WO2015194926A1 - Composición farmacéutica que combina un anticonvulsivante y un derivado del ácido nicotínico - Google Patents
Composición farmacéutica que combina un anticonvulsivante y un derivado del ácido nicotínico Download PDFInfo
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- WO2015194926A1 WO2015194926A1 PCT/MX2014/000091 MX2014000091W WO2015194926A1 WO 2015194926 A1 WO2015194926 A1 WO 2015194926A1 MX 2014000091 W MX2014000091 W MX 2014000091W WO 2015194926 A1 WO2015194926 A1 WO 2015194926A1
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- gabapentin
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- A—HUMAN NECESSITIES
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- 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
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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
- A61K31/185—Acids; Anhydrides, halides or salts thereof, e.g. sulfur acids, imidic, hydrazonic or hydroximic acids
- A61K31/19—Carboxylic acids, e.g. valproic acid
- A61K31/195—Carboxylic acids, e.g. valproic acid having an amino group
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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
- A61K31/435—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
- A61K31/44—Non condensed pyridines; Hydrogenated derivatives thereof
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- 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
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
- A61P25/00—Drugs for disorders of the nervous system
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
- A61P25/00—Drugs for disorders of the nervous system
- A61P25/02—Drugs for disorders of the nervous system for peripheral neuropathies
Definitions
- the present invention relates to pharmaceutical compositions containing two active ingredients, one of them being an anticonvulsant, gabapentin, and the other a derivative of nicotinic acid, lysine clonixinate.
- Gabapentin referred to in the present invention is 2- [l - (aminomethyl) cyclohexyl] acetic acid, has a molecular weight of 171.24 and its structural formula is represented in Figure 1.
- the lysine clonixinate referred to The present invention is the lysine salt of 2 - [(3-chloro-2-methylphenyl) amino] -3-pyridinecarboxylic acid and belongs to the group of derivatives of nicotinic acid, its molecular weight is 408.88 and its structural formula is represented in figure 2.
- the combination of gabapentin with lysine clonixinate (CLG) in specific proportions allows to alleviate neuropathic pain caused by both diabetic neuropathy and a nerve injury, the CLG combination results in a super-additivity (synergy) of the pharmacological effects that it has each of the drugs separately.
- Neuropathic pain has been defined as "a pain that occurs as a direct consequence of an injury or a disease that directly affects the somatosensory system” (Treede RD, Jensen TS, Campbell JN, et al., 2008). This type of pain differs from nociceptive, somatic or visceral pain, because the latter occurs in non-nervous tissue and is caused either by a mechanical injury or by damage caused internally by some pathology. Nociceptive pain is usually associated with an inflammatory process subsequent to tissue damage and as a result there are reversible adaptive changes in the sensory nervous system that lead to the generation of pain hypersensitivity which is a protective mechanism that alerts and prevents subsequent damage at the site of the injury ensuring adequate repair of damaged tissue.
- This painful sensation is mediated in the periphery by high primary sensory neurons threshold, the so-called nociceptors, which transmit information through nociceptive pathways of the spinal cord to the brain.
- the so-called nociceptors which transmit information through nociceptive pathways of the spinal cord to the brain.
- neither the structure nor the function of the nervous system is damaged and the pain disappears when the damaged tissue has been repaired.
- damage ⁇ pain / inflammation ⁇ tissue repair ⁇ absence of pain in the case of neuropathic pain, it occurs because it is the central or peripheral nervous system itself that directly receives the damage, this causes morphological and functional changes occur in the sensory pathways which can become persistent without the pain disappearing.
- neuropathic pain can be considered as the manifestation of a pathological neural plasticity that manifests itself as a disease state. autonomic of the nervous system that controls itself, (von Hehn CA, Baron R, Woolf CJ. 2012).
- neuropathic pain Within the etiology of neuropathic pain are physical injuries such as trauma, resection or compression of the dorsal roots of the spinal cord, metabolic disorders such as diabetes mellitus or vitamin B deficiency, some infections such as those caused by varicella-zoster virus or HIV, neurotoxins such as alcohol, or chemotherapy.
- Peripheral diabetic neuropathy is a frequent complication of diabetes, it presents as a variety of syndromes among which is motor / sensory motor diabetic poly-neuropathy (PNDMS), being a very common condition, since it affects between 25% and 30% of diabetic patients.
- PNDMS is attributed to peripheral nerve damage due to metabolic and microvascular alterations as a result of chronic hyperglycemic exposure (diabetes), associated with cardiovascular risk factors (Tesfaye S, Boulton AJ, DyckPJ, et al. 2010).
