Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/56—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
• • 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
  • A61K9/00—Medicinal preparations characterised by special physical form
  • A61K9/0012—Galenical forms characterised by the site of application
  • A61K9/0048—Eye, e.g. artificial tears
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P27/00—Drugs for disorders of the senses
  • A61P27/02—Ophthalmic agents
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P27/00—Drugs for disorders of the senses
  • A61P27/02—Ophthalmic agents
  • A61P27/12—Ophthalmic agents for cataracts
• • 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]

Definitions

• a cataract is clouding of the lens of the eye, which impedes the passage of light. Most cataracts are related to ageing, but occasionally children are born with the condition; or the cataract may develop after an injury, inflammation, or disease. Risk factors for age-related cataracts include diabetes, prolonged exposure to sunlight, tobacco use, and excessive alcohol consumption.
• a patient having undergone cataract surgery is administered about 5 ⁇ of a formulation consisting of about 6%, about 9% or about 12 % (w/w) dexamethasone in triethyl acetyl citrate, which is injected into the anterior chamber of the eye.
• inflammation is controlled post-cataract surgery by this single, minute volume injection.
• the present medication regimen replaces steroidal eye drops and provides improved benefit in ease of treatment, patient compliance, and clinical outcome for cataract surgery patients.
• An aspect of the present embodiments provides for use of a formulation consisting of about 1 ⁇ L ⁇ to about 12 of a composition consisting essentially of about 1% to about 20% (w/w) dexamethasone and about 80% to about 99% (w/w) triethyl acetyl citrate, that is administered as a single dose by injection into the anterior chamber of eye for the treatment of inflammation following cataract surgery, wherein said dosage form releases dexamethasone for at least 3 days as measured in saline solution under infinite sink conditions.
• a unit dosage consisting essentially of about 1% to about 20% (w/w) dexamethasone and about 80% to 99% triethyl acetyl citrate, wherein said dosage form releases dexamethasone for at least 3 days, as measured in saline solution under infinite sink conditions.
• the unit dosage form comprises about 200 ⁇ g to about 800 ⁇ g of dexamethasone; about 342 ⁇ g of dexamethasone; about 517 ⁇ g of dexamethasone; or about 697 ⁇ g of dexamethasone.
• a unit dosage for the treatment of inflammation following cataract surgery consisting of a unit dose of about 5 of a formulation consisting essentially of either 342 ⁇ g, 517 ⁇ g or 697 ⁇ g dexamethasone in triethyl acetyl citrate, wherein the unit dose is injected into the anterior chamber of the eye following cataract surgery, and wherein administration results in an anterior chamber cell count below 2 within 30 days of administration when assessed by slit lamp microscopy.
• the composition releases dexamethasone for at least 3 days, as measured in saline solution under infinite sink conditions.
• the composition of the method includes about 200 ⁇ g to about 1100 ⁇ g of dexamethasone; about 342 ⁇ g of dexamethasone; about 517 ⁇ g dexamethasone; or about 697 ⁇ g dexamethasone.
• the total dose volume of the composition is about 4 ⁇ L ⁇ to about 7.5 ⁇ L ⁇ .
• FIG. 5 presents data on the viscosities of three formulations of Dex in ATEC. ⁇ 342 ⁇ g/5 ⁇ ; o 517 ⁇ g/5 ⁇ ; ⁇ 697 ⁇ g/5 ⁇ .
• cataract surgery is accompanied by a lengthy and messy regimen of eye drops that are required to reduce inflammation in the eye.
• prednisolone eye drops are typically applied four times daily for the first week, three times daily for the second week, two time daily for the third week, and once daily for the fourth week and beyond until the bottle runs dry.
• ketorolac eye drops are applied four times daily for the first through the fourth weeks following cataract surgery.
• These anti-inflammatory eye drops are used along with other eye drops such as antibiotic eye drops.
• the anti-inflammatory eye drops are sometimes opaque and render vision blurry. They are also messy, as the eye floods with drops and insoluble components collect in the corner of the eyes or on the eye lids.
• many individuals have trouble applying these drops formulations correctly, with the right amount of dosing at the right time, for the correct length of weeks. In other words, beyond the inconvenience of such eye drops, compliance in the eye drops dosing regimen can be an issue.
• the present embodiments provide for the use of an anti-inflammatory
• This liquid formulation maintains a single, generally spherical bolus shape (a monolithic shape or cohesive structure), at the site of placement; is biocompatible, biodegradable; provides for the sustained release of dexamethasone; then disappears entirely after delivering dexamethasone to the desired site.
• the formulations provide for novel post- cataract surgery therapy that is manipulated easily and injected by qualified medical
• a particularly useful citrate for the short-term sustained release of dexamethasone in the anterior chamber of the eye is acetyl triethyl citrate (also called ATEC, triethyl acetyl citrate, TEAC, triethyl O-acetyl citrate, or 1,2,3-Propanetricarboxylic acid,2-(acetyloxy)-triethyl ester).
