Classifications

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  • A61K31/165—Amides, e.g. hydroxamic acids having aromatic rings, e.g. colchicine, atenolol, progabide
  • A61K31/167—Amides, e.g. hydroxamic acids having aromatic rings, e.g. colchicine, atenolol, progabide having the nitrogen of a carboxamide group directly attached to the aromatic ring, e.g. lidocaine, paracetamol
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  • 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
  • A61K31/439—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 the ring forming part of a bridged ring system, e.g. quinuclidine
• • A—HUMAN NECESSITIES
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  • 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
  • A61K31/46—8-Azabicyclo [3.2.1] octane; Derivatives thereof, e.g. atropine, cocaine
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  • 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
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  • A61K31/56—Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids
  • A61K31/57—Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids substituted in position 17 beta by a chain of two carbon atoms, e.g. pregnane or progesterone
  • A61K31/573—Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids substituted in position 17 beta by a chain of two carbon atoms, e.g. pregnane or progesterone substituted in position 21, e.g. cortisone, dexamethasone, prednisone or aldosterone
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  • A61K47/06—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite
  • A61K47/26—Carbohydrates, e.g. sugar alcohols, amino sugars, nucleic acids, mono-, di- or oligo-saccharides; Derivatives thereof, e.g. polysorbates, sorbitan fatty acid esters or glycyrrhizin
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  • A61K9/0012—Galenical forms characterised by the site of application
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  • A61K9/0073—Sprays or powders for inhalation; Aerolised or nebulised preparations generated by other means than thermal energy
  • A61K9/0075—Sprays or powders for inhalation; Aerolised or nebulised preparations generated by other means than thermal energy for inhalation via a dry powder inhaler [DPI], e.g. comprising micronized drug mixed with lactose carrier particles
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
  • A61M15/00—Inhalators
• • A—HUMAN NECESSITIES
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  • A61M15/00—Inhalators
  • A61M15/0001—Details of inhalators; Constructional features thereof
  • A61M15/0021—Mouthpieces therefor
• • A—HUMAN NECESSITIES
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  • A61M15/00—Inhalators
  • A61M15/0028—Inhalators using prepacked dosages, one for each application, e.g. capsules to be perforated or broken-up
  • A61M15/003—Inhalators using prepacked dosages, one for each application, e.g. capsules to be perforated or broken-up using capsules, e.g. to be perforated or broken-up
  • A61M15/0033—Details of the piercing or cutting means
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• • A—HUMAN NECESSITIES
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  • A61M15/00—Inhalators
  • A61M15/0028—Inhalators using prepacked dosages, one for each application, e.g. capsules to be perforated or broken-up
  • A61M15/0045—Inhalators using prepacked dosages, one for each application, e.g. capsules to be perforated or broken-up using multiple prepacked dosages on a same carrier, e.g. blisters
  • A61M15/0046—Inhalators using prepacked dosages, one for each application, e.g. capsules to be perforated or broken-up using multiple prepacked dosages on a same carrier, e.g. blisters characterized by the type of carrier
  • A61M15/0051—Inhalators using prepacked dosages, one for each application, e.g. capsules to be perforated or broken-up using multiple prepacked dosages on a same carrier, e.g. blisters characterized by the type of carrier the dosages being arranged on a tape, e.g. strips
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
  • A61M15/00—Inhalators
  • A61M15/0086—Inhalation chambers
• • A—HUMAN NECESSITIES
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  • A61P11/00—Drugs for disorders of the respiratory system
• • A—HUMAN NECESSITIES
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  • A61P11/00—Drugs for disorders of the respiratory system
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• • A—HUMAN NECESSITIES
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• • A—HUMAN NECESSITIES
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  • A61M11/00—Sprayers or atomisers specially adapted for therapeutic purposes
• • A—HUMAN NECESSITIES
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  • A61M2202/00—Special media to be introduced, removed or treated
  • A61M2202/06—Solids
  • A61M2202/064—Powder
• • F—MECHANICAL ENGINEERING; LIGHTING; HEATING; WEAPONS; BLASTING
  • F04—POSITIVE - DISPLACEMENT MACHINES FOR LIQUIDS; PUMPS FOR LIQUIDS OR ELASTIC FLUIDS
  • F04C—ROTARY-PISTON, OR OSCILLATING-PISTON, POSITIVE-DISPLACEMENT MACHINES FOR LIQUIDS; ROTARY-PISTON, OR OSCILLATING-PISTON, POSITIVE-DISPLACEMENT PUMPS
  • F04C2270/00—Control; Monitoring or safety arrangements
  • F04C2270/04—Force
  • F04C2270/042—Force radial
  • F04C2270/0421—Controlled or regulated

Definitions

• This invention relates to a novel dosage for aclidinium and to novel methods and formulations for the treatment of respiratory diseases, especially asthma and chronic obstructive pulmonary disease (COPD), using aclidinium.
