WO2020081562A1 - Methods and compositions for treatment of glaucoma and related conditions - Google Patents

Methods and compositions for treatment of glaucoma and related conditions Download PDF

Info

Publication number
WO2020081562A1
WO2020081562A1 PCT/US2019/056324 US2019056324W WO2020081562A1 WO 2020081562 A1 WO2020081562 A1 WO 2020081562A1 US 2019056324 W US2019056324 W US 2019056324W WO 2020081562 A1 WO2020081562 A1 WO 2020081562A1
Authority
WO
WIPO (PCT)
Prior art keywords
patient
eye
dosage
alpha
phentolamine
Prior art date
Application number
PCT/US2019/056324
Other languages
French (fr)
Inventor
William H. PITLICK
Alan R. Meyer
Mina SOOCH
Konstantinos Charizanis
Original Assignee
Ocuphire Pharma, Inc.
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Ocuphire Pharma, Inc. filed Critical Ocuphire Pharma, Inc.
Priority to JP2021545286A priority Critical patent/JP2022508715A/en
Priority to CA3115815A priority patent/CA3115815A1/en
Priority to AU2019360953A priority patent/AU2019360953A1/en
Priority to US17/283,038 priority patent/US20210346350A1/en
Priority to EP19872569.9A priority patent/EP3866790A4/en
Priority to CN201980076399.2A priority patent/CN113164451A/en
Publication of WO2020081562A1 publication Critical patent/WO2020081562A1/en

Links

Classifications

    • 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
    • A61K31/41—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with two or more ring hetero atoms, at least one of which being nitrogen, e.g. tetrazole
    • A61K31/4164—1,3-Diazoles
    • A61K31/417—Imidazole-alkylamines, e.g. histamine, phentolamine
    • 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
    • A61K31/13—Amines
    • A61K31/135—Amines having aromatic rings, e.g. ketamine, nortriptyline
    • A61K31/138—Aryloxyalkylamines, e.g. propranolol, tamoxifen, phenoxybenzamine
    • 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
    • A61K31/21—Esters, e.g. nitroglycerine, selenocyanates
    • A61K31/215—Esters, e.g. nitroglycerine, selenocyanates of carboxylic acids
    • A61K31/22—Esters, e.g. nitroglycerine, selenocyanates of carboxylic acids of acyclic acids, e.g. pravastatin
    • A61K31/222—Esters, e.g. nitroglycerine, selenocyanates of carboxylic acids of acyclic acids, e.g. pravastatin with compounds having aromatic groups, e.g. dipivefrine, ibopamine
    • 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
    • A61K31/21—Esters, e.g. nitroglycerine, selenocyanates
    • A61K31/27—Esters, e.g. nitroglycerine, selenocyanates of carbamic or thiocarbamic acids, meprobamate, carbachol, neostigmine
    • 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
    • A61K31/38—Heterocyclic compounds having sulfur as a ring hetero atom
    • A61K31/382—Heterocyclic compounds having sulfur as a ring hetero atom having six-membered rings, e.g. thioxanthenes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/40—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with one nitrogen as the only ring hetero atom, e.g. sulpiride, succinimide, tolmetin, buflomedil
    • A61K31/403—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with one nitrogen as the only ring hetero atom, e.g. sulpiride, succinimide, tolmetin, buflomedil condensed with carbocyclic rings, e.g. carbazole
    • A61K31/404—Indoles, e.g. pindolol
    • A61K31/4045—Indole-alkylamines; Amides thereof, e.g. serotonin, melatonin
    • 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
    • A61K31/41—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with two or more ring hetero atoms, at least one of which being nitrogen, e.g. tetrazole
    • A61K31/4164—1,3-Diazoles
    • 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
    • A61K31/41—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with two or more ring hetero atoms, at least one of which being nitrogen, e.g. tetrazole
    • A61K31/4164—1,3-Diazoles
    • A61K31/4168—1,3-Diazoles having a nitrogen attached in position 2, e.g. clonidine
    • 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
    • A61K31/41—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with two or more ring hetero atoms, at least one of which being nitrogen, e.g. tetrazole
    • A61K31/4164—1,3-Diazoles
    • A61K31/4178—1,3-Diazoles not condensed 1,3-diazoles and containing further heterocyclic rings, e.g. pilocarpine, nitrofurantoin
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
    • A61K31/439—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom the ring forming part of a bridged ring system, e.g. quinuclidine
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
    • A61K31/44—Non condensed pyridines; Hydrogenated derivatives thereof
    • A61K31/4427—Non condensed pyridines; Hydrogenated derivatives thereof containing further heterocyclic ring systems
    • A61K31/444—Non condensed pyridines; Hydrogenated derivatives thereof containing further heterocyclic ring systems containing a six-membered ring with nitrogen as a ring heteroatom, e.g. amrinone
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
    • A61K31/47—Quinolines; Isoquinolines
    • A61K31/4704—2-Quinolinones, e.g. carbostyril
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
    • A61K31/47—Quinolines; Isoquinolines
    • A61K31/472—Non-condensed isoquinolines, e.g. papaverine
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
    • A61K31/47—Quinolines; Isoquinolines
    • A61K31/475—Quinolines; Isoquinolines having an indole ring, e.g. yohimbine, reserpine, strychnine, vinblastine
    • 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
    • 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
    • A61K31/498—Pyrazines or piperazines ortho- and peri-condensed with carbocyclic ring systems, e.g. quinoxaline, phenazine
    • 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
    • A61K31/505—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim
    • A61K31/517—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim ortho- or peri-condensed with carbocyclic ring systems, e.g. quinazoline, perimidine
    • 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
    • A61K31/535—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with at least one nitrogen and one oxygen as the ring hetero atoms, e.g. 1,2-oxazines
    • A61K31/5375—1,4-Oxazines, e.g. morpholine
    • A61K31/5377—1,4-Oxazines, e.g. morpholine not condensed and containing further heterocyclic rings, e.g. timolol
    • 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
    • A61K31/55—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having seven-membered rings, e.g. azelastine, pentylenetetrazole
    • 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
    • A61K31/55—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having seven-membered rings, e.g. azelastine, pentylenetetrazole
    • A61K31/551—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having seven-membered rings, e.g. azelastine, pentylenetetrazole having two nitrogen atoms, e.g. dilazep
    • 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
    • A61K31/557—Eicosanoids, e.g. leukotrienes or prostaglandins
    • A61K31/5575—Eicosanoids, e.g. leukotrienes or prostaglandins having a cyclopentane, e.g. prostaglandin E2, prostaglandin F2-alpha
    • 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
    • A61K31/557—Eicosanoids, e.g. leukotrienes or prostaglandins
    • A61K31/558—Eicosanoids, e.g. leukotrienes or prostaglandins having heterocyclic rings containing oxygen as the only ring hetero atom, e.g. thromboxanes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/66—Phosphorus compounds
    • A61K31/683—Diesters of a phosphorus acid with two hydroxy compounds, e.g. phosphatidylinositols
    • 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
    • A61K31/70—Carbohydrates; Sugars; Derivatives thereof
    • A61K31/7042—Compounds having saccharide radicals and heterocyclic rings
    • A61K31/7052—Compounds having saccharide radicals and heterocyclic rings having nitrogen as a ring hetero atom, e.g. nucleosides, nucleotides
    • A61K31/706—Compounds having saccharide radicals and heterocyclic rings having nitrogen as a ring hetero atom, e.g. nucleosides, nucleotides containing six-membered rings with nitrogen as a ring hetero atom
    • A61K31/7064—Compounds having saccharide radicals and heterocyclic rings having nitrogen as a ring hetero atom, e.g. nucleosides, nucleotides containing six-membered rings with nitrogen as a ring hetero atom containing condensed or non-condensed pyrimidines
    • A61K31/7076—Compounds having saccharide radicals and heterocyclic rings having nitrogen as a ring hetero atom, e.g. nucleosides, nucleotides containing six-membered rings with nitrogen as a ring hetero atom containing condensed or non-condensed pyrimidines containing purines, e.g. adenosine, adenylic acid
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K45/00—Medicinal preparations containing active ingredients not provided for in groups A61K31/00 - A61K41/00
    • A61K45/06—Mixtures of active ingredients without chemical characterisation, e.g. antiphlogistics and cardiaca
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
    • A61K47/06—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
    • A61K47/26—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
    • A61K9/0012—Galenical forms characterised by the site of application
    • A61K9/0048—Eye, e.g. artificial tears
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00—Medicinal preparations characterised by special physical form
    • A61K9/08—Solutions
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P27/00—Drugs for disorders of the senses
    • A61P27/02—Ophthalmic agents
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P27/00—Drugs for disorders of the senses
    • A61P27/02—Ophthalmic agents
    • A61P27/06—Antiglaucoma agents or miotics

