Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K9/00—Medicinal preparations characterised by special physical form
  • A61K9/0012—Galenical forms characterised by the site of application
  • A61K9/007—Pulmonary tract; Aromatherapy
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K9/00—Medicinal preparations characterised by special physical form
  • A61K9/0012—Galenical forms characterised by the site of application
  • A61K9/007—Pulmonary tract; Aromatherapy
  • A61K9/0073—Sprays or powders for inhalation; Aerolised or nebulised preparations generated by other means than thermal energy
  • A61K9/0075—Sprays or powders for inhalation; Aerolised or nebulised preparations generated by other means than thermal energy for inhalation via a dry powder inhaler [DPI], e.g. comprising micronized drug mixed with lactose carrier particles
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
  • A61K31/496—Non-condensed piperazines containing further heterocyclic rings, e.g. rifampin, thiothixene or sparfloxacin
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
  • A61K47/02—Inorganic compounds
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
  • A61K47/06—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite
  • A61K47/08—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite containing oxygen, e.g. ethers, acetals, ketones, quinones, aldehydes, peroxides
  • A61K47/12—Carboxylic acids; Salts or anhydrides thereof
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
  • A61K47/06—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite
  • A61K47/08—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite containing oxygen, e.g. ethers, acetals, ketones, quinones, aldehydes, peroxides
  • A61K47/14—Esters of carboxylic acids, e.g. fatty acid monoglycerides, medium-chain triglycerides, parabens or PEG fatty acid esters
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
  • A61K47/06—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite
  • A61K47/16—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite containing nitrogen, e.g. nitro-, nitroso-, azo-compounds, nitriles, cyanates
  • A61K47/18—Amines; Amides; Ureas; Quaternary ammonium compounds; Amino acids; Oligopeptides having up to five amino acids
  • A61K47/183—Amino acids, e.g. glycine, EDTA or aspartame
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
  • A61K47/06—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite
  • A61K47/26—Carbohydrates, e.g. sugar alcohols, amino sugars, nucleic acids, mono-, di- or oligo-saccharides; Derivatives thereof, e.g. polysorbates, sorbitan fatty acid esters or glycyrrhizin
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K9/00—Medicinal preparations characterised by special physical form
  • A61K9/14—Particulate form, e.g. powders, Processes for size reducing of pure drugs or the resulting products, Pure drug nanoparticles
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K9/00—Medicinal preparations characterised by special physical form
  • A61K9/14—Particulate form, e.g. powders, Processes for size reducing of pure drugs or the resulting products, Pure drug nanoparticles
  • A61K9/141—Intimate drug-carrier mixtures characterised by the carrier, e.g. ordered mixtures, adsorbates, solid solutions, eutectica, co-dried, co-solubilised, co-kneaded, co-milled, co-ground products, co-precipitates, co-evaporates, co-extrudates, co-melts; Drug nanoparticles with adsorbed surface modifiers
  • A61K9/145—Intimate drug-carrier mixtures characterised by the carrier, e.g. ordered mixtures, adsorbates, solid solutions, eutectica, co-dried, co-solubilised, co-kneaded, co-milled, co-ground products, co-precipitates, co-evaporates, co-extrudates, co-melts; Drug nanoparticles with adsorbed surface modifiers with organic compounds
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P11/00—Drugs for disorders of the respiratory system
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P31/00—Antiinfectives, i.e. antibiotics, antiseptics, chemotherapeutics
  • A61P31/10—Antimycotics

Definitions

• the antifungal agent in crystalline particulate form is in the form of a sub-particle of about 50 nm to about 5,000 nm (Dv50). In one embodiment the sub-particle is about 50 nm to about 800 nm (Dv50). In one embodiment the sub-particle is about 50 nm to about 300 nm (Dv50). In one embodiment, the sub-particle is about 50 to about 200 nm (Dv50). In one embodiment, the sub-particle is about 100 nm to about 300 nm (Dv50).
• the antifungal agent is present in an amount of about 1% to about 95% by weight. The antifungal agent is present in an amount of about 40% to about 90% by weight.
• This disclosure relates to respirable dry powders that contain an antifungal agent in crystalline particulate form.
• dry powder formulations that contain antifungal agents, such as itraconazole, in amorphous form have shorter lung residence times, reduced lung to plasma exposure ratios and undesirable toxic effects on lung tissue when inhaled at therapeutic doses.
• antifungal agents such as itraconazole
• the crystalline forms (e.g., nanocrystalline forms) of the material have a slower dissolution rate in the lung, providing more continuous exposure over a 24 hour period after administration and minimizing systemic exposure.
• the observed local toxicity in lung tissue without amorphous dosing is not related to the total exposure of the lung tissue to the drug, in terms of total dose or duration of exposure.
• Itraconazole has no known activity against human or animal lung cells and so increasing local concentration has no local pharmacological activity to explain the local toxicity.