• respiratory diseases especially asthma and chronic obstructive pulmonary disease (COPD)
• COPD chronic obstructive pulmonary disease
• Aclidinium bromide is 3(R)-(2-hydroxy-2,2-dithien-2-ylacetoxy)-1-(3-phenoxypropyl)- 1-azoniabicyclo[2.2.2]octane bromide, described in, e.g., WO 01/04118.
• An optimized process for the production of aclidinium bromide is described in WO 2008/009397.
• the structural formula is
• Aclidinium bromide is a white powder with a molecular formula of C 26 H 3 oN0 4 S 2 Br and a molecular mass of 564.56. It is very slightly soluble in water and ethanol and sparingly soluble in methanol. This compound is known to be a long-acting anticholinergic useful in the treatment of respiratory diseases.
• aclidinium is most effective upon administration by inhalation in a dosage of about 322 micrograms ⁇ g) delivered dose (weight corresponding to aclidinium free base, ie. free ammonium cation), and/or a fine particle dose equivalent to about 140 ⁇ g aclidinium bromide.
• the dose is a single dose or a twice daily dose, preferably a twice daily dose.
• a delivered dose of about 322 ⁇ g aclidinium free base corresponds to a delivered dose of about 375 ⁇ g aclidinium bromide.
• the invention thus provides in a first embodiment a pharmaceutical composition for inhalation comprising aclidinium in the form of a dry powder of a pharmaceutically acceptable salt, e.g., aclidinium bromide, in admixture with lactose powder (ie.
• lactose particles (i) providing a delivered dose of aclidinium equivalent to about 322 ⁇ g aclidinium (per inhalation) and/or a fine particle dose equivalent to about 140 ⁇ g aclidinium bromide (per inhalation), or (ii) in a multidose dry powder inhaler device calibrated to provide a delivered dose of aclidinium equivalent to about 322 ⁇ g aclidinium (per inhalation) and/or a fine particle dose equivalent to about 140 ⁇ g aclidinium bromide (per inhalation).
• This composition can be administered one or more times per day. Preferably once or twice a day.
• the invention provides a method of treating a respiratory condition, e.g., selected from asthma and chronic obstructive pulmonary disease, in a patient in need of such treatment, comprising administering a dose, typically a single daily dose or twice daily dose, of aclidinium, e.g., aclidinium bromide, equivalent to about 322 ⁇ g aclidinium and/or a fine particle dose equivalent to about 140 ⁇ g aclidinium bromide, e.g., comprising
• the invention further provides the use of aclidinium in the manufacture of a medicament, e.g., as described in the preceding paragraph, for use in such a method.
• the aclidinium may be administered as monotherapy, or in combination with one or more additional anti-inflammatory and/or bronchodilating agents, e.g., corticosteroids, PDE IV inhibitors and p2-agonists, e.g., formoterol, salmeterol, budesonide, and mometasone, and the invention thus further provides methods as described above further comprising administration of an effective amount of such an agent, as well as pharmaceutical compositions as described above, further comprising such additional agent(s).