Definitions

  • the invention provides methods, compositions, and kits containing an alpha- adrenergic antagonist, such as phentolamine, for treating patients suffering from glaucoma, ocular hypertension, and/or other ocular disorders.
  • an alpha- adrenergic antagonist such as phentolamine
  • Glaucoma is a disease of the eye that often affects the retina and/or optic nerve and, if left untreated, can lead to blindness.
  • Various forms of glaucoma are described in the literature, such as congenital, open-angle, closed-angle, primary, and secondary glaucoma.
  • Prolonged periods of elevated intraocular pressure are a common characteristic of many forms of glaucoma. Such prolonged periods of elevated intraocular pressure can result in irreversible damage to the retina and optic nerve, resulting in progressive, permanent vision loss.
  • Ocular hypertension is a condition characterized by elevated intraocular pressure, and can be present in patients where no apparent vision loss has yet occurred. Treatments that reduce intraocular pressure provide benefits to suffering from ocular hypertension and/or glaucoma.
  • Miotic agents can cause headaches and undesired visual effects, such as blurry vision and visual impairment (e.g., dim, dark,“jumping” vision), which can limit the ability of patients to perform certain activities, such as driving an automobile during low light conditions, such as night time.
  • Certain orally administered carbonic anhydrase inhibitors such as acetazolamide, can cause metabolic acidosis, fatigue, and/or dyspepsia.
  • Certain compounds having alpha adrenergic agonistic activity (such as brimonidine and tra convincedoson) can cause allergic conjunctivitis, hyperemia, and/or itchy eyes.
  • various existing drug therapies for reducing intraocular pressure have the undesired feature that the agents must be administered to the patient more than once a day given due to the relatively short duration efficacy of the drug.
  • Rho kinase inhibitors can leave comeal deposits (verticillata), reduce the patient’s visual acuity, and/or cause eye redness lasting for a duration of many hours up to a day.
  • Bunazosin has been described in the literature as an alpha-adrenoceptor antagonist potentially useful as a therapeutic agent for treatment of glaucoma. See, for example, Hara el al. in Cardiovascular Drug Reviews (2005) vol. 23(1), pages 43-56. It was reported that bunazosin decreased intraocular pressure in patients. Id. However, not all alpha-adrenoceptor antagonists cause a reduction in intraocular pressure in patients. For example, the alpha- adrenoceptor antagonist dapiprazole hydrochloride has been reported to not significantly alter intraocular pressure in normotensive eyes or in eyes with elevated intraocular pressure.
  • the present invention addresses the aforementioned need for methods and compositions for treating patients suffering from glaucoma, ocular hypertension, and other ocular disorders while minimizing undesirable side effects, and the invention provides other related advantages.
  • the invention provides methods, compositions, and kits containing an alpha- adrenergic antagonist, such as phentolamine, for treating patients suffering from glaucoma, ocular hypertension, and/or other ocular disorders.
  • the alpha-adrenergic antagonist such as phentolamine
  • the alpha-adrenergic antagonist is administered topically to the eye of the patient, preferably in the form of a liquid aqueous ophthalmic formulation.
  • the alpha-adrenergic antagonist is administered to the patient once daily in order to reduce intraocular pressure in the eye of the patient, such as to achieve a reduction in intraocular pressure of at least 10%, 20% or more.
  • Such reduction in intraocular pressure due to the alpha-adrenergic antagonist provides therapeutic benefits to patients suffering from glaucoma, ocular hypertension, and/or other ocular disorders.
  • One benefit of therapeutic methods described herein is that the patient may also experience an improvement in visual performance.
  • Such improvement in the patient’s ability to see clearly, as well as ability to distinguish between an object and its background, is a benefit in addition to the therapeutic benefits provided for treating glaucoma, ocular hypertension, and/or other ocular disorders. Exemplary aspects and embodiments of the invention are described below.
  • One aspect of the invention provides a method of treating a condition selected from the group consisting of glaucoma, ocular hypertension, and non-arteritic anterior ischemic optic neuropathy in a patient while minimizing eye redness during the patient’s waking hours.
  • the method comprises administering to an eye of a patient in need thereof at or near the bedtime of the patient an effective amount of a once daily dosage of phentolamine or a pharmaceutically acceptable salt thereof to thereby treat the condition.
  • the once daily dosage may be administered to the eye of the patient for, for example, at least three, five, or fourteen consecutive days.
  • the once daily dosage contains phentolamine mesylate.
  • Another aspect of the invention provides a method of treating a condition selected from the group consisting of glaucoma, ocular hypertension, and non-arteritic anterior ischemic optic neuropathy in a patient according to a monotherapy treatment regimen.
  • the method comprises administering to an eye of a patient in need thereof a dosage of a single therapeutic agent in an amount effective for treatment of said condition, wherein the single therapeutic agent is phentolamine or a pharmaceutically acceptable salt thereof.
  • the daily dosage may be administered to the eye of the patient according to a particular dosing protocol, such as administration to the eye of the patient once per day, which may be, for example, at or near the bed time of the patient. Such dosing protocol may entail for, for example, administering the dosage to the eye of the patient for at least three, five, or fourteen consecutive days.
  • the single therapeutic agent is phentolamine mesylate.
  • Another aspect of the invention provides a method of treating a condition selected from the group consisting of glaucoma, ocular hypertension, and non-arteritic anterior ischemic optic neuropathy in a patient.
  • the method comprises administering to an eye of a patient in need thereof a dosage of an alpha-adrenergic antagonist in an amount sufficient to achieve a reduction in a symptom or feature of the condition for a duration of at least 8 hours, to thereby treat the condition without at least one of the following adverse events: (a) stinging or burning sensation experienced by the patient upon administration of the alpha-adrenergic antagonist to the eye; or
  • the symptom or feature of the condition is intraocular pressure.
  • the method achieves a reduction in intraocular pressure in the eye of at least 5%, 10%, or 20% for a duration of at least 12, 18, or 24 hours.
  • Another aspect of the invention provides a pharmaceutical composition
  • a pharmaceutical composition comprising an alpha-adrenergic antagonist and a second therapeutic agent selected from the group consisting of prostaglandin analog, a beta blocker, an alpha adrenergic agonist, a carbonic anhydrase inhibitor, a cholinergic agonist, NMDA receptor antagonist, adenosine receptor agonist, 5-HT 2 A receptor agonist, and a Rho kinase inhibitor.
  • the pharmaceutical composition is formulated for ophthalmic administration.
  • Another aspect of the invention provides a method of treating keratoconus in a patient, wherein the method comprises administering to an eye of a patient in need thereof a therapeutically effective dosage of an alpha-adrenergic antagonist to treat the keratoconus.
  • Figure 1 depicts exemplary eye redness as measured according to (1) the CCLRU Redness Grading Scale, and (2) the NYX-OOl Redness Grading Scale.
  • the invention provides methods, compositions, and kits containing an alpha- adrenergic antagonist, such as phentolamine, for treating patients suffering from glaucoma, ocular hypertension, and/or other ocular disorders.
  • the alpha-adrenergic antagonist such as phentolamine
  • the alpha-adrenergic antagonist is administered topically to the eye of the patient, preferably in the form of a liquid aqueous ophthalmic formulation.
  • the alpha-adrenergic antagonist is administered to the patient once daily in order to reduce intraocular pressure in the eye of the patient, such as to achieve a reduction in intraocular pressure of at least 10%, 20% or more.
  • Such reduction in intraocular pressure due to the alpha-adrenergic antagonist provides therapeutic benefits to patients suffering from glaucoma, ocular hypertension, and/or other ocular disorders.
  • One benefit of therapeutic methods described herein is that the patient may also experience an improvement in visual performance.
  • Such improvement in the patient’s ability to see clearly, as well as ability to distinguish between an object and its background, is a benefit in addition to the therapeutic benefits provided for treating glaucoma, ocular hypertension, and/or other ocular disorders.
  • Various aspects of the invention are set forth below in sections; however, aspects of the invention described in one particular section are not to be limited to any particular section.
  • the term“patient” refers to organisms to be treated by the methods of the present invention.
  • Such organisms preferably include, but are not limited to, mammals (e.g., murines, simians, equines, bovines, porcines, canines, felines, and the like), and most preferably includes humans.
  • the term“effective amount” refers to the amount of a compound sufficient to effect beneficial or desired results. Unless specified otherwise, an effective amount can be administered in one or more administrations, applications or dosages and is not intended to be limited to a particular formulation or administration route.
  • the term“treating” includes any effect, e.g., lessening, reducing, modulating, ameliorating or eliminating, that results in the improvement of the condition, disease, disorder, and the like, or ameliorating a symptom thereof.
  • the term“pharmaceutical composition” refers to the combination of an active agent with a carrier, inert or active, making the composition especially suitable for therapeutic use in vivo or ex vivo.
  • the term“pharmaceutically acceptable carrier” refers to any of the standard pharmaceutical carriers, such as a phosphate buffered saline solution, water, emulsions (e.g., such as an oil/water or water/oil emulsions), and various types of wetting agents.
  • the compositions also can include stabilizers and preservatives.
  • stabilizers and adjuvants see Martin in Remington's Pharmaceutical Sciences, 15th Ed., Mack Publ. Co., Easton, PA [1975]
  • “pharmaceutically acceptable salt” refers to any pharmaceutically acceptable salt (e.g., acid or base) of a compound of the present invention which, upon administration to a subject, is capable of providing a compound of this invention.
  • “salts” of the compounds of the present invention may be derived from inorganic or organic acids and bases.
  • acids include, but are not limited to, hydrochloric, hydrobromic, sulfuric, nitric, perchloric, fumaric, maleic, phosphoric, glycolic, lactic, salicylic, succinic, toluene-p-sulfonic, tartaric, acetic, citric, methanesulfonic, ethanesulfonic, formic, benzoic, malonic, naphthalene-2-sulfonic, benzenesulfonic acid, and the like.
  • Other acids such as oxalic, while not in themselves pharmaceutically acceptable, may be employed in the preparation of salts useful as intermediates in obtaining the compounds of the invention and their pharmaceutically acceptable acid addition salts.
  • bases include, but are not limited to, alkali metals (e.g., sodium) hydroxides, alkaline earth metals (e.g., magnesium), hydroxides, ammonia, and compounds of formula NW 3 , wherein W is C 1-4 alkyl, and the like.
  • alkali metals e.g., sodium
  • alkaline earth metals e.g., magnesium
  • hydroxides e.g., ammonia
  • NW 3 wherein W is C 1-4 alkyl, and the like.
  • salts include, but are not limited to: acetate, adipate, alginate, aspartate, benzoate, benzenesulfonate, bisulfate, butyrate, citrate, camphorate,
  • camphorsulfonate cyclopentanepropionate, digluconate, dodecylsulfate, ethanesulfonate, fumarate, flucoheptanoate, glycerophosphate, hemisulfate, heptanoate, hexanoate,
  • salts include anions of the compounds of the present invention compounded with a suitable cation such as Na + , NH 4 1 . and NW 4 + (wherein W is a C1-4 alkyl group), and the like.
  • salts of the compounds of the present invention are contemplated as being pharmaceutically acceptable.
  • salts of acids and bases that are non-pharmaceutically acceptable may also find use, for example, in the preparation or purification of a pharmaceutically acceptable compound.
  • alkanoate is art-recognized and refers to alkyl-C(0)0 .
  • alkyl is art-recognized, and includes saturated aliphatic groups, including straight-chain alkyl groups, branched-chain alkyl groups, cycloalkyl (alicyclic) groups, alkyl substituted cycloalkyl groups, and cycloalkyl substituted alkyl groups.
  • a straight chain or branched chain alkyl has about 30 or fewer carbon atoms in its backbone (e.g., C 1 -C 30 for straight chain, C 3 -C 30 for branched chain), and alternatively, about 20 or fewer.
  • cycloalkyls have from about 3 to about 10 carbon atoms in their ring structure, and alternatively about 5, 6 or 7 carbons in the ring structure.
  • compositions and kits are described as having, including, or comprising specific components, or where processes and methods are described as having, including, or comprising specific steps, it is contemplated that, additionally, there are compositions and kits of the present invention that consist essentially of, or consist of, the recited components, and that there are processes and methods according to the present invention that consist essentially of, or consist of, the recited processing steps.
  • compositions specifying a percentage are by weight unless otherwise specified. Further, if a variable is not accompanied by a definition, then the previous definition of the variable controls.
  • the invention provides methods for treating patients suffering from glaucoma, ocular hypertension, and/or other ocular disorders by administering to the eye of the patient an alpha-adrenergic antagonist, such as phentolamine.
  • the alpha-adrenergic antagonist is administered topically to the eye of the patient, preferably in the form of a liquid aqueous ophthalmic formulation.
  • Various aspects and embodiments of the therapeutic methods are described in the sections below. The sections are arranged for convenience and information in one section is not to be limited to that section, but may be applied to methods in other sections.
  • One aspect of the invention provides a method of treating a condition selected from the group consisting of glaucoma, ocular hypertension, and non-arteritic anterior ischemic optic neuropathy in a patient while minimizing eye redness during the patient’s waking hours, wherein the method comprises administering to an eye of a patient in need thereof at or near the bedtime of the patient an effective amount of a once daily dosage of phentolamine or a pharmaceutically acceptable salt thereof to thereby treat the condition.
  • the method may be further characterized by additional features, such as the dosing regimen and the identity of the phentolamine or pharmaceutically acceptable salt thereof.
  • additional features such as the dosing regimen and the identity of the phentolamine or pharmaceutically acceptable salt thereof.
  • the invention embraces all permutations and combinations of these features.
  • the method may be further characterized according to the dosing regimen.
  • the dosage is administered for at least three consecutive days.
  • the dosage is administered for at least seven consecutive days.
  • the dosage is administered for at least 14 consecutive days.
  • the dosage is administered on at least three days in a five day period.
  • the dosage is administered on at least three days in a seven day period.
  • the dosage is administered on one day in a three day period.
  • the dosage is administered on one day in a five day period.
  • the method may be further characterized according to the identity of the dosage.
  • the dosage comprises a pharmaceutically acceptable salt of phentolamine.
  • the dosage comprises phentolamine mesylate.
  • Another aspect of the invention provides a method of treating a condition selected from the group consisting of glaucoma, ocular hypertension, and non-arteritic anterior ischemic optic neuropathy in a patient according to a monotherapy treatment regimen, wherein the method comprises administering to an eye of a patient in need thereof a dosage of a single therapeutic agent in an amount effective for treatment of said condition, wherein the single therapeutic agent is phentolamine or a pharmaceutically acceptable salt thereof.
  • the method may be further characterized by additional features, such as the dosing regimen and the identity of the single therapeutic agent.
  • additional features such as the dosing regimen and the identity of the single therapeutic agent.
  • the invention embraces all permutations and combinations of these features.
  • the method may be further characterized according to the dosing regimen.
  • the dosage is administered to the eye of the patient at or near the bedtime of the patient.
  • the dosage is administered to the eye of the patient at or near the bedtime of the patient.
  • the dosage is administered at least once daily for at least three consecutive days. In certain embodiments, the dosage is administered at least once daily for at least seven consecutive days. In certain embodiments, the dosage is administered at least once daily for at least 14 consecutive days. In certain embodiments, the dosage is administered on at least three days in a five day period. In certain embodiments, the dosage is administered on at least three days in a seven day period.
  • the dosage is administered on one day in a three day period. In certain embodiments, the dosage is administered on one day in a five day period.
  • the dosage is administered once per day. In certain other embodiments, the dosage is administered twice, three times, or four times per day.
  • the method may be further characterized according to the identity of the single therapeutic agent.
  • the single therapeutic agent is a pharmaceutically acceptable salt of phentolamine.
  • the single therapeutic agent is phentolamine mesylate.
  • Another aspect of the invention provides a method of treating a condition selected from the group consisting of glaucoma, ocular hypertension, and non-arteritic anterior ischemic optic neuropathy in a patient, wherein the method comprises administering to an eye of a patient in need thereof a dosage of an alpha-adrenergic antagonist in an amount sufficient to achieve a reduction in a symptom or feature of the condition for a duration of at least 8 hours, to thereby treat the condition without at least one of the following adverse events:
  • the stinging or burning sensation is a stinging or burning sensation that lasts for a duration of at least 0.1, 0.5, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 12, 15, 20, or 30 minutes. In certain embodiments, the stinging or burning sensation is a stinging or burning sensation that lasts for a duration of at least 1 minute.
  • the symptom or feature of the condition is intraocular pressure.
  • the method achieves a reduction in intraocular pressure in the eye of at least 5%, 10%, or 20% for a duration of at least 12, 18, or 24 hours.
  • the alpha-adrenergic antagonist causes a reduction in intraocular pressure.
  • the invention provides a method of treating a condition selected from the group consisting of glaucoma, ocular hypertension, and non- arteritic anterior ischemic optic neuropathy in a patient, wherein the method comprises administering to an eye of a patient in need thereof a dosage of an alpha-adrenergic antagonist in an amount sufficient to achieve a reduction in a symptom or feature of the condition for a duration of at least 8 hours, to thereby treat the condition without at least one of the following adverse events: (a) stinging or burning sensation experienced by the patient at a time that is greater than two minute after administration of the alpha-adrenergic antagonist to the eye; or
  • the method may be further characterized by additional features, such as the dosing regimen and the identity of the alpha-adrenergic antagonist.
  • additional features such as the dosing regimen and the identity of the alpha-adrenergic antagonist.
  • the invention embraces all permutations and combinations of these features.
  • the method may be further characterized according to the dosing regimen for the alpha-adrenergic antagonist.
  • the alpha- adrenergic antagonist is administered to the eye of the patient at or near the bedtime of the patient.
  • the alpha-adrenergic antagonist is administered to the eye of the patient within 1 hour of the patient’s bedtime.
  • the alpha- adrenergic antagonist is administered at least once daily for at least three consecutive days.
  • the alpha-adrenergic antagonist is administered at least once daily for at least seven consecutive days.
  • the alpha-adrenergic antagonist is administered at least once daily for at least 14 consecutive days.
  • the dosage is administered once per day. In certain embodiments, the dosage is administered on at least three days in a five day period. In certain embodiments, the dosage is administered on at least three days in a seven day period. In certain embodiments, the dosage is administered on one day in a three day period. In certain embodiments, the dosage is administered on one day in a five day period.
  • the dosage is administered twice, three times, or four times per day.
  • the method may be further characterized according to the dosage of alpha- adrenergic antagonist.
  • the dosage of alpha-adrenergic antagonist is an amount sufficient to achieve a reduction in a symptom or feature of the condition for a duration of at least 12 hours, to thereby treat the condition without any of the following adverse events: (a) stinging or burning sensation experienced by the patient upon administration of the alpha-adrenergic antagonist to the eye; and (b) an increase in eye redness more than two grades measured using the CCLRU Redness Grading Scale compared to the patient’s level of eye redness without receiving the amount of alpha-adrenergic antagonist.
  • the dosage of alpha-adrenergic antagonist is an amount sufficient to achieve a reduction in a symptom or feature of the condition for a duration of at least 24 hours, to thereby treat the condition without any of the following adverse events: (a) stinging or burning sensation experienced by the patient upon administration of the alpha-adrenergic antagonist to the eye; and (b) an increase in eye redness more than two grades measured using the CCLRU Redness Grading Scale compared to the patient’s level of eye redness without receiving the amount of alpha-adrenergic antagonist.
  • the method may be further characterized according to the identity of the alpha- adrenergic antagonist.
  • the alpha-adrenergic antagonist is phentolamine, phenoxybenzamine, tolazoline, trazodone, alfuzosin, doxazosin, prazosin, tamsulosin, terazosin, silodosin, atipamezole, idazoxan, mirtazapine, yohimbine, fenoldopam, thymoxamine, or a pharmaceutically acceptable salt of any of the foregoing.
  • the alpha-adrenergic antagonist is phentolamine or a pharmaceutically acceptable salt thereof. In certain embodiments, the alpha-adrenergic antagonist is a pharmaceutically acceptable salt of phentolamine. In certain embodiments, the alpha- adrenergic antagonist is phentolamine mesylate. In certain embodiments, the alpha-adrenergic antagonist is fenoldopam mesylate.
  • the alpha-adrenergic antagonist is a non-selective alpha- adrenergic antagonist. In certain embodiments, the alpha-adrenergic antagonist is a reversible, non-selective alpha-adrenergic antagonist.
  • the alpha-adrenergic antagonist is characterized according to its activity towards certain alpha-adrenergic receptors. Accordingly, in certain embodiments, the alpha-adrenergic antagonist has antagonist activity towards an alpha-l adrenergic receptor. Activity toward the alpha-l adrenergic receptor may be further characterized according to whether there is activity toward one or more of the alpha-l adrenergic receptor subtypes (e.g., alpha-l A, alpha- 1B, and alpha- 1D). Accordingly, in certain embodiments, the alpha- adrenergic antagonist has antagonist activity towards the alpha-l A adrenergic receptor.
  • the alpha-adrenergic antagonist has antagonist activity towards the alpha-l A adrenergic receptor.
  • the alpha-adrenergic antagonist has antagonist activity towards the alpha- 1B adrenergic receptor. In certain embodiments, the alpha-adrenergic antagonist has antagonist activity towards the alpha- 1D adrenergic receptor. In certain embodiments, the alpha- adrenergic antagonist has antagonist activity towards each of the alpha-l adrenergic receptor subtypes. [0053] In certain embodiments, the alpha-adrenergic antagonist has antagonist activity towards an alpha-2 adrenergic receptor.
  • Activity toward the alpha-2 adrenergic receptor may be further characterized according to whether there is activity toward one or more of the alpha- 2 adrenergic receptor subtypes (e.g., alpha-2A, alpha-2B, and alpha-2C). Accordingly, in certain embodiments, the alpha-adrenergic antagonist has antagonist activity towards the alpha- 2A adrenergic receptor. In certain embodiments, the alpha-adrenergic antagonist has antagonist activity towards the alpha-2B adrenergic receptor. In certain embodiments, the alpha-adrenergic antagonist has antagonist activity towards the alpha-2C adrenergic receptor.
  • the alpha-adrenergic receptor subtypes e.g., alpha-2A, alpha-2B, and alpha-2C.
  • the alpha-adrenergic antagonist has antagonist activity towards each of the alpha-2 adrenergic receptor subtypes.
  • the alpha-adrenergic antagonist may be characterized according to its activity towards (i) an alpha- 1 adrenergic receptor versus (ii) an alpha-2 adrenergic receptor.
  • the alpha-adrenergic antagonist has antagonist activity at both (i) an alpha- 1 adrenergic receptor and (ii) an alpha-2 adrenergic receptor.
  • the alpha- adrenergic antagonist has antagonist activity at (i) an alpha- 1 adrenergic receptor but not (ii) an alpha-2 adrenergic receptor.
  • the alpha-adrenergic antagonist has antagonist activity at (i) an alpha-2 adrenergic receptor but not (ii) an alpha-l adrenergic receptor.
  • the inhibitory activity (as, for example, measured by an IC50 value) of the alpha-adrenergic antagonist is at least 10-fold greater towards (i) the alpha-l adrenergic receptor compared to the (ii) alpha-2 adrenergic receptor.
  • the inhibitory activity (as, for example, measured by an IC50 value) of the alpha-adrenergic antagonist is at least 10-fold greater towards (i) the alpha-2 adrenergic receptor compared to (ii) the alpha-l adrenergic receptor.
  • Another aspect of the invention provides a method of treating a condition selected from the group consisting of glaucoma, ocular hypertension, and non-arteritic anterior ischemic optic neuropathy in a patient, wherein the method comprises administering to an eye of a patient in need thereof a therapeutically effective dosage of an alpha-adrenergic antagonist and a second therapeutic agent selected from the group consisting of prostaglandin analog, a beta blocker, an alpha adrenergic agonist, a carbonic anhydrase inhibitor, a cholinergic agonist, NMD A receptor antagonist, adenosine receptor agonist, 5-HT2A receptor agonist, and a Rho kinase inhibitor, to thereby treat the condition.
  • the method may be further characterized by additional features, such as the dosing regimen and the identity of the alpha-adrenergic antagonist, and the identity of the second therapeutic agent.
  • the invention embraces all permutations and combinations of these features.
  • the method may be further characterized according to the dosing regimen for the alpha-adrenergic antagonist.
  • the alpha- adrenergic antagonist is administered once per day.
  • the alpha- adrenergic antagonist is administered two times, three times, or four times per day.
  • the method may be further characterized according to the identity of the second therapeutic agent.
  • the second therapeutic agent is selected from the group consisting of latanoprost, bimatoprost, travoprost, tafluprost, latanoprostene bunod, timolol, brimonidine, dorzolamide, brinzolamide, acetazolamide, methazolamide, pilocarpine, netarsudil, ripasudil, AMA0076, traêtoson, BOL-303259-X, ONO-9054, or a pharmaceutically acceptable salt of any one of the foregoing.
  • the second therapeutic agent is selected from the group consisting of latanoprost, bimatoprost, travoprost, tafluprost, latanoprostene bunod, timolol, brimonidine, dorzolamide, brinzolamide, acetazolamide, methazolamide, pilocarpine, netarsudil, ripasudil, AMA0076, traêtoson, BOL-303259-X, ONO-9054, carbachol, aceclidine, oxotremorine, or a pharmaceutically acceptable salt of any one of the foregoing.
  • the second therapeutic agent is selected from the group consisting of latanoprost, timolol, netarsudil, or a pharmaceutically acceptable salt of any one of the foregoing.
  • the second therapeutic agent is betaxolol, apraclonidine, brinzolamide, unoprostone, levobunolol, carteolol, metipranolol, carbachol, ecothiophate iodide, omidenepag isopropyl (an EP2 agonist), sepetaprost, NO-bimatoprost, H-1337 (a leucine-rich repeat kinase inhibitor), or a pharmaceutically acceptable salt of any one of the foregoing.
  • the second therapeutic agent is latanoprost.
  • the second therapeutic agent is latanoprost administered at a daily dose of about 1.5 micrograms.
  • the method may be further characterized according to the identity of the alpha- adrenergic antagonist.
  • the alpha-adrenergic antagonist is phentolamine, phenoxybenzamine, tolazoline, trazodone, alfuzosin, doxazosin, prazosin, tamsulosin, terazosin, silodosin, atipamezole, idazoxan, mirtazapine, yohimbine, fenoldopam, thymoxamine, or a pharmaceutically acceptable salt of any of the foregoing.
  • the alpha-adrenergic antagonist is phentolamine or a pharmaceutically acceptable salt thereof. In certain embodiments, the alpha-adrenergic antagonist is a pharmaceutically acceptable salt of phentolamine. In certain embodiments, the alpha- adrenergic antagonist is phentolamine mesylate.
  • Another aspect of the invention provides a method of treating keratoconus in a patient, wherein the method comprises administering to an eye of a patient in need thereof a therapeutically effective dosage of an alpha-adrenergic antagonist to treat the keratoconus.
  • the method may be further characterized by additional features, such as the dosing regimen and the identity of the alpha-adrenergic antagonist, and the identity of any second therapeutic agent.
  • additional features such as the dosing regimen and the identity of the alpha-adrenergic antagonist, and the identity of any second therapeutic agent.
  • the invention embraces all permutations and combinations of these features.
  • the method may be further characterized according to the dosing regimen for the alpha-adrenergic antagonist.
  • the alpha- adrenergic antagonist is administered once per day.
  • the alpha- adrenergic antagonist is administered two times, three times, or four times per day.
  • the dosage is administered to the eye of the patient at or near the bedtime of the patient. In certain embodiments, the dosage is administered to the eye of the patient within 1 hour of the patient’s bedtime.
  • the alpha-adrenergic antagonist is a pharmaceutically acceptable salt of phentolamine. In certain embodiments, the alpha-adrenergic antagonist is phentolamine mesylate.
  • Additional therapeutic methods are provided below.
  • the methods may be further characterized by additional features, such as the dosing regimen and the identity of the alpha- adrenergic antagonist.
  • One aspect of the invention provides a method of improving visual performance in a patient suffering from a disorder selected from the group consisting of glaucoma, elevated intraocular pressure, and a combination thereof, wherein the method comprises administering to an eye of a patient in need thereof a therapeutically effective dosage of an alpha-adrenergic antagonist to thereby improve visual performance and treat the disorder.
  • a disorder selected from the group consisting of glaucoma, elevated intraocular pressure, and a combination thereof
  • the method comprises administering to an eye of a patient in need thereof a therapeutically effective dosage of an alpha-adrenergic antagonist to thereby improve visual performance and treat the disorder.
  • the disorder is glaucoma.
  • Another aspect of the invention provides a method of improving visual
  • the method comprises administering to an eye of a patient in need thereof a therapeutically effective dosage of an alpha-adrenergic antagonist to thereby improve visual performance, reduce intraocular pressure, and treat the disorder.
  • the disorder is glaucoma.
  • Another aspect of the invention provides a method of improving visual performance in a patient suffering from keratoconus, wherein the method comprises administering to an eye of a patient in need thereof an effective amount of an alpha-adrenergic antagonist to thereby improve visual performance.
  • the alpha- adrenergic antagonist is a pharmaceutically acceptable salt of phentolamine.
  • the alpha-adrenergic antagonist is phentolamine mesylate.
  • Another aspect of the invention provides a method of improving visual performance and reducing pupil diameter in a patient suffering from a disorder selected from the group consisting of glaucoma, elevated intraocular pressure, and a combination thereof, wherein the method comprises administering to an eye of a patient in need thereof a therapeutically effective dosage of an alpha-adrenergic antagonist to thereby improve visual performance, reduce pupil diameter, and treat the disorder.
  • the disorder is glaucoma.
  • Another aspect of the invention provides a method of reducing intraocular pressure and reducing pupil diameter in a patient suffering from a disorder selected from the group consisting of glaucoma, elevated intraocular pressure, and a combination thereof, wherein the method comprises administering to an eye of a patient in need thereof a therapeutically effective dosage of an alpha-adrenergic antagonist to thereby reduce intraocular pressure, reduce pupil diameter, and treat the disorder.
  • the disorder is glaucoma.
  • Another aspect of the invention provides a method of treating glaucoma and achieving one or more of improving visual performance, reducing intraocular pressure, and reducing pupil diameter in a patient suffering from glaucoma, wherein the method comprises administering to an eye of a patient in need thereof a therapeutically effective dosage of an alpha-adrenergic antagonist to thereby treat the glaucoma and achieve one or more of improving visual performance, reducing intraocular pressure, and reducing pupil diameter in the patient.
  • Another aspect of the invention provides a method of treating glaucoma and elevated intraocular pressure and optionally improving visual performance in a patient, wherein the method comprises administering to an eye of a patient in need thereof a therapeutically effective dosage of an alpha-adrenergic antagonist to thereby treat the glaucoma and elevated intraocular pressure and optionally improve visual performance in the patient. In certain embodiments, the method improves visual performance.
  • the methods may be further characterized according to, for example, the improvement in visual performance.
  • the improvement in visual performance is near-distance improvement in visual performance.
  • the improvement in visual performance is improvement in visual performance at a distance.
  • the improvement in visual performance is an improvement in visual acuity.
  • the improvement in visual performance is an improvement in contrast sensitivity.
  • the methods may be further characterized according to, for example,
  • the patient has poor visual performance at a near distance. In certain embodiments, the patient has poor visual performance at a far distance.
  • Additional optional features of the first, third, and fifth therapeutic methods include administering a second therapeutic agent.
  • the method further comprises administering to the eye of the patient a second therapeutic agent selected from the group consisting of a prostaglandin analog, a beta blocker, an alpha adrenergic agonist, a carbonic anhydrase inhibitor, a cholinergic agonist, NMDA receptor antagonist, adenosine receptor agonist, 5-HT 2A receptor agonist, and a Rho kinase inhibitor.
  • the method further comprises administering to the eye of the patient a second therapeutic agent selected from the group consisting of latanoprost, bimatoprost, travoprost, tafluprost, latanoprostene bunod, timolol, brimonidine, dorzolamide, brinzolamide, acetazolamide, methazolamide, pilocarpine, netarsudil, ripasudil, AMA0076, traêtoson, BOL-303259-X, ONO-9054, or a pharmaceutically acceptable salt of any one of the foregoing.
  • a second therapeutic agent selected from the group consisting of latanoprost, bimatoprost, travoprost, tafluprost, latanoprostene bunod, timolol, brimonidine, dorzolamide, brinzolamide, acetazolamide, methazolamide, pilocarpine,
  • the method further comprises administering to the eye of the patient a second therapeutic agent selected from the group consisting of latanoprost, bimatoprost, travoprost, tafluprost, latanoprostene bunod, timolol, brimonidine, dorzolamide, brinzolamide, acetazolamide, methazolamide, pilocarpine, netarsudil, ripasudil, AMA0076, traêtoson, BOL-303259-X, ONO-9054, carbachol, aceclidine, oxotremorine, or a pharmaceutically acceptable salt of any one of the foregoing.
  • a second therapeutic agent selected from the group consisting of latanoprost, bimatoprost, travoprost, tafluprost, latanoprostene bunod, timolol, brimonidine, dorzolamide, brinzolamide,
  • the method further administering to the eye of the patient a second therapeutic agent selected from the group consisting of betaxolol, apraclonidine, brinzolamide, unoprostone, levobunolol, carteolol, metipranolol, carbachol, ecothiophate iodide, omidenepag isopropyl, sepetaprost, NO-bimatoprost, and H-1337, or a pharmaceutically acceptable salt of any one of the foregoing.
  • the second therapeutic agent is latanoprost.
  • the second therapeutic agent is latanoprost administered at a daily dose of about 1.5 micrograms.
  • the method further comprises administering to the eye of the patient an additional therapeutic agent, such as an alpha-adrenergic antagonist.
  • an additional therapeutic agent such as an alpha-adrenergic antagonist.
  • the method further comprises administering to the eye of the patient an additional therapeutic agent that is an alpha-adrenergic antagonist.
  • the additional therapeutic agent is bunazosin or a pharmaceutically acceptable salt thereof.
  • Bunazosin is a compound featuring greater inhibitory activity towards (i) the alpha- 1 adrenergic receptor compared to the (ii) alpha-2 adrenergic receptor.
  • the methods may be further characterized according to the degree of eye redness the patient experiences.
  • the degree of eye redness can be evaluated and characterized using procedures described in the literature, such as the Cornea and Contact Lens Research Unit (CCLRU) Redness Grading Scale developed by the School of Optometry, University of New South Wales. See, for example, Terry et al. in Optom. Vis. Sci. (1993) vol. 70, pages 234-243; and Pult et al. in Ophthal. Physiol. Opt. (2008) vol. 28, pages 13-20.
  • CCLRU Cornea and Contact Lens Research Unit
  • the CCLRU Redness Grading Scale evaluates eye redness on a four-point scale: (0) no eye redness, (1) very slight eye redness, (2) slight eye redness, (3) moderate eye redness, and (4) severe eye redness. See Figure 1 for an illustration of the eye redness scale.
  • the patient experiences an increase in eye redness of no more than two grades measured using the CCLRU Redness Grading Scale during the patient’s waking hours compared to the patient’s level of eye redness without receiving said dosage.
  • any increase in eye redness experienced by the patient is less than one grade measured using the CCLRU Redness Grading Scale during the patient’s waking hours compared to the patient’s level of eye redness without receiving said dosage.
  • the methods may be further characterized according to the amount of phentolamine or pharmaceutically acceptable salt thereof in the dosage. For example, in certain embodiments, in certain
  • the dosage contains from about 0.1 mg to about 2.0 mg of phentolamine or a pharmaceutically acceptable salt thereof. In certain embodiments, the dosage contains from about 0.5 mg to about 1.0 mg of phentolamine or a pharmaceutically acceptable salt thereof. In certain other embodiments, the dosage contains from about 0.1 mg to about 2.0 mg of phentolamine mesylate. In certain embodiments, the dosage contains from about 0.3 mg to about 0.7 mg of phentolamine mesylate. In certain embodiments, the dosage contains about 0.5 mg of phentolamine mesylate. In certain other embodiments, the dosage contains from about 0.8 mg to about 1.2 mg of phentolamine mesylate. In certain embodiments, the dosage contains about 1 mg of phentolamine mesylate.
  • the dosage of phentolamine or a pharmaceutically acceptable salt thereof is desirably administered to the eye of the patient in the form of an ophthalmic solution, which is delivered to the eye in the form of eye drop.
  • a standard eye drop typically contains from about 0.03 mL to about 0.05 mL of solution.
  • the dosage may be in the form of an aqueous ophthalmic solution.
  • the dosage is an aqueous ophthalmic solution free of a chelating agent containing:
  • the solution has a pH in the range of 4 to 6 and does not contain a chelating agent.
  • the dosage is an aqueous ophthalmic solution free of a chelating agent containing:
  • the solution has a pH in the range of 4.5 to 5.5 and does not contain a chelating agent.
  • the at least one polyol is mannitol.
  • the solution contains 4% (w/v) mannitol.
  • the alkali metal acetate is sodium acetate.
  • the solution comprises 3 mM sodium acetate.
  • the dosage is an aqueous ophthalmic solution free of a chelating agent containing:
  • the dosage is an aqueous ophthalmic solution free of a chelating agent containing:
  • the solution has a pH in the range of 4.6 to 5.2 and does not contain a chelating agent.
  • the dosage is an aqueous ophthalmic solution free of a chelating agent containing:
  • the solution has a pH in the range of 4.6 to 5.2 and does not contain a chelating agent.
  • the dosage is an aqueous ophthalmic solution containing:
  • the solution has a pH in the range of 4.5 to 5.2 and does not contain any additional component that is a chelating agent.
  • the dosage is an aqueous ophthalmic solution containing:
  • the solution has a pH in the range of 4.5 to 5.2 and does not contain any additional component that is a chelating agent.
  • the dosage is an aqueous ophthalmic solution containing: (a) about 0.25% (w/v) to about 2% (w/v) of phentolamine mesylate; (b) about 3% (w/v) to about 5% (w/v) of mannitol;
  • the solution has a pH in the range of 4.5 to 5.2 and does not contain any additional component that is a chelating agent.
  • the dosage is an aqueous ophthalmic solution containing:
  • the solution has a pH in the range of 4.6 to 5.2 and does not contain any additional component that is a chelating agent.
  • the dosage is an aqueous ophthalmic solution containing:
  • the solution has a pH in the range of 4.6 to 5.2 and does not contain any additional component that is a chelating agent.
  • the dosage is an aqueous ophthalmic solution comprising: (a) about 1% (w/v) of phentolamine mesylate; (b) about 4% (w/v) mannitol; (c) about 3 mM of a buffer comprising sodium acetate; and (d) water; wherein the solution has a pH in the range of 4.5 to 5.5 and does not contain any additional component that is a chelating agent.
  • the dosage is an aqueous ophthalmic solution free of a chelating agent comprising: (a) about 1% (w/v) of phentolamine mesylate; (b) about 4% (w/v) mannitol; (c) about 3 mM of a buffer comprising sodium acetate; and (d) water; wherein the solution has a pH in the range of 4.0 to 7.5 and does not contain a chelating agent.
  • a chelating agent comprising: (a) about 1% (w/v) of phentolamine mesylate; (b) about 4% (w/v) mannitol; (c) about 3 mM of a buffer comprising sodium acetate; and (d) water; wherein the solution has a pH in the range of 4.0 to 7.5 and does not contain a chelating agent.
  • the methods may be further characterized according to the reduction in intraocular pressure in the eye due to the administering.
  • the patient experiences at least a 5% reduction in intraocular pressure in the eye due to the administering.
  • the patient experiences at least a 10% reduction in intraocular pressure in the eye due to the administering.
  • the patient experiences at least a 15% reduction in intraocular pressure in the eye due to the administering.
  • the patient experiences at least a 20% reduction in intraocular pressure in the eye due to the administering.
  • the patient experiences at least a 1 mmHg reduction in intraocular pressure in the eye due to the administering. In certain embodiments, the patient experiences at least a 2 mmHg reduction in intraocular pressure in the eye due to the administering. In certain embodiments, the patient experiences at least a 3 mmHg reduction in intraocular pressure in the eye due to the administering. In certain embodiments, the patient experiences at least a 4 mmHg reduction in intraocular pressure in the eye due to the administering. In certain embodiments, the patient experiences at least a 5 mmHg reduction in intraocular pressure in the eye due to the administering.
  • the patient experiences at least a 6 mmHg reduction in intraocular pressure in the eye due to the administering. In certain embodiments, the patient experiences at least a 7 mmHg reduction in intraocular pressure in the eye due to the administering. In certain embodiments, the patient experiences at least an 8 mmHg reduction in intraocular pressure in the eye due to the administering.
  • the methods may be further characterized according to the duration of reduction in intraocular pressure.
  • the reduction lasts for a duration of at least 12 hours. In certain embodiments, the reduction lasts for a duration of at least 24 hours. In certain embodiments, the reduction lasts for a duration of at least 2 days. In certain embodiments, the reduction lasts for a duration of at least 5 days. In certain embodiments, the reduction lasts for a duration of at least 7 days. In certain embodiments, the reduction lasts for a duration of at least 10, 14, 21, or 28 days.
  • the reduction lasts for a duration of from about 5 to about 24 hours. In certain embodiments, the reduction lasts for a duration of from about 12 to about 24 hours. In certain embodiments, the reduction lasts for a duration of from about 1 day to about 3 days. In certain embodiments, the reduction lasts for a duration of from about 3 days to about 5 days. In certain embodiments, the reduction lasts for a duration of from about 5 days to about 7 days. In certain embodiments, the reduction lasts for a duration of from about 7 days to about 14 days.
  • the methods may be further characterized according to the condition being treated.
  • the condition is glaucoma.
  • the condition is glaucoma.
  • the glaucoma is congenital glaucoma. In certain other embodiments, the glaucoma is open-angle glaucoma. In certain other embodiments, the glaucoma is closed-angle glaucoma. In certain other embodiments, the glaucoma is primary glaucoma. In certain other embodiments, the glaucoma is secondary glaucoma. In certain other embodiments, the glaucoma is pigmentary glaucoma, pseudoexfoliative glaucoma, traumatic glaucoma, neovascular glaucoma, uveitic glaucoma, or glaucoma due to irido comeal endothelial syndrome. In certain other embodiments, the glaucoma is normal tension glaucoma.
  • the condition is ocular hypertension.
  • the condition is ocular hypertension after surgery.
  • the condition is keratoconus. In certain embodiments, the condition is non-arteritic anterior ischemic optic neuropathy.
  • the methods may be further characterized according to patient populations that may derive particular benefits from the therapeutic methods.
  • the patient’s eye has an intraocular pressure greater than about 22 mmHg.
  • the patient to begin treatment is characterized as having an intraocular pressure in the range of from about 20 mmHg to about 30 mmHg.
  • the patient to begin treatment is characterized as having an intraocular pressure in the range of from about 20 mmHg to about 25 mmHg.
  • the patient to begin treatment is characterized as having an intraocular pressure in the range of from about 25 mmHg to about 30 mmHg.
  • the patient’s eye has an intraocular pressure not greater than than about 22 mmHg.
  • the patient to begin treatment is characterized as having an intraocular pressure in the range of from about 12 mmHg to about 22 mmHg.
  • the patient to begin treatment is characterized as having an intraocular pressure in the range of from about 15 mmHg to about 22 mmHg.
  • the patient to begin treatment is characterized as having an intraocular pressure in the range of from about 18 mmHg to about 22 mmHg.
  • the patient to begin treatment is characterized as having an intraocular pressure in the range of from about 10 mmHg to about 12 mmHg, from about 12 mmHg to about 14 mmHg, from about 14 mmHg to about 16 mmHg, from about 16 mmHg to about 18 mmHg, from about 18 mmHg to about 20 mmHg, or from about 20 mmHg to about 22 mmHg.
  • the patient to begin treatment is characterized as having an intraocular pressure less than about 15, 17, 19, 21 or 22 mmHg.
  • the patient to begin treatment is characterized as having an intraocular pressure less than 26 mmHg. In certain other embodiments, the patient to begin treatment is characterized as having an intraocular pressure less than 24 mmHg. In certain other embodiments, the patient to begin treatment is characterized as having an intraocular pressure less than 22 mmHg. In certain other embodiments, the patient to begin treatment is characterized as having an intraocular pressure less than 20 mmHg. In certain other embodiments, the patient to begin treatment is characterized as having an intraocular pressure less than 18 mmHg. In certain other embodiments, the patient to begin treatment is characterized as having an intraocular pressure less than 16 mmHg.
  • the patient to begin treatment is characterized as having an intraocular pressure in the range of from about 17 mmHg to about 36 mmHg, from about 17 mmHg to about 32 mmHg, from about 17 mmHg to about 28 mmHg, from about 17 mmHg to about 26 mmHg, from about 17 mmHg to about 24 mmHg, or from about 17 mmHg to about 22 mmHg.
  • the patient to begin treatment is characterized as having an intraocular pressure in the range of from about 17 mmHg to about 36 mmHg, from about 17 mmHg to about 32 mmHg, from about 17 mmHg to about 28 mmHg, from about 17 mmHg to about 26 mmHg, from about 17 mmHg to about 24 mmHg, or from about 17 mmHg to about 22 mmHg.
  • the patient to begin treatment is
  • an intraocular pressure in the range of from about 20 mmHg to about 36 mmHg, from about 20 mmHg to about 32 mmHg, from about 20 mmHg to about 28 mmHg, from about 20 mmHg to about 26 mmHg, from about 20 mmHg to about 24 mmHg, or from about 20 mmHg to about 22 mmHg.
  • the patient to begin treatment is characterized as having an intraocular pressure in the range of from about 20 mmHg to about 26 mmHg, from about 20 mmHg to about 25 mmHg, from about 20 mmHg to about 24 mmHg, from about 20 mmHg to about 23 mmHg, or from about 20 mmHg to about 22 mmHg.
  • the patient to begin treatment is characterized as having an intraocular pressure less than about 23, 24, 25, or 26 mmHg
  • the patient is a human. In certain embodiments, the patient is an adult human. In certain embodiments, the patient is a pediatric human.
  • the dosage is administered at or near the bedtime of the patient. Accordingly, in certain embodiments, the dosage is administered within 2 hours, 1.5 hours, 1 hour, 45 minutes, 30 minutes, or 15 minutes of the patient’s bedtime. In certain embodiments, the dosage is administered within 1 hour of the patient’s bedtime.
  • One benefit of the therapeutic methods is that the patient may also experience an improvement in visual performance.
  • Visual performance pertains to the patient’s overall vision quality and includes a patient’s ability to see clearly, as well as ability to distinguish between an object and its background.
  • Visual acuity is a measure of a patient’s ability to see clearly. Visual acuity can be measured using, for example, a Snellen chart. Further, the visual acuity measurement can be taken under scotopic conditions, mesopic conditions, and/or photopic conditions.
  • Contrast sensitivity is a measure of the patient’s ability to distinguish between an object and its background. Contrast sensitivity can be measured using, for example, a Holladay Automated Contrast Sensitivity System. The contrast sensitivity can be measured under various light conditions, including, for example, photopic conditions, mesopic conditions, and scotopic conditions, each either with or without glare. In certain embodiments, the contrast sensitivity is measured under mesopic conditions either with or without glare.
  • the improvement in visual performance provided by the method is improved visual acuity. In certain embodiments, the improvement in visual performance provided by the method is improved visual acuity under scotopic conditions. In certain embodiments, the improvement in visual performance provided by the method is improved visual acuity under mesopic conditions. In certain embodiments, the improvement in visual performance provided by the method is improved visual acuity under photopic conditions. In certain embodiments, the improvement in visual acuity is a two-line
  • the improvement in visual acuity is a one-line improvement in the patient’s vision as measured using the Snellen chart.
  • the improvement in visual performance provided by the method is improved contrast sensitivity.
  • the improvement in contrast sensitivity can be measured under various light conditions, such as photopic conditions, mesopic conditions, and scotopic conditions.
  • the improvement in visual performance provided by the method is improved contrast sensitivity under photopic conditions.
  • the improvement in visual performance provided by the method is improved contrast sensitivity under mesopic conditions.
  • the improvement in visual performance provided by the method is improved contrast sensitivity under scotopic conditions.
  • contrast sensitivity can be measured in the presence of glare or the absence of glare. All combinations of light conditions and glare are contemplated.
  • the improvement in contrast sensitivity is at least a 10% (or 20%, 30%, 50%, 60%, or 70%) improvement measured under mesopic conditions using the Holladay Automated Contrast Sensitivity System.
  • the improvement in contrast sensitivity is at least a 10% (or 20%, 30%, 50%, 60%, or 70%) improvement measured under photopic conditions using the Holladay Automated Contrast Sensitivity System.
  • the improvement in contrast sensitivity is at least a 10% (or 20%, 30%, 50%, 60%, or 70%) improvement measured under mesopic conditions or scotopic conditions using the Holladay Automated Contrast Sensitivity System.
  • the improvement in visual performance provided by the method is both (i) improved visual acuity (such as under scotopic conditions, mesopic conditions, and/or photopic conditions) and (ii) improved contrast sensitivity (such as under scotopic conditions, mesopic conditions, and/or photopic conditions).
  • the improvement in visual performance is improvement in near-vision performance. In certain embodiments, the improvement in visual performance is improvement in visual performance at a distance. In certain embodiments, the improvement in visual performance is improved visual performance under low-light conditions. In certain embodiments, the improvement in visual performance is improved visual acuity. In certain embodiments, the improvement in visual performance is improved contrast sensitivity.
  • the method provides at least a 10% reduction in pupil diameter in the eye of the patient. In certain embodiments, the method provides at least a 15% reduction in pupil diameter in the eye of the patient. In certain embodiments, the method provides at least a 20% reduction in pupil diameter in the eye of the patient. In certain embodiments, the method provides at least a 25% reduction in pupil diameter in the eye of the patient. In certain embodiments, the method provides at least a 30% reduction in pupil diameter in the eye of the patient.
  • One benefit of the therapeutic methods is that the patient may also experience a reduction in pupil diameter. Reduction in pupil diameter can result in improvement in visual performance.
  • the reduction in pupil diameter can be characterized according to, for example, the percent reduction in pupil diameter and size of the pupil measured under certain light conditions. Accordingly, in certain embodiments, the reduction in pupil diameter under mesopic conditions is at least 5% compared to the pupil diameter of the patient under the same mesopic conditions but not having received the therapy defined by the method. In certain other embodiments, the reduction in pupil diameter under mesopic conditions is at least 10% compared to the pupil diameter of the patient under the same mesopic conditions but not having received the therapy defined by the method.
  • the patient experiences a reduction in pupil diameter of at least 0.5 mm when measured under mesopic conditions relative to the diameter of the patient’s pupil under the same mesopic conditions but not having received the therapy defined by the method. In certain other embodiments, the patient experiences a reduction in pupil diameter ranging from about 0.6 mm to about 3 mm, about 0.6 mm to about 2.5 mm, or about 0.6 mm to about 2 mm when measured under mesopic conditions relative to the diameter of the patient’s pupil under the same mesopic conditions but not having received the therapy defined by the method.
  • the patient experiences a reduction in pupil diameter ranging from about 0.6 mm to about 1.2 mm when measured under mesopic conditions relative to the diameter of the patient’s pupil under the same mesopic conditions but not having received the therapy defined by the method.
  • the patient’s pupil is reduced to a diameter of about 3 mm to about 5 mm, about 3 mm to about 6 mm, about 4 mm to about 5 mm, about 4 mm to about 6 mm, or about 4 mm to about 7 mm under mesopic conditions due to the therapy defined by the method.
  • the patient’s pupil is reduced to a diameter of about 4 mm to about 6 mm under mesopic conditions due to the therapy defined by the method.
  • the method provides at least a 10% reduction in pupil diameter in the eye of the patient. In certain embodiments, the method provides at least a 15% reduction in pupil diameter in the eye of the patient. In certain embodiments, the method provides at least a 20% reduction in pupil diameter in the eye of the patient. In certain embodiments, the method provides at least a 25% reduction in pupil diameter in the eye of the patient. In certain embodiments, the method provides at least a 30% reduction in pupil diameter in the eye of the patient.
  • the patient may also experience a reduction in aberrant focus of scattered light rays in the patient’s eye. This can provide improvement in visual performance for the patient.
  • the therapeutic method provides a reduction in aberrant focus of scattered light rays in a patient’s eye for at least twenty hours.
  • the therapeutic method provides a reduction aberrant focus of scattered light rays in a patient’s eye for at least twenty -four hours.
  • the therapeutic method provides a reduction aberrant focus of scattered light rays in a patient’s eye for at least thirty-six hours, forty-eight hours, sixty hours, or seventy-two hours.
  • the First and Third Therapeutic Methods described hereinabove may optionally further comprise administering one or more second therapeutic agents to the patient.
  • Exemplary second therapeutic agents include, for example:
  • a prostaglandin analog such as latanoprost, bimatoprost, travoprost, tafluprost,
  • a beta blocker such as timolol or a pharmaceutically acceptable salt thereof
  • An alpha agonist such as brimonidine or a pharmaceutically acceptable salt thereof
  • a carbonic anhydrase inhibitor such as dorzolamide, brinzolamide, acetazolamide, methazolamide, or a pharmaceutically acceptable salt thereof;
  • a cholinergic agonist such as pilocarpine or a pharmaceutically acceptable salt thereof
  • Rho kinase inhibitor such as netarsudil or a pharmaceutically acceptable salt thereof.
  • Latanaoprost may be administered in the form of a sterile, isotonic, buffered aqueous solution of latanoprost with a pH of approximately 6.7 and an osmolality of approximately 267 mOsmol/kg, where each 1 mL of the solution contains 50 micrograms of latanoprost.
  • the solution may optionally contain benzalkonium chloride (0.02% w/w), sodium chloride, sodium dihydrogen phosphate monohydrate, and disodium hydrogen phosphate.
  • Latanaoprost may be administered to the patient according to the procedures described in the XALATAN ® prescribing information, which is hereby incorporated by reference.
  • a single daily dose of 1.5 micrograms of latanaoprost is administered to the patient’s eye.
  • a single daily dose in the range of about 0.5 to about 1.0 micrograms, about 1.0 to about 1.5 micrograms, or about 1.5 to about 2.0 micrograms of latanaoprost is administered to the patient’s eye.
  • Timolol may be administered as timolol maleate in the form of an ophthalmic solution.
  • One or two drops per day of a solution that contains on a 1 mL basis 3.4 mg of timolol maleate may be administered to the eye of the patient.
  • one drop per day of a solution that contains on a 1 mL basis 6.8 mg of timolol maleate may be administered to the eye of the patient.
  • Netarsudil may be administered to the patient in the form of an ophthalmic solution, such as a sterile, isotonic, buffered aqueous solution containing netarsudil dimesylate (0.02% w/w) having a pH of approximately 5 and an osmolality of approximately 295 mOsmol/kg. Each 1 mL of the solution contains 0.28 mg of netarsudil dimesylate.
  • the aqueous solution may contain benzalkonium chloride (e.g., 0.015% w/w), boric acid, and mannitol.
  • Netarsudil dimesylate may be administered to the patient once per day as one eye drop of the sterile, isotonic, buffered aqueous solution containing netarsudil dimesylate (0.02% w/w) having a pH of approximately 5 and an osmolality of approximately 295 mOsmol/kg.
  • each therapeutic agent and the relative timing of administration of each therapeutic agent may be selected in order to achieve a desired combined therapeutic effect.
  • the therapeutic agents in the combination, or a pharmaceutical composition or compositions comprising the therapeutic agents may be administered in any order such as, for example, sequentially, concurrently, together, simultaneously and the like
  • the therapeutic agents may act additively or
  • a synergistic combination may allow the use of lower dosages of one or more agents and/or less frequent administration of one or more agents of a combination therapy.
  • a lower dosage or less frequent administration of one or more agents may lower toxicity of the therapy without reducing the efficacy of the therapy.
  • compositions Containing At Least Two Active Agents
  • compositions containing at least two active agents For example, one aspect of the invention provides a pharmaceutical composition comprising an alpha-adrenergic antagonist and a second therapeutic agent selected from the group consisting of prostaglandin analog, a beta blocker, an alpha adrenergic agonist, a carbonic anhydrase inhibitor, a cholinergic agonist, NMDA receptor antagonist, adenosine receptor agonist, 5-HT 2A receptor agonist, and a Rho kinase inhibitor.
  • a pharmaceutical composition comprising an alpha-adrenergic antagonist and a second therapeutic agent selected from the group consisting of prostaglandin analog, a beta blocker, an alpha adrenergic agonist, a carbonic anhydrase inhibitor, a cholinergic agonist, NMDA receptor antagonist, adenosine receptor agonist, 5-HT 2A receptor agonist, and a Rho kinase inhibitor.
  • the pharmaceutical composition may be further characterized according to the identity of the second therapeutic agent.
  • the second therapeutic agent is selected from the group consisting of latanoprost, bimatoprost, travoprost, tafluprost, latanoprostene bunod, timolol, brimonidine, dorzolamide, brinzolamide, acetazolamide, methazolamide, pilocarpine, netarsudil, ripasudil, AMA0076, traêtoson, BOL-303259-X, ONO-9054, or a pharmaceutically acceptable salt of any one of the foregoing.
  • the second therapeutic agent is selected from the group consisting of latanoprost, bimatoprost, travoprost, tafluprost, latanoprostene bunod, timolol, brimonidine, dorzolamide, brinzolamide, acetazolamide, methazolamide, pilocarpine, netarsudil, ripasudil, AMA0076, traêtoson, BOL-303259-X, ONO-9054, carbachol, aceclidine, oxotremorine, or a pharmaceutically acceptable salt of any one of the foregoing.
  • the second therapeutic agent is selected from the group consisting of latanoprost, timolol, netarsudil, or a pharmaceutically acceptable salt of any one of the foregoing.
  • the second therapeutic agent selected is betaxolol, apraclonidine, brinzolamide, unoprostone, levobunolol, carteolol, metipranolol, carbachol, ecothiophate iodide, omidenepag isopropyl (an EP2 agonist), sepetaprost, NO-bimatoprost, H-1337 (a leucine-rich repeat kinase inhibitor), or a pharmaceutically acceptable salt of any one of the foregoing
  • the pharmaceutical composition may be further characterized according to the identity of the alpha-adrenergic antagonist.
  • the alpha- adrenergic antagonist is phentolamine, phenoxybenzamine, tolazoline, trazodone, alfuzosin, doxazosin, prazosin, tamsulosin, terazosin, silodosin, atipamezole, idazoxan, mirtazapine, yohimbine, fenoldopam, thymoxamine, or a pharmaceutically acceptable salt of any of the foregoing.
  • the alpha-adrenergic antagonist is phentolamine or a pharmaceutically acceptable salt thereof. In certain embodiments, the alpha-adrenergic antagonist is a pharmaceutically acceptable salt of phentolamine. In certain embodiments, the alpha-adrenergic antagonist is phentolamine mesylate.
  • the pharmaceutical composition comprises (i) pharmaceutically acceptable salt of phentolamine and (ii) latanoprost.
  • the pharmaceutical composition is formulated for ophthalmic administration.
  • the invention provides an aqueous ophthalmic solution comprising:
  • latanoprost e.g., about 0.005% (w/v) latanoprost
  • the solution has a pH in the range of 4 to 6 and does not contain any additional component that is a chelating agent.
  • the invention provides an aqueous ophthalmic solution comprising:
  • latanoprost e.g., about 0.005% (w/v) latanoprost
  • the dosage is an aqueous ophthalmic solution comprising:
  • latanoprost e.g., about 0.005% (w/v) latanoprost
  • the solution has a pH in the range of 4.5 to 5.5 and does not contain any additional component that is a chelating agent.
  • the at least one polyol is mannitol.
  • the solution contains 4% (w/v) mannitol.
  • the alkali metal acetate is sodium acetate.
  • the solution comprises 3 mM sodium acetate.
  • the dosage is an aqueous ophthalmic solution containing:
  • latanoprost e.g., about 0.005% (w/v) latanoprost
  • the solution has a pH in the range of 4.5 to 5.2 and does not contain any additional component that is a chelating agent.
  • the dosage is an aqueous ophthalmic solution containing:
  • latanoprost e.g., about 0.005% (w/v) latanoprost
  • the solution has a pH in the range of 4.5 to 5.2 and does not contain any additional component that is a chelating agent.
  • the dosage is an aqueous ophthalmic solution containing:
  • latanoprost e.g., about 0.005% (w/v) latanoprost
  • latanoprost e.g., about 0.005% (w/v) latanoprost
  • latanoprost about 3% (w/v) to about 5% (w/v) of mannitol
  • the solution has a pH in the range of 4.5 to 5.2 and does not contain any additional component that is a chelating agent.
  • the dosage is an aqueous ophthalmic solution containing:
  • latanoprost e.g., about 0.005% (w/v) latanoprost
  • the solution has a pH in the range of 4.6 to 5.2 and does not contain any additional component that is a chelating agent.
  • the dosage is an aqueous ophthalmic solution containing:
  • latanoprost e.g., about 0.005% (w/v) latanoprost
  • the solution has a pH in the range of 4.6 to 5.2 and does not contain any additional component that is a chelating agent.
  • the dosage is an aqueous ophthalmic solution comprising: (a) about 1% (w/v) of phentolamine mesylate; (b) about 4% (w/v) mannitol; (c) about 3 mM of a buffer comprising sodium acetate; (d) water; and (e) latanoprost (e.g., about 0.005% (w/v) latanoprost); wherein the solution has a pH in the range of 4.5 to 5.5 and does not contain any additional component that is a chelating agent.
  • the dosage is an aqueous ophthalmic solution free of a chelating agent comprising: (a) about 1% (w/v) of phentolamine mesylate; (b) about 4% (w/v) mannitol; (c) about 3 mM of a buffer comprising sodium acetate; (d) water; and (e) latanoprost (e.g., about 0.005% (w/v) latanoprost); wherein the solution has a pH in the range of 4.0 to 7.5 and does not contain a chelating agent.
  • Implantable Ocular Device comprising: (a) about 1% (w/v) of phentolamine mesylate; (b) about 4% (w/v) mannitol; (c) about 3 mM of a buffer comprising sodium acetate; (d) water; and (e) latanoprost (e.g., about 0.005% (w/v) latanopros
  • compositions described herein may be administered to the patient’s eye via an implantable ocular device that dispenses the composition.
  • the implantable ocular device may be configured to dispense the composition at a desired rate and/or frequency.
  • the implantable ocular device is a slow release insert.
  • Therapeutically active agents are desirably administered to the eye of the patient in the form of an ophthalmic solution.
  • an ophthalmic solution comprises one or more therapeutically active agents and a pharmaceutically acceptable carrier.
  • the ophthalmic solution exhibits good storage stability to permit distribution of the ophthalmic solution through normal distribution channels for pharmaceuticals.
  • the pharmaceutically acceptable carrier is water. Additional components may be added to the ophthalmic solution in order to optimize performance properties of the ophthalmic solution.
  • Exemplary additional components include, for example, a chelating agent (e.g., EDTA), polyol compound, poly(C24alkylene)glycol polymer, dextran, cellulose agent, buffer, tonicity modifier, preservative, antioxidant, viscosity modifying agent, comeal permeation enhancing agent, solubilizing agent, stabilizing agent, surfactant, demulcent polymer, wetting agent, and other materials.
  • a chelating agent e.g., EDTA
  • polyol compound poly(C24alkylene)glycol polymer
  • dextran e.g., cellulose agent
  • buffer tonicity modifier
  • preservative e.g., antioxidant, viscosity modifying agent
  • comeal permeation enhancing agent e.g., solubilizing agent
  • stabilizing agent e.g., surfactant, demulcent polymer, wetting agent, and other materials.
  • Ophthalmic solutions may be further characterized according to the presence or absence of one or more of a chelating agent (e.g., EDTA), polyol compound, poly(C2- 4alkylene)glycol polymer, dextran, cellulose agent, buffer, tonicity modifier, preservative, antioxidant, viscosity modifying agent, comeal permeation enhancing agent, solubilizing agent, stabilizing agent, surfactant, demulcent polymer, wetting agent, and other materials.
  • a chelating agent e.g., EDTA
  • polyol compound poly(C2- 4alkylene)glycol polymer
  • dextran e.g., cellulose agent
  • buffer tonicity modifier
  • preservative e.g., antioxidant
  • viscosity modifying agent e.g., comeal permeation enhancing agent
  • solubilizing agent e.g., stabilizing agent
  • surfactant demulcent polymer, wetting agent, and other materials.
  • Various therapeutic methods above involve administering a dosage of phentolamine or a pharmaceutically acceptable salt thereof to the patient.
  • the dosage of phentolamine or a pharmaceutically acceptable salt thereof is desirably in the form of an ophthalmic solution.
  • the ophthalmic solution is formulated to be suitable for administration to the eye of a patient, and desirably provides immediate release of phentolamine, that is, the ophthalmic solution is not a sustained release formulation that delivers phentolamine over an extended duration, such as hours, days or weeks.
  • the ophthalmic solution desirably comprises an aqueous pharmaceutically acceptable carrier and phentolamine or a pharmaceutically acceptable salt thereof.
  • the ophthalmic solution may contain excipients(s) that are suitable for administration to the eye.
  • Various pharmaceutically acceptable salts are described in the literature.
  • the preferred salt form of phentolamine is phentolamine mesylate. Accordingly, the methods may use an ophthalmic solution that comprises an aqueous pharmaceutically acceptable carrier and phentolamine mesylate.
  • the dosage utilized in the methods is an ophthalmic solution comprising an aqueous pharmaceutically acceptable carrier and phentolamine or a pharmaceutically acceptable salt thereof.
  • the dosage is an ophthalmic solution comprising an aqueous pharmaceutically acceptable carrier and phentolamine mesylate.
  • the dosage is an ophthalmic solution comprising water, a polyol, and phentolamine or a pharmaceutically acceptable salt thereof.
  • the dosage is an ophthalmic solution comprising water, mannitol, and phentolamine mesylate.
  • the dosage is an ophthalmic solution comprising water, a polyol, an alkali metal carboxylate, and phentolamine or a pharmaceutically acceptable salt thereof.
  • the dosage is an ophthalmic solution comprising water, mannitol, sodium acetate, and phentolamine mesylate.
