WO2017029225A1

WO2017029225A1 - Solid pharmaceutical composition of abacavir, lamivudine, and efavirenz

Info

Publication number: WO2017029225A1
Application number: PCT/EP2016/069260
Authority: WO
Inventors: Biljana JANKOVIC; Katja BERGINC; Tatjana JOKSIMOVIC
Original assignee: Sandoz Ag
Priority date: 2015-08-14
Filing date: 2016-08-12
Publication date: 2017-02-23
Also published as: EP3334419A1; WO2017029226A1

Abstract

The present invention describes a fixed dose oral formulation of a triple HIV antiviral combination of abacavir (notably abacavir sulphate), lamivudine and efavirenz, useful in the treatment of HIV infections. The described formulations combine a number of valuable use 5 attributes, including reduction of mouth burning effect caused by efavirenz as well as for providing of palatable formulations for high drug loaded system that is important for a triple fixed dose combination, without however to the detriment of dissolution properties for each active ingredient.

Description

Solid pharmaceutical composition of Abacavir, Lamivudine, and Efavirenz

Field of the invention The present invention belongs to the field of pharmaceutical industry and relates to anti-viral and particularly anti-HIV medication, in particular involving administration of nucleoside inhibitors of HIV-1 reverse transcriptase abacavir (in particular abacavir sulphate) and lamivudine, and of non-nucleoside inhibitor of HIV-1 reverse transcriptase efavirenz. Description of the background art

A high number of anti-HIV therapeutic compounds and a high number of possible

combination proposals have become known and described. In the development of the present invention, the active compounds abacavir, lamivudine and efavirenz respectively represent particularly selected active compounds to be combined.

The chemical name for abacavir is [4R-(2-Amino-6-(cyclopropylamino)-9H-purin-9-yl)-2- cyclopentene-1 -methanol. It typically is present in the form of its sulphate salt, notably at a ratio of abacavir to sulphate of 2:1 , in the following also denoted as compound of formula 1. It is nucleoside inhibitor of reverse transcriptase. The main mechanism of action for abacavir represents the inhibition of the HIV reverse transcriptase enzyme, an event which results in chain termination and interruption of the viral replication cycle. Intracellular^, the drug is metabolized to the active moiety, carbovir 5'-triphosphate. Recommended daily intake of abacavir is 600 mg.

The empirical formula of the compound of formula 1 is

and the molecular weight is 670.76. Abacavir sulphate is a tan to yellow crystalline powder, soluble in water throughout the pH range from 1 .2 to 8.0, and very slightly soluble in methanol and ethanol. The chemical structure of abacavir sul hate is depicted below.

Chemical structure of abacavir sulphate Lamivudine is effective as chain termination agent of viral reverse transcription. Lamivudine is metabolized intracellular^ to the active moiety, lamivudine 5'-triphosphate. The triphosphate has selective inhibitory activity against HIV-1 and HIV-2 replication in vitro. Recommended daily intake of lamivudine is 300 mg.

The chemical name of lamivudine is 2(1 H)-pyrimidinone-4-amino-1 -[(2R,5S)-2- (hydroxymethyl)-1 ,3-oxathiolan-5-yl] , in the following also denoted as compound of formula 2. Its empirical formula is C₈HH N₃O₃S and the molecular weight is 229.3. Lamivudine is white to off-white crystalline powder, soluble in water throughout the pH range from 1.2 to 6.8, sparingly soluble in methanol and ethanol and slightly soluble in acetone.

The chemical structure of lamivu

Chemical structure of lamivudine

Efavirenz (chemical name: (4S)-6-chloro-4-(-2-cyclopropylethynyl)-4-(trifluromethyl)-2,4- dihydro-1 H-3, 1 benzoxazin-2-one), in the following also denoted as compound of formula 3, is a benzoxazinone of the non-nucleoside reverse transcriptase (RT) inhibitors group (NNRTIs), which interrupts the reverse transcription of viral RNA to DNA, a crucial step for HIV replication. Efavirenz is specific for HIV-1 reverse transcriptase and is a mixed type, mainly non-competitive inhibitor. Its empirical formula is C14H₉CIF₃NO2 and the molecular weight is 315.68. Efavirenz is white to off-white crystalline powder, practically insoluble in water. It is very slightly to slightly soluble in water and buffers with addition of wetting agent (sodium dodecyl sulphate). The chemical structure of efavirenz is depicted below.

Chemical structure of efavirenz Current solid formulation of efavirenz at the market is related to compressed tablets (Stocrin^®), which is 50 % by weight drug loaded and film coated with hydroxypropylmethylcellulose/hydroxypropylcellulose (HPMC/HPC), described in EP 1 332 757 A1. According to the summary of product characteristics, efavirenz tablets should be swallowed intact with liquid. The dose strength is 600 mg. W09951239 A1 is directed to formulation of efavirenz capsules (Sustiva^®), that dissolves rapidly thereby enhancing the therapeutic characteristics of the formulation. The registered dose strength of Efavirenz capsules is 200 mg. In case of capsule opening, the content should be taken with grape jelly or yogurt. Nevertheless, such way of administration may result in hot "jalapeno" sensation in oral mucosa (Kaul et al. AHJP 2010; 67: 217-22). According to W09951239 A1 , a high level of disintegrant must be included to achieve sufficient release of efaviranz.

Few documents from the literature reported about oral mucosa irritation caused by efavirenz (Borras-Blasco J Ann Pharmacother. 2006 Jul-Aug; 40(7-8): 1471 -2). Mechanism of this effect has not been explained yet. Besides solid dosage form of efavirenz, liquid formulation is also present at the market, which is intended for HIV therapy of adults, adolescents and children 3 years of age and older, who are unable to swallow hard capsules or film-coated tablets. The formulation contains medium-chain triglycerides as solvent, sucralose and strawberry/mint flavour. The presence of the drug as an oily solution, with a low thermodynamic tendency to partition into the aqueous environment of the throat and mouth, minimizes the intrinsic burning properties of the efavirenz, making it palatable (Bahal et al, Pharm. Dev Technol., 2003).

Efavirenz can be provided as micronized, crystalline and anhydrous powder. It belongs to Class 2 (poor solubility/high permeability) drug according to Biopharmaceutical Classification system. Solubility of efavirenz in water is 0.01 mg/mL. pH of this solution is 5.7.

In the current therapy of HIV, the recommended dose is 600 mg of Abacavir, 300 mg Lamivudine, and 600 mg of Efavirenz given once daily, which represents four (Stocrin^®, 2x Ziagen^®, Epivir^®) or two (Stocrin^® and Kivexa^®) tablets of different reference products. The patient has to swallow multiple tablets of considerable size from different packaging units.

Two fixed dose triple combination dosage forms are currently available, Trizivir^® and Atripla^®. Trizivir^® is in the form of a single film-coated tablet comprising 150 mg of lamivudine 300 mg of zidovudine, and 300 mg of abacavir base (351 mg of abacavir sulphate). Atripla® is in the form of a single film-coated tablet comprising 600 mg of efavirenz, 200 mg of emtricitabine, and 245 mg of tenofovir disoproxil fumarate (expressed as tenofovir disoproxil).

WO201 1/061302A (=US2012283177A) and WO201 1/061303A (=US20120270828A) respectively provide overviews about the current date multi-active anti-HIV therapies and itself teaches a treatment scheme against HIV in humans, including three or four active principles. While a multitude of various triple and quadruple anti-HIV combinations are listed in the description, the respectively claimed combinations are defined as triple or quadruple combinations: in WO201 1/061302A the claimed selected anti-HIV actives are: a nucleoside reverse transcriptase inhibitor (NRTI) selected from lamivudine and emtricitabine; another nucleoside or nucleotide reverse transcriptase inhibitor (NRTI) selected from didanosine, abacavir and tenofovir; and the combination of ritonavir with a protease inhibitor (PI) selected from lopinavir, fosamprenavir, atazanavir and darunavir, or an non-nucleoside reverse transcriptase inhibitor (NNIRT) selected from efavirenz and etravirine, for daily administration to said human being one to four days per week. In WO201 1/061303A the claimed selected anti-HIV actives are: a non-nucleoside reverse transcriptase inhibitor (NNRTI) selected from selected from nevirapine, efavirenz and etravirine, a nucleoside reverse transcriptase inhibitor (NRTI) selected from lamivudine and emtricitabine; and two different nucleoside or nucleotide reverse transcriptase inhibitors (NRTIs) selected from didanosine, abacavir and tenofovir. Specific descriptions or examples of formulating triple or quadruple unit dose combinations, let alone specific formulations containing, in one common dosage form, all of abacavir, lamivudine and efavirenz, are not given in WO201 1/061302A and WO201 1/061303A.

Further WO201 1/094150 discloses combinations of dolutegravir (GSK1349572) with one or more therapeutic agents selected from the group consisting of abacavir, efavirenz, and lopinavi and possibly lamivudine in addition. Again, specific descriptions or examples of formulating triple or quadruple unit dose combinations, let alone specific formulations containing, in one common dosage form, all of abacavir, lamivudine and efavirenz, are not given in WO201 1/094150 either.

Behind the above background, there was a need to provide an effective while concurrently patient compliant anti-HIV therapy.

Summary of the invention

Despite the challenge facing formulation scientist to provide an effective multi-active component formulation suitable for anti-HIV treatment, the present invention provides a useful fixed dose combination in a common combinational product (dosage form) comprising all of abacavir, lamivudine and efavirenz, which allows high drug load effective to meet the daily dose of each active compound, without compromising bioequivalence with comparative approved drug formulations (notably relevant drug formulations mentioned above), while at the same time being a swallowable dosage and minimizing the generation of mouth burning taste sensation inherent to the active compound efavirenz. Accordingly, the present invention provides, as set forth in the following items, various aspects, subject-matters and preferred embodiments, which respectively taken alone or in combination, contribute to solving the object of the present invention as well as further objects:

1. A solid pharmaceutical composition, which is a multi-unit particulate dosage form in the form of mini-tablets, wherein each mini-tablet comprises a fixed combination of active ingredients (a) to (c):

(a) a compound of the followin formula

(b) a compound of formula 2

formula 2

(c) a compound of formula 3

formula 3 and at least one pharmaceutically acceptable excipient selected from the group consisting of disintegrants, binders, fillers, lubricants, surfactants and film-forming agents. 2. A solid pharmaceutical composition, which is a multi-unit particulate dosage form in the form of granules or pellets,

wherein the solid pharmaceutical composition comprises a fixed combination of active ingredients (a) to (c):

(a) a compound of the followin formula

(b) a compound of formu

formula 2

(c) a compound of formula 3

formula 3 and at least one pharmaceutically acceptable excipient selected from the group consisting of disintegrants, binders, fillers, lubricants, surfactants and film-forming agents.