• the toxicity of the amorphous form appears related to the increased solubility secondary to the amorphous nature of the itraconazole, resulting in supersaturation of the drug in the interstitial space and the resultant recrystallization in the tissue leading to local, granulomatous inflammation.
• dry powders that contain antifungal agents in crystalline particulate form are less toxic to lung tissue.
• respirable dry particles refers to particles that have a volume median geometric diameter (VMGD) of about 10 microns or less, preferably about 5 microns or less, or less than 5 microns.
• VMGD volume median geometric diameter
• stabilizer refers to a compound that improves the physical stability of antifungal agents in crystalline particulate form when suspended in a liquid in which the antifungal agent is poorly soluble (e.g., reduces the aggregation, agglomeration, Ostwald ripening and/or flocculation of the particulates).
• the invention relates to dry powder formulations comprising respirable dry particles that contain 1) an antifungal agent in crystalline particulate form, 2) a stabilizer, and 3) one or more excipients.
• Any desired antifungal agents can be included in the formulations described herein.
• Many antifungal agents are well-known, for example, polyene antifungals, such as amphotericin B; triazole antifungals, such as itraconazole, ketoconazole, fluconazole, voriconazole, and posaconazole; echinocandin antifungals, such as caspofungin, micafungin, and anidulafungin.
• triazole antifungals include clotrimazole, Isavuconazole, and miconazole. Included are a new chemical class of triterpenoid glucan synthase inhibitors, for example, SCY-078. Also included are orotomide antifungals, such as F901318, which inhibits dihydroorotate dehydrogenase.
• the dry powders described herein can be formulated using antifungal agents in crystalline particulate form that provide for a desired degree of crystallinity and sub-particle size, and can be tailored to achieve desired pharmacokinetic properties while avoiding unacceptable toxicity in the lungs.
• the sub-particle size can be about 100 nm, about 300 nm, about 1500 nm, about 80 nm to about 300 nm, about 80 nm to about 250 nm, about 80 nm to about 200 nm, about 100 nm to about 150 nm, about 1200 nm to about 1500 nm, about 1500 nm to about 1750 nm, about 1200 nm to about 1400 nm, or about 1200 nm to about 1350 nm (Dv50).
• the ratio of antifungal agent: stabilizer (wt:wt) in the dry particles can be > (greater than or equal to) 10: 1, about 10: 1, about 20: 1, or about 10: 1 to about 20: 1.
• the ratio is about 5: 1 to about 20: 1, about 7: 1 to about 15: 1, or about 9: 1 to about 11 : 1.
• the amount of stabilizer that is present in the dry particles can be in a range of about 0.05% to about 45% by weight (wt%).
• the range is about 1% to about 15%, about 4% to about 10%, or about 5% to about 8% by weight (wt%).
• excipients are well-known in the art and can be included in the dry powders and dry particles described herein.
• Pharmaceuticallyacceptable excipients that are particularly preferred for the dry powders and dry particles described herein include monovalent and divalent metal cation salts, carbohydrates, sugar alcohols and amino acids.
• Suitable magnesium salts include, for example, magnesium lactate, magnesium fluoride, magnesium chloride, magnesium bromide, magnesium iodide, magnesium phosphate, magnesium sulfate, magnesium sulfite, magnesium carbonate, magnesium oxide, magnesium nitrate, magnesium borate, magnesium acetate, magnesium citrate, magnesium gluconate, magnesium maleate, magnesium succinate, magnesium malate, magnesium taurate, magnesium orotate, magnesium glycinate, magnesium naphthenate, magnesium
• the dry particles described herein contain 1) an antifungal agent in crystalline particulate form, 2) a stabilizer, and optionally 3) one or more excipients.
• the dry particles contain a first excipient that is a monovalent or divalent metal cation salt, and a second excipient that is an amino acid, carbohydrate or sugar alcohol.
• the first excipient can be a sodium salt or a magnesium salt
• the second excipient can be an amino acid (such as leucine).
• the first excipient can be sodium sulfate, sodium chloride or magnesium lactate, and the second excipient can be leucine.
• the invention relates to a dry powder formulation comprising 70%
• Itraconazole 15% sodium, 8% leucine, and 7% polysorbate 80.
• the invention in another aspect, relates to a dry powder formulation comprising 75% Itraconazole, 9.5% sodium sulfate, 8% leucine, and 7.5% polysorbate 80.
• the invention in another aspect, relates to a dry powder formulation comprising 80% Itraconazole, 11% sodium sulfate, 1% leucine, and 8% polysorbate 80.
• the dry powders and/or respirable dry particles are preferably small, mass dense, and dispersible.