  • ophthalmic solutions that are contemplated for use in the present invention include, for example, (i) aqueous ophthalmic solutions free of a chelating agent, and (ii) polyvinylpyrrolidone artificial tears formulations, each of which are described in more detail below.
  • Ophthalmic solutions may be further characterized according to the viscosity of the solution.
  • the ophthalmic solution at a temperature of about 25°C has a viscosity in the range of 0.9 cP to about 1.1 cP.
  • the ophthalmic solution at a temperature of about 25°C has a viscosity of about 1 cP.
  • the dosage utilized in the methods is an aqueous ophthalmic solution free of a chelating agent, wherein said solution comprises (a) phentolamine or a pharmaceutically acceptable salt thereof; (b) at least one polyol compound, such as a polyol compound having a molecular weight less than 250 g/mol; (c) at least one buffer; and (d) water; wherein the solution does not contain a chelating agent.
  • the amount of ingredients in the aqueous ophthalmic solutions may be selected in order to achieve particular performance properties, such as stability to storage, minimize irritation to the eye of a patient, and enhance penetration of phentolamine into the eye of a patient.
  • One exemplary preferred solution is an aqueous ophthalmic solution free of a chelating agent comprising: (a) about 0.1% (w/v) to about 4% (w/v) of phentolamine or a pharmaceutically acceptable salt thereof; (b) about 1% (w/v) to about 6% (w/v) of at least one polyol compound having a molecular weight less than 250 g/mol; (c) about 0.1 mM to about 10 mM of at least one buffer; and (d) water; wherein the solution has a pH in the range of 4.0 to 7.5 and does not contain a chelating agent.
  • the aqueous ophthalmic solution comprises phentolamine or a pharmaceutically acceptable salt of phentolamine.
  • exemplary pharmaceutically acceptable salts include, for example, the hydrochloric acid salt and mesylate salt.
  • the solution comprises phentolamine (i.e., as the free base).
  • the solution comprises phentolamine hydrochloride.
  • the solution comprises phentolamine mesylate.
  • the amount of phentolamine or a pharmaceutically acceptable salt thereof in the aqueous ophthalmic solution may be adjusted in order to achieve desired performance properties. For example, where is it desired to provide a larger amount of phentolamine (or pharmaceutically acceptable salt thereof) to the patient in a single administration of the aqueous ophthalmic solution, the concentration of phentolamine (or pharmaceutically acceptable salt thereof) is increased in the aqueous ophthalmic solution.
  • Single administration of aqueous ophthalmic solutions having a higher concentration of phentolamine (or pharmaceutically acceptable salt thereof) may provide the patient with reduced intraocular pressure for a longer duration of time because more phentolamine (or pharmaceutically acceptable salt thereof) is administered to the patient.
  • the aqueous ophthalmic solution comprises from about 0.1% (w/v) to about 5% (w/v) of phentolamine or a pharmaceutically acceptable salt thereof.
  • the aqueous ophthalmic solution comprises from about 0.1% (w/v) to about 1% (w/v) of phentolamine or a pharmaceutically acceptable salt thereof, about 1% (w/v) to about 2% (w/v) of phentolamine or a pharmaceutically acceptable salt thereof, about 2% (w/v) to about 3% (w/v) of phentolamine or a pharmaceutically acceptable salt thereof, about 3% (w/v) to about 4% (w/v) of phentolamine or a pharmaceutically acceptable salt thereof, about 4% (w/v) to about 5% (w/v) of phentolamine or a pharmaceutically acceptable salt thereof, about 4% (w/v) to about 5% (w/v) of phentolamine or a pharmaceutically acceptable salt thereof, about 4% (
  • the aqueous ophthalmic solution comprises from about 0.1% (w/v) to about 2% (w/v) of phentolamine or a
  • the aqueous ophthalmic solution comprises from about 0.25% (w/v) to about 2% (w/v) of phentolamine or a pharmaceutically acceptable salt thereof. In certain other embodiments, the aqueous ophthalmic solution comprises from about 0.5% (w/v) to about 2% (w/v) of phentolamine or a pharmaceutically acceptable salt thereof. In certain other embodiments, the aqueous ophthalmic solution comprises from about 0.25% (w/v) to about 1% (w/v) of phentolamine or a pharmaceutically acceptable salt thereof.
  • the aqueous ophthalmic solution comprises about 1% (w/v) of phentolamine or a pharmaceutically acceptable salt thereof. In certain other embodiments, the aqueous ophthalmic solution comprises from about 0.1% (w/v) to about 4% (w/v) of phentolamine mesylate. In certain other embodiments, the aqueous ophthalmic solution comprises from about 0.1% (w/v) to about 2% (w/v) of phentolamine mesylate. In certain other embodiments, the aqueous ophthalmic solution comprises from about 0.25% (w/v) to about 2% (w/v) of phentolamine mesylate.
  • the aqueous ophthalmic solution comprises from about 0.5% (w/v) to about 2% (w/v) of phentolamine mesylate. In certain other embodiments, the aqueous ophthalmic solution comprises from about 0.25% (w/v) to about 1% (w/v) of phentolamine mesylate. In certain other embodiments, the aqueous ophthalmic solution comprises about 1% (w/v) of phentolamine mesylate. In certain other embodiments, the aqueous ophthalmic solution comprises about 0.25% (w/v) or about 0.5% (w/v) of phentolamine mesylate.
  • the aqueous ophthalmic solution comprises one or more polyol compounds.
  • the polyol compound is an organic compound having at least two hydroxyl groups (e.g., from 2 to about 6 hydroxyl groups).
  • the polyol compound is beneficial to the aqueous ophthalmic solution because, for example, it can increase the stability of the aqueous ophthalmic solution to storage and/or modify the tonicity of the aqueous ophthalmic solution.
  • Exemplary polyol compounds include, for example, mannitol, glycerol, propylene glycol, ethylene glycol, sorbitol, and xylitol.
  • the aqueous ophthalmic solution may contain a single polyol compound or a mixture of one or more polyol compounds.
  • the aqueous ophthalmic solution comprises at least one polyol compound.
  • the aqueous ophthalmic solution comprises at least one polyol compound that is mannitol, glycerol, propylene glycol, ethylene glycol, sorbitol, or xylitol.
  • the at least one polyol compound is mannitol.
  • the at least one polyol compound is glycerol.
  • the at least one polyol compound is propylene glycol.
  • the at least one polyol compound is mannitol, and the solution further comprises glycerol. In certain other embodiments, the at least one polyol compound is mannitol, and the solution further comprises propylene glycol. In certain other embodiments, the at least one polyol compound is glycerol, and the solution further comprises propylene glycol. In certain other embodiments, the mannitol described in embodiments above is D- mannitol.
  • the amount of the at least one polyol compound in the aqueous ophthalmic solution may be selected in order to achieve desired performance properties for the solution.
  • the polyol compound may, for example, increase the stability of the solution to storage and/or modify the tonicity of the solution to make it more suitable for administration to the eye of a patient.
  • the aqueous ophthalmic solution comprises from about 2% (w/v) to about 5% (w/v) of the at least one polyol compound. In certain other embodiments, the aqueous ophthalmic solution comprises from about 3.5% (w/v) to about 4.5% (w/v) of the at least one polyol compound.
  • the aqueous ophthalmic solution comprises about 4% (w/v) of the at least one polyol compound. In certain other embodiments, the aqueous ophthalmic solution comprises from about 2% (w/v) to about 3% (w/v) mannitol, and about 0.5% (w/v) to about 1.5% (w/v) glycerin. In certain other embodiments, the mannitol described in embodiments above is D-mannitol.
  • the amount of polyol may be selected based on the amount of phentolamine (or pharmaceutically acceptable salt thereof), such that there is an inverse relationship between the amount of phentolamine (or pharmaceutically acceptable salt thereof) and the polyol in order to achieve isotonicity with the eye.
  • the aqueous ophthalmic solution contains about 2% (w/v) phentolamine
  • mannitol is present in the solution at a concentration of about 3% (w/v).
  • mannitol is present in the solution at a concentration of about 4% (w/v).
  • mannitol may be present in the solution at a concentration of about 4.5% (w/v).
  • the mannitol described in embodiments above is D-mannitol.
  • the aqueous ophthalmic solution can contain additional ingredients described herein, such as various polymer materials.
  • One such embodiment is an aqueous ophthalmic solution comprising, for example, at least one polyol compound that is propylene glycol, and further comprising polypropylene glycol, such as polypropylene glycol having a weight average molecular weight in the range of about 5,000 g/mol to about 100,000 g/mol.
  • the aqueous ophthalmic solution may optionally comprise a poly(C2- 4alkylene)glycol polymer.
  • An exemplary poly(C2-4alkylene)glycol polymer is polypropylene glycol, such as a polypropylene glycol having a weight average molecular weight in the range of about 5,000 g/mol to about 100,000 g/mol, about 10,000 g/mol to about 50,000 g/mol, or about 50,000 g/mol to about 100,000 g/mol.
  • the aqueous ophthalmic solution may optionally comprise dextran.
  • Dextran is a commercially available, branched polysaccharide comprising glucose molecules.
  • the amount of dextran in the aqueous ophthalmic solution may be selected to achieve certain performance properties.
  • the aqueous ophthalmic solution comprises from about 0.01% (w/v) to about 2% (w/v) dextran. In certain other embodiments, the aqueous ophthalmic solution comprises from about 0.01% (w/v) to about 1% (w/v) dextran.
  • the dextran may be further characterized according to its weight average molecular weight.
  • the dextran has a weight average molecular weight in the range of about 65,000 g/mol to about 75,000 g/mol. In certain other embodiments, the dextran has a weight average molecular weight of about 70,000 g/mol. In yet other embodiments, the dextran has a weight average molecular weight in the range of about 5,000 g/mol to about 100,000 g/mol, about 10,000 g/mol to about 50,000 g/mol, or about 50,000 g/mol to about 100,000 g/mol.
  • the aqueous ophthalmic solution may optionally comprise a cellulose agent.
  • Exemplary cellulose agents include, for example, cellulose, carboxymethyl cellulose, hydroxyethylcellulose, hydroxpropylcellulose, and hydroxypropylmethyl cellulose.
  • the cellulose agent is hydroxypropylmethyl cellulose.
  • the cellulose agent is cellulose, carboxymethyl cellulose, hydroxyethylcellulose, or hydroxpropylcellulose.
  • the amount of cellulose agent in the aqueous ophthalmic solution may be selected in order to achieve desired performance properties.
  • the aqueous ophthalmic solution comprises from about 0.01% (w/v) to about 2% (w/v) cellulose agent.
  • the cellulose agent may be further characterized according to its weight average molecular weight.
  • the cellulose agent has a weight average molecular weight in the range of about 5,000 g/mol to about 100,000 g/mol, about 10,000 g/mol to about 50,000 g/mol, or about 50,000 g/mol to about 100,000 g/mol.
  • the aqueous ophthalmic solution comprises at least one buffer.
  • the buffer imparts to the solution a buffering capacity, that is, the capacity to neutralize, within limits, either acids or bases (alkali) with relatively little or no change in the original pH.
  • the buffer may be an acid, a base, or a combination of an acid and a base.
  • the buffer may be organic, inorganic, or a combination of organic and inorganic components. It should be understood that the buffer at least partially dissociates in aqueous solution to form a mixture of, e.g., an acid and conjugate base or a base and conjugate acid.
  • the buffer may be a combination of a carboxylic acid and its carboxylate salt (e.g., a combination of acetic acid and sodium acetate).
  • the buffer may be a combination of an acid and a base, where the acid and the base are not conjugates.
  • the acid may be boric acid and the base may be tris(hydroxymethyl)aminomethane (TRIS).
  • Exemplary buffers include organic acids (e.g., acetic acid, sorbic acid, and oxalic acid), a borate salt, a hydrogen carbonate salt, a carbonate salt, a gluconate salt, a lactate salt, a phosphate salt, a propionate salt, a perborate salt, tris-(hydroxymethyl)aminomethane (TRIS), bis(2-hydroxyethyl)-imino-tris-(hydroxymethyl)aminoalcohol (bis-tris), N-[2-hydroxy-l , 1 - bis(hydroxymethyl)ethyl] glycine (tricene), N-[2-hydroxy-l, l-bis(hydroxymethyl)ethyl]glycine, 3-(N-morpholino)propanesulfonic acid, N-(carbamoylmethyl)taurine (ACES), an amino acid, salts thereof, and combinations thereof.
  • organic acids e.g., acetic acid, sorbic
  • the buffer can be characterized according to its strength, i.e., the buffering capacity.
  • the buffering capacity can be tested, for example, by determining the millimoles (mM) of strong acid or base (or respectively, hydrogen or hydroxide ions) required to change the pH of a buffer solution by one unit when added to one liter (a standard unit) of the buffer solution.
  • the buffering capacity generally depends on the type and concentration of the buffer components and can be greater in particular pH ranges.
  • a buffer may have an optimal buffering capacity in a pH range near the pK a of the buffer, e.g., within about 1 pH unit or within about 2 pH units of the pK a the buffer.
  • the buffer is a weak buffer, such as an alkali metal carboxylate (e.g., sodium acetate).
  • the buffer is a weak acid buffer having one or more of the following characteristics: (a) a pKa of from about 4.0 to about 6.0; more preferably, from about 4.5 to about 5.5; and (b) a bpophibcity value Log P of from about -0.50 to about 1.5; more preferably, from about -0.25 to about 1.35.
  • the amount of buffer can be adjusted in order to achieve desired performance properties for the aqueous ophthalmic solution.
  • the buffer may be present at a concentration of less than about 10 mM, less than about 7 mM, less than about 5 mM, less than about 3 mM, or less than about 2 mM.
  • the buffer may be present at a concentration of from about 1 mM to about 10 mM, from about 1 mM to about 7 mM, from about 1 mM to about 5 mM, from about 1 mM to about 3 mM, from about 1 mM to about 2 mM, from about 2 mM to about 5 mM, or from about 2 mM to about 3 mM. In yet other embodiments, the buffer is present at a concentration of about 3 mM.
  • the amount and identity of the buffer may be selected in order to achieve certain performance properties for the aqueous ophthalmic solution.
  • the amount of buffer may impact the quantity of acid that may be neutralized before there is substantial change in the pH of the aqueous ophthalmic solution.
  • the amount of buffer may impact the tonicity of the aqueous ophthalmic solution.
  • the quantity and identity of the buffer should be selected in order to minimize any irritation that may be caused by
  • the buffer is present at a concentration in the range of about 2 mM to about 4 mM. In yet other embodiments, the buffer is present at a concentration of about 3 mM.
  • the buffer comprises an alkali metal alkylcarboxylate. In certain other embodiments, the buffer comprises an alkali metal acetate. In yet other embodiments, the buffer comprises sodium acetate.
  • the aqueous ophthalmic solution may be characterized according to the pH of the solution.
  • the aqueous ophthalmic solution has a pH in the range of 4.0 to 7.5.
  • the aqueous ophthalmic solution has a pH in the range of 4.5 to 7.5.
  • the solution has a pH in the range of 4.5 to 6.0.
  • the solution has a pH in the range of 4.5 to 5.5.
  • the solution has a pH in the range of 4.7 to 5.1.
  • the aqueous ophthalmic solutions may contain additional materials in order to make the composition more suitable for administration to the eye of a patient.
  • additional materials include, for example, a tonicity modifier, preservative, antioxidant, viscosity modifying agent, stabilizing agent, comeal permeation enhancing agent, and surfactants.
  • the aqueous ophthalmic solution may optionally comprise one or more tonicity modifiers.
  • the tonicity modifier may be ionic or non-ionic.
  • the tonicity modifier may be a salt, a carbohydrate, or a polyol.
  • Exemplary tonicity modifiers include alkali metal or alkaline earth metal halides (such as LiBr, LiCl, Lil, KBr, KC1, KI, NaBr, NaCl, Nal, CaC'h.
  • dextran e.g., Dextran 70
  • cyclodextrin dextrose
  • mannitol e.g., mannitol
  • glycerin e.g., mannitol
  • urea sorbitol
  • propylene glycol e.g., propylene glycol
  • the tonicity modifier may be added to the aqueous ophthalmic solution in an amount sufficient to provide a desired osmolality.
  • the tonicity modifier is present in the aqueous ophthalmic solution in an amount sufficient so that the aqueous ophthalmic solution has an osmolality ranging from about 50 to about 1000 mOsm/kg, from about 100 to about 400 mOsm/kg, from about 200 to about 400 mOsm/kg, or from about 280 to about 380 mOsm/kg.
  • a tonicity modifier may be present in an amount ranging from about 0.01% (w/v) to about 7% (w/v), about 0.01% (w/v) to about 5% (w/v), about 0.01% (w/v) to about 1% (w/v), about 0.1% (w/v) to about 1% (w/v), about 0.05% (w/v) to about 5% (w/v), about 0.05% (w/v) to about 0.5% (w/v), about 1% (w/v) to about 3% (w/v), or about 2% (w/v) to about 4% (w/v), of the aqueous ophthalmic solution.
  • the aqueous ophthalmic solution may optionally comprise one or more preservatives in order to, for example, reduce or prevent microbial contamination.
  • preservatives include quaternary ammonium salts such as polyquatemium-l, cetrimide, benzalkonium chloride, or benzoxonium chloride; alkyl-mercury salts of thiosalicylic acid such as thiomersal, phenylmercuric nitrate, phenylmercuric acetate, or phenylmercuric borate; parabens such as methylparaben or propylparaben; alcohols such as chlorobutanol, benzyl alcohol, phenyl ethanol, cyclohexanol, 3-pentanol, or resorcinol; a peroxide; chlorine dioxide or PURITE; guanidine derivatives such as chlorohexidine gluconate or polyaminopropyl biguanide
  • the amount of preservative can be adjusted in order to achieve desired performance properties for the aqueous ophthalmic solution.
  • the preservative is present in an amount less than about 5% (w/v), 3% (w/v), 1% (w/v), or 0.1% (w/v) of the aqueous ophthalmic solution.
  • the preservative is present in an amount ranging from about 0.01% (w/v) to about 5% (w/v), about 0.01% (w/v) to about 1% (w/v), about 0.1% (w/v) to about 1% (w/v), about 0.05% (w/v) to about 5% (w/v), or about 0.05% (w/v) to about 0.5% (w/v), of the aqueous ophthalmic solution.
  • the aqueous ophthalmic solution may optionally comprise one or more antioxidants.
  • antioxidants for use in the aqueous ophthalmic solutions described herein include water soluble antioxidants such as ascorbic acid, cysteine hydrochloride, sodium bisulfate, sodium metabisulfite, sodium bisulfite, sodium sulfite, and the like; and oil-soluble antioxidants, such as ascorbyl palmitate, butylated hydroxyanisole (BHA), butylated hydroxytoluene (BHT), lecithin, propyl gallate, alpha-tocopherol, and the like.
  • water soluble antioxidants such as ascorbic acid, cysteine hydrochloride, sodium bisulfate, sodium metabisulfite, sodium bisulfite, sodium sulfite, and the like
  • oil-soluble antioxidants such as ascorbyl palmitate, butylated hydroxyanisole (BHA), butylated hydroxytoluene (BHT), lecit
  • the amount of antioxidant can be adjusted in order to achieve desired performance properties for the aqueous ophthalmic solution.
  • the antioxidant is present in an amount less than about 5% (w/v), 3% (w/v), 1% (w/v), or 0.1% (w/v) of the aqueous ophthalmic solution.
  • the antioxidant is present in an amount ranging from about 0.01% (w/v) to about 5% (w/v), about 0.01% (w/v) to about 1% (w/v), about 0.1% (w/v) to about 1% (w/v), about 0.05% (w/v) to about 5% (w/v), or about 0.05% (w/v) to about 0.5% (w/v), of the aqueous ophthalmic solution.
  • the aqueous ophthalmic solution may optionally comprise one or more viscosity modifying agents.
  • the viscosity modifying agent may be used, for example, to increase the absorption of an active agent or increase the retention time of the aqueous ophthalmic solution in the eye.
  • Exemplary viscosity modifying agents include polyvinylpyrrolidone,
  • hydroxpropylcellulose carboxymethylcellulose (CMC) and salts thereof (e.g., CMC sodium salt), gelatin, cellulose glycolate, sorbitol, niacinamide, an alpha-cyclodextran, polyvinyl alcohol, polyethylene glycol, hyaluronic acid, a polysachcharaide, a monosaccharide, and combinations thereof.
  • CMC carboxymethylcellulose
  • salts thereof e.g., CMC sodium salt
  • the amount of viscosity modifying agent can be adjusted in order to achieve desired performance properties for the aqueous ophthalmic solution.
  • the viscosity modifying agent is present in an amount less than about 10% (w/v), 5% (w/v), 3% (w/v), 1% (w/v), or 0.1% (w/v) of the aqueous ophthalmic solution.
  • the viscosity modifying agent is present in an amount ranging from about 0.01% (w/v) to about 5% (w/v), about 0.01% (w/v) to about 1% (w/v), about 0.1% (w/v) to about 1% (w/v), about 0.05% (w/v) to about 5% (w/v), or about 0.05% (w/v) to about 0.5% (w/v), of the aqueous ophthalmic solution.
  • the viscosity modifying agent is present in an amount sufficient to provide an aqueous ophthalmic solution with a viscosity in the range of about 30 centipoise to about 100 centipoise.
  • the viscosity modifying agent may be a polymer that results in delayed release of one or more therapeutic agents in the solution.
  • the identity of the polymer may be selected so as to achieve a desired time-release profile for the one or more therapeutic agents.
  • the aqueous ophthalmic solution may optionally comprise one or more agents for enhancing comeal permeation of phentolamine (or a pharmaceutically acceptable salt thereof).
  • agents for enhancing comeal permeation include polymers, organic acids, esters of an organic acid (e.g., a monoglyceride of fatty acid having 8 to 12 carbon atoms), cyclodextrin, benzalkonium chloride (BAK), EDTA, caprylic acid, citric acid, boric acid, sorbic acid, polyoxyethylene-20-stearyl ether (PSE), polyethoxylated castor oil (PCO), deoxycholic acid sodium salt (DC), cetylpyridinium chloride (CPC), laurocapram, hexamethylenelauramide, hexamethyleneoctanamide, decylmethylsulfoxide, methyl sulfone, dimethyl sulfoxide, and combinations thereof.
  • organic acids e.g., a monogly
  • the amount of comeal permeation enhancing agent can be adjusted in order to achieve desired performance properties for the aqueous ophthalmic solution.
  • the comeal permeation enhancing agent is present in an amount less than about 10% (w/v), 5% (w/v), 1% (w/v), or 0.1% (w/v) of the aqueous ophthalmic solution.
  • the comeal permeation enhancing agent is present in an amount ranging from about 0.01% (w/v) to about 5% (w/v), about 0.01% (w/v) to about 1% (w/v), about 0.1% (w/v) to about 1% (w/v), about 0.05% (w/v) to about 5% (w/v), about 0.05% (w/v) to about 0.5% (w/v), about 1% (w/v) to about 3% (w/v), or about 2% (w/v) to about 4% (w/v), of the aqueous ophthalmic solution.
  • the aqueous ophthalmic solution may optionally comprise one or more solubilizing agents to improve the solubility of phentolamine (or a pharmaceutically acceptable salt thereof) in the aqueous ophthalmic solution.
  • solubilizing agents include, for example, a fatty acid glycerol poly-lower alkylene (i.e., a Ci to C 7 , linear or branched) glycol ester, fatty acid poly-lower alkylene glycol ester, polyalkylene glycol (e.g., polyethylene glycol), glycerol ether of vitamin E, tocopherol polyethylene glycol 1000 succinate (TPGS), tyloxapol, polysorbate 20, polysorbate 40, polysorbate 60, polysorbate 80,
  • polyoxyethylene/polyoxypropylene surfactants e.g., Pluronic F-68, F-84 and P-103
  • cyclodextrin e.g., cyclodextrin, and combinations thereof.
  • the amount of solubilizing agent can be adjusted in order to achieve desired performance properties for the aqueous ophthalmic solution.
  • the solubilizing agent is present in an amount less than about 10% (w/v), 5% (w/v), 3% (w/v), 1% (w/v), or 0.1% (w/v) of the aqueous ophthalmic solution.
  • the solubilizing agent is present in an amount ranging from about 0.01% (w/v) to about 5% (w/v), about 0.01% (w/v) to about 1% (w/v), about 0.1% (w/v) to about 1% (w/v), about 0.05% (w/v) to about 5% (w/v), or about 0.05% (w/v) to about 0.5% (w/v), of the aqueous ophthalmic solution.
  • the aqueous ophthalmic solution may optionally comprise one or more stabilizing agents in order to improve the stability of the aqueous ophthalmic solution to storage, etc.
  • Stabilizing agents described in the pharmaceutical literature are contemplated to be amenable for use in the aqueous ophthalmic solutions described herein.
  • Exemplary stabilizing agents include an alcohol (e.g., polyols, such as mannitol, glycerol, propylene glycol, sorbitol, and xylitol), polyalkylene glycols such as polyethylene glycol, polypropylene glycol, polyethylene glycol-nonphenol ether, polyethylene glycol sorbitan monolaurate, polyethylene glycol sorbitan monooleate, polyethylene glycol sorbitan monooleate, polyethylene glycol sterarate, polyethylene glycol polypropylene glycol ether, polyvinyl alcohol, polyvinyl pyrrolidine, ascorbic acid, vitamin E, N-acetylcamosine (NAC), sorbic acid, and combinations thereof.
  • an alcohol e.g., polyols, such as mannitol, glycerol, propylene glycol, sorbitol, and xylitol
  • polyalkylene glycols such as polyethylene glycol
  • the stabilizing agent is a polymer, such as one of the polymers mentioned above.
  • the amount of stabilizing agent can be adjusted in order to achieve desired performance properties for the aqueous ophthalmic solution.
  • the stabilizing agent is present in an amount less than about 10% (w/v), 5% (w/v), or 1% (w/v) of the aqueous ophthalmic solution.
  • the stabilizing agent is present in an amount ranging from about 0.01% (w/v) to about 5% (w/v), about 0.01% (w/v) to about 1% (w/v), or about 0.01% (w/v) to about 0.1% (w/v) of the aqueous ophthalmic solution.
  • the aqueous ophthalmic solution may optionally comprise one or more surfactants.
  • exemplary surfactants include Polysorbate 20 (i.e., polyoxyethylene (20) sorbitan
  • Polysorbate 40 i.e., polyoxyethylene (20) sorbitan monopalmitate
  • Polysorbate 60 i.e., polyoxyethylene (20) sorbitan monostearate
  • Polysorbate 80 i.e., polyoxyethylene (20) sorbitan monooleate
  • glyceryl stearate isopropyl stearate, polyoxyl stearate, propylene glycol stearate, sucrose stearate, polyethylene glycol, a polypropylene oxide, a polypropylene oxide copolymer
  • Pluronic F68, Pluronic F-84, Pluronic P-103 an alcohol ethoxylate, an alkylphenol ethoxylate, an alkyl glycoside, an alkyl polyglycoside, a fatty alcohol,
  • HPMC hydroxypropylmethyl cellulose
  • CMC carboxymethyl cellulose
  • cyclodextrin a polyacrylic acid
  • phosphatidyl chlorine phosphatidyl serine, and combinations thereof.
  • the amount of surfactant can be adjusted in order to achieve desired performance properties for the aqueous ophthalmic solution.
  • the surfactant is present in an amount less than about 10% (w/v), 5% (w/v), 3% (w/v), 1% (w/v), or 0.1% (w/v) of the aqueous ophthalmic solution.
  • the surfactant is present in an amount ranging from about 0.01% (w/v) to about 5% (w/v), about 0.01% (w/v) to about 1% (w/v), about 0.1% (w/v) to about 1% (w/v), about 0.05% (w/v) to about 5% (w/v), or about 0.05% (w/v) to about 0.5% (w/v), of the aqueous ophthalmic solution.
  • the aqueous ophthalmic solution may optionally comprise one or more demulcent polymers. Because of their ability to hold large amounts of water, demulcent polymers are useful for coating and moisturizing the cornea of the eye.
  • demulcent polymers include cellulose derivatives, dextran 40, dextran 70, gelatin, and liquid polyols.
  • the aqueous ophthalmic solution may optionally comprise one or more wetting agents.
  • Wetting agents can be used to wet the surface of the eye.
  • Exemplary wetting agents include polysorbates, poloxamers, tyloxapol, and lecithin.
  • the aqueous ophthalmic solutions may optionally comprise one or more additional materials, such as acetylcysteine, cysteine, sodium hydrogen sulfite, butyl-hydroxyanisole, butyl-hydroxytoluene, alpha-tocopherol acetate, thiourea, thiosorbitol, sodium dioctyl sulfosuccinate, monothioglycerol, lauric acid sorbitol ester, triethanol amine oleate, or palmitic acid esters.
  • additional materials such as acetylcysteine, cysteine, sodium hydrogen sulfite, butyl-hydroxyanisole, butyl-hydroxytoluene, alpha-tocopherol acetate, thiourea, thiosorbitol, sodium dioctyl sulfosuccinate, monothioglycerol, lauric acid sorbitol ester, triethanol amine
  • the aqueous ophthalmic solutions may comprise a carrier, such as one or more of the exemplary carriers are described in for example, Martin, Remington’s
  • the carrier can be, for example, a mixture of water and a water-miscible solvent (e.g., an alcohol such as glycerin, a vegetable oil, or a mineral oil).
  • a water-miscible solvent e.g., an alcohol such as glycerin, a vegetable oil, or a mineral oil.
  • exemplary carriers include a mixture of water and one or more of the following materials: hydroxyethylcellulose, carboxymethylcellulose, methylcellulose, an alkali metal salt of carboxymethylcellulose, hydroxymethylcellulose, methylhydroxypropylcellulose, hydroxypropylcellulose, ethyl oleate, polyvinylpyrrolidone, an acrylate polymer, a methacrylate polymer, a polyacrylamide, gelatin, an alginate, a pectin, tragacanth, karaya gum, xanthan gum, carrageenin, agar, acacia, a starch (such as starch acetate or hydroxypropyl starch), polyvinyl alcohol, polyvinyl methyl ether, polyethylene oxide, or a cross-linked polyacrylic acid.
  • hydroxyethylcellulose carboxymethylcellulose, methylcellulose, an alkali metal salt of carboxymethylcellulose, hydroxymethylcellulose, methylhydroxypropylcellulose, hydroxypropy
  • One such exemplary solution is an aqueous ophthalmic solution free of a chelating agent comprising: (a) about 0.1% (w/v) to about 2% (w/v) of phentolamine mesylate; (b) about 1% (w/v) to about 6% (w/v) of at least one polyol compound selected from the group consisting of is mannitol, glycerol, and propylene glycol; (c) about 1 mM to about 6 mM of an alkali metal acetate; and (d) water; wherein the solution has a pH in the range of 4 to 6 and does not contain a chelating agent.
  • a aqueous ophthalmic solution free of a chelating agent comprising: (a) about 0.1% (w/v) to about 2% (w/v) of phentolamine mesylate; (b) about 1% (w/v) to about 6% (w/v) of at least one polyol compound selected from
  • the aqueous ophthalmic solution may be more specifically defined according to the following embodiments.
  • the aqueous ophthalmic solution comprises from about 0.25% (w/v) to about 1% (w/v) of phentolamine mesylate.
  • the aqueous ophthalmic solution comprises from about 1% (w/v) to about 4% (w/v) mannitol.
  • the aqueous ophthalmic solution comprises 4% (w/v) mannitol.
  • the alkali metal acetate is sodium acetate.
  • the aqueous ophthalmic solution comprises 3 mM sodium acetate.
  • the aqueous ophthalmic solution consists of (i) about 0.25% (w/v) to about 1% (w/v) of phentolamine mesylate; (ii) about 1% (w/v) to about 6% (w/v) of one or more polyol compounds selected from the group consisting of mannitol, glycerol, and propylene glycol; (iii) about 1 mM to about 6 mM of an alkali metal acetate; (iv) acetic acid; and (v) water; wherein the solution has a pH in the range of 4 to 6.
  • Another such exemplary solution is an aqueous ophthalmic solution free of a chelating agent comprising: (a) about 0.5% (w/v) to about 2% (w/v) of phentolamine mesylate; (b) about 1% (w/v) to about 6% (w/v) of at least one polyol compound selected from the group consisting of is mannitol, glycerol, and propylene glycol; (c) about 1 mM to about 6 mM of an alkali metal acetate; and (d) water; wherein the solution has a pH in the range of 4.5 to 5.5 and does not contain a chelating agent.
  • a aqueous ophthalmic solution free of a chelating agent comprising: (a) about 0.5% (w/v) to about 2% (w/v) of phentolamine mesylate; (b) about 1% (w/v) to about 6% (w/v) of at least one polyol compound
  • the aqueous ophthalmic solution may be more specifically defined according to the following embodiments.
  • the at least one polyol is mannitol.
  • the aqueous ophthalmic solution comprises from about 1% (w/v) to about 4% (w/v) mannitol.
  • the aqueous ophthalmic solution comprises 4% (w/v) mannitol.
  • the alkali metal acetate is sodium acetate.
  • the aqueous ophthalmic solution comprises 3 mM sodium acetate.
  • the aqueous ophthalmic solution consists of (i) about 0.5% (w/v) to about 2% (w/v) of phentolamine mesylate; (ii) about 1% (w/v) to about 6% (w/v) of one or more polyol compounds selected from the group consisting of mannitol, glycerol, and propylene glycol; (iii) about 1 mM to about 6 mM of an alkali metal acetate;
  • Another such exemplary solution is an aqueous ophthalmic solution free of a chelating agent comprising: (a) about 0.25% (w/v) to about 2% (w/v) of phentolamine mesylate; (b) about 1% (w/v) to about 6% (w/v) of at least one polyol compound selected from the group consisting of is mannitol, glycerol, and propylene glycol; (c) about 1 mM to about 6 mM of an alkali metal acetate; and (d) water; wherein the solution has a pH in the range of 4.5 to 5.5 and does not contain a chelating agent.
  • the aqueous ophthalmic solution may be more specifically defined according to the following embodiments.
  • the aqueous ophthalmic solution comprises from about 0.25% (w/v) to about 1% (w/v) of phentolamine mesylate.
  • the aqueous ophthalmic solution comprises from about 1% (w/v) to about 4% (w/v) mannitol.
  • the aqueous ophthalmic solution comprises 4% (w/v) mannitol.
  • the alkali metal acetate is sodium acetate.
  • the aqueous ophthalmic solution comprises 3 mM sodium acetate.
  • the aqueous ophthalmic solution consists of (i) about 0.5% (w/v) to about 1% (w/v) of phentolamine mesylate; (ii) about 1% (w/v) to about 6% (w/v) of one or more polyol compounds selected from the group consisting of mannitol, glycerol, and propylene glycol; (iii) about 1 mM to about 6 mM of an alkali metal acetate;
  • aqueous ophthalmic solutions are provided in Tables 1-3 below, where in each instance the solution has a pH in the range of 4.7 to 5.1.
  • Another exemplary aqueous ophthalmic solution comprises phentolamine mesylate (e.g., at 1% w/v), mannitol (e.g., at 4% w/v), dextran having a weight average molecular weight of about 70,000 g/mol (e.g., at 0.1% w/v), hydroxypropyl methylcellulose (e.g., at 0.3% w/v), potassium chloride, purified water, sodium borate, and sodium chloride; wherein the solution has a pH in the range of about 4 to about 6. In certain embodiments, the solution has a pH in the range of 4.5 to 5.1.
  • the aqueous ophthalmic solution consists essentially of phentolamine mesylate (e.g., at 1% w/v), mannitol (e.g., at 4% w/v), dextran having a weight average molecular weight of about 70,000 g/mol (e.g., at 0.1% w/v), hydroxypropyl methylcellulose (e.g., at 0.3% w/v), potassium chloride, purified water, sodium borate, and sodium chloride; wherein the solution has a pH in the range of 4 to 6.
  • the aqueous ophthalmic solution consists of phentolamine mesylate (e.g., at 1% w/v), mannitol (e.g., at 4% w/v), dextran having a weight average molecular weight of about 70,000 g/mol (e.g., at 0.1% w/v), hydroxypropyl methylcellulose (e.g., at 0.3% w/v), potassium chloride, purified water, sodium borate, and sodium chloride; wherein the solution has a pH in the range of 4.5 to 5.1.
  • Another exemplary aqueous ophthalmic solution comprises phentolamine mesylate (e.g., at 1% w/v), mannitol (e.g., at 4% w/v), sodium acetate (e.g., at 3 mM), and water, wherein the solution has a pH in the range of about 4 to about 6. In certain embodiments, the solution has a pH in the range of 4.5 to 5.1.
  • the aqueous ophthalmic solution consists essentially of phentolamine mesylate (e.g., at 1% w/v), mannitol (e.g., at 4% w/v), sodium acetate (e.g., at 3 mM), and water, wherein the solution has a pH in the range of 4 to 6.
  • the aqueous ophthalmic solution comprises phentolamine mesylate at 1% w/v, mannitol 4% w/v, sodium acetate at 3 mM, and water, wherein the solution has a pH in the range of 4.5 to 5.1.
  • the aqueous ophthalmic solution consists of phentolamine mesylate (e.g., at 1% w/v), mannitol (e.g., at 4% w/v), sodium acetate (e.g., at 3 mM), and water, wherein the solution has a pH in the range of 4.5 to 5.1.
  • the aqueous ophthalmic solution consists essentially of phentolamine mesylate at 1% w/v, mannitol 4% w/v, sodium acetate at 3 mM, and water, wherein the solution has a pH in the range of 4.5 to 5.1.
  • Yet another exemplary solution is an aqueous ophthalmic solution free of a chelating agent that comprises: (a) about 0.1% (w/v) to about 2% (w/v) of phentolamine mesylate; (b) about 1% (w/v) to about 6% (w/v) of at least one polyol compound selected from the group consisting of is mannitol, glycerol, and propylene glycol; (c) about 1 mM to about 6 mM of an alkali metal acetate; and (d) water; wherein the solution has a pH in the range of 4 to 6 and does not contain a chelating agent.
  • Yet another exemplary solution is an aqueous ophthalmic solution free of a chelating agent that comprises: (a) about 0.25% (w/v) to about 2% (w/v) of phentolamine mesylate; (b) about 3% (w/v) to about 5% (w/v) of mannitol; (c) about 2 mM to about 4 mM of sodium acetate; and (d) water; wherein the solution has a pH in the range of 4.6 to 5.2 and does not contain a chelating agent.
  • Yet another exemplary solution is an aqueous ophthalmic solution free of a chelating agent that comprises: (a) about 0.1% (w/v) to about 2% (w/v) of phentolamine mesylate; (b) about 3% (w/v) to about 5% (w/v) of mannitol; (c) about 2 mM to about 4 mM of sodium acetate; and (d) water; wherein the solution has a pH in the range of 4.6 to 5.2 and does not contain a chelating agent.
  • the aqueous ophthalmic solution free of a chelating agent that comprises about 0.25% (w/v) to about 1% (w/v) of phentolamine mesylate.
  • Yet another exemplary solution is an aqueous ophthalmic solution free of a chelating agent, comprising: (a) about 0.25% (w/v) to about 2% (w/v) of phentolamine mesylate; (b) about 3% (w/v) to about 5% (w/v) of mannitol; (c) about 2 mM to about 4 mM of sodium acetate; and (d) water; wherein the solution has a pH in the range of 4.5 to 5.2 and does not contain a chelating agent.
  • Yet another exemplary solution is an aqueous ophthalmic solution free of a chelating agent that comprises: (a) about 0.5% (w/v) to about 2% (w/v) of phentolamine mesylate; (b) about 3% (w/v) to about 5% (w/v) of mannitol; (c) about 2 mM to about 4 mM of sodium acetate; and (d) water; wherein the solution has a pH in the range of 4.6 to 5.2 and does not contain a chelating agent.
  • Yet another exemplary solution is an aqueous ophthalmic solution free of a chelating agent that comprises: (a) about 0.5% (w/v) to about 1% (w/v) of phentolamine mesylate; (b) about 3% (w/v) to about 5% (w/v) of mannitol; (c) about 1 mM to about 4 mM of sodium acetate; and (d) water; wherein the solution has a pH in the range of 4.6 to 5.2 and does not contain a chelating agent.
  • Yet another exemplary solution is an aqueous ophthalmic solution free of a chelating agent, comprising: (a) about 0.1% (w/v) to about 1% (w/v) of phentolamine mesylate; (b) about 4% mannitol; (c) about 3 mM sodium acetate; and (d) water; wherein the solution has a pH in the range of 4.6 to 5.2 and does not contain a chelating agent.
  • the aqueous ophthalmic solution free of a chelating agent that comprises about 0.25% (w/v) to about 1% (w/v) of phentolamine mesylate.
  • Yet another exemplary solution is an aqueous ophthalmic solution free of a chelating agent, comprising: (a) about 0.5% (w/v) to about 1% (w/v) of phentolamine mesylate; (b) about 4% mannitol; (c) about 3 mM sodium acetate; and (d) water; wherein the solution has a pH in the range of 4.6 to 5.2 and does not contain a chelating agent.
  • Yet another exemplary solution is an aqueous ophthalmic solution free of a chelating agent, comprising: (a) about 0.25% (w/v) to about 2% (w/v) of phentolamine mesylate; (b) about 3% (w/v) to about 5% (w/v) of mannitol; (c) about 2 mM to about 4 mM of a buffer comprising sodium acetate; and (d) water; wherein the solution has a pH in the range of 4.5 to 5.2 and does not contain a chelating agent.
  • Yet another exemplary solution is an aqueous ophthalmic solution free of a chelating agent that comprises: (a) about 0.5% (w/v) to about 2% (w/v) of phentolamine mesylate; (b) about 3% (w/v) to about 5% (w/v) of mannitol; (c) about 2 mM to about 4 mM of a buffer comprising sodium acetate; and (d) water; wherein the solution has a pH in the range of 4.6 to 5.2 and does not contain a chelating agent.
  • Yet another exemplary solution is an aqueous ophthalmic solution free of a chelating agent that comprises: (a) about 0.5% (w/v) to about 1% (w/v) of phentolamine mesylate; (b) about 3% (w/v) to about 5% (w/v) of mannitol; (c) about 1 mM to about 4 mM of a buffer comprising sodium acetate; and (d) water; wherein the solution has a pH in the range of 4.6 to 5.2 and does not contain a chelating agent.
  • Yet another exemplary solution is an aqueous ophthalmic solution free of a chelating agent, comprising: (a) about 0.1% (w/v) to about 1% (w/v) of phentolamine mesylate; (b) about 4% mannitol; (c) about 3 mM of a buffer comprising sodium acetate; and (d) water; wherein the solution has a pH in the range of 4.6 to 5.2 and does not contain a chelating agent.
  • the aqueous ophthalmic solution free of a chelating agent that comprises about 0.25% (w/v) to about 1% (w/v) of phentolamine mesylate.
  • Yet another exemplary solution is an aqueous ophthalmic solution free of a chelating agent, comprising: (a) about 0.5% (w/v) to about 1% (w/v) of phentolamine mesylate; (b) about 4% mannitol; (c) about 3 mM of a buffer comprising sodium acetate; and (d) water; wherein the solution has a pH in the range of 4.6 to 5.2 and does not contain a chelating agent.
  • aqueous ophthalmic solutions described herein may be further characterized according to their stability features, such as the percentage of phentolamine (or
  • aqueous ophthalmic solution after storage for a certain length of time.
  • a pharmaceutically acceptable salt thereof that is present in the aqueous ophthalmic solution after storage for a certain length of time.
  • one of the benefits of the present aqueous ophthalmic solutions is that they possess good stability over extended periods of time, even though they do not have a chelating agent.
  • the aqueous ophthalmic solution is characterized by less than 2% by weight of the phentolamine or pharmaceutically acceptable salt thereof degrades upon storage of the solution at 25°C for 12 weeks. In certain other embodiments, the aqueous ophthalmic solution is characterized by less than 2% by weight of the phentolamine or pharmaceutically acceptable salt thereof degrades upon storage at 25°C for 24 weeks (or 36 weeks or 48 weeks). In yet other embodiments, less than 7% by weight of the phentolamine or pharmaceutically acceptable salt thereof degrades upon storage at 40°C for 12 weeks (or 24, 36, or 48 weeks).
  • the aqueous ophthalmic solution is characterized by less than 10% by weight of the phentolamine or pharmaceutically acceptable salt thereof degrades upon storage at 25°C for 18 months, 24 months, or 36 months. In yet other embodiments, the aqueous ophthalmic solution is characterized by less than 10% by weight of the phentolamine or pharmaceutically acceptable salt thereof degrades upon storage at temperature in the range of 2-8 °C for 18 months, 24 months, or 36 months.
  • the aqueous ophthalmic solution is characterized by less than 4% by weight (or preferably less than 3% by weight) of the phentolamine or pharmaceutically acceptable salt thereof degrades upon storage at 25°C for 18 months, 24 months, or 36 months. In yet other embodiments, less than 10% by weight of the phentolamine or pharmaceutically acceptable salt thereof degrades upon storage at 40°C for 4, 5, or 6 months.
  • Another ophthalmic solution contemplated for use in the present invention is an ophthalmic solution comprising an alpha-adrenergic antagonist (e.g., phentolamine or a pharmaceutically acceptable salt thereof) and a polyvinylpyrrolidone artificial tears composition.
  • an alpha-adrenergic antagonist e.g., phentolamine or a pharmaceutically acceptable salt thereof
  • a polyvinylpyrrolidone artificial tears composition are described in, for example, U.S. Patent Nos. 5,895,654; 5,627,611; and 5,591,426; and U.S. Patent
  • an exemplary polyvinylpyrrolidone artificial tear composition comprises:
  • polyvinylpyrrolidone preferably in the amount of about 0.1-5% by weight of the solution
  • composition is an aqueous solution having isotonic properties.
  • the therapeutic agent(s) may be administered to the patient in the form of a sustained release delivery system.
  • sustained release delivery systems are described in the published literature. Exemplary sustained release delivery systems include intracanalicular inserts, a slow release contact lens, a bio-erodible IVT insert, and an intracameral insert.
  • Inserts may be biodegradable or non-biodegradable.
  • Exemplary materials described in the literature for use in sustained release delivery systems include a mixture of EVA and PVA polymers, a mixture of silicone and PVA polymer, a mixture of polyimide and PVA polymer, a mixture of PMMA and EVA polymers, PLGA polymer, and liposomes.
  • Another aspect of the invention provides a medical kit comprising, for example, (i) a therapeutic agent described herein, and (ii) instructions for treating glaucoma, ocular hypertension, and/or other ocular disorders according to methods described herein.
  • test articles in Table 1 were administered in the form an eye drop to the eye of a healthy human subject having normal intraocular pressure. Intraocular pressure of the subject’s eye was measured before administration of the test article and then again 2-3 hours after administration of test article. TABLE 1.
  • IOP intraocular pressure
  • phentolamine mesylate to reduce intraocular pressure (IOP) in the eye of a human subject having an IOP >22 mmHg may be evaluated according to a clinical study in which an aqueous ophthalmic solution containing phentolamine mesylate is administered to the eye of a patient, and then the patient is evaluated for reduction in intraocular pressure in the eye that received the aqueous ophthalmic solution containing phentolamine mesylate.
  • Clinically significant ocular disease e.g., comeal edema, uveitis, severe
  • cerebrovascular spasm cerebrovascular occlusion, coronary insufficiency, angina, or other evidence suggestive of coronary artery disease.
  • a history of heart rate abnormalities such as tachycardia or arrhythmias.
  • Treatment Groups with a 1: 1 randomization will receive single doses of either: • Placebo Ophthalmic Solution,
  • Doses of study medication are given once daily for one or more weeks; each subject will receive all the treatments.
  • One or more of intraocular pressure, pupil diameter, Best Corrected Distance Visual Acuity (BCDVA), Distance Corrected Near Vision Acuity (DCNVA), Vision questionnaire, and Near Visual Acuity (NVA) will be measured at the screening visit, and throughout the study.
  • phentolamine mesylate to reduce intraocular pressure in the eye of a human subject with bilateral open-angle glaucoma or ocular hypertension may be evaluated according to a clinical study in which an aqueous ophthalmic solution containing phentolamine mesylate is administered to the eye of a patient, and then the patient is evaluated for reduction in intraocular pressure in the eye that received the aqueous ophthalmic solution containing phentolamine mesylate.
  • Experimental procedures and results are described below. Part I - Experimental Procedures
  • BCVA Best-corrected visual acuity
  • Intraocular laser surgery such as laser capsulotomy, laser iridotomy, and/or retinal laser within 1 month prior to Screening Visit in either eye. • Significant media opacity in either eye that would impede adequate posterior segment examination.
  • glaucoma • Other forms of glaucoma such as primary congenital, juvenile onset, chronic angle closure, and secondary glaucoma of any type including steroid-induced, inflammation- induced, or exfoliation glaucoma in either eye. Pigment dispersion syndrome/glaucoma is permitted in either eye.
  • conjunctivitis and non-infective dermatitis are acceptable.
  • Progressive retinal including, but not limited to worsening dry age-related macular degeneration (AMD), presence of active wet AMD, or unstable diabetic retinopathy) or optic nerve disease in either eye from any cause other than glaucoma.
  • AMD dry age-related macular degeneration
  • AMD active wet AMD
  • unstable diabetic retinopathy optic nerve disease in either eye from any cause other than glaucoma.
  • Clinically significant systemic, psychiatric or psychological disease for example, renal, hepatic, uncontrolled diabetes, uncontrolled blood pressure, autoimmune disorders, psychiatric disorders, endocrine disorders, or any other disorders
  • Clinically significant systemic, psychiatric or psychological disease for example, renal, hepatic, uncontrolled diabetes, uncontrolled blood pressure, autoimmune disorders, psychiatric disorders, endocrine disorders, or any other disorders
  • dependency which, in the investigator's judgment, would be unsafe and interfere with interpretation of the study results or the subject's ability to comply with the study requirements.
  • systemic blood pressure within 7 days prior to Baseline/Day 0 e.g., oral anti hypertensives such as sympathomimetic agents, beta-adrenergic blocking agents, alpha agonists, alpha adrenergic blocking agents, calcium channel blockers, angiotensin converting enzyme inhibitors; [diuretics are allowed]
  • oral anti hypertensives such as sympathomimetic agents, beta-adrenergic blocking agents, alpha agonists, alpha adrenergic blocking agents, calcium channel blockers, angiotensin converting enzyme inhibitors; [diuretics are allowed]
  • Baseline/Day 0 for corticosteroids i.e., oral, nasal, topical [dermal, mucosal], and/or inhaled corticosteroids. If there are no further anticipated changes in medications that could affect IOP and/or systemic blood pressure, then once the subject is stable on their new dose of medication for the required time period, the subject may complete the Baseline Visit, assuming that all other screening requirements are met. Medications used on an adjustable or sliding scale based on testing results are allowed.
  • the human subject is assigned to a Treatment Group in random order. There will be two or more Treatment Groups, as set forth in Table 1 below. Subjects enrolled in the study will discontinue use of their ocular hypotensive therapy during the washout period. The duration of the washout period will depend on the subject's pre-study ocular hypotensive therapy.
  • Human subjects shall receive study medication as set forth in Table 1 according to the Treatment Group to which the subject is assigned. Study medication is listed in Table 2. Evaluations of human subjects are performed at the Screening Visit, optionally before treatment on Study Days 0, 7, 14, and 21, and then on Day 28. All human subjects are examined seven days after the last dose for follow-up evaluation.
  • Evaluation of human subjects during the study will include measurement of intraocular pressure, eye redness, heart rate, blood pressure, and any adverse events.
  • the primary efficacy endpoint is reduction in intraocular pressure in the patient’s eye measured at day 28 of the study relative to placebo control.
  • Target enrollment is to enroll at least 40 patients, which will be divided approximately equally among the two or more Treatment Groups.
  • phentolamine mesylate to reduce intraocular pressure in the eye of a human subject with bilateral open-angle glaucoma or ocular hypertension may be evaluated according to a clinical study in which an aqueous ophthalmic solution containing phentolamine mesylate is administered to the eye of a patient, and then the patient is evaluated for reduction in intraocular pressure (IOP) in the eye that received the aqueous ophthalmic solution containing phentolamine mesylate.
  • IOP intraocular pressure
  • IOP after washout from prior IOP-lowering medications is required to be > 20 mmHg at 08:00 hours and > 17 mmHg at 10:00 and 16:00 hours.
  • IOP has to be ⁇ 27 mmHg in both eyes at all qualification time points.
  • the human subject is assigned to a Treatment Group in random order. There will be two Treatment Groups, as set forth in Table 1 below. Human subjects shall receive study medication as set forth in Table 1 according to the Treatment Group to which the subject is assigned. Study medication is listed in Table 2. A period of thirty days is required for washout periods for ocular hypotensive medications prior to study initiation. Evaluations of human subjects may be performed at Screening, Qualification #1, Day 1 / Qualifying #2, Day 15, Day 43, and Day 90. For visits at Day 1, Day 15, Day 43, and Day 90, subjects may be evaluated at 08:00, 10:00, and 16:00 hours within the visit day.
  • Evaluation of human subjects during the study may include measurement of intraocular pressure, eye redness, heart rate, blood pressure, and any adverse events.
  • the primary efficacy endpoint is mean IOP at one or more of the following time points: 08:00, 10:00, and 16:00 hours at Week 2 (Day 15), Week 6 (Day 43), and Month 3 (Day 90).
  • Target enrollment is to enroll at least 200 patients, which will be divided approximately equally among the Treatment Groups.
  • phentolamine mesylate to reduce intraocular pressure in the eye of human subjects with bilateral open-angle glaucoma (OAG) or ocular hypertension (OHT) was evaluated according to a clinical study in which an aqueous ophthalmic solution containing phentolamine mesylate was administered to the eye of a patient, and then the patient was evaluated for reduction in intraocular pressure in the eye that received the aqueous ophthalmic solution containing phentolamine mesylate. Approximately 40 subjects with either OAG or OHT were randomized, for a target of 36 completed subjects.
  • IOP intraocular pressure
  • Glaucoma pseudo-exfoliation or pigment dispersion component, history of angle
  • Refractive surgery in either eye e.g., radial keratotomy, photorefractive keratectomy (PRK), laser-assisted in situ keratomileusis (LASIK), or comeal cross linking.
  • PRK photorefractive keratectomy
  • LASIK laser-assisted in situ keratomileusis
  • Ocular medication in either eye of any kind within 30 days of Screening with the exception of a) ocular hypotensive medications (which had to be washed out), b) lid scrubs (which could be used prior to Screening but could not be used after Screening) or c) lubricating drops for dry eye (preservative-free artificial tears), which could be used throughout the study.
  • a- and/or b-adrenoceptor antagonists e.g., chronic obstructive pulmonary disease or bronchial asthma; abnormally low blood pressure or heart rate; second or third degree heart block or congestive heart failure; or severe diabetes.
  • HR Resting heart rate outside the normal range (50-110 beats per minute) at the Screening or Qualification Visit. HR could be repeated only once if outside the normal range, following at least a 5 minute rest period in the sitting position.
  • BP diastolic blood pressure
  • Subjects with an ophthalmic history of increased IOP were selected for study participation and were screened for study eligibility.
  • eligible subjects if being treated at the time with glaucoma medications, were required to washout and refrain from administration of any glaucoma drugs for at least 28 days and no more than 35 days prior to the Qualification Visit.
  • the washout subjects were brought back at approximately two weeks after starting the washout period for an IOP safety check.
  • IOP eligibility was determined with a Goldmann tonometer using the two-person method (one person physically applies the tonometer, while another reads the result) at 8AM, 10AM, and 4PM (mean IOP at 8 AM must be > 22 mmHg and ⁇ 30 mmHg, and > 19 mmHg at 10AM and 4PM). IOP was measured twice in both eyes at each timepoint and the mean value was used in eligibility assessments. All IOP measurements had a window of ⁇ 15 minutes with at least 2 hours between the 8AM and 10AM assessments.
  • the eye with the higher IOP at the Qualification Visit at 8AM was designated as the study eye for the primary endpoint efficacy analysis. In the case where both eyes had the same IOP, the study eye was the right eye. All treatments were administered to both eyes (OU).
  • HR and BP were measured at 8 AM and 4PM. Blood pressure, using the same arm, same cuff size appropriate for arm circumference throughout the study, and heart rate were measured after at least 3 minutes rest in the sitting position. If HR or BP were outside the normal range (HR ⁇ 50 or >110 beats per minute, resting diastolic blood pressure (BP) > 105 mmHg or systolic BP > 160 mmHg), they could be repeated only once following at least a 5 minute rest period in the sitting position.
  • the subject should be in a seated position and should tilt his or her head backward for administration of the study medication.
  • the bottle of study medication should be held at an almost vertical position above the eye while the lower eyelid is pulled down gently, and 1 drop is placed into the conjunctival cul-de-sac.
  • the tip of the bottle should not touch the eye.
  • the subject After a drop is instilled in each eye, the subject should keep the eyes gently closed for approximately 30 seconds. After successful instillation of the drop in each eye, the subject should carefully empty any remaining contents as directed.
  • the subject was instructed to administer one drop to each eye from a new single unit-dose bottle, each evening of dosing, and close the eyes gently for 30 seconds, then empty the remaining bottle contents (and store the opened bottle in the baggie provided and place it in the medication box for return to the study site at the Day 8 Visit).
  • the subject was instructed to follow the same procedures each subsequent evening of dosing (approximately 24 hours between doses).
  • the medication box, complete with opened bottles and any unopened study medication was to be returned to the study site where the baggies of opened medication were removed, and the study medication box was re-dispensed with the unopened medication.
  • Treatment-study visits occurred twice - on Day 8 ⁇ 1 Day and Day 15 ⁇ 1 Day. IOP evaluations were performed at 8AM, 10AM and 4PM on each of these days. On Study Day 8, the following was performed:
  • IOP measurements were performed at 8AM, 10AM and 4PM. All IOP measurements had a window of ⁇ 15 minutes with at least 2 hours between the 8AM and 10AM assessments. IOP was measured twice in both eyes at each timepoint. The mean value at each timepoint for the study eye was used in efficacy assessments. If the difference in the two IOP measurements was >5 mmHg, a third measurement was obtained, and the three values were averaged.
  • IOP measurements were performed at 8AM, 10AM and 4PM. All IOP measurements had a window of ⁇ 15 minutes with at least 2 hours between the 8AM and 10AM assessments. IOP was measured twice in both eyes at each timepoint. The mean value at each time point for the study eye was used in efficacy assessments. If the difference in the two IOP measurements was >5 mmHg, a third measurement was obtained, and the three values were averaged.
  • a follow-up Visit occurred at 8AM ⁇ 15 minutes on Day 16. Assessments performed at this visit included an IOP measurement at 8AM ⁇ 15 minutes, visual acuity, pupil diameter, and safety measures. More specifically, the following were performed:
  • IOP was measured twice in the study eye at 8AM ⁇ 15 minutes, and the two values were averaged. If the difference in the two IOP measurements was >5 mmHg, a third measurement was obtained, and the three values were averaged.
  • AEs adverse events
  • Visits on Day 8 and 15 were allowed to be 1 day early or late. If the visit was late, the subject was advised to take an additional dose from one of the 2 spare dropper bottles provided in the study medication box the night before the visit. The subject was instructed to then empty the remaining contents and store the opened bottle in the baggie provided and place it in the medication box for return to the study site at their next visit. If the Day 15 Visit occurred one day early or late, the Day 16 Visit and the Day 22 telephone call were adjusted accordingly.
  • Any subject was permitted to voluntarily withdraw from the study at any time without prejudice.
  • a non-completing subject was defined as one who exited the study by their own volition or at the discretion of the Investigator and/or the Medical Monitor prior to completing all of the study procedures required in the protocol.
  • Study subjects received study medication as set forth in Table 1 according to the Treatment Group to which the subject was assigned. Study medication is listed in Table 2.
  • Evaluation of human subjects during the study included measurement of intraocular pressure, eye redness, heart rate, blood pressure, and any adverse events.
  • the primary efficacy endpoint was the change from Baseline to Day 15 in mean diurnal IOP in the study eye.
  • Mean diurnal IOP was the mean of the IOP measurements at all three timepoints (8 AM, 10AM, 4PM).
  • IOP measurements at the Baseline Visit and both Treatment-study Visits were performed at 8AM, 10AM and 4PM. All IOP measurements had a window of ⁇ 15 minutes with at least 2 hours between the 8AM and 10AM assessments.
  • IOP was measured twice in both eyes at each timepoint. The mean value at each timepoint for the study eye was used in efficacy assessments. If the difference in the two IOP measurements was > 5mmHg, a third measurement was obtained, and the three values were averaged.
  • timepoint 8AM, 10AM, 4PM
  • Day 16 8AM
  • BCDVA corrected distance visual acuity
  • DCNVA near visual acuity
  • the primary safety measures were objective biomicroscopic and ophthalmoscopic examination, subjective ocular tolerability, and AEs. Other safety measures were systemic safety as measured by heart rate and blood pressure. Urine pregnancy tests for females of childbearing potential were conducted. Conjunctival hyperemia was measured with a CCLRU card 4-point scale:
  • Moderate (+2) Bright, scarlet red color of the bulbar and palpebral conjunctiva.
  • Severe (+3) Beefy red with petechiae, dark red bulbar and palpebral conjunctiva with evidence of subconjunctival hemorrhage.
  • Biomicroscopy of anterior segment was performed, including evaluation of cornea, conjunctiva and anterior chamber. Fluorescein staining was used.
  • ophthalmoscopy a dilated fundus exam was performed including examination of the optic nerve, macula, vessels and periphery. Blood pressure was measured using the same arm and same cuff size appropriate for arm circumference throughout the study. Blood pressure and heart rate were measured after at least 3 minutes rest in the sitting position.
  • HR or BP were outside the normal range (HR ⁇ 50 or >110 beats per minute, resting diastolic blood pressure (BP) > 105 mmHg or systolic BP > 160 mmHg), they could be repeated only once following at least a 5 minute rest period in the sitting position.
  • Baseline was defined as the pre-dose value from the Baseline Visit/Day 1. If there was no pre-dose value from Day 1, then Baseline was the value from the Screening Visit.
  • IOP was measured twice in both eyes at each timepoint. The mean value at each timepoint for the study eye was used in efficacy assessments. If the difference in the two IOP measurements was >5 mmHg, a third measurement was obtained, and the three values were averaged. The lighting conditions were kept the same from visit to visit.
  • Diurnal IOP was the mean of all three measurements (8 AM, 10AM, and 4PM) on a specific day.
  • the primary efficacy endpoint was the change from Baseline to Day 15 in mean diurnal IOP.
  • the primary efficacy endpoint was analyzed using analysis of covariance (ANCOVA) with change from Baseline to Day 15 in diurnal IOP as the dependent variable; treatment as a factor; and Baseline diurnal IOP as the covariate.
  • ANCOVA was performed using the FAS, with subjects included in their randomized treatment group regardless of the treatment they actually received. Observed case data only was used; that is, any missing Day 15 diurnal IOP was not imputed.
  • LSM least-squares mean
  • SE standard error
  • each of the continuous secondary efficacy endpoints the same ANCOVA for the primary efficacy endpoint was used, with the respective Baseline included as the covariate.
  • Each ANCOVA was performed using the FAS with subjects included in their randomized treatment group regardless of the treatment they actually received. Only observed case data was used; that is, missing values for post-randomization visits were not imputed.
  • the output from each ANCOVA included the LSM and SE for both treatment groups, along with the placebo-corrected LSM, its 95% Cl and associated p-value.
  • Baseline was defined as the pre-dose value from the Baseline Visit/Day. If there was no pre-dose value from Day 1, then Baseline was the value from the Screening Visit.
  • Biomicroscopy results and ophthalmoscopy results were summarized by treatment group using the SP. As both eyes were treated in the study; both eyes were included in the summarizations for visual acuity, biomicroscopy, and ophthalmoscopy. Separate summary tables were created for the study eye versus the fellow eye.
  • Heart rate and blood pressure values and change from Baseline in the values were summarized by treatment group and time point (8AM on Day 8, Day 15 and Day 16; 4PM on Day 15).
  • TEAEs treatment- emergent AEs
  • SAEs serious AEs
  • Tables 4A and 4B The observed reduction in IOP for categories of human subjects is provided in Tables 4A and 4B.
  • Results in Table 4A are from human subjects that received 1% w/w Phentolamine Mesylate Ophthalmic Solution.
  • Results in Table 4B are from human subjects that placebo.
  • the observed change in pupil diameter under phototopic conditions at day 15 in the human subjects is listed in Tables 5 A and 5B.
  • the observed change in pupil diameter under phototopic conditions at day 16 in the human subjects is listed in Tables 6A and 6B.
  • the observed change in pupil diameter under mesopic conditions at day 15 in the human subjects is listed in Table 7A.
  • the observed change in pupil diameter under mesopic conditions at day 16 in the human subjects is listed in Table 7B.
  • Cl Confidence interval. Percentages are the number of subjects achieving the improvement divided by the number of subjects with an assessment at the timepoint.
  • Cl Confidence interval. Percentages are the number of subjects achieving the improvement divided by the number of subjects with an assessment at the timepoint.
  • Percentages are the number of subjects in the category divided by the number of subjects with an examination at the timepoint.
  • Percentages are the number of subjects in the category divided by the number of subjects with an examination at the timepoint.
  • Percentages are the number of subjects in the category divided by the number of subjects with an examination at the timepoint.
  • Percentages are the number of subjects in the category divided by the number of subjects with an examination at the timepoint.
  • Percentages are the number of subjects in the category divided by the number of subjects randomized in the group.
  • an adverse event is defined as an event with a unique subject identification number, system organ class, preferred term, and site. Bilateral ocular events are counted twice, i.e. once for each eye.
  • the clinical study was conducted as a placebo-controlled, randomized, double-masked, 2-arm cross-over, Phase 2b study in 32 randomized human subjects. Approximately one-half of the randomized subjects received phenylephrine 1 hour before treatment with 1% w/w Phentolamine Mesylate Ophthalmic Solution and approximately one-half received tropicamide 1 hour before treatment with 1% w/w Phentolamine Mesylate Ophthalmic Solution. Each subject received the same mydriatic agent throughout the study. Intraocular pressure (IOP) of the subject’s eye was measured before administration of the test article (i.e., placebo or 1% w/w Phentolamine Mesylate Ophthalmic Solution) and then again 2-3 hours and at 6 hours after administration of test article. Study medication is further described in Table 1 below.
  • IOP Intraocular pressure
  • phentolamine mesylate to reduce intraocular pressure in the eye of a human subject with bilateral open-angle glaucoma (OAG) or ocular hypertension (OHT) alone or combination with latanoprost may be evaluated according to a clinical study in which an aqueous ophthalmic solution containing phentolamine mesylate is administered to the eye of a patient in combination with latanoprost, and then the patient is evaluated for reduction in intraocular pressure in the eye that received the phentolamine mesylate and latanoprost.
  • OAG open-angle glaucoma
  • OHT ocular hypertension
  • Subjects with either OAG or OHT may be randomized in a 1 : 1 : 1 ratio to receive (i) 1% w/w Phentolamine Mesylate Ophthalmic Solution Containing 0.005% w/w Latanoprost, (ii) just 1% w/w Phentolamine Mesylate Ophthalmic Solution, or (iii) just 0.005% w/w Latanoprost Ophthalmic Solution once daily in the evening.
  • Efficacy evaluations of intraocular pressure (IOP) are to take place at the Baseline and the Treatment- study Visit days (week 2, week 6, and month 3) at 8AM, 10AM, and 4PM.
  • the study may administer (a) 1% w/w Phentolamine Mesylate Ophthalmic Solution and (b) 0.005% w/w Latanoprost Ophthalmic Solution. Further experimental procedures are provided below.
  • the study is to be configured as a double-masked, active-controlled, parallel-group, randomized clinical trial. Human subjects are to be screened for potential enrollment and, if qualified, enrolled in the study. Eligible patients will have bilateral open-angle glaucoma or ocular hypertension and are aged >18 years with unmedicated IOP between 20 and 36 mmHg (i.e., >20 mmHg and ⁇ 36 mm Hg) in both eyes at 8:00 AM at two qualification visits (2-7 days apart) and between 17 mmHg and 36 mmHg (i.e., an IOP >17 mmHg and ⁇ 36 mm Hg) in both eyes at 10:00 AM and 4:00 PM at the second qualification visit.
  • IOP unmedicated IOP between 20 and 36 mmHg (i.e., >20 mmHg and ⁇ 36 mm Hg) in both eyes at 8:00 AM at two qualification visits (2-7 days apart) and between 17 mmHg and 36 mmHg (i.e.,
  • Exclusion criteria include individuals treated with greater than two ocular hypotensive medications within 30 days of screening, pseudoexfoliation or pigment dispersion glaucoma, a history of iridocorneal angle closure or narrow angles (including previous peripheral iridotomy), previous glaucoma incisional or laser surgery, previous refractive surgery, central corneal thickness >620 pm, or known hypersensitivity or contraindications to phentolamine mesylate or latanoprost (or their excipients).
  • Enrolled patients will be randomized (1 : 1 : 1) via an interactive web-based response system to receive 1% w/w Phentolamine Mesylate Ophthalmic Solution Containing 0.005% w/w Latanoprost 0.005%, only 1% w/w Phentolamine Mesylate Ophthalmic Solution, or only 0.005% w/w Latanoprost Ophthalmic Solution.
  • Each study treatment will be dosed once daily in the evening. Randomization will be stratified by maximum baseline IOP ( ⁇ 25 vs >25 mm Hg). Treatment assignments will be masked to the investigator, clinical study team, and patients. An independent person at the investigative site not responsible for performing any study procedure will be assigned to dispense, collect, and store study treatment.
  • IOP maximum baseline IOP
  • the study may administer (a) 1% w/w Phentolamine Mesylate Ophthalmic Solution and (b) 0.005% w/w Latanoprost Ophthalmic Solution.
  • Exemplary study medication is further described in the following table.
  • An exemplary 0.005% w/w Latanoprost Ophthalmic Solution is, for example, latanoprost ophthalmic solution available commercially under the tradename XALATAN ® , which contains 0.005% w/w latanoprost as a sterile, isotonic, buffered aqueous solution having a pH of approximately 6.7 and an osmolality of approximately 267 mOsmol/kg. Each 1 mL of XALATAN ® solution contains 50 micrograms of latanoprost.
  • Inactive ingredients in the XALATAN ® solution are sodium chloride, sodium dihydrogen phosphate monohydrate, disodium hydrogen phosphate anhydrous, water for injection, and benzalkonium chloride (0.02% w/w) which functions as a preservative.
  • XALATAN ® solution contains approximately 1.5 micrograms of latanoprost.
  • the primary efficacy endpoint is mean IOP at 8:00 AM, 10:00 AM, and 4:00 PM at week 2, week 6, and month 3.
  • Secondary efficacy endpoints include mean diurnal IOP, mean change and mean percent change from diumally adjusted (time-consistent) baseline IOP, and percentages of patients achieving pre-specified thresholds for mean, mean change, and mean percent change in mean diurnal IOP.
  • Both eyes will be treated; the study eye is the eye with higher IOP at 8:00 AM on day 1, or the OD eye if IOP is the same in both eyes.
  • the intent-to- treat population includes all randomized patients who received >1 dose of study medication and is the primary population for efficacy analyses.
  • the per-protocol population is the subset of patients in the intent-to-treat population who will not have major protocol violations and is the secondary population for efficacy analyses.
  • Safety outcomes measures are ocular and systemic adverse events (AEs) during the 3 -month treatment period. Safety outcomes for the total study duration (3 months) will be reported separately. Safety and tolerability will be assessed using patient responses to open- ended questions (e.g.,“How are you feeling?”) and ophthalmic and systemic examinations. Ocular safety assessments, which will be undertaken at all study time points, include symptoms and AEs, best-corrected visual acuity (Early Treatment of Diabetic Retinopathy Study measurement), pupil size, biomicroscopy, pachymetry, visual field and cup-disc ratio measurements, and dilated ophthalmoscopy.
  • AEs ocular and systemic adverse events

