WO2020223237A1 - Dry powder compositions of treprostinil prodrugs and methods of use thereof - Google Patents

Dry powder compositions of treprostinil prodrugs and methods of use thereof Download PDF

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Publication number
WO2020223237A1
WO2020223237A1 PCT/US2020/030282 US2020030282W WO2020223237A1 WO 2020223237 A1 WO2020223237 A1 WO 2020223237A1 US 2020030282 W US2020030282 W US 2020030282W WO 2020223237 A1 WO2020223237 A1 WO 2020223237A1
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Prior art keywords
dry powder
powder composition
dspe
peg2000
compound
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PCT/US2020/030282
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English (en)
French (fr)
Inventor
Ju Du
Adam PLAUNT
Vladimir Malinin
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Insmed Inc
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Insmed Inc
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Priority to KR1020217039071A priority Critical patent/KR20220002600A/ko
Priority to AU2020265576A priority patent/AU2020265576B2/en
Priority to JP2021564297A priority patent/JP7455144B2/ja
Priority to CA3138530A priority patent/CA3138530A1/en
Priority to CN202411615109.6A priority patent/CN119632930A/zh
Priority to BR112021021775A priority patent/BR112021021775A2/pt
Priority to MX2021013329A priority patent/MX2021013329A/es
Priority to EP20798330.5A priority patent/EP3962472A4/en
Application filed by Insmed Inc filed Critical Insmed Inc
Priority to CN202080047360.0A priority patent/CN114072136B/zh
Publication of WO2020223237A1 publication Critical patent/WO2020223237A1/en
Anticipated expiration legal-status Critical
Priority to JP2024037977A priority patent/JP7732017B2/ja
Priority to JP2025137209A priority patent/JP2025164854A/ja
Priority to AU2025271236A priority patent/AU2025271236A1/en
Ceased legal-status Critical Current

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00—Medicinal preparations characterised by special physical form
    • A61K9/14—Particulate form, e.g. powders, Processes for size reducing of pure drugs or the resulting products, Pure drug nanoparticles
    • A61K9/141—Intimate drug-carrier mixtures characterised by the carrier, e.g. ordered mixtures, adsorbates, solid solutions, eutectica, co-dried, co-solubilised, co-kneaded, co-milled, co-ground products, co-precipitates, co-evaporates, co-extrudates, co-melts; Drug nanoparticles with adsorbed surface modifiers
    • A61K9/146—Intimate drug-carrier mixtures characterised by the carrier, e.g. ordered mixtures, adsorbates, solid solutions, eutectica, co-dried, co-solubilised, co-kneaded, co-milled, co-ground products, co-precipitates, co-evaporates, co-extrudates, co-melts; Drug nanoparticles with adsorbed surface modifiers with organic macromolecular compounds
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00—Medicinal preparations characterised by special physical form
    • A61K9/14—Particulate form, e.g. powders, Processes for size reducing of pure drugs or the resulting products, Pure drug nanoparticles
    • A61K9/16—Agglomerates; Granulates; Microbeadlets ; Microspheres; Pellets; Solid products obtained by spray drying, spray freeze drying, spray congealing,(multiple) emulsion solvent evaporation or extraction
    • A61K9/1605—Excipients; Inactive ingredients
    • A61K9/1617—Organic compounds, e.g. phospholipids, fats
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00—Medicinal preparations characterised by special physical form
    • A61K9/0012—Galenical forms characterised by the site of application
    • A61K9/007—Pulmonary tract; Aromatherapy
    • A61K9/0073—Sprays or powders for inhalation; Aerolised or nebulised preparations generated by other means than thermal energy
    • A61K9/0075—Sprays or powders for inhalation; Aerolised or nebulised preparations generated by other means than thermal energy for inhalation via a dry powder inhaler [DPI], e.g. comprising micronized drug mixed with lactose carrier particles
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/185—Acids; Anhydrides, halides or salts thereof, e.g. sulfur acids, imidic, hydrazonic or hydroximic acids
    • A61K31/19—Carboxylic acids, e.g. valproic acid
    • A61K31/195—Carboxylic acids, e.g. valproic acid having an amino group