• additional anti-inflammatory and/or bronchodilating agents e.g., corticosteroids, PDE IV inhibitors and p2-agonists, e.g., formoterol, salmeterol, budesonide, and mometasone
• aclidinium is administered in the form of a salt with an anion X, wherein X is a pharmaceutically acceptable anion of a mono or polyvalent acid. More typically, X is an anion derived from an inorganic acid, such as hydrochloric acid, hydrobromic acid, sulphuric acid and phosphoric acid, or an organic acid such as methanesulphonic acid, acetic acid, fumaric acid, succinic acid, lactic acid, citric acid or maleic acid.
• aclidinium is in the form of aclidinium bromide.
• the aclidinium is preferably administered in the form of a dry powder, in admixture with a suitable carrier, e.g., lactose powder (ie. lactose particles), suitable for inhalation.
• a suitable carrier e.g., lactose powder (ie. lactose particles)
• lactose is in the form of alpha-lactose monohydrate, preferably crystalline alpha-lactose monohydrate.
• the aclidinium is aclidinium bromide in admixture with lactose powder.
• the respiratory disease or condition to be treated with the formulations and methods of the present invention is typically asthma, acute or chronic bronchitis, emphysema, chronic obstructive pulmonary disease (COPD), bronchial hyperreactivity or rhinitis, in particular asthma or chronic obstructive pulmonary disease (COPD), especially COPD.
• COPD chronic obstructive pulmonary disease
• delivered dose it is meant the amount of the drug which is available at the mouth for inhalation (dose emitted from the mouthpiece of the inhaler device per actuation).
• the delivered dose can be measured using standard techniques known to those skilled in the art.
• "about” as used herein means within the normal limits of acceptable variations as defined by the European and US Pharmacopeia of plus/minus 35% or preferably acceptable variations as defined by the current most stringent requirement, the US FDA draft guidance for inhaler of plus/minus 25%, or more preferably according to the CHMP Guideline on the Pharmaceutical Quality of Inhalation and Nasal Products of plus/minus 15%, and especially within the metered dosing accuracy for the dispensing system e.g.
• a delivered dose of "about 322 ⁇ g aclidinium free base” it is meant a target dose of 322 ⁇ g aclidinium subject to variation within the normal limits of acceptance for the dispensing system, e.g.
• a delivered dose of "about 375 ⁇ g aclidinium bromide” it is meant a target dose of 375 ⁇ g aclidinium bromide subject to variation within the normal limits of acceptance for the dispensing system, e.g.
• the fine particle dose can be measured using standard techniques known to those skilled in the art.
• a fine particle dose of 140 ⁇ 9 aclidinium bromide corresponds to a fine particle dose of about 120 ⁇ 9 aclidinium.
• a fine particle dose of "about 120 ⁇ 9 aclidinium” it is meant a target dose of 67-139 ⁇ g aclidinium, preferably 86-163 ⁇ g aclidinium, more preferably 94-155 ⁇ g aclidinium.
• the invention is direct to a pharmaceutical composition for inhalation comprising aclidinium, in the form of a dry powder of a pharmaceutically acceptable salt, ie. aclidinium bromide, in admixture with lactose powder (ie.
• alpha-lactose monohydrate lactose particles providing a fine particle dose equivalent to about 120 ⁇ g aclidinium (aclidinium free ammonium cation), which corresponds to about 140 ⁇ g aclidinium bromide per inhalation, preferably 86-163 ⁇ g aclidinium (aclidinium free ammonium cation), which corresponds to 100-190 ⁇ g aclidinium bromide per inhalation.
• the dose is a single dose or a twice daily dose, preferably a twice daily dose.
• Packaging of the formulation may be suitable for unit dose or multi-dose delivery.
• the formulation can be pre-metered or metered in use. Dry powder inhalers are thus classified into three groups: (a) single dose, (b) multiple unit dose and (c) multi dose devices.
• Formulations generally contain a powder mix for inhalation of the compounds of the invention and a suitable powder base (carrier substance) such as lactose.
• a suitable powder base such as lactose.