Landscapes

  • Health & Medical Sciences (AREA)
  • Chemical & Material Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Medicinal Chemistry (AREA)
  • Pharmacology & Pharmacy (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Epidemiology (AREA)
  • Ophthalmology & Optometry (AREA)
  • Engineering & Computer Science (AREA)
  • Chemical Kinetics & Catalysis (AREA)
  • General Chemical & Material Sciences (AREA)
  • Bioinformatics & Cheminformatics (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Organic Chemistry (AREA)
  • Emergency Medicine (AREA)
  • Molecular Biology (AREA)
  • Oil, Petroleum & Natural Gas (AREA)
  • Biochemistry (AREA)
  • Pharmaceuticals Containing Other Organic And Inorganic Compounds (AREA)
  • Medicines That Contain Protein Lipid Enzymes And Other Medicines (AREA)
  • Medicinal Preparation (AREA)

Abstract

Methods, compositions and kits comprising alpha-adrenergic antagonists, such as phentolamine, for the treatment of glaucoma, ocular hypertension, and/or other ocular disorders, such as non-arteritic anterior ischemic optic neuropathy or keratoconus, are provided. Said methods, compositions and kits may further comprise additional therapeutic agents, including prostaglandin analogues such as latanoprost, beta-adrenergic antagonists, alpha-adrenergic agonists, carbonic anhydrase inhibitors, cholinergic agonists, NMDA receptor antagonist, adenosine receptor antagonists, 5-HT2a receptor agonists, or Rho kinase inhibitors.