- Neuropathy due to traumatic or post-surgical neural injury.
- neuropathic pain When a mechanical injury to the peripheral nerve occurs, the resulting pain is due to spontaneous activity generated at any site along the nociceptive pathway. However, more frequently, the spontaneous sensations that occur as a result of peripheral nerve injuries are generated as a result of the hyper-excitability of the primary sensory neurons. After the nerve injury has occurred, ectopic nerve activity is the main cause of spontaneous sensations of pain, paraesthesia, dysesthesia.
- the pain can be episodic or continuous, superficial or deep and often occurs as burner-type shots (von Hehn CA, Baron R, Woolf CJ. 2012).
- the prevalence of neuropathic pain indicates that it occurs in about 7% of the population worldwide (Bouhassira D, Lanteri-Minet M, Attal N, Laurent B. et al, 2008). However, the management of patients with chronic neuropathic pain is complex and many patients do not respond to treatment, obtaining only partial pain relief, or experiencing intolerable adverse effects.
- Gabapentin is a structural analogue of the aminobutyric acid range (GABA), which unlike this neurotransmitter has an anticonvulsant effect that is not due to the binding to the GABA A or GABA B receptors in the central nervous system (CNS).
- GABA aminobutyric acid range
- Gabapentin binds to the ⁇ 2- ⁇ site of the voltage-dependent calcium channels and modulates calcium entry with a reduction of excitatory neurotransmission and as a result a decrease in glutamate receptor activation and therefore a decrease in painful signal ... (Dworkin R, O'Connor A, Audette J. et al. 2010). Therefore, according to this mechanism of action, gabapentin, in addition to acting as an anticonvulsant, has the property of decreasing the transmission of painful signals in the CNS.
- gabapentin has been demonstrated in peripheral diabetic neuropathy (Finnerup NB, Sindrup SH, Jensen TS, 2010), in post-herpetic neuralgia (Wiffen P, McQuay H, Edwards J, 2009) and in neuropathic pain due to traumatic nerve injury (Gordh TE, Stubhaug A, Jensen TS, et al, 2008).
- gabapentin has been classified as first-line medications for pain management in cases of peripheral diabetic neuropathy (Tesfaye S , Vileikyte L, Rayman G., et al 201 1).
- Lysine clonixinate is an analgesic whose best known function is the inhibition of cyclooxygenase enzymes (COX-1 and COX-2) responsible for the synthesis of prostaglandins (PGs).
- PGs are powerful hyperalgesic mediators that modulate the signals that are transmitted along the pain path, increasing both the transduction (peripheral sensitizing effect), and the transmission (central sensitizing effect) of the painful stimulus. Therefore the inhibition of the synthesis of PGs both peripherally and in the CNS results in a decrease in pain.
- NOSn nitric oxide synthase neural
- NOSi induced nitric oxide synthases
- NOSn and NOSe endothelial nitric oxide synthase
- NOSi endothelial nitric oxide synthase
- NOSi cyclic guanosine monophosphate
- gabapentin plus opioid versus gabapentin alone in two studies with 386 participants
- this combination also produced a more frequent abandonment to the combined treatment (related to adverse effects), compared to the treatment of gabapentin alone.
- MX 288732 "Pharmaceutical Composition comprising a Non-Steroidal Anti-Inflammatory Agent and an Anticonvulsant Agent” describes a pharmaceutical composition composed of the combination Gabapentin and Meloxicam (7.5 and 300 mg respectively), in a single dosage unit, for the treatment of neuropathic pain caused by various etiologies.
- This pain model evaluates somatic / inflammatory pain and was described since 1962 to validate analgesic-anti-inflammatory drugs (Winter CA, Risley EA and Nuss GW, 1962), and is used to date (Mert T. Ocal 1. Cinar E. et al.
- WO 2008/077599 "Combination Therapy of Lower Urinary Tract Disorders With ⁇ 2 ⁇ Ligands and NSAIDS" claims the combination of gabapentin and an NSAID (NSAID) which can be celecoxib, diclofenac, diflunisal, flurbiprofen, naproxen, nimesulide or sulindac for monotherapy treatment of urinary incontinence.
- NSAID NSAID
- WO 2006123247 A2 "Synergistic combinations of non-steroidal anti-inflammatory drugs with alpha-delta-ligands" Mentions combinations of non-steroidal anti-inflammatory drugs, particularly caprofen, with gabapentin or pregabalin for the treatment of pain and / or inflammation, particularly in Dogs, cats and horses. In the claims the treatment for neuropathic pain is not mentioned.