    • A61K31/197—Carboxylic acids, e.g. valproic acid having an amino group the amino and the carboxyl groups being attached to the same acyclic carbon chain, e.g. gamma-aminobutyric acid [GABA], beta-alanine, epsilon-aminocaproic acid or pantothenic acid
    • A61K31/198—Alpha-amino acids, e.g. alanine or edetic acid [EDTA]
    • 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
    • A61K31/216—Esters, e.g. nitroglycerine, selenocyanates of carboxylic acids of acids having aromatic rings, e.g. benactizyne, clofibrate
    • 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
    • A61K31/5578—Eicosanoids, e.g. leukotrienes or prostaglandins having a pentalene ring system, e.g. carbacyclin, iloprost
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
    • A61K47/06—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite
    • A61K47/16—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite containing nitrogen, e.g. nitro-, nitroso-, azo-compounds, nitriles, cyanates
    • A61K47/18—Amines; Amides; Ureas; Quaternary ammonium compounds; Amino acids; Oligopeptides having up to five amino acids
    • A61K47/183—Amino acids, e.g. glycine, EDTA or aspartame
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00—Medicinal preparations characterised by special physical form
    • A61K9/14—Particulate form, e.g. powders, Processes for size reducing of pure drugs or the resulting products, Pure drug nanoparticles
    • A61K9/141—Intimate drug-carrier mixtures characterised by the carrier, e.g. ordered mixtures, adsorbates, solid solutions, eutectica, co-dried, co-solubilised, co-kneaded, co-milled, co-ground products, co-precipitates, co-evaporates, co-extrudates, co-melts; Drug nanoparticles with adsorbed surface modifiers
    • A61K9/145—Intimate drug-carrier mixtures characterised by the carrier, e.g. ordered mixtures, adsorbates, solid solutions, eutectica, co-dried, co-solubilised, co-kneaded, co-milled, co-ground products, co-precipitates, co-evaporates, co-extrudates, co-melts; Drug nanoparticles with adsorbed surface modifiers with organic compounds
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00—Medicinal preparations characterised by special physical form
    • A61K9/14—Particulate form, e.g. powders, Processes for size reducing of pure drugs or the resulting products, Pure drug nanoparticles
    • A61K9/16—Agglomerates; Granulates; Microbeadlets ; Microspheres; Pellets; Solid products obtained by spray drying, spray freeze drying, spray congealing,(multiple) emulsion solvent evaporation or extraction
    • A61K9/1605—Excipients; Inactive ingredients
    • A61K9/1617—Organic compounds, e.g. phospholipids, fats
    • A61K9/1623—Sugars or sugar alcohols, e.g. lactose; Derivatives thereof; Homeopathic globules
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P9/00—Drugs for disorders of the cardiovascular system
    • A61P9/12—Antihypertensives

Definitions

  • Pulmonary hypertension is characterized by an abnormally high blood pressure in the lung vasculature. It is a progressive, lethal disease that leads to heart failure and can occur in the pulmonary artery, pulmonary vein, or pulmonary capillaries. Symptomatically patients experience shortness of breath, dizziness, fainting, and other symptoms, all of which are made worse by exertion. There are multiple causes, and can be of unknown origin, idiopathic, and can lead to hypertension in other systems, for example, portopulmonary hypertension in which patients have both portal and pulmonary hypertension.
  • Pulmonary hypertension has been classified into five groups by the World Health Organization (WHO).
  • Group 1 is called pulmonary arterial hypertension (PAH), and includes PAH that has no known cause (idiopathic), inherited PAH (i.e., familial PAH or FPAH), PAH that is caused by drugs or toxins, and PAH caused by conditions such as connective tissue diseases, HIV infection, liver disease, and congenital heart disease.
  • Group 2 pulmonary hypertension is characterized as pulmonary hypertension associated with left heart disease.
  • Group 3 pulmonary hypertension is characterized as PH associated with lung diseases, such as chronic obstructive pulmonary disease and interstitial lung diseases, as well as PH associated with sleep-related breathing disorders (e.g., sleep apnea).
