WO2015063602A1 - Desmopressine et glycémie - Google Patents

Desmopressine et glycémie Download PDF

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Publication number
WO2015063602A1
WO2015063602A1 PCT/IB2014/002967 IB2014002967W WO2015063602A1 WO 2015063602 A1 WO2015063602 A1 WO 2015063602A1 IB 2014002967 W IB2014002967 W IB 2014002967W WO 2015063602 A1 WO2015063602 A1 WO 2015063602A1
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Prior art keywords
desmopressin
blood glucose
pharmaceutically acceptable
acceptable salt
glucose levels
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PCT/IB2014/002967
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English (en)
Inventor
Jens Peter NØRGAARD
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Ferring B.V.
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Publication of WO2015063602A1 publication Critical patent/WO2015063602A1/fr

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/40—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with one nitrogen as the only ring hetero atom, e.g. sulpiride, succinimide, tolmetin, buflomedil
    • 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
    • A61K9/0053—Mouth and digestive tract, i.e. intraoral and peroral administration
    • A61K9/0056—Mouth soluble or dispersible forms; Suckable, eatable, chewable coherent forms; Forms rapidly disintegrating in the mouth; Lozenges; Lollipops; Bite capsules; Baked products; Baits or other oral forms for animals
    • 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
    • A61P3/08—Drugs for disorders of the metabolism for glucose homeostasis

