Classifications

• • 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
• • 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
  • A61K47/30—Macromolecular organic or inorganic compounds, e.g. inorganic polyphosphates
  • A61K47/36—Polysaccharides; Derivatives thereof, e.g. gums, starch, alginate, dextrin, hyaluronic acid, chitosan, inulin, agar or pectin
• • 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
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/56—Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids
  • A61K31/58—Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids containing heterocyclic rings, e.g. danazol, stanozolol, pancuronium or digitogenin
• • 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
  • A61K31/66—Phosphorus compounds
  • A61K31/661—Phosphorus acids or esters thereof not having P—C bonds, e.g. fosfosal, dichlorvos, malathion or mevinphos
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K45/00—Medicinal preparations containing active ingredients not provided for in groups A61K31/00 - A61K41/00
  • A61K45/06—Mixtures of active ingredients without chemical characterisation, e.g. antiphlogistics and cardiaca
• • 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
  • A61K47/02—Inorganic compounds
• • 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
  • A61K9/0085—Brain, e.g. brain implants; Spinal cord
• • 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
  • A61K9/08—Solutions
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P19/00—Drugs for skeletal disorders
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P19/00—Drugs for skeletal disorders
  • A61P19/02—Drugs for skeletal disorders for joint disorders, e.g. arthritis, arthrosis
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P19/00—Drugs for skeletal disorders
  • A61P19/04—Drugs for skeletal disorders for non-specific disorders of the connective tissue
• • A—HUMAN NECESSITIES
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  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P19/00—Drugs for skeletal disorders
  • A61P19/06—Antigout agents, e.g. antihyperuricemic or uricosuric agents
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P19/00—Drugs for skeletal disorders
  • A61P19/08—Drugs for skeletal disorders for bone diseases, e.g. rachitism, Paget's disease
• • 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
  • A61P25/04—Centrally acting analgesics, e.g. opioids
• • 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]
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P37/00—Drugs for immunological or allergic disorders
  • A61P37/02—Immunomodulators
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P37/00—Drugs for immunological or allergic disorders
  • A61P37/02—Immunomodulators
  • A61P37/06—Immunosuppressants, e.g. drugs for graft rejection
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P7/00—Drugs for disorders of the blood or the extracellular fluid
  • A61P7/04—Antihaemorrhagics; Procoagulants; Haemostatic agents; Antifibrinolytic agents

Definitions

• the present application relates to a pharmaceutical composition
• a pharmaceutical composition comprising a soluble corticosteroid and a viscosity enhancing agent.
• the pharmaceutical composition is suitable for local administration such as epidural injection, intra-articular injection, or intra- lesional injection.
• the epidural space (also known as “extradural space” or “peridural space”) is the outermost part of the spinal canal. It is the space within the canal (formed by the surrounding vertebrae) lying outside the dura mater (which encloses the arachnoid mater, subarachnoid space, the cerebrospinal fluid, and the spinal cord).
• the epidural space contains lymphatics, spinal nerve roots, loose fatty tissue, small arteries, and a network of large, thin-walled blood vessels called the epidural venous plexus.
• An epidural steroid injection is a minimally invasive procedure that can help relieve neck, arm, back, and leg pain in an individual caused by inflamed spinal nerves.
• an epidural steroid injection may be performed to relieve pain caused by spinal stenosis, spondylolysis, or disc herniation in an individual.
• Medicines are delivered to the spinal nerve through the epidural space, the area between the protective covering (dura) of the spinal cord and vertebrae.
• Corticosteroid injections can reduce inflammation and can be effective when delivered directly into the painful area of the individual.
• An epidural steroid injection is to place the medication near the area of injury and/or pathology within the spine.
• Interlaminar, caudal, and transforaminal injections are typically used for epidural steroid injections.
• An interlaminar epidural injection is performed by placing a needle between the bony vertebrae in the epidural space, followed by injection of medicine.
• a caudal injection is an injection into the lowest portion of the epidural space, into the area between the membrane that contains the spinal fluid and the thickest ligament between vertebrae.
• a transforaminal injection is an injection into the opening (also known as a foramen) at the side of the spine where a nerve roots exits.
• Prednisolone is a corticosteroid drug with predominant glucocorticoid and low mineralocorticoid activity, making it useful for the treatment of a wide range of inflammatory and auto-immune conditions such as asthma, uveitis, pyoderma gangrenosum, rheumatoid arthritis, ulcerative colitis, temporal arteritis and Crohn's disease, Bell's palsy, multiple sclerosis, cluster headaches, vasculitis, acute lymphoblastic leukemia and autoimmune hepatitis, systemic lupus erythematosus, Kawasaki disease and dermatomyositis.
• inflammatory and auto-immune conditions such as asthma, uveitis, pyoderma gangrenosum, rheumatoid arthritis, ulcerative colitis, temporal arteritis and Crohn's disease, Bell's palsy, multiple sclerosis, cluster headaches, vasculitis, acute
• Methylprednisolone is typically used for its anti-inflammatory effects.
• the list of medical conditions for which methylprednisolone is prescribed is rather long, and is similar to other corticosteroids such as prednisolone.
• Common uses include arthritis therapy and short-term treatment of bronchial inflammation or acute bronchitis due to various respiratory diseases. It is used both in the treatment of acute periods and long-term management of autoimmune diseases, most notably systemic lupus erythematosus. It is also used as a treatment for multiple sclerosis.
• Dexamethasone is a potent synthetic member of the glucocorticoid class of steroid drugs. It acts as an anti-inflammatory and immunosuppressant. Dexamethasone is used to treat many inflammatory and autoimmune conditions, such as rheumatoid arthritis and bronchospasm. Dexamethasone may also be used to treat idiopathic thrombocytopenic purpura, which is a decreased number of platelets due to an immune problem.
• Triamcinolone acetonide is a synthetic corticosteroid with marked antiinflammatory action.