  • Group 4 PH is PH due to chronic thrombotic and/or embolic disease, e.g., PH caused by blood clots in the lungs or blood clotting disorders.
  • Group 5 includes PH caused by other disorders or conditions, e.g, blood disorders (e.g, polycythemia vera, essential thrombocythemia), systemic disorders (e.g., sarcoidosis, vasculitis), and metabolic disorders (e.g, thyroid disease, glycogen storage disease).
  • blood disorders e.g, polycythemia vera, essential thrombocythemia
  • systemic disorders e.g., sarcoidosis, vasculitis
  • metabolic disorders e.g, thyroid disease, glycogen storage disease.
  • Pulmonary arterial hypertension afflicts approximately 200,000 people globally with approximately 30,000-40,000 of those patients in the United States. PAH patients experience constriction of pulmonary arteries which leads to high pulmonary arterial pressures, making it difficult for the heart to pump blood to the lungs. Patients suffer from shortness of breath and fatigue which often severely limits the ability to perform physical activity.
  • the New York Heart Association has categorized PAH patients into four functional classes to rate the severity of the disease.
  • Class I PAH patients as categorized by the NYHA do not have a limitation of physical activity, as ordinary physical activity does not cause undue dyspnoea or fatigue, chest pain, or near syncope.
  • Class P PAH patients as categorized by the NYHA have a slight limitation on physical activity. These patients are comfortable at rest, but ordinary physical activity causes undue dyspnoea or fatigue, chest pain or near syncope.
  • Class HI PAH patients as categorized by the NYHA have a marked limitation of physical activity.
  • class HI PAH patients Although comfortable at rest, class HI PAH patients experience undue dyspnoea or fatigue, chest pain or near syncope as a result of less than ordinary physical activity.
  • Class IV PAH patients as categorized by the NYHA are unable to carry out any physical activity without symptoms.
  • Class IV PAH patients might experience dyspnoea and/or fatigue at rest, and discomfort is increased by any physical activity. Signs of right heart failure are often manifested by class IV PAH patients.
  • ERA endothelin receptor antagonist
  • PDE-5 inhibitors indicated for the treatment of PAH include sildenafil (Revatio®) and tadalafil (Adcirca®).
  • Prostanoids indicated for the treatment of PAH include iloprost, epoprosentol and treprostinil (Remodulin®, Tyvaso®).
  • the one approved guanylate cyclase stimulator is riociguat (Adempas®). Additionally, patients are often treated with combinations of the aforementioned compounds.
  • Portopulmonary hypertension is defined by the coexistence of portal and pulmonary hypertension, and is a serious complication of liver disease.
  • the diagnosis of portopulmonary hypertension is based on hemodynamic criteria: (1) portal hypertension and/or liver disease (clinical diagnosis-ascites/varices/splenomegaly), (2) mean pulmonary artery pressure > 25 mmHg at rest, (3) pulmonary vascular resistance > 240 dynes s/cm 5 , (4) pulmonary artery occlusion pressure ⁇ 15mmHg or transpulmonary gradient > 12 mmHg.
  • PPH is a serious complication of liver disease, and is present in 0.25 to 4% of patients suffering from cirrhosis. Today, PPH is comorbid in 4-6% of those referred for a liver transplant.
  • Pulmonary fibrosis is a respiratory disease in which scars are formed in the lung tissues, leading to serious breathing problems. Scar formation, i.e., the accumulation of excess fibrous connective tissue, leads to thickening of the walls, and causes reduced oxygen supply in the blood. As a result, pulmonary fibrosis patients suffer from perpetual shortness of breath. In some patients the specific cause of the disease can be diagnosed, but in others the probable cause cannot be determined, a condition called idiopathic pulmonary fibrosis.
  • the present invention addresses the need for novel treatment options for pulmonary hypertension (PH) (including pulmonary arterial hypertension (PAH)), portopulmonary hypertension (PPH), and pulmonary fibrosis by providing dry powder compositions of treprostinil prodrugs useful for pulmonary administration, and methods for administering the same to patients in need of treatment. .