3. The solid pharmaceutical composition according to item 1 or 2, wherein the solid pharmaceutical composition is a triple combination of active ingredients (a) to (c); in particular said solid pharmaceutical composition is free of ritonavir and free of didanosine and tenofovir specifically, and preferably contains no any further anti-HIV active substance. 4. The solid pharmaceutical composition according to anyone of items 2 or 3, wherein said fixed combination of active ingredients (a) to (c) is contained in each granule or pellet of the multitude of granules or pellets.

5. The solid pharmaceutical composition according to anyone of the preceding items, wherein the whole composition which defines the multi-unit particulate dosage form contains at least 1500 mg of active ingredients (a) to (c) in total, preferably 1500 mg (calculated on the basis of the free base active compound).

In a preferred embodiment, the triple combination of active ingredients (a) to (c) in the common solid pharmaceutical composition contains 600 mg abacavir (calculated as free base) respectively 702 mg abacavir sulphate, 300 mg lamivudine and 600 mg efavirenz.

6. The solid pharmaceutical composition according to anyone of the preceding items, wherein the amount of active ingredients in total represent at least 60% by weight of the whole composition, preferably up to 90% by weight of the whole composition.

7. The solid pharmaceutical composition according to the preceding item, comprising granules which contain not more than 80% by weight of active ingredients in total in the whole composition.

8. The solid pharmaceutical composition according to item 6, formulated as mini-tablets which contain the active ingredients in a total amount of not less than 70% by weight, preferably not less than 80% by weight of the whole composition.

9. The solid pharmaceutical composition according to anyone of the preceding items, wherein the compound (a) is

contained in the form of an abacavir salt preferably the sulphate of formula 1 :

formula 1

10. The solid pharmaceutical composition according to anyone of the preceding items, wherein the initial DO.5 primary particle size of efavirenz, whether agglomerated in the composition or not, is in a range of 2-8 μηη, and DO.9 in a range of 9-26 μηη, preferably efavirenz is incorporated into the composition in micronized form.

1 1. The solid pharmaceutical composition according to anyone of the preceding items, wherein the solid pharmaceutical composition respectively each of the mini-tablets or of the granules or pellets comprise a surfactant, a superdisintegrant, a binder and optionally a filler and/or a lubricant.

12. The solid pharmaceutical composition according to item 1 1 , further comprising a glidant, a sweetener, a flavouring agent and/or a coating of a film-forming agent.

13. The solid pharmaceutical composition according to item 1 1 or 12, formulated as mini- tablets wherein each mini-tablet includes an excipient selected from the group consisting of: a surfactant, a superdisintegrant, a binder, a lubricant and optionally a sweetener, a flavouring agent and a film-forming agent.

14. The solid pharmaceutical composition according to anyone of the preceding items, comprising in association with efaviranz a surfactant, a superdisintegrant and a binder.

15. The solid pharmaceutical composition according to anyone of the preceding items, wherein particulate units are obtainable by wet granulation using an aqueous solution of polymer binder and surfactant.

16. The solid pharmaceutical composition according to the preceding item, wherein the polymer binder is a cellulose derivative, preferably hydroxypropylcellulose, and/or the surfactant is sodium lauryl sulphate.

17. The solid pharmaceutical composition according to the two preceding items, wherein the wet granulation is applied to a compartment containing at least efavirenz.

18. The solid pharmaceutical composition according to anyone of the preceding items, wherein the mini-tablets or the granules include, or are a result of, a two-phase granulation, a first granulation with efavirenz and a second granulation with abacavir and lamivudine, wherein the second granulation material covers at least partially the first efavirenz-containing granulated particles.

Preferably, the total amount of efavirenz is used in the first granulation, and/or the total amount of abacavir and lamivudine is used in the second granulation.

19. The solid pharmaceutical composition according to anyone of the preceding items, formulated as mini-tablets which comprise granules with efavirenz and granules with abacavir and lamivudine.

20. The solid pharmaceutical composition according to anyone items 1 to 18, formulated as mini-tablets which comprise granules with efavirenz and abacavir and granules with lamivudine.

21. The solid pharmaceutical composition according to anyone of items 1 to 20, formulated as mini-tablets which comprise an intra-granular phase and an extragranular phase, wherein the total of efavirenz is present in the intra-granular phase (granule).

22. The solid pharmaceutical composition according to the preceding item, wherein the total of abacavir and lamivudine are present in the extragranular phase. 23. The solid pharmaceutical composition according to item 21 , wherein either abacavir or lamivudine, preferably only lamivudine, is partitioned between the intragranular and the extragranular phase, or wherein both abacavir and lamivudine are partitioned between the intragranular and the extragranular phase.

24. The solid pharmaceutical composition according to item 23, wherein only lamivudine is partitioned between the intragranular and the extragranular phase, and wherein 40-60% by weight of lamivudine, preferably 50% by weight of lamivudine, is comprised the extragranular phase.

25. The solid pharmaceutical composition according to anyone of the preceding items, wherein the filler is selected from cellulose, silicified microcrystalline cellulose, non-cellulose filler of polyol type such as mannitol or polymer type filler such as starch and lactose, preferably is microcrystalline cellulose, silicified microcrystalline cellulose and/or the polyol type filler mannitol.

26. The solid pharmaceutical composition according to anyone of the preceding items, wherein filler is present in an amount of from 2 to 30% by weight, preferably of from 3% to

25% by weight, and most preferably of from 4 % to 20% by weight of the total weight of the pharmaceutical composition without coating.

27. The solid pharmaceutical composition according to anyone of the preceding items, wherein the binder is selected from povidone, tragacanth, sodium alginate, gum arabic, starch pregelatinized, gelatin, and cellulosic derivatives, povidone, and starch pregelatinized, preferably is a cellulosic derivative, more preferably hydroxypropylcellulose.

28. The solid pharmaceutical composition according to anyone of the preceding items, wherein binder is present in the pharmaceutical composition in an amount of from 1 to 40% by weight, preferably of from 2% to 20% by weight, more preferably of from 2% to 10% by weight, and most preferably of from 3% to 8% by weight of the total weight of the pharmaceutical composition without coating.

29. The solid pharmaceutical composition according to anyone of the preceding items, wherein the disintegrant is selected from the group consisting of carmellose calcium, carboxymethylstarch sodium, croscarmellose sodium (cellulose carboxymethylether sodium salt, cross-linked), starch, modified starch such as pregelatinized starch, starch derivatives such as sodium starch glycolate, cross-linked polyvinylpyrrolidone (crospovidone), and low- substituted hydroxypropylcellulose; particularly preferably the disintegrants are superdisintegrants selected from the group consisting of sodium starch glycolate, croscarmellose sodium and crospovidone, in particular is croscarmellose sodium.

30. The solid pharmaceutical composition according to anyone of the preceding items, wherein disintegrant is present in the pharmaceutical composition in an amount of from 1 to 20% by weight, preferably of from 2% to 10% by weight, and most preferably of from 3% to 8% by weight of the total weight of the pharmaceutical composition without coating.

31. The solid pharmaceutical composition according to anyone of the preceding items, wherein the surfactant is selected from the group consisting of sodium lauryl sulphate, docusate sodium, benzalkonium chloride, benzethonium chloride, and cetrimide, and polyoxyethylene-polyoxypropylene copolymers, preferably is sodium lauryl sulphate.

32. The solid pharmaceutical composition according to anyone of the preceding items, wherein surfactant is present in the pharmaceutical composition in an amount of from above 0 to 7% by weight, preferably of from 0.5% to 5% by weight, more preferably of from 0.5 % to 4% by weight, and most preferably of from 0.5 % to 3% by weight of the total weight of the pharmaceutical composition without coating.

33. The solid pharmaceutical composition according to anyone of the preceding items, wherein the lubricant is selected from the group consisting of stearic acid, magnesium stearate, calcium stearate, zinc stearate, glyceryl behenate, sodium stearyl fumarate, polyethylene glycol, and silicon dioxide, preferably the lubricant is magnesium stearate, and wherein .

34. The solid pharmaceutical composition according to anyone of the preceding items, wherein lubricant is present in the pharmaceutical composition in an amount of from above 0 to 10% by weight, preferably of from 0.1 % to 8% by weight, more preferably of from 1 % to 5% by weight, and most preferably of from 1 % to 3% by weight of the total weight of the pharmaceutical composition without coating.

35. The solid pharmaceutical composition according to anyone of the preceding items, further comprising a glidant, preferably selected from talc and colloidal silicon dioxide.

36. The solid pharmaceutical composition according to anyone of the preceding items, having an outer coating layer of a film-forming polymer.

37. The solid pharmaceutical composition according to the preceding item, wherein the dosage form has an outer coating layer of a film-forming polymer which is uniform and coherent at the body and the edges of the dosage form.

38. The solid pharmaceutical composition according to anyone of the preceding items, wherein the film forming polymer is a hydrophilic polymer, preferably selected from the group consisting of cellulose derivatives, vinyl derivatives, graft copolymer PVA-polyethylene glycol, copolymers of acrylic and/or methacrylic acid esters with trimethylammonium-methylacrylate, copolymers of dimethylaminomethacrylic acid and neutral methacrylic acid esters, polymers of methacrylic acid or methacrylic acid esters, copolymers of acrylic acid ethylester and methacrylic acid methyl ester, and copolymers of acrylic acid and acrylic acid methylester, preferably hydroxypropylmethyl cellulose (HPMC) and polyvinyl alcohol (PVA, most preferably polyvinyl alcohol (PVA). 39. The solid pharmaceutical composition according to anyone of the preceding items, wherein film forming polymer is present in the pharmaceutical composition in an amount of from 1 to 15% by weight, preferably of from 3% to 10% by weight, and most preferably of from 4 % to 8% by weight of the total weight of the pharmaceutical composition.