- mice Two experimental models were used in mice: 1) Streptozotocin-induced diabetic neuropathy pain model and 2) Neuropathic pain experimental model due to sciatic nerve injury.
- neuropathic pain was recorded by measuring the level of mechanical allodynia using, for this purpose, the Von Frey fiber test.
- the analgesic interaction between gabapentin and Usina clonixinate was determined by isobolographic analysis for the determination of addition, antagonism or synergism of the antialodinic effect.
- Example I Analgesia of the CLG Combination in Diabetic Neuropathy.
- STZ streptozotocin
- GLTU 2 glucose transporter
- the histology in the limbs of these animals shows a reduction in the size of the nerve fibers, axons and myelin sheaths, nerve damage causes a decrease in motor and sensory nerve conduits and tactile allodynia.
- the procedure used was based on a described and widely validated (Ahlgren SC. And Levine JD. 1993), which consists in the application of an intraperitoneal injection of streptozotocin (45 mg / kg) in 0.2 ml of saline solution.
- streptozotocin 45 mg / kg
- saline solution 0.2 ml of saline solution.
- Blood glucose levels were evaluated in 4 groups of mice with the following characteristics: 1) Without treatment (baseline); 2) With fasting treatment; 3) After 1 day of treatment and 4) After 4 days of treatment.
- a plasma glucose level> 200 mg / dl was taken as a diabetes parameter.
- Figure 3 shows that on the third day, most mice developed diabetes, considering that glucose levels increased significantly to 409 ⁇ 27.2 mg / dL with respect to baseline levels of approximately 138.9 ⁇ 9.9 mg / dL.
- the results in each group represent the average and standard error with an n of 10 mice.
- the allodynia was determined by mechanical stimulation by means of the progressive downward application of different forces with von Frey filaments of different caliber.
- the mice were placed in plastic cylinders on a wire mesh table for 15 minutes, verifying that they were calm and subsequently the filaments were progressively applied to the lateral part of the leg.
- the filament of 0.02 g of force was the first to be applied to the left leg, five times for a total period of 30 seconds (approximately 2 seconds per stimulus) determining the reaction of the mouse after each application.
- the response observed is the withdrawal or licking of the leg, if three of the five stimuli are observed the reaction is considered positive and the mechanical response threshold is established.
- the average, in each group, of the threshold as a function of time after the administration of the drugs individually or in combination was plotted and the area under the curve (ABC) was obtained by the method of trapezoids
- the percentage of the threshold increase was calculated using the following equation: with faiffiaco
- Figure 5 depicts the Dose-Effect antialodinic curves corresponding to gabapentin and Usina clonixinate administered individually. In both curves an increase in the antialodynic effect is observed in a dose-dependent manner. In the case of gabapentin this increase is similar to other studies reported in rodents (Kusunose N, oyanagi S, Hamamura K., et al, 2010), however for Usina clonixinate there are no reports in rodents, however in this study it found a discrete antialodinic effect, the data represent the average and standard error of 8 mice.
- the interaction index describes the experimental DE 30 as a fraction of the additive DE 30 , values close to 1 indicate additive interaction, values greater than 1 imply an antagonistic interaction and values smaller than 1 indicate potentiation.
- the interaction index was 0.089, this means that the experimental DE 30 was significantly lower than the theoretical DE 3 or additive theoretical (p ⁇ 0.05), so the combination between gabapentin and lysine clonixinate is considered have an analgesic synergy interaction.
- mice For the evaluation of the analgesic efficacy of the CLG combination in neuropathic pain due to nerve injury, an experimental model of neuropathic pain due to ligation and cutting of sciatic nerve was used in mice. The procedure used was based on that described by DecosterdI. and Woolf CJ (2000), which consists of isolating, ligating and injuring the sciatic nerve of the mouse, followed by the evaluation of mechanical allodynia resulting from nerve damage.
- the surgery consisted of making an incision of approximately 1 cm in the longitudinal direction proximal to the knee and subsequently, opening the skin by blunt dissection and separating the muscular layer by dissection lateral to the blood vessel near the femur.
- the right sciatic nerve was then exposed under the muscles and carefully separated to visualize the sciatic nerve in the region where it makes a branch with the sural nerve. Only the sciatic nerve was sutured with a No. 6 thread trying not to damage the sural nerve at all, and a tight surgical knot was made over the sciatic nerve by cutting below the suture with a pair of tweezers, then suturing the muscular layer and the skin through surgical knots.