  • PH pulmonary hypertension
  • PAH pulmonary arterial hypertension
  • PPH portopulmonary hypertension
  • pulmonary fibrosis by providing dry powder compositions of treprostinil prodrugs useful for pulmonary administration, and methods for administering the same to patients in need of treatment.
  • the present disclosure relates to a dry powder composition.
  • the dry powder composition includes (a) from about 0.1 wt% to about 3 wt% of a compound of Formula (I):
  • R 1 is tetradecyl, pentadecyl, hexadecyl, heptadecyl, or octadecyl; (b) from about 0.01 wt% to about 3 wt% of distearoylphosphatidylethanolamine-polyethylene glycol 2000 (DSPE-PEG2000), (c) from about 10 wt% to about 50 wt% of leucine, and the balance being (d) a sugar selected from the group consisting of trehalose and mannitol. The entirety of (a), (b), (c), and (d) is 100 wt%.
  • R 1 is tetradecyl. In a further embodiment, R 1 is linear tetradecyl. [0012] In one embodiment, R 1 is pentadecyl. In a further embodiment, R 1 is linear pentadecyl.
  • R 1 is heptadecyl. In a further embodiment, R 1 is linear heptadecyl.
  • R 1 is octadecyl. In a further embodiment, R 1 is linear octadecyl.
  • R 1 is hexadecyl. In a further embodiment, R 1 is linear hexadecyl.
  • the compound of Formula (I), or an enantiomer, diaster eomer, or a pharmaceutically acceptable salt thereof is present at from about 0.5 wt% to about 2 wt% of the total weight of the dry powder composition, and the DSPE-PEG2000 is present at from about 0.05 wt% to about 2 wt% of the total weight of the dry powder composition.
  • R 1 is hexadecyl.
  • R 1 is linear hexadecyl.
  • the DSPE-PEG2000 is present at from about 0.15 wt% to about 1.4 wt% of the total weight of the dry powder composition.
  • the DSPE-PEG2000 is present at from about 0.25 wt% to about 1 wt% of the total weight of the dry powder composition.
  • the compound of Formula (I), or an enantiomer, diaster eomer, or a pharmaceutically acceptable salt thereof is present at from about 1 wt% to about 2 wt% of the total weight of the dry powder composition, and the DSPE-PEG2000 is present at from about 0.1 wt% to about 2 wt% of the total weight of the dry powder composition.
  • R 1 is hexadecyl.
  • R 1 is linear hexadecyl.
  • the DSPE-PEG2000 is present at from about 0.3 wt% to about 1.4 wt% of the total weight of the dry powder composition.
  • the DSPE-PEG2000 is present at from about 0.5 wt% to about 1 wt% of the total weight of the dry powder composition.
  • the compound of Formula (I), or an enantiomer, diaster eomer, or a pharmaceutically acceptable salt thereof is present at from about 1.2 wt% to about 1.8 wt% of the total weight of the dry powder composition, and the DSPE-PEG2000 is present at from about 0.12 wt% to about 1.8 wt% ofthe total weight of the dry powder composition.
  • R 1 is hexadecyl.
  • R 1 is linear hexadecyl.
  • the DSPE-PEG2000 is present at from about 0.36 wt% to about 1.26 wt% of the total weight of the dry powder composition.
  • the DSPE-PEG2000 is present at from about 0.6 wt% to about 0.9 wt% of the total weight of the dry powder composition.
  • the compound of Formula (I), or an enantiomer, diastereomer, or a pharmaceutically acceptable salt thereof is present at from about 1 wt% to about 1.5 wt% of the total weight of the dry powder composition, and the DSPE-PEG2000 is present at from about 0.1 wt% to about 1.5 wt% of the total weight of the dry powder composition.
  • R 1 is hexadecyl. In even a further embodiment, R 1 is linear hexadecyl.
  • the DSPE-PEG2000 is present at from about 0.3 wt% to about 1.05 wt% of the total weight of the dry powder composition. In even a further embodiment, the DSPE-PEG2000 is present at from about 0.5 wt% to about 0.75 wt% of the total weight of the dry powder composition.
