Classifications

• • 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
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/59—Compounds containing 9, 10- seco- cyclopenta[a]hydrophenanthrene ring systems
  • A61K31/592—9,10-Secoergostane derivatives, e.g. ergocalciferol, i.e. vitamin D2
• • 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
  • A61K31/59—Compounds containing 9, 10- seco- cyclopenta[a]hydrophenanthrene ring systems
  • A61K31/593—9,10-Secocholestane derivatives, e.g. cholecalciferol, i.e. vitamin D3
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
  • A61K47/06—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
  • A61K47/06—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite
  • A61K47/08—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite containing oxygen, e.g. ethers, acetals, ketones, quinones, aldehydes, peroxides
  • A61K47/14—Esters of carboxylic acids, e.g. fatty acid monoglycerides, medium-chain triglycerides, parabens or PEG fatty acid esters
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
  • A61K47/06—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite
  • A61K47/16—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite containing nitrogen, e.g. nitro-, nitroso-, azo-compounds, nitriles, cyanates
  • A61K47/18—Amines; Amides; Ureas; Quaternary ammonium compounds; Amino acids; Oligopeptides having up to five amino acids
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
  • A61K47/44—Oils, fats or waxes according to two or more groups of A61K47/02-A61K47/42; Natural or modified natural oils, fats or waxes, e.g. castor oil, polyethoxylated castor oil, montan wax, lignite, shellac, rosin, beeswax or lanolin
• • 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
  • A61K9/10—Dispersions; Emulsions
  • A61K9/107—Emulsions ; Emulsion preconcentrates; Micelles
  • A61K9/1075—Microemulsions or submicron emulsions; Preconcentrates or solids thereof; Micelles, e.g. made of phospholipids or block copolymers
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P17/00—Drugs for dermatological disorders
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P17/00—Drugs for dermatological disorders
  • A61P17/06—Antipsoriatics
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P17/00—Drugs for dermatological disorders
  • A61P17/08—Antiseborrheics
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P17/00—Drugs for dermatological disorders
  • A61P17/10—Anti-acne agents
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P29/00—Non-central analgesic, antipyretic or antiinflammatory agents, e.g. antirheumatic agents; Non-steroidal antiinflammatory drugs [NSAID]
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P3/00—Drugs for disorders of the metabolism
  • A61P3/02—Nutrients, e.g. vitamins, minerals
• • 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 relates to a cutaneous pharmaceutical composition which comprises a vitamin D analogue as a therapeutically active compound and a mixture of a solvent and surfactants in a pharmaceutically acceptable carrier.
• Psoriasis is a chronic inflammatory skin disease that manifests as erythematous, dry, scaling plaques resulting from hyperkeratosis.
• the plaques are most often found on the elbows, knees and scalp, though more extensive lesions may appear on other parts of the body, notably the lumbosacral region.
• the most common treatment of mild to moderate psoriasis involves topical application of a composition containing a
• corticosteroid as the active ingredient. While efficacious, corticosteroids have the disadvantage of a number of adverse effects such as skin atrophy, striae, acneiform eruptions, perioral dermatitis, overgrowth of skin fungus and bacteria, hypopigmentation of pigmented skin and rosacea.
• an advantageous non-steroidal treatment of psoriasis has consisted in topical treatment with the vitamin D analogue compound, calcipotriol, formulated in an ointment composition (marketed as Daivonex® or Dovonex ® ointment by LEO Pharma) in which the calcipotriol is present in solution or a cream composition (marketed as Daivonex® or Dovonex® cream by LEO Pharma) in which the calcipotriol is present as a suspension.
• the solvent in the ointment composition is propylene glycol which has the advantage of enhancing penetration of the active ingredient into the skin, leading to an improved efficacy, but which is also known to act as a skin irritant.
• Daivonex® ointment Due to the improved penetration of calcipotriol into the skin resulting, inter alia, from the presence of propylene glycol, Daivonex® ointment has been found to be more efficacious in the treatment of psoriatic lesions than Daivonex® cream, but has also caused skin irritation in a significant proportion of psoriasis patients.
