WO2012127501A2 - Composition pour améliorer l'épaisseur endométriale au cours de la stimulation ovarienne - Google Patents

Composition pour améliorer l'épaisseur endométriale au cours de la stimulation ovarienne Download PDF

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Publication number
WO2012127501A2
WO2012127501A2 PCT/IN2012/000166 IN2012000166W WO2012127501A2 WO 2012127501 A2 WO2012127501 A2 WO 2012127501A2 IN 2012000166 W IN2012000166 W IN 2012000166W WO 2012127501 A2 WO2012127501 A2 WO 2012127501A2
Authority
WO
WIPO (PCT)
Prior art keywords
highly purified
composition
fsh
hcg
ovarian stimulation
Prior art date
Application number
PCT/IN2012/000166
Other languages
English (en)
Other versions
WO2012127501A3 (fr
Inventor
Prasad K.V.S.
L. Soman JAY
Original Assignee
Sanzyme Limited
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Sanzyme Limited filed Critical Sanzyme Limited
Publication of WO2012127501A2 publication Critical patent/WO2012127501A2/fr
Publication of WO2012127501A3 publication Critical patent/WO2012127501A3/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K38/00—Medicinal preparations containing peptides
    • A61K38/16—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
    • A61K38/17—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans
    • A61K38/22—Hormones
    • A61K38/24—Follicle-stimulating hormone [FSH]; Chorionic gonadotropins, e.g. HCG; Luteinising hormone [LH]; Thyroid-stimulating hormone [TSH]
    • 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
    • A61K9/0019—Injectable compositions; Intramuscular, intravenous, arterial, subcutaneous administration; Compositions to be administered through the skin in an invasive manner