40. The solid pharmaceutical composition according to anyone of the preceding items, wherein the coating layer provides for a lag time not less than 3 minutes.

41. The solid pharmaceutical composition according to any one of the preceding items, comprising, respectively based on the total weight of the composition:

(a) at least 60% by weight of abacavir, lamivudine and efavirenz;

(b) from 1 to 20% by weight of a disintegrant;

(c) from 1 to 20% by weight of a binder;

(d) from 0.1 to 7% by weight of a surfactant;

(e) from 0 to 30% by weight of a filler;

(f) optionally up to 10% by weight of a lubricant, and

(g) optionally an outer coating comprising 1 to 15 % by weight of a film-forming polymer.

42. The solid pharmaceutical composition according to any one of the preceding items, comprising, respectively based on the total weight of the composition:

(a) from 60 to 90% by weight of abacavir, lamivudine and efavirenz;

(b) from 2 to 10% by weight of a superdisintegrants selected from the group consisting of sodium starch glycolate, croscarmellose sodium and crospovidone, preferably croscarmellose sodium;

(c) from 2 to 10% by weight of a binder selected from cellulosic derivatives, preferably hydroxypropylcellulose;

(d) from 0.5 to 3% by weight of sodium lauryl sulphate;

(e) from 2 to 25% by weight of a filler selected from the group consisting of microcrystalline cellulose, silicified microcrystalline cellulose and mannitol;

(f) optionally 0.1 to 8% by weight of magnesium stearate; and

(g) optionally an outer coating comprising 3 to 10 % by weight of a film-forming polymer.

43. The solid pharmaceutical composition according to items 18 to 24, preferably having a composition according to item 41 or 42 and formulated as mini-tablets, each mini-tablet having an intra-granular phase and an extragranular phase, wherein the total of efavirenz is present in the intra-granular phase together with a part of filler, a part of disintegrant, the total of binder and the total of surfactant, and wherein the extragranular phase comprises the remaining part of filler and disintegrant.

Herein, the type and the amount of filler in the intragranular phase can be the same or different as the filler in the extragranular phase, and the type and the amount of disintegrant in the intragranular phase can be the same or different as the disintegrant in the extragranular phase; preferably the types of filler and disintegrant are the same and the respective amounts of filler and disintegrant can be appropriately apportioned typically the weight ratio intra- to extragranular parts is, for example, half-half or higher than 50% by weight.

44. The solid pharmaceutical composition according to any one of the preceding items for use in the treatment of HIV infection, in particular immunodefiency virus type 1 (HIV-1 ) infection.

45. The solid pharmaceutical composition according to any one of the preceding items for use according to item 44, wherein the solid pharmaceutical composition in the form of a multi-unit particulate dosage form is poured from single dossier into mouth and orally administered with a prescribed amount of water.

46. A pharmaceutical product in the form of a stick pack or a sachet, the stick pack or a sachet containing a set of multi-unit dosage forms as defined by anyone of the preceding items.

47. The pharmaceutical product as defined in item 46, wherein the multi-unit dosage forms are mini-tablets which are dosed in prescribed number that define an administration amount of therapeutic portion of medicine, preferably 120 to 150 mini-tablets, preferably 130 to 140 minitablets, in particular about or precisely 133 mini-tablets.

48. A process for preparing an solid pharmaceutical composition comprising a fixed combination of active ingredients (a) to (c) according to anyone of items 1 -43, wherein the active ingredients (a) to (c) are combined within a common oral solid dosage form together with at least one pharmaceutically acceptable excipient selected from the group consisting of disintegrants, binders, fillers, lubricants, surfactants and film-forming agents.

49. The process according to item 48, wherein the solid pharmaceutical composition, particularly each particulate unit, is prepared using a wet-granulation process or a dry- granulation process, preferably a wet-granulation process.

50. The process according to the preceding item, wherein the wet granulation uses an aqueous solution of polymer binder and surfactant.

51. The process according to the preceding item, wherein the polymer binder is a cellulose derivative, preferably hydroxypropylcellulose, and/or the surfactant is sodium lauryl sulphate.

52. The solid pharmaceutical composition according to the two preceding items, wherein the wet granulation is applied to a compartment containing at least efavirenz.

53. The solid pharmaceutical composition according to any one of items 50 to 52, wherein the wet granulation is applied to a compartment containing efavirenz and abacavir.

54. The solid pharmaceutical composition according to any one of items 50 to 52, wherein the wet granulation is applied to a compartment containing efavirenz, abacavir and a least a part of lamivudine or a total amount of lamivudine. 55. The process according to anyone of items 49 to 54, wherein the wet-granulation process further involves drying, sieving, optionally preparation of granules or compressing into mini- tablets, and coating.

56. The process according to anyone of items 49 to 55 for manufacturing an oral multi-unit dosage form, wherein wet granulation is carried out in two steps, a first granulation phase with efavirenz to obtain efavirenz-containing first granulate, and a second granulation phase with abacavir and lamivudine subjected to the obtained efavirenz-containing first granulate. Accordingly, a granulate comprises, preferably consists of, efavirenz-containing granulated particles, which forms an inner part of granules, covered at least partially and preferably majorly by the granulation material of the other two active substances abacavir and lamivudine in the second granulation step.

Preferably, the two-phase based granules are subsequently coated by a layer containing a film-forming polymer as specified above.

57. A process of manufacturing an oral multi-unit dosage form in the form of mini-tablets, comprising the steps of:

(i) mixing the active ingredients abacavir, lamivudine and efavirenz with appropriate pharmaceutical excipients including surfactant, binder, filler and/or disintegrant (preferably superdisintegrant), preferably each of the aforementioned excipient type;

(ii) optionally sieving of the obtained mixture of step (i) through appropriate mesh size, preferably through a 1.0-2-0 mm mesh sieve;

(iii) adding a binder and surfactant into granulation fluid, for example water;

(iv) wet granulation of mixture from step (i) or (ii) with the granulation fluid (iii) in fluid bed dryer;

(v) drying of the wet granules to appropriate water content;

(vi) sieving of the obtained mixture through appropriate mesh size, preferably through a 0.25 mm to 1 .0 mm mesh sieve and more preferably through a 0.71 mm mesh sieve; preferably the dried granules are sieved to achieve an appropriate particle size, for example a DO.5 to lie in a range of from 50 to 350 μηη;

(vii) mixing of the obtained granules with any remaining excipients, including at least lubricant, preferably further including disintegrant (preferably superdisintegrant), diluent and/or binder;

(viii) compression of the final blend by using multitip compression tools, for instance using standard rotary tablet press;

(ix) optionally and preferably coating of the mini-tablets in fluid bed system, preferably using a Wurster insert, with a coating material comprising film-forming polymer.

58. The process according to anyone of items 49 to 52 for manufacturing an oral multi-unit dosage form in the form of mini-tablets, comprising wet granulating efavirenz, mixing efavirenz granules with granules of abacavir and lamivudine and compressing into mini- tablets.

59. The process according to anyone of items 48 to 58 for manufacturing an oral multi-unit dosage form in the form of mini-tablets respectively comprising an intra-granular phase and an extragranular phase, wherein the total of efavirenz is subjected to wet granulation to become a first granulate for forming the intragranular phase of each mini-tablet, wherein the first granulate is mixed with the total of abacavir and lamivudine and suitable excipients, followed by compression into mini-tablets while forming the extragranular phase.

60. The process according to anyone of items 48 to 58 for manufacturing an oral multi-unit dosage form in the form of mini-tablets respectively comprising an intra-granular phase and an extragranular phase, wherein the total of efavirenz is subjected to wet granulation together with either the total of abacavir or lamivudine or with a part of abacavir and/or lamivudine, preferably only with abacavir, to become a first granulate for forming the intragranular phase of each mini-tablet, wherein the resulting first granulate is mixed with the remainder active ingredient(s) and suitable excipients, followed by compression into mini- tablets while forming the extragranular phase.

In the process according to item 60 - while the total of efavirenz will be included into the intergranular phase - the other active ingredients of either abacavir or lamivudine, preferably only lamivudine, becomes partitioned between the intragranular and the extragranular phase, or both abacavir and lamivudine become partitioned between the intragranular and the extragranular phase.

61. A process of manufacturing an oral multi-unit dosage form in the form of mini-tablets, comprising the steps of:

(i) mixing the active ingredients efavirenz and optionally the total or a part of other active ingredients abacavir and/or lamivudine with appropriate pharmaceutical excipients such as surfactant, binder, filler and/or disintegrant (preferably superdisintegrant), preferably each of the aforementioned excipient type;

(iii) adding a binder and surfactant into granulation fluid, for example water;

(v) drying of the wet granules to appropriate water content;

(vi) sieving of the obtained mixture through appropriate mesh size, preferably through a 0.25 mm to 1 .0 mm mesh sieve and more preferably through a 0.71 mm mesh sieve; preferably the dried granules are sieved to achieve an appropriate particle size, for example a DO.5 to lie in a range of from 50 to 350 μηη; (vii) mixing of the obtained granules with any remaining active ingredients of abacavir and/or lamivudine and with any remaining excipients, including at least lubricant, preferably further including disintegrant (preferably superdisintegrant), diluent and/or binder;

62. A process of manufacturing an oral multi-unit dosage form in the form of mini-tablets, comprising the steps of:

(i) mixing the active ingredients efavirenz and abacavir and optionally the total or a part of lamivudine with appropriate pharmaceutical excipients such as surfactant, binder, filler and/or disintegrant (preferably superdisintegrant), preferably each of the aforementioned excipient type;

(iii) adding a binder and surfactant into granulation fluid, for example water;

(v) drying of the wet granules to appropriate water content;

(vii) mixing of the obtained granules with any remaining active ingredients of lamivudine and with any remaining excipients, including at least lubricant, preferably further including disintegrant (preferably superdisintegrant), diluent and/or binder;

Detailed description of the invention

The present invention is in further described in more details by preferred embodiments and examples, which are however presented for illustrative purpose only and shall not be understood as limiting the scope of the present invention. The present invention overcomes shortcomings of the prior art related to single dose administration of listed compounds abacavir, lamivudine, and efavirenz (Ziagen^®, Epivir^®, Stocrin^®, and combinational product Kivexa^®) as well as liquid formulation of efavirenz. The present invention made feasible a fixed combination of all three compounds abacavir, lamivudine and efavirenz within one and the same, i.e. a common solid pharmaceutical composition, despite the remarkably different properties and use constraints of the specifically combined distinct active compounds. Accordingly, the solid pharmaceutical composition according to the present invention has demonstrated to combine, in a common solid dosage form, specifically selected active ingredients being associated with properties which seemingly are in conflict when brought together for formulation purposes, notably highly water-soluble abacavir (water solubility 77 mg/ml as sulphate salt) and lamivudine (water solubility 70 mg/ml) with poorly water-soluble efavirenz (water solubility 0.00855 mg/ml), while allowing to reduce mouth-burning effect of efavirenz in a still maintained high variability of solid dosage form designs to an acceptable level. Unexpectedly, bioequivalent common fixed dose triple combination abacavir, lamivudine and efavirenz was feasible at a high total drug load of at least 60% by weight based on the total weight of the whole composition, which correspondingly means low content of functional excipients which normally is considered responsible for processing, stability and dissolution performance of an entire pharmaceutical composition.