• It is therefore an object of the invention to provide a topical composition comprising a vitamin D derivative or analogue as the active ingredient, which has skin penetration and biological activity properties comparable to those of Daivonex® ointment, but which does not contain propylene glycol as the solvent.
• Human skin in particular the outer layer, the stratum corneum, provides an effective barrier against penetration of microbial pathogens and toxic chemicals. While this property of skin is generally beneficial, it complicates the dermal administration of pharmaceuticals in that a large quantity, if not most, of the active ingredient applied on the skin of a patient suffering from a dermal disease may not penetrate into the viable layers of the skin where it exerts its activity.
• Propylene glycol is a well-known penetration enhancer, i.e. a substance which is capable of penetrating the stratum corneum and "draw" low-molecular components such as therapeutically active components in the vehicle into the epidermis.
• Propylene glycol may in itself give rise to significant skin irritation, and it is also capable of "drawing" low-molecular and potentially irritative components of the vehicle into the epidermis, leading to an overall irritative effect of conventional vehicles including propylene glycol. For this reason, the presence of propylene glycol as a solvent in compositions intended for the treatment of inflammatory skin diseases may exacerbate the inflammatory response.
• compositions according to the invention comprising a vitamin D derivative or analogue have surprisingly been found to lead to a very high activation of the target gene cathelicidin in the biological assay described in Example 7 below, suggesting that the active ingredient is internalized by the keratinocytes on which the compositions are applied and activates the vitamin D receptor to a higher than usual degree.
• the three-component surfactant-solvent mixture when it permeates the viable skin layers, modifies the cell wall of the keratinocytes in such a way that the vitamin D derivative or analogue is more readily taken up by the cells. While it might be expected that the higher biological activity presumed to be the result of cell wall modification would lead to increased skin irritation, this was not apparent when a composition of the invention was tested in a local tolerance study in minipigs, cf. Example 8, or in human volunteers.
• the present invention relates to a substantially anhydrous pharmaceutical composition for cutaneous application comprising an isotropic solvent mixture of (a) a hydrophilic or lipophilic non-ionic surfactant;
• said isotropic solvent mixture being capable of forming a microemulsion in the presence of an excess of water
• composition further comprising a vitamin D derivative or analogue dissolved or solubilized in said isotropic solvent mixture, and
• a pharmaceutically acceptable, substantially anhydrous lipid carrier is a pharmaceutically acceptable, substantially anhydrous lipid carrier.
• US 5,645,856 discloses a pharmaceutical composition comprising a hydrophobic drug, a digestible oil, a hydrophilic surfactant and a lipophilic surfactant.
• the composition is intended to increase the solubility of the hydrophobic drug on oral administration in that the oil-surfactant mixture self-emulsifies in gastric fluid resulting in the formation of a microemulsion claimed to result in faster and more complete absorption of the drug.
• the solvent mixtures disclosed in US 5,645,856 could be incorporated in compositions intended for dermal application.
• US 5,948,825 discloses a water-in-oil microemulsion comprising an oil phase, an aqueous phase and a combination of hydrophilic and lipophilic surfactants, the dispersed oil droplets of the microemulsion having a particle size of 0.4-100 nm.
• microemulsions are intended for systemic delivery of pharmaceutically active proteins dissolved in an aqueous phase, or to improve the bioavailability of low molecular weight drugs. There is no indication that the microemulsions disclosed in US 5,948,825 could be incorporated in a composition intended for dermal application.
• composition forms a clear aqueous dispersion when mixed with water in a ratio of 1 : 100.
• the composition is intended for oral administration to provide improved absorption of the active ingredient in the gastrointestinal tract. There is no suggestion of mixing the composition with excipients that would make it appropriate for cutaneous application.
• composition of the invention differs from those disclosed in these publications by being intended for cutaneous application and by comprising one or more excipients that are suitable for dermal use.
• the substantially anhydrous lipid carrier is expected to provide an occlusive layer on the skin surface on which the composition is applied such that moisture evaporating or secreted from the skin accumulates between the skin surface and the occlusive layer. While the amount of moisture is not expected to be sufficient to cause self-emulsification of the isotropic solvent mixture to form a microemulsion, such as is disclosed in the publications mentioned above, it is presumed to result in the formation of ordered structures such as liquid crystalline, lamellar phases or micelles comprising the solubilized or dissolved active ingredient, depending on the amount of water present. The presence of surfactant and co-surfactant in the
• composition may contribute to the penetration of the active ingredient as the
• surfactant(s) may modulate the cellular membrane to increase its permeability to small chemical entities such as vitamin D derivatives or analogues.