Definitions

  • the present invention relates to a pharmaceutical composition
  • a pharmaceutical composition comprising combination of Follicle Stimulating Hormone (FSH) and Human Chorionic Gonadotropin (HCG) for improving endometrial thickness during ovarian stimulation.
  • FSH Follicle Stimulating Hormone
  • HCG Human Chorionic Gonadotropin
  • ART assisted reproduction treatment
  • Clomiphene citrate has been used as the first line treatment for improving endometrial thickness in women seeking fertility treatment. However, it- is observed not to provide the successful outcome. In some of the studies, Clomiphene citrate was given along with gonadotropin like HMG, however the endometrium was found to be thinner when Clomiphene citrate was combined with hMG (Gonen and Casper, 1990; Check et al., 1991; Saito et al., 1991). There are cases in which ovulation, proper follicular development and fertilization are achieved, and yet improper implantation of the embryo prevents pregnancy. In other cases, spontaneous abortion (miscarriage) occurs during the first trimester.
  • pre-ovulatory endometrial thickness is predictive of prospective embryo (pregnancy) potential following In Vitro Fertilization/Embryo Transfer (IVF/ET). It has been shown that, optimum implantation potential requires the endometrium should be of sufficient thickness. Thus, increased endometrial thickness is associated with improved treatment outcome for patients undergoing ART treatment, particularly in vitro fertilization-embryo transfer.
  • ART assisted reproduction treatment
  • composition which can help improve endometrium thickness during ovarian stimulation. It is another object of the invention that such composition provides user friendly and cost effective regimen.
  • the invention provides composition for improving endometrium thickness optionally and preferably during ovarian stimulation, in which the composition comprises combination of Follicle Stimulating Hormone (FSH) and Human Chorionic Gonadotropin (HCG).
  • FSH Follicle Stimulating Hormone
  • HCG Human Chorionic Gonadotropin
  • the invention provides a pharmaceutical formulation for improving endometrium thickness during ovarian stimulation, in which the composition comprises combination of highly purified hCG 50 IU to 1000 IU and highly purified FSH 5 IU to 50 IU per dosage.
  • the invention provides a kit for improving endometrium thickness during ovarian stimulation, comprising daily doses of highly purified hCG 50 IU to 1000 IU and highly purified FSH 5 IU to 50 IU per dosage.
  • the present invention is directed towards providing a composition which can help improve endometrium thickness during ovarian stimulation and that such composition provides user friendly and cost effective regimen for improving the outcome of assisted reproduction treatment.
  • Endometrial thickness is regarded as a reflection of the degree of endometrial proliferation in the absence of intrauterine pathology, and is measured in the midsagittal plane during transvaginal ultrasound scan. Adequate endometrial development is required for pregnancy to occur, the endometrium has been found to be significantly thicker in cycles that resulted in pregnancy. Pregnancy rates were found to be higher when the endometrium reached at least 10 mm thickness. Studies conducted world over suggest that adequate endometrial development is one of the factors that play a significant role in IVF outcome. Therefore, for clinicians providing IVF for infertile couples as much as follicle growth, to ensure sufficient endometrial development is achieved is a challenge.
  • the inventors have unexpectedly discovered that administration of the composition comprising combination of highly purified hCG and highly purified FSH at low doses during the ovarian stimulation can improve endometrium thickness and that it can have positive effect on outcome of assisted reproduction treatment.
  • Conventionally offered treatments such as with that of clomiphene citrate either alone or in combination with hormones or other agent as well as treatment with estrogen supplement have not found to be satisfactory in providing the successful regimen for increasing the endometrial thickness during ovarian stimulation so as to improve the final outcome of assisted reproduction treatment.
  • So far combination of Follicle Stimulating Hormone (FSH) and Human Chorionic Gonadotropin (HCG) has not been attempted for improving the endometrial thickness during ovarian stimulation.
  • composition of the present invention gives rise to surprising advantages in terms of increasing the endometrial thickness during ovarian stimulation which can help to improve the final outcome of assisted reproduction treatment with the help of combination of Follicle Stimulating Hormone (FSH) and Human Chorionic Gonadotropin (HCG) during ovarian stimulation. Further, the low dose requirement of both the agents, particularly FSH also can help in lowering the cost and improving the safety of ART cycles through a reduction of the total dose of FSH administered during ovarian stimulation.
  • FSH Follicle Stimulating Hormone
  • HCG Human Chorionic Gonadotropin
  • the present invention accordingly provides a compositions comprising combination of Follicle Stimulating Hormone (FSH) and Human Chorionic Gonadotropin (HCG) for improving endometrium thickness during ovarian stimulation.
  • the composition comprises the combination of FSH and HCG in optimum therapeutic concentrations which may provide synergistic activity thereby reducing the dose of both the agents.
  • FSH Follicle Stimulating Hormone
  • HCG Human Chorionic Gonadotropin
  • the present invention provides a composition for improving endometrium thickness during ovarian stimulation comprising combination of highly purified hCG 50 IU to 1000 IU and highly purified FSH 5 IU to 50 IU per dosage.
  • Highly purified FSH and hCG to be used in the composition of the present invention may be obtained from natural sources, e.g. isolated from urine, pituitary or placenta and further purified so as to have low endotoxin levels. They may also be obtained using recombinant DNA technology. Biologically-active analogues thereof include peptidic analogues, non-peptidic analogues and chimeras. It is preferred that human FSH and hCG are used in the present invention.
  • the highly purified hCG to be used in the composition of present invention has reduced endotoxin level of less than 0.03 EU/IU, preferably less than 0.01EU/IU. Such highly purified hCG is contemplated to be without structural damage or loss of potency.
  • the present invention provides a composition for improving endometrium thickness during ovarian stimulation comprising combination of 5 IU to 50 IU of highly purified FSH and 50 IU to 1000 IU of highly purified hCG having reduced endotoxin level of less than 0.03 EU/IU, preferably less than 0.01EU/IU per dosage.
  • composition of the present invention in addition to the combination of hCG and FSH may comprise of pharmaceutical acceptable excipient(s) and /or carriers.
  • the composition of the present invention optionally may comprise of other ac- tive drugs.
  • other drugs that can be included in the composition may be selected from but not limiting to gonadotropin releasing hormone, gonadotropin releasing hormone agonists, gonadotropin releasing hormone antagonists, preparations with luetinizing hormone activity, progesterone preparations, or aromatase inhibitors. Dose ranges for these drugs are at the dose range that provides bioactivity desired for the composition of the present invention for promoting endometrial growth either as a sole agent or as a concomitant intervention as a part of protocol.