• ATEC triethyl acetyl citrate
• TEAC triethyl O-acetyl citrate
• 1,2,3-Propanetricarboxylic acid 1,2,3-Propanetricarboxylic acid,2-(acetyloxy)-triethyl ester
• the amount of dexamethasone in the formulation can be expressed in strength, such as from about 100 micrograms ⁇ ig) to about 1100 ⁇ g per dose, inclusive, for example about200 ⁇ g to about 800 ⁇ g, about 300 ⁇ g to about 750 ⁇ g, about 300 ⁇ g to about 400 ⁇ g, about 500 ⁇ g to about 600 ⁇ g, and about 650 ⁇ g to about 750 ⁇ g, inclusive, such as about 114 ⁇ g, about 342 ⁇ g, about 513 ⁇ g, about 517 ⁇ g, about 684 ⁇ g, about 697 ⁇ g about 776 ⁇ g, or about 1046 ⁇ g.
• the amount of in a citrate vehicle, such as ATEC, in the formulation can range from about 55% to about 99% (w/w) citrate, inclusive, for example, about 65% to about 85%, about 75% to about 97%, about 80% to about 97%, about 85% to about 95%, about 86% to about 96%, inclusive, such as about 91%, about 94%, or about 88%.
• the weight ratio of dexamethasone :ATEC can be about 1:99, about 3:97, about 4:96, about 4.5:95.5, about 6:94, about 9:91, about 12:88, or about 20:80, inclusive. More specifically, for a low dose formulation consisting of 6% dexamethasone, a 5 dose weighs 5.7 mg, and contains 0.342 mg dexamethasone and 5.358 mg ATEC; for a medium dose of 9% dexamethasone, a 5 ⁇ dose weighs 5.75 mg, and contains 0.5175 mg
• dexamethasone and 5.2325 mg ATEC Alternative dosage forms include, for example, the following amounts of dexamethasone in the given dose volume: about 342 ⁇ g/about 5 ⁇ , about 517 ⁇ g/about 5 ⁇ , about 697 ⁇ g/about 5 ⁇ , about 1046 ⁇ g/about 7.5 ⁇ ,
• a single administration of the dosage form, for example about 5 ⁇ , about 7.5 ⁇ or about 10 ⁇ , into the anterior chamber of the eye can alleviate inflammation and replace the current eye drops regimen or the need for solid implants in patients in need thereof, i.e., following cataract surgery.
• the formulation is administered into the anterior chamber through a small gauge cannula or needle.
• the dosage form can be placed in the anterior chamber of the eye, either in front of or behind the iris, and the dosage form does not interfere with the patient' s vision.
• the formulation can be
• a small gauge cannula and syringe can be used for administration behind the iris, but a small gauge needle can also be used, especially for injection in front of the iris.
• a small gauge needle can also be used, especially for injection in front of the iris.
• 25 gauge cannula e.g., single use, anterior chamber cannula, 25 gauge, 8 mm, bend to tip from MSI Precision Specialty Instruments, Phoenixville, PA
• 28 or 30 gauge needle are suitable to administer the dosage form, for example from about 4 ⁇ to about 12 ⁇ , inclusive, such as about 5 ⁇ , about 7.5 ⁇ or about 10 ⁇ into the anterior chamber.
• the formulation retains its monolithic shape after injection, the physician can view proper placement of the formulation dosage form.
• the formulation disappears leaving behind nothing.
• the use of one administration of about 4 ⁇ to about 12 ⁇ of this dexamethasone formulation is sufficient to provide relief from inflammation following cataract surgery, and is may be used without the use of additional anti-inflammatory therapy such as steroidal or non-steroidal anti-inflammatory eye drops or solid implants.
• a dosing guide for a syringe can be used to accurately load and deliver the minute volume of the present regimen. See WO 2012/149040. Briefly, an injection syringe is filled in excess of the volume required for the correct dose, and a spacer that is configured to regulate the dose loaded into the syringe is inserted abutting the plunger rod of the syringe at the top of the barrel of the syringe (the proximal end of the syringe) in between the grip-end of the plunger, and the excess formulation expelled until the spacer impedes further axial distal motion of the plunger.
• Syringe loading and dosing guides have been made commercially (Berlin Food & Lab Equip., South San Francisco, CA; Encore Machining, San Jose, CA), and specifications are designed for the particular syringe and dose volume.
• minute amounts of medicament such as about 5.0 ⁇ or about 7.5 ⁇ , can be placed into the eye, depending on the size guide(s) used.
• Syringes suitable for use in delivering the formulations include disposable insulin syringes with permanently attached needles, particularly a 0.3 mL sterile insulin syringe (Becton Dickenson), or a sterile single-use glass syringe without attached needle, such as a 0.5 ml glass syringe (Hypak by Becton Dickenson).
• the formulation, syringe, cannula or needle, dose loading guide and, optionally, dose delivery guide are included in a kit for accurate administration of the formulation dose unit.
• a single dose of the formulation consisting essentially of dexamethasone in citrate has been observed to adequately control (prevent or ameliorate) inflammation following cataract surgery in humans.
• a particular embodiment of the present invention provides for the use of a dosage form of about 5 ⁇ of a formulation consisting essentially of dexamethasone and ATEC in a single administration into the anterior chamber for the treatment of inflammation in the human eye following cataract surgery.