Definitions

  • compositions and methods for reducing random blood glucose levels such as may be desired in patients with a recognized need for random blood glucose level lowering.
  • this random blood glucose lowering can be useful for preventing and treating diabetes, diabetic complications, insulin resistance and insulin resistance syndrome, for reducing the risks of such conditions and/or for delaying the onset or progression of such conditions.
  • prediabetes in which blood glucose levels are higher than normal, but not yet high enough to be diagnosed as diabetes. As such prediabetic conditions continue into diabetes mellitus, glucose tolerance of the patient is reduced, and abnormally high random glucose levels are maintained for longer periods of time, a circumstance that is dangerous for a diabetic patient.
  • Carbohydrates which are ingested appear in the blood as glucose, and are metabolized into lipids (cholesterol, phospholipids, triglycerides, etc.). Excessive carbohydrate intake can lead to increased biosynthesis of such lipids, resulting in
  • Atherosclerosis hyperlipidemia and an accumulation of lipids, both in adipose tissue and in other systems in the organism.
  • Atherosclerosis, obesity, myocardial infarction and other heart diseases may be some of the consequences of such glucose intolerance.
  • compositions and methods for reducing random blood glucose levels wherein the compositions and methods comprise the administration of desmopressin.
  • desmopressin can achieve clinically significant lowering of random blood glucose levels, including in human patients who have a recognized need for random glucose level reduction.
  • the present disclosure provides desmopressin or a pharmaceutically acceptable salt thereof for reducing the random blood glucose of a mammalian subject, by methods comprising administering to the subject a hypoglycemically effective amount of desmopressin.
  • the subject is selected as being in need of reduction of its random blood glucose levels.
  • administration of desmopressin decreases random blood glucose levels of the selected mammalian subject.
  • hypoglycemically effective amount of desmopressin or a pharmaceutically acceptable salt thereof are also described. Also described are methods for reducing the blood glucose of a mammalian subject comprising: selecting a mammalian subject in need of reduction of its blood glucose, and administering to the selected mammalian subject, a hypoglycemically effective amount of desmopressin or a pharmaceutically acceptable salt thereof, whereby the administration of desmopressin of pharmaceutically acceptable salt thereof decreases the blood glucose of the selected mammalian subject.
  • the desmopressin may be in the form of desmopressin acetate.
  • the hypoglycemically effective amount of desmopressin or a pharmaceutically acceptable salt thereof may be from about 0.5 to about 800 ⁇ g, or from about 1.0 to about 600 ⁇ g,
  • the desmopressin or pharmaceutically acceptable salt thereof may be present in a pharmaceutical dosage form, such as an orodispersible dosage form, such as an orodispersible dosage form comprising an open matrix network comprising desmopressin, wherein the open matrix network comprises levan.
  • the methods may comprise at least once daily administration of desmopressin or a pharmaceutically acceptable salt thereof, such that a course of therapy may comprise at least once daily administration of desmopressin or a pharmaceutically acceptable salt thereof.
  • the method results in reduced random blood glucose levels in the subject of from about 70 mg/dL to about 200 mg/dL, from about 70 mg/dL to about 180 mg/dL, or from about 70 mg/dL to about 150 mg/dL.
  • the reduced random blood glucose levels are achieved after a course of therapy of at least one day, at least one week, at least 2 weeks, at least one month, at least three months, at least six months, or at least twelve months.
  • desmopressin or a pharmaceutically acceptable salt thereof for reducing the blood glucose level of a mammalian subject in need thereof, such as in accordance with any method described herein.
  • first sleep period refers to the time elapsed from bedtime to either first void or morning rising.
  • hypothalatraemia refers to a serum sodium value below the lower limit of the normal reference range, for example, a serum sodium level of less than 130 mmol/L.
  • nocturnal enuresis refers to a condition in which a person who has bladder control while awake urinates while asleep.
  • nocturnal polyuria refers to an increased nocturnal output of urine. For example, a ratio of nighttime urine volume over the 24-hour urine volume to be equal to or greater than 33%.
  • administer refers to (1) providing, giving, dosing and/or prescribing, such as by either a health professional or his authorized agent or under his direction, and (2) putting into, taking or consuming, such as by the patient or person herself or himself.
  • effective amount means that dosage that provides the specific pharmacological effect for which the drug is administered (e.g., random blood glucose level lowering) in a subject in need to such treatment. It is emphasized that a therapeutically effective amount will not always be effective in treating the conditions described herein, even though such dosage is deemed to be a therapeutically effective amount by those of skill in the art. For convenience only, exemplary dosages and therapeutically effective amounts are provided below with reference to adult human subjects. Those skilled in the art can adjust such amounts in accordance with standard practices as needed to treat a specific subject and/or condition/disease.
  • desmopressin refers to desmopressin and any pharmaceutically acceptable salt thereof, or any other pharmaceutically acceptable form (such as a hydrate or solvate), including desmopressin acetate.
  • Pharmaceutical dosage forms for use in the methods described herein may be adapted to supply the active ingredient to the oral cavity.
  • Desmopressin may be absorbed across the sublingual mucosa, and/or otherwise from the oral cavity (e.g., across the buccal and/or gingival mucosa) and/or from the gastrointestinal tract for systemic distribution.
  • Desmopressin typically is provided in a solid dosage form, optionally with a pharmaceutically acceptable carrier.
  • desmopressin is provided in an orodispersible dosage form.
  • orodispersible indicates that the dosage form disintegrates rapidly in the mouth, for example, within 15 seconds, or within 10 seconds, or within 5 seconds, or within 2 seconds or even within 1 second.