• Each capsule or cartridge may generally contain between 2 ⁇ g and 400 ⁇ g of each therapeutically active ingredient.
• the active ingredient (s) may be presented without excipients.
• single dose inhalers of the first type single doses have been weighed by the manufacturer into small containers, which are mostly hard gelatine capsules.
• a capsule has to be taken from a separate box or container and inserted into a receptacle area of the inhaler.
• the capsule has to be opened or perforated with pins or cutting blades in order to allow part of the inspiratory air stream to pass through the capsule for powder entrainment or to discharge the powder from the capsule through these perforations by means of centrifugal force during inhalation.
• the emptied capsule has to be removed from the inhaler again.
• Some capsule inhalers have a magazine from which individual capsules can be transferred to a receiving chamber, in which perforation and emptying takes place, as described in WO 92/03175.
• Other capsule inhalers have revolving magazines with capsule chambers that can be brought in line with the air conduit for dose discharge (e. g. WO91/02558 and GB 2242134). They comprise the type of multiple unit dose inhalers together with blister inhalers, which have a limited number of unit doses in supply on a disk or on a strip.
• Blister inhalers provide better moisture protection of the medicament than capsule inhalers. Access to the powder is obtained by perforating the cover as well as the blister foil, or by peeling off the cover foil.
• a blister strip is used instead of a disk, the number of doses can be increased, but it is inconvenient for the patient to replace an empty strip. Therefore, such devices are often disposable with the incorporated dose system, including the technique used to transport the strip and open the blister pockets.
• Multi-dose inhalers do not contain pre-measured quantities of the powder formulation. They consist of a relatively large container and a dose measuring principle that has to be operated by the patient. The container bears multiple doses that are isolated individually from the bulk of powder by volumetric displacement.
• Various dose measuring principles exist, including rotatable membranes (e. g. EP0069715) or disks (e. g. GB 2041763; EP 0424790; DE 4239402 and EP 0674533), rotatable cylinders (e. g. EP 0166294; GB 2165159 and WO 92/09322) and rotatable frustums (e. g.
• WO 92/00771 all having cavities which have to be filled with powder from the container.
• Other multi dose devices have measuring slides (e. g.US 5201308 and WO 97/00703) or measuring plungers with a local or circumferential recess to displace a certain volume of powder from the container to a delivery chamber or an air conduit e. g. EP 0505321 , WO 92/04068 and WO 92/04928.
• Reproducible dose measuring is one of the major concerns for multi dose inhaler devices.
• the powder formulation has to exhibit good and stable flow properties, because filling of the dose measuring cups or cavities is mostly under the influence of the force of gravity.
• the dose measuring accuracy and reproducibility can be guaranteed by the manufacturer.
• Multi dose inhalers on the other hand, can contain a much higher number of doses, whereas the number of handlings to prime a dose is generally lower.
• the aclidinium is administered via a breath-activated, multidose, dry powder inhaler, which delivers up to 200 metered doses from a non-removable cartridge.
• An especially preferred inhaler device for this purpose is Genuair®, (formerly known as Novolizer SD2FL), or as described in WO 97/00703, WO 03/000325 or WO 2006/008027 the contents of which applications are incorporated herein by reference. Genuair® is also described in H. Chrystyn et al. Int J Clin Pract, March 2012, 66, 3, 309-317; and in H. Magnussen et al. Respiratory Medicine (2009) 103, 1832-1837.
• Novolizer® Another breath-activated, multidose, dry powder inhaler suitable for the administration of aclidinium is Novolizer®, which is described in C. Fenton et al., Drugs 2003; 63 (22): 2437-2445; and D. Kohler, Respiratory Medicine (2004) Supplement A, S17-S21.
• aclidinium can also be administered via single dose dry powder inhalers such as the devices described in WO 2005/113042 or in EP1270034. These devices are low resistance unit dosage form inhalers.