Further, a high freedom of fixed dose solid dosage form design has been found even by combination of abacavir, lamivudine and efavirenz in a common solid composition, without detriment to a fast disintegration and rapid onset of action.

Further, the fixed-dose combination formulation of abacavir, lamivudine and efavirenz according to the present invention has been found to satisfy a hitherto unmet need to a simplification of anti-HIV therapy by decreasing the number of individual dosage forms to be taken by the patient, notably to fixed dose to be taken only once per day, thereby significantly improving patient compliance compared with prior art reference products. The improvement of patient compliance is considered especially important in situations where it may contribute reducing the incidence of resistance. Thereby, the triple fixed-dose combination of the present invention is associated with advantages for the individual patient as well as for the whole society with regards to the burden of disease and fighting the emergence of resistance.

Accordingly and in more detail, particular advantages achieved by the present invention are: - Decrease of pill burden (administration from single dossier): With the once daily, single dose in-take of the fixed combination, a decrease in the number of administrations can be achieved compared to the single agent preparations or fixed dose combinations currently available on the market.

Increased compliance:

Simplification of therapy improves patient compliance. This was demonstrated not only in the case of HIV but also in other aspects of anti-infective treatments where way of drug administration or dose frequency had an impact on patient compliance especially in paediatric patients. Depending on a patient's choice and convenience, the solid pharmaceutical composition can be provided in easy swallowing form and flexible for intake. - Fighting emergence of resistance:

Poor adherence can result in sub-therapeutic plasma antiretroviral drug concentrations, facilitating development of drug resistance to one or more drugs in a given regimen, and possibly cross-resistance to other drugs in the same class. Multiple factors (including regimen potency, pharmacokinetics, drug interactions, viral fitness, and the genetic barrier to antiretroviral resistance) influence the adherence-resistance relationship.

Acceptable swallowable dosage form:

The present invention provides dosage forms in still acceptable in physical volume even at high drug loading (1500 mg of active compounds). In preferred embodiments even small physical volumes can be achieved despite high drug load, in order to be easily swallowable by patients and administrated directly from single packaging unit, e.g. stick pack or sachet.

Prevent mouth burning effect:

Despite the different use attributes of the distinct active ingredients to be combined, the solid fixed-dose combination formulation according to the present invention still allows by suitable physical separation and/or by physical barrier to protect oral mucosa from direct contact with efavirenz, which is primarily involved in mouth burning effect. Ameliorated palatability of proposed dosage form can improve compliance in comparison to efavirenz liquid formulation or for the patients with difficulties with the swallowing. Adequate taste, aftertaste and texture could be demonstrated by representative common oral dosage forms described in more detail below by reference to illustrative embodiments.

Accordingly, the formulations disclosed herein combine a number of valuable use attributes which are difficult to unify in a fixed triple combination of abacavir, lamivudine and efavirenz, including bioequivalence, reduction of mouth burning effect caused by efavirenz as well as for providing of palatable formulations even for high drug loaded system that is important for a triple fixed dose combination but which inherently cannot make use of a high amount of functional excipients.

In the drawings: Fig. 1 shows electron micrographs of structure of granules after 1 in 2 phase of granulation (Example 3).

Fig. 2 shows electron micrographs of granules structure after coating of granules with PVA coating (Example 4).

Figure 3 shows results of mouth burning test by micro-dissolution of efavirenz in 5 ml of artificial saliva for different dosage forms.

Figure 4 shows a comparison of the remaining quantity of efavirenz on filter paper for different dosage forms, mimicking mouth burning effect.

Particularly, the solid pharmaceutical composition of the present invention is a special fixed dose combination comprising:

(a) a compound of formula I

formula 1

(b) a compound of formula II

formula 2

(c) a compound of formula 3

formula 3 Accordingly, the present invention provides a triple combinational product containing abacavir, lamivudine, and efavirenz which is beneficially suitable for once daily administration. The preferred quantity of the total of the three active substances in triple combination product is at least 1500 mg, notably 1500 mg exact - noting that in case a salt or other modified form is used, such as abacavir sulphate, the amount of the modified form is recalculated into the active substance - e.g. abacavir - itself. Two basic embodiments make use of appropriately swallowable dosage forms by way of multi-unit particulate dosage forms where the total dosage form encompasses a number of multi-units, namely mini-tablets, or granules or pellets, such that the mentioned triple dose amount is met in total, wherein mini- tablets are particularly preferred. Multi-unit particulate dosage forms of granules, pellets and in particular mini-tablets accomplishes patient compliance by allowing small physical volumes despite high total amounts of triple actives. Therefore, the present invention allows a choice of an appropriate triple fixed combinational product design to be made by a patient depending on desire and individual convenience. All % indications used herein denote % by weight unless stated otherwise.

The abacavir compound in the triple combination product is suitably in salt form, preferably sulphate salt and notably at a ratio of abacavir to sulphate of 2:1 . The amount of abacavir is calculated as the free base abacavir compound; hence for instance 600 mg of abacavir is equivalent to 702 mg of abacavir sulphate which can be used for formulation design.

The lamivudine compound in the triple combination is suitably present in stable form, for example the known anhydrous polymorphic form (form II). The amount of lamivudine in the formulation is equivalent to once daily dose and it represents 300 mg.

The efavirenz compound in the triple combination product is beneficially enhanced in its otherwise poor solubility by micronization and increment of specific surface area. The efavirenz form preferably included into the pharmaceutical composition according to present invention has a primary particle size of D(0.5) of 2-8 μηη, for example about ~ 5 μηη, and of D(0.9) in the range of 9-26 μηη, for example in the range of D(0.9) of 10-14 μηη. The primary efavirenz particles of indicated size can be in the form of agglomerated particles, without inacceptable detriment to solubility increase. Specific surface area of efavirenz is mostly influenced by extent of particle agglomeration, and is preferably ranged from 2.5 to 7.0 m²/g. Particle size distribution can be measured for instance using a laser diffraction analyzer, such as with a Malvern Mastersizer 3000. Formulating efavirenz together with a surfactant has been found to further significantly enhance the poor solubility thereof.

In a preferred embodiment the solid pharmaceutical composition of the present invention has an outer coating. In particular when the coating comprises a water swellable, or preferably a water soluble hydrophilic polymer as a film forming polymer, effective physical barrier function against mouth burning effect due to presence of efavirenz is combined with a rapid onset of action due to appropriate swelling or solubility of the coating after swallowing. The coating is provided as outer layer(s) of the respective dosage form, i.e. coating of granules, pellets or mini-tablets respectively present in the multi-unit particulate dosage forms. The water soluble or water swellable hydrophilic polymer is preferably selected from the group consisting of cellulose derivatives, such as hydroxypropylmethyl cellulose (HPMC), hydroxypropylcellulose (HPC), carboxymethylcellulose sodium, hydroxyethylcellulose; vinyl derivatives such as polyvinyl alcohol (PVA), graft copolymer PVA-polyethylene glycol such as Kolicoat^®; copolymers of acrylic and/or methacrylic acid esters with trimethylammonium- methylacrylate, copolymers of dimethylaminomethacrylic acid and neutral methacrylic acid esters; polymers of methacrylic acid or methacrylic acid esters; copolymers of acrylic acid ethylester and methacrylic acid methyl ester; and copolymers of acrylic acid and acrylic acid methylester. In view of the intended function, most preferred film-forming polymer in the coating is HPMC or polyvinyl alcohol (PVA), in particular PVA. Besides the film-forming polymer the coating may contain further ingredients, such as plasticizer, pigment, etc.

Accordingly, the coating layer beneficially provides for a lag time not less than 3 minutes. That is, the coating ensures lag time not less than 3 minutes in mouth before swallowing of the dosage form with an appropriate amount of water (e.g. mini-tablets with the 240 mL of water.) Further, the coating contributes to obtaining smoother surfaces, thereby assisting in swallowing and reducing the retention time of the dosage form in the mouth to thereby further reducing the chance of generating mouth burning effect. More preferred are dosage units comprising the triple combination which have a constant specific surface, a smooth outer surface, and robust mechanical properties. The film forming polymer is suitably present in the pharmaceutical composition in an amount of from 1 to 20% by weight, preferably of from 3% to 15% by weight, and most preferably of from 4 % to 10% by weight of the total weight of the pharmaceutical composition. The filler, when preferably contained in the solid pharmaceutical composition according to the present invention, is preferably selected from cellulose fillers such as microcrystalline cellulose, e.g. Avicel^® such as Avicel PH 102, and silicified microcrystalline cellulose (e.g. Prosolv^®), and non-cellulose fillers such as polyols, for instance isomalt (e.g. GalenlQ^®), mannitol (e.g. Pearlitol^®) or xylitol, or polymer filler such as starch (e.g. starch 1500) or lactose. The selected filler preferably has plastic deformation properties under compression, microcrystalline cellulose or silicified microcrystalline cellulose are particularly preferred, as these do have beneficial plastic deformation properties and additionally have diluent as well as disintegrant function (in the specified content ranges, these cellulose types are however counted as filler materials, not as diluents or disintegrants). Depending on the type of formulation, notably in case of granules, mannitol has the benefit of not only mainly acting as filler (which hence, when present, will be counted as such), but also as taste modifier.