  • the invention also provides pharmaceutical formulations comprising composition of the present invention for improving endometrium thickness during ovarian stimulation comprising combination of 5 IU to 50 IU of highly purified FSH and 50 IU to 1000 IU of highly purified hCG per dosage.
  • the invention also provides pharmaceutical formulations comprising composition of the present invention for improving endometrium thickness during ovarian stimulation comprising combination of 5 1U to 50 1U of highly purified FSH and 50 )U to 1000 )U of highly purified hCG having reduced endotoxin level of less than 0.03 EU/IU, preferably less than 0.01EU/IU per dosage.
  • the pharmaceutical formulations of the present invention may be formulated in dosage form suitable for oral or any other form of administration.
  • the pharmaceutical formulations of the invention may be formulated for administration by any convenient route, often in association with a pharmaceutically and/or veterinarily acceptable carrier. It is preferred that the pharmaceutical formulations are formulated for parenteral administration.
  • hCH and FSH are administered subcutaneously in In vitro fertilisation (IVF) / Intracytoplasmic Sperm injection (ICSCI) procedures.
  • IVF In vitro fertilisation
  • ICSCI Intracytoplasmic Sperm injection
  • the pharmaceutical formulations for parenteral administration will usually be sterile.
  • compositions adapted for parenteral administration include aqueous and non-aqueous sterile injection solutions which may contain anti- oxidants, buffers, bacteriostats and solutes which render the formulation isotonic with the blood of the intended recipient; aqueous and non-aqueous sterile suspensions which may include suspending agents and thickening agents are also within the scope of the invention.
  • the formulations may be presented in unit- dose or multi-dose containers, for example sealed ampoules and vials, and may be stored irr a freeze-dried (lyophilised) condition requiring only the addition of the sterile liquid carrier, for example water for injections, immediately prior to use.
  • Extemporaneous injection solutions and suspensions may be prepared from sterile powders, granules and tablets.
  • the formulations can be administered through a prefilled syringe, an auto-injector or a multidose auto-injector.
  • the present invention provides a pharmaceutical formulation comprising composition of the present invention for improving endometrium thickness during ovarian stimulation comprising combination of 5 IU to 50 IU of highly purified FSH and 50 IU to 1000 IU of highly purified hCG, and pharmaceutically acceptable suitable excipients such as Lactose, Sucrose etc. which may aid in the stabilization of the lyophilized product.
  • a pharmaceutical formulation comprising composition of the present invention for improving endometrium thickness during ovarian stimulation comprising combination of 5 IU to 50 IU of highly purified FSH and 50 IU to 1000 IU of highly purified hCG, and pharmaceutically acceptable suitable excipients such as Lactose, Sucrose etc. which may aid in the stabilization of the lyophilized product.
  • Such formulation is filled into glass ampoules.
  • the present invention provides pharmaceutical formulation comprising the composition for improving endometrium thickness during ovarian stimulation comprising combination of 5 IU to 50 IU of highly purified FSH and 50 IU to 1000 IU of highly purified hCG, formulated as a unit dosage in the form of a solid ready for dissolution to form a sterile injectable solution for intramuscular or for subcutaneous use.
  • the solid usually results from lyophilisation.
  • Typical excipients and carriers include sucrose, lactose, sodium chloride, buffering agents like sodium phosphate monobasic and sodium phosphate dibasic.
  • the solution may be prepared by diluting with water for injection immediately prior to use.
  • Oral and other enteral pharmaceutical formulations need not be sterile and may be presented in unit- or multi-dose form.
  • Oral pharmaceutical formulations may be in the form of solids, such as powders, granules, tablets, capsules (for example hard or soft gelatin capsules) or lozenges, or liquids, such as syrups or elixirs.
  • Fillers and/or carriers may be present as appropriate, and those skilled in the art of pharmaceutical formulation will be able to provide such additional or alternative excipients as may be necessary or desirable; flavouring agents are one example.
  • Any pharmaceutical formulation intended for oral administration may be formulated for enteric resistance, so as to assist delivery to the small intestine by avoiding or mitigating any digestion of the compound(s) as may occur in the stomach or the proximal part of the small intestine.
  • Tablets or capsules may be enteric coated, for example by conventional procedures.
  • Liquid pharmaceutical formulations may be effectively rendered enteric resistant by including or being co-administered with a suitable agent such as medium-chain triglycerides.
  • Enteral pharmaceutical formulations other than oral pharmaceutical formulations include rectal compositions, which may be in the form of a suppository.
  • Suppositories will generally include a suppository base, such as cocoa butter.
  • particular formulations containing the active ingredient(s) may routinely be prepared by those skilled in the art of pharmaceutical formulation.
  • the present invention provides a kit for improving endometrium thickness during ovarian stimulation, comprising daily doses of highly purified hCG 50 IU to 1000 IU and highly purified FSH 5 IU to 50 IU.
  • the daily dose of the composition comprising combination of 5 IU to 50 IU of highly purified FSH and 50 IU to 1000 IU of highly purified hCG or pharmaceutical formulation comprising the same may be administered once a day from day 2 to about day 11 or 12 of the stimulatory cycle.
  • composition of the present invention comprising of a stable combination of physiological gonadotropin and the analog of another physiological gonadotropin can be targeted to given to women in older age groups or those having poor ovarian reserves where large amount of gonadotropins are required.
  • a newer treatment modality using controlled dosage forms of highly purified HCG and highly purified FSH can be used for female patients seeking infertility treatment, using much lower doses of HCG in place of LH due to its longer half-life and also FSH in unconventional doses rather than 325 - 475 IU.
  • the proposed invention of hCG in the range of about 50 IU to about 500 IU and FSH in the range of about 10 IU to about 100 IU is a valuable regimen for use in patients, where OHSS and intolerance to higher doses of FSH are a problem in clinical settings in Assisted Reproductive Therapy (ART) procedures of Intrauterine Insemination (IUI), In vitro fertilisation (IVF), Intracytoplasmic Sperm injection (ICSCI), Zygote Intrafallopian Transfer (ZIFT), Gamete Intra-fallopian Transfer (GIFT) and other procedures of future.
  • the composition of the present invention comprising combination of hCG and FSH in a unit formulation may act synergistically and reduce the total gonadotropin required to be administered.
  • the composition may also reduce the total number of injections to be taken by the subject.
  • the composition is advantageous with respect to providing ease of administration, reduced number of administrations and cost effective.
  • Rats were fed normally with no dietary restrictions and any form of pre- treatment
  • ovaries Post sacrifice, ovaries were removed surgically and were damped with tissue paper and weighed. The ovaries were then introduced into glass vials containing formaldehyde diluted with normal saline.
  • Endometrial thickness was measured using the modified method using a