• the dexamethasone can be present in the particular embodiment is in the concentration of example, about 6%, about 9% or about 12% (w/w). As examples, the dexamethasone can be in an amount of about 342 ⁇ g, about 517 ⁇ g, or about 697 ⁇ g in the dosage form volume of about 5 ⁇ delivered into the anterior chamber of the eye. More specifically, for a low dose formulation consisting of 6% dexamethasone, a 5 ⁇ dose weighs 5.7 mg, and contains 0.342 mg dexamethasone and 5.358 mg ATEC; for a medium dose of 9% dexamethasone, a 5 ⁇ dose weighs 5.75 mg, and contains 0.5175 mg dexamethasone and 5.2325 mg ATEC.
• These dosage forms are injected only once: at the time of cataract surgery, after the surgery is complete and while the patient is still under anesthesia (local or systemic anesthesia).
• the administration is done after the new lens has been inserted, essentially after the cataract replacement portion of the surgery has been completed.
• the present use can be combined with other therapies.
• Antibiotic therapy will likely be used after cataract surgery, such as antibiotic drops or sustained release antibiotic therapy (see U.S. Patent No. 7,906,136), as the healthcare provider prescribes. Additionally, should the patient require additional anti-inflammatory medications for some reason, these are not contraindicated by the use of the present formulations. Also, some patients may need anti- glaucoma therapy after cataract surgery. These therapies are known in the art.
• Another aspect of the present invention provides for use of a formulation consisting of dexamethasone in ATEC for the preparation of a medicament for the treatment of intraocular inflammation following cataract surgery wherein the single, fixed dosage amount is, for example, about 5 ⁇ of about 342 ⁇ g, 517 ⁇ g, or 697 ⁇ g of dexamethasone.
• the present invention provides use of a formulation that treats an acute inflammatory response to a surgical event.
• a formulation that treats an acute inflammatory response to a surgical event.
• it is formulated to deliver an immediate, high dose very quickly to give a quick response.
• the amount of dexamethasone released from the formulation then tapers off quickly to minimize the potential of any adverse events associated with the use of steroids. In clinical trials, this use resulted in positive outcome for humans following cataract surgery.
• a Phase II post-cataract surgery inflammation study was undertaken to compare three dosage forms of short-term sustained release dexamethasone. This was a multicenter, randomized, double-masked, dose ranging study for efficacy and safety.
• the human patients were over 40 years of age, having visual acuity potential greater than 20/30 in the study eye and having a corneal endothelial cell count of > 2000 cells/mm 2 underwent unilateral cataract surgery by phacoemulsification.
• Dexamethasone in ATEC prepared as a mixture as in Example 2, was supplied with a fill volume of 0.5 mL and packaged in a 2 mL glass vial, sealed with a ruber stopper and an aluminum seal. Each vial was intended to be used only once.
• the formulations were sterile, preservative-free suspensions; sterilization was accomplished using E-beam at 28 + 3 kGy after vial fill.
• Particle size % volume-size was 10% ⁇ 10.0 ⁇ , 50 ⁇ 30.0 ⁇ , 90 ⁇ 90 ⁇ .
• SOP for product content, uniformity, endotoxin, pH, sterility, etc. were followed.
• Viscosity was also measured at 25°C. At shear rates ranging from 7.5 to 23.55 sec-1, the viscosity of 697 ⁇ g/5 ⁇ L ⁇ Dex ranged from 106.66 cp to 84.24 cp. At shear rates ranging from 7.50 to 34.28 sec-1, the viscosity of 517 ⁇ g/5 ⁇ L ⁇ Dex ranged from 73.87 cP to 62.64 cP. At shear rates ranging from 7.50 to 45.00 sec-1, the viscosity of 342 ⁇ g/5 ⁇ L ⁇ Dex ranged from 53.02 cP to 43.47 cP. From the viscosity data, the formulations showed
• a single dose containing either 342 ⁇ g, 517 ⁇ g or 697 ⁇ g Dex in ATEC was delivered by injection using a disposable sterile insulin syringe that was used to withdraw and inject about 5 ⁇ L ⁇ , using syringe loading and dosing guides to position the plunger to deliver a unit dose volume of 5 ⁇ L ⁇ into the anterior chamber of the study eye.
• the amount of dexamethasone per patient was assigned at random.
• Anterior chamber cells (ACC) were graded as a score of 0 to 4, assessed by slit lamp biomicroscopy. Ocular and non-ocular safety was monitored through day 90.
• Examples 2 and 3 was compared with standard anti-inflammatory eye drops therapy in reduction of anterior chamber inflammation.
• FIG. 9 A comparison graph is shown in FIG. 9, for anterior chamber cell clearing at Day 8 and Day 15, created using preliminary data in twenty-six patients treated with dexamethasone in citrate following cataract surgery as described herein, compared with published data for anterior chamber cell clearing using Durezol® difluprednate steroid eye drops and Surodex® PLGA-based sustained release-dexamethasone implant.

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• 2014
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