• Kenalog®-10 Injection (triamcinolone acetonide injectable suspension, USP) is triamcinolone acetonide, in a sterile aqueous suspension suitable for intralesional and intra- articular injection, and not suitable for intravenous, intramuscular, intraocular, epidural, or intrathecal use.
• Each mL of the sterile aqueous suspension provides 10 mg triamcinolone acetonide, with sodium chloride for isotonicity, 0.9% (w/v) benzyl alcohol as preservative, 0.75% carboxymethylcellulose sodium, and 0.04% polysorbate 80; sodium hydroxide or hydrochloric acid may have been added to adjust pH between 5.0 and 7.5.
• Existing pharmaceutical compositions may have immediate or short-term effects on alleviating pain. This may be sufficient for purposes of short-term administration such as to overcome an acute episode or exacerbation of pain. However, such formulations may require repeated administration, especially for sustained or chronic pain.
• epidural injections that result in the diffusion of the active ingredient outside of the target area may be undesirable and may increase the need for an overall higher dose to ensure that the target area is exposed to an effective dose.
• pharmaceuticallyceras for localized pain, epidural injections that result in the diffusion of the active ingredient outside of the target area may be undesirable and may increase the need for an overall higher dose to
• compositions and methods of administration that contribute to unintended placement of the composition can lead to undesirable effects such as arachnoiditis caused from an epidural injection.
• the application discloses an aqueous pharmaceutical composition
• a soluble corticosteroid comprising a soluble corticosteroid and at least one viscosity enhancing agent, wherein the pharmaceutical composition has a viscosity of between 1 kcP and 200 kcP.
• the application discloses an aqueous pharmaceutical composition, wherein the soluble corticosteroid is selected from salts and esters of the group consisting of dexamethasone, methylprednisolone, prednisolone, and triamcinolone acetonide.
• the soluble corticosteroid is selected from the group consisting of dexamethasone sodium phosphate, methylprednisolone sodium succinate, prednisolone sodium succinate, and triamcinolone acetonide phosphate ester.
• the soluble corticosteroid is dexamethasone sodium phosphate.
• At least one viscosity enhancing agent is selected from the group consisting of sodium hyaluronate, hyaluronic acid, cross-linked hyaluronic acid, polyvinylpyrrolidone, hydroxypropyl methylcellulose, hydroxypropyl cellulose, hydroxyethyl cellulose, and glycerol.
• at least one viscosity enhancing agent is sodium hyaluronate.
• the soluble corticosteroid is dexamethasone sodium phosphate and at least one viscosity enhancing agent is sodium hyaluronate.
• the aqueous pharmaceutical composition comprises less than 2% w/v of the viscosity enhancing agent. In still other embodiments, the aqueous pharmaceutical composition further comprises a preservative and/or an anesthetic.
• the application provides a method for treating inflammation and/or pain in an individual in need thereof, comprising injecting into an individual an aqueous pharmaceutical composition disclosed herein.
• the aqueous pharmaceutical composition disclosed herein.
• the pharmaceutical composition is injected into the epidural space.
• less than 20 N of force is used to inject the pharmaceutical composition into the epidural space at a rate of about 0.5"/min.
• the individual is injected with the formulation once every 1 to 12 weeks.
• the soluble corticosteroid is selected from salts and esters of the group consisting of dexamethasone, methylprednisolone, prednisolone, and triamcinolone acetonide.
• the soluble corticosteroid is selected from salts and esters of the group consisting of dexamethasone, methylprednisolone, prednisolone, and triamcinolone acetonide.
• the soluble corticosteroid is selected from salts and esters of the group consisting of dexamethasone, methylprednisolone, prednisolone, and triamcinolone acetonide.
• the soluble corticosteroid is selected from salt
• corticosteroid is selected from the group consisting of dexamethasone sodium phosphate, methylprednisolone sodium succinate, prednisolone sodium succinate, and triamcinolone acetonide phosphate ester.
• the soluble corticosteroid is dexamethasone sodium phosphate.
• at least one viscosity enhancing agent is selected from the group consisting of sodium hyaluronate, hyaluronic acid, cross- linked hyaluronic acid, polyvinylpyrrolidone, hydroxypropyl methylcellulose, hydroxypropyl cellulose, hydroxyethyl cellulose, and glycerol.
• At least one viscosity enhancing agent is sodium hyaluronate.
• the soluble corticosteroid is dexamethasone sodium phosphate and at least one viscosity enhancing agent is sodium hyaluronate.
• the formulation comprises less than 2% w/v of the viscosity enhancing agent.
• the formulation further comprises a preservative and/or an anesthetic.
• the application provides a syringe comprising an aqueous pharmaceutical composition disclosed herein.
• Figure 1 shows the dissolution profile of SP-102 formulations in phosphate buffer, (0.05 M, pH 7) and 0.5% Tween 80.
• Figure 2 shows the dissolution profile of SP-102 formulations in phosphate buffer, (0.05 M, pH 7).
• Figure 3 shows the images recorded immediately post-injection in animal #1 injected with the control (3A) and formulations SP-102 (0.5% HA) (3B) and SP-102 (1.25% HA) (3C).
• Figure 4 shows the images recorded 30 minutes post-injection in animal #1 injected with the control (4 A) and formulations SP-102 (0.5% HA) (4B) and SP-102 (1.25% HA) (4C).
• Figure 5 shows the images recorded 60 minutes post-injection in animal #1 injected with the control (5 A) and formulations SP-102 (0.5% HA) (5B) and SP-102 (1.25% HA) (5C).
• Figure 6 shows the images recorded 120 minutes post-injection in animal #1 injected with the control (6A) and formulation SP-102 (1.25% HA) (6B).
• Figure 7 shows the image recorded 180 minutes post- injection in animal #1 injected with formulation SP-102 (1.25% HA).
• Figure 8 shows the images recorded immediately post-injection in animal #2 injected with formulations SP-102 (1.0% HA) (8A) and SP-102 (1.25% HA) (8B).