  • Examples of these include intrabuccally disintegrating solid formulations and preparations which comprise the active ingredient, a sugar comprising lactose and/or mannitol and 0.12 w/w%, based on the solid components, of agar and which has a density of 400 mg/ml to 1000 mg/ml and have a sufficient strength for handling, which in practice may mean sufficient strength to withstand removal from a blister packaging without
  • the sugar may be used in the formulation in an amount of at least 50 w/w%, such as 80 w/w% or more, including 90 w/w% or more, based on the total solid components, although it may vary depending on the quality and quantity of the active ingredient to be used.
  • Orodispersible dosage forms can also be in the form of an open matrix network carrying pharmaceutically active ingredients, for example, desmopressin or pharmaceutically acceptable salts thereof, as generally described for example, in WO 2011/120904 and WO 2013/037708, each of which is incorporated herein in their entireties.
  • Such open matrix networks can comprise materials such as levan (a polymeric form of fructose), or inulin (a polymeric form of fructose), or combinations thereof, and other pharmaceutically acceptable excipients, for example, mannitol, trehalose or raffinose.
  • Such open matrix networks also rapidly disintegrate or dissolve in aqueous media or saliva.
  • desmopressin melt tablets contain desmopressin acetate in a freeze-dried (lyophilized) presentation formulated with fish gelatin, mannitol and citric acid.
  • the desmopressin melt tablet formulation disintegrates essentially instantaneously (for example, in less than about 10 seconds) in the mouth (for example, super- or sublingually) without the need for water.
  • the desmopressin dosage is expressed herein in terms of the free base amount (e.g., the desmopressin moiety), even if the desmopressin is actually supplied as a salt, such as the acetate salt.
  • the doses described herein reflect equivalent amounts of desmopressin free base, even though desmopressin acetate may have been used.
  • a 100 ⁇ g dose of desmopressin refers to 100 ⁇ g of desmopressin free base equivalent, which corresponds to a proportionally higher amount of desmopressin acetate.
  • 100 ⁇ g of desmopressin may be provided by approximately 1 12.4 ⁇ g of desmopressin acetate which comprises 89% w/w desmopressin free base and 1 1% w/w (the balance) acetate, water and impurities.
  • 50 ⁇ g, 25 ⁇ g and 10 ⁇ g dosages of desmopressin refer to those amounts of desmopressin free base equivalent, such that the corresponding amounts of desmopressin acetate would be proportionately higher.
  • 0.1 mg of desmopressin acetate is deemed to be equivalent to about 89 ⁇ g of desmopressin free base.
  • Desmopressin may be formulated in strengths, measured as the free base, from about 0.5 or 1.0 ⁇ g to about 1 mg per dosage form.
  • the strength will typically range from about 2 ⁇ g to about 800 ⁇ g desmopressin per dosage form or, for example, from about 10 ⁇ g to about 600 ⁇ g.
  • Relatively low doses are also specifically contemplated, for example, from about 0.5 ⁇ g to about 75 ⁇ g, including from about 0.5 ⁇ g or 1.0 ⁇ g to about 50 ⁇ g.
  • the desmopressin is administered once per day. When one dosage form per day is administered, the above listed doses will typically be the dose per dosage form. In some embodiments, the desmopressin is administered in divided doses, at the same time or at different times. When the daily dose is administered in two or more dosages, the amount of desmopressin per dosage form will be reduced accordingly.
  • desmopressin or a pharmaceutically acceptable salt thereof for reducing the random blood glucose of a mammalian subject by methods that comprise administering desmopressin to a patient in need thereof, such as a patient selected as having a need for random blood glucose level reduction.
  • the patient may be a human or other mammal, and may be determined to be in need of random blood glucose level reduction, such as exhibiting glucose intolerance, being prediabetic, or being diabetic.
  • the patient may suffer from diabetes mellitus and/or from one or more conditions such as atherosclerosis, obesity, myocardial infarction, or other heart disease.
  • the desmopressin may be administered in any dosage form, such as those described above, at dosages described above.
  • the dose administered is effective to reduce the random blood glucose levels of the patient, e.g., is a hypoglycemically effective dose.
  • the dose administered is effective to achieve more specific random blood glucose target levels, as discussed below.
  • the dose of desmopressin administered is from about 0.5 to about 800 ⁇ g, or from about 1.0 to about 600 ⁇ g.
  • the methods comprise administering a dose of desmopressin of from about 0.5 to about 800 ⁇ g a day, or from about 1.0 to about 600 ⁇ g a day, including from about 0.5 or 1.0 ⁇ g to about 1 mg, from about 2 ⁇ g to about 800 ⁇ g, from about 10 ⁇ g to about 600 ⁇ g, or from 0.5 ⁇ g to about 75 ⁇ g, including from about 0.5 ⁇ g or 1.0 ⁇ g to about 50 ⁇ g, per day, including 25 ⁇ g, 50 ⁇ g, or 75 ⁇ g per day, in a single dose or in two or more divided doses.
  • a course of therapy may comprise at least once daily administration of
  • a course of therapy may comprise at least a few days, e.g., 1-3 days, or a week, or up to one month, or two months, or several months, e.g., 3 months or 6 months or 12 months or more.
  • Blood sugar levels can be measured with a glucose meter, which gives results in either mg/dL (milligrams per deciliter, favored in, for example, the United States), or in mmol/L (millimoles per liter, favored in, for example, Canada and Europe).
  • Glycemic control is a term which reflects typical levels of blood sugar (glucose) in a person with diabetes mellitus. Evidence suggests that many of the long-term complications of diabetes, especially the microvascular complications, result from many years of hyperglycemia (elevated levels of glucose in the blood). Good glycemic control, in the context of a treatment target, is considered an important goal of diabetes care.
  • Perfect glycemic control would mean that random blood glucose levels were always normal (about 70 to about 130 mg/dL or about 3.9 - 7.2 mmol/L). Practically, since treatment measures are imperfect, even "good glycemic control" describes random blood glucose levels that average somewhat higher than normal much of the time. Accepted target levels of random blood sugar that constitute good glycemic control have been reduced over the last 25 years, because of improvements in the diagnostic tools available for diabetic care, because of increasing evidence that glycemic control has value in controlling complications, and by the expectations of both doctors and patients. The concept of "good glycemic control" also depends on the age of a patient, and the degree of her susceptibility to hypoglycemia.