The filler when preferably present is contained in the solid pharmaceutical composition in an amount of from 2 to 30% by weight, preferably of from 3% to 25% by weight, and most preferably of from 4 % to 20% by weight of the total weight of the pharmaceutical composition without coating.

The binder, when preferably contained in the solid pharmaceutical composition according to the present invention, is preferably selected from matrix type polymer binder and/or a granulation polymer binder, specifically cellulose derivative-type polymer binder such as hydroxypropyl cellulose (e.g. Klucel^®),, hydroxypropylmethylcellulose (e.g. Methocel^®), povidone, tragacanth, sodium alginate, gum arabic, gelatin, and starch pregelatinized. Preferably the binder is cellulosic derivatives, more preferably hydroxypropylcellulose. Binding agents is generally used to improve adhesion of powder particles during wet granulation. The selected binder preferably has plastic deformation properties under compression. For that purpose, excipients from the group of cellulose derivatives can favourably be utilized and are preferred.

In this context, it is noted that it lies in the nature of pharmaceutical excipients that they sometimes can perform more than one function in a pharmaceutical formulation. In the context of the present invention, in order to provide an unambiguous definitions, the fiction will therefore preferably apply that a substance which is used as a particular excipient, is not simultaneously also used as a further pharmaceutical excipient. For example, a filler such as microcrystalline cellulose used as a filler, is not also used for example as a disintegrant and not also used for example as a binder (even though a microcrystalline cellulose filler might also exhibit a certain disintegrating effect and a certain binding effect) while the term "binder" is meant within the context of the present invention as defined above and which, in particular in the form of a polymer binder and more specifically as a cellulose derivative polymer binder, and should be counted as such.

The binder when preferably present is contained in the solid pharmaceutical composition in an amount of from 1 to 40% by weight, preferably of from 2% to 20% by weight, more preferably of from 2% to 10% by weight, and most preferably of from 3% to 8% by weight of the total weight of the pharmaceutical composition without coating.

The disintegrant, when preferably contained in the solid pharmaceutical composition according to the present invention, is preferably selected from the group consisting of carmellose calcium, carboxymethylstarch sodium, croscarmellose sodium (cellulose carboxymethylether sodium salt, cross-linked), starch, modified starch such as pregelatinized starch, starch derivatives such as sodium starch glycolate, cross-linked polyvinylpyrrolidone (crospovidone), and low-substituted hydroxypropylcellulose. Particularly preferable disintegrants are superdisintegrants and are selected from the group consisting of sodium starch glycolate, croscarmellose sodium and crospovidone, in particular is croscarmellose sodium. When preferably present, the disintegrant and preferably the superdisintegrant is added to be in contact with the efavirenz compound, for instance by adding it into the same compartment or granulate of the dosage form as efavirenz, significantly contributing to its better wettability dissolution from the dosage form. When an efavirenz containing granulate (containing disintegrant, preferably superdisintegrant, and further preferred containing surfactant) - no matter whether further active ingredients are also contained in the efavirenz containing granulate - is formulated into mini-tablets, it is further preferred that the extragranular phase - no matter whether further active ingredients are also contained in the extragranular phase - also contains disintegrant, preferably superdisintegrant.

The disintegrant when preferably present is contained in the solid pharmaceutical composition in an amount of from 1 to 20% by weight, preferably of from 2% to 10% by weight, and most preferably of from 3% to 8% by weight of the total weight of the pharmaceutical composition without coating, if present.

The lubricant, when contained in the solid pharmaceutical composition and especially in the mini-tablets according to the present invention, is preferably selected from the group consisting of colloidal silicon dioxide such as Aerosil^®, talc, stearic acid, magnesium stearate, calcium stearate, zinc stearate, glyceryl behenate, sodium stearyl fumarate, polyethylene glycol, and silicon dioxide; more preferably the lubricant is magnesium stearate. The glidants, when contained in the solid pharmaceutical composition and especially in the mini-tablets according to the present invention, can improve the flow characteristics of granulation material, and is preferably selected from talc and colloidal silicon dioxide.

The lubricant and/or glidant when preferably present is contained in the solid pharmaceutical composition in an amount of from 0 to 10% by weight, preferably of from 0.1 % to 8% by weight, more preferably of from 1 % to 5% by weight, and most preferably of from 1 % to 3% by weight of the total weight of the pharmaceutical composition without coating. The solid pharmaceutical composition may optionally further comprise glidants, preferably selected from the group consisting of colloidal silica, silicon dioxide, powdered cellulose, talc, tribasic calcium phosphate, mixtures thereof.

The surfactant, when preferably contained in the solid pharmaceutical composition according to the present invention, is preferably selected from the group consisting of anionic and cationic surfactants, such as sodium lauryl sulphate, docusate sodium (dioctyl sulfosuccinate sodium salt), benzalkonium chloride, benzethonium chloride, and cetrimide (alkyltrimethylammonium bromide, predominantly d₄ alkyl, and polyoxyethylene- polyoxypropylene copolymers; preferably the surfactant is sodium lauryl sulphate. It improves wettability and rate of dissolution of efavirenz, in particular if present in micronized form.

The surfactant when preferably present is contained in the solid pharmaceutical composition in an amount of from 0 to 5% by weight, preferably of from 0.1 % to 4% by weight, more preferably of from 0.5 % to 3% by weight, and most preferably of from 0.5 % to 2% by weight of the total weight of the pharmaceutical composition without coating.

The sweeteners and/or flavours/aromas, when contained in the solid pharmaceutical composition according to the present invention and notably in the embodiment of granules, is preferably selected from aspartame, saccharine sodium, sucralose, glycyrrhiza, and one or more flavors such as mint, orange, lemon, strawberry, vanilla, raspberry and cola flavour. The solid pharmaceutical composition according to the present invention may beneficially further include substances having pleasant cooling effect, for instance menthol and polyols such as mannitol, xylitol, isomalt, eritriol). Alternative to and preferably in addition to the physical barrier obtained by the above described outer coating layer, the addition of sweeteners and/or flavours/aromas and optionally cooling-effect substances further contributes to a beneficial taste masking effect.

The excipient selected from the group of sweeteners, flavours/aromas and cooling effect substances when preferably present is contained in the solid pharmaceutical composition in an amount of from 0 to 5% by weight, preferably of from 0.1 % to 4% by weight, more preferably of from 0.5 % to 3% by weight, and most preferably of from 0.5 % to 2% by weight of the total weight of the pharmaceutical composition without coating (calculated without polyol, if present, due to their main function as filler).

Plasticizers, if used, may include, but are not limited to polyethylene glycol, diethyl phthalate and glycerol. Preference is given to polyethylene glycol.

The particular advantage of the solid pharmaceutical composition according to the present invention resides in that dosage forms with a respective high drug load covering all of active ingredients (a) to (c) could be formulated while correspondingly minimizing, without however abstaining from relevant excipients that compromise the different use attributes of the three distinct active compounds. Accordingly, despite high drug load of all active ingredients (a) to (c) while managing for low amounts of excipients, the solid pharmaceutical composition can beneficially comprise each (at least one of each group) of a disintegrant, a binder, a lubricant, a surfactant and a film-forming agent, optionally further comprising a glidant, a sweetener and/or a flavouring agent.

In one embodiment each granule, pellet or mini-tablet comprises apixaban, lamivudine and efavirenz. In case of multiple granules or pellets, all three active ingredients are included in the same granules or pellets.

In a preferred embodiments it has been found that the triple combination of the present invention allows to make use of a separation and/or partition of the three active ingredients into discrete compartments - especially if the multi-unit dosage form is formed as the a multitude of mini-tablets. In these preferred embodiments, specific requirements of each active ingredient alone or in combination with one another can be well harmonized, especially in terms of overall performance of: dissolution and bioequivalence at high drug load and correspondingly inherent relative low proportion of functional excipients, combined with prevention of mouth burning effect.

Such separation or partitioning concepts particularly include (i) to (viii):

(i) The mini-tablets or the granules or pellets include, or are a result of, a two-phase granulation, a first granulation (first compartment) with the total amount of efavirenz and a second granulation (second compartment) with abacavir and lamivudine, wherein the second granulation material covers at least partially the first efavirenz-containing granulated particles; in case of mini-tablets, the combined, yet discretely prepared compartments are further formulated and compacted into the multitude of mini-tablets together with suitable excipients.

(ii) The total amount of efavirenz is used in the first granulation (to become first compartment), and the total amount of abacavir and lamivudine is used in the second granulation (to become second compartment).

(iii) Mini-tablets respectively comprise granules with efavirenz, granules with abacavir and granules with lamivudine.

(iv) Mini-tablets respectively comprise granules with efavirenz and granules with abacavir and lamivudine.

(v) Mini-tablets respectively comprise granules with efavirenz and abacavir and granules with lamivudine.

(vi) Mini-tablets respectively comprise an intra-granular phase (first compartment) and an extragranular phase (second compartment), wherein the total of efavirenz is present in the intra-granular phase, and the total of abacavir and lamivudine are present in the extra- granular phase.

(vii) Mini-tablets respectively comprise an intra-granular phase (first compartment) and an extragranular phase (second compartment), wherein the total of efavirenz and abacavir is present in the intra-granular phase, and the total of lamivudine is present in the extra- granular phase.

(viii) Mini-tablets comprise an intra-granular phase (first compartment) and an extragranular phase (second compartment), wherein the total of efavirenz is present in the intra-granular phase, and either abacavir or lamivudine is partitioned between the intragranular and the extragranular phase, or where both abacavir and lamivudine are partitioned between the intragranular and the extragranular phase. Preferably the total of lamivudine is either completely in the extragranular phase, or is partitioned while abacavir is in the intragranular phase with efavirenz. The partitioning can be half/half, or can use other respective proportions, e.g. 40-60% by weight of lamivudine in the intragranular phase.