• the invention relates to a pharmaceutical composition as described herein for use in the prevention or treatment of dermal diseases or conditions.
• Fig. 1 is a ternary phase diagram for an isotropic solvent mixture comprising MCT with Cremophor RH40 and Akoline MCM.
• the solid line represents the area where a microemulsion is formed on addition of 250 ml of water to 1 gram of the mixture, and the dotted line represents the areas where the mixture is monophasic.
• Fig. 2 is a ternary phase diagram for an isotropic solvent mixture comprising LCT with Cremophor RH40 and Peceol.
• the solid line represents the area where a microemulsion is formed on addition of 250 ml of water to 1 gram of the mixture, and the dotted line represents the areas where the mixture is monophasic.
• Fig. 3 is a graph showing the penetration into the skin and flux through the skin of calcipotriol from a composition of the invention as reported in Example 6 below. It appears from the figure that a significant amount of calcipotriol penetrated into the viable layers of the skin, whereas only a minor amount permeated through the skin into the receptor fluid.
• Fig. 4 is a schematic representation of the activation of the gene encoding cathelicidin by vitamin D 3 in human keratinocytes.
• the mechanism of cathelicidin gene activation is used in a biological assay using reconstructed human epidermis (human keratinocytes cultured so as to form the epidermal layers characteristic of human skin) on which calcipotriol-containing compositions of the invention are applied to activate cathelicidin as described in detail in Example 7 below.
• Fig. 5 is a graph showing the efficacy of a composition of the invention (Composition 1A) compared to Daivonex® cream on application on psoriatic plaques once daily for 29 days, determined as change in total clinical score (TCS).
• non-ionic surfactant is intended to indicate a surfactant comprising a hydrophilic and a hydrophobic portion in which the hydrophilic portion carries no charge but derives its surface activity from highly polar groups such as polyoxyethylene groups.
• a hydrophilic surfactant is an oil-in- water surfactant with an HLB (hydrophilic-lipophilic balance) value of 10-18
• a lipophilic surfactant is a water-in-oil surfactant with an HLB value of 2-9, in particular 3- 7.
• isotropic solvent mixture is intended to indicate a mixture of solvents and/or surfactants which is capable of solubilizing or dissolving the vitamin D derivative or analogue and whose physical properties are independent of direction.
• vitamin D derivative is intended to indicate a biologically active metabolite of vitamin D 3 , such as calcitriol, or a precursor to such a metabolite, such as alfacalcidol.
• vitamin D analogue is intended to indicate a synthetic compound comprising a vitamin D scaffold with sidechain modifications and/or modifications of the scaffold itself.
• the analogue exhibits a biological activity on the vitamin D receptor comparable to that of naturally occurring vitamin D compounds.
• Calcipotriol is a vitamin D analogue of the formula
• Calcipotriol has been found to exist in two crystalline forms, an anhydrate and a monohydrate. Calcipotriol monohydrate and its preparation are disclosed in WO
• storage stability is intended to indicate that the composition exhibits chemical and physical stability characteristics that permit storage of the composition, at refrigeration or, preferably, room temperature for a sufficient period of time to make the composition commercially viable, such as at least 12 months, in particular at least 18 months, and preferably at least 2 years.
• chemical stability or “chemically stable” is intended to indicate that no more than 10%, preferably no more than 6%, of the vitamin D derivative or analogue degrades over the shelf-life of the product, typically 2 years.
• An approximation of chemical stability at room temperature is obtained by subjecting the composition to accelerated stability studies at 40°C. If less than about 10% of the substance has degraded after 3 months at 40°C, this is usually taken to correspond to a shelf-life of 2 years at room temperature.