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Endocrinology (AREA)
  • Bioinformatics & Cheminformatics (AREA)
  • Medicinal Chemistry (AREA)
  • Gastroenterology & Hepatology (AREA)
  • Chemical & Material Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • Reproductive Health (AREA)
  • Immunology (AREA)
  • Zoology (AREA)
  • Pharmacology & Pharmacy (AREA)
  • Proteomics, Peptides & Aminoacids (AREA)
  • Epidemiology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Medicines That Contain Protein Lipid Enzymes And Other Medicines (AREA)

Abstract

La présente invention concerne une composition pharmaceutique comprenant une combinaison d'hormone de stimulation folliculaire (FSH) hautement purifiée et d'une gonadotropine chorionique humaine (HCG) hautement purifiée pour améliorer l'épaisseur endométriale au cours de la stimulation ovarienne. En particulier, l'invention concerne également une composition pour améliorer l'épaisseur de l'endomètre au cours de la stimulation ovarienne, comprenant une combinaison de 5 IU à 50 IU de FSH hautement purifiée et de 50 IU à 1000 IU de hCG hautement purifiée par dose ainsi que des préparations pharmaceutiques les comprenant.
PCT/IN2012/000166 2011-03-11 2012-03-12 Composition pour améliorer l'épaisseur endométriale au cours de la stimulation ovarienne WO2012127501A2 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
IN693/MUM/2011 2011-03-11
IN693MU2011 2011-03-11

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WO2012127501A2 true WO2012127501A2 (fr) 2012-09-27
WO2012127501A3 WO2012127501A3 (fr) 2013-03-21

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Cited By (18)