In any of the above embodiments, the resulting mini-tablet, granules or pellets are preferably coated, as described elsewhere herein. For preparing mini-tablets, the first compartment and the second compartment are suitably formulated, including mixing and compaction into the multitude of mini-tablets together with suitable excipients.

Applying the concept of separation or partitioning according to the preferred embodiments of the present invention provides superior balance between otherwise conflicting API-specific properties. In particular, a dual mode action of favourable disintegration for the first compartment effectively co-acts with disintegration and/or dissolution for the second compartment, combined with effective taste masking and mouth-burning prevention. Moreover, placing lamivudine partially or completely into the extragranular phase (second compartment) exhibits additional advantages of improved bioequivalent conformity. Furthermore, placing lamivudine and/or abacavir, especially only lamivudine, partially into the intra-granular phase (first compartment) exhibits additional advantages of reducing stickiness during processing of the extragranular phase.

In the following further exemplified embodiments to formulate the fixed solid pharmaceutical combination composition will be described. Granules

In an embodiment of the present invention, the dosage form is designed as oral granules. Provided as multi-unit dosage forms by way of a multitude of granules, due to substantially smaller sizes of individual granules it can offer to an attracted group of patients a more patient-friendlier administration form. From a suitable dossier, for instance a stick pack or sachets, the oral granules can be poured directly into mouth and administrated with a suitable amount of water for swallowing. This oral formulation can contain total drug loads as high as about 70-90% of active compounds (a) to (c), the remainder being composed of functional excipients, optionally including a coating for the respective individual granules, as described above.

A suitable and particularly preferred process of manufacturing the granules may include wet granulation. For example abacavir sulphate, lamivudine and efavirenz are granulated with excipients, for instance binder, filler and/or disintegrant (preferably superdisintegrant), using water solution including binder and surfactant. Granulation may be performed in fluid-bed dryer. Drying of the wet granules is conducted until adequate water content is achieved (for instance LOD 2.0% or lower, suitably at LOD of 1.0%). Obtained mixture is sieved through appropriate mesh size, for instance through a 1.0 mm mesh sieve. Sieved granulated powder can subsequently be mixed with further excipients such as sweetener and/or flavor, e.g. in planetary mixer for 5 minutes.

Oral granules can be used with direct administration from single packaging unit into mouth. In a preferred embodiment, the granules are coated by a layer containing a film-forming polymer such as HPMC and in particular PVA in order to further diminish mouth burning effect. Preferably, Wurster coating technology is used for further taste-masking of the granules. Alternative to the above single step granulation, granules are preferably obtained by granulation in two steps, by which efavirenz predominantly forms inner part of granules, covered at least partially and preferably the majority of efavirenz particles are covered by the granulation material of the other two active substances abacavir and lamivudine through the second granulation step.

Here, the abacavir and lamivudine containing second granulation phase exerts physical barrier to thereby further diminish mouth burning effect associated with efavirenz. Efficacy of coating of efavirenz with the abacavir sulphate and lamivudine was checked by visual inspection at scanning electron microscope (SEM), see Figure 1 . Accordingly, in the first granulation step the granules still have a porous structure. Efavirenz particles can still be detected at the surface as plate like micronized particles. However, after 2^nd phase of granulation, the majority of efavirenz particles were covered with the active ingredients and excipients added in the second step.

Care can and preferably shall be taken during sieving and drying step that the granules are not damaged or crushed to thereby uncover efavirenz micronized particles to occur at the surface and to thereby increase risk of mouth burning effect. For example, mild conditions in the phase of drying can be used, such as decreased air flow, and/or larger mesh size can be used during sieving. Further, a drying of the granules in tray dryer substantially reduces granule destruction. Moreover, suitable additives already introduced as excipient can help to avoid granule damage or destruction, for instance when HPC is added as binder into the granulation fluid in order to produce stiffer granules.

A suitable process of manufacturing the two-step granulated form is as follows: In the first step of process, efavirenz is granulated with excipients, for instance binder, filler and/or disintegrant (preferably superdisintegrant), using water solution including binder and surfactant (granulation solution I). Granulation may be performed in fluid bed dryer. Subsequently, abacavir, lamivudine and excipient, such as filler and/or binder, are added to granulated powder of efavirenz and second phase of granulation is conducted with water solution of further binder. Drying of the wet granules is conducted until adequate water content is achieved (for instance LOD 2.0% or lower, suitably at LOD of 1.0%). Obtained mixture is sieved through appropriate mesh size, for instance through a 1.0 mm mesh sieve. Sieved granulated powder can subsequently be mixed with the further excipients, in particular such as sweetener and/or flavor, e.g. in planetary mixer for 5 minutes.

In a preferred embodiment, the two-phase based granules are coated by a layer containing a film-forming polymer such as HPMC and in particular PVA. Preferably, Wurster coating technology (e.g. using Wurster chamber 7', mesh plate 4) is used for further taste-masking of the two-phase based granules. Coated granules were dried until adequate water content was achieved (LOD 1 %) and subsequently sieved through 1 .5 mm sieve.

Optional and preferred mixing with sweeteners and/or flavours is done after coating, and is applied to the above sieved coated granules, for instance in a planetary mixer for 5 minutes.

After observation through SEM, it was demonstrated that the surface of correspondingly prepared and coated granules is mostly covered with PVA coating (Fig. 2).

Pellets

In another embodiment of the invention, the dosage form is designed as oral pellets. Provided as multi-unit dosage forms by way of a multitude of pellets, due to substantially smoother surface compared to granules and thus less prone to be damaged or falling apart as well as providing better options for a beneficial coating, it can likewise offer to another attractive administration form. From a suitable dossier, for instance a stick pack or sachets, also the oral pellets can be poured directly into mouth and administrated with a suitable amount of water for swallowing.

A suitable process of manufacturing of the oral pellets is as follows: In the first step of process, wet granulation of abacavir sulphate, lamivudine, efavirenz and excipients using water solution of surfactant is performed, preferably in high shear granulator. Wet mass is kneaded and mixed in extruder in order to obtain sufficiently plastic extrudes (in form of spaghetti) for spheronization step. During spheronization, rod like particle are moulded into spherical pellets, which are subsequently dried in fluid bed dryer until adequate water content is achieved (for instance LOD 2.0% or lower, suitably at LOD of 1.0%). Obtained pellets are sieved through appropriate mesh size, for instance through a 1.25-1 .50 mm mesh sieve. Sieved fraction is coated with polymeric solution, preferably in fluid bed dryer with »diskjet« (tangential air exits). Obtained coated pellets are sieved through appropriate mesh size, for instance through a 1.5 - 2.0 mm mesh sieve in order to fraction agglomerated pellets. Care should be taken during sieving and drying step that the pellets are not damaged or crushed to thereby uncover efavirenz micronized particles to occur at the surface and to thereby increase risk of mouth burning effect.

Coating by sweetener and/or flavour containing material or by taste-masking polymer film is facilitated in case of pellets owing to a smooth surface of correspondingly produced pellets.

Mini-tablets

According to a preferred embodiment of the present invention, the dosage form is designed as oral mini-tablets. Mini-tablets are used as multiple unit dosage forms and in the context of the present invention, the term "mini-tablet" typically refers to a particle size with a mean diameter in the range of 1-5 mm, preferably 1.5 mm - 4 mm, more preferably 1 .7-3 mm. The possibility of combining, despite the presence of a high drug load of containing the three active ingredients abacavir, lamivudine and efavirenz (a correspondingly advantageous high percentage by weight of the triple combination for the total composition is represented in every single mini-tablet), such small sized particulate dosage form with enhanced mechanical strength associated with mini-tablets makes this dosage form particularly suitable for the purpose of the present triple fixed solid pharmaceutical composition, while at the same time further reducing the risk of mouth burning effect. Advantageously, the amount of the active ingredients abacavir, lamivudine and efavirenz in total can be even increased to not less than 80% of the whole composition.

In view of a preferred provision of an outer protective coating, the embodiment of the triple fixed combination of abacavir, lamivudine and efavirenz utilizing mini-tablets have revealed several advantages. It was found that they can be coated reproducibly with relatively low amount of coating material, and due to their constant specific surface area, smooth outer surface and robust mechanical properties were obtained. Surprisingly, although most of reported cases relate to single API to incorporate into mini-tablets with the intention of immediate or delayed drug release, it was found that a high drug load inherent to the fixed triple combination of APIs could be compressed into the mini-tablets. Further, the preparation of mini-tablets has been found to be particularly suitable for the fixed triple combination of efavirenz, lamivudine and abacavir according to the present invention, as this was able to provide a good compromise between opposing use attributes of efavirenz, which typically in its crystalline and micronized form has poor flowability and compressibility properties, and lamivudine and abacavir, which conventionally in their conventional single formulation forms required relatively high amounts of compressible filler. Moreover, it was found that the embodiment of mini-tablets according to the present invention is particularly amenable to applying the separation and/or partition concept as described above, wherein by the targeted distribution of the three active ingredients into discrete compartments allows to even better harmonize otherwise hardly consistent API- specific attributes despite of the high drug load and thus inherent low functional excipient content, notably poor water-solubility, poor flowability and compressibility of efavirenz, combined with good water solubility, yet stickiness and limited compressibility of either or both of lamivudine and abacavir, while still simultaneously prevent mouth burning effect associated with efavirenz.

A suitable process of manufacturing an oral multi-unit dosage form in the form of mini-tablets is described. In one embodiment, the multi-unit mini-tablet form is prepared using a wet- granulation process, drying, sieving, compressing into mini-tablets, and optionally and preferably coating.