• “chemical stability” is intended to mean that the calcipotriol does not degrade significantly over time to 24- epi calcipotriol or other degradation products of calcipotriol in the finished
• C 6 - 2 2 acylglyceride is intended to indicate a triglyceride or a mixture of mono- and diglycerides or mono-, di- and triglycerides of C 6 -22 fatty acids.
• medium chain triglycerides is intended to indicate triglyceride esters of fatty acids with a chain length of 6-12 carbon atoms.
• a currently favoured example of such medium chain triglycerides is a mixture of caprylic (C 8 ) and capric (C 10 ) triglycerides, e.g. available under the trade name Miglyol 812.
• compositions retains its macroscopic and microscopic appearance over the shelf-life of the product, e.g. that the vitamin D derivative or analogue does not precipitate from the solvent phase or that there is no phase separation of the solvent phase and carrier phase visible to the naked eye.
• a composition wherein the isotropic solvent mixture is fully miscible with the lipid carrier and a composition wherein microscopic droplets of the isotropic solvent mixture are homogeneously distributed in the lipid carrier are both considered to be physically stable at this context.
• substantially anhydrous is intended to mean that the content of free water in the lipophilic carrier or vehicle is less than about 2% by weight, preferably less than about 1% by weight, such as less than 0.5% by weight, of the carrier or vehicle.
• solubilization capacity is intended to indicate the ability of the isotropic solvent mixture disclosed herein to dissolve a given substance, expressed as the amount required to effect complete solubilization of the substance.
• biological activity is intended to mean the activity of a vitamin D derivative or analogue when applied to skin in a composition of the invention.
• the biological activity of compositions is determined in an in vitro assay measuring the activation of a target gene expressing the biomarker cathelicidin in a reconstructed human epidermis model involving cultured human keratinocytes, as described in detail in Example 7 below.
• skin penetration is intended to mean the diffusion of the active ingredient into the different layers of the skin, i.e. the stratum corneum, epidermis and dermis.
• skin permeation is intended to mean the flux of the active ingredient through the skin into the systemic circulation or, in case of in vitro studies such as those reported in Example 2 below, the receptor fluid of the Franz cell apparatus used in the experiment.
• the composition of the invention comprises a vitamin D derivative or analogue selected from the group consisting of calcipotriol, calcitriol, tacalcitol, maxacalcitol, paricalcitol and alfacalcidol.
• the composition comprises calcipotriol or calcipotriol monohydrate as the vitamin D analogue.
• the amount of the non-ionic surfactant in the isotropic mixture is from about 5% by weight to about 90% by weight, or from about 10% by weight to about 70% by weight, in particular from about 30% by weight to about 60% by weight, such as from about 40% by weight to about 50% by weight of the mixture.
• the non-ionic surfactant is a hydrophilic surfactant with an HLB value of >9.
• the hydrophilic surfactant may for instance be a polyethylene glycol ester of a vegetable oil containing at least 20 mole of ethylene oxide groups/mole of glyceride, such esters being selected from the group consisting of polyoxyethylene castor oil derivatives, e.g. PEG 20, 30, 35, 38, 40, 50 or 60 castor oil or PEG 20, 25, 30, 40, 45, 50, 60 or 80 hydrogenated castor oil, PEG 20 or 60 corn glycerides, PEG 20 or 60 almond glycerides or PEG 40 palm kernel oil.
• the amount of the non-ionic co-surfactant in the isotropic mixture is from about 5% by weight to about 90% by weight, or from about 10% by weight to about 50% by weight, in particular from about 20% by weight to about 40% by weight, such as from about 25% by weight to about 30% by weight of the mixture.
• the surfactant an co-surfactant are both lipophilic surfactants with an HLB value of ⁇ 9.