• the unit dosage form of the dry powder formulation are capsules typically made of gelatin or a synthetic polymer, preferably
• compositions of the invention can be administered in aerosols which operate via propellant gases or by means of so-called atomisers or nebulizers, via which solutions or suspensions of pharmacologically- active substances can be sprayed under high pressure so that a mist of inhalable particles results.
• Medicaments for administration by inhalation desirably have a controlled particle size.
• the optimum particle size for inhalation into the bronchial system is usually 1 -10 ⁇ , preferably 2-5 ⁇ . Particles having a size above 20 ⁇ are generally too large when inhaled to reach the small airways.
• the particles of the active ingredient as produced may be size reduced by conventional means eg by micronisation or supercritical fluid techniques. The desired fraction may be separated out by air classification or sieving.
• the particles will be crystalline.
• an excipient for example lactose is generally employed.
• the particle size of the excipient will usually be much greater than the inhaled medicament within the present invention.
• lactose it will typically be present as lactose particles, preferably crystalline alpha-lactose monohydrate, e.g., having an average particle size range of 20-1000 ⁇ , preferably in the range of 90-150 ⁇ .
• the median particle size approximately corresponds to the average and is the diameter where 50 mass-% of the particles have a larger equivalent diameter, and the other 50 mass-% have a smaller equivalent diameter.
• the average particle size is generally referred to in the art as equivalent d50.
• the distribution of particle size around may affect flow properties, bulk density, etc.
• other equivalent diameters can be used in addition to d50, such as d10 and d90.
• d10 is the equivalent diameter where 10 mass-% of the particles have a smaller diameter (and hence the remaining 90% is coarser).
• d90 is the equivalent diameter where 90 mass-% of the particles have a smaller diameter.
• the lactose particles for use in formulations of the invention have a d10 of 90 - 160 ⁇ , a d50 of 170 - 270 ⁇ , and d90 ⁇ 290 - 400 ⁇ .
• Suitable lactose materials for use in the present invention are commercially available, e.g., from DMW Internacional (Respitose GR-001 , Respitose SV-001 , Respitose SV-003); Meggle (Capsulac 60, Inhalac 70, Capsulac 60 INH); and Borculo Domo (Lactohale 100-200, Lactohale 200-300, and Lactohale 100-300).
• the ratio between the lactose particles and the aclidinium by weight will depend on the inhaler device used, but is typically, e.g., 5: 1 to 100: 1 , for example 25:1 to 75:1 , preferably 25:1 to 50: 1 , more preferably 30: 1 to 35: 1.
• aclidinium is administered in the form of a dry powder formulation of aclidinium bromide in admixture with lactose, preferably alpha-lactose
• aclidinium particles have an average particle size of from 2 to 5 ⁇ in diameter, e.g., less than 3 ⁇ in diameter, and the lactose particles have a d 10 of 90 - 160 ⁇ , a d50 of 170 - 270 ⁇ , and d90 of 290 - 400 ⁇ .
• Additional active agents such as p2-agonists , PDE IV inhibitors, corticosteroids, leukotriene D4 antagonists, inhibitors of egfr-kinase, p38 kinase inhibitors or NK1 receptor agonists may be utilized in the methods and formulations of the inventions.
• the invention provides aclidinium formulations as described herein further comprising an effective amount of one or more such additional active agents, e.g. further comprising an effective amount of a p2-agonist and/or a PDE IV inhibitor and/or a corticosteroid.
• the invention also provides methods for treating respiratory conditions as herein before described, e.g., asthma or COPD, comprising administering an aclidinium formulation as described herein and further comprising administering simultaneously an effective amount of one or more such additional active agents, e.g. further comprising an effective amount of a p2-agonist and/or a PDE IV inhibitor and/or a corticosteroid.