More specifically, the process for preparing a pharmaceutical composition preferably comprises the steps of:

(i) mixing the active ingredients abacavir, lamivudine and efavirenz (i.e. the total amounts of each active ingredient) with appropriate pharmaceutical excipients such as surfactant, binder, filler and/or disintegrant (preferably superdisintegrant);

(iii) adding a binder and surfactant into granulation fluid, for example water;

(v) optionally drying of the wet granules to appropriate water content;

(vi) sieving of the obtained mixture through appropriate mesh size, preferably through a

0.25 mm and 1.0 mm mesh sieve and more preferably through a 0.71 mm mesh sieve; preferably the dried granules are sieved to achieve an appropriate particle size, for example a DO.5 to lie in a range of from 50 to 350 μηη;

(ix) optionally and preferably coating of the mini-tablets in fluid bed system, preferably using a Wurster insert, with a coating material comprising film-forming polymer. When applying the separation or partitioning concept, step (i) is suitably modified, in that mixing the active ingredients efavirenz (i.e. the total amount thereof) and optionally the total or a part of other active ingredients abacavir and/or lamivudine with appropriate pharmaceutical excipients such as surfactant, binder, filler and/or disintegrant (preferably superdisintegrant); and then step (vii) is correspondingly modified, by mixing of the obtained granules with any remaining active ingredients of abacavir and/or lamivudine and with any remaining excipients, including at least lubricant, preferably further including disintegrant (preferably superdisintegrant), diluent and/or binder;

Typically, the mini-tablets are dosed in prescribed amounts that assure the administration of therapeutic portion of medicine. In the context of the present invention, this dose represents approximately 120 to 150 mini-tablets, preferably 130 to 140 mini-tablets, for example suitably 133 mini-tablets. Accordingly the present invention provides a dossier in the form of a stick pack or sachets which included the corresponding number of mini-tablets.

Examples

The present invention is described below in more detail by reference to non-limiting, illustrative Examples.

Example 1

Composition Content [mg] % Function

Abacavir sulphate^* 702.0 34.4 API

Lamivudine 150.0 7.35 API

Efavirenz 600,0 29.4 API

Microcrystalline cellulose 123.9 6.1 Filler (also acts as binder in the extragranular phase)

Hydroxypropylcellulose 48.9 2.4 Binder

Crospovidone 1 17.0 5.7 Superdisintegrant

Sodium lauryl sulphate 12.2 0.6 Surface active agent

Water q.s. / Granulation liquid

Lamivudine^** 150.0 7.35 API

Crospovidone^** 43.5 2.1 Superdisintegrant

Microcrystalline cellulose ^** 73.4 3.6 Filler (also acts as binder in the extragranular phase)

Magnesium stearate^** 20.4 1 Lubricant SUM 1 2041 .3 / /

PVA coating^*** 81.6 3,8

Sum 2122.9 / /

^* 702 mg of abacavir sulphate is equivalent to 600 mg of abacavir as base.

*^* Extragranular

^***PVA is applied on mini-tablets cores and is not a part of granulated powder.

Abacavir sulphate, a half of lamivudine and efavirenz were granulated with the listed excipients (microcrystalline cellulose, crospovidone) by using water solution of hydroxypropyl-cellulose and sodium lauryl sulphate. Granulation was performed in fluid-bed dryer. Drying of the wet granules was conducted until adequate water content was achieved (LOD 1 .0%). Obtained mixture was sieved through appropriate mesh size, preferably through a 0.71 mm mesh sieve. Sieved granulated powder was mixed with the remaining components (a second half of lamivudine, microcrystalline cellulose, superdisintegrant, diluent and lubricant). Lubricated final blend was compressed into 15 mg mini-tablets at standard rotary press by using 3 mm multitip tool. Tablet cores were coated in fluid bed system with Wurster insert by using HPMC or PVA coating solution.

Example 2

^* 702 mg of abacavir sulphate is equivalent to 600 mg of abacavir as base. Abacavir sulphate, lamivudine and efavirenz were granulated with the listed excipients (microcrystalline cellulose, mannitol and croscarmellose) by using water solution of hydroxypropylcellulose and sodium lauryl sulphate. Granulation was performed in fluid-bed dryer. Drying of the wet granules was conducted until adequate water content was achieved (LOD 1 .0%). Obtained mixture was sieved through appropriate mesh size, preferably through a 1 .0 mm mesh sieve. Sieved granulated powder was mixed with the remaining components (cola flavour, sucralose and menthol) in planetary mixer for 5 minutes.

Example 3

^* 702 mg of abacavir sulphate is equivalent to 600 mg of abacavir as base.

In the first step of process, efavirenz, microcrystalline cellulose and croscarmellose were granulated with water solution of hydroxypropylcellulose and sodium lauryl sulphate (granulation solution I). Granulation was performed in fluid bed dryer. Subsequently, abacavir, lamivudine and mannitol were added to granulated powder of efavirenz and second phase of granulation was conducted with water solution of hydroxypropylcellulose. Drying of the wet granules is conducted until adequate water content was achieved (LOD 1.0%). Obtained mixture was sieved through appropriate mesh size, preferably through a 1.0 mm mesh sieve. Sieved granulated powder was mixed with the remaining components (cola flavour, sucralose and menthol) in planetary mixer for 5 minutes.

Example 4

^* 702 mg of abacavir sulphate is equivalent to 600 mg of abacavir as base.

Technological step in Example 4 was equivalent to Example 3 for the phase of granulation. Dried granules were coated in fluid bed dryer with Wurster chamber (7', mesh plate 4) by using PVA water suspension. Coated granules were dried until adequate water content was achieved (LOD 1 %) and subsequently sieved through 1 .5 mm sieve. Sieved coated granules were mixed with the remaining components (cola flavour, sucralose and menthol) in planetary mixer for 5 minutes.

Example 5

^* 702 mg of abacavir sulphate is equivalent to 600 mg of abacavir as base.

*^* Extragranular

Abacavir sulphate, lamivudine and efavirenz were granulated with the listed excipients (microcrystalline cellulose, croscarmellose) by using water solution of hydroxypropylcellulose and sodium lauryl sulphate. Granulation was performed in fluid-bed dryer. Drying of the wet granules was conducted until adequate water content was achieved (LOD 1 .0%). Obtained mixture was sieved through appropriate mesh size, preferably through a 0.71 mm mesh sieve. Sieved granulated powder was mixed with the remaining components (microcrystalline cellulose, superdisintegrant, diluent and lubricant). Lubricated final blend was compressed into 15 mg mini-tablets at standard rotary press by using 3 mm multitip tool. Tablet cores were coated in fluid bed system with Wurster insert by using HPMC or PVA coating solution. Example 6

^* 702 mg of abacavir sulphate is equivalent to 600 mg of abacavir as base.

*^* Extragranular

Abacavir sulphate, a half of lamivudine and efavirenz were granulated with the listed excipients (microcrystalline cellulose, croscarmellose) by using water solution of hydroxypropyl-cellulose and sodium lauryl sulphate. Granulation was performed in fluid-bed dryer. Drying of the wet granules was conducted until adequate water content was achieved (LOD 1 .0%). Obtained mixture was sieved through appropriate mesh size, preferably through a 0.71 mm mesh sieve. Sieved granulated powder was mixed with the remaining components (a second half of lamivudine, microcrystalline cellulose, superdisintegrant, diluent and lubricant). Lubricated final blend was compressed into 15 mg mini-tablets at standard rotary press by using 3 mm multitip tool. Tablet cores were coated in fluid bed system with Wurster insert by using HPMC or PVA coating solution. Example 7 - Dissolution tests

Dissolution of abacavir sulphate and lamivudine was monitored in 900 ml. of 0.1 M HCI, using paddle method at 50 rpms. Peak vessels were used to assure sufficient mixing of the tableting mass instead of higher agitation rate.

Mini-tablets prepared according to Example 1 and Example 6 and reference products Ziagen^® and Epivir^® all provided very fast release (> 85 % of abacavir and lamivudine dissolved at 15 min). Efavirenz dissolution tests were performed according to FDA dissolution method in 900 ml_ of 2% SLS in water using paddle method at 50 rpms. Adequate mixing of formulation components of mini-tablets and single unit tablets could only be achieved with peak vessels, thus all samples were analyzed accordingly.

Mini-tablets prepared according to Example 1 and Example 6 and reference product Stocrin^® all provided very fast release (> 85 % of efavirenz dissolved at 15 min).

Example 8 - In vitro prediction for prevention of mouth burning effect

Mouth burning sensation in oral mucosa depends from efavirenz solubility in the saliva and surface/textural properties of dosage forms used to deliver it. Namely, if the surface of the administered dosage form is not smooth, the probability of physically entrapment of the applied formulation on the mucosal membrane increases, thus increasing the residence time of formulation on the oral mucosa and consequently the probability of more pronounced mouth burning effect.

To simulate efavirenz solubility in saliva and surface properties of different dosage forms presented herein, in vitro efavirenz micro-dissolution in artificial saliva (Marques MRC et al, "Simulated biological fluids with possible application in dissolution testing", Dissolution Technologies, August 201 1 , pp.15-28) was monitored (Figure 3).

Adhesive properties of different dosage forms were assessed with the aid of standard laboratory labware (rough filter paper); after a short period of time (approximately 20 sec) that formulation was allowed to stand on wetted filter paper, the filter was thoroughly rinsed in 100 ml of artificial saliva and the entrapped quantity of efavirenz was extracted (Figure 4). Effects

Based on data provided above, the multi-unit dosage forms, in particular the mini-tablets according to the Examples of the present invention containing all three APIs do provide the best protection of oral mucosa from efavirenz, and despite being fixed together in a common dosage form they surprisingly do yield comparable dissolution profile as already commercially available, comparable mono reference products such as Ziagen^®, Epivir^® and Stocrin^® tablets, while having the advantage of being easily swallowable as compressed mini-tablets or granules or pellets and thus showing patient compliance benefits, in particular compared to Sustiva^® capsules. Additionally, the surface properties of mini-tablets prevent potential entrapment of mini-tablets in the oral mucosa or in the esophagus, further contributing to a full patient-compliant use of such dosage forms. Other exemplified dosage forms represented by granules or pellets provide values for ultra-performance liquid chromatography (UPLC) response comparable to oral solutions, without detriment to dissolution behaviour despite the fixed combination with efavirenz. Overall UPLC response was found statistically most significant in favour of the mini-tablet form, and was found comparable for granules, respectively compared with Sustiva^® and oral solution.