Description

METHODS AND COMPOSITIONS FOR TREATMENT OF GLAUCOMA AND
RELATED CONDITIONS
CROSS-REFERENCE TO RELATED APPLICATIONS
[0001] This application claims the benefit of and priority to United States Provisional Patent Application serial number 62/745,806, filed October 15, 2018, and United States Provisional Patent Application serial number 62/752,088, filed October 29, 2018; the contents of each of which are hereby incorporated by reference in their entirety.
FIELD OF THE INVENTION
[0002] The invention provides methods, compositions, and kits containing an alpha- adrenergic antagonist, such as phentolamine, for treating patients suffering from glaucoma, ocular hypertension, and/or other ocular disorders.
BACKGROUND
[0003] Glaucoma is a disease of the eye that often affects the retina and/or optic nerve and, if left untreated, can lead to blindness. Various forms of glaucoma are described in the literature, such as congenital, open-angle, closed-angle, primary, and secondary glaucoma. Prolonged periods of elevated intraocular pressure are a common characteristic of many forms of glaucoma. Such prolonged periods of elevated intraocular pressure can result in irreversible damage to the retina and optic nerve, resulting in progressive, permanent vision loss. Ocular hypertension is a condition characterized by elevated intraocular pressure, and can be present in patients where no apparent vision loss has yet occurred. Treatments that reduce intraocular pressure provide benefits to suffering from ocular hypertension and/or glaucoma.
[0004] Existing drug therapies to reduce intraocular pressure are not effective for all patients and/or have undesirable side effects. For example, certain prostaglandin analogs can cause temporary or permanent darkening or pigmentation of the periorbital skin, eyelashes, and iris hyperemia, and/or ocular itching. Beta blockers can have effects on pulmonary tissue, leading to the possibility of cardiac side effects as well as hypertension, increased reactivity to allergens, and/or decreased visual acuity. Miotic agents, such as pilocarpine, can cause headaches and undesired visual effects, such as blurry vision and visual impairment (e.g., dim, dark,“jumping” vision), which can limit the ability of patients to perform certain activities, such as driving an automobile during low light conditions, such as night time. Certain orally administered carbonic anhydrase inhibitors, such as acetazolamide, can cause metabolic acidosis, fatigue, and/or dyspepsia. Certain compounds having alpha adrenergic agonistic activity (such as brimonidine and trabodenoson) can cause allergic conjunctivitis, hyperemia, and/or itchy eyes. Further, various existing drug therapies for reducing intraocular pressure have the undesired feature that the agents must be administered to the patient more than once a day given due to the relatively short duration efficacy of the drug.
[0005] Additional classes of therapeutic agents that have been described for treatment of glaucoma include rho kinase inhibitors, adenosine receptor agonists, NMDA receptor antagonists, and 5-HT2A receptor agonists. Rho kinase inhibitors can leave comeal deposits (verticillata), reduce the patient’s visual acuity, and/or cause eye redness lasting for a duration of many hours up to a day.
[0006] Bunazosin has been described in the literature as an alpha-adrenoceptor antagonist potentially useful as a therapeutic agent for treatment of glaucoma. See, for example, Hara el al. in Cardiovascular Drug Reviews (2005) vol. 23(1), pages 43-56. It was reported that bunazosin decreased intraocular pressure in patients. Id. However, not all alpha-adrenoceptor antagonists cause a reduction in intraocular pressure in patients. For example, the alpha- adrenoceptor antagonist dapiprazole hydrochloride has been reported to not significantly alter intraocular pressure in normotensive eyes or in eyes with elevated intraocular pressure.
Accordingly, there remains a need for additional safe and effective methods and compositions for treating glaucoma, ocular hypertension, and/or other ocular disorders.
[0007] The present invention addresses the aforementioned need for methods and compositions for treating patients suffering from glaucoma, ocular hypertension, and other ocular disorders while minimizing undesirable side effects, and the invention provides other related advantages.
SUMMARY
[0008] The invention provides methods, compositions, and kits containing an alpha- adrenergic antagonist, such as phentolamine, for treating patients suffering from glaucoma, ocular hypertension, and/or other ocular disorders. The alpha-adrenergic antagonist, such as phentolamine, is administered topically to the eye of the patient, preferably in the form of a liquid aqueous ophthalmic formulation. Desirably the alpha-adrenergic antagonist is administered to the patient once daily in order to reduce intraocular pressure in the eye of the patient, such as to achieve a reduction in intraocular pressure of at least 10%, 20% or more. Such reduction in intraocular pressure due to the alpha-adrenergic antagonist provides therapeutic benefits to patients suffering from glaucoma, ocular hypertension, and/or other ocular disorders. One benefit of therapeutic methods described herein is that the patient may also experience an improvement in visual performance. Such improvement in the patient’s ability to see clearly, as well as ability to distinguish between an object and its background, is a benefit in addition to the therapeutic benefits provided for treating glaucoma, ocular hypertension, and/or other ocular disorders. Exemplary aspects and embodiments of the invention are described below.
[0009] One aspect of the invention provides a method of treating a condition selected from the group consisting of glaucoma, ocular hypertension, and non-arteritic anterior ischemic optic neuropathy in a patient while minimizing eye redness during the patient’s waking hours. The method comprises administering to an eye of a patient in need thereof at or near the bedtime of the patient an effective amount of a once daily dosage of phentolamine or a pharmaceutically acceptable salt thereof to thereby treat the condition. The once daily dosage may be administered to the eye of the patient for, for example, at least three, five, or fourteen consecutive days. One benefit of the dosing protocol is that it minimizes eye redness experienced by the patient during the patient’s waking hours, while achieving a reduction in intraocular pressure that is desirable for treatment of glaucoma and ocular hypertension. In certain embodiments, the once daily dosage contains phentolamine mesylate.
[0010] Another aspect of the invention provides a method of treating a condition selected from the group consisting of glaucoma, ocular hypertension, and non-arteritic anterior ischemic optic neuropathy in a patient according to a monotherapy treatment regimen. The method comprises administering to an eye of a patient in need thereof a dosage of a single therapeutic agent in an amount effective for treatment of said condition, wherein the single therapeutic agent is phentolamine or a pharmaceutically acceptable salt thereof. The daily dosage may be administered to the eye of the patient according to a particular dosing protocol, such as administration to the eye of the patient once per day, which may be, for example, at or near the bed time of the patient. Such dosing protocol may entail for, for example, administering the dosage to the eye of the patient for at least three, five, or fourteen consecutive days. In certain embodiments, the single therapeutic agent is phentolamine mesylate.
[0011] Another aspect of the invention provides a method of treating a condition selected from the group consisting of glaucoma, ocular hypertension, and non-arteritic anterior ischemic optic neuropathy in a patient. The method comprises administering to an eye of a patient in need thereof a dosage of an alpha-adrenergic antagonist in an amount sufficient to achieve a reduction in a symptom or feature of the condition for a duration of at least 8 hours, to thereby treat the condition without at least one of the following adverse events: (a) stinging or burning sensation experienced by the patient upon administration of the alpha-adrenergic antagonist to the eye; or
(b) an increase in eye redness more than two grades measured using the CCLRU Redness Grading Scale compared to the patient’s level of eye redness without receiving the amount of alpha-adrenergic antagonist.
In certain embodiments, the symptom or feature of the condition is intraocular pressure. In certain embodiments, the method achieves a reduction in intraocular pressure in the eye of at least 5%, 10%, or 20% for a duration of at least 12, 18, or 24 hours.
[0012] Another aspect of the invention provides a pharmaceutical composition comprising an alpha-adrenergic antagonist and a second therapeutic agent selected from the group consisting of prostaglandin analog, a beta blocker, an alpha adrenergic agonist, a carbonic anhydrase inhibitor, a cholinergic agonist, NMDA receptor antagonist, adenosine receptor agonist, 5-HT2A receptor agonist, and a Rho kinase inhibitor. Preferably, the pharmaceutical composition is formulated for ophthalmic administration.
[0013] Another aspect of the invention provides a method of treating keratoconus in a patient, wherein the method comprises administering to an eye of a patient in need thereof a therapeutically effective dosage of an alpha-adrenergic antagonist to treat the keratoconus.
BRIEF DESCRIPTION OF FIGURES
[0014] Figure 1 depicts exemplary eye redness as measured according to (1) the CCLRU Redness Grading Scale, and (2) the NYX-OOl Redness Grading Scale.
DETAILED DESCRIPTION OF THE INVENTION
[0015] The invention provides methods, compositions, and kits containing an alpha- adrenergic antagonist, such as phentolamine, for treating patients suffering from glaucoma, ocular hypertension, and/or other ocular disorders. The alpha-adrenergic antagonist, such as phentolamine, is administered topically to the eye of the patient, preferably in the form of a liquid aqueous ophthalmic formulation. Desirably the alpha-adrenergic antagonist is administered to the patient once daily in order to reduce intraocular pressure in the eye of the patient, such as to achieve a reduction in intraocular pressure of at least 10%, 20% or more. Such reduction in intraocular pressure due to the alpha-adrenergic antagonist provides therapeutic benefits to patients suffering from glaucoma, ocular hypertension, and/or other ocular disorders. One benefit of therapeutic methods described herein is that the patient may also experience an improvement in visual performance. Such improvement in the patient’s ability to see clearly, as well as ability to distinguish between an object and its background, is a benefit in addition to the therapeutic benefits provided for treating glaucoma, ocular hypertension, and/or other ocular disorders. Various aspects of the invention are set forth below in sections; however, aspects of the invention described in one particular section are not to be limited to any particular section.
Definitions
[0016] To facilitate an understanding of the present invention, a number of terms and phrases are defined below.
[0017] The terms“a,”“an” and“the” as used herein mean“one or more” and include the plural unless the context is inappropriate.
[0018] As used herein, the term“patient” refers to organisms to be treated by the methods of the present invention. Such organisms preferably include, but are not limited to, mammals (e.g., murines, simians, equines, bovines, porcines, canines, felines, and the like), and most preferably includes humans.
[0019] As used herein, the term“effective amount” refers to the amount of a compound sufficient to effect beneficial or desired results. Unless specified otherwise, an effective amount can be administered in one or more administrations, applications or dosages and is not intended to be limited to a particular formulation or administration route. As used herein, the term“treating” includes any effect, e.g., lessening, reducing, modulating, ameliorating or eliminating, that results in the improvement of the condition, disease, disorder, and the like, or ameliorating a symptom thereof.
[0020] As used herein, the term“pharmaceutical composition” refers to the combination of an active agent with a carrier, inert or active, making the composition especially suitable for therapeutic use in vivo or ex vivo.
[0021] As used herein, the term“pharmaceutically acceptable carrier” refers to any of the standard pharmaceutical carriers, such as a phosphate buffered saline solution, water, emulsions (e.g., such as an oil/water or water/oil emulsions), and various types of wetting agents. The compositions also can include stabilizers and preservatives. For examples of carriers, stabilizers and adjuvants, see Martin in Remington's Pharmaceutical Sciences, 15th Ed., Mack Publ. Co., Easton, PA [1975]
[0022] As used herein, the term“pharmaceutically acceptable salt” refers to any pharmaceutically acceptable salt (e.g., acid or base) of a compound of the present invention which, upon administration to a subject, is capable of providing a compound of this invention. As is known to those of skill in the art,“salts” of the compounds of the present invention may be derived from inorganic or organic acids and bases. Examples of acids include, but are not limited to, hydrochloric, hydrobromic, sulfuric, nitric, perchloric, fumaric, maleic, phosphoric, glycolic, lactic, salicylic, succinic, toluene-p-sulfonic, tartaric, acetic, citric, methanesulfonic, ethanesulfonic, formic, benzoic, malonic, naphthalene-2-sulfonic, benzenesulfonic acid, and the like. Other acids, such as oxalic, while not in themselves pharmaceutically acceptable, may be employed in the preparation of salts useful as intermediates in obtaining the compounds of the invention and their pharmaceutically acceptable acid addition salts.
[0023] Examples of bases include, but are not limited to, alkali metals (e.g., sodium) hydroxides, alkaline earth metals (e.g., magnesium), hydroxides, ammonia, and compounds of formula NW3, wherein W is C1-4 alkyl, and the like.
[0024] Examples of salts include, but are not limited to: acetate, adipate, alginate, aspartate, benzoate, benzenesulfonate, bisulfate, butyrate, citrate, camphorate,
camphorsulfonate, cyclopentanepropionate, digluconate, dodecylsulfate, ethanesulfonate, fumarate, flucoheptanoate, glycerophosphate, hemisulfate, heptanoate, hexanoate,
hydrochloride, hydrobromide, hydroiodide, 2-hydroxyethanesulfonate, lactate, maleate, methanesulfonate (mesylate), 2-naphthalenesulfonate, nicotinate, oxalate, palmoate, pectinate, persulfate, phenylpropionate, picrate, pivalate, propionate, succinate, sulfate, tartrate, thiocyanate, tosylate, undecanoate, and the like. Other examples of salts include anions of the compounds of the present invention compounded with a suitable cation such as Na+, NH4 1. and NW4 + (wherein W is a C1-4 alkyl group), and the like.
[0025] For therapeutic use, salts of the compounds of the present invention are contemplated as being pharmaceutically acceptable. However, salts of acids and bases that are non-pharmaceutically acceptable may also find use, for example, in the preparation or purification of a pharmaceutically acceptable compound.
[0026] The term "alkanoate" is art-recognized and refers to alkyl-C(0)0 .
[0027] The term "alkyl" is art-recognized, and includes saturated aliphatic groups, including straight-chain alkyl groups, branched-chain alkyl groups, cycloalkyl (alicyclic) groups, alkyl substituted cycloalkyl groups, and cycloalkyl substituted alkyl groups. In certain embodiments, a straight chain or branched chain alkyl has about 30 or fewer carbon atoms in its backbone (e.g., C1-C30 for straight chain, C3-C30 for branched chain), and alternatively, about 20 or fewer. Likewise, cycloalkyls have from about 3 to about 10 carbon atoms in their ring structure, and alternatively about 5, 6 or 7 carbons in the ring structure.
[0028] Throughout the description, where compositions and kits are described as having, including, or comprising specific components, or where processes and methods are described as having, including, or comprising specific steps, it is contemplated that, additionally, there are compositions and kits of the present invention that consist essentially of, or consist of, the recited components, and that there are processes and methods according to the present invention that consist essentially of, or consist of, the recited processing steps.
[0029] As a general matter, compositions specifying a percentage are by weight unless otherwise specified. Further, if a variable is not accompanied by a definition, then the previous definition of the variable controls.
I. Therapeutic Methods
[0030] The invention provides methods for treating patients suffering from glaucoma, ocular hypertension, and/or other ocular disorders by administering to the eye of the patient an alpha-adrenergic antagonist, such as phentolamine. The alpha-adrenergic antagonist is administered topically to the eye of the patient, preferably in the form of a liquid aqueous ophthalmic formulation. Various aspects and embodiments of the therapeutic methods are described in the sections below. The sections are arranged for convenience and information in one section is not to be limited to that section, but may be applied to methods in other sections.
A. First Method
[0031] One aspect of the invention provides a method of treating a condition selected from the group consisting of glaucoma, ocular hypertension, and non-arteritic anterior ischemic optic neuropathy in a patient while minimizing eye redness during the patient’s waking hours, wherein the method comprises administering to an eye of a patient in need thereof at or near the bedtime of the patient an effective amount of a once daily dosage of phentolamine or a pharmaceutically acceptable salt thereof to thereby treat the condition.
[0032] The method may be further characterized by additional features, such as the dosing regimen and the identity of the phentolamine or pharmaceutically acceptable salt thereof. The invention embraces all permutations and combinations of these features.
[0033] Accordingly, the method may be further characterized according to the dosing regimen. For example, in certain embodiments, the dosage is administered for at least three consecutive days. In certain embodiments, the dosage is administered for at least seven consecutive days. In certain embodiments, the dosage is administered for at least 14 consecutive days. In certain embodiments, the dosage is administered on at least three days in a five day period. In certain embodiments, the dosage is administered on at least three days in a seven day period. In certain embodiments, the dosage is administered on one day in a three day period. In certain embodiments, the dosage is administered on one day in a five day period.
[0034] The method may be further characterized according to the identity of the dosage.
For example, in certain embodiments, the dosage comprises a pharmaceutically acceptable salt of phentolamine. In certain embodiments, the dosage comprises phentolamine mesylate.
B. Second Method
[0035] Another aspect of the invention provides a method of treating a condition selected from the group consisting of glaucoma, ocular hypertension, and non-arteritic anterior ischemic optic neuropathy in a patient according to a monotherapy treatment regimen, wherein the method comprises administering to an eye of a patient in need thereof a dosage of a single therapeutic agent in an amount effective for treatment of said condition, wherein the single therapeutic agent is phentolamine or a pharmaceutically acceptable salt thereof.
[0036] The method may be further characterized by additional features, such as the dosing regimen and the identity of the single therapeutic agent. The invention embraces all permutations and combinations of these features.
[0037] Accordingly, the method may be further characterized according to the dosing regimen. For example, in certain embodiments, the dosage is administered to the eye of the patient at or near the bedtime of the patient. In certain embodiments, the dosage is
administered at least once daily for at least three consecutive days. In certain embodiments, the dosage is administered at least once daily for at least seven consecutive days. In certain embodiments, the dosage is administered at least once daily for at least 14 consecutive days. In certain embodiments, the dosage is administered on at least three days in a five day period. In certain embodiments, the dosage is administered on at least three days in a seven day period.
In certain embodiments, the dosage is administered on one day in a three day period. In certain embodiments, the dosage is administered on one day in a five day period.
[0038] In certain embodiments, the dosage is administered once per day. In certain other embodiments, the dosage is administered twice, three times, or four times per day.
[0039] The method may be further characterized according to the identity of the single therapeutic agent. For example, in certain embodiments, the single therapeutic agent is a pharmaceutically acceptable salt of phentolamine. In certain embodiments, the single therapeutic agent is phentolamine mesylate.
C. Third Method
[0040] Another aspect of the invention provides a method of treating a condition selected from the group consisting of glaucoma, ocular hypertension, and non-arteritic anterior ischemic optic neuropathy in a patient, wherein the method comprises administering to an eye of a patient in need thereof a dosage of an alpha-adrenergic antagonist in an amount sufficient to achieve a reduction in a symptom or feature of the condition for a duration of at least 8 hours, to thereby treat the condition without at least one of the following adverse events:
(a) stinging or burning sensation experienced by the patient upon administration of the alpha-adrenergic antagonist to the eye; or
(b) an increase in eye redness more than two grades measured using the CCLRU Redness Grading Scale compared to the patient’s level of eye redness without receiving the amount of alpha-adrenergic antagonist.
[0041] In certain embodiments, the stinging or burning sensation is a stinging or burning sensation that lasts for a duration of at least 0.1, 0.5, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 12, 15, 20, or 30 minutes. In certain embodiments, the stinging or burning sensation is a stinging or burning sensation that lasts for a duration of at least 1 minute.
[0042] In certain embodiments, the symptom or feature of the condition is intraocular pressure. In certain embodiments, the method achieves a reduction in intraocular pressure in the eye of at least 5%, 10%, or 20% for a duration of at least 12, 18, or 24 hours.
[0043] Desirably, the alpha-adrenergic antagonist causes a reduction in intraocular pressure.
[0044] In an alternative embodiment, the invention provides a method of treating a condition selected from the group consisting of glaucoma, ocular hypertension, and non- arteritic anterior ischemic optic neuropathy in a patient, wherein the method comprises administering to an eye of a patient in need thereof a dosage of an alpha-adrenergic antagonist in an amount sufficient to achieve a reduction in a symptom or feature of the condition for a duration of at least 8 hours, to thereby treat the condition without at least one of the following adverse events: (a) stinging or burning sensation experienced by the patient at a time that is greater than two minute after administration of the alpha-adrenergic antagonist to the eye; or
(b) an increase in eye redness more than two grades measured using the CCLRU Redness Grading Scale compared to the patient’s level of eye redness without receiving the amount of alpha-adrenergic antagonist.
[0045] In certain embodiments, there is no stinging or burning sensation experienced by the patient at a time that is greater than 3, 4, 5, 6, 7, 8, 9, 10, 15, or 20 minutes after administration of the alpha-adrenergic antagonist to the eye.
[0046] The method may be further characterized by additional features, such as the dosing regimen and the identity of the alpha-adrenergic antagonist. The invention embraces all permutations and combinations of these features.
[0047] Accordingly, the method may be further characterized according to the dosing regimen for the alpha-adrenergic antagonist. For example, in certain embodiments, the alpha- adrenergic antagonist is administered to the eye of the patient at or near the bedtime of the patient. In certain embodiments, the alpha-adrenergic antagonist is administered to the eye of the patient within 1 hour of the patient’s bedtime. In certain embodiments, the alpha- adrenergic antagonist is administered at least once daily for at least three consecutive days. In certain embodiments, the alpha-adrenergic antagonist is administered at least once daily for at least seven consecutive days. In certain embodiments, the alpha-adrenergic antagonist is administered at least once daily for at least 14 consecutive days. In certain embodiments, the dosage is administered once per day. In certain embodiments, the dosage is administered on at least three days in a five day period. In certain embodiments, the dosage is administered on at least three days in a seven day period. In certain embodiments, the dosage is administered on one day in a three day period. In certain embodiments, the dosage is administered on one day in a five day period.
[0048] In certain other embodiments, the dosage is administered twice, three times, or four times per day.
[0049] The method may be further characterized according to the dosage of alpha- adrenergic antagonist. For example, in certain embodiments, the dosage of alpha-adrenergic antagonist is an amount sufficient to achieve a reduction in a symptom or feature of the condition for a duration of at least 12 hours, to thereby treat the condition without any of the following adverse events: (a) stinging or burning sensation experienced by the patient upon administration of the alpha-adrenergic antagonist to the eye; and (b) an increase in eye redness more than two grades measured using the CCLRU Redness Grading Scale compared to the patient’s level of eye redness without receiving the amount of alpha-adrenergic antagonist. In certain other embodiments, the dosage of alpha-adrenergic antagonist is an amount sufficient to achieve a reduction in a symptom or feature of the condition for a duration of at least 24 hours, to thereby treat the condition without any of the following adverse events: (a) stinging or burning sensation experienced by the patient upon administration of the alpha-adrenergic antagonist to the eye; and (b) an increase in eye redness more than two grades measured using the CCLRU Redness Grading Scale compared to the patient’s level of eye redness without receiving the amount of alpha-adrenergic antagonist.
[0050] The method may be further characterized according to the identity of the alpha- adrenergic antagonist. For example, in certain embodiments, the alpha-adrenergic antagonist is phentolamine, phenoxybenzamine, tolazoline, trazodone, alfuzosin, doxazosin, prazosin, tamsulosin, terazosin, silodosin, atipamezole, idazoxan, mirtazapine, yohimbine, fenoldopam, thymoxamine, or a pharmaceutically acceptable salt of any of the foregoing. In certain embodiments, the alpha-adrenergic antagonist is phentolamine or a pharmaceutically acceptable salt thereof. In certain embodiments, the alpha-adrenergic antagonist is a pharmaceutically acceptable salt of phentolamine. In certain embodiments, the alpha- adrenergic antagonist is phentolamine mesylate. In certain embodiments, the alpha-adrenergic antagonist is fenoldopam mesylate.
[0051] In certain embodiments, the alpha-adrenergic antagonist is a non-selective alpha- adrenergic antagonist. In certain embodiments, the alpha-adrenergic antagonist is a reversible, non-selective alpha-adrenergic antagonist.
[0052] In certain embodiments, the alpha-adrenergic antagonist is characterized according to its activity towards certain alpha-adrenergic receptors. Accordingly, in certain embodiments, the alpha-adrenergic antagonist has antagonist activity towards an alpha-l adrenergic receptor. Activity toward the alpha-l adrenergic receptor may be further characterized according to whether there is activity toward one or more of the alpha-l adrenergic receptor subtypes (e.g., alpha-l A, alpha- 1B, and alpha- 1D). Accordingly, in certain embodiments, the alpha- adrenergic antagonist has antagonist activity towards the alpha-l A adrenergic receptor. In certain embodiments, the alpha-adrenergic antagonist has antagonist activity towards the alpha- 1B adrenergic receptor. In certain embodiments, the alpha-adrenergic antagonist has antagonist activity towards the alpha- 1D adrenergic receptor. In certain embodiments, the alpha- adrenergic antagonist has antagonist activity towards each of the alpha-l adrenergic receptor subtypes. [0053] In certain embodiments, the alpha-adrenergic antagonist has antagonist activity towards an alpha-2 adrenergic receptor. Activity toward the alpha-2 adrenergic receptor may be further characterized according to whether there is activity toward one or more of the alpha- 2 adrenergic receptor subtypes (e.g., alpha-2A, alpha-2B, and alpha-2C). Accordingly, in certain embodiments, the alpha-adrenergic antagonist has antagonist activity towards the alpha- 2A adrenergic receptor. In certain embodiments, the alpha-adrenergic antagonist has antagonist activity towards the alpha-2B adrenergic receptor. In certain embodiments, the alpha-adrenergic antagonist has antagonist activity towards the alpha-2C adrenergic receptor.
In certain embodiments, the alpha-adrenergic antagonist has antagonist activity towards each of the alpha-2 adrenergic receptor subtypes.
[0054] The alpha-adrenergic antagonist may be characterized according to its activity towards (i) an alpha- 1 adrenergic receptor versus (ii) an alpha-2 adrenergic receptor. In certain embodiments, the alpha-adrenergic antagonist has antagonist activity at both (i) an alpha- 1 adrenergic receptor and (ii) an alpha-2 adrenergic receptor. In certain embodiments, the alpha- adrenergic antagonist has antagonist activity at (i) an alpha- 1 adrenergic receptor but not (ii) an alpha-2 adrenergic receptor. In certain embodiments, the alpha-adrenergic antagonist has antagonist activity at (i) an alpha-2 adrenergic receptor but not (ii) an alpha-l adrenergic receptor. In certain embodiments, the inhibitory activity (as, for example, measured by an IC50 value) of the alpha-adrenergic antagonist is at least 10-fold greater towards (i) the alpha-l adrenergic receptor compared to the (ii) alpha-2 adrenergic receptor. In certain embodiments, the inhibitory activity (as, for example, measured by an IC50 value) of the alpha-adrenergic antagonist is at least 10-fold greater towards (i) the alpha-2 adrenergic receptor compared to (ii) the alpha-l adrenergic receptor.
D. Fourth Method
[0055] Another aspect of the invention provides a method of treating a condition selected from the group consisting of glaucoma, ocular hypertension, and non-arteritic anterior ischemic optic neuropathy in a patient, wherein the method comprises administering to an eye of a patient in need thereof a therapeutically effective dosage of an alpha-adrenergic antagonist and a second therapeutic agent selected from the group consisting of prostaglandin analog, a beta blocker, an alpha adrenergic agonist, a carbonic anhydrase inhibitor, a cholinergic agonist, NMD A receptor antagonist, adenosine receptor agonist, 5-HT2A receptor agonist, and a Rho kinase inhibitor, to thereby treat the condition. [0056] The method may be further characterized by additional features, such as the dosing regimen and the identity of the alpha-adrenergic antagonist, and the identity of the second therapeutic agent. The invention embraces all permutations and combinations of these features.
[0057] Accordingly, the method may be further characterized according to the dosing regimen for the alpha-adrenergic antagonist. For example, in certain embodiments, the alpha- adrenergic antagonist is administered once per day. In certain embodiments, the alpha- adrenergic antagonist is administered two times, three times, or four times per day.
[0058] The method may be further characterized according to the identity of the second therapeutic agent. For example, in certain embodiments, the second therapeutic agent is selected from the group consisting of latanoprost, bimatoprost, travoprost, tafluprost, latanoprostene bunod, timolol, brimonidine, dorzolamide, brinzolamide, acetazolamide, methazolamide, pilocarpine, netarsudil, ripasudil, AMA0076, trabodenoson, BOL-303259-X, ONO-9054, or a pharmaceutically acceptable salt of any one of the foregoing. In certain embodiments, the second therapeutic agent is selected from the group consisting of latanoprost, bimatoprost, travoprost, tafluprost, latanoprostene bunod, timolol, brimonidine, dorzolamide, brinzolamide, acetazolamide, methazolamide, pilocarpine, netarsudil, ripasudil, AMA0076, trabodenoson, BOL-303259-X, ONO-9054, carbachol, aceclidine, oxotremorine, or a pharmaceutically acceptable salt of any one of the foregoing. In certain embodiments, the second therapeutic agent is selected from the group consisting of latanoprost, timolol, netarsudil, or a pharmaceutically acceptable salt of any one of the foregoing. In certain embodiments, the second therapeutic agent is betaxolol, apraclonidine, brinzolamide, unoprostone, levobunolol, carteolol, metipranolol, carbachol, ecothiophate iodide, omidenepag isopropyl (an EP2 agonist), sepetaprost, NO-bimatoprost, H-1337 (a leucine-rich repeat kinase inhibitor), or a pharmaceutically acceptable salt of any one of the foregoing. In certain embodiments, the second therapeutic agent is latanoprost. In certain embodiments, the second therapeutic agent is latanoprost administered at a daily dose of about 1.5 micrograms.
[0059] The method may be further characterized according to the identity of the alpha- adrenergic antagonist. For example, in certain embodiments, the alpha-adrenergic antagonist is phentolamine, phenoxybenzamine, tolazoline, trazodone, alfuzosin, doxazosin, prazosin, tamsulosin, terazosin, silodosin, atipamezole, idazoxan, mirtazapine, yohimbine, fenoldopam, thymoxamine, or a pharmaceutically acceptable salt of any of the foregoing. In certain embodiments, the alpha-adrenergic antagonist is phentolamine or a pharmaceutically acceptable salt thereof. In certain embodiments, the alpha-adrenergic antagonist is a pharmaceutically acceptable salt of phentolamine. In certain embodiments, the alpha- adrenergic antagonist is phentolamine mesylate.
E. Fifth Method
[0060] Another aspect of the invention provides a method of treating keratoconus in a patient, wherein the method comprises administering to an eye of a patient in need thereof a therapeutically effective dosage of an alpha-adrenergic antagonist to treat the keratoconus.
[0061] The method may be further characterized by additional features, such as the dosing regimen and the identity of the alpha-adrenergic antagonist, and the identity of any second therapeutic agent. The invention embraces all permutations and combinations of these features.
[0062] Accordingly, the method may be further characterized according to the dosing regimen for the alpha-adrenergic antagonist. For example, in certain embodiments, the alpha- adrenergic antagonist is administered once per day. In certain embodiments, the alpha- adrenergic antagonist is administered two times, three times, or four times per day.
[0063] In certain embodiments, the dosage is administered to the eye of the patient at or near the bedtime of the patient. In certain embodiments, the dosage is administered to the eye of the patient within 1 hour of the patient’s bedtime.
[0064] In certain embodiments, the alpha-adrenergic antagonist is a pharmaceutically acceptable salt of phentolamine. In certain embodiments, the alpha-adrenergic antagonist is phentolamine mesylate.
F. Additional Methods
[0065] Additional therapeutic methods are provided below. The methods may be further characterized by additional features, such as the dosing regimen and the identity of the alpha- adrenergic antagonist.
[0066] One aspect of the invention provides a method of improving visual performance in a patient suffering from a disorder selected from the group consisting of glaucoma, elevated intraocular pressure, and a combination thereof, wherein the method comprises administering to an eye of a patient in need thereof a therapeutically effective dosage of an alpha-adrenergic antagonist to thereby improve visual performance and treat the disorder. In certain
embodiments, the disorder is glaucoma.
[0067] Another aspect of the invention provides a method of improving visual
performance and reducing intraocular pressure in a patient suffering from a disorder selected from the group consisting of glaucoma, elevated intraocular pressure, and a combination thereof, wherein the method comprises administering to an eye of a patient in need thereof a therapeutically effective dosage of an alpha-adrenergic antagonist to thereby improve visual performance, reduce intraocular pressure, and treat the disorder. In certain embodiments, the disorder is glaucoma.
[0068] Another aspect of the invention provides a method of improving visual performance in a patient suffering from keratoconus, wherein the method comprises administering to an eye of a patient in need thereof an effective amount of an alpha-adrenergic antagonist to thereby improve visual performance. In certain embodiments, the alpha- adrenergic antagonist is a pharmaceutically acceptable salt of phentolamine. In certain embodiments, the alpha-adrenergic antagonist is phentolamine mesylate.
[0069] Another aspect of the invention provides a method of improving visual performance and reducing pupil diameter in a patient suffering from a disorder selected from the group consisting of glaucoma, elevated intraocular pressure, and a combination thereof, wherein the method comprises administering to an eye of a patient in need thereof a therapeutically effective dosage of an alpha-adrenergic antagonist to thereby improve visual performance, reduce pupil diameter, and treat the disorder. In certain embodiments, the disorder is glaucoma.
[0070] Another aspect of the invention provides a method of reducing intraocular pressure and reducing pupil diameter in a patient suffering from a disorder selected from the group consisting of glaucoma, elevated intraocular pressure, and a combination thereof, wherein the method comprises administering to an eye of a patient in need thereof a therapeutically effective dosage of an alpha-adrenergic antagonist to thereby reduce intraocular pressure, reduce pupil diameter, and treat the disorder. In certain embodiments, the disorder is glaucoma.
[0071] Another aspect of the invention provides a method of treating glaucoma and achieving one or more of improving visual performance, reducing intraocular pressure, and reducing pupil diameter in a patient suffering from glaucoma, wherein the method comprises administering to an eye of a patient in need thereof a therapeutically effective dosage of an alpha-adrenergic antagonist to thereby treat the glaucoma and achieve one or more of improving visual performance, reducing intraocular pressure, and reducing pupil diameter in the patient. [0072] Another aspect of the invention provides a method of treating glaucoma and elevated intraocular pressure and optionally improving visual performance in a patient, wherein the method comprises administering to an eye of a patient in need thereof a therapeutically effective dosage of an alpha-adrenergic antagonist to thereby treat the glaucoma and elevated intraocular pressure and optionally improve visual performance in the patient. In certain embodiments, the method improves visual performance.
[0073] The methods may be further characterized according to, for example, the improvement in visual performance. In certain embodiments, the improvement in visual performance is near-distance improvement in visual performance. In certain embodiments, the improvement in visual performance is improvement in visual performance at a distance. In certain embodiments, the improvement in visual performance is an improvement in visual acuity. In certain embodiments, the improvement in visual performance is an improvement in contrast sensitivity.
[0074] The methods may be further characterized according to, for example,
characteristics of the patient. In certain embodiments, the patient has poor visual performance at a near distance. In certain embodiments, the patient has poor visual performance at a far distance.
G. Additional Optional Features of First, Third, and Fifth Therapeutic Methods
[0075] Additional optional features of the first, third, and fifth therapeutic methods include administering a second therapeutic agent. Accordingly, in certain embodiments, the method further comprises administering to the eye of the patient a second therapeutic agent selected from the group consisting of a prostaglandin analog, a beta blocker, an alpha adrenergic agonist, a carbonic anhydrase inhibitor, a cholinergic agonist, NMDA receptor antagonist, adenosine receptor agonist, 5-HT2A receptor agonist, and a Rho kinase inhibitor. In certain other embodiments, the method further comprises administering to the eye of the patient a second therapeutic agent selected from the group consisting of latanoprost, bimatoprost, travoprost, tafluprost, latanoprostene bunod, timolol, brimonidine, dorzolamide, brinzolamide, acetazolamide, methazolamide, pilocarpine, netarsudil, ripasudil, AMA0076, trabodenoson, BOL-303259-X, ONO-9054, or a pharmaceutically acceptable salt of any one of the foregoing. In certain other embodiments, the method further comprises administering to the eye of the patient a second therapeutic agent selected from the group consisting of latanoprost, bimatoprost, travoprost, tafluprost, latanoprostene bunod, timolol, brimonidine, dorzolamide, brinzolamide, acetazolamide, methazolamide, pilocarpine, netarsudil, ripasudil, AMA0076, trabodenoson, BOL-303259-X, ONO-9054, carbachol, aceclidine, oxotremorine, or a pharmaceutically acceptable salt of any one of the foregoing. In certain other embodiments, the method further administering to the eye of the patient a second therapeutic agent selected from the group consisting of betaxolol, apraclonidine, brinzolamide, unoprostone, levobunolol, carteolol, metipranolol, carbachol, ecothiophate iodide, omidenepag isopropyl, sepetaprost, NO-bimatoprost, and H-1337, or a pharmaceutically acceptable salt of any one of the foregoing. In certain embodiments, the second therapeutic agent is latanoprost. In certain embodiments, the second therapeutic agent is latanoprost administered at a daily dose of about 1.5 micrograms.
[0076] In certain embodiments, the method further comprises administering to the eye of the patient an additional therapeutic agent, such as an alpha-adrenergic antagonist.
Accordingly, in certain embodiments, the method further comprises administering to the eye of the patient an additional therapeutic agent that is an alpha-adrenergic antagonist. In certain embodiments, the additional therapeutic agent is bunazosin or a pharmaceutically acceptable salt thereof. Bunazosin is a compound featuring greater inhibitory activity towards (i) the alpha- 1 adrenergic receptor compared to the (ii) alpha-2 adrenergic receptor.
H. General Considerations for Therapeutic Methods
[0077] General considerations that may be applied to therapeutic methods described herein (e.g., the methods described in Parts A-G above) are provided below and include, for example, the degree of eye redness, the amount of phentolamine or pharmaceutically acceptable salt thereof in the dosage, the reduction in intraocular pressure in the eye due to the administering, the duration of reduction in intraocular pressure, the condition being treated, and patient populations that may derive particular benefits from the therapeutic methods. A more thorough description of such features is provided below. The invention embraces all permutations and combinations of these features.
Degree of Eye Redness
[0078] The methods may be further characterized according to the degree of eye redness the patient experiences. The degree of eye redness can be evaluated and characterized using procedures described in the literature, such as the Cornea and Contact Lens Research Unit (CCLRU) Redness Grading Scale developed by the School of Optometry, University of New South Wales. See, for example, Terry et al. in Optom. Vis. Sci. (1993) vol. 70, pages 234-243; and Pult et al. in Ophthal. Physiol. Opt. (2008) vol. 28, pages 13-20. The CCLRU Redness Grading Scale evaluates eye redness on a four-point scale: (0) no eye redness, (1) very slight eye redness, (2) slight eye redness, (3) moderate eye redness, and (4) severe eye redness. See Figure 1 for an illustration of the eye redness scale.
[0079] In certain embodiments, the patient experiences an increase in eye redness of no more than two grades measured using the CCLRU Redness Grading Scale during the patient’s waking hours compared to the patient’s level of eye redness without receiving said dosage. In certain embodiments, the patient experiences an increase in eye redness of no more than one grade measured using the CCLRU Redness Grading Scale during the patient’s waking hours compared to the patient’s level of eye redness without receiving said dosage. In certain embodiments, any increase in eye redness experienced by the patient is less than one grade measured using the CCLRU Redness Grading Scale during the patient’s waking hours compared to the patient’s level of eye redness without receiving said dosage.
Dosage of Phentolamine or Pharmaceutically Acceptable Salt Thereof
[0080] The methods may be further characterized according to the amount of phentolamine or pharmaceutically acceptable salt thereof in the dosage. For example, in certain
embodiments, the dosage contains from about 0.1 mg to about 2.0 mg of phentolamine or a pharmaceutically acceptable salt thereof. In certain embodiments, the dosage contains from about 0.5 mg to about 1.0 mg of phentolamine or a pharmaceutically acceptable salt thereof. In certain other embodiments, the dosage contains from about 0.1 mg to about 2.0 mg of phentolamine mesylate. In certain embodiments, the dosage contains from about 0.3 mg to about 0.7 mg of phentolamine mesylate. In certain embodiments, the dosage contains about 0.5 mg of phentolamine mesylate. In certain other embodiments, the dosage contains from about 0.8 mg to about 1.2 mg of phentolamine mesylate. In certain embodiments, the dosage contains about 1 mg of phentolamine mesylate.
[0081] The dosage of phentolamine or a pharmaceutically acceptable salt thereof is desirably administered to the eye of the patient in the form of an ophthalmic solution, which is delivered to the eye in the form of eye drop. A standard eye drop typically contains from about 0.03 mL to about 0.05 mL of solution. [0082] In certain embodiments, the dosage may be in the form of an aqueous ophthalmic solution. For example, in certain embodiments, the dosage is an aqueous ophthalmic solution free of a chelating agent containing:
(a) about 0.1% (w/v) to about 2% (w/v) of phentolamine mesylate;
(b) about 1% (w/v) to about 6% (w/v) of at least one polyol compound selected from the group consisting of mannitol, glycerol, and propylene glycol;
(c) about 1 mM to about 6 mM of an alkali metal acetate; and
(d) water;
wherein the solution has a pH in the range of 4 to 6 and does not contain a chelating agent.
[0083] In certain embodiments, the dosage is an aqueous ophthalmic solution free of a chelating agent containing:
(a) about 0.5% (w/v) to about 2% (w/v) of phentolamine mesylate;
(b) about 1% (w/v) to about 6% (w/v) of at least one polyol compound selected from the group consisting of mannitol, glycerol, and propylene glycol;
(c) about 1 mM to about 6 mM of an alkali metal acetate; and
(d) water;
wherein the solution has a pH in the range of 4.5 to 5.5 and does not contain a chelating agent.
[0084] In certain embodiments, the at least one polyol is mannitol. In certain
embodiments, the solution contains 4% (w/v) mannitol. In certain embodiments, the alkali metal acetate is sodium acetate. In certain embodiments, the solution comprises 3 mM sodium acetate.
[0085] In certain embodiments, the dosage is an aqueous ophthalmic solution free of a chelating agent containing:
(a) about 0.25% (w/v) to about 2% (w/v) of phentolamine mesylate;
(b) about 3% (w/v) to about 5% (w/v) of mannitol;
(c) about 2 mM to about 4 mM of sodium acetate; and
(d) water;
wherein the solution has a pH in the range of 4.5 to 5.2 and does not contain a chelating agent. [0086] In certain embodiments, the dosage is an aqueous ophthalmic solution free of a chelating agent containing:
(a) about 0.5% (w/v) to about 2% (w/v) of phentolamine mesylate;
(b) about 3% (w/v) to about 5% (w/v) of mannitol;
(c) about 2 mM to about 4 mM of sodium acetate; and
(d) water;
wherein the solution has a pH in the range of 4.6 to 5.2 and does not contain a chelating agent.
[0087] In certain embodiments, the dosage is an aqueous ophthalmic solution free of a chelating agent containing:
(a) about 0.5% (w/v) to about 1% (w/v) of phentolamine mesylate;
(b) about 4% mannitol;
(c) about 3 mM sodium acetate; and
(d) water;
wherein the solution has a pH in the range of 4.6 to 5.2 and does not contain a chelating agent.
[0088] In certain embodiments, the dosage is an aqueous ophthalmic solution containing:
(a) about 0.25% (w/v) to about 2% (w/v) of phentolamine mesylate;
(b) about 3% (w/v) to about 5% (w/v) of mannitol;
(c) about 1 mM to about 6 mM of sodium acetate; and
(d) water;
wherein the solution has a pH in the range of 4.5 to 5.2 and does not contain any additional component that is a chelating agent.
[0089] In certain embodiments, the dosage is an aqueous ophthalmic solution containing:
(a) about 1% (w/v) of phentolamine mesylate;
(b) about 3% (w/v) to about 5% (w/v) of mannitol;
(c) about 2 mM to about 4 mM of a buffer comprising sodium acetate; and
(d) water;
wherein the solution has a pH in the range of 4.5 to 5.2 and does not contain any additional component that is a chelating agent.
[0090] In certain embodiments, the dosage is an aqueous ophthalmic solution containing: (a) about 0.25% (w/v) to about 2% (w/v) of phentolamine mesylate; (b) about 3% (w/v) to about 5% (w/v) of mannitol;
(c) about 2 mM to about 4 mM of sodium acetate; and
(d) water;
wherein the solution has a pH in the range of 4.5 to 5.2 and does not contain any additional component that is a chelating agent.
[0091] In certain embodiments, the dosage is an aqueous ophthalmic solution containing:
(a) about 0.5% (w/v) to about 2% (w/v) of phentolamine mesylate;
(b) about 3% (w/v) to about 5% (w/v) of mannitol;
(c) about 2 mM to about 4 mM of a buffer comprising sodium acetate; and
(d) water;
wherein the solution has a pH in the range of 4.6 to 5.2 and does not contain any additional component that is a chelating agent.
[0092] In certain embodiments, the dosage is an aqueous ophthalmic solution containing:
(a) about 0.5% (w/v) to about 1% (w/v) of phentolamine mesylate;
(b) about 4% mannitol;
(c) about 3 mM of a buffer comprising sodium acetate; and
(d) water;
wherein the solution has a pH in the range of 4.6 to 5.2 and does not contain any additional component that is a chelating agent.
[0093] In certain embodiments, the dosage is an aqueous ophthalmic solution comprising: (a) about 1% (w/v) of phentolamine mesylate; (b) about 4% (w/v) mannitol; (c) about 3 mM of a buffer comprising sodium acetate; and (d) water; wherein the solution has a pH in the range of 4.5 to 5.5 and does not contain any additional component that is a chelating agent.
[0094] In certain embodiments, the dosage is an aqueous ophthalmic solution free of a chelating agent comprising: (a) about 1% (w/v) of phentolamine mesylate; (b) about 4% (w/v) mannitol; (c) about 3 mM of a buffer comprising sodium acetate; and (d) water; wherein the solution has a pH in the range of 4.0 to 7.5 and does not contain a chelating agent.
Reduction in Intraocular Pressure in the Eye
[0095] The methods may be further characterized according to the reduction in intraocular pressure in the eye due to the administering. For example, in certain embodiments, the patient experiences at least a 5% reduction in intraocular pressure in the eye due to the administering. In certain embodiments, the patient experiences at least a 10% reduction in intraocular pressure in the eye due to the administering. In certain embodiments, the patient experiences at least a 15% reduction in intraocular pressure in the eye due to the administering. In certain embodiments, the patient experiences at least a 20% reduction in intraocular pressure in the eye due to the administering. In certain embodiments, the patient experiences at least a 25% reduction in intraocular pressure in the eye due to the administering. In certain embodiments, the patient experiences at least a 30% reduction in intraocular pressure in the eye due to the administering.
[0096] In certain embodiments, the patient experiences at least a 1 mmHg reduction in intraocular pressure in the eye due to the administering. In certain embodiments, the patient experiences at least a 2 mmHg reduction in intraocular pressure in the eye due to the administering. In certain embodiments, the patient experiences at least a 3 mmHg reduction in intraocular pressure in the eye due to the administering. In certain embodiments, the patient experiences at least a 4 mmHg reduction in intraocular pressure in the eye due to the administering. In certain embodiments, the patient experiences at least a 5 mmHg reduction in intraocular pressure in the eye due to the administering. In certain embodiments, the patient experiences at least a 6 mmHg reduction in intraocular pressure in the eye due to the administering. In certain embodiments, the patient experiences at least a 7 mmHg reduction in intraocular pressure in the eye due to the administering. In certain embodiments, the patient experiences at least an 8 mmHg reduction in intraocular pressure in the eye due to the administering.
[0097] In certain embodiments, the patient experiences reduction in intraocular pressure in the eye in the range of from about 1 mmHg to about 5 mmHg due to the administering. In certain embodiments, the patient experiences reduction in intraocular pressure in the eye in the range of from about 5 mmHg to about 10 mmHg due to the administering. In certain embodiments, the patient experiences reduction in intraocular pressure in the eye in the range of from about 10 mmHg to about 15 mmHg due to the administering. In certain embodiments, the patient experiences reduction in intraocular pressure in the eye in the range of from about 4 mmHg to about 8 mmHg due to the administering. In certain embodiments, the patient experiences reduction in intraocular pressure in the eye in the range of from about 8 mmHg to about 12 mmHg due to the administering.
Duration of Reduction in Intraocular Pressure
[0098] The methods may be further characterized according to the duration of reduction in intraocular pressure. For example, in certain embodiments, the reduction lasts for a duration of at least 12 hours. In certain embodiments, the reduction lasts for a duration of at least 24 hours. In certain embodiments, the reduction lasts for a duration of at least 2 days. In certain embodiments, the reduction lasts for a duration of at least 5 days. In certain embodiments, the reduction lasts for a duration of at least 7 days. In certain embodiments, the reduction lasts for a duration of at least 10, 14, 21, or 28 days.
[0099] In certain embodiments, the reduction lasts for a duration of from about 5 to about 24 hours. In certain embodiments, the reduction lasts for a duration of from about 12 to about 24 hours. In certain embodiments, the reduction lasts for a duration of from about 1 day to about 3 days. In certain embodiments, the reduction lasts for a duration of from about 3 days to about 5 days. In certain embodiments, the reduction lasts for a duration of from about 5 days to about 7 days. In certain embodiments, the reduction lasts for a duration of from about 7 days to about 14 days.
Condition Being Treated
[00100] The methods may be further characterized according to the condition being treated. For example, in certain embodiments, the condition is glaucoma. In certain other
embodiments, the glaucoma is congenital glaucoma. In certain other embodiments, the glaucoma is open-angle glaucoma. In certain other embodiments, the glaucoma is closed-angle glaucoma. In certain other embodiments, the glaucoma is primary glaucoma. In certain other embodiments, the glaucoma is secondary glaucoma. In certain other embodiments, the glaucoma is pigmentary glaucoma, pseudoexfoliative glaucoma, traumatic glaucoma, neovascular glaucoma, uveitic glaucoma, or glaucoma due to irido comeal endothelial syndrome. In certain other embodiments, the glaucoma is normal tension glaucoma.
[00101] In certain embodiments, the condition is ocular hypertension. In certain
embodiments, the condition is ocular hypertension after surgery.
[00102] In certain embodiments, the condition is keratoconus. In certain embodiments, the condition is non-arteritic anterior ischemic optic neuropathy.
Patient Populations That May Derive Particular Benefits from the Therapeutic Methods
[00103] The methods may be further characterized according to patient populations that may derive particular benefits from the therapeutic methods. For example, in certain embodiments, the patient’s eye has an intraocular pressure greater than about 22 mmHg. In certain other embodiments, the patient to begin treatment is characterized as having an intraocular pressure in the range of from about 20 mmHg to about 30 mmHg. In certain embodiments, the patient to begin treatment is characterized as having an intraocular pressure in the range of from about 20 mmHg to about 25 mmHg. In certain other embodiments, the patient to begin treatment is characterized as having an intraocular pressure in the range of from about 25 mmHg to about 30 mmHg.
[00104] In certain other embodiments, the patient’s eye has an intraocular pressure not greater than than about 22 mmHg. In certain other embodiments, the patient to begin treatment is characterized as having an intraocular pressure in the range of from about 12 mmHg to about 22 mmHg. In certain other embodiments, the patient to begin treatment is characterized as having an intraocular pressure in the range of from about 15 mmHg to about 22 mmHg. In certain other embodiments, the patient to begin treatment is characterized as having an intraocular pressure in the range of from about 18 mmHg to about 22 mmHg. In certain other embodiments, the patient to begin treatment is characterized as having an intraocular pressure in the range of from about 10 mmHg to about 12 mmHg, from about 12 mmHg to about 14 mmHg, from about 14 mmHg to about 16 mmHg, from about 16 mmHg to about 18 mmHg, from about 18 mmHg to about 20 mmHg, or from about 20 mmHg to about 22 mmHg. In certain other embodiments, the patient to begin treatment is characterized as having an intraocular pressure less than about 15, 17, 19, 21 or 22 mmHg.
[00105] In certain other embodiments, the patient to begin treatment is characterized as having an intraocular pressure less than 26 mmHg. In certain other embodiments, the patient to begin treatment is characterized as having an intraocular pressure less than 24 mmHg. In certain other embodiments, the patient to begin treatment is characterized as having an intraocular pressure less than 22 mmHg. In certain other embodiments, the patient to begin treatment is characterized as having an intraocular pressure less than 20 mmHg. In certain other embodiments, the patient to begin treatment is characterized as having an intraocular pressure less than 18 mmHg. In certain other embodiments, the patient to begin treatment is characterized as having an intraocular pressure less than 16 mmHg.
[00106] In certain other embodiments, the patient to begin treatment is characterized as having an intraocular pressure in the range of from about 17 mmHg to about 36 mmHg, from about 17 mmHg to about 32 mmHg, from about 17 mmHg to about 28 mmHg, from about 17 mmHg to about 26 mmHg, from about 17 mmHg to about 24 mmHg, or from about 17 mmHg to about 22 mmHg. In certain other embodiments, the patient to begin treatment is
characterized as having an intraocular pressure in the range of from about 20 mmHg to about 36 mmHg, from about 20 mmHg to about 32 mmHg, from about 20 mmHg to about 28 mmHg, from about 20 mmHg to about 26 mmHg, from about 20 mmHg to about 24 mmHg, or from about 20 mmHg to about 22 mmHg. In certain other embodiments, the patient to begin treatment is characterized as having an intraocular pressure in the range of from about 20 mmHg to about 26 mmHg, from about 20 mmHg to about 25 mmHg, from about 20 mmHg to about 24 mmHg, from about 20 mmHg to about 23 mmHg, or from about 20 mmHg to about 22 mmHg. In certain other embodiments, the patient to begin treatment is characterized as having an intraocular pressure less than about 23, 24, 25, or 26 mmHg
[00107] In certain embodiments, the patient is a human. In certain embodiments, the patient is an adult human. In certain embodiments, the patient is a pediatric human.
Time of Administration
[00108] Various methods described above require administration of the dosage at or near the bedtime of the patient. Accordingly, in certain embodiments, the dosage is administered within 2 hours, 1.5 hours, 1 hour, 45 minutes, 30 minutes, or 15 minutes of the patient’s bedtime. In certain embodiments, the dosage is administered within 1 hour of the patient’s bedtime.
Improvement in Visual Performance
[00109] One benefit of the therapeutic methods is that the patient may also experience an improvement in visual performance. Visual performance pertains to the patient’s overall vision quality and includes a patient’s ability to see clearly, as well as ability to distinguish between an object and its background.
[00110] One aspect of visual performance is visual acuity. Visual acuity is a measure of a patient’s ability to see clearly. Visual acuity can be measured using, for example, a Snellen chart. Further, the visual acuity measurement can be taken under scotopic conditions, mesopic conditions, and/or photopic conditions.
[00111] Another aspect of visual performance is contrast sensitivity. Contrast sensitivity is a measure of the patient’s ability to distinguish between an object and its background. Contrast sensitivity can be measured using, for example, a Holladay Automated Contrast Sensitivity System. The contrast sensitivity can be measured under various light conditions, including, for example, photopic conditions, mesopic conditions, and scotopic conditions, each either with or without glare. In certain embodiments, the contrast sensitivity is measured under mesopic conditions either with or without glare.
[00112] In certain embodiments, the improvement in visual performance provided by the method is improved visual acuity. In certain embodiments, the improvement in visual performance provided by the method is improved visual acuity under scotopic conditions. In certain embodiments, the improvement in visual performance provided by the method is improved visual acuity under mesopic conditions. In certain embodiments, the improvement in visual performance provided by the method is improved visual acuity under photopic conditions. In certain embodiments, the improvement in visual acuity is a two-line
improvement in the patient’s vision as measured using the Snellen chart. In certain other embodiments, the improvement in visual acuity is a one-line improvement in the patient’s vision as measured using the Snellen chart.
[00113] In certain embodiments, the improvement in visual performance provided by the method is improved contrast sensitivity. The improvement in contrast sensitivity can be measured under various light conditions, such as photopic conditions, mesopic conditions, and scotopic conditions. In certain embodiments, the improvement in visual performance provided by the method is improved contrast sensitivity under photopic conditions. In certain embodiments, the improvement in visual performance provided by the method is improved contrast sensitivity under mesopic conditions. In certain embodiments, the improvement in visual performance provided by the method is improved contrast sensitivity under scotopic conditions. Further, contrast sensitivity can be measured in the presence of glare or the absence of glare. All combinations of light conditions and glare are contemplated.
[00114] Benefits provided by the therapeutic methods can be characterized according to the patient’s improvement in contrast sensitivity. For example, in certain embodiments, the improvement in contrast sensitivity is at least a 10% (or 20%, 30%, 50%, 60%, or 70%) improvement measured under mesopic conditions using the Holladay Automated Contrast Sensitivity System. In certain embodiments, the improvement in contrast sensitivity is at least a 10% (or 20%, 30%, 50%, 60%, or 70%) improvement measured under photopic conditions using the Holladay Automated Contrast Sensitivity System. In certain other embodiments, the improvement in contrast sensitivity is at least a 10% (or 20%, 30%, 50%, 60%, or 70%) improvement measured under mesopic conditions or scotopic conditions using the Holladay Automated Contrast Sensitivity System.
[00115] In certain other embodiments, the improvement in visual performance provided by the method is both (i) improved visual acuity (such as under scotopic conditions, mesopic conditions, and/or photopic conditions) and (ii) improved contrast sensitivity (such as under scotopic conditions, mesopic conditions, and/or photopic conditions). [00116] In certain embodiments, the improvement in visual performance is improvement in near-vision performance. In certain embodiments, the improvement in visual performance is improvement in visual performance at a distance. In certain embodiments, the improvement in visual performance is improved visual performance under low-light conditions. In certain embodiments, the improvement in visual performance is improved visual acuity. In certain embodiments, the improvement in visual performance is improved contrast sensitivity. In certain embodiments, the method provides at least a 10% reduction in pupil diameter in the eye of the patient. In certain embodiments, the method provides at least a 15% reduction in pupil diameter in the eye of the patient. In certain embodiments, the method provides at least a 20% reduction in pupil diameter in the eye of the patient. In certain embodiments, the method provides at least a 25% reduction in pupil diameter in the eye of the patient. In certain embodiments, the method provides at least a 30% reduction in pupil diameter in the eye of the patient.
Reduction in Pupil Diameter
[00117] One benefit of the therapeutic methods is that the patient may also experience a reduction in pupil diameter. Reduction in pupil diameter can result in improvement in visual performance.