• Figure 9 shows the images recorded 30 minutes post-injection in animal #2 injected with formulations SP-102 (1.0% HA) (9A) and SP-102 (1.25% HA) (9B).
• Figure 10 shows the images recorded 60 minutes post-injection in animal #2 injected with formulations SP-102 (1.0% HA) (10A) and SP-102 (1.25% HA) (10B).
• Figure 11 shows the images recorded 120 minutes post-injection in animal #2 injected with formulations SP-102 (1.0% HA) (11A) and SP-102 (1.25% HA) (11B).
• Figure 12 shows the image recorded 180 minutes post- injection in animal #2 injected with formulation SP-102 (1.25% HA).
• Figure 13 shows a plot of the estimated percentage of visible contrast dye as a function of time for formulations SP-102 (0.5% HA), SP-102 (1.0% HA), and SP-102 (1.25% HA).
• Figure 14 shows a plot of the estimated percentage of visible contrast dye as a function of time for commercial injectable steroid products.
• the present application is directed to a pharmaceutical composition
• a pharmaceutical composition comprising a soluble corticosteroid and a viscosity enhancing agent.
• the pharmaceutical composition is suitable for local administration such as epidural injection, intra-articular injection, or intra- lesional injection.
• Suitable corticosteroids for the present application include salts or esters of the following: methylprednisolone, dexamethasone, prednisolone, and triamcinolone acetonide.
• the inventor has discovered the advantages of combining a soluble form of a corticosteroid with a viscosity enhancing agent in a pharmaceutical composition for a local injection.
• the viscosity enhancing agent significantly prolongs the duration of direct corticosteroid exposure at the injection site.
• the viscosity enhancing agent also provides for slow release of the steroid.
• the released steroid provides onset of action on a target site such as inflamed nerves and tissues in a sustained and/or prolonged manner. The longer lasting effect may allow a steroid to be injected periodically instead of daily, which is difficult to do via epidural or intra-articular administration.
• ophthalmological preparations is typically 25-50 cps.
• the viscosity of the injection solution must be much higher (minimum of 2000-3000 cps). Highly viscous solutions, however, can be difficult to inject without undue force.
• mixtures of the anesthetic drug bupivacaine with 1% (w/w) hyaluronic acid could not be administered through an epidural needle or catheter (Dollo, G. et al. Intl. J. Pharmaceutics, 2004, 272, 109-119).
• the present invention provides for mixtures of soluble steroids and viscosity enhancing agents that have desirable characteristics of syringeability and injectability for local administration such as epidural injection, intra-articular injection, or intra-lesional injection.
• Soluble corticosteroids include salts or esters of the following: dexamethasone, methylprednisolone, prednisolone, and triamcinolone acetonide.
• the soluble corticosteroid may possess a range of solubilities, but it is sufficiently soluble to be dissolved in the pharmaceutical formulation.
• the solubility of the corticosteroid is determined in part by its chemical form, such as salts or esters.
• Soluble forms of corticosteroids include salts thereof, such as sodium, phosphate, succinate, and combinations thereof.
• Non-limiting examples of soluble corticosteroids include dexamethasone sodium phosphate, methylprednisolone sodium succinate, prednisolone sodium succinate, and triamcinolone acetonide phosphate ester.
• the soluble corticosteroid can provide both a quick and a sustained effect, by virtue of release from the viscosity enhancing agent, after administration to the individual.
• injection of the soluble corticosteroid into an individual provides a pharmacodynamic action of corticosteroid for at least about 1, about 2, about 3, about 4, about 5, about 6, about 7, about 8, about 9, about 10, about 11, or about 12 weeks.
• the pharmacodynamic action of the corticosteroid provides an amount effective to reduce or inhibit inflammation and/or pain.
• the pharmacodynamic action of the corticosteroid provides an amount effective to inhibit inflammation and/or pain for up to 8 weeks.
• the pharmacodynamic action of the corticosteroid provides an amount effective to reduce inflammation and/or pain for up to 12 weeks.
• compositions described herein are substantially free of insoluble corticosteroids. In some embodiments, the pharmaceutical compositions are completely free of insoluble corticosteroids.
• Viscosity enhancing agent A viscosity enhancing agent is included in the pharmaceutical composition.
• the viscosity enhancing agent provides an advantage that when the pharmaceutical composition is administered into a target site (e.g., the epidural space of an individual), the formulation stays longer in the target site due to a low degree of circulation of the viscous formulation in the target site.
• the viscosity enhancing agent may also promote the binding of the active drug to a target site and to enhance drug absorption and bioavailability locally.
• the viscosity of the composition also contributes to the stability of the composition
• compositions Higher viscosities may improve shelf-life.
• the viscosity of the composition is, in large part, influenced by the amount of the viscosity enhancing agent. Higher concentrations of the viscosity enhancing agent compared to lower concentrations results in a higher viscosity. Temperature also affects viscosity, with lower temperatures resulting in higher viscosities compared to higher temperatures of the same composition.
• Suitable viscosity enhancing agent include sodium hyaluronate, hyaluronic acid, polyvinylpyrrolidone (PVP), cross-linked hyaluronic acid, hydroxypropyl methylcellulose, hydroxypropyl cellulose, hydroxylethyl cellulose, glycerol, or a mixture thereof.
• Preferred viscosity enhancing agents include sodium hyaluronate, polyvinylpyrrolidone (PVP), sodium hydroxypropyl cellulose, and carboxy methylcellulose.
• the present formulation does not include polyethylene glycol due to potential side effects.
• the amount of the viscosity enhancing agent is based on the agent used, and is in general in an amount of about 0.05-30% (w/v).
• the concentration of the viscosity enhancing agent is about 0.1% w/v, about 0.25% w/v, about 0.5% w/v, about 0.75% w/v, about 1.0% w/v, about 1.1% w/v, about 1.15% w/v, about 1.20% w/v, about 1.25% w/v, about 1.30% w/v, about 1.35% w/v, about 1.40% w/v, about 1.45% w/v, or about 1.5% w/v.