- Von Frey was performed in the same way as described above for the pain model for diabetic neuropathy.
- the response thresholds on both ipsilateral (right) and contralateral (left) legs were evaluated.
- the curves of Figure 10 represent the temporal cusus of the percentage of the antialodynic effect after intraperitoneal administration of gabapentin and lysine clonixinate respectively. In both curves there is an increase in the antialodynic effect of dose dependent manner. In the same way as for the diabetic neuropathy model, in the case of gabapentin this increase is similar to other studies reported in rodents (Kusunose N, Koyanagi S, Hamamura K., et al, 2010), while lysine clonixinate found a discreet antialodynic effect, which had not been previously reported.
- Figure 1 1 represents the dose-effect curves antialodinic, corresponding to gabapentin and lysine clonixinate administered individually.
- the values of the ED 30 of the drugs administered individually were obtained.
- the DE 3 or obtained was 83.82 mg / kg.
- mice Four experimental groups of 10 mice were used, to which the following doses were administered intraperitoneally: 1) 0.9% physiological saline; 2) Gabapentin 31 mg / kg; 3) Lysine clonixinate 150 mg / kg; 4) Combination gabapentin 31 mg / kg plus lysine clonixinate 150 mg / kg. This administration was done consecutively every 24 hours. After 14 days of exposure, toxicological tests were performed.
- mice were evaluated as it represents, in In many cases, an assertive way to assess damage to systems regulated by some neurotransmitter systems such as dopamine and others that control posture and movement, in this study we evaluated the number of times mice cross 2 zones of a cylinder with a diameter of 20 cm in 1 minute.
- mice were subjected to an evaluation of the neurological profile of the experimental animals.
- Table 3 shows the results of that evaluation after the administration of each drug; gabapentin (31.09 mg / kg) and lysine clonixinate (150.41 mg / kg) and the CLG combination, in addition to a control group administered with saline solution.
- gabapentin 31.09 mg / kg
- lysine clonixinate 150.41 mg / kg
- the CLG combination in addition to a control group administered with saline solution.
- no relevant interaction is observed in any of the parameters evaluated, in the 14 days that the treatment lasted, the value in all parameters was equal to 0, that is to say absent, indicating that at these doses nor gabapentin, lysine clonixinate and its combination do not cause neurological damage.
- mice The results of the laboratory tests revealed that there were no changes in glucose levels or plasma protein concentration in the 14 days of treatment. In none of the markers of liver function (GOT and GPT), nor in the levels of creatinine and urea was any statistically significant change with respect to the control group. In each group they used 10 mice.
- neuropathic pain is complex whether it is caused by a nerve injury or manifested as a result of a disease such as diabetes mellitus. Frequently this type of pain is treated with drugs that act in the CNS which have limited therapeutic effects and have adverse effects when administered at high doses.
- drugs that act in the CNS which have limited therapeutic effects and have adverse effects when administered at high doses.
- gabapentin has been reported to be effective for the treatment of diabetic neuropathy and post-herpetic neuralgia at effective doses of up to 1800 to 3600 mg per day.
- the most common adverse effects are at the CNS level, since it has been reported that more than 10% of patients treated with gabapentin have drowsiness, dizziness, ataxia, headache and fatigue.
- the combination of gabapentin / lysine clonixinate in a ratio of 1/7 has an analgesic potency and the isobolographic analysis demonstrated a synergy between both drugs with a value of the index of ⁇ interaction equal to 0.31 1.
- the analgesic effect was approximately 3 times greater than that of the individual drugs.
- gabapentin / lysine clonixinate ratios equal to 100/50 mg / kg (1 / 0.5), 100/100 mg / kg (1/1) and 100/150 mg / kg (1/1 .5 ) mg / kg provided relief from neuropathic pain in the mice.
- Lenzen S The mechanisms of alloxan- and streptozotocin-induced diabetes. Diabetology 2008 Feb; 51 (2): 216-26. Naoki K, Koyanagi S, Hamamura K, Matunaga N, Yoshida M, Uchida T, Tsuda M, Inoue K. and Ohdo S. Molecular basis for the dosing time-dependency of anti-allodynic effects of gabapentin in a mouse model of neuropathic pain . Molecular Pain 2010, 6:83.
