may be further improved by adding a chelating agent.
• the method of the present invention use a pharmaceutical formulation that includes: about 0.3 by weight (wt-%) 2-methyl-l-(2-methylpropyl)-lH- imidazo[4,5-c][l,5]naphthyridin-4-amine; a preservative system that includes sorbic acid, esters thereof, salts thereof, or combinations thereof; and an antioxidant.
• a chelating agent may also beneficially be included.
• the method of the present invention uses a pharmaceutical formulation that includes: about 0.3 wt-% 2-methyl-l-(2-methylpropyl)-lH-imidazo[4,5- c][l,5]naphthyridin-4-amine; a preservative system that includes a sorbic acid preservative selected from the group consisting of sorbic acid, esters thereof, salts thereof, and combinations thereof; an antioxidant (preferably having hydrogen atom donating functionality); a fatty acid; and a hydrophobic, aprotic component miscible with the fatty acid and having a hydrocarbyl group of 7 or more carbon atoms.
• a chelating agent may also beneficially be included.
• the method of the present invention uses a pharmaceutical formulation that includes: about 0.3 wt-% 2-methyl-l-(2-methylpropyl)-lH-imidazo[4,5- c][l,5]naphthyridin-4-amine; 0.001% by weight to 0.2% by weight of an antioxidant having hydrogen atom donating functionality; 0 to 0.1% by weight of a chelating agent; 1% by weight to 30% by weight of a fatty acid; 1% by weight to 15% by weight of a medium-chain triglyceride; 0.2% by weight to 2.0% by weight of a viscosity enhancing agent; 0.1% by weight to 6.0% by weight of an emulsifier; and water; wherein the formulation has a p ⁇ of 4.0 to 6.0 and the weight percentages are based on the total weight of the formulation.
• the preservative system includes: 0.02% by weight to 0.2% by weight of a sorbic acid preservative selected from the group consisting of sorbic acid, esters thereof, salts thereof, and combinations thereof; 0 to 10.0% by weight of a preservative enhancing solubilizer; and 0.05% by weight to 0.2% by weight of a secondary preservative compound.
• a "sorbic acid preservative" means sorbic acid, esters of sorbic acid, salts of sorbic acid, or combinations thereof.
• sorbic acid preservative in an IRM-containing formulation does not decrease by more than 15% of the initial concentration (i.e., its concentration when initially formulated) when stored for at least 6 months at 40 0 C and 75% relative humidity.
• a or “an” or “the” are used interchangeably with “at least one,” to mean “one or more” of the listed element.
• the present invention provides methods that include applying topically (e.g., to a dermal or mucosal surface) of a patient in need thereof (i.e., a patient with actinic keratosis lesions) a pharmaceutical formulation that includes 2-methyl-l -(2-methylpropyl)- IH- imidazo[4,5-c] [1 ,5]naphthyridin-4-amine.
• Formulations according to the present invention can be applied to any suitable location, for example topically to dermal and/or mucosal surfaces, or internally to a particular tissue location having actinic keratosis lesions.
• the therapeutic effect of the IRM compound typically extends only to the superficial layers of the dermal surface or to tissues below the dermal surface.
• another aspect of the present invention is directed to a method for the treatment of actinic keratosis lesions by applying to skin or other surface including AK lesions one of the formulations described herein.
• actinic keratosis lesions also includes pre-actinic keratosis lesions.
• the amount of 2-methyl- 1 -(2-methylpropyl)- 1 H-imidazo[4,5- c][l,5]naphthyridin-4-amine present in a topical formulation of the invention will be about 0.3 wt-% upon addition, based on the total weight of the formulation.
• “upon addition” means that the amount of the compound is reported as that amount added to the formulation upon preparation of the formulation.
• the formulations used in the examples below were prepared using the free base form of l-(2-methylpropyl)-lH-imidazo[4,5-c][l,5]naphthyridin- 4-amine.
• formulations can be prepared using a pharmaceutically acceptable salt of l-(2-methylpropyl)-lH-imidazo[4,5-c][l,5]naphthyridin-4-amine.