• a laser diffraction system may be used, e.g., a Spraytec system (particle size analysis instrument, Malvern Instruments) and a
• the respirable dry particles have a VMGD as measured by laser diffraction at the dispersion pressure setting (also called regulator pressure) of 1.0 bar at a maximum orifice ring pressure using a HELOS/RODOS system of about 10 microns or less, about 5 microns or less, about 4 ⁇ or less, about 3 ⁇ or less, about 1 ⁇ to about 5 ⁇ , about 1 ⁇ to about 4 ⁇ , about 1.5 ⁇ to about 3.5 ⁇ , about 2 ⁇ to about 5 ⁇ , about 2 ⁇ to about 4 ⁇ , or about 2 ⁇ to about 3 ⁇ .
• the VMGD is about 5 microns or less or about 4 ⁇ or less.
• the dry powders and/or respirable dry particles have a minimum VMGD of about 0.5 microns or about 1.0 micron.
• the dry powders and/or respirable dry particles preferably have a FPF of less than about 3.4 microns (FPF ⁇ 3.4 ⁇ ) of the total dose of at least about 20%, preferably at least about 25%, at least about 30%, at least about 40%, between about 25% and about 60%, or between about 40% and about 60%.
• FPF 3.4 microns
• the receptacle holding the dry powders and/or respirable dry particles may contain about 5 mg, about 7.5 mg, about 10 mg, about 15 mg, about 20 mg, or about 30 mg.
• the dry powders and/or respirable dry particles are characterized by a CEPM of 80% or greater and a VMGD of 5 microns or less when emitted from a passive dry powder inhaler having a resistance of about 0.036 sqrt(kPa)/liters per minute under the following conditions: an air flow rate of 30 LPM, run for 3 seconds using a size 3 capsule that contains a total mass of 10 mg.
• HELOS/RODOS system of about 10 microns or less, preferably about 5 microns or less; 2) a 1 bar/4 bar dispersibility ratio and/or a 0.5 bar/4 bar dispersibility ratio of about 1.5 or less, about 1.4 or less or about 1.3 or less; 3) a MMAD of about 10 microns or less, preferably about 5 microns or less; 4) a FPF ⁇ 5.6 ⁇ of the total dose of at least about 45% or at least about 60%; and/or 5) a FPF ⁇ 3.4 ⁇ of the total dose of at least about 25% or at least about 40%.
• the invention is a method for the treatment, reduction in incidence or severity, or prevention of acute exacerbations caused by a fungal infection in the respiratory tract, such as an aspergillus infection.
• the invention is a method for the treatment, reduction in incidence or severity, or prevention of exacerbations caused by a fungal infection in the respiratory trat, such as an aspergillus infection.
• the invention is a method for the treatment, reduction in incidence or severity, or prevention of exacerbations caused by allergic bronchopulmonary aspergillosis (ABPA), for example, in patients with pulmonary disease such as asthma or cystic fibrosis.
• ABPA allergic bronchopulmonary aspergillosis
• Sodium chloride, sodium sulfate, polysorbate 80, oleic acid, ammonium hydroxide, mannitol, magnesium lactate, and L-leucine were obtained from Sigma- Aldrich Co. (St. Louis, MO), Spectrum Chemicals (Gardena, CA), Applichem (Maryland Heights, MO), Alfa Aesar (Tewksbury, MA), Thermo Fisher (Waltham, MA), Croda Chemicals (East Yorkshire, United Kingdom) or Merck (Darmstadt, Germany). Itraconazole was obtained from Neuland (Princeton, NJ) or SMS Pharmaceutical ltd (Telengana State, India). Amphotericin B was obtained from Synbiotics Ltd (Ahmedabad, India). Ultrapure (Type II ASTM) water was from a water purification system (Millipore Corp., Billerica, MA), or equivalent.
• the capsules HPMC, Size 3; Capsugel Vcaps, Peapack, NJ
• DPI breath-activated dry powder inhaler
• the capsule was punctured and the powder was drawn through the cascade impactor operated at a flow rate of 60.0 L/min for 2.0 s.
• the calibrated cut-off diameters for the eight stages are 8.6, 6.5, 4.4, 3.3, 2.0, 1.1, 0.5 and 0.3 microns and for the two stages used with the short stack cascade impactor, based on the Andersen Cascade Impactor, the cut-off diameters are 5.6 microns and 3.4 microns.
• the fractions were collected by placing filters in the apparatus and determining the amount of powder that impinged on them by gravimetric measurements or chemical measurements on an HPLC.
• Fine Particle Dose indicates the mass of one or more therapeutics in a specific size range and can be used to predict the mass which will reach a certain region in the respiratory tract.
• the fine particle dose can be measured gravimetrically or chemically via either an ACI or NGI. If measured gravimetrically, since the dry particles are assumed to be homogenous, the mass of the powder on each stage and collection filter can be multiplied by the fraction of therapeutic agent in the formulation to determine the mass of therapeutic. If measured chemically, the powder from each stage or filter is collected, separated, and assayed for example on an HPLC to determine the content of the therapeutic.