• the concentration of the viscosity enhancing agent is between 0.05 % w/v and 1.5% w/v; 0.05% w/v and 0.5% w/v; 0.1% w/v and 3.0% w/v; 0.1% w/v and 1.5% w/v; 0.1% w/v and 1.0% w/v; 0.5% w/v and 1% w/v; 0.5% w/v and 2.5% w/v; 1.0% w/v and 3.0% w/v; 1.0% w/v and 1.5% w/v; 1.0% w/v and 1.25% w/v; 1.25% w/v and 1.5% w/v; or 1.5% w/v and 3.0% w/v.
• the molecular weight of the viscosity enhancing agent is between 500 kDa and 5.0 MDa; 500 kDa and 3.0 MDa; 500 kDa and 2.0 MDa; 500 kDa and 1.0 MDa; 500 kDa and 2.0 MDa; 1.0 MDa and 3.0 MDa; 1.0 MDa and 2.5 MDa; 1.0 MDa and 2.0 MDa; and 1.2 MDa and 1.8 MDa.
• the molecular weights of sodium hyaluronate is about 711 kDa; about 880 kDa; about 1.56 MDa; about 1.8 MDa and about 2.65 MDa.
• the molecular weight is the number average molecular weight, and in other embodiments the molecular weight is the weight average molecular weight.
• the viscosity enhancing agent is sodium hyaluronate.
• the viscosity enhancing agent is hyaluronic acid or a pharmaceutically acceptable salt of hyaluronate, such as sodium salt, phosphate salt or calcium salt.
• the viscosity of the pharmaceutical composition is about 300 kcP, about 250 kcP, about 200 kcP, about 150 kcP, about 140 kcP, about 130 kcP, about 120 kcP, about 110 kcP, about 100 kcP, about 90 kcP, about 80 kcP, about, 70 kcP, about 40 kcP, about, 30 kcP, about 25 kcP, about 20 kcP, about 15 kcP, about 10 kcP, about 5 kcP, about 4kcP, about 3 kcP, about 2kcP, or about 1 kcP.
• the viscosity of the composition is between 1 kcP and 300 kcP; 1 kcP and 100 kcP; 1 kcP and 50 kcP; 1 kcP and 10 kcP; 10 kcP and 50 kcP; 10 kcP and 100 kcP; 50 kcP and 100 kcP; 100 kcP and 300 kcP; 50 kcP and 200 kcP; 75 kcP and 180 kcP; 100 kcP and 150 kcP; 150 kcP and 200 kcP; 200 kcP and 250 kcP; 250 kcP and 300 kcP.
• the pharmaceutical composition is a gel. In alternative embodiments, the pharmaceutical composition is an aqueous solution.
• Buffer Suitable buffering agents for use with the pharmaceutical compositions disclosed herein include, but are not limited to, organic acid salts such as salts of citric acid, ascorbic acid, gluconic acid, carbonic acid, tartaric acid, succinic acid, acetic acid or phthalic acid; Tris, thomethamine hydrochloride, or phosphate buffer.
• the buffer is physiologically compatible.
• the pH of the formulation may be inherently provided by the excipients present in the formulation; alternatively, a pH adjustment agent may be employed.
• a pH adjustment agent such as a buffer or a simple acid or base can be added to the pharmaceutical composition to maintain the pH to 6-8.
• the amount of a pH adjusting agent is in general 0.1-10%.
• the pH of the formulation is within physiological range.
• the osmolality of the formulation is between 200 mOsm/kg and 350 mOsm/kg, 250 mOsm/kg and 300 mOsm/kg, 280 mOsm/kg and 290 mOsm/kg. In some embodiments, the osmolality of the formulation is within a physiological range. In some embodiments, the pharmaceutical composition is isotonic in a human.
• the pharmaceutical composition further comprises an anesthetic agent such as lidocaine, bupivacaine, or benzocaine.
• the present formulation preferably does not include a surfactant.
• the pharmaceutical composition comprises one or more non-ionic surfactants. Inclusion of a surfactant increases the solubility and wettability of the drug particles.
• Suitable non-ionic surfactants include polysorbates (e.g., TWEEN®-80, TWEEN®-20), tyloxapol, polyoxyl castor oil, polaxamers, polyethylene glycol, caprylic triglyceride, polyoxyl stearates (e.g., oxyethylene monostearate), polyoxyethylated vegetable oils and glyceryl monostearate.
• a preferred non-ionic surfactant is a polysorbate such as TWEEN®-80.
• the amount of the non-ionic surfactant in the pharmaceutical composition, if present, is in general 0.001-10, or 0.01-1 % (w/v) of the pharmaceutical composition.
• shelf life refers to the amount of time the pharmaceutical composition may be stored without loss of potency and/or performance profile. In some embodiments, shelf life refers to the amount of time the pharmaceutical composition may be stored without a loss of more than 2%, 5%, 8% or 10% of the potency and/or performance.
• the preservative-free pharmaceutical compositions provided herein are designed to have shelf life of at least 12, 24 or 36 months. In some embodiments, the pharmaceutical compositions have a shelf life of between 12 and 24 months. In some embodiments, the pharmaceutical composition is stored at room temperature and is shelf stable for at least 12, 24 or 36 months. In some embodiments, the pharmaceutical composition is stored below room temperature and has a shelf life of at least 12, 24, or 36 months.
• Preservatives The present formulation preferably does not include a preservative.
• the pharmaceutical composition comprises one or more preservatives.
• a preservative such as an anti-microbial preservative, increases the shelf-life of the pharmaceutical composition.
• Any preservative which does not adversely interact with the active drug or any of the excipients may be employed.
• preservatives include ethanol, benzyl alcohol, benzalkonium chloride, benzethonium chloride, benzoic acid, bronopol, butyl-paraben, cetrimide, chlorhexidine.
• the amount of preservative may range, for example, from about 0.01-1%.
• the aqueous pharmaceutical composition comprises a soluble corticosteroid and at least one viscosity enhancing agent, wherein the aqueous pharmaceutical composition has a viscosity of between 1 kcP and 200 kcP.