• the salt form is used in an amount sufficient to provide the equivalent of about 0.3% by weight of l-(2- methylpropyl)-lH-imidazo[4,5-c][l,5]naphthyridin-4-amine free base.
• a formulation prepared using 0.34% by weight of the hydrochloride salt of 1 -(2-methylpropyl)- lH-imidazo[4,5-c][l,5]naphthyridin-4-amine would contain the equivalent of about 0.3% 1-
• Formulations used in delivering 2-methyl-l-(2-methylpropyl)-lH-imidazo[4,5- c][l,5]naphthyridin-4-amine can include a preservative system, an antioxidant, a chelating agent, a fatty acid, a hydrophobic component, a viscosity enhancing agent, an emulsifier, a p ⁇ adjuster, and combinations thereof.
• formulations used in delivering 2-methyl-l-(2-methylpropyl)- lH-imidazo[4,5-c][l,5]naphthyridin-4-amine typically include a preservative system that includes a sorbic acid preservative (i.e., sorbic acid, esters of sorbic acid, salts of sorbic acid, or combinations thereof).
• a sorbic acid preservative i.e., sorbic acid, esters of sorbic acid, salts of sorbic acid, or combinations thereof.
• an antioxidant more preferably an antioxidant having hydrogen atom donating functionality. Additional stability, particularly of the antioxidant, can be obtained through the incorporation of a chelating agent.
• the concentration of the sorbic acid preservative in an IRM-containing formulation remains substantially constant relative to its initial concentration (i.e., its concentration when initially formulated) when stored for at least 6 months at 4O 0 C and 75% relative humidity.
• the concentration of sorbic acid preservative in an IRM-containing formulation does not decrease by more than 15% of the initial concentration (i.e., its concentration when initially formulated) when stored for at least 6 months at 40°C and 75% relative humidity.
• the concentration of the sorbic acid preservative in an IRM-containing formulation does not decrease by more than 10% of the initial concentration when stored for at least 6 months at 40°C and 75% relative humidity.
• the concentration of the sorbic acid preservative in an IRM-containing formulation does not decrease by more than 5% of the initial concentration when stored for at least 6 months at 40 0 C and 75% relative humidity.
• formulations described herein can be in the form of an oil-in- water emulsion such as a cream or a lotion.
• an emulsion can include an oil phase that includes one or more IRM compounds, a fatty acid in an amount sufficient to solubilize the IRM compound(s), a hydrophobic, aprotic component; and an aqueous phase that includes a preservative system, and a hydrophilic viscosity enhancing agent.
• Such components, as well as all others of the formulations described herein, are preferably pharmaceutically acceptable.
• formulations used in delivering 2-methyl-l-(2-methylpropyl)- lH-imidazo[4,5-c][l,5]naphthyridin-4-amine include a preservative system.
• the preservative system includes one or more compounds that inhibit microbial growth (e.g., fungal and bacterial growth) within the formulation (for example, during manufacturing and use).
• a preservative system includes at least one preservative compound chosen from methylparaben, ethylparaben, propylparaben, phenoxyethanol, iodopropynyl butylcarbamate, sorbic acid, a fatty acid monoester of glycerin such as glycerol monolaurate (e.g., poly(ethylene glycol)(4) monolaurate), and a fatty acid monoester of propylene glycol such as propylene glycol monocaprylate.
• glycerol monolaurate e.g., poly(ethylene glycol)(4) monolaurate
• propylene glycol such as propylene glycol monocaprylate.
• the preservative system can include at least one preservative compound chosen from sorbic acid, esters or salts thereof, such as, for example, isopropyl sorbate, calcium sorbate, potassium sorbate, sodium sorbate, and triethanolamine sorbate. Combinations of these may be used in formulations of the present invention. Such preservatives adversely affect the stability of the formulations as described herein.
• the preservative system in addition to the sorbic acid preservative, will generally include at least one additional (i.e., secondary) preservative compound, such as, for example, methylparaben, ethylparaben, propylparaben, butylparaben, and phenoxyethanol. Various combinations of these compounds can be included in the preservative system.