  • Blood glucose levels measured in this fashion typically exhibit values in the low- to mid- 100's (mg/dL).
  • a random blood glucose level of about 180 mg/dL or higher is indicative of a condition of hyperglycemia, and a level of about 200 mg/dL or higher is indicative of the presence of or a risk for developing a disorder associated with impaired glucose regulation, e.g., diabetes.
  • the methods described herein result in lower random blood glucose levels in the patient. In some embodiments, the methods described herein result in good glycemic control in the patient. [0045] Therefore, in one aspect, the present methods and compounds/compositions are useful for maintaining or achieving blood glucose levels, determined by random blood glucose test, at normal levels, i.e., low- to mid-100's (mg/dL). In a further aspect, the present methods and compounds/compositions can be used to lower/reduce random blood glucose levels which are elevated above normal levels, i.e., above low- to mid-100's (mg/dL).
  • the present methods and compounds/compositions are effective to reduce elevated random blood glucose levels to levels below about 200 mg/dL and above about 70 mg/dL, for example, to levels below about 180 mg/dL and above about 70 mg/dL, including to levels below about 150 mg/dL and above about 70 mg/dL.
  • Reductions in random blood glucose such as those described herein may be achieved after a course of therapy that is at least a few days, e.g., 1-3 days, or a week, or up to one month, or two months, or several months, e.g., 3 months or 6 months or 12 months or more.
  • Example 1 Efficacy and Safety of Low Dose Orally Disintegrating Tablet in Women with Nocturia - Results of a Multi-Center, Randomized, Double-Blind, Placebo- Controlled Parallel Group Study
  • Randomization was stratified by age (younger than 65 vs. 65 years old or older).
  • Desmopressin and placebo orally dissolving tablets were supplied by Ferring Pharmaceuticals, and were indistinguishable with respect to appearance, smell, taste and packaging.
  • the Food and Drug Administration-requested co-primary efficacy end points were change from baseline in mean number of nocturnal voids and 33% responder status during 3 months of treatment using a longitudinal analysis.
  • a 33% responder was defined as a patient with a decrease of at least 33% in the mean number of nocturnal voids at each visit compared to baseline. This end point captures information on the distribution of reductions.
  • Secondary end points included change from baseline at 3 months in mean number of nocturnal voids, proportion of 33% responders, mean time to first nocturnal void (the time from going to bed with the intention of sleeping to first void) and mean nocturnal urine volume. Exploratory end points included mean self-rated sleep quality, N-QoL scores and WPAI percentages.
  • AEs adverse events
  • Serum sodium was measured during screening and on all study visits after treatment. If serum sodium was 130 mmol/L or less the patient was asked to visit the trial site as soon as possible for further evaluation. Patients with a serum sodium of 125 mmol/L or less were withdrawn from the study immediately.
  • Additional safety measurements included a standard battery of blood and urine analyses, vital signs and physical examinations. All patients who received 1 or more doses of the study drug or placebo and had 1 or more safety assessments were included in the safety analyses.
  • ANCOVA ANCOVA
  • baseline mean nocturnal voids was a covariate, and treatment, visit (including a treatment by visit interaction term) and age stratification (younger than 65, 65 years old or older) were factors. If the treatment by visit interaction was not significant at the 5% level, it was removed from the model.
  • All secondary end points were tested using cross-sectional analyses at month 3 using the respective baseline as covariate, and age stratification and treatment as factors. Missing values were imputed using last observation carried forward. Exploratory end points were analyzed in a manner similar to the secondary end points. SAS® version 9.2 was used.
  • Daytime frequency of 6 or more voids was reported by 40% to 50% of patients in the treatment groups and 5 patients were included despite having 8 or more voids at baseline.
  • the most common concomitant medications were vitamins, lipid modifying agents, analgesics, anti-inflammatory agents and antirheumatic agents.
  • Example 2 Efficacy and Safety of Low Dose Orally Disintegrating Tablet in Men with Nocturia - Results of a Multi-Center, Randomized, Double-Blind, Placebo-Controlled Parallel Group Study
  • Desmopressin and placebo ODT were supplied by Ferring Pharmaceuticals, and were indistinguishable with respect to appearance, smell, taste and packaging.
  • the WPAI outcomes were expressed as impairment percentages of the 4 scores of absenteeism (work time missed), presenteeism (impairment at work/reduced on the job effectiveness), work productivity loss (overall work impairment/absenteeism plus presenteeism) and activity impairment.
  • the co-primary efficacy end points were the change from baseline in mean number of nocturnal voids and proportion of 33% responders during 3 months of treatment analyzed using a longitudinal analysis.
  • a 33% responder was defined as a patient with a decrease of at least 33% in the mean number of nocturnal voids at each visit compared to baseline.
  • Secondary end points included change from baseline at 3 months in mean number of nocturnal voids, proportion of 33% responders, mean time to first void and mean nocturnal urine volume.
  • the exploratory end points included mean self-rated sleep quality, N-QoL scores and WPAI percentages.
  • AEs and serum sodium were measured during screening and on all study visits (day 4, week 1, month 1, month 2 and month 3) after treatment. If serum sodium was 130 mmol/L or less, the patient was asked to visit the trial site as soon as possible for further evaluation. Patients with a serum sodium of 125 mmol/L or less were withdrawn from the study immediately.
  • Additional safety measurements included a standard battery of blood and urine analyses, vital signs and physical examinations. All patients who received 1 or more doses of desmopressin or placebo were included in the safety analyses.
  • FUSP Undisturbed Sleep Period
  • results shown here indicate the impact of desmopressin on FUSP, the clinical significance of FUSP as a marker for sleep which is associated with sleep quality and quantity, and the association between FUSP and random blood glucose levels.