• p2-agonists suitable for use with the aclidinium in the present invention include, e.g., arformoterol, bambuterol, bitolterol, broxaterol, carbuterol, clenbuterol, dopexamine, fenoterol, formoterol, hexoprenaline, ibuterol, isoetharine, isoprenaline, levosalbutamol, mabuterol, meluadrine, metaprotenerol, nolomirole, orciprenaline, pirbuterol, procaterol, reproterol, ritodrine, rimoterol, salbutamol, salmefamol, salmeterol, sibenadet, sotenerot, sulfonterol, terbutaline, tiaramide, tulobuterol, GSK-597901 , milveterol, GSK-678007, GSK-59
• aclidinium Since aclidinium has a long duration of action, it is preferred that it is combined with long-acting p2-agonists (also known as LABAs).
• LABAs long-acting p2-agonists
• LABAs are formoterol, salmeterol and GSK-597901 , milveterol, LAS100977 (5-(2- ⁇ [6-(2,2-difluoro-2-phenylethoxy)hexyl]amino ⁇ -1 (RJ-hydroxyethyl)-8- hydroxyquinolin-2(1 H)-one), KUL-1248, carmoterol and indacaterol optionally in the form of their racemates, their enantiomers, their diastereomers and mixtures thereof, and optionally their pharmacologically-compatible acid addition salts. More preferred are salmeterol, formoterol, abediterol (LAS100977), and indacaterol.
• salmeterol, formoterol and LAS100977 (5-(2- ⁇ [6-(2,2-difluoro-2-phenylethoxy)hexyl]amino ⁇ -1 (RJ-hydroxyethyl)-8- hydroxyquinolin-2(1 H)-one), in particular salmeterol xinafoate.formoterol fumarate and
• LAS100977 (5-(2- ⁇ [6-(2,2-difluoro-2-phenylethoxy)hexyl]amino ⁇ -1 (RJ-hydroxyethyl)-8- hydroxyquinolin-2(1 H)-one).
• the invention provides a pharmaceutical composition for inhalation comprising aclidinium in the form of a dry powder of a pharmaceutically acceptable salt, e.g., bromide, in admixture with lactose particles, together with formoterol fumarate, (i) providing a delivered dose of aclidinium equivalent to about 322 ⁇ g aclidinium free base and/or a fine particle dose equivalent to about 140 ⁇ g aclidinium bromide together with a single metered nominal dose of about 5-25 ⁇ g (e.g.
• a pharmaceutically acceptable salt e.g., bromide
• a multidose dry powder inhaler device calibrated to provide a delivered dose of aclidinium equivalent to about 322 ⁇ 9 aclidinium free base and/or a fine particle dose equivalent to about 140 ⁇ 9 aclidinium bromide together with a metered nominal dose of about 5- 25 ⁇ 9 (e.g. 6, 8.5, 12, 18 or 24 ⁇ g, for example 6 or 12 ⁇ g) formoterol fumarate.
• a metered nominal dose of about 6 ⁇ g formoterol fumarate typically corresponds to a delivered dose of about 4.5 ⁇ g formoterol fumarate and a metered nominal dose of about 12 ⁇ g formoterol fumarate typically corresponds to a delivered dose of about 9 ⁇ g formoterol fumarate.
• a delivered dose of "about 4.5 ⁇ g formoterol fumarate” it is meant a target dose of 4.5 ⁇ g formoterol fumarate subject to variation within the normal limits of acceptance for the dispensing system, e.g.
• a delivered dose of "about 9 ⁇ g formoterol fumarate” it is meant a target dose of 9 ⁇ g formoterol fumarate subject to variation within the normal limits of acceptance for the dispensing system, e.g.
• a metered nominal dose of about 6 ⁇ g formoterol fumarate typically corresponds to a delivered dose of about 5.8 ⁇ g formoterol fumarate.
• a delivered dose of "about 5.8 ⁇ g formoterol fumarate” it is meant a target dose of 5.8 ⁇ g formoterol fumarate subject to variation within the normal limits of acceptance for the dispensing system, e.g.
• a metered nominal dose of about 12 ⁇ 9 formoterol fumarate typically corresponds to a delivered dose of about 11.8 ⁇ 9 formoterol fumarate.
• a delivered dose of "about 1 1.8 ⁇ 9 formoterol fumarate” it is meant a target dose of 1 1.8 ⁇ 9 formoterol fumarate subject to variation within the normal limits of acceptance for the dispensing system, e.g.