• the secondary preservative compound is methylparaben.
• the preservative system may also include a preservative enhancing solubilizer which enhances the solubility of the preservative in the aqueous phase, examples of which include diethylene glycol monoethyl ether, propylene glycol, and poly(ethylene glycol)(4) monolaurate. Combinations of such enhancing solubilizers can be used in formulations of the present invention.
• a preservative such as a sorbic acid preservative (i.e., sorbic acid, esters or salts thereof, or combinations thereof) is preferably present in a formulation in an amount of at least 0.005% by weight, more preferably at least 0.01% by weight, even more preferably at least 0.02% by weight, even more preferably at least 0.05% by weight, and even more preferably at least 0.08% by weight, based on the total weight of the formulation.
• a sorbic acid preservative i.e., sorbic acid, esters or salts thereof, or combinations thereof
• the preservative is preferably present in a formulation in an amount of no greater than 1% by weight, more preferably no greater than 0.5% by weight, even more preferably no greater than 0.2% by weight, even more preferably no greater than 0.12% by weight, and even more preferably, no greater than 0.10% by weight, based on the total weight of the formulation.
• the secondary preservative compound is present in an amount of at least 0.01% by weight, such as for example, at least 0.02%, at least 0.03%, at least 0.04%, and at least 0.05%, by weight based on the total weight of the formulation. In other embodiments of the invention the secondary preservative compound is present in an amount of at most 0.5 %, such as for example, at most 0.4%, at most 0.3%, and at most 0.2%, by weight based on the total weight of the formulation.
• propylene glycol is present in an amount of at least 1.0% by weight, such as for example, at least 2.0%, at least 3.0%, at least 4.0%, and at least 5.0%, by weight based on the total weight of the formulation. In other embodiments of the present invention, propylene glycol is present in at most 10.0% by weight, such as for example, at most 8.0%, at most 6.0%, and at most 5.0%, by weight based on the total weight of the formulation.
• formulations used in delivering 2-methyl-l-(2-methylpropyl)- lH-imidazo[4,5-c][l,5]naphthyridin-4-amine include an antioxidant.
• the stability issue of the IRM/sorbic acid preservative combination can be addressed through the addition of one or more antioxidants.
• Antioxidants suitable for use herein are those that inhibit the autoxidation of the sorbic acid preservative.
• antioxidants having hydrogen atom donating functionality have demonstrated much greater improvement than others.
• autoxidation intermediates typically, radicals
• Suitable antioxidants are those that are pharmaceutically acceptable and described in the International Cosmetic Ingredient Dictionary and Handbook, Ninth Edition, Volume 4, 2002, and in the USP NF 2004: The United States Pharmacopeia, 27 th Revision and The National Formulary, 22 nd Edition.
• antioxidants examples include ascorbic acid (D and/or L enantiomers), ascorbyl palmitate (D and/or L enantiomers), butylated hydroxyanisole (BHA), butylated hydroxytoluene (BHT), cysteine (D and/or L enantiomers), propyl gallate, sodium formaldehyde sulfoxylate, sodium thiosulfate, sulfur dioxide, and tocopherol.
• ascorbic acid D and/or L enantiomers
• ascorbyl palmitate D and/or L enantiomers
• BHA butylated hydroxyanisole
• BHT butylated hydroxytoluene
• cysteine D and/or L enantiomers
• propyl gallate sodium formaldehyde sulfoxylate
• sodium thiosulfate sulfur dioxide
• tocopherol examples include ascorbic acid (D and/or L enantiomers), ascorbyl palmitate
• Preferred antioxidants are those containing hydrogen atom donating functional groups.
• examples of such antioxidants include ascorbic acid, ascorbyl palmitate, BHT, BHA, cysteine, propyl gallate, sodium formaldehyde sulfoxylate, and tocopherol.
• More preferred antioxidants are those containing aromatic hydroxy groups capable of hydrogen atom donation. Examples of such antioxidants include BHA, BHT, propyl gallate, and tocopherol.