- Tesfaye S Boulton AJ, Dyck PJ, Freeman R, Horowitz M, Kempler P, Lauria G, Malik RA, Spallone V, Vinik A, Bernardi L, Valensi P. Toronto Diabetic Neuropathy Expert Group. Diabetic neuropathies: update on definitions, diagnostic criteria, estimation of severity, and treatments. Diabetes Care 2010; 33: 2285-2293. Tesfaye S, Vileikyte L, Rayman G, Sindrup S, Perkins B, Baconja M, Vinik A and Boulton A. On behalf of the Toronto Expert Panel on Diabetic Neuropathy. Painful diabetic peripheral neuropathy: consensus recommendations on diagnosis, assessment and management. The Toronto Consensus Panel on Diabetic Neuropathy guidelines.
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Abstract
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Priority Applications (8)
Application Number | Priority Date | Filing Date | Title |
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US15/319,287 US9895362B2 (en) | 2014-06-16 | 2014-06-16 | Pharmaceutical composition combining an anticonvulsant and a derivate of nicotinic acid |
EP14894818.5A EP3156051B1 (en) | 2014-06-16 | 2014-06-16 | Pharmaceutical composition combining an anticonvulsant and a derivate of nicotinic acid |
PCT/MX2014/000091 WO2015194926A1 (es) | 2014-06-16 | 2014-06-16 | Composición farmacéutica que combina un anticonvulsivante y un derivado del ácido nicotínico |
MX2015003519A MX344937B (es) | 2014-06-16 | 2014-06-16 | Composición farmacéutica que combina un anticonvulsivante y un derivado del ácido nicotínico. |
CR20160573A CR20160573A (es) | 2014-06-16 | 2014-06-16 | Composición farmaceutica que combina un anticonvulsivante y un derivado del ácido nicotínico |
CA2951987A CA2951987C (en) | 2014-06-16 | 2014-06-16 | Pharmaceutical composition that combines an anticonvulsant and a nicotinic acid derivative |
ES14894818T ES2709758T3 (es) | 2014-06-16 | 2014-06-16 | Composición farmacéutica que combina un anticonvulsivante y un derivado del ácido nicotínico |
BR112016028924A BR112016028924A2 (pt) | 2014-06-16 | 2014-06-16 | composição farmacêutica que combina um anticonvulsivante e um derivado de ácido nicotínico |
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WO2006123247A2 (en) * | 2005-05-20 | 2006-11-23 | Pfizer Limited | Synergistic combinations of non-steroidal antiinflammatory drugs with alpha-delta-ligands |
WO2007083985A1 (es) * | 2006-01-19 | 2007-07-26 | Farmacéuticos Rayere, S.A. | Composición farmacéutica sinergística de diclofenaco y clonixinato de lisina |
WO2007148950A1 (es) * | 2006-06-20 | 2007-12-27 | Farmacéuticos Rayere, S.A. | Composición farmacéutica sinergística de ketorolaco y clonixinato de lisina |
WO2008077599A1 (en) * | 2006-12-22 | 2008-07-03 | Recordati Ireland Limited | COMBINATION THERAPY OF LOWER URINARY TRACT DISORDERS WITH α2δ LIGANDS AND NSAIDS |
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Publication number | Priority date | Publication date | Assignee | Title |
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WO2006123247A2 (en) * | 2005-05-20 | 2006-11-23 | Pfizer Limited | Synergistic combinations of non-steroidal antiinflammatory drugs with alpha-delta-ligands |
WO2007083985A1 (es) * | 2006-01-19 | 2007-07-26 | Farmacéuticos Rayere, S.A. | Composición farmacéutica sinergística de diclofenaco y clonixinato de lisina |
WO2007148950A1 (es) * | 2006-06-20 | 2007-12-27 | Farmacéuticos Rayere, S.A. | Composición farmacéutica sinergística de ketorolaco y clonixinato de lisina |
WO2008077599A1 (en) * | 2006-12-22 | 2008-07-03 | Recordati Ireland Limited | COMBINATION THERAPY OF LOWER URINARY TRACT DISORDERS WITH α2δ LIGANDS AND NSAIDS |
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MX344937B (es) | 2017-01-11 |
ES2709758T3 (es) | 2019-04-17 |
CA2951987C (en) | 2017-10-24 |
EP3156051A4 (en) | 2018-01-03 |
EP3156051A1 (en) | 2017-04-19 |
CR20160573A (es) | 2017-03-14 |
BR112016028924A2 (pt) | 2017-08-22 |
EP3156051B1 (en) | 2018-11-07 |
US9895362B2 (en) | 2018-02-20 |
US20170151223A1 (en) | 2017-06-01 |
CA2951987A1 (en) | 2015-12-23 |
MX2015003519A (es) | 2016-03-15 |
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