• Mass Median Aerodynamic Diameter Mass median aerodynamic diameter (MMAD) was determined using the information obtained by the Andersen Cascade Impactor (ACI). The cumulative mass under the stage cut-off diameter is calculated for each stage and normalized by the recovered dose of powder. The MMAD of the powder is then calculated by linear interpolation of the stage cut-off diameters that bracket the 50th percentile. An alternative method of measuring the MMAD is with the Next Generation Impactor (NGI). Like the ACI, the MMAD is calculated with the cumulative mass under the stage cut-off diameter is calculated for each stage and normalized by the recovered dose of powder. The MMAD of the powder is then calculated by linear interpolation of the stage cut-off diameters that bracket the 50th percentile.
• ACI Andersen Cascade Impactor
• volume median diameter (Dv50) of the powder after it is emitted from a dry powder inhaler which may also be referred to as volume median geometric diameter (VMGD)
• VMGD volume median geometric diameter
• Powder was filled into size 3 capsules (V-Caps, Capsugel) and placed in a capsule based dry powder inhaler (RSOl Model 7 High resistance, Plastiape, Italy), or DPI, and the DPI sealed inside a cylinder.
• the cylinder was connected to a positive pressure air source with steady air flow through the system measured with a mass flow meter and its duration controlled with a timer controlled solenoid valve.
• the air flow rate drawn through the DPI was sometimes run at 15 L/min, 20 L/min, or 30 L/min.
• the resulting geometric particle size distribution of the aerosol was calculated from the software based on the measured scatter pattern on the photodetectors with samples typically taken at 1000Hz for the duration of the inhalation.
• the Dv50, GSD, FPF ⁇ 5 ⁇ m measured were then averaged over the duration of the inhalation.
• the Emitted Dose refers to the mass of therapeutic which exits a suitable inhaler device after a firing or dispersion event.
• the ED is determined using a method based on USP Section 601 Aerosols, Metered-Dose Inhalers and Dry Powder Inhalers, Delivered- Dose Uniformity, Sampling the Delivered Dose from Dry Powder Inhalers, United States Pharmacopeia convention, Rockville, MD, 13th Revision, 222-225, 2007.
• Contents of capsules are dispersed using either the RSOl HR inhaler at a pressure drop of 4kPa and a typical flow rate of 60 LPM or the UHR2 RSOl at a pressure drop of 4kPa and a typical flow rate of 39 LPM.
• the emitted powder is collected on a filter in a filter holder sampling apparatus.
• the sampling apparatus is rinsed with a suitable solvent such as water and analyzed using an HPLC method.
• a shorter length filter holder sampling apparatus is used to reduce deposition in the apparatus and the filter is weighed before and after to determine the mass of powder delivered from the DPI to the filter.
• the emitted dose of therapeutic is then calculated based on the content of therapeutic in the delivered powder. Emitted dose can be reported as the mass of therapeutic delivered from the DPI or as a percentage of the filled dose.
• X-Ray Powder Diffraction The crystalline character of the formulations was assessed via powder X-ray diffraction (PXRD). A 20-30 mg sample of material is analyzed in a powder X-ray diffractometer (D8 Discover with LINXEYE detector; Bruker Corporation, Billerica, MA or equivalent) using a Cu X-ray tube with 1.5418A at a data accumulation time 1.2 second/step over a scan range of 5 to 45°2 ⁇ and a step size of 0.02°2 ⁇ .
• PXRD powder X-ray diffractometer
• HPLC chromatography
• UV ultraviolet
• the reverse phase column is equilibrated to 30°C and the autosampler is set to 5°C.
• the mobile phases, 20 mM sodium phosphate monobasic at a pH of 2.0 (mobile phase A) and acetonitrile (mobile phase B) are used in a gradient elution from a ratio of 59:41 (A:B) to 5:95 (A:B), over the course of a 19.5 minute run time.
• Detection is by UV at 258 nm and the injection volume is 10 ⁇ ,.
• Itraconazole content in powders are quantified relative to a standard curve.
• Particle Size Reduction The particle size distribution of the crystalline active agent can be modulated using a number of techniques familiar to those of skill in the art, including but not limited to, high-pressure homogenization, high-shear homogenization, jet- milling, pin milling, microfluidization, or wet milling (also known as ball milling, pearl milling or bead milling). Wet milling is often preferred, as it is able to achieve a wide range of particle size distributions, including those in the nanometer ( ⁇ 1 ⁇ ) size domain.
• Particle Size Reduction using Low Energy Wet Milling One technique for reducing the particle size of the active agent was via low energy wet milling, (also known as roller milling, or jar milling). Suspensions of the active agent were prepared in an anti- solvent, which can be water, or any solvent in which the active agent is not appreciably soluble. Stabilizers, which can be, but are not limited to, non-ionic surfactants or amphiphilic polymers, are then added to the suspension along with milling media, which can be, but are not limited to, spherical with high wear resistance and in the size range from 0.03 to 0.70 millimeters in diameter.