• antioxidants are BHA and BHT, which can be used in combination.
• the antioxidant is preferably present in a fo ⁇ nulation in an amount of at least 0.001% by weight, more preferably at least 0.005% by weight, even more preferably at least 0.008% by weight, and even more preferably at least 0.01% by weight, based on the total weight of the formulation.
• the antioxidant is preferably present in a formulation in an amount of no greater than 0.3% by weight, more preferably no greater than 0.2% by weight, and even more preferably no greater than 0.012% by weight, and even more preferably no greater than 0.1% by weight, based on the total weight of the formulation.
• the sorbic acid preservative (i.e., sorbic acid/ester/salt) to antioxidant weight ratio is preferably at least 1 :20, more preferably at least 1:1, and even more preferably at least 5:1.
• the sorbic acid to antioxidant weight ratio is preferably no greater than 1000:1, more preferably no greater than 20:1, and even more preferably no greater than 10:1.
• formulations used in delivering 2-methyl-l-(2-methylpropyl)- lH-imidazo[4,5-c][l,5]naphthyridin-4-amine include a chelating agent.
• the chelating agent functions to stabilize the antioxidant(s) present in the formulation.
• Chelating agents are compounds that complex with metal ions. Suitable chelating agents are those that are pharmaceutically acceptable and described in the International Cosmetic Ingredient Dictionary and Handbook, Ninth Edition, Volume 4, 2002.
• Suitable chelating agents include ethylenediaminetetraacetic acid (EDTA) and citric acid, hydrates thereof, salts thereof, and hydrates of the salts thereof.
• EDTA ethylenediaminetetraacetic acid
• examples of such chelating agents include ethylenediaminetetraacetic acid disodium salt, ethylenediaminetetraacetic acid disodium salt dihydrate, and citric acid monohydrate.
• EDTA ethylenediaminetetraacetic acid
• citric acid monohydrate ethylenediaminetetraacetic acid disodium salt
• Various combinations of chelating agents can be used if desired.
• the chelating agent is preferably present in a formulation in an amount of at least 0.001% by weight, more preferably at least 0.005% by weight, even more preferably at least 0.01% by weight, and even more preferably at least 0.05% by weight, based on the total weight of the formulation.
• the chelating agent is preferably present in a formulation in an amount of no greater than 0.2% by weight, and more preferably no greater than 0.1% by weight, based on the total weight of the formulation.
• the antioxidant to chelating agent weight ratio is preferably at least 1 :200, more preferably at least 1:10, and even more preferably at least 1:5.
• the antioxidant to chelating agent weight ratio is preferably no greater than 300: 1 , more preferably no greater than 10:1, and even more preferably no greater than 2:1.
• formulations used in delivering 2-methyl-l-(2-methylpropyl)- lH-imidazo[4,5-c][l,5]naphthyridin-4-amine include a fatty acid.
• fatty acid means a carboxylic acid, either saturated or unsaturated having 6 to 28 carbon atoms, such as, for example, from 10 to 22 carbon atoms.
• Non-limiting examples of such fatty acids include isostearic acid, oleic acid, and linear- or branched-chain carboxylic acids of 6 to 18 carbon atoms.
• the fatty acid may be present in the formulation in an amount sufficient to solubilize the IRM compound.
• the amount of the fatty acid is at least 0.05% by weight, at least 1.0% by weight, at least 3.0% by weight, at least 5.0%, at least 10%, at least 15%, or at least 25%, based on the total weight of the formulation. In certain embodiments, the amount of the fatty acid is at most 40% by weight, at most 30% by weight, at most 15% by weight, or at most 10%, based on the total weight of the formulation.
• the fatty acid component of the formulation can comprise one or more fatty acids.
• formulations used in delivering 2-methyl-l-(2-methylpropyl)- lH-imidazo [4,5-c] [ 1 ,5]naphthyridin-4-amine include a hydrophobic, aprotic component miscible with the fatty acid and comprising a hydrocarbyl group of 7 or more carbon atoms.