[00118] The reduction in pupil diameter can be characterized according to, for example, the percent reduction in pupil diameter and size of the pupil measured under certain light conditions. Accordingly, in certain embodiments, the reduction in pupil diameter under mesopic conditions is at least 5% compared to the pupil diameter of the patient under the same mesopic conditions but not having received the therapy defined by the method. In certain other embodiments, the reduction in pupil diameter under mesopic conditions is at least 10% compared to the pupil diameter of the patient under the same mesopic conditions but not having received the therapy defined by the method. In certain other embodiments, the patient experiences a reduction in pupil diameter of at least 0.5 mm when measured under mesopic conditions relative to the diameter of the patient’s pupil under the same mesopic conditions but not having received the therapy defined by the method. In certain other embodiments, the patient experiences a reduction in pupil diameter ranging from about 0.6 mm to about 3 mm, about 0.6 mm to about 2.5 mm, or about 0.6 mm to about 2 mm when measured under mesopic conditions relative to the diameter of the patient’s pupil under the same mesopic conditions but not having received the therapy defined by the method. In certain other embodiments, the patient experiences a reduction in pupil diameter ranging from about 0.6 mm to about 1.2 mm when measured under mesopic conditions relative to the diameter of the patient’s pupil under the same mesopic conditions but not having received the therapy defined by the method. In yet other embodiments, the patient’s pupil is reduced to a diameter of about 3 mm to about 5 mm, about 3 mm to about 6 mm, about 4 mm to about 5 mm, about 4 mm to about 6 mm, or about 4 mm to about 7 mm under mesopic conditions due to the therapy defined by the method. In certain embodiments, the patient’s pupil is reduced to a diameter of about 4 mm to about 6 mm under mesopic conditions due to the therapy defined by the method.
[00119] In certain embodiments, the method provides at least a 10% reduction in pupil diameter in the eye of the patient. In certain embodiments, the method provides at least a 15% reduction in pupil diameter in the eye of the patient. In certain embodiments, the method provides at least a 20% reduction in pupil diameter in the eye of the patient. In certain embodiments, the method provides at least a 25% reduction in pupil diameter in the eye of the patient. In certain embodiments, the method provides at least a 30% reduction in pupil diameter in the eye of the patient.
Reducing Aberrant Focus of Scattered Light Rays in a Patient’s Eye
[00120] One benefit of the therapeutic methods is that the patient may also experience a reduction in aberrant focus of scattered light rays in the patient’s eye. This can provide improvement in visual performance for the patient. In certain embodiments, the therapeutic method provides a reduction in aberrant focus of scattered light rays in a patient’s eye for at least twenty hours. In certain embodiments, the therapeutic method provides a reduction aberrant focus of scattered light rays in a patient’s eye for at least twenty -four hours. In yet other embodiments, the therapeutic method provides a reduction aberrant focus of scattered light rays in a patient’s eye for at least thirty-six hours, forty-eight hours, sixty hours, or seventy-two hours.
II. Combination Therapy
[00121] Another aspect of the invention provides for combination therapy. The First and Third Therapeutic Methods described hereinabove may optionally further comprise administering one or more second therapeutic agents to the patient. Exemplary second therapeutic agents include, for example:
• A prostaglandin analog, such as latanoprost, bimatoprost, travoprost, tafluprost,
latanoprostene bunod, or a pharmaceutically acceptable salt thereof;
• A beta blocker, such as timolol or a pharmaceutically acceptable salt thereof;
• An alpha agonist, such as brimonidine or a pharmaceutically acceptable salt thereof; • A carbonic anhydrase inhibitor, such as dorzolamide, brinzolamide, acetazolamide, methazolamide, or a pharmaceutically acceptable salt thereof;
• A cholinergic agonist, such as pilocarpine or a pharmaceutically acceptable salt thereof;
• A Rho kinase inhibitor, such as netarsudil or a pharmaceutically acceptable salt thereof.
[00122] Latanaoprost may be administered in the form of a sterile, isotonic, buffered aqueous solution of latanoprost with a pH of approximately 6.7 and an osmolality of approximately 267 mOsmol/kg, where each 1 mL of the solution contains 50 micrograms of latanoprost. The solution may optionally contain benzalkonium chloride (0.02% w/w), sodium chloride, sodium dihydrogen phosphate monohydrate, and disodium hydrogen phosphate.
[00123] Latanaoprost may be administered to the patient according to the procedures described in the XALATAN® prescribing information, which is hereby incorporated by reference. In certain embodiments, a single daily dose of 1.5 micrograms of latanaoprost is administered to the patient’s eye. In certain embodiments, a single daily dose in the range of about 0.5 to about 1.0 micrograms, about 1.0 to about 1.5 micrograms, or about 1.5 to about 2.0 micrograms of latanaoprost is administered to the patient’s eye.
[00124] Timolol may be administered as timolol maleate in the form of an ophthalmic solution. One or two drops per day of a solution that contains on a 1 mL basis 3.4 mg of timolol maleate may be administered to the eye of the patient. Alternatively, one drop per day of a solution that contains on a 1 mL basis 6.8 mg of timolol maleate may be administered to the eye of the patient.
[00125] Netarsudil may be administered to the patient in the form of an ophthalmic solution, such as a sterile, isotonic, buffered aqueous solution containing netarsudil dimesylate (0.02% w/w) having a pH of approximately 5 and an osmolality of approximately 295 mOsmol/kg. Each 1 mL of the solution contains 0.28 mg of netarsudil dimesylate. The aqueous solution may contain benzalkonium chloride (e.g., 0.015% w/w), boric acid, and mannitol. Netarsudil dimesylate may be administered to the patient once per day as one eye drop of the sterile, isotonic, buffered aqueous solution containing netarsudil dimesylate (0.02% w/w) having a pH of approximately 5 and an osmolality of approximately 295 mOsmol/kg.
[00126] The amount of each therapeutic agent and the relative timing of administration of each therapeutic agent may be selected in order to achieve a desired combined therapeutic effect. For example, when administering a combination therapy to a patient in need of such administration, the therapeutic agents in the combination, or a pharmaceutical composition or compositions comprising the therapeutic agents, may be administered in any order such as, for example, sequentially, concurrently, together, simultaneously and the like
[00127] In certain embodiments, the therapeutic agents may act additively or
synergistically. A synergistic combination may allow the use of lower dosages of one or more agents and/or less frequent administration of one or more agents of a combination therapy. A lower dosage or less frequent administration of one or more agents may lower toxicity of the therapy without reducing the efficacy of the therapy.
Pharmaceutical Compositions Containing At Least Two Active Agents
[00128] Another aspect of the invention provides pharmaceutical compositions containing at least two active agents. For example, one aspect of the invention provides a pharmaceutical composition comprising an alpha-adrenergic antagonist and a second therapeutic agent selected from the group consisting of prostaglandin analog, a beta blocker, an alpha adrenergic agonist, a carbonic anhydrase inhibitor, a cholinergic agonist, NMDA receptor antagonist, adenosine receptor agonist, 5-HT2A receptor agonist, and a Rho kinase inhibitor.
[00129] The pharmaceutical composition may be further characterized according to the identity of the second therapeutic agent. For example, in certain embodiments, the second therapeutic agent is selected from the group consisting of latanoprost, bimatoprost, travoprost, tafluprost, latanoprostene bunod, timolol, brimonidine, dorzolamide, brinzolamide, acetazolamide, methazolamide, pilocarpine, netarsudil, ripasudil, AMA0076, trabodenoson, BOL-303259-X, ONO-9054, or a pharmaceutically acceptable salt of any one of the foregoing. In certain embodiments, the second therapeutic agent is selected from the group consisting of latanoprost, bimatoprost, travoprost, tafluprost, latanoprostene bunod, timolol, brimonidine, dorzolamide, brinzolamide, acetazolamide, methazolamide, pilocarpine, netarsudil, ripasudil, AMA0076, trabodenoson, BOL-303259-X, ONO-9054, carbachol, aceclidine, oxotremorine, or a pharmaceutically acceptable salt of any one of the foregoing. In certain embodiments, the second therapeutic agent is selected from the group consisting of latanoprost, timolol, netarsudil, or a pharmaceutically acceptable salt of any one of the foregoing. In certain embodiments, the second therapeutic agent selected is betaxolol, apraclonidine, brinzolamide, unoprostone, levobunolol, carteolol, metipranolol, carbachol, ecothiophate iodide, omidenepag isopropyl (an EP2 agonist), sepetaprost, NO-bimatoprost, H-1337 (a leucine-rich repeat kinase inhibitor), or a pharmaceutically acceptable salt of any one of the foregoing
[00130] The pharmaceutical composition may be further characterized according to the identity of the alpha-adrenergic antagonist. For example, in certain embodiments, the alpha- adrenergic antagonist is phentolamine, phenoxybenzamine, tolazoline, trazodone, alfuzosin, doxazosin, prazosin, tamsulosin, terazosin, silodosin, atipamezole, idazoxan, mirtazapine, yohimbine, fenoldopam, thymoxamine, or a pharmaceutically acceptable salt of any of the foregoing. In certain embodiments, the alpha-adrenergic antagonist is phentolamine or a pharmaceutically acceptable salt thereof. In certain embodiments, the alpha-adrenergic antagonist is a pharmaceutically acceptable salt of phentolamine. In certain embodiments, the alpha-adrenergic antagonist is phentolamine mesylate.
[00131] In certain embodiments, the pharmaceutical composition comprises (i) pharmaceutically acceptable salt of phentolamine and (ii) latanoprost.
[00132] In certain embodiments, the pharmaceutical composition is formulated for ophthalmic administration.
[00133] In certain embodiments, the invention provides an aqueous ophthalmic solution comprising:
(a) about 0.1% (w/v) to about 2% (w/v) of phentolamine mesylate;
(b) latanoprost (e.g., about 0.005% (w/v) latanoprost);
(c) about 1% (w/v) to about 6% (w/v) of at least one polyol compound selected from the group consisting of mannitol, glycerol, and propylene glycol;
(d) about 1 mM to about 6 mM of an alkali metal acetate; and
(e) water;
wherein the solution has a pH in the range of 4 to 6 and does not contain any additional component that is a chelating agent.
[00134] In certain embodiments, the invention provides an aqueous ophthalmic solution comprising:
(a) about 0.1% (w/v) to about 2% (w/v) of phentolamine mesylate;
(b) latanoprost (e.g., about 0.005% (w/v) latanoprost);
(c) about 1% (w/v) to about 6% (w/v) of at least one polyol compound selected from the group consisting of mannitol, glycerol, and propylene glycol;
(d) about 1 mM to about 6 mM of an alkali metal acetate; and
(e) water;
wherein the solution has a pH in the range of 4 to 6 and does not contain any additional component that is a chelating agent. [00135] In certain embodiments, the dosage is an aqueous ophthalmic solution comprising:
(a) about 0.5% (w/v) to about 2% (w/v) of phentolamine mesylate;
(b) latanoprost (e.g., about 0.005% (w/v) latanoprost);
(c) about 1% (w/v) to about 6% (w/v) of at least one polyol compound selected from the group consisting of mannitol, glycerol, and propylene glycol;
(d) about 1 mM to about 6 mM of an alkali metal acetate; and
(e) water;
wherein the solution has a pH in the range of 4.5 to 5.5 and does not contain any additional component that is a chelating agent.
[00136] In certain embodiments, the at least one polyol is mannitol. In certain
embodiments, the solution contains 4% (w/v) mannitol. In certain embodiments, the alkali metal acetate is sodium acetate. In certain embodiments, the solution comprises 3 mM sodium acetate.
[00137] In certain embodiments, the dosage is an aqueous ophthalmic solution containing:
(a) about 0.25% (w/v) to about 2% (w/v) of phentolamine mesylate;
(b) latanoprost (e.g., about 0.005% (w/v) latanoprost);
(c) about 3% (w/v) to about 5% (w/v) of mannitol;
(d) about 1 mM to about 6 mM of sodium acetate; and
(e) water;
wherein the solution has a pH in the range of 4.5 to 5.2 and does not contain any additional component that is a chelating agent.
[00138] In certain embodiments, the dosage is an aqueous ophthalmic solution containing:
(a) about 1% (w/v) of phentolamine mesylate;
(b) latanoprost (e.g., about 0.005% (w/v) latanoprost);
(c) about 3% (w/v) to about 5% (w/v) of mannitol;
(d) about 2 mM to about 4 mM of a buffer comprising sodium acetate; and
(e) water;
wherein the solution has a pH in the range of 4.5 to 5.2 and does not contain any additional component that is a chelating agent.
[00139] In certain embodiments, the dosage is an aqueous ophthalmic solution containing:
(a) about 0.25% (w/v) to about 2% (w/v) of phentolamine mesylate;
(b) latanoprost (e.g., about 0.005% (w/v) latanoprost); (c) about 3% (w/v) to about 5% (w/v) of mannitol;
(d) about 2 mM to about 4 mM of sodium acetate; and
(e) water;
wherein the solution has a pH in the range of 4.5 to 5.2 and does not contain any additional component that is a chelating agent.
[00140] In certain embodiments, the dosage is an aqueous ophthalmic solution containing:
(a) about 0.5% (w/v) to about 2% (w/v) of phentolamine mesylate;
(b) latanoprost (e.g., about 0.005% (w/v) latanoprost);
(c) about 3% (w/v) to about 5% (w/v) of mannitol;
(d) about 2 mM to about 4 mM of a buffer comprising sodium acetate; and
(e) water;
wherein the solution has a pH in the range of 4.6 to 5.2 and does not contain any additional component that is a chelating agent.
[00141] In certain embodiments, the dosage is an aqueous ophthalmic solution containing:
(a) about 0.5% (w/v) to about 1% (w/v) of phentolamine mesylate;
(b) latanoprost (e.g., about 0.005% (w/v) latanoprost);
(c) about 4% mannitol;
(d) about 3 mM of a buffer comprising sodium acetate; and
(e) water;
wherein the solution has a pH in the range of 4.6 to 5.2 and does not contain any additional component that is a chelating agent.
[00142] In certain embodiments, the dosage is an aqueous ophthalmic solution comprising: (a) about 1% (w/v) of phentolamine mesylate; (b) about 4% (w/v) mannitol; (c) about 3 mM of a buffer comprising sodium acetate; (d) water; and (e) latanoprost (e.g., about 0.005% (w/v) latanoprost); wherein the solution has a pH in the range of 4.5 to 5.5 and does not contain any additional component that is a chelating agent.
[00143] In certain embodiments, the dosage is an aqueous ophthalmic solution free of a chelating agent comprising: (a) about 1% (w/v) of phentolamine mesylate; (b) about 4% (w/v) mannitol; (c) about 3 mM of a buffer comprising sodium acetate; (d) water; and (e) latanoprost (e.g., about 0.005% (w/v) latanoprost); wherein the solution has a pH in the range of 4.0 to 7.5 and does not contain a chelating agent. Implantable Ocular Device
[00144] Compositions described herein may be administered to the patient’s eye via an implantable ocular device that dispenses the composition. The implantable ocular device may be configured to dispense the composition at a desired rate and/or frequency. In certain embodiments, the implantable ocular device is a slow release insert.
III. Ophthalmic Solutions
[00145] Therapeutically active agents are desirably administered to the eye of the patient in the form of an ophthalmic solution. Such an ophthalmic solution comprises one or more therapeutically active agents and a pharmaceutically acceptable carrier. Desirably, the ophthalmic solution exhibits good storage stability to permit distribution of the ophthalmic solution through normal distribution channels for pharmaceuticals. In certain embodiments, the pharmaceutically acceptable carrier is water. Additional components may be added to the ophthalmic solution in order to optimize performance properties of the ophthalmic solution. Exemplary additional components include, for example, a chelating agent (e.g., EDTA), polyol compound, poly(C24alkylene)glycol polymer, dextran, cellulose agent, buffer, tonicity modifier, preservative, antioxidant, viscosity modifying agent, comeal permeation enhancing agent, solubilizing agent, stabilizing agent, surfactant, demulcent polymer, wetting agent, and other materials.
[00146] Ophthalmic solutions may be further characterized according to the presence or absence of one or more of a chelating agent (e.g., EDTA), polyol compound, poly(C2- 4alkylene)glycol polymer, dextran, cellulose agent, buffer, tonicity modifier, preservative, antioxidant, viscosity modifying agent, comeal permeation enhancing agent, solubilizing agent, stabilizing agent, surfactant, demulcent polymer, wetting agent, and other materials. In certain embodiments, the ophthalmic solution does not contain a chelating agent (e.g., EDTA). In certain embodiments, the ophthalmic solution does not contain a preservative.
[00147] Various therapeutic methods above involve administering a dosage of phentolamine or a pharmaceutically acceptable salt thereof to the patient. The dosage of phentolamine or a pharmaceutically acceptable salt thereof is desirably in the form of an ophthalmic solution.
The ophthalmic solution is formulated to be suitable for administration to the eye of a patient, and desirably provides immediate release of phentolamine, that is, the ophthalmic solution is not a sustained release formulation that delivers phentolamine over an extended duration, such as hours, days or weeks. [00148] The ophthalmic solution desirably comprises an aqueous pharmaceutically acceptable carrier and phentolamine or a pharmaceutically acceptable salt thereof. The ophthalmic solution may contain excipients(s) that are suitable for administration to the eye. Various pharmaceutically acceptable salts are described in the literature. The preferred salt form of phentolamine is phentolamine mesylate. Accordingly, the methods may use an ophthalmic solution that comprises an aqueous pharmaceutically acceptable carrier and phentolamine mesylate.
[00149] Accordingly, in certain embodiments, the dosage utilized in the methods is an ophthalmic solution comprising an aqueous pharmaceutically acceptable carrier and phentolamine or a pharmaceutically acceptable salt thereof. In certain other embodiments, the dosage is an ophthalmic solution comprising an aqueous pharmaceutically acceptable carrier and phentolamine mesylate. In certain other embodiments, the dosage is an ophthalmic solution comprising water, a polyol, and phentolamine or a pharmaceutically acceptable salt thereof. In certain other embodiments, the dosage is an ophthalmic solution comprising water, mannitol, and phentolamine mesylate. In certain other embodiments, the dosage is an ophthalmic solution comprising water, a polyol, an alkali metal carboxylate, and phentolamine or a pharmaceutically acceptable salt thereof. In certain other embodiments, the dosage is an ophthalmic solution comprising water, mannitol, sodium acetate, and phentolamine mesylate.
[00150] Other ophthalmic solutions that are contemplated for use in the present invention include, for example, (i) aqueous ophthalmic solutions free of a chelating agent, and (ii) polyvinylpyrrolidone artificial tears formulations, each of which are described in more detail below.
[00151] Ophthalmic solutions may be further characterized according to the viscosity of the solution. In certain embodiments, the ophthalmic solution at a temperature of about 25°C has a viscosity in the range of 0.9 cP to about 1.1 cP. In certain embodiments, the ophthalmic solution at a temperature of about 25°C has a viscosity of about 1 cP.
Aqueous Ophthalmic Solution Free of a Chelating Agent
[00152] In certain embodiments, the dosage utilized in the methods is an aqueous ophthalmic solution free of a chelating agent, wherein said solution comprises (a) phentolamine or a pharmaceutically acceptable salt thereof; (b) at least one polyol compound, such as a polyol compound having a molecular weight less than 250 g/mol; (c) at least one buffer; and (d) water; wherein the solution does not contain a chelating agent. The amount of ingredients in the aqueous ophthalmic solutions may be selected in order to achieve particular performance properties, such as stability to storage, minimize irritation to the eye of a patient, and enhance penetration of phentolamine into the eye of a patient.
[00153] One exemplary preferred solution is an aqueous ophthalmic solution free of a chelating agent comprising: (a) about 0.1% (w/v) to about 4% (w/v) of phentolamine or a pharmaceutically acceptable salt thereof; (b) about 1% (w/v) to about 6% (w/v) of at least one polyol compound having a molecular weight less than 250 g/mol; (c) about 0.1 mM to about 10 mM of at least one buffer; and (d) water; wherein the solution has a pH in the range of 4.0 to 7.5 and does not contain a chelating agent.
[00154] Exemplary components and features of the aqueous ophthalmic solutions are described in more detail below.
Phentolamine & Pharmaceutically Acceptable Salts
[00155] The aqueous ophthalmic solution comprises phentolamine or a pharmaceutically acceptable salt of phentolamine. Exemplary pharmaceutically acceptable salts include, for example, the hydrochloric acid salt and mesylate salt. Accordingly, in certain embodiments, the solution comprises phentolamine (i.e., as the free base). In certain other embodiments, the solution comprises phentolamine hydrochloride. In certain yet other embodiments, the solution comprises phentolamine mesylate.
[00156] The amount of phentolamine or a pharmaceutically acceptable salt thereof in the aqueous ophthalmic solution may be adjusted in order to achieve desired performance properties. For example, where is it desired to provide a larger amount of phentolamine (or pharmaceutically acceptable salt thereof) to the patient in a single administration of the aqueous ophthalmic solution, the concentration of phentolamine (or pharmaceutically acceptable salt thereof) is increased in the aqueous ophthalmic solution. Single administration of aqueous ophthalmic solutions having a higher concentration of phentolamine (or pharmaceutically acceptable salt thereof) may provide the patient with reduced intraocular pressure for a longer duration of time because more phentolamine (or pharmaceutically acceptable salt thereof) is administered to the patient.
[00157] Accordingly, in certain embodiments, the aqueous ophthalmic solution comprises from about 0.1% (w/v) to about 5% (w/v) of phentolamine or a pharmaceutically acceptable salt thereof. In certain embodiments, the aqueous ophthalmic solution comprises from about 0.1% (w/v) to about 1% (w/v) of phentolamine or a pharmaceutically acceptable salt thereof, about 1% (w/v) to about 2% (w/v) of phentolamine or a pharmaceutically acceptable salt thereof, about 2% (w/v) to about 3% (w/v) of phentolamine or a pharmaceutically acceptable salt thereof, about 3% (w/v) to about 4% (w/v) of phentolamine or a pharmaceutically acceptable salt thereof, about 4% (w/v) to about 5% (w/v) of phentolamine or a
pharmaceutically acceptable salt thereof. In certain embodiments, the aqueous ophthalmic solution comprises from about 0.1% (w/v) to about 2% (w/v) of phentolamine or a
pharmaceutically acceptable salt thereof. In certain embodiments, the aqueous ophthalmic solution comprises from about 0.25% (w/v) to about 2% (w/v) of phentolamine or a pharmaceutically acceptable salt thereof. In certain other embodiments, the aqueous ophthalmic solution comprises from about 0.5% (w/v) to about 2% (w/v) of phentolamine or a pharmaceutically acceptable salt thereof. In certain other embodiments, the aqueous ophthalmic solution comprises from about 0.25% (w/v) to about 1% (w/v) of phentolamine or a pharmaceutically acceptable salt thereof. In certain other embodiments, the aqueous ophthalmic solution comprises about 1% (w/v) of phentolamine or a pharmaceutically acceptable salt thereof. In certain other embodiments, the aqueous ophthalmic solution comprises from about 0.1% (w/v) to about 4% (w/v) of phentolamine mesylate. In certain other embodiments, the aqueous ophthalmic solution comprises from about 0.1% (w/v) to about 2% (w/v) of phentolamine mesylate. In certain other embodiments, the aqueous ophthalmic solution comprises from about 0.25% (w/v) to about 2% (w/v) of phentolamine mesylate. In certain other embodiments, the aqueous ophthalmic solution comprises from about 0.5% (w/v) to about 2% (w/v) of phentolamine mesylate. In certain other embodiments, the aqueous ophthalmic solution comprises from about 0.25% (w/v) to about 1% (w/v) of phentolamine mesylate. In certain other embodiments, the aqueous ophthalmic solution comprises about 1% (w/v) of phentolamine mesylate. In certain other embodiments, the aqueous ophthalmic solution comprises about 0.25% (w/v) or about 0.5% (w/v) of phentolamine mesylate.
Polyol Compounds
[00158] The aqueous ophthalmic solution comprises one or more polyol compounds. The polyol compound is an organic compound having at least two hydroxyl groups (e.g., from 2 to about 6 hydroxyl groups). The polyol compound is beneficial to the aqueous ophthalmic solution because, for example, it can increase the stability of the aqueous ophthalmic solution to storage and/or modify the tonicity of the aqueous ophthalmic solution. Exemplary polyol compounds include, for example, mannitol, glycerol, propylene glycol, ethylene glycol, sorbitol, and xylitol.
[00159] The aqueous ophthalmic solution may contain a single polyol compound or a mixture of one or more polyol compounds. In other words, the aqueous ophthalmic solution comprises at least one polyol compound. In certain embodiments, the aqueous ophthalmic solution comprises at least one polyol compound that is mannitol, glycerol, propylene glycol, ethylene glycol, sorbitol, or xylitol. In certain other embodiments, the at least one polyol compound is mannitol. In certain other embodiments, the at least one polyol compound is glycerol. In certain other embodiments, the at least one polyol compound is propylene glycol. In certain other embodiments, the at least one polyol compound is mannitol, and the solution further comprises glycerol. In certain other embodiments, the at least one polyol compound is mannitol, and the solution further comprises propylene glycol. In certain other embodiments, the at least one polyol compound is glycerol, and the solution further comprises propylene glycol. In certain other embodiments, the mannitol described in embodiments above is D- mannitol.
[00160] The amount of the at least one polyol compound in the aqueous ophthalmic solution may be selected in order to achieve desired performance properties for the solution. The polyol compound may, for example, increase the stability of the solution to storage and/or modify the tonicity of the solution to make it more suitable for administration to the eye of a patient. In certain embodiments, the aqueous ophthalmic solution comprises from about 2% (w/v) to about 5% (w/v) of the at least one polyol compound. In certain other embodiments, the aqueous ophthalmic solution comprises from about 3.5% (w/v) to about 4.5% (w/v) of the at least one polyol compound. In certain other embodiments, the aqueous ophthalmic solution comprises about 4% (w/v) of the at least one polyol compound. In certain other embodiments, the aqueous ophthalmic solution comprises from about 2% (w/v) to about 3% (w/v) mannitol, and about 0.5% (w/v) to about 1.5% (w/v) glycerin. In certain other embodiments, the mannitol described in embodiments above is D-mannitol.
[00161] In certain embodiments, the amount of polyol may be selected based on the amount of phentolamine (or pharmaceutically acceptable salt thereof), such that there is an inverse relationship between the amount of phentolamine (or pharmaceutically acceptable salt thereof) and the polyol in order to achieve isotonicity with the eye. For example, in embodiments where the aqueous ophthalmic solution contains about 2% (w/v) phentolamine, mannitol is present in the solution at a concentration of about 3% (w/v). In embodiments where the aqueous ophthalmic solution contains about 1% (w/v) phentolamine, mannitol is present in the solution at a concentration of about 4% (w/v). To further illustrate this principle, in embodiments where the aqueous ophthalmic solution contains about 0.5% (w/v) phentolamine, mannitol may be present in the solution at a concentration of about 4.5% (w/v). In certain embodiments, the mannitol described in embodiments above is D-mannitol. [00162] It is appreciated that the aqueous ophthalmic solution can contain additional ingredients described herein, such as various polymer materials. One such embodiment is an aqueous ophthalmic solution comprising, for example, at least one polyol compound that is propylene glycol, and further comprising polypropylene glycol, such as polypropylene glycol having a weight average molecular weight in the range of about 5,000 g/mol to about 100,000 g/mol.
PolvfC alkylenejglvcol Polymer
[00163] The aqueous ophthalmic solution may optionally comprise a poly(C2- 4alkylene)glycol polymer. An exemplary poly(C2-4alkylene)glycol polymer is polypropylene glycol, such as a polypropylene glycol having a weight average molecular weight in the range of about 5,000 g/mol to about 100,000 g/mol, about 10,000 g/mol to about 50,000 g/mol, or about 50,000 g/mol to about 100,000 g/mol.
Dextran
[00164] The aqueous ophthalmic solution may optionally comprise dextran. Dextran is a commercially available, branched polysaccharide comprising glucose molecules. The amount of dextran in the aqueous ophthalmic solution may be selected to achieve certain performance properties. In certain embodiments, the aqueous ophthalmic solution comprises from about 0.01% (w/v) to about 2% (w/v) dextran. In certain other embodiments, the aqueous ophthalmic solution comprises from about 0.01% (w/v) to about 1% (w/v) dextran.
[00165] The dextran may be further characterized according to its weight average molecular weight. In certain embodiments, the dextran has a weight average molecular weight in the range of about 65,000 g/mol to about 75,000 g/mol. In certain other embodiments, the dextran has a weight average molecular weight of about 70,000 g/mol. In yet other embodiments, the dextran has a weight average molecular weight in the range of about 5,000 g/mol to about 100,000 g/mol, about 10,000 g/mol to about 50,000 g/mol, or about 50,000 g/mol to about 100,000 g/mol.
Cellulose Agent
[00166] The aqueous ophthalmic solution may optionally comprise a cellulose agent.
Exemplary cellulose agents include, for example, cellulose, carboxymethyl cellulose, hydroxyethylcellulose, hydroxpropylcellulose, and hydroxypropylmethyl cellulose. In certain embodiments, the cellulose agent is hydroxypropylmethyl cellulose. In certain other embodiments, the cellulose agent is cellulose, carboxymethyl cellulose, hydroxyethylcellulose, or hydroxpropylcellulose. The amount of cellulose agent in the aqueous ophthalmic solution may be selected in order to achieve desired performance properties. For example, in certain embodiments, the aqueous ophthalmic solution comprises from about 0.01% (w/v) to about 2% (w/v) cellulose agent.
[00167] The cellulose agent may be further characterized according to its weight average molecular weight. In certain embodiments, the cellulose agent has a weight average molecular weight in the range of about 5,000 g/mol to about 100,000 g/mol, about 10,000 g/mol to about 50,000 g/mol, or about 50,000 g/mol to about 100,000 g/mol.
Buffer
[00168] The aqueous ophthalmic solution comprises at least one buffer. The buffer imparts to the solution a buffering capacity, that is, the capacity to neutralize, within limits, either acids or bases (alkali) with relatively little or no change in the original pH. The buffer may be an acid, a base, or a combination of an acid and a base. The buffer may be organic, inorganic, or a combination of organic and inorganic components. It should be understood that the buffer at least partially dissociates in aqueous solution to form a mixture of, e.g., an acid and conjugate base or a base and conjugate acid. For example, the buffer may be a combination of a carboxylic acid and its carboxylate salt (e.g., a combination of acetic acid and sodium acetate). In another embodiment, the buffer may be a combination of an acid and a base, where the acid and the base are not conjugates. For example, the acid may be boric acid and the base may be tris(hydroxymethyl)aminomethane (TRIS).
[00169] Exemplary buffers include organic acids (e.g., acetic acid, sorbic acid, and oxalic acid), a borate salt, a hydrogen carbonate salt, a carbonate salt, a gluconate salt, a lactate salt, a phosphate salt, a propionate salt, a perborate salt, tris-(hydroxymethyl)aminomethane (TRIS), bis(2-hydroxyethyl)-imino-tris-(hydroxymethyl)aminoalcohol (bis-tris), N-[2-hydroxy-l , 1 - bis(hydroxymethyl)ethyl] glycine (tricene), N-[2-hydroxy-l, l-bis(hydroxymethyl)ethyl]glycine, 3-(N-morpholino)propanesulfonic acid, N-(carbamoylmethyl)taurine (ACES), an amino acid, salts thereof, and combinations thereof. It should be understood that the salt form of a buffer may comprise any suitable counterion. For example, the salt form of an acid may comprise an alkali or alkaline earth metal counterion.
[00170] The buffer can be characterized according to its strength, i.e., the buffering capacity. The buffering capacity can be tested, for example, by determining the millimoles (mM) of strong acid or base (or respectively, hydrogen or hydroxide ions) required to change the pH of a buffer solution by one unit when added to one liter (a standard unit) of the buffer solution. The buffering capacity generally depends on the type and concentration of the buffer components and can be greater in particular pH ranges. For example, a buffer may have an optimal buffering capacity in a pH range near the pKa of the buffer, e.g., within about 1 pH unit or within about 2 pH units of the pKa the buffer. In certain embodiments, the buffer is a weak buffer, such as an alkali metal carboxylate (e.g., sodium acetate).
[00171] In certain embodiments, the buffer is a weak acid buffer having one or more of the following characteristics: (a) a pKa of from about 4.0 to about 6.0; more preferably, from about 4.5 to about 5.5; and (b) a bpophibcity value Log P of from about -0.50 to about 1.5; more preferably, from about -0.25 to about 1.35.
[00172] The amount of buffer can be adjusted in order to achieve desired performance properties for the aqueous ophthalmic solution. For example, in certain embodiments, the buffer may be present at a concentration of less than about 10 mM, less than about 7 mM, less than about 5 mM, less than about 3 mM, or less than about 2 mM. In some embodiments, the buffer may be present at a concentration of from about 1 mM to about 10 mM, from about 1 mM to about 7 mM, from about 1 mM to about 5 mM, from about 1 mM to about 3 mM, from about 1 mM to about 2 mM, from about 2 mM to about 5 mM, or from about 2 mM to about 3 mM. In yet other embodiments, the buffer is present at a concentration of about 3 mM.
[00173] The amount and identity of the buffer may be selected in order to achieve certain performance properties for the aqueous ophthalmic solution. For example, the amount of buffer may impact the quantity of acid that may be neutralized before there is substantial change in the pH of the aqueous ophthalmic solution. Also, the amount of buffer may impact the tonicity of the aqueous ophthalmic solution. Desirably, the quantity and identity of the buffer should be selected in order to minimize any irritation that may be caused by
administration of the aqueous ophthalmic solution to the eye of a patient. Accordingly, in certain embodiments, the buffer is present at a concentration in the range of about 2 mM to about 4 mM. In yet other embodiments, the buffer is present at a concentration of about 3 mM. In certain embodiments, the buffer comprises an alkali metal alkylcarboxylate. In certain other embodiments, the buffer comprises an alkali metal acetate. In yet other embodiments, the buffer comprises sodium acetate.
Solution vH
[00174] The aqueous ophthalmic solution may be characterized according to the pH of the solution. Desirably, the aqueous ophthalmic solution has a pH in the range of 4.0 to 7.5. In certain embodiments, the aqueous ophthalmic solution has a pH in the range of 4.5 to 7.5. In certain embodiments, the solution has a pH in the range of 4.5 to 6.0. In certain other embodiments, the solution has a pH in the range of 4.5 to 5.5. In yet other embodiments, the solution has a pH in the range of 4.7 to 5.1.
Additional Materials for Aqueous Ophthalmic Solutions
[00175] The aqueous ophthalmic solutions may contain additional materials in order to make the composition more suitable for administration to the eye of a patient. Exemplary additional materials are described below and include, for example, a tonicity modifier, preservative, antioxidant, viscosity modifying agent, stabilizing agent, comeal permeation enhancing agent, and surfactants.
A. Tonicity Modifier
[00176] The aqueous ophthalmic solution may optionally comprise one or more tonicity modifiers. The tonicity modifier may be ionic or non-ionic. In certain embodiments, the tonicity modifier may be a salt, a carbohydrate, or a polyol. Exemplary tonicity modifiers include alkali metal or alkaline earth metal halides (such as LiBr, LiCl, Lil, KBr, KC1, KI, NaBr, NaCl, Nal, CaC'h. and MgCh), boric acid, dextran (e.g., Dextran 70), cyclodextrin, dextrose, mannitol, glycerin, urea, sorbitol, propylene glycol, or a combination thereof.
[00177] It is appreciated that the tonicity modifier may be added to the aqueous ophthalmic solution in an amount sufficient to provide a desired osmolality. In certain embodiments, the tonicity modifier is present in the aqueous ophthalmic solution in an amount sufficient so that the aqueous ophthalmic solution has an osmolality ranging from about 50 to about 1000 mOsm/kg, from about 100 to about 400 mOsm/kg, from about 200 to about 400 mOsm/kg, or from about 280 to about 380 mOsm/kg. In certain embodiments, a tonicity modifier may be present in an amount ranging from about 0.01% (w/v) to about 7% (w/v), about 0.01% (w/v) to about 5% (w/v), about 0.01% (w/v) to about 1% (w/v), about 0.1% (w/v) to about 1% (w/v), about 0.05% (w/v) to about 5% (w/v), about 0.05% (w/v) to about 0.5% (w/v), about 1% (w/v) to about 3% (w/v), or about 2% (w/v) to about 4% (w/v), of the aqueous ophthalmic solution.
B. Preservative
[00178] The aqueous ophthalmic solution may optionally comprise one or more preservatives in order to, for example, reduce or prevent microbial contamination. Exemplary preservatives include quaternary ammonium salts such as polyquatemium-l, cetrimide, benzalkonium chloride, or benzoxonium chloride; alkyl-mercury salts of thiosalicylic acid such as thiomersal, phenylmercuric nitrate, phenylmercuric acetate, or phenylmercuric borate; parabens such as methylparaben or propylparaben; alcohols such as chlorobutanol, benzyl alcohol, phenyl ethanol, cyclohexanol, 3-pentanol, or resorcinol; a peroxide; chlorine dioxide or PURITE; guanidine derivatives such as chlorohexidine gluconate or polyaminopropyl biguanide; and combinations thereof.
[00179] The amount of preservative can be adjusted in order to achieve desired performance properties for the aqueous ophthalmic solution. In certain embodiments, the preservative is present in an amount less than about 5% (w/v), 3% (w/v), 1% (w/v), or 0.1% (w/v) of the aqueous ophthalmic solution. In certain other embodiments, the preservative is present in an amount ranging from about 0.01% (w/v) to about 5% (w/v), about 0.01% (w/v) to about 1% (w/v), about 0.1% (w/v) to about 1% (w/v), about 0.05% (w/v) to about 5% (w/v), or about 0.05% (w/v) to about 0.5% (w/v), of the aqueous ophthalmic solution.
C. Antioxidant
[00180] The aqueous ophthalmic solution may optionally comprise one or more antioxidants. Exemplary antioxidants for use in the aqueous ophthalmic solutions described herein include water soluble antioxidants such as ascorbic acid, cysteine hydrochloride, sodium bisulfate, sodium metabisulfite, sodium bisulfite, sodium sulfite, and the like; and oil-soluble antioxidants, such as ascorbyl palmitate, butylated hydroxyanisole (BHA), butylated hydroxytoluene (BHT), lecithin, propyl gallate, alpha-tocopherol, and the like.
[00181] The amount of antioxidant can be adjusted in order to achieve desired performance properties for the aqueous ophthalmic solution. In certain embodiments, the antioxidant is present in an amount less than about 5% (w/v), 3% (w/v), 1% (w/v), or 0.1% (w/v) of the aqueous ophthalmic solution. In certain other embodiments, the antioxidant is present in an amount ranging from about 0.01% (w/v) to about 5% (w/v), about 0.01% (w/v) to about 1% (w/v), about 0.1% (w/v) to about 1% (w/v), about 0.05% (w/v) to about 5% (w/v), or about 0.05% (w/v) to about 0.5% (w/v), of the aqueous ophthalmic solution.
I). Viscosi tv Modi fyins Agent
[00182] The aqueous ophthalmic solution may optionally comprise one or more viscosity modifying agents. The viscosity modifying agent may be used, for example, to increase the absorption of an active agent or increase the retention time of the aqueous ophthalmic solution in the eye. Exemplary viscosity modifying agents include polyvinylpyrrolidone,
methylcellulose, hydroxypropyl methylcellulose, hydroxyethylcellulose,
hydroxpropylcellulose, carboxymethylcellulose (CMC) and salts thereof (e.g., CMC sodium salt), gelatin, cellulose glycolate, sorbitol, niacinamide, an alpha-cyclodextran, polyvinyl alcohol, polyethylene glycol, hyaluronic acid, a polysachcharaide, a monosaccharide, and combinations thereof.
[00183] The amount of viscosity modifying agent can be adjusted in order to achieve desired performance properties for the aqueous ophthalmic solution. In certain embodiments, the viscosity modifying agent is present in an amount less than about 10% (w/v), 5% (w/v), 3% (w/v), 1% (w/v), or 0.1% (w/v) of the aqueous ophthalmic solution. In certain other embodiments, the viscosity modifying agent is present in an amount ranging from about 0.01% (w/v) to about 5% (w/v), about 0.01% (w/v) to about 1% (w/v), about 0.1% (w/v) to about 1% (w/v), about 0.05% (w/v) to about 5% (w/v), or about 0.05% (w/v) to about 0.5% (w/v), of the aqueous ophthalmic solution. In certain other embodiments, the viscosity modifying agent is present in an amount sufficient to provide an aqueous ophthalmic solution with a viscosity in the range of about 30 centipoise to about 100 centipoise.
[00184] The viscosity modifying agent may be a polymer that results in delayed release of one or more therapeutic agents in the solution. The identity of the polymer may be selected so as to achieve a desired time-release profile for the one or more therapeutic agents.
E. Corneal Permeation Enhancing Agent
[00185] The aqueous ophthalmic solution may optionally comprise one or more agents for enhancing comeal permeation of phentolamine (or a pharmaceutically acceptable salt thereof). Exemplary agents for enhancing comeal permeation include polymers, organic acids, esters of an organic acid (e.g., a monoglyceride of fatty acid having 8 to 12 carbon atoms), cyclodextrin, benzalkonium chloride (BAK), EDTA, caprylic acid, citric acid, boric acid, sorbic acid, polyoxyethylene-20-stearyl ether (PSE), polyethoxylated castor oil (PCO), deoxycholic acid sodium salt (DC), cetylpyridinium chloride (CPC), laurocapram, hexamethylenelauramide, hexamethyleneoctanamide, decylmethylsulfoxide, methyl sulfone, dimethyl sulfoxide, and combinations thereof.
[00186] The amount of comeal permeation enhancing agent can be adjusted in order to achieve desired performance properties for the aqueous ophthalmic solution. In certain embodiments, the comeal permeation enhancing agent is present in an amount less than about 10% (w/v), 5% (w/v), 1% (w/v), or 0.1% (w/v) of the aqueous ophthalmic solution. In certain other embodiments, the comeal permeation enhancing agent is present in an amount ranging from about 0.01% (w/v) to about 5% (w/v), about 0.01% (w/v) to about 1% (w/v), about 0.1% (w/v) to about 1% (w/v), about 0.05% (w/v) to about 5% (w/v), about 0.05% (w/v) to about 0.5% (w/v), about 1% (w/v) to about 3% (w/v), or about 2% (w/v) to about 4% (w/v), of the aqueous ophthalmic solution.
F. Solubilizing Agent
[00187] The aqueous ophthalmic solution may optionally comprise one or more solubilizing agents to improve the solubility of phentolamine (or a pharmaceutically acceptable salt thereof) in the aqueous ophthalmic solution. Exemplary solubilizing agents include, for example, a fatty acid glycerol poly-lower alkylene (i.e., a Ci to C7, linear or branched) glycol ester, fatty acid poly-lower alkylene glycol ester, polyalkylene glycol (e.g., polyethylene glycol), glycerol ether of vitamin E, tocopherol polyethylene glycol 1000 succinate (TPGS), tyloxapol, polysorbate 20, polysorbate 40, polysorbate 60, polysorbate 80,
polyoxyethylene/polyoxypropylene surfactants (e.g., Pluronic F-68, F-84 and P-103), cyclodextrin, and combinations thereof.
[00188] The amount of solubilizing agent can be adjusted in order to achieve desired performance properties for the aqueous ophthalmic solution. In certain embodiments, the solubilizing agent is present in an amount less than about 10% (w/v), 5% (w/v), 3% (w/v), 1% (w/v), or 0.1% (w/v) of the aqueous ophthalmic solution. In certain other embodiments, the solubilizing agent is present in an amount ranging from about 0.01% (w/v) to about 5% (w/v), about 0.01% (w/v) to about 1% (w/v), about 0.1% (w/v) to about 1% (w/v), about 0.05% (w/v) to about 5% (w/v), or about 0.05% (w/v) to about 0.5% (w/v), of the aqueous ophthalmic solution.
G. Stabilizing Agent
[00189] The aqueous ophthalmic solution may optionally comprise one or more stabilizing agents in order to improve the stability of the aqueous ophthalmic solution to storage, etc. Stabilizing agents described in the pharmaceutical literature are contemplated to be amenable for use in the aqueous ophthalmic solutions described herein. Exemplary stabilizing agents include an alcohol (e.g., polyols, such as mannitol, glycerol, propylene glycol, sorbitol, and xylitol), polyalkylene glycols such as polyethylene glycol, polypropylene glycol, polyethylene glycol-nonphenol ether, polyethylene glycol sorbitan monolaurate, polyethylene glycol sorbitan monooleate, polyethylene glycol sorbitan monooleate, polyethylene glycol sterarate, polyethylene glycol polypropylene glycol ether, polyvinyl alcohol, polyvinyl pyrrolidine, ascorbic acid, vitamin E, N-acetylcamosine (NAC), sorbic acid, and combinations thereof. In certain embodiments, the stabilizing agent is a polymer, such as one of the polymers mentioned above. [00190] The amount of stabilizing agent can be adjusted in order to achieve desired performance properties for the aqueous ophthalmic solution. In certain embodiments, the stabilizing agent is present in an amount less than about 10% (w/v), 5% (w/v), or 1% (w/v) of the aqueous ophthalmic solution. In certain other embodiments, the stabilizing agent is present in an amount ranging from about 0.01% (w/v) to about 5% (w/v), about 0.01% (w/v) to about 1% (w/v), or about 0.01% (w/v) to about 0.1% (w/v) of the aqueous ophthalmic solution.
H. Surfactant
[00191] The aqueous ophthalmic solution may optionally comprise one or more surfactants. Exemplary surfactants include Polysorbate 20 (i.e., polyoxyethylene (20) sorbitan
monolaurate), Polysorbate 40 (i.e., polyoxyethylene (20) sorbitan monopalmitate), Polysorbate 60 (i.e., polyoxyethylene (20) sorbitan monostearate), Polysorbate 80 (i.e., polyoxyethylene (20) sorbitan monooleate), glyceryl stearate, isopropyl stearate, polyoxyl stearate, propylene glycol stearate, sucrose stearate, polyethylene glycol, a polypropylene oxide, a polypropylene oxide copolymer, Pluronic F68, Pluronic F-84, Pluronic P-103, an alcohol ethoxylate, an alkylphenol ethoxylate, an alkyl glycoside, an alkyl polyglycoside, a fatty alcohol,
hydroxypropylmethyl cellulose (HPMC), carboxymethyl cellulose (CMC), cyclodextrin, a polyacrylic acid, phosphatidyl chlorine, phosphatidyl serine, and combinations thereof.
[00192] The amount of surfactant can be adjusted in order to achieve desired performance properties for the aqueous ophthalmic solution. In certain embodiments, the surfactant is present in an amount less than about 10% (w/v), 5% (w/v), 3% (w/v), 1% (w/v), or 0.1% (w/v) of the aqueous ophthalmic solution. In certain other embodiments, the surfactant is present in an amount ranging from about 0.01% (w/v) to about 5% (w/v), about 0.01% (w/v) to about 1% (w/v), about 0.1% (w/v) to about 1% (w/v), about 0.05% (w/v) to about 5% (w/v), or about 0.05% (w/v) to about 0.5% (w/v), of the aqueous ophthalmic solution.
I. Demulcent Polymers
[00193] The aqueous ophthalmic solution may optionally comprise one or more demulcent polymers. Because of their ability to hold large amounts of water, demulcent polymers are useful for coating and moisturizing the cornea of the eye. Exemplary demulcent polymers include cellulose derivatives, dextran 40, dextran 70, gelatin, and liquid polyols. Wetting Agents
[00194] The aqueous ophthalmic solution may optionally comprise one or more wetting agents. Wetting agents can be used to wet the surface of the eye. Exemplary wetting agents include polysorbates, poloxamers, tyloxapol, and lecithin.
K. Additional Materials
[00195] The aqueous ophthalmic solutions may optionally comprise one or more additional materials, such as acetylcysteine, cysteine, sodium hydrogen sulfite, butyl-hydroxyanisole, butyl-hydroxytoluene, alpha-tocopherol acetate, thiourea, thiosorbitol, sodium dioctyl sulfosuccinate, monothioglycerol, lauric acid sorbitol ester, triethanol amine oleate, or palmitic acid esters.
[00196] Further, the aqueous ophthalmic solutions may comprise a carrier, such as one or more of the exemplary carriers are described in for example, Martin, Remington’s
Pharmaceutical Sciences, l5th Ed., Mack Publ. Co., Easton, PA [1975]). The carrier can be, for example, a mixture of water and a water-miscible solvent (e.g., an alcohol such as glycerin, a vegetable oil, or a mineral oil). Other exemplary carriers include a mixture of water and one or more of the following materials: hydroxyethylcellulose, carboxymethylcellulose, methylcellulose, an alkali metal salt of carboxymethylcellulose, hydroxymethylcellulose, methylhydroxypropylcellulose, hydroxypropylcellulose, ethyl oleate, polyvinylpyrrolidone, an acrylate polymer, a methacrylate polymer, a polyacrylamide, gelatin, an alginate, a pectin, tragacanth, karaya gum, xanthan gum, carrageenin, agar, acacia, a starch (such as starch acetate or hydroxypropyl starch), polyvinyl alcohol, polyvinyl methyl ether, polyethylene oxide, or a cross-linked polyacrylic acid.
Exemplary Aqueous Ophthalmic Solutions
[00197] The aqueous ophthalmic solutions having been generally described above will now be more specifically described by reference to the following more specific examples. The following more specific examples are only exemplary and are not intended to limit the scope of the invention in any way.
[00198] One such exemplary solution is an aqueous ophthalmic solution free of a chelating agent comprising: (a) about 0.1% (w/v) to about 2% (w/v) of phentolamine mesylate; (b) about 1% (w/v) to about 6% (w/v) of at least one polyol compound selected from the group consisting of is mannitol, glycerol, and propylene glycol; (c) about 1 mM to about 6 mM of an alkali metal acetate; and (d) water; wherein the solution has a pH in the range of 4 to 6 and does not contain a chelating agent.
[00199] The aqueous ophthalmic solution may be more specifically defined according to the following embodiments. For example, in certain embodiments, the aqueous ophthalmic solution comprises from about 0.25% (w/v) to about 1% (w/v) of phentolamine mesylate. In certain embodiments, the aqueous ophthalmic solution comprises from about 1% (w/v) to about 4% (w/v) mannitol. In certain other embodiments, the aqueous ophthalmic solution comprises 4% (w/v) mannitol. In certain embodiments, the alkali metal acetate is sodium acetate. In certain other embodiments, the aqueous ophthalmic solution comprises 3 mM sodium acetate.
In still other embodiments, the aqueous ophthalmic solution consists of (i) about 0.25% (w/v) to about 1% (w/v) of phentolamine mesylate; (ii) about 1% (w/v) to about 6% (w/v) of one or more polyol compounds selected from the group consisting of mannitol, glycerol, and propylene glycol; (iii) about 1 mM to about 6 mM of an alkali metal acetate; (iv) acetic acid; and (v) water; wherein the solution has a pH in the range of 4 to 6.
[00200] Another such exemplary solution is an aqueous ophthalmic solution free of a chelating agent comprising: (a) about 0.5% (w/v) to about 2% (w/v) of phentolamine mesylate; (b) about 1% (w/v) to about 6% (w/v) of at least one polyol compound selected from the group consisting of is mannitol, glycerol, and propylene glycol; (c) about 1 mM to about 6 mM of an alkali metal acetate; and (d) water; wherein the solution has a pH in the range of 4.5 to 5.5 and does not contain a chelating agent.
[00201] The aqueous ophthalmic solution may be more specifically defined according to the following embodiments. For example, in certain embodiments, the at least one polyol is mannitol. In certain embodiments, the aqueous ophthalmic solution comprises from about 1% (w/v) to about 4% (w/v) mannitol. In certain other embodiments, the aqueous ophthalmic solution comprises 4% (w/v) mannitol. In certain embodiments, the alkali metal acetate is sodium acetate. In certain other embodiments, the aqueous ophthalmic solution comprises 3 mM sodium acetate. In still other embodiments, the aqueous ophthalmic solution consists of (i) about 0.5% (w/v) to about 2% (w/v) of phentolamine mesylate; (ii) about 1% (w/v) to about 6% (w/v) of one or more polyol compounds selected from the group consisting of mannitol, glycerol, and propylene glycol; (iii) about 1 mM to about 6 mM of an alkali metal acetate;
(iv) acetic acid; and (v) water; wherein the solution has a pH in the range of 4.5 to 5.5.
[00202] Another such exemplary solution is an aqueous ophthalmic solution free of a chelating agent comprising: (a) about 0.25% (w/v) to about 2% (w/v) of phentolamine mesylate; (b) about 1% (w/v) to about 6% (w/v) of at least one polyol compound selected from the group consisting of is mannitol, glycerol, and propylene glycol; (c) about 1 mM to about 6 mM of an alkali metal acetate; and (d) water; wherein the solution has a pH in the range of 4.5 to 5.5 and does not contain a chelating agent.
[00203] The aqueous ophthalmic solution may be more specifically defined according to the following embodiments. For example, in certain embodiments, the aqueous ophthalmic solution comprises from about 0.25% (w/v) to about 1% (w/v) of phentolamine mesylate. In certain other embodiments, the aqueous ophthalmic solution comprises from about 1% (w/v) to about 4% (w/v) mannitol. In certain other embodiments, the aqueous ophthalmic solution comprises 4% (w/v) mannitol. In certain embodiments, the alkali metal acetate is sodium acetate. In certain other embodiments, the aqueous ophthalmic solution comprises 3 mM sodium acetate. In still other embodiments, the aqueous ophthalmic solution consists of (i) about 0.5% (w/v) to about 1% (w/v) of phentolamine mesylate; (ii) about 1% (w/v) to about 6% (w/v) of one or more polyol compounds selected from the group consisting of mannitol, glycerol, and propylene glycol; (iii) about 1 mM to about 6 mM of an alkali metal acetate;
(iv) acetic acid; and (v) water; wherein the solution has a pH in the range of 4.5 to 5.5.
[00204] Further exemplary aqueous ophthalmic solutions are provided in Tables 1-3 below, where in each instance the solution has a pH in the range of 4.7 to 5.1.
TABLE 1 - EXEMPLARY AQUEOUS OPHTHALMIC SOLUTIONS.
Figure imgf000051_0001
TABLE 2 - EXEMPLARY AQUEOUS OPHTHALMIC SOLUTIONS.
Figure imgf000052_0001
TABLE 3 - EXEMPLARY AQUEOUS OPHTHALMIC SOLUTIONS.
Figure imgf000052_0002
[00205] Another exemplary aqueous ophthalmic solution comprises phentolamine mesylate (e.g., at 1% w/v), mannitol (e.g., at 4% w/v), dextran having a weight average molecular weight of about 70,000 g/mol (e.g., at 0.1% w/v), hydroxypropyl methylcellulose (e.g., at 0.3% w/v), potassium chloride, purified water, sodium borate, and sodium chloride; wherein the solution has a pH in the range of about 4 to about 6. In certain embodiments, the solution has a pH in the range of 4.5 to 5.1. In certain embodiments, the aqueous ophthalmic solution consists essentially of phentolamine mesylate (e.g., at 1% w/v), mannitol (e.g., at 4% w/v), dextran having a weight average molecular weight of about 70,000 g/mol (e.g., at 0.1% w/v), hydroxypropyl methylcellulose (e.g., at 0.3% w/v), potassium chloride, purified water, sodium borate, and sodium chloride; wherein the solution has a pH in the range of 4 to 6. In certain other embodiments, the aqueous ophthalmic solution consists of phentolamine mesylate (e.g., at 1% w/v), mannitol (e.g., at 4% w/v), dextran having a weight average molecular weight of about 70,000 g/mol (e.g., at 0.1% w/v), hydroxypropyl methylcellulose (e.g., at 0.3% w/v), potassium chloride, purified water, sodium borate, and sodium chloride; wherein the solution has a pH in the range of 4.5 to 5.1.
[00206] Another exemplary aqueous ophthalmic solution comprises phentolamine mesylate (e.g., at 1% w/v), mannitol (e.g., at 4% w/v), sodium acetate (e.g., at 3 mM), and water, wherein the solution has a pH in the range of about 4 to about 6. In certain embodiments, the solution has a pH in the range of 4.5 to 5.1. In certain embodiments, the aqueous ophthalmic solution consists essentially of phentolamine mesylate (e.g., at 1% w/v), mannitol (e.g., at 4% w/v), sodium acetate (e.g., at 3 mM), and water, wherein the solution has a pH in the range of 4 to 6. In certain embodiments, the aqueous ophthalmic solution comprises phentolamine mesylate at 1% w/v, mannitol 4% w/v, sodium acetate at 3 mM, and water, wherein the solution has a pH in the range of 4.5 to 5.1. In certain other embodiments, the aqueous ophthalmic solution consists of phentolamine mesylate (e.g., at 1% w/v), mannitol (e.g., at 4% w/v), sodium acetate (e.g., at 3 mM), and water, wherein the solution has a pH in the range of 4.5 to 5.1. In certain embodiments, the aqueous ophthalmic solution consists essentially of phentolamine mesylate at 1% w/v, mannitol 4% w/v, sodium acetate at 3 mM, and water, wherein the solution has a pH in the range of 4.5 to 5.1.
[00207] Yet another exemplary solution is an aqueous ophthalmic solution free of a chelating agent that comprises: (a) about 0.1% (w/v) to about 2% (w/v) of phentolamine mesylate; (b) about 1% (w/v) to about 6% (w/v) of at least one polyol compound selected from the group consisting of is mannitol, glycerol, and propylene glycol; (c) about 1 mM to about 6 mM of an alkali metal acetate; and (d) water; wherein the solution has a pH in the range of 4 to 6 and does not contain a chelating agent.
[00208] Yet another exemplary solution is an aqueous ophthalmic solution free of a chelating agent that comprises: (a) about 0.25% (w/v) to about 2% (w/v) of phentolamine mesylate; (b) about 3% (w/v) to about 5% (w/v) of mannitol; (c) about 2 mM to about 4 mM of sodium acetate; and (d) water; wherein the solution has a pH in the range of 4.6 to 5.2 and does not contain a chelating agent.
[00209] Yet another exemplary solution is an aqueous ophthalmic solution free of a chelating agent that comprises: (a) about 0.1% (w/v) to about 2% (w/v) of phentolamine mesylate; (b) about 3% (w/v) to about 5% (w/v) of mannitol; (c) about 2 mM to about 4 mM of sodium acetate; and (d) water; wherein the solution has a pH in the range of 4.6 to 5.2 and does not contain a chelating agent. In certain embodiments, the aqueous ophthalmic solution free of a chelating agent that comprises about 0.25% (w/v) to about 1% (w/v) of phentolamine mesylate.
[00210] Yet another exemplary solution is an aqueous ophthalmic solution free of a chelating agent, comprising: (a) about 0.25% (w/v) to about 2% (w/v) of phentolamine mesylate; (b) about 3% (w/v) to about 5% (w/v) of mannitol; (c) about 2 mM to about 4 mM of sodium acetate; and (d) water; wherein the solution has a pH in the range of 4.5 to 5.2 and does not contain a chelating agent.
[00211] Yet another exemplary solution is an aqueous ophthalmic solution free of a chelating agent that comprises: (a) about 0.5% (w/v) to about 2% (w/v) of phentolamine mesylate; (b) about 3% (w/v) to about 5% (w/v) of mannitol; (c) about 2 mM to about 4 mM of sodium acetate; and (d) water; wherein the solution has a pH in the range of 4.6 to 5.2 and does not contain a chelating agent.
[00212] Yet another exemplary solution is an aqueous ophthalmic solution free of a chelating agent that comprises: (a) about 0.5% (w/v) to about 1% (w/v) of phentolamine mesylate; (b) about 3% (w/v) to about 5% (w/v) of mannitol; (c) about 1 mM to about 4 mM of sodium acetate; and (d) water; wherein the solution has a pH in the range of 4.6 to 5.2 and does not contain a chelating agent.
[00213] Yet another exemplary solution is an aqueous ophthalmic solution free of a chelating agent, comprising: (a) about 0.1% (w/v) to about 1% (w/v) of phentolamine mesylate; (b) about 4% mannitol; (c) about 3 mM sodium acetate; and (d) water; wherein the solution has a pH in the range of 4.6 to 5.2 and does not contain a chelating agent. In certain embodiments, the aqueous ophthalmic solution free of a chelating agent that comprises about 0.25% (w/v) to about 1% (w/v) of phentolamine mesylate.
[00214] Yet another exemplary solution is an aqueous ophthalmic solution free of a chelating agent, comprising: (a) about 0.5% (w/v) to about 1% (w/v) of phentolamine mesylate; (b) about 4% mannitol; (c) about 3 mM sodium acetate; and (d) water; wherein the solution has a pH in the range of 4.6 to 5.2 and does not contain a chelating agent.
[00215] Yet another exemplary solution is an aqueous ophthalmic solution free of a chelating agent, comprising: (a) about 0.25% (w/v) to about 2% (w/v) of phentolamine mesylate; (b) about 3% (w/v) to about 5% (w/v) of mannitol; (c) about 2 mM to about 4 mM of a buffer comprising sodium acetate; and (d) water; wherein the solution has a pH in the range of 4.5 to 5.2 and does not contain a chelating agent. [00216] Yet another exemplary solution is an aqueous ophthalmic solution free of a chelating agent that comprises: (a) about 0.5% (w/v) to about 2% (w/v) of phentolamine mesylate; (b) about 3% (w/v) to about 5% (w/v) of mannitol; (c) about 2 mM to about 4 mM of a buffer comprising sodium acetate; and (d) water; wherein the solution has a pH in the range of 4.6 to 5.2 and does not contain a chelating agent.
[00217] Yet another exemplary solution is an aqueous ophthalmic solution free of a chelating agent that comprises: (a) about 0.5% (w/v) to about 1% (w/v) of phentolamine mesylate; (b) about 3% (w/v) to about 5% (w/v) of mannitol; (c) about 1 mM to about 4 mM of a buffer comprising sodium acetate; and (d) water; wherein the solution has a pH in the range of 4.6 to 5.2 and does not contain a chelating agent.
[00218] Yet another exemplary solution is an aqueous ophthalmic solution free of a chelating agent, comprising: (a) about 0.1% (w/v) to about 1% (w/v) of phentolamine mesylate; (b) about 4% mannitol; (c) about 3 mM of a buffer comprising sodium acetate; and (d) water; wherein the solution has a pH in the range of 4.6 to 5.2 and does not contain a chelating agent. In certain embodiments, the aqueous ophthalmic solution free of a chelating agent that comprises about 0.25% (w/v) to about 1% (w/v) of phentolamine mesylate.
[00219] Yet another exemplary solution is an aqueous ophthalmic solution free of a chelating agent, comprising: (a) about 0.5% (w/v) to about 1% (w/v) of phentolamine mesylate; (b) about 4% mannitol; (c) about 3 mM of a buffer comprising sodium acetate; and (d) water; wherein the solution has a pH in the range of 4.6 to 5.2 and does not contain a chelating agent.
Stability Features of Aqueous Ophthalmic Solutions
[00220] The aqueous ophthalmic solutions described herein may be further characterized according to their stability features, such as the percentage of phentolamine (or
pharmaceutically acceptable salt thereof) that is present in the aqueous ophthalmic solution after storage for a certain length of time. As explained above, one of the benefits of the present aqueous ophthalmic solutions is that they possess good stability over extended periods of time, even though they do not have a chelating agent.
[00221] Accordingly, in certain embodiments, the aqueous ophthalmic solution is characterized by less than 2% by weight of the phentolamine or pharmaceutically acceptable salt thereof degrades upon storage of the solution at 25°C for 12 weeks. In certain other embodiments, the aqueous ophthalmic solution is characterized by less than 2% by weight of the phentolamine or pharmaceutically acceptable salt thereof degrades upon storage at 25°C for 24 weeks (or 36 weeks or 48 weeks). In yet other embodiments, less than 7% by weight of the phentolamine or pharmaceutically acceptable salt thereof degrades upon storage at 40°C for 12 weeks (or 24, 36, or 48 weeks). In yet other embodiments, the aqueous ophthalmic solution is characterized by less than 10% by weight of the phentolamine or pharmaceutically acceptable salt thereof degrades upon storage at 25°C for 18 months, 24 months, or 36 months. In yet other embodiments, the aqueous ophthalmic solution is characterized by less than 10% by weight of the phentolamine or pharmaceutically acceptable salt thereof degrades upon storage at temperature in the range of 2-8 °C for 18 months, 24 months, or 36 months. In yet other embodiments, the aqueous ophthalmic solution is characterized by less than 4% by weight (or preferably less than 3% by weight) of the phentolamine or pharmaceutically acceptable salt thereof degrades upon storage at 25°C for 18 months, 24 months, or 36 months. In yet other embodiments, less than 10% by weight of the phentolamine or pharmaceutically acceptable salt thereof degrades upon storage at 40°C for 4, 5, or 6 months.
Polyvinylpyrrolidone Artificial Tears Formulation
[00222] Another ophthalmic solution contemplated for use in the present invention is an ophthalmic solution comprising an alpha-adrenergic antagonist (e.g., phentolamine or a pharmaceutically acceptable salt thereof) and a polyvinylpyrrolidone artificial tears composition. Exemplary polyvinylpyrrolidone artificial tears compositions are described in, for example, U.S. Patent Nos. 5,895,654; 5,627,611; and 5,591,426; and U.S. Patent