• Stabilizers which can be, but are not limited to, non-ionic surfactants or amphiphilic polymers
• the vessels containing the suspensions are then rotated using ajar mill (US Stoneware, East furniture, OH USA) while taking samples periodically to assess particle size (LA-950, HORIBA, Kyoto, Japan).
• ajar mill US Stoneware, East furniture, OH USA
• particle size LA-950, HORIBA, Kyoto, Japan
• Particle Size Reduction using High Energy Wet Milling Another technique for reducing the particle size of the active agent was via high-energy wet milling using a rotor- stator, or agitated media mill.
• Suspensions of the active agent were prepared in an anti- solvent, which can be water, or any solvent in which the active agent is not appreciably soluble.
• Stabilizers which can be, but are not limited to, non-ionic surfactants or amphiphilic polymers, are then added to the suspension along with milling media, which can be, but are not limited to, spherical with high wear resistance and in the size range from 0.03 to 0.70 millimeters in diameter.
• the suspensions are then charged into the mill, which can be operated in either batch or recirculation mode.
• the process consists of the suspension and milling media being agitated within the milling chamber, which increases the energy input to the system and accelerates the particle size reduction process.
• the milling chamber and recirculation vessel are jacketed and actively cooled to avoid temperature increases in the product.
• the agitation rate and recirculation rate of the suspension are controlled during the process. Samples are taken periodically to assess particle size (LA-950, HORIBA, Kyoto, Japan). When the particle size is sufficiently reduced, or when a particle size minimum is reached, the suspension is discharged from the mill.
• Particle size of the active agent is monitored periodically via laser diffraction (LA-950, HORIBA, Kyoto, Japan). When the particle size is sufficiently reduced, or when a particle size minimum is reached, the suspension is recovered from the unit.
• Feedstock Preparation for Spray Drying Spray drying homogenous particles requires that the ingredients of interest be solubilized in solution or suspended in a uniform and stable suspension.
• the feedstock can utilize water, or a combination of water and other miscible solvents such as alcohols or ketones, as the solvent in the case of solutions, or as the continuous phase in the case of suspensions.
• Feedstocks of the various formulations were prepared by dissolving the soluble components in the desired solvent(s) followed by dispersing the surfactant- stabilized active agent-containing suspension in the resulting solution while mixing, although the process is not limited to this specific order of operations.
• Niro Spray Dryer Dry powders were produced by spray drying utilizing a Niro Mobile Minor spray dryer (GEA Process Engineering Inc., Columbia, MD) with powder collection from a cyclone, a product filter or both. Atomization of the liquid feed was performed using a co-current two-fluid nozzle either from Niro (GEA Process Engineering Inc., Columbia, MD) or a Spraying Systems (Carol Stream, IL) 1/4J two-fluid nozzle with gas cap 67147 and fluid cap 2850SS, although other two-fluid nozzle setups are also possible. In some embodiments, the two-fluid nozzle can be in an internal mixing setup or an external mixing setup.
• Niro Mobile Minor spray dryer GSA Process Engineering Inc., Columbia, MD
• Atomization of the liquid feed was performed using a co-current two-fluid nozzle either from Niro (GEA Process Engineering Inc., Columbia, MD) or a Spraying Systems (Carol Stream, IL) 1/4J two-fluid
• the drying gas inlet temperature can range from 70 °C to 300 °C and outlet temperature from 30 °C to 120 °C with a liquid feedstock rate of 10 niL/min to 100 niL/min.
• the gas supplying the two-fluid atomizer can vary depending on nozzle selection and for the Niro co-current two-fluid nozzle can range from 5 kg/hr to 50 kg/hr or for the Spraying Systems 1/4J two-fluid nozzle can range from 30 g/min to 150 g/min.
• the atomization gas rate can be set to achieve a certain gas to liquid mass ratio, which directly affects the droplet size created.
• the pressure inside the drying drum can range from +3 "WC to -6 "WC.
• Spray dried powders can be collected in a container at the outlet of the cyclone, onto a cartridge or baghouse filter, or from both a cyclone and a cartridge or baghouse filter.
• Spray Drying Using Biichi Spray Dryer Dry powders were prepared by spray drying on a Biichi B-290 Mini Spray Dryer (BUCHI Labortechnik AG, Flawil, Switzerland) with powder collection from either a standard or High Performance cyclone. The system was run either with air or nitrogen as the drying and atomization gas in open- loop (single pass) mode. When run using air, the system used the Biichi B-296 dehumidifier to ensure stable temperature and humidity of the air used to spray dry.
• Inlet temperature of the process gas can range from 100 °C to 220 °C and outlet temperature from 30 °C to 120 °C with a liquid feedstock flowrate of 3 mL/min to 10 niL/min.
• the two-fluid atomizing gas ranges from 25 mm to 45 mm (300 LPH to 530 LPH) for the Biichi two-fluid nozzle and for the Schlick atomizer an atomizing air pressure of upwards of 0.3 bar.
• the aspirator rate ranges from 50% to 100%.