• hydrophobic is meant that the component is essentially insoluble in water, i.e. immiscible with water and unable to form a micelle in water, and does not contain polyoxyethylene or acid salt groups.
• the hydrophobic, aprotic component has a hydrophilic lipophilic balance ( ⁇ LB) of less than 2.
• the ⁇ LB of a component may be determined as described, for example, in Attwood, D., Florence, A. T. Surfactant Systems: Their Chemistry, Pharmacy, and Biology; New York: Chapman & Hall, 471-473, 1983.
• aprotic is meant that the component cannot donate a proton to the IRM and does not contain groups such as carboxyl, hydroxy, primary and secondary amino, primary and secondary amido, or quaternary ammonium groups.
• this component has a pKa of at least 14.2 and does not substantially solubilize or form a complex such as an acid-base pair or complex or a hydrogen bond complex with the IRM compound.
• not substantially is meant that the ratio of the IRM compound's solubility in the hydrophilic, aprotic component to that in isostearic acid is less than 1 :40.
• Formulations intended for dermal or topical use typically have amounts of an oil phase and a hydrophobic, aprotic component sufficient to provide desirable qualities such as spreadability and feel.
• hydrophobic, aprotic components include but are not limited to fatty acid esters, for example, isopropyl mysristate, isopropyl palmitate, diisopropyl dimer dilinoleate; medium-chain (e.g., 8 to 14 carbon atoms) triglycerides, for example, caprylic/capric triglyceride; cetyl esters; hydrocarbons of 8 or more carbon atoms, for example, light mineral oil, white petrolatum; and waxes, for example, beeswax.
• fatty acid esters for example, isopropyl mysristate, isopropyl palmitate, diisopropyl dimer dilinoleate
• medium-chain (e.g., 8 to 14 carbon atoms) triglycerides for example, caprylic/capric triglyceride
• cetyl esters hydrocarbons of 8 or more carbon atoms, for example, light mineral oil,
• the hydrophobic, aprotic component is chosen from one or more of isopropyl mysristate, isopropyl palmitate, caprylic/capric triglyceride, and diisopropyl dimer dilinoleate, Various combinations of such hydrophobic, aprotic components can be used if desired.
• the amount of the hydrophobic, aprotic component is at least 1.0% by weight, at least 3.0% by weight, at least 5.0% by weight, or at least 10% by weight, based on the total weight of the formulation. In certain embodiments, the amount of the hydrophobic, aprotic component is at most 30% by weight, at most 15% by weight, or at most 10% by weight, based on the total weight of the formulation.
• the weight ratio of the hydrophobic, aprotic component to the fatty acid can be 0.025:1 to 600:1, for example, 0.5:1 to 50:1, and 2:1 to 30:1.
• the combined amount (weight percent of the total topical formulation weight) of the hydrophobic, aprotic component and the fatty acid can be 2% to 50% by weight, for example 2% to 30%, 5% to 30%, 5% to 20%, and 10% to 20%.
• formulations used in delivering 2-methyl-l-(2-methylpropyl)- lH-imidazo[4,5-c][l,5]naphthyridin-4-amine can also include a hydrophilic viscosity enhancing agent.
• suitable hydrophilic viscosity enhancing agents include cellulose ethers such as hydroxypropylmethylcellulose, hydroxyethylcellulose, hydroxypropylcellulose, and carboxymethylcellulose; polysaccharide gums such as xanthan gum; and homopolymers and copolymers of acrylic acid crosslinked with allyl sucrose or allyl pentaerythriol such as those polymers designated as carbomers in the United States Pha ⁇ nacopoeia.
• Suitable carbomers include, for example, those available as CARBOPOL 934P, CARBOPOL 97 IP, CARBOPOL 940, CARBOPOL 974P, CARBOPOL 980, and PEMULEN TR-I (USP/NF Monograph; Carbomer 1342), all available from Noveon, Cleveland, Ohio.
• the viscosity enhancing agent is chosen from CARBOPOL 974P and 980.