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Veterinary Medicine (AREA)
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  • General Health & Medical Sciences (AREA)
  • Chemical & Material Sciences (AREA)
  • Medicinal Chemistry (AREA)
  • Pharmacology & Pharmacy (AREA)
  • Animal Behavior & Ethology (AREA)
  • Diabetes (AREA)
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  • Emergency Medicine (AREA)
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  • Engineering & Computer Science (AREA)
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  • Chemical Kinetics & Catalysis (AREA)
  • General Chemical & Material Sciences (AREA)
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  • Organic Chemistry (AREA)
  • Medicines That Contain Protein Lipid Enzymes And Other Medicines (AREA)
  • Pharmaceuticals Containing Other Organic And Inorganic Compounds (AREA)

Abstract

La présente invention se rapporte à des méthodes permettant de réduire les taux de glycémie aléatoire d'un patient par administration de desmopressine.
PCT/IB2014/002967 2013-10-29 2014-10-28 Desmopressine et glycémie WO2015063602A1 (fr)

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US61/897,034 2013-10-29

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Citations (8)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5466464A (en) 1991-12-24 1995-11-14 Yamanouchi Pharmaceutical Co., Ltd. Intrabuccally disintegrating preparation and production thereof
US6024981A (en) 1997-04-16 2000-02-15 Cima Labs Inc. Rapidly dissolving robust dosage form
US6200604B1 (en) 1998-03-27 2001-03-13 Cima Labs Inc. Sublingual buccal effervescent
WO2005046707A1 (fr) * 2003-11-10 2005-05-26 Fein Seymour H Compositions pharmaceutiques comportant de la desmopressine faiblement dosee
US7560429B2 (en) 2002-05-07 2009-07-14 Ferring B.V. Orodispersible dosage forms of desmopressin acetate
WO2009143356A1 (fr) * 2008-05-21 2009-11-26 Ferring International Center S.A. Desmopressine orodispersible augmentant la période initiale de sommeil non perturbé par la nycturie
WO2011120904A2 (fr) 2010-03-29 2011-10-06 Ferring B.V. Composition pharmaceutique à dissolution rapide
WO2013037708A1 (fr) 2011-09-16 2013-03-21 Ferring B.V. Composition pharmaceutique à dissolution rapide

Patent Citations (11)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5466464A (en) 1991-12-24 1995-11-14 Yamanouchi Pharmaceutical Co., Ltd. Intrabuccally disintegrating preparation and production thereof
US6024981A (en) 1997-04-16 2000-02-15 Cima Labs Inc. Rapidly dissolving robust dosage form
US6221392B1 (en) 1997-04-16 2001-04-24 Cima Labs Inc. Rapidly dissolving robust dosage form
US6200604B1 (en) 1998-03-27 2001-03-13 Cima Labs Inc. Sublingual buccal effervescent
US7560429B2 (en) 2002-05-07 2009-07-14 Ferring B.V. Orodispersible dosage forms of desmopressin acetate
US7947654B2 (en) 2002-05-07 2011-05-24 Ferring B.V. Pharmaceutical formulations
WO2005046707A1 (fr) * 2003-11-10 2005-05-26 Fein Seymour H Compositions pharmaceutiques comportant de la desmopressine faiblement dosee
WO2009143356A1 (fr) * 2008-05-21 2009-11-26 Ferring International Center S.A. Desmopressine orodispersible augmentant la période initiale de sommeil non perturbé par la nycturie
WO2011120904A2 (fr) 2010-03-29 2011-10-06 Ferring B.V. Composition pharmaceutique à dissolution rapide
US20130123179A1 (en) * 2010-03-29 2013-05-16 Ferring B.V. Fast dissolving pharmaceutical composition
WO2013037708A1 (fr) 2011-09-16 2013-03-21 Ferring B.V. Composition pharmaceutique à dissolution rapide

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