• the aqueous pharmaceutical composition is in a unit dose and has a volume of 1 mL, 2 mL, 3 mL, 4 mL, 5 mL, 6 mL, 7 mL, 8 mL, or 10 mL.
• the viscosity enhancing agent concentration is between 0.05 % w/v and 1.5% w/v; 0.05% w/v and 0.5% w/v; 0.1% w/v and 1.5% w/v; 0.1% w/v and 1.0% w/v; 0.5% w/v and 1% w/v; 0.5% w/v and 2.5% w/v; 1.0% w/v and 1.5% w/v; 1.0% w/v and 1.25% w/v; or 1.25% w/v and 1.5% w/v.
• the pharmaceutical composition comprises soluble
• the aqueous pharmaceutical composition is in a unit dose and has a volume of 1 mL, 2 mL, 3 mL, 4 mL, 5 mL, 6 mL, 7 mL, 8 mL, or 10 mL.
• the viscosity enhancing agent concentration is between 0.05 % w/v and 1.5% w/v; 0.05% w/v and 0.5% w/v; 0.1% w/v and 1.5% w/v; 0.1% w/v and 1.0% w/v; 0.5% w/v and 1% w/v; 0.5% w/v and 2.5% w/v; 1.0% w/v and 1.5% w/v; 1.0% w/v and 1.25% w/v; or 1.25% w/v and 1.5% w/v.
• the dose per injection of methylprednisolone is in the range of 20 to 120 mg/dose in 1 to 10 ml of a sterile solution such as water for injection or saline.
• the pharmaceutical composition comprises soluble
• the aqueous pharmaceutical composition is in a unit dose and has a volume of 1 mL, 2 mL, 3 mL, 4 mL, 5 mL, 6 mL, 7 mL, 8 mL, or 10 mL.
• the viscosity enhancing agent concentration is between 0.05 % w/v and 1.5% w/v; 0.05% w/v and 0.5% w/v; 0.1% w/v and 1.5% w/v; 0.1% w/v and 1.0% w/v; 0.5% w/v and 1% w/v; 0.5% w/v and 2.5% w/v; 1.0% w/v and 1.5% w/v; 1.0% w/v and 1.25% w/v; or 1.25% w/v and 1.5% w/v.
• the dose per injection of prednisolone is in the range of 20 to 120 mg/dose in 1 to 10 ml of a sterile solution such as water for injection or saline.
• the pharmaceutical composition comprises soluble
• the aqueous pharmaceutical composition is in a unit dose and has a volume of 1 mL, 2 mL, 3 mL, 4 mL, 5 mL, 6 mL, 7 mL, 8 mL, or 10 mL.
• the viscosity enhancing agent concentration is between 0.05 % w/v and 1.5% w/v; 0.05% w/v and 0.5% w/v; 0.1% w/v and 1.5% w/v; 0.1% w/v and 1.0% w/v; 0.5% w/v and 1% w/v; 0.5% w/v and 2.5% w/v; 1.0% w/v and 1.5% w/v; 1.0% w/v and 1.25% w/v; or 1.25% w/v and 1.5% w/v.
• the dose per injection of dexamethasone is in the range of 3 to 20 mg/dose in 1 to 10 ml of a sterile solution such as water for injection or saline.
• the pharmaceutical composition comprises soluble triamcinolone acetonide phosphate ester and at least one viscosity enhancing agent in an aqueous solution such as water, wherein the pharmaceutical composition has a viscosity of between 1 kcP and 200 kcP.
• the aqueous pharmaceutical composition is in a unit dose and has a volume of 1 mL, 2 mL, 3 mL, 4 mL, 5 mL, 6 mL, 7 mL, 8 mL, or 10 mL.
• the viscosity enhancing agent concentration is between 0.05 % w/v and 1.5% w/v; 0.05% w/v and 0.5% w/v; 0.1% w/v and 1.5% w/v; 0.1% w/v and 1.0% w/v; 0.5% w/v and 1% w/v; 0.5% w/v and 2.5% w/v; 1.0% w/v and 1.5% w/v; 1.0% w/v and 1.25% w/v; or 1.25% w/v and 1.5% w/v.
• the dose per injection of triamcinolone is in the range of 20 mg to 120 mg/dose in 1 to 10 ml of a sterile solution such as water for injection or saline.
• the aqueous pharmaceutical composition comprises soluble dexamethasone sodium phosphate and sodium hyaluronate, wherein the aqueous
• the pharmaceutical composition has a viscosity of between 1 kcP and 200 kcP.
• the molecular weight of sodium hyaluronate is 500 kDa and 2.0 MDa. In other embodiments, the molecular weight of sodium hyaluronate is 1.2 MDa and 1.8 MDa.
• the sodium hyaluronate concentration is between 0.05 % w/v and 1.5% w/v; 0.05% w/v and 0.5% w/v; 0.1% w/v and 1.5% w/v; 0.1% w/v and 1.0% w/v; 0.5% w/v and 1% w/v; 0.5% w/v and 2.5% w/v; 1.0% w/v and 1.5% w/v; 1.0% w/v and 1.25% w/v; or 1.25% w/v and 1.5% w/v.
• the aqueous pharmaceutical composition is in a unit dose and has a volume of 1 mL, 2 mL, 3 mL, 4 mL, 5 mL, 6 mL, 7 mL, 8 mL, 9 mL, or 10 mL.
• the aqueous pharmaceutical composition comprises soluble dexamethasone sodium phosphate and hyaluronic acid, wherein the aqueous pharmaceutical composition has a viscosity of between 1 kcP and 200 kcP.
• the molecular weight of hyaluronic acid is 500 kDa and 2.0 MDa. In other embodiments, the molecular weight of hyaluronic acid is 1.2 MDa and 1.8 MDa.