• the lipophilic surfactant may be selected from the group consisting of monoglyceride esters of C 6 -22 fatty acids such as glyceryl monocaprylate, glyceryl monocaprate, glyceryl monostearate, glyceryl monobehenate, diglyceride esters of -22 fatty acids such as glyceryl dilaurate, mono- and diglyceride esters of C 6 . 2 2 fatty acids such as
• caprylic/capric mono- and diglycerides or glyceryl mono- and diricinoleate propylene glycol esters of C 6 . 2 2 fatty esters such as propylene glycol monocaprylate or propylene glycol monolaurate, dialkylene glycol monoalkyl ethers such as diethylene glycol monoethyl ether, polyglyceryl C 6 - 2 2 fatty acid esters such as polyglyceryl-3- diisostearate, polyethylene glycol esters of a triglyceride/vegetable oil containing 4-8 mole of ethylene oxide groups/mole of glyceride such as PEG-6 corn oil, PEG-6 almond oil, PEG-6 apricot kernel oil, PEG-6 olive oil, PEG-6 peanut oil, PEG-6 palm kernel oil or hydrogenated palm kernel oil, PEG-6 triolein or PEG-8 corn oil, or polysorbates such as polysorbate 20, polysorbate 40, polysorbate 60 or polysorbate 80.
• the surfactant and co-surfactant are lipophilic surfactants
• the surfactant and co-surfactant are preferably selected from different chemical surfactant classes.
• the amount of the C 6 -22 acylglyceride in the isotropic solvent mixture is from about 5% by weight to about 90% by weight, or from about 10% by weight to about 70% by weight, e.g. from about 15% by weight to about 40% by weight such as from about 20% by weight to about 30% by weight of the mixture.
• acylglyceride may for instance be a non-amphiphilic C 6 - 22 fatty acid glyceride selected from the group consisting of highly purified vegetable oils with an acid value of 0, 1 or less, i.e. containing little or no acidic reacting substances such as free fatty acids, e.g. pharmaceutical grades of medium chain triglycerides, long chain triglycerides or castor oil, or an amphiphilic C 6 -22 acylglyceride selected from the group consisting of
• caprylic/capric mono-and diglycerides and caprylic/capric mono-, di-and triglycerides.
• the ratio of first surfactant:second surfactant:C 6 -22 acylglyceride may favourably be about 2 : 1 : 1 as this ratio may result in the formation of a monophasic system as shown in Figs. 1 and 2. Formation of a monophasic system is regarded as advantageous as such a system is generally physically stable, i.e. unlikely to result in phase separation.
• the isotropic solvent mixture included in the present composition is surprisingly effective to dissolve a sparingly soluble compound such as a vitamin D derivative or analogue.
• a sparingly soluble compound such as a vitamin D derivative or analogue.
• the high solubilization capacity where the mixture is more effective than the individual components of the mixture to dissolve the active ingredient makes it possible to use a lower amount of surfactants and consequently decrease the risk of skin irritation while retaining a high biological activity.
• the isotropic solvent mixture only constitutes a minor proportion of the composition, the lipid carrier and optionally other excipients making up the remainder of the composition.
• the isotropic solvent mixture may constitute about 1-20% by weight, such as about 5-15% by weight or about 8-12% by weight or about 9-11% by weight, e.g. about 10% by weight, of the composition.
• the C 6 - 22 acylglyceride is medium chain triglycerides
• the surfactant is polyoxyl 40 hydrogenated castor oil
• the co- surfactant is caprylic/capric mono- and diglycerides, or the C 6 .
• 2 2 acylglyceride is long chain triglycerides
• the surfactant is polyoxyl 40 hydrogenated castor oil
• the co- surfactant is caprylic/capric mono- and diglycerides
• the C 6 -22 acylglyceride is caprylic/capric mono-, di-and triglycerides
• the surfactant is PEG-6 palm kernel oil
• the co-surfactant is polyglyceryl-3 diisostearate, PEG-6 corn oil, diethylene glycol monoethyl ether, propylene glycol monolaurate or propylene glycol monocaprylate.
• the lipid carrier may be a hydrocarbon or mixture of hydrocarbons with chain lengths ranging from C 5 to C 60 .
• a frequently used ointment carrier is petrolatum, or white soft paraffin, which is composed of hydrocarbons of different chain lengths peaking at about C 40 -44, or a mixture of petrolatum and liquid paraffin (consisting of hydrocarbons of different chain lengths peaking at C 2 s-4o) - While petrolatum provides occlusion of the treated skin surface, reducing transdermal loss of water and potentiating the therapeutic effect of the active ingredient in the composition, it tends to have a greasy and/or tacky feel which persists for quite some time after application, and it is not easily spreadable.