• Stability Assessment The physicochemical stability and aerosol performance of select formulations were assessed at 2-8 °C, 25°C/60% RH, and when material quantities permitted, 40°C/75% RH as detailed in the International Conference on Harmonisation (ICH) Ql guidance. Stability samples were stored in calibrated chambers (Darwin Chambers Company Models PH024 and PH074, St. Louis. MO). Bulk powder samples were weighed into amber glass vials, sealed under 30% RH, and induction- sealed in aluminum pouches (Drishield 3000, 3M, St. Paul, MN) with silica desiccant (2.0g, Multisorb Technologies, Buffalo, NY ).
• Example 1 Dry powder formulations of polysorbate 80-stabilized nanocrystalline itraconazole containing sodium sulfate/mannitol
• the nanocrystalline itraconazole was prepared by compounding 11.662 g of itraconazole (Neuland lot ITI0114005) in 103.789 g of water and 1.1662 g of polysorbate 80 (Spectrum lot 2DI0112). 129.625 g of 500 ⁇ polystyrene milling media (Dow Chemical, Midland MI) was then added to the suspension, and the suspension was milled at 1000 rpm for one hour then 1500 rpm for 30 minutes before being collected. The final median particle size (Dv(50)) of the milled suspension was 124 nm.
• Dry powders of Formulations I and II were manufactured from these feedstocks by spray drying on the Biichi B-290 Mini Spray Dryer (B1JCHI Labortechnik AG, Flawil, Switzerland) with cyclone powder collection. The system was run in open- loop (single pass) mode using nitrogen as the drying and atomization gas. Atomization of the liquid feed utilized a Biichi nozzle with 1.5mm cap and 0.7 liquid tip. The aspirator of the system was adjusted to maintain the system pressure at -2.0" water column.
• the bulk particle size characteristics for the two formulations are found in Table 4.
• Formulations I and II were determined to be stable after being stored for six months at 2-8°C and 25°C/60% RH.
• Dry powders of Formulations I and II were manufactured from these feedstocks by spray drying on the Biichi B-290 Mini Spray Dryer (BlJCffl Labortechnik AG, Flawil, Switzerland) with cyclone powder collection. The system was run in open- loop (single pass) mode using nitrogen as the drying and atomization gas. Atomization of the liquid feed utilized a Biichi nozzle with 1.5mm cap and 0.7 liquid tip. The aspirator of the system was adjusted to maintain the system pressure at -2.0" water column.
• the bulk particle size characteristics for the two formulations are found in Table 9.
• the span at 1 bar of 1.76 and 1.86 for Formulations III and IV, respectively, indicates a relatively narrow size distribution.
• the 1 bar/4 bar dispersibility ratio of 1.19 and 1.05 for Formulations III and IV respectively, indicate that they are relatively independent of dispersion energy, a desirable characteristic which allows similar particle dispersion range of dispersion energies.
• CEPM geometric particle size and capsule emitted powder mass
• LPM liters per minute
• 20 LPM simulated patient flow rates were measured for the two formulations and reported in Table 10.
• the small changes in CEPM and geometric size from 60 LPM to 20 LPM indicates that the dry powder formulations are relatively independent of patient inspiratory flowrate, indicating that patients breathing in at varying flow rates would receive a relatively similar therapeutic dose.
• Formulations III and IV were determined to be stable after being stored for six months at 2-8°C and 25°C/60% RH.
• Dry powders of Formulations V and VI were manufactured from these feedstocks by spray drying on the Biichi B-290 Mini Spray Dryer (BIJCHI Labortechnik AG, Flawil, Switzerland) with cyclone powder collection. The system was run in open- loop (single pass) mode using nitrogen as the drying and atomization gas. Atomization of the liquid feed utilized a Biichi nozzle with 1.5mm cap and 0.7 liquid tip. The aspirator of the system was adjusted to maintain the system pressure at -2.0" water column.
• Table 13 Dry powder compositions, dry basis
• the bulk particle size characteristics for the two formulations are found in Table 14.
• the span at 1 bar of 1.70 and 1.83 for Formulations V and VI, respectively, indicates a relatively narrow size distribution.
• the 1 bar/4 bar dispersibility ratio of 1.02 and 1.05 for Formulations V and VI respectively, indicate that they are relatively independent of dispersion energy, a desirable characteristic which allows similar particle dispersion across a range of dispersion energies.
• Table 18 Dry powder compositions, dry basis
• Formulation X is a nano- suspension of itraconazole with polysorbate 80.
• the itraconazole concentration in the liquid is 5 mg/mL.
• the ratio of itraconazole to polysorbate 80 is 10:1 (wgt/wgt).
• the median size of the itraconazole crystals is 132 nanometers.
• Dry powders of Formulations XII-XV were manufactured from these feedstocks by spray drying on the Biichi B-290 Mini Spray Dryer (B1JCHI Labortechnik AG, Flawil, Switzerland) with cyclone powder collection. The system was run in open- loop (single pass) mode using nitrogen as the drying and atomization gas. Atomization of the liquid feed utilized a Biichi nozzle with 1.5mm cap and 0.7 liquid tip. The aspirator of the system was adjusted to maintain the system pressure at -2.0" water column.