• the hyaluronic acid concentration is between 0.05 % w/v and 1.5% w/v; 0.05% w/v and 0.5% w/v; 0.1% w/v and 1.5% w/v; 0.1% w/v and 1.0% w/v; 0.5% w/v and 1% w/v; 0.5% w/v and 2.5% w/v; 1.0% w/v and 1.5% w/v; 1.0% w/v and 1.25% w/v; or 1.25% w/v and 1.5% w/v.
• the aqueous pharmaceutical composition is in a unit dose and has a volume of 1 mL, 2 mL, 3 mL, 4 mL, 5 mL, 6 mL, 7 mL, 8 mL, 9 mL, or 10 mL.
• Each of the exemplary formulations in Table 1 comprises soluble dexamethasone sodium phosphate at a weight equivalent to 5 mg/mL of dexamethasone and varying amounts of sodium hyaluronate.
• the molecular weight of the sodium hyaluronate is 1.56 MDa.
• the formulations further comprise a physiologically compatible buffer solution, such as 15 mM PBS solution.
• Each of the formulations are prepared in a 1 mL, 2 mL, 3 mL, 4 mL, 5 mL, 6 mL, 7 mL, 8 mL, 9 mL, and 10 mL unit doses.
• each of the formulations listed in Table 1 further optionally contain an anesthetic and/or preservative.
• the soluble corticosteroids of each of the formulations disclosed in Table 1 can be replaced with corticosteroids selected from the group consisting of methylprednisolone sodium succinate, prednisolone sodium succinate, and triamcinolone acetonide phosphate ester.
• the present formulation can be packaged in a unit dose vial or syringe. It can also be packaged in a two-compartment vial or syringe with the soluble steroid and viscosity enhancing agent each in a separate compartment. In some
• the unit dose is between 1 mL and 10 mL; 2 mL and 8 mL; and 2 mL and 5 mL. In some embodiments, the unit dose is about 1 mL, about 2 mL, about 2.5 mL, about 3 mL, about 3.5 mL, about 4 mL, about 4.5 mL, about 5 mL, or about 5.5 mL. In any of the foregoing embodiments, the unit dose is a gel pharmaceutical composition. In other foregoing embodiments, the unit dose is an aqueous pharmaceutical composition.
• the present disclosure also provides for a kit comprising a pharmaceutical formulation disclosed herein and instructions for use.
• the pharmaceutical composition is aseptic.
• the pharmaceutical composition is prepared using aseptic techniques. For instance, the various components of the composition may be individually sterilized and then combined under aseptic conditions to provide the sterile pharmaceutical composition. In some of the foregoing embodiments, the pharmaceutical composition is terminally sterilized.
• the present application also provides methods for treating inflammation and/or pain such as those associated with rheumatoid arthritis, osteoarthritis, lower back pain, tendonitis, spinal stenosis, disc herniation, radiculitis and chronic discogenic pain with any of the aqueous pharmaceutical compositions disclosed herein.
• the method comprises the steps of identifying an individual suffering from inflammation and/or pain, and injecting to the epidural space of the individual any of the aqueous pharmaceutical compositions disclosed herein.
• the method optionally comprises a step of injecting to the epidural space of the individual an anesthetic agent such as lidocaine, bupivacaine, or benzocaine.
• the anesthetic agent can be administered in a separate injection or can be combined with the aqueous pharmaceutical composition and injected together.
• the method comprises the steps of identifying an individual suffering from inflammation and/or pain, and injecting to a skin lesion of the individual any of the aqueous pharmaceutical compositions disclosed herein.
• the method optionally comprises a step of injecting to the skin lesion of the individual an anesthetic agent.
• the anesthetic agent can be administered in a separate injection or can be combined with the aqueous pharmaceutical composition and injected together.
• the method comprises the steps of identifying an individual suffering from inflammation and/or pain, and injecting to an affected joint of the individual any of the aqueous pharmaceutical compositions disclosed herein.
• the method optionally comprises a step of injecting to the affected joint of the individual an anesthetic agent.
• the anesthetic agent can be administered in a separate injection or can be combined with the pharmaceutical composition and injected together.
• the dose of the steroid injected is based on the potency of the steroid.
• the amount of corticosteroid administered to an individual in a single dose is between 2 mg and 20 mg; 5 mg and 15 mg; and 5 mg and 10 mg. In some embodiments, the amount of corticosteroid administered to an individual in a single dose is about 2 mg, 5 mg, 8 mg, 10 mg, 15 mg and 20 mg.
• the dosage of dexamethasone is about 3 to 20 mg/dose; the dosage of methylprednisolone is about 20 to 120 mg/dose, the dosage of prednisolone is about 20 to 120 mg/dose; the dosage of triamcinolone acetonide is about 20 to 120 mg/dose.
• the individual is injected with the pharmaceutical composition once every 1 to 12 weeks; 1 to 8 weeks; 1 to 4 weeks; 2 to 12 weeks; 4 to 12 weeks; 8 to 12 weeks; 2 to 8 weeks; or 2 to 4 weeks. In some embodiments, the individual is injected with the pharmaceutical composition about every 1, 2, 4, 6, 8, 10, or 12 weeks.
• the methods and compositions disclosed herein are useful in treating an individual that is a mammal, such as a human, dog, or cat.
• the methods and compositions disclosed herein are particularly useful in treating humans.
• Intralesional injection is a direct delivery of medication
• Intralesional injections are introduced into or performed within a lesion.
• the skin serves as a reservoir, allowing medication deposited in the dermis to be delivered over a period of time, resulting in prolonged therapy while avoiding or minimizing the adverse effects of systemic therapy.
• Intra-articular injection is a procedure used in the treatment of inflammatory joint conditions, such as rheumatoid arthritis, psoriatic arthritis, gout, tendinitis, bursitis and occasionally osteoarthritis.
• a hypodermic needle is injected into the affected joint where it delivers an anti-inflammatory agent such as a corticosteroid.
• the application discloses pharmaceutical compositions with a range of viscosities.