• paraffins consisting of hydrocarbons of a somewhat lower chain length, such as paraffins consisting of hydrocarbons with chain lengths peaking at Ci 4 -i 6 , C 1& . 2 2, C 2 Q-22, 2 O-26 or mixtures thereof (the hydrocarbon composition of the paraffins has been determined by gas chromatography) . It has been found that such paraffins are more cosmetically acceptable in that they are less tacky and/or greasy on application and more easily spreadable. They are therefore expected to result in improved patient compliance. Suitable paraffins of this type, termed petrolatum jelly, are manufactured by Sonneborn and marketed under the trade name Sonnecone, e.g .
• the wax may be a mineral wax composed of a mixture of high molecular weight hydrocarbons, e.g . saturated C35.70 alkanes, such as microcrystalline wax.
• the wax may be a vegetable or animal wax, e.g . esters of C14-32 fatty acids and C14-32 fatty alcohols, such as beeswax.
• the amount of viscosity-increasing ingredient may vary according to the viscosifying power of the ingredient, but may typically be in the range of about 1-20% by weight of the composition.
• the viscosity-increasing ingredient is microcrystalline wax it is typically present in an amount in the range of about 5- 15% by weight, e.g. about 10% by weight, of the composition.
• the composition may additionally comprise an emollient which may act to soften the thickened epidermis of the psoriatic plaques.
• emollient for inclusion in the present composition may be a silicone wax or a volatile silicone oil as the presence of silicone has additionally been found to aid penetration of calcipotriol into the skin.
• compositions including silicone oil have also been found to result in less skin irritation.
• Suitable silicone oils for inclusion in the present composition may be selected from cyclomethicone, dimethicone.
• the amount of silicone oil included in the present composition is typically in the range of from about 1 to about 10% by weight, e.g . about 5% by weight, of the composition.
• an anti-irritant compound in the present composition, such as glycerol, butylene glycol, sorbitol, sucrose, saccharin, menthol or nicotinamide.
• Glycerol has been described as a substance that is capable of protecting the skin against irritative substances (J. Bettinger et al., Dermatology 197, 1998, pp.
• glycerol is capable of potentiating the biological activity of calcipotriol in that the expression of cathelicidin (in the assay described in Example 7 below) has been found to be increased with a low amount of glycerol in the composition (i.e. more cathelicidin is expressed when the amount of glycerol is 5% by weight than when the amount of glycerol is 10% or 15%, respectively).
• a balance has to be struck between a favourable anti-irritative effect and a favourable potentiating effect.
• Calcipotriol is known to be a substance which is extremely sensitive to acid conditions (pH below about 7.0 in aqueous compositions or acidic reacting substances in nonaqueous compositions) which contribute to the rapid degradation of calcipotriol.
• acid conditions pH below about 7.0 in aqueous compositions or acidic reacting substances in nonaqueous compositions
• the acid neutralizing compound may favourably be selected from a buffer such as a phosphate buffer which may be included in an amount of about 0.025-0.1% by weight of the composition.
• the acid neutralizing compound may also be a tertiary amine such as triethanolamine, trometamol, monoethanolamine or diethanolamine, which may be included in the composition in an amount of about 0.1-2% by weight.
• the present composition comprises
• composition comprises
• caprylic/capric mono-, di- and triglycerides 0.5-1.5% w/w of caprylic/capric mono-, di- and triglycerides
• polyglyceryl-3-diisostearate 5-15% w/w polyglyceryl-3-diisostearate, diethylene glycol monoethyl ether or propylene glycol monolaurate or monocaprylate
• the present composition may also comprise other components commonly used in dermal formulations, e.g. antioxidants (e.g. alpha-tocopherol), preservatives, sodium edetate, pigments, skin soothing agents, skin healing agents and skin conditioning agents such as urea, allantoin or bisabolol, cf. CTFA Cosmetic Ingredients Handbook, 2 nd Ed., 1992.
• antioxidants e.g. alpha-tocopherol
• preservatives e.g. alpha-tocopherol
• sodium edetate e.g. alpha-tocopherol
• composition according to the invention preferably contains topical administration once or twice a day of a therapeutically sufficient dosage of said composition.