• a feedstock solution was prepared and used to manufacture a dry powder composed of nanocrystalline itraconazole, polysorbate 80 and other additional excipients.
• the feedstock solution that was used to spray dry particles were made as follows. The required quantity of water was weighed into a suitably sized glass vessel. The excipients were added to the water and the solution allowed to stir until visually clear. The itraconazole-containing suspension was then added to the excipient solution and stirred until visually homogenous. The feedstock was then spray-dried. The feedstock volume was 3000g, which supported a manufacturing campaign of approximately one hour. Table 34 lists the components of the feedstock used in preparation of the dry powder.
• the itraconazole-containing THF solution was then added to the excipient solution and stirred until visually homogenous.
• the feedstock was then spray-dried.
• the feedstock volume was 5L, which supported a manufacturing campaign of approximately 8.5hours.
• Table 45 lists the components of the feedstock used in preparation of the dry powder.
• Formulations were encapsulated into size 3 HPMC capsules under the same conditions.
• the fill weight for the powder preparations was 10 mg.
• the formulations were aerosolized from capsules in a unit-dose, capsule -based DPI device (RS01, Plastiape, Osnago, Italy).
• One capsule of each formulation was aerosolized at 60 L/min (4L inhaled volume) using the Plastiape RS01 dry powder inhaler (DPI).
• the aerosol dose was collected in the UniDose system.
• One milliliter of the suspension formulations was aerosolized into the cNGI at 15 L/min using a Micro MistTM Nebuliser (Hudson RCI, Temecula, CA, USA).
• the UniDose collection system was used to uniformly deposit the whole impactor stage mass (i.e. , below stage 2 of an NGI) onto a glass microfiber filter membrane, which can be seen as where the circles (representing particles or droplets) deposit.
• TEER transepithelial electrical resistance
• Rate of Diffusion -—
• Plasma concentrations of itraconazole and hydroxy-itraconazole in samples taken at the end of the exposure period, and up to 96 hours after the end of exposure were measured by validated LC-MS/MS methods.
• the C max and AUCi ast values for hydroxy-itraconazole were highest following exposure to Formulation XIX, and were lower following exposure to Formulation XII, Formulation XI, Formulation XIV and Formulation XV, but were broadly similar for all four of these formulations.
• the lung tissue plasma ratios for itraconazole were lowest following exposure to Formulation XIX, were similar following exposure to Formulation XII and Formulation XI and were somewhat higher following exposure to Formulation XIV. The highest ratio was observed following exposure to Formulation XV.
• Example 15 Dry powder formulations of amorphous itraconazole prepared for use in 28-day toxicity studies
• a feedstock solution utilizing a water-tetrahydrofuran (THF) co-solvent system was prepared and used to manufacture a dry powder composed of itraconazole, sodium sulfate and leucine.
• the feedstock solution that was used to spray dry particles was made as follows. The required quantity of water was weighed into a suitably sized glass vessel. The excipients were added to the water and the solution allowed to stir until visually clear. The required amount of THF was weighed into a suitably sized glass vessel. The itraconazole was added to the THF and the solution allowed to stir until visually clear.
• the itraconazole-containing THF solution was then added to the excipient solution and stirred until visually homogenous.
• the feedstock was then spray-dried.
• the individual feedstock volume was 9.5625L. Fourteen of these feedstocks were prepared for a total of 133.875Lwhich supported a manufacturing campaign of approximately 30 hours.
• Table 58 lists the components of each feedstock used in preparation of the dry powder.
• the mill speed was 3000RPM
• the inlet pump speed was lOORPM
• the recirculating chiller was 10°C
• the inlet air pressure was 4.5 bar
• run time was 30-40 minutes. Eight suspensions were processed this way and combined to make the final suspension lot..
• the final median particle size (Dv(50)) of the milled suspension was 130 nm.
• the mill speed was 3000RPM
• the inlet pump speed was 100RPM
• the recirculating chiller was 10°C
• the inlet air pressure was 4.5 bar
• run time was 200-240 minutes. Eight suspensions were processed this way and combined to make the final suspension lot.
• the final median particle size (Dv(50)) of the milled suspension was 115 nm.
• the microcrystalline itraconazole for Formulation XXIII was prepared using a Qualification Micronizer jet mill (Sturtevant, Hanover, MA USA). The feed pressure was set to 85 psig and the grind pressure was set to 45 psig. Itraconazole was continuously fed into the mill until 480.0 g of itraconazole was milled. The final median particle size (Dv(50)) of the milled API was 1640nm.
• the micronized itraconazole for Formulation XXIII was then compounded into a suspension consisting of 10 wt% itraconazole and 0.25 wt% polysorbate 80 in deionized water. The batch size was 4800 g. The polysorbate 80 was dissolved in 88.75% deionized water via magnetic stir bar, then the itraconazole was slowly added and allowed to mix until the suspension was observed to be visually dispersed and homogeneous.