• the choice of the viscosity is in part dependent on the desired location of the injected pharmaceutical composition in the individual. For instance, when a localized amount of the pharmaceutical composition is desired, a pharmaceutical composition with a higher viscosity may be selected. Alternatively, if broader coverage of the pharmaceutical composition is desired, a pharmaceutical composition with a lower viscosity may be selected.
• the method comprises administering the pharmaceutical composition via a transforaminal injection, wherein the pharmaceutical composition comprises between 0.5% and 1.5%, 1.0% and 1.5%, or 0.75% and 1.25%, of a viscosity enhancing agent.
• the method comprises administering the pharmaceutical composition via an interlaminar injection, wherein the pharmaceutical composition comprises between 0.1% and 1.5%, 0.1% and 1.0%, 0.1% and 0.75%, 0.1% and 0.5%, 0.1% and 0.25%, 0.75% and 1.5%, 1.0% and 1.5%, or 0.75% and 1.25% of a viscosity enhancing agent.
• the method comprises administering the pharmaceutical composition via a caudal injection, wherein the pharmaceutical composition comprises between 0.1% and 1.5%, 0.1% and 1.0%, 0.1% and 0.75%, 0.1% and 0.5%, 0.1% and 0.25%, 0.75% and 1.5%, 1.0% and 1.5%, or 0.75% and 1.25% of a viscosity enhancing agent.
• the viscosity enhancing agent is hyaluronic acid or a salt thereof.
• Syringeability and injectability are the ability of an injectable therapeutic to pass easily through a hypodermic needle on transfer from a vial prior to an injection. Syringeability includes such factors as ease of withdrawal, clogging and foaming tendencies, and accuracy of dose measurements. Injectability refers to the performance of the formulation during injection. Injectability includes pressure or force required for injection, evenness of flow, and freedom from clogging (i.e., no blockage of the syringe needle). The syringability and injectability is influenced in part by the viscosity of the pharmaceutical composition, the injection or transfer flow rate, and the needle characteristics (such as length and gauge).
• Desirable characteristics of injectability include, for example, a smooth and continuous injection without undue force. Such an injection allows the person administrating the injection to maintain continuous control over the procedure without incurring undue strain.
• the application discloses compositions that are easily syringeable and/or injectable into an individual.
• the application also discloses methods for injecting an individual with a pharmaceutical composition, wherein the injecting is easy and provides a continuous flow of the pharmaceutical composition.
• the method comprises applying an injecting force of between 5 N and 90 N, 5 N and 50 N, 50N and 100 N, 5 N and 25 N, 25 N and 50 N, or 10 N and 40 N to the syringe.
• the method comprises applying a force of no more than 5 N, no more than 7 N, no more than 10 N, no more than 15 N, no more than 17, no more than 21 N, no more than 27 N, no more than 29 N, no more than 33 N, no more than 38 N, no more than 39 N, no more than 46 N, no more than 59 N, no more than 70, no more than 78 N or no more than 90 N to the syringe.
• a force of no more than 5 N, no more than 7 N, no more than 10 N, no more than 15 N, no more than 17, no more than 21 N, no more than 27 N, no more than 29 N, no more than 33 N, no more than 38 N, no more than 39 N, no more than 46 N, no more than 59 N, no more than 70, no more than 78 N or no more than 90 N to the syringe.
• the method comprises applying a force of about 5 N, about 7 N, about 10 N, about 15 N, about 17, about 21 N, about 27 N, about 29 N, about 33 N, about 38 N, about 39 N, about 46 N, about 59 N, about 70, about 78 N or about 90 N to the syringe.
• the injection force results in the injection of the pharmaceutical composition at a rate (i.e. extrusion rate) of about 0.4"/min, about 0.5"/min, about 0.6"/min, about 0.7'Vmin, about 0.8"/min, about 0.9"/min, about 1.0'Vmin, about l. l'Vmin, about 1.2"/min, about 1.3"/min, about 1.4"/min, about 1.5"/min, about 1.75"/min, about 2.0"/min, about 2.25"/min, or at about 2.36"/min.
• the syringe comprises a needle having needle gauge of 19, 20, 21, 22, 23, 24, or 25. In one embodiment, the syringe comprises a needle having needle gauge of 25.
• the application discloses a method for injection which reduces the "stringing effect".
• the stringing effect refers to a phenomenon that when the injection of the pharmaceutical composition into an individual is finished, the remaining composition in the bore of the needle used in the injection comes into contact with the individual. For instance, when the needle is withdrawn from the target site, the remaining composition in the bore of the needle is drawn out due to the viscous nature of the composition and elongates like string. The needle may leave a trail of the composition as it exits the individual, potentially exposing unintended areas and tissues to the composition. Unintended placement of the composition can lead to undesirable effects such as arachnoditis caused from an epidural injection. In some instances, upon withdrawal of the needle the composition injected into the target site may elongate and stretch and may come into contact with unintended areas and tissues of the individual.
• the methods and compositions disclosed herein reduce the occurrence of the stringing effect.
• no pharmaceutical composition disclosed herein exits the needle into the individual.
• the pharmaceutical composition enters an individual only when an injection force is applied.
• the composition makes a clean break with very little stringing upon separation or division.
• the application discloses a method for treating inflammation and/or pain in an individual in need thereof, comprising injecting an aqueous pharmaceutical composition disclosed herein into the epidural, intralesional, or intra-articular space of the individual; and wherein the method comprises one or more of the steps selected from the group consisting of 1) applying a force of less than 5 N, less than 7 N, less than 10 N, less than 15 N, less than 17, or less than 21 N to inject the aqueous pharmaceutical composition at a rate of about 0.4"/min, about 0.5"/min, about 0.6"/min, about 0.7"/min, about 0.8"/min, about 0.9"/min, about 1.0'Vmin, about l.
• the application discloses a method for treating inflammation and/or pain in an individual in need thereof, comprising injecting an aqueous pharmaceutical composition disclosed herein into the epidural, intralesional, or intra-articular space of the individual; and wherein the method comprises one or more of the steps selected from the group consisting of 1) applying a force of less than 21 N to inject the aqueous pharmaceutical composition at a rate of about 0.5"/min; and 2) injecting the aqueous pharmaceutical composition once every 1 to 12 weeks.