Application Publication No. 2002/0082288, all of which are hereby incorporated by reference. Artificial tears compositions are understood to promote wettability and spread, have good retention and stability on the eye, and desirably do not cause any significant discomfort to the user. Accordingly, an exemplary polyvinylpyrrolidone artificial tear composition comprises:
(1) polyvinylpyrrolidone, preferably in the amount of about 0.1-5% by weight of the solution;
(2) benzalkonium chloride, preferably in an amount of about 0.01-0.10% by weight of the solution; (3) hydroxypropyl methylcellulose, preferably in an amount of about 0.2- 1.5% by weight of the solution; (4) glycerin, preferably in an amount of about 0.2- 1.0% by weight of the solution, and (5) water, wherein the composition is an aqueous solution having isotonic properties.
Sustained Release Delivery Systems
[00223] When it is desirable to have sustained release of one or more therapeutic agents to the patient, the therapeutic agent(s) may be administered to the patient in the form of a sustained release delivery system. Sustained release delivery systems are described in the published literature. Exemplary sustained release delivery systems include intracanalicular inserts, a slow release contact lens, a bio-erodible IVT insert, and an intracameral insert.
Inserts may be biodegradable or non-biodegradable. Exemplary materials described in the literature for use in sustained release delivery systems include a mixture of EVA and PVA polymers, a mixture of silicone and PVA polymer, a mixture of polyimide and PVA polymer, a mixture of PMMA and EVA polymers, PLGA polymer, and liposomes.
IV. Medical Kits
[00224] Another aspect of the invention provides a medical kit comprising, for example, (i) a therapeutic agent described herein, and (ii) instructions for treating glaucoma, ocular hypertension, and/or other ocular disorders according to methods described herein.
EXAMPLES
[00225] The invention now being generally described, will be more readily understood by reference to the following examples, which are included merely for purposes of illustrating certain aspects and embodiments of the present invention, and are not intended to limit the invention.
EXAMPLE 1 Reduction in Intraocular Pressure by Phentolamine Mesylate in Healthy Human Subjects Having Normal Intraocular Pressure
[00226] An aqueous solution containing phentolamine mesylate was applied as an eye drop to the eye of healthy human subjects having normal intraocular pressure, and reduction in intraocular pressure in the eye was measured. Experimental procedures and results are described below.
Part I - Experimental Procedures
[00227] One of the test articles in Table 1 was administered in the form an eye drop to the eye of a healthy human subject having normal intraocular pressure. Intraocular pressure of the subject’s eye was measured before administration of the test article and then again 2-3 hours after administration of test article. TABLE 1.
Figure imgf000058_0001
Part II - Results
[00228] Results are provided in Tables 2 and 3 below. The abbreviation IOP refers to intraocular pressure.
TABLE 2.
Figure imgf000058_0002
Figure imgf000059_0001
TABLE 3.
Figure imgf000059_0002
Figure imgf000059_0003
EXAMPLE 2 Reduction in Intraocular Pressure by Phentolamine Mesylate in Human Subjects with Intraocular Pressure of At Least 22 mmHG
[00229] Ability of phentolamine mesylate to reduce intraocular pressure (IOP) in the eye of a human subject having an IOP >22 mmHg may be evaluated according to a clinical study in which an aqueous ophthalmic solution containing phentolamine mesylate is administered to the eye of a patient, and then the patient is evaluated for reduction in intraocular pressure in the eye that received the aqueous ophthalmic solution containing phentolamine mesylate.
Experimental procedures and results are described below.
Part I - Experimental Procedures
[00230] Human subjects are screened for potential enrollment and, if qualified, enrolled in the study. Inclusion criteria and exclusion criteria for the study are set forth below. If a subject does not meet the inclusion/exclusion criteria but the investigator believes the subject should be in the study, a deviation may be allowed following a discussion between the Principal
Investigator and Sponsor of the study.
Inclusion Criteria
• Written informed consent to participate in this trial.
• Males or females greater than 45 years of age. • Good general health.
• Baseline IOP > 22 mmHG.
• BCDVA of 20/40 or better in at least one eye.
• Able and willing to give informed consent and comply with all protocol mandated procedures.
Exclusion Criteria
• Cataract(s).
• Ocular trauma within the past six months, or ocular surgery or laser treatment within the past three months.
• Refractive surgery or cataract surgery in either eye.
• Use of ocular medication within 4 weeks of Visit 1.
• Clinically significant ocular disease (e.g., comeal edema, uveitis, severe
keratoconjunctivitis sicca, retinal degenerative disease) which might interfere with the study.
• Any abnormality preventing reliable applanation tonometry of either eye.
• Known hypersensitivity or contraindication to phentolamine mesylate, or any
component of the formulation, or to topical anesthetics.
• Contraindications to phentolamine (including history of myocardial infarction,
cerebrovascular spasm, cerebrovascular occlusion, coronary insufficiency, angina, or other evidence suggestive of coronary artery disease).
• Low blood pressure - systolic <100 mm Hg or diastolic <60 mm Hg.
• A history of heart rate abnormalities, such as tachycardia or arrhythmias.
• Clinically significant systemic disease (e.g., uncontrolled diabetes, myasthenia gravis, hepatic, renal, cardiovascular or endocrine disorders) which might interfere with the study.
• Use of any topical or systemic alpha adrenergic or cholinergic drugs up to 30 days prior to screening, or during the study.
• Changes of systemic medication that could have a substantial effect on ocular
autonomic pupil tone 4 weeks prior to screening, or anticipated during the study.
• Participation in any investigational study within the past 30 days.
[00231] Human subjects enrolled in the study shall randomized into two (or more)
Treatment Groups with a 1: 1 randomization. The Treatment Groups will receive single doses of either: • Placebo Ophthalmic Solution,
• 1% w/w Phentolamine Mesylate Ophthalmic Solution, or
• 2% w/w Phentolamine Mesylate Ophthalmic Solution.
Description of the study medications is provided in Table 1.
TABLE 1. Study Medication
Figure imgf000061_0001
[00232] Doses of study medication are given once daily for one or more weeks; each subject will receive all the treatments. One or more of intraocular pressure, pupil diameter, Best Corrected Distance Visual Acuity (BCDVA), Distance Corrected Near Vision Acuity (DCNVA), Vision questionnaire, and Near Visual Acuity (NVA) will be measured at the screening visit, and throughout the study.
EXAMPLE 3 -Reduction in Intraocular Pressure by Phentolamine Mesylate in Human Subjects with Bilateral Open-Angle Glaucoma or Ocular Hypertension
[00233] Ability of phentolamine mesylate to reduce intraocular pressure in the eye of a human subject with bilateral open-angle glaucoma or ocular hypertension may be evaluated according to a clinical study in which an aqueous ophthalmic solution containing phentolamine mesylate is administered to the eye of a patient, and then the patient is evaluated for reduction in intraocular pressure in the eye that received the aqueous ophthalmic solution containing phentolamine mesylate. Experimental procedures and results are described below. Part I - Experimental Procedures
[00234] Human subjects are screened for potential enrollment and, if qualified, enrolled in the study. Inclusion criteria and exclusion criteria for the study are set forth below.
Inclusion Criteria
• 18 years of age or older.
• Diagnosis of bilateral primary open angle glaucoma or ocular hypertension.
• One qualifying IOP criteria after washout: · Baseline (Day 0) at TO (TO = 8 am ± 30 min) IOP > 23 mmHg in the study eye.
• IOP criteria after washout < 32 mmHg OU at all time points.
• Best-corrected visual acuity (BCVA) in both eyes of 20/200 or better on Snellen,
equivalent to + 1.0 log Mar.
• Able and willing to sign informed consent, follow study instructions and complete all study visits.
• As applicable, must be willing to discontinue the use of all ocular hypotensive
medication(s) in both eyes prior to receiving the study medication and for the entire course of the study.
• Able to self-administer or have a caretaker administer study eye drops.
Exclusion Criteria
• Closed or very narrow angles (Grade 0-1) or those the investigator judges as occludable and/or with evidence of peripheral anterior synechiae (PAS) > 180 degrees by gonioscopy within 6 months prior to Screening Visit in either eye. (Patent laser iridotomy with Grade 1-2 angles is acceptable in either eye, providing the PAS criteria are still met).
• Previous glaucoma intraocular surgery in either eye. Prior laser trabeculoplasty (ALT or SLT) in either eye is allowed if performed more than 6 months prior to Screening Visit.
• Any non-glaucoma intraocular surgery within 3 months prior to Screening Visit in either eye.
• Intraocular laser surgery such as laser capsulotomy, laser iridotomy, and/or retinal laser within 1 month prior to Screening Visit in either eye. • Significant media opacity in either eye that would impede adequate posterior segment examination.
• Contraindications to pupil dilation in either eye.
• Other forms of glaucoma such as primary congenital, juvenile onset, chronic angle closure, and secondary glaucoma of any type including steroid-induced, inflammation- induced, or exfoliation glaucoma in either eye. Pigment dispersion syndrome/glaucoma is permitted in either eye.
• Clinically significant comeal dystrophy, epithelial or endothelial disease, comeal
irregularities or scarring that, in the investigator's judgment, would impede an accurate measurement of IOP or visualization of intraocular anatomy in the study eye.
• History of refractive surgery in either eye (i.e., radial keratotomy, photorefractive
keratectomy, LASIK).
• History of comeal cross-linking procedure in either eye.
• Unwillingness to be contact lens free during study participation.
• Any history of uveitis, keratitis, or scleritis in either eye.
• Any history of penetrating ocular trauma in either eye.
• History within 3 months prior to Screening Visit of clinically significant moderate or severe chronic or active blepharitis, ocular dermatitis, or recent ocular conjunctivitis and/or ocular inflammation in either eye. Mild blepharitis, hyperemia (due to prostaglandin use) and/or blepharitis, and/or mild inactive seasonal allergic
conjunctivitis and non-infective dermatitis are acceptable.
• Comeal thickness < 480 or > 620 pm in the study eye. Pachymetry measurement within 6 months prior to Screening Visit is acceptable.
• Advanced or severe glaucoma with progressive visual field loss and/or optic nerve changes in either eye that, in the investigator's best judgment, prevent safe withdrawal from treatment for the time periods required in this protocol.
• Progressive retinal (including, but not limited to worsening dry age-related macular degeneration (AMD), presence of active wet AMD, or unstable diabetic retinopathy) or optic nerve disease in either eye from any cause other than glaucoma.
• Any prior intravitreal steroid injection in either eye. • Sub-tenon's, sub-conjunctival or periocular steroid injections within the 6 months prior to Screening Visit in either eye.
• Any use of ocular topical corticosteroids in either eye within 7 days, or chronic (as determined by the investigator) topical steroids within 28 days prior to Baseline and ensuing trial participation.
• Known hypersensitivity to any component of the study medication, or to topical
anesthetics or diagnostic drops used during the study.
• Any ocular, condition that, in the investigator's judgment, could prevent the subject from safe participation the study.
• Planned ocular surgery or intraocular injection procedure in either eye during study participation.
• Participation in a clinical study with use of any investigational drug or treatment within 30 days prior to Baseline (Day 0).
• Clinically significant abnormalities in: laboratory tests, physical examination, vital signs and/or ECG at Screening Visit. If in the investigator's judgment a subject with clinically significant abnormalities is appropriate for enrollment in the study, a discussion between the investigator and the Medical Monitor must occur and be documented prior to enrollment of this subject in the study.
• Clinically significant systemic, psychiatric or psychological disease (for example, renal, hepatic, uncontrolled diabetes, uncontrolled blood pressure, autoimmune disorders, psychiatric disorders, endocrine disorders, or any other disorders) or dependency which, in the investigator's judgment, would be unsafe and interfere with interpretation of the study results or the subject's ability to comply with the study requirements.
• Anticipated changes or initiation of medications which might affect IOP and/or
systemic blood pressure within 7 days prior to Baseline/Day 0 (e.g., oral anti hypertensives such as sympathomimetic agents, beta-adrenergic blocking agents, alpha agonists, alpha adrenergic blocking agents, calcium channel blockers, angiotensin converting enzyme inhibitors; [diuretics are allowed]), and 2 months prior to
Baseline/Day 0 for corticosteroids (i.e., oral, nasal, topical [dermal, mucosal], and/or inhaled corticosteroids). If there are no further anticipated changes in medications that could affect IOP and/or systemic blood pressure, then once the subject is stable on their new dose of medication for the required time period, the subject may complete the Baseline Visit, assuming that all other screening requirements are met. Medications used on an adjustable or sliding scale based on testing results are allowed.
• Known history of Hepatitis B + C, HIV+, or AIDS and/or inadequate venous access.
• Women of childbearing potential who are pregnant, nursing, planning a pregnancy, or not using a medically acceptable form of birth control. An adult woman is considered to be of childbearing potential unless she is one year post-menopausal or three months post-surgical sterilization. All females of childbearing potential must have a negative serum pregnancy test result at Screening Visit and a negative urine and serum pregnancy test at Baseline (Day 0) prior to randomization in the study and must not intend to become pregnant during the study.
• History of drug or alcohol abuse within the last 5 years.
• Related to site study staff and/or site employees.
[00235] For human subjects enrolled in the study, the human subject is assigned to a Treatment Group in random order. There will be two or more Treatment Groups, as set forth in Table 1 below. Subjects enrolled in the study will discontinue use of their ocular hypotensive therapy during the washout period. The duration of the washout period will depend on the subject's pre-study ocular hypotensive therapy.
[00236] Human subjects shall receive study medication as set forth in Table 1 according to the Treatment Group to which the subject is assigned. Study medication is listed in Table 2. Evaluations of human subjects are performed at the Screening Visit, optionally before treatment on Study Days 0, 7, 14, and 21, and then on Day 28. All human subjects are examined seven days after the last dose for follow-up evaluation.
TABLE 1. Treatment Groups
Figure imgf000065_0001
TABLE 2. Study Medication
Figure imgf000066_0001
[00237] Evaluation of human subjects during the study will include measurement of intraocular pressure, eye redness, heart rate, blood pressure, and any adverse events. The primary efficacy endpoint is reduction in intraocular pressure in the patient’s eye measured at day 28 of the study relative to placebo control.
[00238] During the study, human subjects are prohibited for taking any additional agent that is a systemic alpha adrenergic antagonists; all eye drops other than study medication are prohibited during the 28 days of dosing. Target enrollment is to enroll at least 40 patients, which will be divided approximately equally among the two or more Treatment Groups.
EXAMPLE 4 -Reduction in Intraocular Pressure by Phentolamine Mesylate in Human Subjects with Bilateral Open-Angle Glaucoma or Ocular Hypertension
[00239] Ability of phentolamine mesylate to reduce intraocular pressure in the eye of a human subject with bilateral open-angle glaucoma or ocular hypertension may be evaluated according to a clinical study in which an aqueous ophthalmic solution containing phentolamine mesylate is administered to the eye of a patient, and then the patient is evaluated for reduction in intraocular pressure (IOP) in the eye that received the aqueous ophthalmic solution containing phentolamine mesylate. Experimental procedures and results are described below. Part I - Experimental Procedures
[00240] Human subjects are screened for potential enrollment and, if qualified, enrolled in the study. Inclusion criteria and exclusion criteria for the study are set forth below.
Inclusion Criteria
• Have a diagnosis of open-angle glaucoma or ocular hypertension in both eyes.
• IOP after washout from prior IOP-lowering medications, if applicable, is required to be > 20 mmHg at 08:00 hours and > 17 mmHg at 10:00 and 16:00 hours.
• IOP has to be < 27 mmHg in both eyes at all qualification time points.
Exclusion Criteria
• Patient’s Open-angle glaucoma or ocular hypertension has a pseudoexfoliation or
pigment dispersion component.
• Patient has a history of angle closure or narrow angles, or has previous glaucoma
intraocular surgery or glaucoma laser procedures in either eye.
• Has a known hypersensitivity or contraindication to alpha-adrenoceptor antagonists.
[00241] For human subjects enrolled in the study, the human subject is assigned to a Treatment Group in random order. There will be two Treatment Groups, as set forth in Table 1 below. Human subjects shall receive study medication as set forth in Table 1 according to the Treatment Group to which the subject is assigned. Study medication is listed in Table 2. A period of thirty days is required for washout periods for ocular hypotensive medications prior to study initiation. Evaluations of human subjects may be performed at Screening, Qualification #1, Day 1 / Qualifying #2, Day 15, Day 43, and Day 90. For visits at Day 1, Day 15, Day 43, and Day 90, subjects may be evaluated at 08:00, 10:00, and 16:00 hours within the visit day.
TABLE 1. Treatment Groups
Figure imgf000067_0001
TABLE 2. Study Medication
Figure imgf000068_0001
[00242] Evaluation of human subjects during the study may include measurement of intraocular pressure, eye redness, heart rate, blood pressure, and any adverse events. The primary efficacy endpoint is mean IOP at one or more of the following time points: 08:00, 10:00, and 16:00 hours at Week 2 (Day 15), Week 6 (Day 43), and Month 3 (Day 90).
[00243] During the study, human subjects are prohibited for taking any additional agent that is a systemic alpha adrenergic antagonist; all eye drops other than study medication are prohibited during the 90 days of dosing. Target enrollment is to enroll at least 200 patients, which will be divided approximately equally among the Treatment Groups.
EXAMPLE 5 -Reduction in Intraocular Pressure by Phentolamine Mesylate in Human Subjects with Open-Angle Glaucoma or Ocular Hypertension
[00244] Ability of phentolamine mesylate to reduce intraocular pressure in the eye of human subjects with bilateral open-angle glaucoma (OAG) or ocular hypertension (OHT) was evaluated according to a clinical study in which an aqueous ophthalmic solution containing phentolamine mesylate was administered to the eye of a patient, and then the patient was evaluated for reduction in intraocular pressure in the eye that received the aqueous ophthalmic solution containing phentolamine mesylate. Approximately 40 subjects with either OAG or OHT were randomized, for a target of 36 completed subjects. Subjects were randomized in a 1 : 1 ratio to receive 1% w/w Phentolamine Mesylate Ophthalmic Solution or placebo once daily for 14 days beginning at 8PM to 10PM on Day 1 and continuing through Day 14. Efficacy evaluations of intraocular pressure (IOP) took place at the Baseline and the Treatment-study Visit days (Day 8 ± 1 Day and Day 15 ± 1 Day) at 8AM, 10AM, and 4PM. All IOP measurements had a window of ± 15 minutes with at least 2 hours between the 8 AM and 10AM assessments. There were Follow-up Visits on Day 16 at 8AM ± 15 minutes and by phone on Day 22 (7 days after the last Treatment-study Visit). Further experimental procedures and results are described below.
Part I - Experimental Procedures
[00245] The total length of subject participation was approximately 7 to 8 weeks with six clinic visits and one telephone call follow up, as summarized below:
• Screening Visit (1 day).
• Washout Visit/period (as necessary) (4-5 weeks with safety check visit at 2 weeks).
• Qualification/Baseline Visit (1 day).
• Treatment-study Visit Day 8 (1 week).
• Treatment-study Visit Day 15 (1 week).
• Follow-up clinic Visit on Day 16 (1 day).
• Follow-up telephone call at Day 22 (1 week).
[00246] Human subjects were screened for potential enrollment and, if qualified, enrolled in the study. Inclusion criteria and exclusion criteria for the study are set forth below. Human subjects could qualify in either eye. The eye with the higher intraocular pressure (IOP) at the Qualification Visit at 8AM was designated as the study eye for the primary endpoint efficacy analysis. In the case where both eyes had the same IOP, the study eye was the right eye.
Inclusion Criteria
• 18 years of age or greater.
• Diagnosis of OAG or OHT. The diagnosis of OHT must have been in both eyes. For OAG, the diagnosis could have been in either eye with OHT in the fellow eye. A reported history of untreated OHT with IOP >22mmHg and < 30mmHg was preferred.
• Untreated or treated OAG/OHT with 2 or fewer ocular hypotensive medications.
• Untreated (post-washout) mean IOP > 22mmHg and <30mmHg in the study eye at the Qualification Visit (8AM). • Corrected visual acuity in each eye +1.0 logMAR or better by Early Treatment Diabetic Retinopathy Study (ETDRS) in each eye (equivalent to 20/200 or beter) at the Screening Visit and Qualification Visit.
• Otherwise healthy and well-controlled subjects.
• Able and willing to give signed informed consent and follow study instructions.
• Able to self-administer study medication or to have study medication administered by a caregiver throughout the study period.
Exclusion Criteria
• Closed or very narrow angles (Grade 0-1, Shaffer) or angles that the investigator judges as occludable and/or with evidence of peripheral anterior synechiae (PAS) > 180 degrees by gonioscopy within 6 months prior to Screening Visit in either eye.
• Glaucoma: pseudo-exfoliation or pigment dispersion component, history of angle
closure or narrow angles. Note: Previous laser peripheral iridotomy was not allowed.
• Known hypersensitivity to any a-adrenoceptor antagonists.
• Previous laser and/or non-laser glaucoma surgery or procedure in either eye.
• Refractive surgery in either eye (e.g., radial keratotomy, photorefractive keratectomy (PRK), laser-assisted in situ keratomileusis (LASIK), or comeal cross linking).
• Ocular trauma in either eye within the 6 months prior to Screening, or ocular surgery or non-refractive laser treatment within the 3 months prior to Screening.
• Recent or current evidence of ocular infection or inflammation in either eye. Current evidence of clinically significant blepharitis, conjunctivitis, or a history of herpes simplex or herpes zoster keratitis at Screening in either eye.
• Ocular medication in either eye of any kind within 30 days of Screening, with the exception of a) ocular hypotensive medications (which had to be washed out), b) lid scrubs (which could be used prior to Screening but could not be used after Screening) or c) lubricating drops for dry eye (preservative-free artificial tears), which could be used throughout the study.
• Clinically significant ocular disease in either eye as deemed by the investigator (e.g., comeal edema, uveitis, or severe keratoconjunctivitis sicca) that might interfere with the study, including glaucomatous damage so severe that washout of ocular hypotensive medications for 1 month was not judged safe (i.e., cup-to-disc ratio > 0.8, severe visual field defect).
• History of diabetic retinopathy. • Contact lens wear within 3 days prior to and for the duration of the study.
• Central corneal thickness in either eye >600 pm at Screening.
• Any abnormality in either eye preventing reliable applanation tonometry (e.g., central comeal scarring).
• Known hypersensitivity or contraindication to a- and/or b-adrenoceptor antagonists (e.g., chronic obstructive pulmonary disease or bronchial asthma; abnormally low blood pressure or heart rate; second or third degree heart block or congestive heart failure; or severe diabetes).
• Clinically significant systemic disease (e.g., uncontrolled diabetes, myasthenia gravis, cancer, hepatic, renal, endocrine or cardiovascular disorders) that might interfere with the study.
• Participation in any investigational study within 30 days prior to Screening.
• Use of any topical or systemic adrenergic or cholinergic drugs up to 30 days prior to Screening, or during the study unless the drug, dose and regimen had been consistent for the 30 days prior to Screening.
• Changes in systemic medication that could have an effect on IOP within 30 days prior to Screening or anticipated during the study.
• Women of childbearing potential who were pregnant, nursing, planning a pregnancy, or not using a medically acceptable form of birth control. An adult woman was considered to be of childbearing potential unless she was 1 year postmenopausal or 3 months post- surgical sterilization. All females of childbearing potential must have had a negative urine pregnancy test result at the Screening and Qualification examinations and must have intended to not become pregnant during the study.
• Resting heart rate (HR) outside the normal range (50-110 beats per minute) at the Screening or Qualification Visit. HR could be repeated only once if outside the normal range, following at least a 5 minute rest period in the sitting position.
• Hypertension with resting diastolic blood pressure (BP) > 105 mmHg or systolic BP > 160 mmHg at the Screening or Qualification Visit. BP could be repeated only once if outside the specified range, following at least a 5 minute rest period in the sitting position.
[00247] Subjects with an ophthalmic history of increased IOP (> 22 mmHg and <30 mmHg) were selected for study participation and were screened for study eligibility. [00248] After Screening, eligible subjects, if being treated at the time with glaucoma medications, were required to washout and refrain from administration of any glaucoma drugs for at least 28 days and no more than 35 days prior to the Qualification Visit. The washout subjects were brought back at approximately two weeks after starting the washout period for an IOP safety check. In the judgement of the investigator, if there was any risk to the eye(s) of the subject, or if the mean IOP in either eye during washout was >30mmHg, then an appropriate rescue or prior medication was administered, and the subject was considered a screen failure. Adverse events occurring during the washout period were also assessed at this visit. After the washout, where applicable, a Qualification Visit occurred before dosing on Day 1.
[00249] Subjects not previously treated with any glaucoma drugs did not require a washout period and could return the following day, or up to 35 days later, for their
Qualification/Baseline Visit.
[00250] At the Qualification Visit, IOP eligibility was determined with a Goldmann tonometer using the two-person method (one person physically applies the tonometer, while another reads the result) at 8AM, 10AM, and 4PM (mean IOP at 8 AM must be > 22 mmHg and < 30 mmHg, and > 19 mmHg at 10AM and 4PM). IOP was measured twice in both eyes at each timepoint and the mean value was used in eligibility assessments. All IOP measurements had a window of ± 15 minutes with at least 2 hours between the 8AM and 10AM assessments.
[00251] The eye with the higher IOP at the Qualification Visit at 8AM was designated as the study eye for the primary endpoint efficacy analysis. In the case where both eyes had the same IOP, the study eye was the right eye. All treatments were administered to both eyes (OU).
[00252] At the Qualification/Baseline Visit:
• Females of childbearing potential took a urine pregnancy test at 8AM.
• Review of concomitant medications was conducted at 8 AM.
• IOP measurements using a Goldmann Applanation tonometer at the Baseline visit and both Treatment-study visits were performed at 8AM, 10AM and 4PM. All IOP measurements had a window of ± 15 minutes with at least 2 hours between the 8AM and 10AM assessments. IOP was measured twice in both eyes at each timepoint. The mean value at each timepoint for the study eye was used in efficacy assessments. If the difference in the two IOP measurements was >5 mmHg, a third measurement was obtained, and the three values were averaged. • Pupil diameter, using a Neuroptics pupillometer, near visual acuity using a standard chart held at 14 inches, and distance visual acuity with ETDRS were measured at 8AM.
• Resting HR and BP were measured at 8 AM and 4PM. Blood pressure, using the same arm, same cuff size appropriate for arm circumference throughout the study, and heart rate were measured after at least 3 minutes rest in the sitting position. If HR or BP were outside the normal range (HR <50 or >110 beats per minute, resting diastolic blood pressure (BP) > 105 mmHg or systolic BP > 160 mmHg), they could be repeated only once following at least a 5 minute rest period in the sitting position.
• Eye redness (conjunctival hyperemia) was visually checked at 8AM, 10AM and 4PM using the CCLRU bulbar redness scale.
• Adverse events were reviewed at each timepoint.
[00253] If the subject met all of the inclusion criteria and none of the exclusion criteria, including all three timepoint IOP measurements, this qualification visit became the Baseline Visit, a subject number was assigned, and he/she was randomized into the study. The first dose of study medication was taken at 8PM to 10PM on the Baseline Visit (Day 1).
[00254] Site personnel demonstrated the proper instillation technique to the subject at the Qualification/Baseline Visit (Day 1) and the subject self-administered a dose of artificial tears at the study site, instilling 1 drop in each eye from the unit-dose bottle (Note: If a drop was not instilled into the eye, the subject was instructed to wait approximately 10-15 seconds and administer a second drop). The subject received the following instructions regarding proper instillation technique:
The subject should be in a seated position and should tilt his or her head backward for administration of the study medication. The bottle of study medication should be held at an almost vertical position above the eye while the lower eyelid is pulled down gently, and 1 drop is placed into the conjunctival cul-de-sac. The tip of the bottle should not touch the eye. After a drop is instilled in each eye, the subject should keep the eyes gently closed for approximately 30 seconds. After successful instillation of the drop in each eye, the subject should carefully empty any remaining contents as directed.
[00255] The subject was given their study medication dropper bottles, instructions when to administer the eye drop (8PM tolOPM), and when to return to the clinic.
[00256] The subject was instructed to administer one drop to each eye from a new single unit-dose bottle, each evening of dosing, and close the eyes gently for 30 seconds, then empty the remaining bottle contents (and store the opened bottle in the baggie provided and place it in the medication box for return to the study site at the Day 8 Visit). The subject was instructed to follow the same procedures each subsequent evening of dosing (approximately 24 hours between doses). At the Day 8 visit, the medication box, complete with opened bottles and any unopened study medication was to be returned to the study site where the baggies of opened medication were removed, and the study medication box was re-dispensed with the unopened medication. During the second week of treatment, subjects were instructed to continue to administer one drop of study medication to each eye every night using a new bottle for each dose, then emptying the remaining contents of that bottle (and storing the opened bottles in the baggies and placing them back in the box to return to the study site at the Day 15 Visit). The Day 15 visit was the last day of study treatment; no further study medication was dispensed at that visit.
[00257] The subject was instructed to contact the investigator should adverse events of concern occur (e.g., shortness of breath, fainting, etc.), or to go to the emergency room if the event was life-threatening.
[00258] Treatment-study visits occurred twice - on Day 8 ± 1 Day and Day 15 ± 1 Day. IOP evaluations were performed at 8AM, 10AM and 4PM on each of these days. On Study Day 8, the following was performed:
• Review of concomitant medications was conducted at 8 AM.
• IOP measurements were performed at 8AM, 10AM and 4PM. All IOP measurements had a window of ± 15 minutes with at least 2 hours between the 8AM and 10AM assessments. IOP was measured twice in both eyes at each timepoint. The mean value at each timepoint for the study eye was used in efficacy assessments. If the difference in the two IOP measurements was >5 mmHg, a third measurement was obtained, and the three values were averaged.
• Pupil diameter, near and distance visual acuity, resting HR and BP were measured at 8AM and 4PM. Blood pressure, using the same arm, same cuff size appropriate for arm circumference throughout the study, and heart rate were measured after at least 3 minutes rest in the sitting position. If HR or BP were outside the normal range (HR <50 or >110 beats per minute, resting diastolic blood pressure (BP) > 105 mmHg or systolic BP > 160 mmHg), they could be repeated only once following at least a 5 minute rest period in the sitting position. • Eye redness (conjunctival hyperemia) was visually checked at each timepoint using the CCLRU bulbar redness scale.
[00259] On Study Day 15, the following was performed:
• Subjects were to bring their used dropper bottles and any unused medications with them for purposes of drug accountability.
• Subjects were asked if they had any problems with their eyes from the last visit, and if there have been any changes in their medical condition, or concomitant medications, since their last visit. Any changes in the condition of the subject were recorded as an adverse event.
• Females of childbearing potential took a urine pregnancy test at 8AM.
• Review of concomitant medications was conducted at 8 AM.
• IOP measurements were performed at 8AM, 10AM and 4PM. All IOP measurements had a window of ± 15 minutes with at least 2 hours between the 8AM and 10AM assessments. IOP was measured twice in both eyes at each timepoint. The mean value at each time point for the study eye was used in efficacy assessments. If the difference in the two IOP measurements was >5 mmHg, a third measurement was obtained, and the three values were averaged.
• Pupil diameter, near and distance visual acuity distance visual acuity, resting HR and BP were measured at 8 AM. Blood pressure, using the same arm, same cuff size appropriate for arm circumference throughout the study, and heart rate were measured after at least 3 minutes rest in the sitting position. If HR or BP were outside the normal range (HR <50 or >110 beats per minute, resting diastolic blood pressure (BP) > 105 mmHg or systolic BP > 160 mmHg), they could be repeated only once following at least a 5 minute rest period in the sitting position.
• Eye redness (conjunctival hyperemia) was visually checked at each time point using the CCLRU bulbar redness scale.
• Adverse events were reviewed at each time point.
• Distance and near visual acuity, pupil diameter, and a complete ophthalmic
examination, including biomicroscopy were also performed at 4 PM.
• Subjects completing their Day 15 Visit were instructed not to resume their original glaucoma medication(s) until after completion of the Day 22 Follow-up phone call. [00260] A Follow-up Visit occurred at 8AM ± 15 minutes on Day 16. Assessments performed at this visit included an IOP measurement at 8AM ± 15 minutes, visual acuity, pupil diameter, and safety measures. More specifically, the following were performed:
• Subjects were asked if they had any problems with their eyes from the last visit, and if there have been any changes in their medical condition, or concomitant medications, since their last visit. Any changes in the condition of the subject were recorded as an adverse event.
• Review of concomitant medications was conducted at 8 AM.
• IOP was measured twice in the study eye at 8AM ± 15 minutes, and the two values were averaged. If the difference in the two IOP measurements was >5 mmHg, a third measurement was obtained, and the three values were averaged.
• Pupil diameter, near and distance visual acuity distance visual acuity, resting HR and BP were measured at 8 AM. Blood pressure, using the same arm, same cuff size appropriate for arm circumference throughout the study, and heart rate were measured after at least 3 minutes rest in the sitting position. If HR or BP were outside the normal range (HR <50 or >110 beats per minute, resting diastolic blood pressure (BP) > 105 mmHg or systolic BP > 160 mmHg), they could be repeated only once following at least a 5 minute rest period in the sitting position.
• Eye redness (conjunctival hyperemia) was visually checked at each timepoint using the CCLRU bulbar redness scale.
• Adverse events were reviewed at 8AM.
• Subjects completing their Day 16 Visit were reminded not to resume their original glaucoma medication(s) until after completion of the Day 22 Follow-up phone call.
[00261] A Follow-up Visit phone call occurred on Day 22, seven days after the last dose. Any concomitant medications, subject-reported conjunctiva redness and adverse events (AEs) were collected.
[00262] Visits on Day 8 and 15 were allowed to be 1 day early or late. If the visit was late, the subject was advised to take an additional dose from one of the 2 spare dropper bottles provided in the study medication box the night before the visit. The subject was instructed to then empty the remaining contents and store the opened bottle in the baggie provided and place it in the medication box for return to the study site at their next visit. If the Day 15 Visit occurred one day early or late, the Day 16 Visit and the Day 22 telephone call were adjusted accordingly.
[00263] Any subject was permitted to voluntarily withdraw from the study at any time without prejudice. A non-completing subject was defined as one who exited the study by their own volition or at the discretion of the Investigator and/or the Medical Monitor prior to completing all of the study procedures required in the protocol.
[00264] Study subjects received study medication as set forth in Table 1 according to the Treatment Group to which the subject was assigned. Study medication is listed in Table 2.
TABLE 1. Treatment Groups
Figure imgf000077_0001
TABLE 2. Study Medication
Figure imgf000077_0002
Evaluation of Efficacy and Safety Endpoints and Measurement Procedures
[00265] Evaluation of human subjects during the study included measurement of intraocular pressure, eye redness, heart rate, blood pressure, and any adverse events. The primary efficacy endpoint was the change from Baseline to Day 15 in mean diurnal IOP in the study eye. Mean diurnal IOP was the mean of the IOP measurements at all three timepoints (8 AM, 10AM, 4PM). IOP measurements at the Baseline Visit and both Treatment-study Visits were performed at 8AM, 10AM and 4PM. All IOP measurements had a window of ± 15 minutes with at least 2 hours between the 8AM and 10AM assessments. IOP was measured twice in both eyes at each timepoint. The mean value at each timepoint for the study eye was used in efficacy assessments. If the difference in the two IOP measurements was > 5mmHg, a third measurement was obtained, and the three values were averaged.
[00266] Secondary efficacy endpoints were analyzed by study eye, fellow eye, and all eyes (unless otherwise indicated) and included:
• Change from Baseline to Day 15 in mean diurnal IOP in the fellow eye and all eyes.
• Change from Baseline to Day 8 in mean diurnal IOP.
• Mean IOP at each post-treatment timepoint (8AM, 10AM and 4PM; on Day 8 and Day 15).
• Change and percent change from Baseline to Day 8 and Day 15 in IOP at each
timepoint (8AM, 10AM, 4PM), and Day 16 at 8AM.
• Percentage of subjects achieving reductions from Baseline to Day 8 and Day 15 in IOP at 8 AM of greater than or equal to 10%, 15%, 20%, 25% and 30%.
• Percentage of subjects achieving Day 8, Day 15 and Day 16 IOP levels at 8AM of less than or equal to 16mmHg, 18mmHg, 20mmHg and 22mmHg.
• Change and percent change from Baseline Day 8, Day 15, and Day 16 in IOP at 8AM.
• Change and percent change to Days 8, 15, and 16 in pupil diameter at 8AM.
• Percentage of subjects achieving reductions from Baseline to Day 8, Day 15 and Day 16 in pupil diameter at 8AM of greater than or equal to 10%, 15%, 20%, 25%, and 30%.
• Change and percent change from Baseline to Day 8, Day 15, and Day 16 in best
corrected distance visual acuity (BCDVA) (ETDRS high contrast) (photopic and mesopic) at 8AM.
• Change and percent change from Baseline to Day 8, Day 15, and Day 16 in distance corrected near visual acuity (DCNVA) (ETDRS high contrast) (photopic and mesopic) at 8AM.
• Percentage of subjects achieving improvements from Baseline to Day 8, Day 15, and Day 16 in BCDVA and DCNVA (photopic and mesopic) of greater than or equal to 1 line, 2 lines and 3 lines.
[00267] All Secondary Endpoints related to IOP were analyzed additionally in those subpopulations with Baseline IOP of <25mmHg and >25mmHg. [00268] For each subject at each timepoint (8AM, 10AM, 4PM), the IOP value was the average IOP (from the 2 measurements taken at that timepoint) in the study eye or in the fellow eye. The lighting conditions were kept the same from visit to visit. Every effort was made to have the same clinician perform the IOP measurements at all timepoints and at all visits.
[00269] The standard procedure for measuring efficacy endpoints at the Screening Visit, the Qualification/Baseline Visit, the Treatment-study visits, and Follow-up Visit utilized the equipment and procedures set forth in Table 3, below.
TABLE 3. Procedures for Measuring Efficacy Endpoints
Figure imgf000079_0001
Figure imgf000080_0001
[00270] For this study photopic and mesopic light conditions were considered to be“with the lights on or with the lights off’. There were no specific light conditions required other than that the same light conditions were to be used throughout the study.
[00271] The primary safety measures were objective biomicroscopic and ophthalmoscopic examination, subjective ocular tolerability, and AEs. Other safety measures were systemic safety as measured by heart rate and blood pressure. Urine pregnancy tests for females of childbearing potential were conducted. Conjunctival hyperemia was measured with a CCLRU card 4-point scale:
• None (0) = Normal Appeared white with a small number of conjunctival blood vessel easily observed.
• Mild (+1) = Prominent, pinkish-red color of both the bulbar and palpebral conjunctiva.
• Moderate (+2) = Bright, scarlet red color of the bulbar and palpebral conjunctiva.
• Severe (+3) = Beefy red with petechiae, dark red bulbar and palpebral conjunctiva with evidence of subconjunctival hemorrhage.
[00272] Biomicroscopy of anterior segment was performed, including evaluation of cornea, conjunctiva and anterior chamber. Fluorescein staining was used. For ophthalmoscopy, a dilated fundus exam was performed including examination of the optic nerve, macula, vessels and periphery. Blood pressure was measured using the same arm and same cuff size appropriate for arm circumference throughout the study. Blood pressure and heart rate were measured after at least 3 minutes rest in the sitting position. If HR or BP were outside the normal range (HR <50 or >110 beats per minute, resting diastolic blood pressure (BP) > 105 mmHg or systolic BP > 160 mmHg), they could be repeated only once following at least a 5 minute rest period in the sitting position.
Evaluation of Efficacy Analysis Procedures [00273] Efficacy was assessed using the full analysis set (FAS) with subjects included in the treatment group they were randomized to, regardless of the treatment they actually received.
For the analysis of the primary efficacy endpoint, observed case data was used (no imputation was performed for missing efficacy data) for the primary analysis. Confirmatory analyses were performed using the all randomized (AR) population, with imputation performed for missing data. For the analysis of the secondary efficacy endpoints, only observed case data was used.
If warranted, confirmatory analyses using the AR population with imputation for missing data were also performed for the secondary efficacy endpoints.
[00274] For all efficacy endpoints, Baseline was defined as the pre-dose value from the Baseline Visit/Day 1. If there was no pre-dose value from Day 1, then Baseline was the value from the Screening Visit.
[00275] IOP was measured twice in both eyes at each timepoint. The mean value at each timepoint for the study eye was used in efficacy assessments. If the difference in the two IOP measurements was >5 mmHg, a third measurement was obtained, and the three values were averaged. The lighting conditions were kept the same from visit to visit.
[00276] Diurnal IOP was the mean of all three measurements (8 AM, 10AM, and 4PM) on a specific day.
[00277] All efficacy data was summarized by treatment group, study day and timepoint (8AM, 10AM, 4PM), as appropriate.
[00278] The primary efficacy endpoint was the change from Baseline to Day 15 in mean diurnal IOP. The primary efficacy endpoint was analyzed using analysis of covariance (ANCOVA) with change from Baseline to Day 15 in diurnal IOP as the dependent variable; treatment as a factor; and Baseline diurnal IOP as the covariate. The ANCOVA was performed using the FAS, with subjects included in their randomized treatment group regardless of the treatment they actually received. Observed case data only was used; that is, any missing Day 15 diurnal IOP was not imputed. The least-squares mean (LSM) and standard error (SE) were determined for both treatment groups, along with the placebo-corrected LSM, its 95% confidence interval (Cl) and associated p-value. A confirmatory analysis of the primary efficacy endpoint was performed, using the AR population with missing Day 15 values imputed.
[00279] For each of the continuous secondary efficacy endpoints, the same ANCOVA for the primary efficacy endpoint was used, with the respective Baseline included as the covariate. Each ANCOVA was performed using the FAS with subjects included in their randomized treatment group regardless of the treatment they actually received. Only observed case data was used; that is, missing values for post-randomization visits were not imputed. The output from each ANCOVA included the LSM and SE for both treatment groups, along with the placebo-corrected LSM, its 95% Cl and associated p-value.
[00280] For each of the secondary efficacy endpoints related to percentage of subjects (or percentage of eyes) meeting certain criteria, the analysis was performed using a logistic regression with treatment and Baseline included as independent factors. For each analysis, the percentage of subjects (or eyes) in each treatment group meeting the criteria, the odds ratio (OR) with 95% Cl and p-value was determined. For all of these endpoints, the FAS was used with subjects included in their randomized treatment group regardless of the treatment they actually received.
Evaluation of Safety Analysis Procedures
[00281] Safety was assessed using the safety population (SP) with subjects included in the treatment group they actually received, regardless of their randomized treatment. Observed case data was used; no imputation was performed for missing safety data.
[00282] For all safety endpoints, Baseline was defined as the pre-dose value from the Baseline Visit/Day. If there was no pre-dose value from Day 1, then Baseline was the value from the Screening Visit.
[00283] Biomicroscopy results and ophthalmoscopy results were summarized by treatment group using the SP. As both eyes were treated in the study; both eyes were included in the summarizations for visual acuity, biomicroscopy, and ophthalmoscopy. Separate summary tables were created for the study eye versus the fellow eye.
[00284] Heart rate and blood pressure values and change from Baseline in the values were summarized by treatment group and time point (8AM on Day 8, Day 15 and Day 16; 4PM on Day 15).
[00285] Verbatim descriptions of AEs were coded using MedDRA. Only treatment- emergent AEs (TEAEs; those that occur after the first dose of study medication or increase in severity after initiation of study medication) were summarized. TEAEs and serious AEs (SAEs) were summarized by treatment group, by system organ class (SOC), severity, and relationship to study medication. Part II - Results
[00286] The observed reduction in IOP for categories of human subjects is provided in Tables 4A and 4B. Results in Table 4A are from human subjects that received 1% w/w Phentolamine Mesylate Ophthalmic Solution. Results in Table 4B are from human subjects that placebo.
[00287] As shown in Table 4A, the reduction in IOP in human subjects receiving 1% w/w Phentolamine Mesylate Ophthalmic Solution was greater in human subjects having a lower baseline IOP (e.g., IOP <23 mmHg) compared to reduction in IOP observed in the category of human subjects having a higher baseline IOP (e.g., the Category A Patients, which have IOP <26 mmHg).
[00288] For human subjects enrolled in this study having a baseline IOP > 26 mmHg and receiving 1% w/w Phentolamine Mesylate Ophthalmic Solution according to the dosing protocol, the observed change in IOP at Day 15 relative to Baseline was similar to that observed in the placebo group.
TABLE 4A. Observed Change in IOP for Human Subjects Having a Baseline IOP <26 mmHg
Figure imgf000083_0001
*Per protocol.
**Subjects that achieved IOP baseline at all time points (8am, lOam, 4pm) on Baseline Day 1. TABLE 4B. Observed Change in IOP for Human Subjects Having a Baseline IOP <26 mini Ig
Figure imgf000084_0001
*Per protocol.
** Subjects that achieved IOP baseline at all time points (8am, lOam, 4pm) on Baseline Day 1.
[00289] The observed change in pupil diameter under phototopic conditions at day 15 in the human subjects is listed in Tables 5 A and 5B. The observed change in pupil diameter under phototopic conditions at day 16 in the human subjects is listed in Tables 6A and 6B. The observed change in pupil diameter under mesopic conditions at day 15 in the human subjects is listed in Table 7A. The observed change in pupil diameter under mesopic conditions at day 16 in the human subjects is listed in Table 7B.
Attorney Docket No. 399256-OPI-006WO (163074)
TABLE 5A. Observed Change in Pupil Diameter Under Photopic Conditions
Figure imgf000085_0001
Min = Minimum, Max = Maximum, SD = Standard deviation, LS = Least-squares, Cl = Confidence interval, SE = Standard error
[1] From an analysis of covariance (ANCOVA) with (percent) change from Baseline in Pupil Diameter as the dependent variable; treatment as a factor; and Baseline Pupil Diameter as the covariate.
[2] From a test comparing the individual treatment change from baseline FS mean to zero.
[3] The pooled data from the Study Eye and Fellow Eye.
TABLE 5B. Observed Change in Pupil Diameter Under Photopic Conditions
Figure imgf000086_0001
Min = Minimum, Max = Maximum, SD = Standard deviation, LS = Least-squares, Cl = Confidence interval, SE = Standard error
[1] Prom an analysis of covariance (ANCOVA) with (percent) change from Baseline in Pupil Diameter as the dependent variable; treatment as a factor; and Baseline Pupil Diameter as the covariate.
[2] From a test comparing the individual treatment change from baseline LS mean to zero.
[3] The pooled data from the Study Eye and Fellow Eye.
TABLE 6A. Observed Change in Pupil Diameter Under Photopic Conditions
Figure imgf000087_0001
Min = Minimum, Max = Maximum, SD = Standard deviation, LS = Least-squares, Cl = Confidence interval, SE = Standard error
[1] From an analysis of covariance (ANCOVA) with (percent) change from Baseline in Pupil Diameter as the dependent variable; treatment as a factor; and Baseline Pupil Diameter as the covariate.
[2] From a test comparing the individual treatment change from baseline LS mean to zero.
[3] The pooled data from the Study Eye and Fellow Eye.
TABLE 6B. Observed Change in Pupil Diameter Under Photopic Conditions
Figure imgf000088_0001
Min = Minimum, Max = Maximum, SD = Standard deviation, LS = Least-squares, Cl = Confidence interval, SE = Standard error
[1] From an analysis of covariance (ANCOVA) with (percent) change from Baseline in Pupil Diameter as the dependent variable; treatment as a factor; and Baseline Pupil Diameter as the covariate.
[2] From a test comparing the individual treatment change from baseline LS mean to zero.
TABLE 7A. Observed Change in Pupil Diameter Under Mesopic Conditions
Figure imgf000089_0001
Min = Minimum, Max = Maximum, SD = Standard deviation, LS = Least-squares, Cl = Confidence interval, SE = Standard error
[1] From an analysis of covariance (ANCOVA) with (percent) change from Baseline in Pupil Diameter as the dependent variable; treatment as a factor; and Baseline Pupil Diameter as the covariate.
[2] From a test comparing the individual treatment change from baseline LS mean to zero.
[3] The pooled data from the Study Eye and Fellow Eye.
TABLE 7B. Observed Change in Pupil Diameter Under Mesopic Conditions
Figure imgf000090_0001
Min = Minimum, Max = Maximum, SD = Standard deviation, LS = Least-squares, Cl = Confidence interval, SE = Standard error
[1] From an analysis of covariance (ANCOVA) with (percent) change from Baseline in Pupil Diameter as the dependent variable; treatment as a factor; and Baseline Pupil Diameter as the covariate.
[2] From a test comparing the individual treatment change from baseline FS mean to zero.
[3] The pooled data from the Study Eye and Fellow Eye.
[00290] The observed change in near visual acuity in the human subjects measured on days 15 and 16 is listed in Tables 8 and 9.
TABLE 8. Observed Change in Near Visual Acuity
Figure imgf000091_0001
Cl = Confidence interval. Percentages are the number of subjects achieving the improvement divided by the number of subjects with an assessment at the timepoint.
[1] 1 line = 1.3 LogMAR; 2 lines = 1.2 LogMAR; 3 lines = 1.1 LogMAR, etc.
[2] From a logistic regression with treatment as a factor; and Baseline DCNVA as the covariate.
[3] The pooled data from the Study Eye and Fellow Eye. Subjects are counted in a category if they meet the reduction criterion for at least one eye.
TABLE 9. Observed Change in Near Visual Acuity
Figure imgf000092_0001
Cl = Confidence interval. Percentages are the number of subjects achieving the improvement divided by the number of subjects with an assessment at the timepoint.
[1] 1 line = 1.3 LogMAR; 2 lines = 1.2 LogMAR; 3 lines = 1.1 LogMAR, etc.
[2] From a logistic regression with treatment as a factor; and Baseline DCNVA as the covariate.
[3] The pooled data from the Study Eye and Fellow Eye. Subjects are counted in a category if they meet the reduction criterion for at least one eye.
Attorney Docket No. 399256-OPI-006WO (163074)
[00291] The observed change in eye redness in the human subjects measured on days 15 and 16 is listed in Tables 10A, 10B, 10C, and 10D. An overall summary of treatment emergent adverse events observed during the study is provided in Table 11.
TABLE 10A. Observed Change in Eye Redness
Figure imgf000094_0001
Percentages are the number of subjects in the category divided by the number of subjects with an examination at the timepoint.
[1] Conjunctival redness is graded on a 4-point scale: 0=none; l=mild; 2=moderate; 3=severe. TABLE 10B. Observed Change in Eye Redness
Figure imgf000095_0001
Percentages are the number of subjects in the category divided by the number of subjects with an examination at the timepoint.
[1] Conjunctival redness is graded on a 4-point scale: 0=none; l=mild; 2=moderate; 3=severe.
TABLE 10C. Observed Change in Eye Redness
Figure imgf000096_0001
Percentages are the number of subjects in the category divided by the number of subjects with an examination at the timepoint.
[1] Conjunctival redness is graded on a 4-point scale: 0=none; l=mild; 2=moderate; 3=severe.
TABLE 10D. Observed Change in Eye Redness
Figure imgf000097_0001
Percentages are the number of subjects in the category divided by the number of subjects with an examination at the timepoint.
[1] Conjunctival redness is graded on a 4-point scale: 0=none; l=mild; 2=moderate; 3=severe.
TABLE 11. Overall Summary of Treatment Emergent Adverse Events
Figure imgf000098_0001
Percentages are the number of subjects in the category divided by the number of subjects randomized in the group.
[1] In counting the number of adverse events reported, an adverse event is defined as an event with a unique subject identification number, system organ class, preferred term, and site. Bilateral ocular events are counted twice, i.e. once for each eye.
EXAMPLE 6 -Reduction in Intraocular Pressure by Phentolamine Mesylate in Human Subjects Pharmacologically Induced Mydriasis
[00292] Ability of phentolamine mesylate to reduce intraocular pressure in the eye of human subjects with pharmacologically induced mydriasis was evaluated according to a clinical study in which placebo or an aqueous ophthalmic solution containing phentolamine mesylate was administered to the eye of a patient having pharmacologically induced mydriasis, and then the patient was evaluated for reduction in intraocular pressure in the eye. In the procedure, one drop test article (i.e., placebo or 1% w/w Phentolamine Mesylate Ophthalmic Solution) was administered to the patient’s eye. The clinical study was conducted as a placebo-controlled, randomized, double-masked, 2-arm cross-over, Phase 2b study in 32 randomized human subjects. Approximately one-half of the randomized subjects received phenylephrine 1 hour before treatment with 1% w/w Phentolamine Mesylate Ophthalmic Solution and approximately one-half received tropicamide 1 hour before treatment with 1% w/w Phentolamine Mesylate Ophthalmic Solution. Each subject received the same mydriatic agent throughout the study. Intraocular pressure (IOP) of the subject’s eye was measured before administration of the test article (i.e., placebo or 1% w/w Phentolamine Mesylate Ophthalmic Solution) and then again 2-3 hours and at 6 hours after administration of test article. Study medication is further described in Table 1 below.
TABLE 1. Study Medication
Figure imgf000100_0001
[00293] Observed experimental results from the IOP measurements are provided in Tables 2 and 3 below.
TABLE 2.
Figure imgf000100_0002
*Per protocol.
**As measured at Week 1 Baseline; changes measured at 6-8 hours post dose.
TABLE 3.
Figure imgf000101_0001
*Per protocol.
**As measured at Week 1 Baseline; changes measured at 6-8 hours post dose.
EXAMPLE 7 -Reduction in Intraocular Pressure by Phentolamine Mesylate in
Combination with Latanoprost in Human Subjects with Open-Angle Glaucoma or Ocular Hypertension
[00294] Ability of phentolamine mesylate to reduce intraocular pressure in the eye of a human subject with bilateral open-angle glaucoma (OAG) or ocular hypertension (OHT) alone or combination with latanoprost may be evaluated according to a clinical study in which an aqueous ophthalmic solution containing phentolamine mesylate is administered to the eye of a patient in combination with latanoprost, and then the patient is evaluated for reduction in intraocular pressure in the eye that received the phentolamine mesylate and latanoprost. Subjects with either OAG or OHT may be randomized in a 1 : 1 : 1 ratio to receive (i) 1% w/w Phentolamine Mesylate Ophthalmic Solution Containing 0.005% w/w Latanoprost, (ii) just 1% w/w Phentolamine Mesylate Ophthalmic Solution, or (iii) just 0.005% w/w Latanoprost Ophthalmic Solution once daily in the evening. Efficacy evaluations of intraocular pressure (IOP) are to take place at the Baseline and the Treatment- study Visit days (week 2, week 6, and month 3) at 8AM, 10AM, and 4PM. As an alternative to administering 1% w/w Phentolamine Mesylate Ophthalmic Solution Containing 0.005% w/w Latanoprost, the study may administer (a) 1% w/w Phentolamine Mesylate Ophthalmic Solution and (b) 0.005% w/w Latanoprost Ophthalmic Solution. Further experimental procedures are provided below.
Part I - Experimental Procedures
[00295] The study is to be configured as a double-masked, active-controlled, parallel-group, randomized clinical trial. Human subjects are to be screened for potential enrollment and, if qualified, enrolled in the study. Eligible patients will have bilateral open-angle glaucoma or ocular hypertension and are aged >18 years with unmedicated IOP between 20 and 36 mmHg (i.e., >20 mmHg and <36 mm Hg) in both eyes at 8:00 AM at two qualification visits (2-7 days apart) and between 17 mmHg and 36 mmHg (i.e., an IOP >17 mmHg and <36 mm Hg) in both eyes at 10:00 AM and 4:00 PM at the second qualification visit. Patients using ocular hypotensive medications will be required to undergo washout before study entry: 4 weeks for prostaglandin analogs and b-adrenergic antagonists, 2 weeks for adrenergic agonists, and 5 days for muscarinic agonists and carbonic anhydrase inhibitors. Best-corrected visual acuity in each eye will be +1.0 logMAR or better by Early Treatment of Diabetic Retinopathy Study
measurement.
[00296] Exclusion criteria include individuals treated with greater than two ocular hypotensive medications within 30 days of screening, pseudoexfoliation or pigment dispersion glaucoma, a history of iridocorneal angle closure or narrow angles (including previous peripheral iridotomy), previous glaucoma incisional or laser surgery, previous refractive surgery, central corneal thickness >620 pm, or known hypersensitivity or contraindications to phentolamine mesylate or latanoprost (or their excipients). Patients with clinically significant ocular disease other than glaucoma in either eye or systemic disease that might interfere with the study, and women of childbearing potential who were pregnant, nursing, planning a pregnancy, or not using a medically acceptable form of birth control will also excluded.
[00297] Enrolled patients will be randomized (1 : 1 : 1) via an interactive web-based response system to receive 1% w/w Phentolamine Mesylate Ophthalmic Solution Containing 0.005% w/w Latanoprost 0.005%, only 1% w/w Phentolamine Mesylate Ophthalmic Solution, or only 0.005% w/w Latanoprost Ophthalmic Solution. Each study treatment will be dosed once daily in the evening. Randomization will be stratified by maximum baseline IOP (<25 vs >25 mm Hg). Treatment assignments will be masked to the investigator, clinical study team, and patients. An independent person at the investigative site not responsible for performing any study procedure will be assigned to dispense, collect, and store study treatment. As an alternative to
administering 1% w/w Phentolamine Mesylate Ophthalmic Solution Containing 0.005% w/w Latanoprost, the study may administer (a) 1% w/w Phentolamine Mesylate Ophthalmic Solution and (b) 0.005% w/w Latanoprost Ophthalmic Solution. Exemplary study medication is further described in the following table.
Exemplary Study Medication
Figure imgf000103_0001
[00298] An exemplary 0.005% w/w Latanoprost Ophthalmic Solution is, for example, latanoprost ophthalmic solution available commercially under the tradename XALATAN®, which contains 0.005% w/w latanoprost as a sterile, isotonic, buffered aqueous solution having a pH of approximately 6.7 and an osmolality of approximately 267 mOsmol/kg. Each 1 mL of XALATAN® solution contains 50 micrograms of latanoprost. Inactive ingredients in the XALATAN® solution are sodium chloride, sodium dihydrogen phosphate monohydrate, disodium hydrogen phosphate anhydrous, water for injection, and benzalkonium chloride (0.02% w/w) which functions as a preservative. One drop of XALATAN® solution contains approximately 1.5 micrograms of latanoprost.
Analysis of Efficacy
[00299] The primary efficacy endpoint is mean IOP at 8:00 AM, 10:00 AM, and 4:00 PM at week 2, week 6, and month 3. Secondary efficacy endpoints include mean diurnal IOP, mean change and mean percent change from diumally adjusted (time-consistent) baseline IOP, and percentages of patients achieving pre-specified thresholds for mean, mean change, and mean percent change in mean diurnal IOP. Both eyes will be treated; the study eye is the eye with higher IOP at 8:00 AM on day 1, or the OD eye if IOP is the same in both eyes. The intent-to- treat population includes all randomized patients who received >1 dose of study medication and is the primary population for efficacy analyses. The per-protocol population is the subset of patients in the intent-to-treat population who will not have major protocol violations and is the secondary population for efficacy analyses.
Analysis of Safety
[00300] Safety outcomes measures are ocular and systemic adverse events (AEs) during the 3 -month treatment period. Safety outcomes for the total study duration (3 months) will be reported separately. Safety and tolerability will be assessed using patient responses to open- ended questions (e.g.,“How are you feeling?”) and ophthalmic and systemic examinations. Ocular safety assessments, which will be undertaken at all study time points, include symptoms and AEs, best-corrected visual acuity (Early Treatment of Diabetic Retinopathy Study measurement), pupil size, biomicroscopy, pachymetry, visual field and cup-disc ratio measurements, and dilated ophthalmoscopy. Biomicroscopic examination of the eyelids, conjunctiva, cornea, anterior chamber, lens, iris, and pupil of both eyes will be performed at every study visit. Systemic safety assessments include measurements of heart rate, and blood pressure. Trial can be extended for up to 12 months for further safety exposure data. INCORPORATION BY REFERENCE
[00301] The entire disclosure of each of the patent documents and scientific articles referred to herein is incorporated by reference for all purposes.
EQUIVALENTS
[00302] The invention may be embodied in other specific forms without departing from the spirit or essential characteristics thereof. The foregoing embodiments are therefore to be considered in all respects illustrative rather than limiting the invention described herein. Scope of the invention is thus indicated by the appended claims rather than by the foregoing
description, and all changes that come within the meaning and range of equivalency of the claims are intended to be embraced therein.