• a metered nominal dose of about 12 ⁇ g formoterol fumarate typically corresponds to a delivered dose of about 12 ⁇ g formoterol fumarate.
• a delivered dose of "about 12 ⁇ g formoterol fumarate” it is meant a target dose of 12 ⁇ g formoterol fumarate subject to variation within the normal limits of acceptance for the dispensing system, e.g.
• composition for inhalation comprising aclidinium and a ⁇ 2- agonist, for example, formoterol or abediterol (LAS100977), can be administered one or more times per day. Preferably once or twice a day.
• PDE4 inhibitors that can be combined with aclidinium in the present invention are benafentrine dimaleate, etazolate, denbufylline, rolipram, cipamfylline, zardaverine, arofylline, filaminast, tipelukast, tofimilast, piclamilast, tolafentrine, mesopram, drotaverine hydrochloride, lirimilast, roflumilast, cilomilast, oglemilast, apremilast, 6-[2-(3,4- Diethoxyphenyl)thiazol-4-yl]pyridine-2-carboxylic acid (tetomilast), (R)-(+)-4-[2-(3- Cyclopentyloxy-4-methoxyphenyl)-2-phenylethyl]pyridine (CDP-840), N-(3,5-Dichloro
• corticosteroids and glucocorticoids that can be combined with aclidinium in the present invention are prednisolone, methylprednisolone, dexamethasone, dexamethasone cipecilate, naflocort, deflazacort, halopredone acetate, budesonide, beclomethasone dipropionate, hydrocortisone, triamcinolone acetonide, fluocinolone acetonide, fluocinonide, clocortolone pivalate, methylprednisolone aceponate, dexamethasone palmitoate, tipredane, hydrocortisone aceponate, prednicarbate, alclometasone dipropionate, Butixocort propionate, RPR-106541 , halometasone, methylprednisolone suleptanate, mometasone
• the invention provides a pharmaceutical composition for inhalation comprising aclidinium in the form of a dry powder of a pharmaceutically acceptable salt, e.g., bromide, in admixture with a pharmaceutically acceptable carrier, e.g., lactose particles, together with mometasone furoate, (i) providing a delivered dose of aclidinium equivalent to about 322 ⁇ 9 aclidinium free base and/or a fine particle dose equivalent to about 140 ⁇ 9 aclidinium bromide together with a single metered nominal dose of about 100-900 ⁇ g (e.g.
• a multidose dry powder inhaler device calibrated to provide a delivered dose of aclidinium equivalent to about 322 ⁇ g aclidinium free base and/or a fine particle dose equivalent to about 140 ⁇ g aclidinium bromide together with a metered nominal dose of about 100-900 ⁇ g (e.g. 100, 1 10, 200, 220, 300, 330, 400, 440, 800 or 880 pg, for example 200-450, e.g 220 or 440 ⁇ g) mometasone furoate.
• a multidose dry powder inhaler device calibrated to provide a delivered dose of aclidinium equivalent to about 322 ⁇ g aclidinium free base and/or a fine particle dose equivalent to about 140 ⁇ g aclidinium bromide together with a metered nominal dose of about 100-900 ⁇ g (e.g. 100, 1 10, 200, 220, 300, 330, 400, 440, 800 or 880 pg, for example 200
• composition for inhalation comprising aclidinium and a corticosteroid, for example mometasone furoate, can be administered one or more times per a day. Preferably once or twice a day.
• the invention also provides a pharmaceutical composition
• a pharmaceutical composition comprising aclidinium, a p2-agonist as defined above and a corticosteroid, as defined above.
• Most preferred p2-agonists are selected from abediterol (LAS100977) and formoterol.
• Most preferred corticosteroid is mometasone furoate.
• composition for inhalation comprising aclidinium bromide and lactose
• a pharmaceutical composition in a batch size of 80 kg comprising aclidinium bromide and alpha-lactose monohydrate having a d10 of 90-160 ⁇ , a d50 of 170-270 ⁇ and a d90 of 290-400 ⁇ , was prepared.