• the amount of the viscosity enhancing agent, when used, is at least 0.1% by weight, at least 0.2% by weight, at least 0.5% by weight, at least 0.6% by weight, at least 0.7% by weight, at least 0.9% by weight, or at least 1.0% by weight, based on the total weight of the formulation. In certain embodiments, the amount of the viscosity enhancing agent, when used, is at most 10% by weight, at most 5.0% by weight, at most 3.0% by weight, at most 2.0% by weight, or at most 1.5% by weight, based on the total weight of the formulation.
• formulations used in delivering 2-methyl-l-(2-methylpropyl)- lH-imidazo[4,5-c][l,5]naphthyridin-4-amine include an emulsifier.
• Suitable emulsifiers include non-ionic surfactants such as, for example, polysorbate 60, sorbitan monostearate, polyglyceryl-4 oleate, polyoxyethylene(4) lauryl ether, etc.
• the emulsifier is chosen from poloxamers (e.g., PLURONIC F68, also known as POLOXAMER 188, a poly(ethylene glycol)-block-poly(propylene glycol)-block-poly(ethylene glycol), available from BASF, Ludwigshafen, Germany) and sorbitan trioleate (e.g., SPAN 85 available from Uniqema, New Castle, DE).
• poloxamers e.g., PLURONIC F68, also known as POLOXAMER 188, a poly(ethylene glycol)-block-poly(propylene glycol)-block-poly(ethylene glycol), available from BASF, Ludwigshafen, Germany
• sorbitan trioleate e.g., SPAN 85 available from Uniqema, New Castle, DE.
• the emulsifier is generally present in an amount of 0.1% to 10% by weight of total formulation weight, for example, from 0.5% to 5.0% by weight, and from 0.75% to 3.5% by weight. In certain embodiments, the amount of the emulsifier, if used, is present in an amount of at least 0.1% by weight, at least 0.5% by weight, at least 0.75% by weight, at least 1.0% by weight, at least 2.5% by weight, at least 3.5% by weight, or at least 5.0% by weight, based on the total weight of the formulation. In certain embodiments, the amount of the emulsifier, if used, is present in an amount of at most 10% by weight, at least 5.0% by weight, or at most 3.5% by weight, based on the total weight of the formulation. pH Adjuster
• formulations used in delivering 2-methyl-l-(2-methylpropyl)- lH-imidazo[4,5-c][l,5]naphthyridin-4-amine include a p ⁇ adjuster.
• Suitable p ⁇ adjusters include organic bases and inorganic bases such as, for example, KO ⁇ and NaOH (e.g., aqueous formulations).
• the p ⁇ of the topical formulations of the present invention generally ranges from 3.5 to 7.0. In one embodiment, the p ⁇ of the topical formulations of the present invention can range from 4.0 to 6.0, preferably 5.0.
• Formulations of the present invention are aqueous based.
• the water used is typically purified water.
• Preferred aqueous formulations of the present invention are as follows.
• a pharmaceutical formulation includes: 0.3% by weight of 2-methyl-l-(2-methylpropyl)-lH-imidazo[4,5-c][l,5]naphthyridin-
• sorbic acid preservative selected from the group consisting of sorbic acid, esters thereof, salts thereof, and combinations thereof;
• ethylenediaminetetraacetic acid a hydrate thereof, a salt thereof, a hydrate of a the salt thereof, or combinations thereof; 1 % by weight to 30% by weight of isostearic acid;
• a medium-chain triglyceride 0.2% by weight to 2.0% by weight of a carbomer; 0.1% by weight to 6.0% by weight of a poloxamer; and water; wherein the formulation has a pH of 4.0 to 6.0 and the weight percentages are based on the total weight of the formulation.
• a pharmaceutical formulation includes: 0.3% by weight of 2-methyl-l-(2-methylpropyl)-lH-imidazo[4,5-c][l,5]naphthyridin-
• caprylic/capric triglyceride 4.0% by weight of caprylic/capric triglyceride
• a pharmaceutical formulation includes:
• caprylic/capric triglyceride 4.0% by weight of caprylic/capric triglyceride; 1.0% by weight of a carbomer; 3.5% by weight of a poloxamer;
• a gradient reversed phase high performance liquid chromatography (HPLC) method was used to determine the amount of 2-methyl-l-(2-methylpropyl)-lH-imidazo[4,5- c][l,5]naphthyridin-4-amine (IRM Compound 1) in cream formulations using B ⁇ A and B ⁇ T as the antioxidants.