Claims

1. A solid pharmaceutical composition, which is a multi-unit particulate dosage form form of mini-tablets,

wherein each mini-tablet comprises a fixed combination of active ingredients (a) to (c):

(a) a compound of the followin formula (abacavir)

(b) a compound of formula 2 (lamivudine)

2. A solid pharmaceutical composition, which is a multi-unit particulate dosage form in the form of granules or pellets, wherein the solid pharmaceutical composition comprises a fixed combination of active ingredients (a) to (c):

(a) a compound of the followin formula (abacavir)

(b) a compound of formula 2 (lamivudine)

formula 2

(c) a compound of formula 3 efavirenz)

3. The solid pharmaceutical composition according to claim 1 or 2, wherein the solid pharmaceutical composition is a triple combination of active ingredients (a) to (c) and contains no further anti-HIV active substance.

4. The solid pharmaceutical composition according to anyone of claims 1 to 3, wherein the compound (a) is contained in the form of an abacavir salt, preferably the sulphate of formula 1 :

and/or wherein the initial DO.5 primary particle size of efavirenz, whether agglomerated in the composition or not, is in a range of 2-8 μηη and DO.9 in a range of 9-26 μηη; preferably efavirenz is incorporated into the composition in micronized form.

5. The solid pharmaceutical composition according to anyone of the preceding claims, wherein each of the particulate multi-unit comprises a disintegrant, a binder, a filler, and a surfactant and a coating of a film-forming agent, optionally further comprising a lubricant, a glidant, a sweetener and/or a flavouring agent.

6. The solid pharmaceutical composition according to anyone of the preceding claims, wherein the whole composition respectively the total multi-unit dosage form contains at least 1500 mg of active ingredients (a) to (c) in total, preferably 1500 mg, respectively calculated on the basis of the free active compound; preferably wherein the whole composition contains 600 mg abacavir (calculated as free base) respectively 702 mg abacavir sulphate, 300 mg lamivudine and 600 mg efavirenz.

7. The solid pharmaceutical composition according to anyone of the preceding claims, wherein the amount of active ingredients in total represent at least 60% by weight, preferably up to 90% by weight of the whole composition respectively the total multi-unit dosage form, preferably wherein the multi-units are mini-tablets where the amount of active ingredients in total represents not less than 70% by weight of the whole composition, more preferably not less than 80% by weight of the whole composition.

8. The solid pharmaceutical composition according to anyone of the preceding claims, wherein each multi-unit has an outer coating layer of a film-forming polymer, preferably wherein the outer coating layer of the film-forming polymer is uniform and coherent at the body and the edges of the multi-units, more preferably wherein the coating layer provides for a lag time not less than 3 minutes.

9. The solid pharmaceutical composition according to anyone of the preceding claims, wherein the multi-units are mini-tablets having a particle size of a mean diameter in the range of 1 -5 mm, preferably 1.5 mm - 4 mm, more preferably 1 .7-3 mm.

10. The solid pharmaceutical composition according to anyone of the preceding claims, wherein the multi-units comprise granules obtained by a two-phase granulation, a first granulation with efavirenz and a second granulation with abacavir and lamivudine, wherein the second granulation material containing abacavir and lamivudine covers at least partially the first efavirenz-containing granulated particles.

1 1. The solid pharmaceutical composition to anyone of claims 1 to 9, formulated as mini- tablets wherein each mini-tablet is respectively configured in anyone of the following structures:

(i) each mini-tablet comprises granules with efavirenz and granules with abacavir and lamivudine;

(ii) each mini-tablet comprises granules with efavirenz and abacavir and granules with lamivudine;

(iii) each mini-tablet comprises an intra-granular phase and an extragranular phase, wherein the total of efavirenz is present in the intra-granular phase (granule); wherein preferably the total of abacavir and lamivudine are present in the extragranular phase;

(iv) each mini-tablet comprises an intra-granular phase and an extragranular phase, wherein the total of efavirenz and abacavir are present in the intra-granular phase (granule); and lamivudine is present in the extragranular phase;

(v) each mini-tablet comprises an intra-granular phase and an extragranular phase, wherein the total of efavirenz is present in the intra-granular phase; and either abacavir or lamivudine, preferably only lamivudine, is partitioned between the intragranular and the extragranular phase, or wherein both abacavir and lamivudine are partitioned between the intragranular and the extragranular phase.

12. The solid pharmaceutical composition according to anyone of the preceding claims, comprising the following excipients (a) to (h), respectively alone or in combination and preferably contained in each of the multi-units:

(a) optionally and preferably a hydrophilic film forming polymer present in an outer coating of the respective unit, preferably selected from the group consisting of cellulose derivatives, vinyl derivatives, graft copolymer PVA-polyethylene glycol, copolymers of acrylic and/or methacrylic acid esters with trimethylammonium-methylacrylate, copolymers of dimethylaminomethacrylic acid and neutral methacrylic acid esters, polymers of methacrylic acid or methacrylic acid esters, copolymers of acrylic acid ethylester and methacrylic acid methyl ester, and copolymers of acrylic acid and acrylic acid methylester, more preferably hydroxypropylmethyl cellulose and polyvinyl alcohol;

(b) optionally and preferably a filler selected from cellulose, silicified microcrystalline cellulose and non-cellulose filler of polyol type filler such as mannitol or polymer type filler such as starch, preferably microcrystalline cellulose, silicified microcrystalline cellulose and/or the polyol type filler mannitol;

(c) a binder selected from povidone, tragacanth, sodium alginate, gum arabic, starch pregelatinized, gelatin, and cellulosic derivatives, povidone, and starch pregelatinized, preferably cellulosic derivative, more preferably hydroxypropylcellulose;

(d) a disintegrant selected from the group consisting of carmellose calcium, carboxymethylstarch sodium, croscarmellose sodium, starch, modified starch, starch derivatives, crospovidone, and low-substituted hydroxypropylcellulose, preferably superdisintegrants selected from the group consisting of sodium starch glycolate, croscarmellose sodium and crospovidone, in particular is croscarmellose sodium;

(e) optionally a lubricant selected from the group consisting of stearic acid, magnesium stearate, calcium stearate, zinc stearate, glyceryl behenate, sodium stearyl fumarate, polyethylene glycol, and silicon dioxide, preferably magnesium stearate;

(f) a surfactant selected from the group consisting of sodium lauryl sulphate, docusate sodium, benzalkonium chloride, benzethonium chloride, cetrimide, and polyoxyethylene- polyoxypropylene copolymers, preferably is sodium lauryl sulphate;

(g) optionally a glidant selected from talc and colloidal silicon dioxide; and

(h) optionally a sweetener selected from aspartame, saccharine sodium, sucralose, glycyrrhiza; a flavouring agent selected from mint, orange, lemon, strawberry, vanilla, raspberry and cola flavour; and a substance exerting a cooling effect selected from menthol and polyols, preferably mannitol, xylitol, isomalt and eritriol polyols,

preferably wherein components (c), (d) and (f) and more preferably also (a) and (b) are mandatorily present.

13. The solid pharmaceutical composition according to anyone of the preceding claims, comprising, respectively based on the total weight of the composition:

(a) at least 60% by weight, preferably from 60 to 90% by weight of abacavir, lamivudine and efavirenz;

(b) from 1 to 20% by weight of a disintegrant, preferably from 2 to 10% by weight of a superdisintegrants selected from the group consisting of sodium starch glycolate, croscarmellose sodium and crospovidone, preferably croscarmellose sodium;

(c) from 1 to 20% by weight of a binder, preferably from 2 to 10% by weight of a binder selected from cellulosic derivatives, preferably hydroxypropylcellulose;

(d) from 0.1 to 7% by weight of a surfactant, preferably from 0.5 to 3% by weight of sodium lauryl sulphate ; (e) from 0 to 30% by weight of a filler, preferably from 2 to 25% by weight of a filler selected from the group consisting of microcrystalline cellulose and mannitol;

(f) optionally up to 10% by weight of a lubricant, preferably 0.1 to 8% by weight of magnesium stearate; and

(g) optionally an outer coating comprising 1 to 15 %, preferably 3 to 10 % by weight of a film- forming polymer.

14. Solid pharmaceutical composition according to any one of the preceding claims for use in the treatment of HIV infection, in particular immunodefiency virus type 1 (HIV-1 ) infection.

15. A pharmaceutical product in the form of a stick pack or a sachet, the stick pack or a sachet containing a set of multi-units as defined in anyone of the preceding claims.

16. A process for preparing an solid pharmaceutical composition comprising a fixed combination of active ingredients (a) to (c) according to anyone of claims 1 to 14, wherein the active ingredients (a) to (c) are combined within a common oral solid dosage form in the form of multi-units together with at least one pharmaceutically acceptable excipient selected from the group consisting of disintegrants, binders, fillers, lubricants, surfactants and film-forming agents.

17. A process according to claim 16 for manufacturing an oral multi-unit dosage form in the form of mini-tablets, comprising the steps of:

(i) mixing the active ingredients abacavir, lamivudine and efavirenz with appropriate pharmaceutical excipients, preferably a binder, a filler and/or a disintegrant, preferably a superdisintegrant;

(iii) adding a binder and surfactant into granulation fluid;

(v) drying of the wet granules;

(vi) sieving of the obtained mixture through appropriate mesh size, preferably through a 0.25 mm to 1 .0 mm mesh sieve;

(vii) mixing of the obtained granules with any remaining excipients, including at least lubricant and preferably further including disintegrant, diluent and/or binder;

(viii) compression of the final blend by using multitip compression tools;

(ix) coating of the mini-tablets in fluid bed system with a coating material comprising a film-forming polymer; or

comprising modified steps wherein step (i) is modified in that the active ingredient efavirenz and optionally the total or a part of other active ingredients abacavir and/or lamivudine are mixed with appropriate pharmaceutical excipients, preferably a surfactant, a binder, a filler and a disintegrant (preferably superdisintegrant); and step (vii) is correspondingly modified by mixing of the obtained granules with any remaining active ingredients of abacavir and/or lamivudine and with any remaining excipients, including at least lubricant, preferably further including disintegrant, preferably superdisintegrant, diluent and/or binder.

18. The process according to claim 16 for manufacturing an oral multi-unit dosage form in the form of granules, involving wet granulation, preferably wherein wet granulation is carried out in two steps, a first granulation phase with efavirenz to obtain efavirenz-containing first granulate, and a second granulation phase with abacavir and lamivudine applied to the obtained efavirenz-containing first granulate, optionally subsequently coating the obtained granules by a layer containing a film-forming polymer.