• Aclidinium bromide (2.462 Kg) and alpha-lactose monohydrate (77.538 Kg) were blended in a Bohle blender, the mixture was sieved through a sieving-machine Bohle BTS and finally, the mixture was blended in a Bohle blender.
• Genuair ® (H. Chrystyn et al. (2009)) cartridges were filled with the composition. The cartridges were calibrated to provide 30 or 60 metered doses. Each actuation of the Genuair ® provided a metered dose of 13 mg of the composition described above.
• the measurement of the delivered dose (amount of the drug which is available at the mouth for inhalation) of the pharmaceutical composition described in point 1.1. is carried out based on European Pharmacopoiea 1 7th Edition (7.0), Chapter 2.9.18 and US Pharmacopoiea 2 USP36-NF31 , Chapter 601 ; using a "Collection Tube” apparatus (CT).
• CT Collection Tube
• the Genuair® inhaler is fitted to the Collection Tube via an adapter, the dosage key of the Genuair® inhaler is pressed and released and then 2L or 4L of air are sucked through the inhaler (inspiratory flow rate through the inhaler was approx. 65 L/min at a pressure drop of 4 KPa) and the Collection Tube.
• the inhalation powder delivered to the Collection Tube is extracted with solvent and analyzed using High Performance Liquid chromatography equipment (HPLC).
• HPLC High Performance Liquid chromatography equipment
• the mean delivered dose per actuation (per inhalation) was 322 ⁇ g aclidinium (aclidinium free ammonium cation), which corresponds to 375 ⁇ g aclidinium bromide.
• the accepted variance defined by the CHMP Guideline 3 on the Pharmaceutical Quality on Inhalation and Nasal Products was 274-370 ⁇ g aclidinium (aclidinium free ammonium cation), which corresponds to 319-431 ⁇ g aclidinium bromide.
• the test on the aerodynamic assessment of the fine particles (FPD ⁇ 5 ⁇ ) of the inhalation powder composition is carried out in the Genuair® inhaler.
• the fine particle dose of the pharmaceutical composition described in point 1.1. was calculated on basis of the principles of the aerodynamic assessment of fine particles according to the European Pharmacopoiea 1 7th Edition (7.0), Chapter 2.9.18 and US Pharmacopoiea 2 USP36-NF31 , Chapter 601 ; by the aid of aerodynamic impactor analyses using a modified Andersen Cascade Impactor (ACI), 60 L/min- configuration including pre-separator, stage -1 , -0, and stage 1-7 (filter stage). The content of the active ingredient on each stage of the impactor is determined my means of HPLC.
• the fine particle dose (FPD ⁇ 5 ⁇ ) was calculated according to European Pharmacopoiea 1 7th Edition (7.0), Chapter 2.9.18 and US Pharmacopoiea 2 USP36-NF31 , Chapter 601 ; by the
• the cumulative percent value (y-value) at which the line of data plot crosses 5 ⁇ mark is determined.
• the found cumulative percent must be multiplied by the sum of mass of the active ingredient per dosage on stage -1 -stage 7 (Filter) to obtain the fine particle dose, ⁇ 5 ⁇ , in ⁇ g.
• FPD Fine particle dose ⁇ 5 ⁇ of the active ingredient per dosage
• jjg Fine particle dose ⁇ 5 ⁇ of the active ingredient per dosage
• yFPD y-value of cumulative percentage of mass at a particle size of 5 ⁇ evaluated by linear point to point interpolation [%].
• F sum of mass on stage -1 -stage 7 (filter) per dosage [ ⁇ ].
• the mean fine particle dose per actuation (per inhalation) was 120 ⁇ g aclidinium (aclidinium free ammonium cation), which corresponds to 140 ⁇ g aclidinium bromide.
• the accepted variance was 86-163 ⁇ g aclidinium (aclidinium free ammonium cation), which corresponds to 100-190 ⁇ g aclidinium bromide

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