• Feedstock suspensions were prepared and used to manufacture dry powders composed of crystalline itraconazole, and other additional excipients.
• the feedstock suspensions that were used to spray dry particles were made as follows. The required quantity of water was weighed into a suitably sized glass vessel. The excipients were added to the water and the solution was allowed to stir until visually clear. The itraconazole-containing suspension was then added to the excipient solution and stirred until visually homogenous. The feedstocks were then spray- dried. Feedstocks were stirred while spray dried. The individual feedstock masses for Formulation XXI were 7.5kg each.
• Table 61 Feedstock compositions for formulations containing polysorbate 80
• Table 62 Feedstock compositions for formulations containing oleic acid
• the liquid feedstock solids concentration was 1.2%
• the process gas inlet temperature was 170-190°C
• the process gas outlet temperature was 65 °C
• the drying gas flowrate was 80.0 kg/hr
• the atomization gas flowrate was 250.0 g/min
• the liquid feedstock flowrate was 50.0 g/min.
• the resulting dry powder formulation is reported in Table 63.
• the bulk particle size characteristics for the three formulations are found in Table 64.
• the span at 1 bar of less than 2.05 for Formulations XXI-XXIII indicates a relatively narrow size distribution.
• the 1 bar/4 bar dispersibility ratio less than 1.25 for Formulations XXI-XXIII indicate that they are relatively independent of dispersion energy, a desirable characteristic which allows similar particle dispersion across a range of dispersion energies.
• 28-Day Study A 5 groups of animals were dosed daily for 28 days with either air or placebo controls or one of three doses of Formulation XX.
• 28-Day Study B 7 groups of rats were dosed with one of three formulations of crystalline nanoparticulate itraconazole, daily for 28 days, or in the case of one group, every three days. Groups and achieved doses are detailed in Tables 67 and 68.
• pulmonary tissue samples were taken from rats following the first and last inhalation administration of each formulations in order to assess the lung and systemic exposure and accumulation of itraconazole in male and female rats.
• pulmonary tissue samples including the larynx, trachea, tracheal bifurcation (carina) and lungs, were collected from all animals 24 hours after the last dose in order to assess microscopic pathology changes resulting from the dosing. Plasma and lung concentrations of itraconazole in samples were measured by validated LC-MS/MS methods.
• Plasma C max and AUCo-i ast for Itraconazole (mg/kg day) Day l Day 28 Day l Day 28
• the Days 1 and 28 trough mean lung tissue concentrations (23 hours after the end of the previous dose) in each group expressed as ratio to the corresponding mean plasma concentration values at the same time point are presented in Table 72.
• the lung tissue:plasma ratios for itraconazole were lowest following exposure to Formulation XX and were consistently much higher for all of the crystalline formulations on both Days 1 and 28. These data indicate that the crystalline formulations provide substantially higher lung exposure with less systemic exposure at the doses tested, increasing the exposure at the site of action while minimizing the potential for unwanted effects of systemic exposure.
• Formulations XXI and XXIII were associated with minimal adverse accumulations of foamy macrophages in the lungs only at 40 mg/kg/day with Formulation XXI, the only formulation dosed at that level. There was no clear difference in the incidence and severity of findings between rats dosed with Formulations XXI-XXIII at comparable dose levels. Overall, the No Observed Adverse Effect Level (NOAEL) was approximately 15mg/kg/day for all three of the crystalline formulations tested.
• NOAEL No Observed Adverse Effect Level
• Pathological findings related to the amorphous compositions in the respiratory tract of rats had a different character from those induced by crystalline formulations, with findings in the latter group more related to a clearance response to accumulated material in the lumen of the airway versus granulomatous inflammation within the mucosa.
• amorphous formulation-related findings involved more regions in the respiratory tract and were adverse at a lower dose.
• the systemic exposure i.e., plasma levels of rats to itraconazole was highest following administration of Formulation XX.
• Systemic exposure was generally less following inhalation administration of Formulations XXI-XXIII, though by Day 28 of dosing the differences were less than after a single dose.
• Lung exposure was markedly and consistently higher with Formulations XXI-XXIII relative to Formulation XX.
• the ratio for Formulation XX favored lung exposure over systemic.
• the lung:plasma ratio was substantially greater for each of the crystalline formulations, XXI-XXIII.
• Formulation XX leads to increased solubility and rapid transit through the lung to the systemic circulation as evidenced by the significantly higher systemic exposure on Day 1.
• Formulation XX dosing also resulted in local toxicity in the form of spicular deposits in the mucosa leading to granulomatous inflammation that was adverse at all doses tested, and as low as 5mg/kg/day.
• the lung retention was substantially greater, leading to higher local exposure than the amorphous formulations with generally the same or less systemic exposure.

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