  • the compound of Formula (I), or an enantiomer, diaster eomer, or a pharmaceutically acceptable salt thereof is present at from about 1.4 wt% to about 1.6 wt% of the total weight of the dry powder composition, and the DSPE-PEG2000 is present at from about 0.14 wt% to about 1.6 wt% of the total weight of the dry powder composition.
  • R 1 is hexadecyl.
  • R 1 is linear hexadecyl.
  • the DSPE-PEG2000 is present at from about 0.42 wt% to about 1.12 wt% of the total weight of the dry powder composition.
  • the DSPE-PEG2000 is present at from about 0.7 wt% to about 0.8 wt% of the total weight of the dry powder composition.
  • the compound of Formula (I), or an enantiomer, diastereomer, or a pharmaceutically acceptable salt thereof is present at about 1.5 wt% of the total weight of the dry powder composition, and the DSPE-PEG2000 is present at from about 0.15 wt% to about 1.5 wt% of the total weight of the dry powder composition.
  • R 1 is hexadecyl.
  • R 1 is linear hexadecyl.
  • the DSPE-PEG2000 is present at from about 0.45 wt% to about 1.05 wt% of the total weight of the dry powder composition.
  • the DSPE-PEG2000 is present at about 0.75 wt% of the total weight of the dry powder composition.
  • the compound of Formula (I), or an enantiomer, diaster eomer, or a pharmaceutically acceptable salt thereof is present at from about 0.1 wt% to about 3 wt% of the total weight of the dry powder composition, and the weight ratio of the DSPE-PEG2000 to the compound of Formula (I), or an enantiomer, diastereomer, or a pharmaceutically acceptable salt thereof is in a range of from about 0.1: 1 (DSPE-PEG2000 : the compound of Formula (I), or an enantiomer, diastereomer, or a pharmaceutically acceptable salt thereof) to about 1 : 1 (DSPE- PEG2000 : the compound of Formula (I), or an enantiomer, diaster eomer, or a pharmaceutically acceptable salt thereof).
  • R 1 is hexadecyl. In even a further embodiment, R 1 is linear hexadecyl.
  • the compound of Formula (I), or an enantiomer, diaster eomer, or a pharmaceutically acceptable salt thereof is present at from about 0.5 wt% to about 2 wt% of the total weight of the dry powder composition. In a further embodiment, the compound of Formula (I), or an enantiomer, diastereomer, or a pharmaceutically acceptable salt thereof is present at from about 1 wt% to about 2 wt% of the total weight of the dry powder composition.
  • the compound of Formula (I), or an enantiomer, diastereomer, or a pharmaceutically acceptable salt thereof is present at from about 1.2 wt% to about 1.8 wt% of the total weight of the dry powder composition. In a further embodiment, the compound of Formula (I), or an enantiomer, diastereomer, or a pharmaceutically acceptable salt thereof is present at from about 1 wt% to about 1.5 wt% of the total weight of the dry powder composition. In a further embodiment, the compound of Formula (I), or an enantiomer, diastereomer, or a pharmaceutically acceptable salt thereof is present at from about 1.4 wt% to about 1.6 wt% of the total weight of the dry powder composition.
  • the compound of Formula (I), or an enantiomer, diastereomer, or a pharmaceutically acceptable salt thereof is present at about 1.5 wt% of the total weight of the dry powder composition.
  • the weight ratio of the DSPE-PEG2000 to the compound of Formula (I), or an enantiomer, diastereomer, or a pharmaceutically acceptable salt thereof is in a range of from about 0.3:1 (DSPE-PEG2000 : the compound of Formula (I), or an enantiomer, diastereomer, or a pharmaceutically acceptable salt thereof) to about 0.7:1 (DSPE-PEG2000 : the compound of Formula (I), or an enantiomer, diastereomer, or a pharmaceutically acceptable salt thereof).