• the composition according to the invention preferably contains about 0.001-0.5 mg/g, preferably about 0.002-0.25 mg/g, in particular 0.005-0.05 mg/g, of the vitamin D derivative or analogue. It is envisaged that the present composition may advantageously been used for maintenance treatment of these dermal diseases, i.e.
• additional therapeutically active ingredients include, but are not limited to, anti-inflammatory drugs such as corticosteroids, such as betamethasone and esters thereof, e.g.
• p38 MAP kinase inhibitors e.g . the p38 MAP kinase inhibitors disclosed in WO 2005/009940 or WO 2006/063585.
• compositions of the invention are provided.
• Composition 1A was prepared by mixing the medium chain triglycerides, caprylic/capric glycerides and polyoxyl 40 hydrogenated castor oil and stirring the mixture for 15 min. at 50°C with a magnetic stirrer.
• the calcipotriol monohydrate was dissolved in the mixture at 40°C using a magnetic stirrer for 15 min.
• White soft paraffin was melted at 80°C, and triethanolamine was dissolved in the melted paraffin.
• the three-component surfactant-solvent mixture containing calcipotriol was added to the melted paraffin and whisked until the ointment mixture was homogenous. The homogenized ointment was cooled to 30°C with stirring and filled into 15 g aluminium tubes.
• Composition IB was prepared in a similar fashion with the exception that glycerol monooleate 40 was used the co-surfactant instead of caprylic/capric glycerides.
• compositions were tested for chemical stability at 40°C for 3 months. The results showed a satisfactory stability of calcipotriol under the test conditions.
• compositions of the invention are provided.
• compositions 2A-2F were prepared in a similar fashion as composition 1A, but with appropriate substitution of the surfactant, co-surfactant and solvent as indicated in the table above.
• compositions were tested for chemical stability at 40°C for 3 months. The results showed a satisfactory stability of calcipotriol under the test conditions.
• compositions of the invention are provided.
• compositions 3A-3H were prepared as described in Example 1, but with the appropriate amounts of solvent, surfactant and co-surfactant shown in the table above.
• Example 4
• compositions of the invention are provided.
• compositions 4A-4L were prepared as described in Example 1, but with the appropriate amounts of solvent, surfactant and co-surfactant shown in the table above.
• Example 5
• compositions of the invention are provided.
• compositions 5A-5G were prepared as described in Example 1, but with the appropriate amounts of Petrolatum jelly white shown in the table above.
• a skin diffusion experiment was conducted. Full thickness skin from pig ears was used in the study. The ears were kept frozen at - 18°C before use. On the day prior to the experiment the ears were placed in a refrigerator (5 ⁇ 3°C) for slow defrosting. On the day of the experiment, the hairs were removed using a veterinary hair trimmer. The skin was cleaned for subcutaneous fat using a scalpel and two pieces of skin were cut from each ear and mounted on Franz diffusion cells in a balanced order.
• Static Franz-type diffusion cells with an available diffusion area of 3.14 cm 2 and receptor volumes ranging from 8.6 to 11.1 ml were used in substantially the manner described by TJ. Franz, "The finite dose technique as a valid in vitro model for the study of percutaneous absorption in man", in Current Problems in Dermatology, 1978, J.W.H. Mall (Ed.), Karger, Basel, pp. 58-68. The specific volume was measured and registered for each cell. A magnetic bar was placed in the receptor compartment of each cell. After mounting the skin, physiological saline (35°C) was filled into each receptor chamber for hydration of the skin. The cells were placed in a thermally controlled water bath which was placed on a magnetic stirrer set at 400 rpm.
• the circulating water in the water baths was kept at 35 ⁇ 1°C resulting in a temperature of about 32°C on the skin surface.
• the saline was replaced by receptor medium, 0.04 M isotonic phosphate buffer, pH 7.4 (35°C), containing 4% bovine serum albumin.
• Sink conditions were maintained at all times during the period of the study, i.e. the concentration of the active compounds in the receptor medium was below 10% of the solubility of the compounds in the medium.