Claims

Claims:
1. A method of treating a condition selected from the group consisting of glaucoma, ocular hypertension, and non-arteritic anterior ischemic optic neuropathy in a patient while minimizing eye redness during the patient’s waking hours, comprising administering to an eye of a patient in need thereof at or near the bedtime of the patient an effective amount of a once daily dosage of phentolamine or a pharmaceutically acceptable salt thereof to thereby treat the condition.
2. The method of claim 1, wherein the dosage is administered within 1 hour of the patient’s bedtime.
3. The method of claim 1 or 2, wherein the dosage is administered for at least three consecutive days.
4. The method of claim 1 or 2, wherein the dosage is administered for at least seven consecutive days.
5. The method of claim 1 or 2, wherein the dosage is administered on one day in a three day period.
6. The method of any one of claims 1-5, wherein the patient experiences an increase in eye redness of no more than two grades measured using the CCLRU Redness Grading Scale during the patient’s waking hours compared to the patient’s level of eye redness without receiving said dosage.
7. The method of any one of claims 1-5, wherein the patient experiences an increase in eye redness of no more than one grade measured using the CCLRU Redness Grading Scale during the patient’s waking hours compared to the patient’s level of eye redness without receiving said dosage.
8. The method of any one of claims 1-7, wherein the dosage comprises a pharmaceutically acceptable salt of phentolamine.
9. The method of any one of claims 1-7, wherein the dosage comprises phentolamine mesylate.
10. A method of treating a condition selected from the group consisting of glaucoma, ocular hypertension, and non-arteritic anterior ischemic optic neuropathy in a patient according to a monotherapy treatment regimen, comprising administering to an eye of a patient in need thereof a dosage of a single therapeutic agent in an amount effective for treatment of said condition, wherein the single therapeutic agent is phentolamine or a pharmaceutically acceptable salt thereof.
11. The method of claim 10, wherein the dosage is administered to the eye of the patient at or near the bedtime of the patient.
12. The method of claim 10, wherein the dosage is administered to the eye of the patient within 1 hour of the patient’s bedtime.
13. The method of any one of claims 10-12, wherein the dosage is administered at least once daily for at least three consecutive days.
14. The method of any one of claims 10-12, wherein the dosage is administered at least once daily for at least seven consecutive days.
15. The method of any one of claims 10-12, wherein the dosage is administered on one day in a three day period.
16. The method of any one of claims 10-12, wherein the dosage is administered once per day.
17. The method of any one of claims 10-12, wherein the dosage is administered twice, three times, or four times per day.
18. The method of any one of claims 10-17, wherein the patient experiences an increase in eye redness of no more than two grades measured using the CCLRU Redness Grading Scale during the patient’s waking hours compared to the patient’s level of eye redness without receiving said dosage.
19. The method of any one of claims 10-17, wherein the patient experiences an increase in eye redness of no more than one grade measured using the CCLRU Redness Grading Scale during the patient’s waking hours compared to the patient’s level of eye redness without receiving said dosage.
20. The method of any one of claims 10-19, wherein the single therapeutic agent is a
pharmaceutically acceptable salt of phentolamine.
21. The method of any one of claims 10-19, wherein the single therapeutic agent is phentolamine mesylate.
22. A method of treating a condition selected from the group consisting of glaucoma, ocular hypertension, and non-arteritic anterior ischemic optic neuropathy in a patient, comprising administering to an eye of a patient in need thereof a dosage of an alpha-adrenergic antagonist in an amount sufficient to achieve a reduction in a symptom or feature of the condition for a duration of at least 8 hours, to thereby treat the condition without at least one of the following adverse events:
(a) stinging or burning sensation experienced by the patient upon administration of the alpha-adrenergic antagonist to the eye; or
(b) an increase in eye redness more than two grades measured using the CCLRU Redness Grading Scale compared to the patient’s level of eye redness without receiving the amount of alpha-adrenergic antagonist.
23. The method of claim 22, wherein the alpha-adrenergic antagonist is administered to the eye of the patient at or near the bedtime of the patient.
24. The method of claim 22, wherein the alpha-adrenergic antagonist is administered to the eye of the patient within 1 hour of the patient’s bedtime.
25. The method of any one of claims 22-24, wherein the alpha-adrenergic antagonist is
administered at least once daily for at least three consecutive days.
26. The method of any one of claims 22-24, wherein the alpha-adrenergic antagonist is
administered at least once daily for at least seven consecutive days.
27. The method of any one of claims 22-24, wherein the alpha-adrenergic antagonist is
administered on one day in a three day period.
28. The method of any one of claims 22-24, wherein the dosage is administered once per day.
29. The method of any one of claims 22-24, wherein the dosage is administered two times, three times, or four times per day.
30. The method of any one of claims 22-29, wherein the patient experiences an increase in eye redness of no more than two grades measured using the CCLRU Redness Grading Scale during the patient’s waking hours compared to the patient’s level of eye redness without receiving said dosage.
31. The method of any one of claims 22-29, wherein the patient experiences an increase in eye redness of no more than one grade measured using the CCLRU Redness Grading Scale during the patient’s waking hours compared to the patient’s level of eye redness without receiving said dosage.
32. The method of any one of claims 22-31, wherein the dosage of alpha-adrenergic antagonist is an amount sufficient to achieve a reduction in a symptom or feature of the condition for a duration of at least 12 hours, to thereby treat the condition without any of the following adverse events: (a) stinging or burning sensation experienced by the patient upon
administration of the alpha-adrenergic antagonist to the eye; and (b) an increase in eye redness more than two grades measured using the CCLRU Redness Grading Scale compared to the patient’s level of eye redness without receiving the amount of alpha-adrenergic antagonist.
33. The method of any one of claims 22-31, wherein the dosage of alpha-adrenergic antagonist is an amount sufficient to achieve a reduction in a symptom or feature of the condition for a duration of at least 24 hours, to thereby treat the condition without any of the following adverse events: (a) stinging or burning sensation experienced by the patient upon
administration of the alpha-adrenergic antagonist to the eye; and (b) an increase in eye redness more than two grades measured using the CCLRU Redness Grading Scale compared to the patient’s level of eye redness without receiving the amount of alpha-adrenergic antagonist.
34. The method of any one of claims 22-33, wherein the alpha-adrenergic antagonist is
phentolamine, phenoxybenzamine, tolazoline, trazodone, alfuzosin, doxazosin, prazosin, tamsulosin, terazosin, silodosin, atipamezole, idazoxan, mirtazapine, yohimbine,
fenoldopam, thymoxamine, or a pharmaceutically acceptable salt of any of the foregoing.
35. The method of any one of claims 22-33, wherein the alpha-adrenergic antagonist is
phentolamine or a pharmaceutically acceptable salt thereof.
36. The method of any one of claims 22-33, wherein the alpha-adrenergic antagonist is a pharmaceutically acceptable salt of phentolamine.
37. The method of any one of claims 22-33, wherein the alpha-adrenergic antagonist is
phentolamine mesylate.
38. The method of any one of claims 1-7 or 22-37, further comprising administering to the eye of the patient a second therapeutic agent is selected from the group consisting of a prostaglandin analog, a beta blocker, an alpha adrenergic agonist, a carbonic anhydrase inhibitor, a cholinergic agonist, NMDA receptor antagonist, adenosine receptor agonist, 5-HT2A receptor agonist, and a Rho kinase inhibitor.
39. The method of any one of claims 1-7 or 22-37, further comprising administering to the eye of the patient a second therapeutic agent selected from the group consisting of latanoprost, bimatoprost, travoprost, tafluprost, latanoprostene bunod, timolol, brimonidine, dorzolamide, brinzolamide, acetazol amide, methazolamide, pilocarpine, netarsudil, ripasudil, AMA0076, trabodenoson, BOL-303259-X, ONO-9054, carbachol, aceclidine, oxotremorine, or a pharmaceutically acceptable salt of any one of the foregoing.
40. The method of claim 39, wherein the second therapeutic agent is latanoprost.
41. The method of claim 39, wherein the second therapeutic agent is latanoprost administered at a daily dose of about 1.5 micrograms.
42. The method of any one of claims 1-7 or 22-37, further comprising administering to the eye of the patient a second therapeutic agent selected from the group consisting of betaxolol, apraclonidine, brinzolamide, unoprostone, levobunolol, carteolol, metipranolol, carbachol, ecothiophate iodide, omidenepag isopropyl, sepetaprost, NO-bimatoprost, and H-1337, or a pharmaceutically acceptable salt of any one of the foregoing.
43. The method of any one of claims 1-7 or 22-43, further comprising administering to the eye of the patient an additional therapeutic agent that is an alpha-adrenergic antagonist.
44. The method of claim 43, wherein the additional therapeutic agent is bunazosin or a
pharmaceutically acceptable salt thereof.
45. A method of treating a condition selected from the group consisting of glaucoma, ocular hypertension, and non-arteritic anterior ischemic optic neuropathy in a patient, comprising administering to an eye of a patient in need thereof a therapeutically effective dosage of an alpha-adrenergic antagonist and a second therapeutic agent selected from the group consisting of prostaglandin analog, a beta blocker, an alpha adrenergic agonist, a carbonic anhydrase inhibitor, a cholinergic agonist, NMDA receptor antagonist, adenosine receptor agonist, 5-HT2A receptor agonist, and a Rho kinase inhibitor, to thereby treat the condition.
46. The method of claim 45, wherein the alpha-adrenergic antagonist is administered once per day.
47. The method of claim 45, wherein the alpha-adrenergic antagonist is administered two times, three times, or four times per day.
48. The method of any one of claims 45-47, wherein the second therapeutic agent is selected from the group consisting of latanoprost, bimatoprost, travoprost, tafluprost, latanoprostene bunod, timolol, brimonidine, dorzolamide, brinzolamide, acetazolamide, methazol amide, pilocarpine, netarsudil, ripasudil, AMA0076, trabodenoson, BOL-303259-X, ONO-9054, carbachol, aceclidine, and oxotremorine, or a pharmaceutically acceptable salt of any one of the foregoing.
49. The method of any one of claims 45-47, wherein the second therapeutic agent is selected from the group consisting of latanoprost, timolol, netarsudil, ripasudil, AMA0076, trabodenoson, BOL-303259-X, ONO-9054, carbachol, aceclidine, and oxotremorine, or a pharmaceutically acceptable salt of any one of the foregoing.
50. The method of any one of claims 45-47, wherein the second therapeutic agent is betaxolol, apraclonidine, brinzolamide, unoprostone, levobunolol, carteolol, metipranolol, carbachol, ecothiophate iodide, omidenepag isopropyl, sepetaprost, NO-bimatoprost, H-1337, or a pharmaceutically acceptable salt of any one of the foregoing.
51. The method of any one of claims 45-47, wherein the second therapeutic agent is latanoprost.
52. The method of any one of claims 45-47, wherein the second therapeutic agent is latanoprost administered at a daily dose of about 1.5 micrograms.
53. The method of any one of claims 45-52, wherein the alpha-adrenergic antagonist is
phentolamine or a pharmaceutically acceptable salt thereof.
54. The method of any one of claims 45-52, wherein the alpha-adrenergic antagonist is phentolamine mesylate.
55. The method of any one of claims 1-7, 10-19, 22-35, or 45-52, wherein the dosage contains from about 0.1 mg to about 2.0 mg of phentolamine or a pharmaceutically acceptable salt thereof.
56. The method of any one of claims 1-7, 10-19, 22-35, or 45-52, wherein the dosage contains from about 0.5 mg to about 1.0 mg of phentolamine or a pharmaceutically acceptable salt thereof.
57. The method of any one of claims 1-7, 10-19, 22-35, or 45-52, wherein the dosage contains from about 0.1 mg to about 2.0 mg of phentolamine mesylate.
58. The method of any one of claims 1-7, 10-19, 22-35, or 45-52, wherein the dosage contains from about 0.3 mg to about 0.7 mg of phentolamine mesylate.
59. The method of any one of claims 1-7, 10-19, 22-35, or 45-52, wherein the dosage contains about 0.5 mg of phentolamine mesylate.
60. The method of any one of claims 1-7, 10-19, 22-35, or 45-52, wherein the dosage contains from about 0.8 mg to about 1.2 mg of phentolamine mesylate.
61. The method of any one of claims 1-7, 10-19, 22-35, or 45-52, wherein the dosage contains about 1 mg of phentolamine mesylate.
62. The method of any one of claims 1-7, 10-19, 22-35, or 45-52, wherein the dosage is an
ophthalmic solution containing an aqueous pharmaceutically acceptable carrier and phentolamine or a pharmaceutically acceptable salt thereof.
63. The method of claim 62, wherein the dosage is an ophthalmic solution containing an aqueous pharmaceutically acceptable carrier and phentolamine mesylate.
64. The method of claim 62, wherein the dosage is an ophthalmic solution containing water, a polyol, and phentolamine or a pharmaceutically acceptable salt thereof.
65. The method of claim 62, wherein the dosage is an ophthalmic solution containing water, mannitol, and phentolamine mesylate.
66. The method of claim 62, wherein the dosage is an ophthalmic solution containing water, a polyol, an alkali metal carboxylate, and phentolamine or a pharmaceutically acceptable salt thereof.
67. The method of claim 62, wherein the dosage is an ophthalmic solution containing water, mannitol, sodium acetate, and phentolamine mesylate.
68. The method of claim 62, wherein the dosage is an aqueous ophthalmic solution free of a chelating agent containing:
(a) about 0.1% (w/v) to about 2% (w/v) of phentolamine mesylate;
(b) about 1% (w/v) to about 6% (w/v) of at least one polyol compound selected from the group consisting of mannitol, glycerol, and propylene glycol;
(c) about 1 mM to about 6 mM of an alkali metal acetate; and
(d) water;
wherein the solution has a pH in the range of 4 to 6 and does not contain a chelating agent.
69. The method of claim 62, wherein the dosage is an aqueous ophthalmic solution free of a chelating agent containing:
(a) about 0.5% (w/v) to about 2% (w/v) of phentolamine mesylate;
(b) about 1% (w/v) to about 6% (w/v) of at least one polyol compound selected from the group consisting of mannitol, glycerol, and propylene glycol;
(c) about 1 mM to about 6 mM of an alkali metal acetate; and
(d) water;
wherein the solution has a pH in the range of 4.5 to 5.5 and does not contain a chelating agent.
70. The method of claim 68 or 69, wherein the at least one polyol is mannitol.
71. The method of claim 68 or 69, wherein the solution contains 4% (w/v) mannitol.
72. The method of any one of claims 68-71, wherein the alkali metal acetate is sodium acetate.
73. The method of any one of claims 68-71, wherein the solution comprises 3 mM sodium
acetate.
74. The method of claim 62, wherein the dosage is an aqueous ophthalmic solution free of a chelating agent containing:
(a) about 0.25% (w/v) to about 2% (w/v) of phentolamine mesylate;
(b) about 3% (w/v) to about 5% (w/v) of mannitol;
(c) about 2 mM to about 4 mM of sodium acetate; and
(d) water;
wherein the solution has a pH in the range of 4.5 to 5.2 and does not contain a chelating agent.
75. The method of claim 62, wherein the dosage is an aqueous ophthalmic solution free of a chelating agent containing:
(a) about 0.5% (w/v) to about 2% (w/v) of phentolamine mesylate;
(b) about 3% (w/v) to about 5% (w/v) of mannitol;
(c) about 2 mM to about 4 mM of sodium acetate; and
(d) water;
wherein the solution has a pH in the range of 4.6 to 5.2 and does not contain a chelating agent.
76. The method of claim 62, wherein the dosage is an aqueous ophthalmic solution free of a chelating agent containing:
(a) about 0.5% (w/v) to about 1% (w/v) of phentolamine mesylate;
(b) about 4% mannitol;
(c) about 3 mM sodium acetate; and
(d) water;
wherein the solution has a pH in the range of 4.6 to 5.2 and does not contain a chelating agent.
77. The method of claim 62, wherein the dosage is an aqueous ophthalmic solution containing:
(a) about 0.25% (w/v) to about 2% (w/v) of phentolamine mesylate;
(b) about 3% (w/v) to about 5% (w/v) of mannitol;
(c) about 1 mM to about 6 mM of sodium acetate; and
(d) water; wherein the solution has a pH in the range of 4.5 to 5.2 and does not contain any additional component that is a chelating agent.
78. The method of claim 62, wherein the dosage is an aqueous ophthalmic solution comprising:
(a) about 1% (w/v) of phentolamine mesylate; (b) about 4% (w/v) mannitol; (c) about 3 mM of a buffer comprising sodium acetate; and (d) water; wherein the solution has a pH in the range of 4.5 to 5.5 and does not contain any additional component that is a chelating agent.
79. The method of any one of claims 1-78, wherein the patient experiences at least a 5%
reduction in intraocular pressure in the eye due to the administering.
80. The method of any one of claims 1-78, wherein the patient experiences at least a 10%
reduction in intraocular pressure in the eye due to the administering.
81. The method of any one of claims 1-78, wherein the patient experiences at least a 15%
reduction in intraocular pressure in the eye due to the administering.
82. The method of any one of claims 1-78, wherein the patient experiences at least a 20%
reduction in intraocular pressure in the eye due to the administering.
83. The method of any one of claims 1-78, wherein the patient experiences at least a 25%
reduction in intraocular pressure in the eye due to the administering.
84. The method of any one of claims 1-78, wherein the patient experiences at least a 30%
reduction in intraocular pressure in the eye due to the administering.
85. The method of any one of claims 1-84, wherein the patient experiences at least a 1 mmHg reduction in intraocular pressure in the eye due to the administering.
86 The method of any one of claims 1-84, wherein the patient experiences at least a 2 mmHg reduction in intraocular pressure in the eye due to the administering.
87. The method of any one of claims 1-84, wherein the patient experiences at least a 3 mmHg reduction in intraocular pressure in the eye due to the administering.
88 The method of any one of claims 1-84, wherein the patient experiences at least a 4 mmHg reduction in intraocular pressure in the eye due to the administering.
89. The method of any one of claims 1-84, wherein the patient experiences at least a 5 mmHg reduction in intraocular pressure in the eye due to the administering.
90. The method of any one of claims 1-84, wherein the patient experiences at least a 6 mmHg reduction in intraocular pressure in the eye due to the administering.
91. The method of any one of claims 1-84, wherein the patient experiences at least a 7 mmHg reduction in intraocular pressure in the eye due to the administering.
92. The method of any one of claims 1-84, wherein the patient experiences at least an 8 mmHg reduction in intraocular pressure in the eye due to the administering.
93. The method of any one of claims 79-92, wherein the reduction lasts for a duration of at least 12 hours.
94. The method of any one of claims 79-92, wherein the reduction lasts for a duration of at least 24 hours.
95. The method of any one of claims 79-92, wherein the reduction lasts for a duration of at least 2 days.
96. The method of any one of claims 79-92, wherein the reduction lasts for a duration of at least 5 days.
97. The method of any one of claims 79-92, wherein the reduction lasts for a duration of at least 7 days.
98. The method of any one of claims 1-97, wherein the condition is glaucoma.
99. The method of claim 98, wherein the glaucoma is congenital glaucoma.
100. The method of claim 98, wherein the glaucoma is open-angle glaucoma.
101. The method of claim 98, wherein the glaucoma is closed-angle glaucoma.
102. The method of any one of claims 98, 100, or 101, wherein the glaucoma is primary glaucoma.
103. The method of any one of claims 98, 100, or 101, wherein the glaucoma is secondary glaucoma.
104. The method of claim 98, wherein the glaucoma is pigmentary glaucoma,
pseudoexfoliative glaucoma, traumatic glaucoma, neovascular glaucoma, uveitic glaucoma, or glaucoma due to irido corneal endothelial syndrome.
105. The method of claim 98, wherein the glaucoma is normal tension glaucoma.
106. The method of any one of claims 1-97, wherein the condition is ocular hypertension.
107. The method of any one of claims 1-104 or 106, wherein the patient’s eye has an
intraocular pressure greater than about 22 mmHg.
108. The method of any one of claims 1-104 or 106, wherein the patient to being treatment is characterized as having an intraocular pressure in the range of from about 20 mmHg to about 30 mmHg.
109. The method of any one of claims 1-104 or 106, wherein the patient to begin treatment is characterized as having an intraocular pressure in the range of from about 20 mmHg to about 25 mmHg.
110. The method of any one of claims 1-104 or 106, wherein the patient to begin treatment is characterized as having an intraocular pressure in the range of from about 25 mmHg to about 30 mmHg.
111. The method of any one of claims 1-104 or 106, wherein the patient to begin treatment is characterized as having an intraocular pressure less than 26 mmHg.
112. The method of any one of claims 1-104 or 106, wherein the patient to begin treatment is characterized as having an intraocular pressure less than 24 mmHg.
113. The method of any one of claims 1-104 or 106, wherein the patient to begin treatment is characterized as having an intraocular pressure less than 22 mmHg.
114. The method of any one of claims 1-104 or 106, wherein the patient to begin treatment is characterized as having an intraocular pressure less than 20 mmHg.
115. The method of any one of claims 1-104 or 106, wherein the patient to begin treatment is characterized as having an intraocular pressure less than 18 mmHg.
116. The method of any one of claims 1-104 or 106, wherein the patient to begin treatment is characterized as having an intraocular pressure less than 16 mmHg.
117. The method of any one of claims 1-116, wherein the patient is a human.
118. A pharmaceutical composition, comprising an alpha-adrenergic antagonist and a second therapeutic agent selected from the group consisting of prostaglandin analog, a beta blocker, an alpha adrenergic agonist, a carbonic anhydrase inhibitor, a cholinergic agonist, NMDA receptor antagonist, adenosine receptor agonist, 5-HT2A receptor agonist, and a Rho kinase inhibitor.
119. The pharmaceutical composition of claim 112, wherein the alpha-adrenergic antagonist is phentolamine or a pharmaceutically acceptable salt thereof.
120. The pharmaceutical composition of claim 112, wherein the alpha-adrenergic antagonist is phentolamine mesylate.
121. The pharmaceutical composition of any one of claims 118-120, wherein the second
therapeutic agent is selected from the group consisting of latanoprost, bimatoprost, travoprost, tafluprost, latanoprostene bunod, timolol, brimonidine, dorzolamide,
brinzolamide, acetazol amide, methazolamide, pilocarpine, netarsudil, ripasudil, AMA0076, trabodenoson, BOL-303259-X, ONO-9054, carbachol, aceclidine, and oxotremorine, or a pharmaceutically acceptable salt of any one of the foregoing.
122. The pharmaceutical composition of any one of claims 118-120, wherein the second
therapeutic agent is betaxolol, apraclonidine, brinzolamide, unoprostone, levobunolol, carteolol, metipranolol, carbachol, ecothiophate iodide, omidenepag isopropyl, sepetaprost, NO-bimatoprost, H-1337, or a pharmaceutically acceptable salt of any one of the foregoing.
123. The pharmaceutical composition of any one of claims 118-120, wherein the second
therapeutic agent is selected from the group consisting of latanoprost, timolol, netarsudil, or a pharmaceutically acceptable salt of any one of the foregoing.
124. The pharmaceutical composition of any one of claims 118-120, wherein the second
therapeutic agent is latanoprost.
125. The pharmaceutical composition of any one of claims 118-124, wherein the
pharmaceutical composition is formulated for ophthalmic administration
126. A method of treating keratoconus in a patient, wherein the method comprises
administering to an eye of a patient in need thereof a therapeutically effective dosage of an alpha-adrenergic antagonist to treat the keratoconus.
127. The method of claim 126, wherein the dosage is administered to the eye of the patient at or near the bedtime of the patient.
128. The method of claim 126, wherein the dosage is administered to the eye of the patient within 1 hour of the patient’s bedtime.
129. The method of any one of claims 126-128, wherein the alpha-adrenergic antagonist is a pharmaceutically acceptable salt of phentolamine.
130. The method of any one of claims 126-128, wherein the alpha-adrenergic antagonist is phentolamine mesylate.
131. The method of any one of claims 1-117 or 126-130, wherein the method provides
improvement in visual performance.
132. A method of improving visual performance in a patient suffering from keratoconus, wherein the method comprises administering to an eye of a patient in need thereof an effective amount of an alpha-adrenergic antagonist to thereby improve visual performance.
133. The method of claim 132, wherein the alpha-adrenergic antagonist is a pharmaceutically acceptable salt of phentolamine.
134. The method of claim 132, wherein the alpha-adrenergic antagonist is phentolamine mesylate.
135. The method of any one of claims 131-134, wherein the improvement in visual
performance is improvement in near-vision performance.
136. The method of claim any one of claims 131-134, wherein the improvement in visual performance is improvement in visual performance at a distance.
137. The method of claim any one of claims 131-134, wherein the improvement in visual performance is improved visual performance under low-light conditions.
138. The method of claim any one of claims 131-134, wherein the improvement in visual performance is improved visual acuity.
139. The method of claim any one of claims 131-134, wherein the improvement in visual performance is improved contrast sensitivity.
140. The method of any one of claims 1-117 or 126-139, wherein the method provides at least a 10% reduction in pupil diameter in the eye of the patient.
141. The method of any one of claims 1-117 or 126-139, wherein the method provides at least a 15% reduction in pupil diameter in the eye of the patient.
142. The method of any one of claims 1-117 or 126-139, wherein the method provides at least a 20% reduction in pupil diameter in the eye of the patient.
143. The method of any one of claims 1-117 or 126-139, wherein the method provides at least a 25% reduction in pupil diameter in the eye of the patient.
144. The method of any one of claims 1-117 or 126-139, wherein the method provides at least a 30% reduction in pupil diameter in the eye of the patient.
PCT/US2019/056324 2018-10-15 2019-10-15 Methods and compositions for treatment of glaucoma and related conditions WO2020081562A1 (en)

Priority Applications (6)

Application Number Priority Date Filing Date Title
JP2021545286A JP2022508715A (en) 2018-10-15 2019-10-15 Methods and compositions for the treatment of glaucoma and related conditions
CA3115815A CA3115815A1 (en) 2018-10-15 2019-10-15 Methods and compositions for treatment of glaucoma and related conditions
AU2019360953A AU2019360953A1 (en) 2018-10-15 2019-10-15 Methods and compositions for treatment of glaucoma and related conditions
US17/283,038 US20210346350A1 (en) 2018-10-15 2019-10-15 Methods and compositions for treatment of glaucoma and related conditions
EP19872569.9A EP3866790A4 (en) 2018-10-15 2019-10-15 Methods and compositions for treatment of glaucoma and related conditions
CN201980076399.2A CN113164451A (en) 2018-10-15 2019-10-15 Methods and compositions for treating glaucoma and related disorders

Applications Claiming Priority (4)

Application Number Priority Date Filing Date Title
US201862745806P 2018-10-15 2018-10-15
US62/745,806 2018-10-15
US201862752088P 2018-10-29 2018-10-29
US62/752,088 2018-10-29

Publications (1)

Publication Number Publication Date
WO2020081562A1 true WO2020081562A1 (en) 2020-04-23

Family

ID=70283123

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/US2019/056324 WO2020081562A1 (en) 2018-10-15 2019-10-15 Methods and compositions for treatment of glaucoma and related conditions

Country Status (7)

Country Link
US (1) US20210346350A1 (en)
EP (1) EP3866790A4 (en)
JP (1) JP2022508715A (en)
CN (1) CN113164451A (en)
AU (1) AU2019360953A1 (en)
CA (1) CA3115815A1 (en)
WO (1) WO2020081562A1 (en)

Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2022226286A1 (en) * 2021-04-23 2022-10-27 Ocuphire Pharma, Inc. Methods and compositions for treating mydriasis, glaucoma, and other ocular conditions
WO2023056295A1 (en) * 2021-09-30 2023-04-06 Regeneron Pharmaceuticals, Inc. Treatment of glaucoma with rho guanine nucleotide exchange factor 12 (arhgef12) inhibitors

Families Citing this family (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN114796219A (en) * 2022-05-18 2022-07-29 沈阳药科大学 Compound pharmaceutical composition for treating glaucoma and application thereof

Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20020082288A1 (en) * 1999-09-16 2002-06-27 Gerald Horn Ophthalmic formulations comprising an imidazoline
WO2014121028A1 (en) * 2013-02-01 2014-08-07 Ocularis Pharma, Llc Methods and compositions for daily ophthalmic administration of phentolamine to improve visual performance
EP2242487B1 (en) * 2007-12-15 2016-02-24 Presbyopia Treatments Limited A medicament comprising pilocarpine and dapiprazole
WO2017152129A2 (en) * 2016-03-03 2017-09-08 Ocular Technologies Sarl Treatment of glaucoma and/or retinal diseases and formulations useful therefore

Family Cites Families (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5021410A (en) * 1989-05-22 1991-06-04 Allergan, Inc. Combinations of selective alpha-adrenergic agonists and antagonists useful in lowering intraocular pressure
BRPI0414277A (en) * 2003-09-12 2006-11-07 Allergan Inc methods and compositions for treating pain and other alpha 2 adrenergic mediated conditions
CA2657481A1 (en) * 2006-07-21 2008-01-24 Queen's University At Kingston Methods and therapies for potentiating a therapeutic action of an alpha- 2 adrenergic receptor agonist and inhibiting and/or reversing tolerance to alpha- 2 adrenergic receptor agonists
KR20140054005A (en) * 2011-06-29 2014-05-08 알러간, 인코포레이티드 Macrogol 15 hydroxystearate formulations

Patent Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20020082288A1 (en) * 1999-09-16 2002-06-27 Gerald Horn Ophthalmic formulations comprising an imidazoline
EP2242487B1 (en) * 2007-12-15 2016-02-24 Presbyopia Treatments Limited A medicament comprising pilocarpine and dapiprazole
WO2014121028A1 (en) * 2013-02-01 2014-08-07 Ocularis Pharma, Llc Methods and compositions for daily ophthalmic administration of phentolamine to improve visual performance
WO2017152129A2 (en) * 2016-03-03 2017-09-08 Ocular Technologies Sarl Treatment of glaucoma and/or retinal diseases and formulations useful therefore

Non-Patent Citations (7)

* Cited by examiner, † Cited by third party
Title
ANONYMOUS: "A Guide to Glaucoma for Primary Health Care Providers - A companion document to NHMRC Guidelines for the screening, prognosis, diagnosis, management and prevention of glaucoma", NHMRC (NATIONAL HEALTH AND MEDICAL RESEARCH COUNCIL), 2011, XP055702963, ISBN: 1864964995, Retrieved from the Internet <URL:https://www.nhmrc.gov.au/sites/default/files/2018-10/cp113_b_glaucoma_guide_healthcare_workers_120404.pdf> *
CHAO, R. ET AL.: "Experience with Intracavemosal Tri-Mixture for the Management of Neurogenic Erectile Dysfunction", ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION, vol. 75, no. 3, 1 March 1994 (1994-03-01), pages 276 - 278, XP002115287 *
DOUCETTE, W. ET AL.: "Adrenergic modulation of olfactory bulb circuitry affects odor discrimination", LEARNING & MEMORY, vol. 14, no. 8, 3 August 2007 (2007-08-03), pages 539 - 547, XP055702959 *
HARA, H. ET AL.: "Bunazosin, a Selective alpha1 -Adrenoceptor Antagonist, as an Anti- glaucoma Drug: Effects on Ocular Circulation and Retinal Neuronal Damage", CARDIOVASCULAR DRUG REVIEWS, vol. 23, no. 1, 200503000, pages 43 - 56, XP055702956 *
KOSTYUCHENKOV, V.N.: "Effect of Phentolamine on the Ophthalmotone", FARMIKOL I TOKSIKOL, vol. 33, no. 5, 1970, pages 569 - 572, XP009527343, ISSN: 0014-8318 *
See also references of EP3866790A4 *
TSUKAMOTO, H. ET AL.: "Additive effect of bunazosm on intraocular pressure when topically added to treatment with latanoprost in patients with glaucoma", JAPANESE JOURNAL OF OPHTHALMOLOGY, vol. 47, no. 5, 2003, pages 526 - 528, XP055801261 *

Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2022226286A1 (en) * 2021-04-23 2022-10-27 Ocuphire Pharma, Inc. Methods and compositions for treating mydriasis, glaucoma, and other ocular conditions
WO2023056295A1 (en) * 2021-09-30 2023-04-06 Regeneron Pharmaceuticals, Inc. Treatment of glaucoma with rho guanine nucleotide exchange factor 12 (arhgef12) inhibitors

Also Published As

Publication number Publication date
EP3866790A4 (en) 2022-08-03
JP2022508715A (en) 2022-01-19
AU2019360953A1 (en) 2021-05-13
CA3115815A1 (en) 2020-04-23
EP3866790A1 (en) 2021-08-25
CN113164451A (en) 2021-07-23
US20210346350A1 (en) 2021-11-11

Similar Documents

Publication Publication Date Title
US10993932B2 (en) Methods and compositions for treatment of presbyopia, mydriasis, and other ocular disorders
JP7470667B2 (en) Use of Pilocarpine Hydrochloride for the Treatment of Ophthalmic Conditions
US6586425B2 (en) Cytoskeletal active agents for glaucoma therapy
JP2005523316A (en) Combination of brimonidine and timolol for topical ophthalmology
US20210346350A1 (en) Methods and compositions for treatment of glaucoma and related conditions
Curran Bimatoprost: a review of its use in open-angle glaucoma and ocular hypertension
EP4326261A1 (en) Methods and compositions for treating mydriasis, glaucoma, and other ocular conditions
Alm et al. A Review of its Pharmacological Properties, Clinical Efficacy and Tolerability in the Management of Primary Open-Angle Glaucoma and Ocular Hypertension

Legal Events

Date Code Title Description
121 Ep: the epo has been informed by wipo that ep was designated in this application

Ref document number: 19872569

Country of ref document: EP

Kind code of ref document: A1

ENP Entry into the national phase

Ref document number: 3115815

Country of ref document: CA

ENP Entry into the national phase

Ref document number: 2021545286

Country of ref document: JP

Kind code of ref document: A

NENP Non-entry into the national phase

Ref country code: DE

ENP Entry into the national phase

Ref document number: 2019360953

Country of ref document: AU

Date of ref document: 20191015

Kind code of ref document: A

ENP Entry into the national phase

Ref document number: 2019872569

Country of ref document: EP

Effective date: 20210517