• ⁇ PLC parameters Analytical column: ZORBAX Bonus RP, 3.5 micron particle, 150 x 4.6 mm (available from Agilent Technologies, Wilmington, Delaware, USA); Column temperature: 35°C; Detector: UV at 240 ran; Flow Rate: 1.0 mL/min; Injection volume: 30 ⁇ L; Mobile phase A: 0.05% trifluoroacetic acid in water; Mobile Phase B: 0.05% trifluoroacetic acid in acetonitrile; Data acquisition time: 25 minutes; ⁇ PLC run time: 35 minutes.
• Gradient program 0 minutes: 80% mobile phase A, 20% mobile phase B; 5 minutes: 80% mobile phase A, 20% mobile phase B; 15 minutes: 75% mobile phase A, 25% mobile phase B; 25 minutes: 35% mobile phase A, 65% mobile phase B; 28 minutes: 10% mobile phase A 5 90% mobile phase B; 29 minutes: 80% mobile phase A, 20% mobile phase B; 35 minutes: 80% mobile phase A, 20% mobile phase B.
• Sample solution A portion of the cream formulation (2500 mg for creams containing 0.03% IRM; 1500 mg for creams containing 0.1% IRM; and 500 mg for creams containing 0.3% IRM) was accurately weighed into a volumetric flask (50 mL for creams containing 0.03% IRM; 100 niL for creams containing 0.1 or 0.3% IRM). Approximately 40 mL of diluent (prepared by combing 200 parts of acetonitrile, 790 parts water, and 10 parts phosphoric acid, all parts by volume) was added to the 50 mL flask or 80 mL to the 100 mL flask.
• diluent prepared by combing 200 parts of acetonitrile, 790 parts water, and 10 parts phosphoric acid, all parts by volume
• the flask was shaken or vortexed to dislodge any cream from the neck of the flask and then sonicated with occasional shaking for 10 minutes or until the cream was completely dispersed.
• the solution was allowed to cool to ambient temperature and then diluted to volume with diluent. A portion of the solution was filtered using a syringe equipped with a 0.2 micron PTFE filter to provide the sample solution.
• HPLC high performance liquid chromatography
• Injection volume 25 ⁇ L; Mobile phase A: 0.05% trifluoroacetic acid in water; Mobile Phase B: 0.05% trifluoroacetic acid in acetonitrile; Data acquisition time: 12 minutes; HPLC run time: 18 minutes.
• Sample solution A portion (approximately 1000 mg) of the cream formulation was accurately weighed into a 100 mL volumetric flask. Approximately 80 mL of diluent (prepared by combining 600 parts of acetonitrile, 400 parts of water, and 1 part trifluoroacetic acid, all parts by volume) was added and the flask was sonicated with occasional shaking for 10 minutes or until the cream was well dispersed. The solution was allowed to cool to ambient temperature and then diluted to volume with diluent. A portion of the solution was filtered using a syringe equipped with a 0.45 micron PTFE filter to provide the sample solution.
• Oil phase preparation The IRM compound and the BHA or BHT were dissolved in the isostearic acid and medium chain triglycerides, with heat if necessary. Generally the CARBOPOL 980 was then dispersed in the oil phase.
• Water phase preparation Edetate disodium dihydrate, methylparaben, sorbic acid, propylene glycol, and POLOXAMER 188 were added to the water and mixed until dissolved, with heat if necessary. If the CARBOPOL was not dispersed in the oil phase, it was dispersed in the water phase.
• Phase combination The oil phase was added to the water phase at ambient conditions. The emulsion was then homogenized. Sodium hydroxide was added either before or after phase combination. The cream was mixed until smooth and uniform. The pH of the cream was measured and a pH adjustment was made with additional sodium hydroxide solution, if necessary, to meet the in-process target of pH 5.