  • the weight ratio of the DSPE-PEG2000 to the compound of Formula (I), or an enantiomer, diastereomer, or a pharmaceutically acceptable salt thereof is about 0.5:1 (DSPE- PEG2000: the compound of Formula (I), or an enantiomer, diastereomer, or a pharmaceutically acceptable salt thereof).
  • the leucine is present at from about 15 wt% to about 40 wt% of the total weight of the dry powder composition.
  • R 1 is hexadecyl.
  • R 1 is linear hexadecyl.
  • the leucine is present at from about 18 wt% to about 33 wt% of the total weight of the dry powder composition.
  • R 1 is hexadecyl.
  • R 1 is linear hexadecyl.
  • the leucine is present at from about 20 wt% to about 30 wt% of the total weight of the dry powder composition.
  • R 1 is hexadecyl.
  • R 1 is linear hexadecyl.
  • the leucine is present at from about 25 wt% to about 30 wt% of the total weight of the dry powder composition.
  • R 1 is hexadecyl.
  • R 1 is linear hexadecyl.
  • the leucine is present at from about 27 wt% to about 30 wt% of the total weight of the dry powder composition.
  • R 1 is hexadecyl. In even a further embodiment, R 1 is linear hexadecyl. In another embodiment, the leucine is present at about 30 wt% of the total weight of the dry powder composition. In a further embodiment, R 1 is hexadecyl. In even a further embodiment, R 1 is linear hexadecyl.
  • the sugar is mannitol.
  • R 1 is hexadecyl.
  • R 1 is linear hexadecyl.
  • the dry powder composition includes (a) about 1.5 wt% of the compound of Formula (I), or an enantiomer, diastereomer, or a pharmaceutically acceptable salt thereof, (b) about 0.7 wt% of the DSPE-PEG2000, (c) about 29.3 wt% of the leucine, and the balance being (d) mannitol.
  • R 1 is hexadecyl.
  • R 1 is linear hexadecyl.
  • the dry powder composition includes (a) about 1.5 wt% of the compound of Formula (I), or an enantiomer, diastereomer, or a pharmaceutically acceptable salt thereof, (b) about 0.75 wt% of the DSPE-PEG2000, (c) about 29.30 wt% of the leucine, and (d) about 68.45 wt% of the mannitol.
  • R 1 is hexadecyl.
  • R 1 is linear hexadecyl.
  • the diy powder composition is in the form of an aerosol having particles with a mass median aerodynamic diameter (MMAD) of from about 1 mm to about 3 mm, as measured by Next Generation Impactor (NGI).
  • MMAD mass median aerodynamic diameter
  • NGI Next Generation Impactor
  • the dry powder composition is in the form of an aerosol having particles with an MMAD of from about 1.3 mm to about 2.0 mm, as measured by NGI.
  • R 1 is hexadecyl.
  • R 1 is linear hexadecyl.
  • the sugar is mannitol
  • the dry powder composition is in the form of an aerosol having particles with an MMAD of from about 1 mm to about 3 mm, as measured by NGI.
  • the sugar is mannitol
  • the dry powder composition is in the form of an aerosol having particles with an MMAD of from about 1.7 mm to about 2.7 mm, as measured by NGI.
  • R 1 is hexadecyl.
  • R 1 is linear hexadecyl.
  • the diy powder composition is in the form of an aerosol having particles with a fine particle fraction (FPF) of from about 30% to about 60%, as measured by NGI.
  • FPF fine particle fraction
  • R 1 is hexadecyl.
  • R 1 is linear hexadecyl.
  • the present disclosure relates to a method for treating pulmonary hypertension in a patient in need thereof.
  • the method includes administering an effective amount of the dry powder composition disclosed herein to the lungs of the patient by inhalation via a dry powder inhaler.
  • the pulmonary hypertension in one embodiment, is pulmonary arterial hypertension (PAH).
  • PAH in one embodiment, is class I PAH, as characterized by the New York Heart Association (NYHA).
  • NYHA New York Heart Association
  • PAH is class P PAH, as characterized by NYHA.
  • PAH is class PI PAH, as characterized by NYHA.
  • PAH is class IV PAH, as characterized by NYHA.