* Cited by examiner, † Cited by third party
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US8933059B2 (en) 2012-06-18 2015-01-13 Therapeuticsmd, Inc. Natural combination hormone replacement formulations and therapies
US8987237B2 (en) 2011-11-23 2015-03-24 Therapeuticsmd, Inc. Natural combination hormone replacement formulations and therapies
US9180091B2 (en) 2012-12-21 2015-11-10 Therapeuticsmd, Inc. Soluble estradiol capsule for vaginal insertion
US9289382B2 (en) 2012-06-18 2016-03-22 Therapeuticsmd, Inc. Vaginal inserted estradiol pharmaceutical compositions and methods
US9931349B2 (en) 2016-04-01 2018-04-03 Therapeuticsmd, Inc. Steroid hormone pharmaceutical composition
US10052386B2 (en) 2012-06-18 2018-08-21 Therapeuticsmd, Inc. Progesterone formulations
US10098894B2 (en) 2014-07-29 2018-10-16 Therapeuticsmd, Inc. Transdermal cream
US10206932B2 (en) 2014-05-22 2019-02-19 Therapeuticsmd, Inc. Natural combination hormone replacement formulations and therapies
US10258630B2 (en) 2014-10-22 2019-04-16 Therapeuticsmd, Inc. Vaginal inserted estradiol pharmaceutical compositions and methods
US10286077B2 (en) 2016-04-01 2019-05-14 Therapeuticsmd, Inc. Steroid hormone compositions in medium chain oils
US10328087B2 (en) 2015-07-23 2019-06-25 Therapeuticsmd, Inc. Formulations for solubilizing hormones
US10471148B2 (en) 2012-06-18 2019-11-12 Therapeuticsmd, Inc. Progesterone formulations having a desirable PK profile
US10471072B2 (en) 2012-12-21 2019-11-12 Therapeuticsmd, Inc. Vaginal inserted estradiol pharmaceutical compositions and methods
US10537581B2 (en) 2012-12-21 2020-01-21 Therapeuticsmd, Inc. Vaginal inserted estradiol pharmaceutical compositions and methods
CN110787286A (zh) * 2019-11-21 2020-02-14 重庆市畜牧科学院 Fsh和hcg在制备促进睾丸细胞功能恢复的药物中的应用
US10806740B2 (en) 2012-06-18 2020-10-20 Therapeuticsmd, Inc. Natural combination hormone replacement formulations and therapies
US11246875B2 (en) 2012-12-21 2022-02-15 Therapeuticsmd, Inc. Vaginal inserted estradiol pharmaceutical compositions and methods
US11266661B2 (en) 2012-12-21 2022-03-08 Therapeuticsmd, Inc. Vaginal inserted estradiol pharmaceutical compositions and methods

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US10206932B2 (en) 2014-05-22 2019-02-19 Therapeuticsmd, Inc. Natural combination hormone replacement formulations and therapies
US11103513B2 (en) 2014-05-22 2021-08-31 TherapeuticsMD Natural combination hormone replacement formulations and therapies
US10098894B2 (en) 2014-07-29 2018-10-16 Therapeuticsmd, Inc. Transdermal cream
US10258630B2 (en) 2014-10-22 2019-04-16 Therapeuticsmd, Inc. Vaginal inserted estradiol pharmaceutical compositions and methods
US10398708B2 (en) 2014-10-22 2019-09-03 Therapeuticsmd, Inc. Vaginal inserted estradiol pharmaceutical compositions and methods
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US10328087B2 (en) 2015-07-23 2019-06-25 Therapeuticsmd, Inc. Formulations for solubilizing hormones
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US10286077B2 (en) 2016-04-01 2019-05-14 Therapeuticsmd, Inc. Steroid hormone compositions in medium chain oils
US9931349B2 (en) 2016-04-01 2018-04-03 Therapeuticsmd, Inc. Steroid hormone pharmaceutical composition
US10532059B2 (en) 2016-04-01 2020-01-14 Therapeuticsmd, Inc. Steroid hormone pharmaceutical composition
CN110787286A (zh) * 2019-11-21 2020-02-14 重庆市畜牧科学院 Fsh和hcg在制备促进睾丸细胞功能恢复的药物中的应用

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