• Table 1 summarizes topical formulations made in accordance with the present invention in a percentage weight-by- weight basis.
• the formulations were packaged in aluminum tubes with an epoxy phenolic lacquer liner.
• Example 1 Four- week treatment period
• a randomized, double-blind study was performed to evaluate single and multi-weekly doses of the formulations prepared above topically applied to actinic keratosis lesions on the head.
• Subjects were instructed to apply 250 milligrams of the formulation to a 25 square centimeter area on the head containing actinic keratosis lesions just prior to sleeping hours according to the dosing regimen they were assigned. The subjects were instructed to wash the treatment area prior to applying the cream, and then rub the cream into the treatment area. The subjects were instructed to leave the formulation in place for at least eight hours without occlusion.
• Subjects completed interval visits at treatment initiation, 1, 2, and 4 weeks after treatment was initiated and at four and eight- weeks after the end of treatment. Subjects were monitored for erythema and other treatment site conditions during the entire 12 weeks of the study. Erythema, as assessed by study investigators, was defined as intense, moderate, mild, or no redness of the skin at the treatment site and given an intensity score of severe, moderate, mild, or none, respectively.
• the treatment area was clinically evaluated for actinic keratosis lesions. Efficacy was measured as complete clearance of actinic keratosis lesions and partial clearance of actinic keratosis lesions at the eight-week post-treatment visit.
• the complete clearance rate is defined as the proportion of subjects at the eight-week post- treatment visit with a count of zero actinic keratosis lesions in the treatment area.
• the partial clearance rate is defined as the proportion of subjects at the eight- week post-treatment visit with at least 75% reduction in the number of lesions counted atbaseline in the treatment area.
• Figures 1 and 2 summarize the complete clearance and partial clearance rates at the eight- week post-treatment visit, respectively.
• Figures 3, 4, and 5 summarize the therapeutic window assessment for the four- week treatment period, expressing the complete clearance and severe erythema rates for the 0.03%, 0.1%, and 0.3% compound formulations, respectively.
• Example 2 Eight week treatment period A randomized, double-blind study was performed to evaluate single and multi-weekly doses of the formulations prepared above topically applied to actinic keratosis lesions on the head.
• Subjects were instructed to apply 250 milligrams of the formulation to a 25 square centimeter area on the head containing actinic keratosis lesions just prior to sleeping hours according to the dosing regimen they were assigned. The subjects were instructed to wash the treatment area prior to applying the cream, and then rub the cream into the treatment area. The subjects were instructed to leave the formulation in place for at least eight hours without occlusion. Subjects completed interval visits at treatment initiation, 1, 2, 4, and 8 weeks after treatment was initiated and at four and eight- weeks after the end of treatment. Subjects were monitored for erythema and other treatment site conditions during the entire 16 weeks of the study. Erythema, as assessed by study investigators, was defined as intense, moderate, mild, or no redness of the skin at the treatment site and given an intensity score of severe, moderate, mild, or none, respectively.
• the treatment area was clinically evaluated for actinic keratosis lesions. Efficacy was measured as complete clearance of actinic keratosis lesions and partial clearance of actinic keratosis lesions at the eight-week post-treatment visit.
• the complete clearance rate is defined as the proportion of subjects at the eight- week posttreatment visit with a count of zero actinic keratosis lesions in the treatment area.
• the partial clearance rate is defined as the proportion of subjects at the eight-week post-treatment visit with at least 75% reduction in the number of lesions counted at baseline in the treatment area.
• Figures 6 and 7 summarize the complete clearance and partial clearance rates at the eight- week post-treatment visit, respectively.
• Figures 8, 9, and 10 summarize the therapeutic window assessment for the eight-week treatment period, expressing the complete clearance and severe erythema rates for the 0.03%, 0.1%, and 0.3% compound formulations, respectively.
• Figure 1 1 summarizes the complete clearance rates of actinic keratosis lesions of the four and eight- week treatment periods.

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