• the application discloses a method for treating inflammation and/or pain in an individual in need thereof, comprising injecting any of the exemplary formulations in Table 1 into the epidural, intralesional, or intra-articular space of the individual; and wherein the method comprises one or more of the steps selected from the group consisting of 1) applying a force of less than 5 N, less than 7 N, less than 10 N, less than 15 N, less than 17, or less than 21 N to inject the aqueous pharmaceutical composition at a rate of about 0.4"/min, about 0.5"/min, about 0.6"/min, about 0.7"/min, about 0.8"/min, about 0.9"/min, about 1.0'Vmin, about l.
• composition occurs about every 1, 2, 4, 6, 8, 10, or 12 weeks.
• the application discloses a method for treating inflammation and/or pain in an individual in need thereof, comprising injecting any of the exemplary formulations in Table 1 into the epidural space of the individual; and wherein the method comprises one or more of the steps selected from the group consisting of 1) applying a force of less than 21 N to inject the aqueous pharmaceutical composition at a rate of about
• the step of injecting the aqueous pharmaceutical composition occurs about every 1, 2, 4, 6, 8, 10, or 12 weeks.
• the application discloses the use of an aqueous
• composition in the manufacture of a formulation for the treatment of inflammation and/or pain in an individual in need thereof, wherein the formulation is injected into the individual.
• the term “about” includes and describes the value or parameter per se.
• “about x” includes and describes "x" per se.
• the term “about” when used in association with a measurement, or used to modify a value, a unit, a constant, or a range of values refers to variations of + 1-10%.
• the term “about” when used in association with a measurement, or used to modify a value, a unit, a constant, or a range of values refers to variations of + 5%.
• the term “about” when used in association with a measurement, or used to modify a value, a unit, a constant, or a range of values refers to variations of + 10%.
• between includes and describes the value or parameter per se.
• between x and y includes and describes "x" and "y” per se.
• any one of the foregoing embodiments may be combined with one or more other embodiments disclosed herein.
• a pharmaceutical composition comprising soluble dexamethasone sodium phosphate, soluble methylprednisolone, and sodium hyaluronate in an aqueous solution such as water, wherein the pharmaceutical composition has a viscosity of between 1 kcP and 200 kcP, is provided by this application.
• a method of treating inflammation and/or pain in an individual in need thereof comprising injecting a pharmaceutical composition comprising soluble
• dexamethasone sodium phosphate, soluble methylprednisolone, and sodium hyaluronate in an aqueous solution such as water, wherein the pharmaceutical composition has a viscosity of between 1 kcP and 200 kcP, is provided by this application.
• This example describes the formulations of dexamethasone sodium phosphate (SP- 102) used in the physical and chemical analysis, dissolution, in vivo, and histopathological studies detailed in Examples 2-5.
• Dexamethasone sodium phosphate, Na 2 HP0 4 -7H 2 0, NaH 2 P0 4 H 2 0, and NaCl were combined in HPLC grade water.
• Sodium hyaluronate (HA, 1.56 MDa) was slowly added and the resulting mixture was stirred overnight to yield a clear colorless gel.
• a batch formulation of 100 mL was typically prepared.
• the amount of dexamethasone sodium phosphate used was equivalent to 5.0 mg/mL dexamethasone.
• the amount of added sodium hyaluronate was varied as shown in Table 2.
• This Example describes the physical and chemical analysis for SP-102 formulations containing 0.5%, 0.75%, 1.0%, and 1.25% sodium hyaluronate.
• the appearance of the samples and the measured pH is presented in Table 4.
• Analysis of dexamethasone sodium phosphate in the samples by HPLC is also presented in Table 4.
• This Example describes the dissolution of SP-102 formulations containing 0.5%, 0.75%, 1.0%, and 1.25% sodium hyaluronate.
• This Example describes the stability of SP-102 (1.25% HA) formulations.
• the stability data demonstrates that SP-102 (1.25% HA) is stable at ambient room temperature up to 2.4 months or at 50 °C for at least 34 days with less than 2% degradation.
• the known impurity (dexamethasone) was increased to 1.1% and the unknown impurity (RRT 1.47) was increased to 1.7%.
• the stability of SP-102 (1.25% HA) is similar to that of commercial dexamethasone sodium phosphate containing sodium bisulfate (antioxidant) and benzyl alcohol (preservative).
• the animals were subsequently repositioned on supine recumbency and the vertebral arteries were canulated from the left subclavian artery following a seldinger technique access on the right femoral artery.
• the vertebral artery was used to deliver the test formulations while fluoroscopic cines were recorded from the brain with special interest on the brainstem.
• the right vertebral artery was used in one animal (animal #1) and the left vertebral artery was used in the second animal (animal #2).
• Animal #1 was injected with three separate formulations.
• the formulations were as follows:
• Injection 1 control: 2 mL of dexamethasone sodium phosphate (4 mg/mL) and 647 iohexol (a contrast agent).
• Injection 2 2 mL SP-102 (0.5% HA) and 647 mg iohexol.
• Injection 3 2 mL SP-102 (1.25% HA) and 647 mg iohexol.
• the post-injection images, recorded immediately following injection of animal #1, are shown in Figures 3A-3C for the control and for formulations SP-102 (0.5% HA) and SP- 102 (1.25% HA).
• the corresponding images, recorded 30 min and 60 min after injection, are presented in Figures 4A-4C and Figures 5A-5C, respectively.
• the images recorded 120 min after injection for the control and formulation SP-102 (1.25% HA) are shown in Figures 6A- 6B.
• the image recorded 180 min post-injection for formulation SP-102 (1.25% HA) is shown in Figure 7.
• Injection 1 2 mL SP-102 (1.0% HA) and 647 mg iohexol.
• Injection 2 2 mL SP-102 (1.25% HA) and 647 mg iohexol.

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