• the stratum corneum was collected by tape stripping 10 times using D-Squame® tape (diameter 22 mm, CuDerm Corp., Dallas, Texas, USA). Each tape strip is applied to the test area using a standard pressure for 5 seconds and removed from the test area in one gentle, continuous move. For each repeated strop, the direction of tearing off was varied. The viable epidermis and dermis was then sampled from the skin in a similar fashion. Samples ( 1 ml) of the receptor fluid remaining in the diffusion cell were collected and analysed. The concentration of calcipotriol in the samples were determined by LC mass
• cathelicidin is an antimicrobial peptide expressed in human keratinocytes.
• the expression of cathelicidin is strongly induced on infection of the skin or disruption of the skin barrier.
• the level of cathelicidin is increased in lesional skin of psoriasis patients.
• the expression of the gene encoding cathelicidin may be induced by vitamin D 3 or vitamin D analogues such as calcipotriol (cf. TT Wang et al, J. Immunol. 173(5), 2004, pp. 2909-2912; J Schauber et al., Immunology 118(4), 2006, pp. 509-519; Schauber and Gallo, J. Allergy Clin
• composition 1A prepared as described in Example 1 above was applied topically in triplicate on reconstructed human epidermis consisting of normal human keratinocytes cultured for 12 days on 0.5 cm 2 polycarbonate filters (available from SkinEthic® Laboratories, Nice, France) in an amount of 10 ⁇ .
• the tissue was treated for two days followed by separation of the epidermis from the polycarbonate filter and snap- frozen in liquid nitrogen.
• RNA was extracted from the cells and cDNA synthesized by conventional procedures. Quantitative real-time PCR (qPCR) was then performed using the following assays from Applied Biosystems: CAMP Hs0018038_ml and GAPDH Hs99999905_ml.
• the expression levels of cathelicidin were normalized to GAPDH and a relative quantification was made by comparison with Daivonex® ointment.
• composition IB prepared as described in Example 1 above
• results from the two experiments showed a 2.7 and 1.5 fold increase, respectively, in the biological activation of cathelicidin relative to that obtained with Daivonex® ointment.
• composition 1A of Example 1 was assessed when administered daily by dermal application to minipigs for 4 weeks. Each day the animals were exposed to the test items for 8 hours. The study was conducted in 10 female Gottingen SPF minipigs. Each animal had 6 application sites and received a volume of 250 mg test formulation per application site. Clinical signs were recorded daily and skin reactions at the application sites were scored once daily prior to start of dosing and, furthermore, on the day of necropsy in relation to erythema and oedema. Food consumption was recorded daily and the body weight weekly. At the end of the treatment period a gross necropsy was performed on all animals and skin samples were collected from histopathological examination.
• compositions of the invention will be well tolerated in human patients as well.
• Compound 1A was tested in a psoriasis plaque test.
• the study consisted of a screening visit, a wash-out period if needed, a treatment period of 29 days, and, if applicable, a follow-up visit. Within 15 days before treatment a screening visit for study eligibility of the subjects took place. Prior to Day 1 (Visit 2) a washout period (up to 15 days) was completed if the subject was treated with anti-psoriatic treatments or other relevant medication.
• Treatment products, the investigational product and the reference product (Daivonex® cream) were given once daily 6 days a week (except Sundays) for four (4) weeks.
• the subjects received study medication on test sites of 2 cm diameter selected on predetermined psoriasis lesions. Twice a week during the treatment phase, clinical assessments were performed. Further, ultrasound measurements of skin thickness were performed at Day 1 (baseline), three times during the study and at end of treatment period.
• the primary response criterion was the absolute change in Total Clinical Score (TCS) of clinical symptoms (sum of erythema, scaling and infiltration) at the end of the treatment period compared to baseline.
• TCS Total Clinical Score
• the change in total lesion thickness measured by ultrasound at end of treatment and at each assessment compared to baseline was also determined.
• the results shown in Fig. 5 indicate that the improvement in TCS is more pronounced and has a faster onset when psoriatic plaques are treated with Composition 1A than when they are treated with Daivonex® cream.
• compositions of the invention are provided.
• Caprylic/capric glycerides (Akoline MCM) 70
• compositions 6A, 6B and 6C were prepared as disclosed in Example 1, except for the addition of the PDE4 compound.

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