  • the pulmonary hypertension is group 1 pulmonary hypertension, as characterized by the World Health Organization (WHO).
  • WHO World Health Organization
  • the pulmonary hypertension is group 2 pulmonary hypertension, as characterized by the WHO.
  • the pulmonary hypertension is group 3 pulmonary hypertension, as characterized by the WHO.
  • the pulmonary hypertension is group 4 pulmonary hypertension, as characterized by the WHO.
  • the pulmonary hypertension is group 5 pulmonary hypertension, as characterized by the WHO.
  • the present disclosure relates to a method for treating portopulmonary hypertension or pulmonary fibrosis in a patient in need thereof. The method includes administering an effective amount of the diy powder composition disclosed herein to the lungs of the patient by inhalation via a dry powder inhaler.
  • the administering is conducted in a once-a-day, twice-a-day, or three- times-a-day dosing.
  • the administering includes aerosolizing the dry powder composition and administering an aerosolized dry powder composition to the lungs of the patient via inhalation.
  • the aerosolized dry powder composition includes particles with an MMAD of from about 1 mm to about 3 mm, as measured by NGI.
  • the aerosolized dry powder composition includes particles with an FPF of from about 30% to about 60%, as measured by NGI.
  • the present disclosure relates to a system for treating pulmonary hypertension, portopulmonary hypertension, or pulmonary fibrosis.
  • the system includes one of the dry powder compositions disclosed herein and a dry powder inhaler (DPI).
  • DPI dry powder inhaler
  • the DPI in one embodiment, is either a single dose or a multidose inhaler.
  • the DPI is pre-metered or device-metered.
  • Figure 1 is a graph showing the effect of leucine content on spray drying recovery of mannitol-based C16TR (treprostinil palmitil) dry powders.
  • Figures 2A-2D are SEM images of mannitol-based C16TR (treprostinil palmitil) dry powders containing different amounts of leucine as indicated.
  • Figure 3 is a graph showing the effect of leucine content on particle size distribution measured by laser diffraction in mannitol-based C16TR (treprostinil palmitil) dry powders.
  • Figure 4 is a graph showing the effect of C16TR (treprostinil palmitil) content on MMAD of mannitol-based C16TR (treprostinil palmitil) dry powders.
  • Figures 5A-5C are SEM images of mannitol-based C16TR (treprostinil palmitil) dry powders spray dried at different inlet temperatures. The images of the upper panel were taken at high magnification and the images of the lower panel were taken at low magnification.
  • Figures 6A and 6B are SEM images showing the morphology of mannitol-based C16TR (treprostinil palmitil) dry powders spray dried at the inlet temperature of 135 °C with or without ammonium bicarbonate (ABC, 0.5 mg/mL). The images of the upper panel were taken at high magnification and the images of the lower panel were taken at low magnification.
  • C16TR mannitol-based C16TR
  • Figure 7A is a graph showing the DSC data of the mannitol-based C16TR (treprostinil palmitil) dry powder batch SD-NNP-179.
  • Figure 7B is a graph showing the X-ray diffraction data of the mannitol-based C16TR (treprostinil palmitil) dry powder batch SD-NNP-179.
  • Figures 8A and 8B are SEM images showing the effect of leucine content on the morphology of the trehalose-based C16TR (treprostinil palmitil) dry powders.
  • Figures 9A-9C are SEM images showing the effect of spray drying inlet temperature on the morphology of the trehalose-based C16TR (treprostinil palmitil) dry powders.
  • Figure 10A is a graph showing the DSC data of the trehalose-based C16TR (treprostinil palmitil) dry powders.
  • Figure 10B is a graph showing the X-ray diffraction data of the trehalose-based C16TR (treprostinil palmitil) dry powders.
  • Figure 11 is a DVS isotherm plot showing moisture absorption of the mannitol-based C16TR (treprostinil palmitil) dry powder batch SD-NNP-167 (C16TR (treprostinil palmitil)/DSPE-PEG2000/Man/Leu, 1/0.5/80/20).
  • Figure 12 is a DVS isotherm plot showing moisture absorption of the trehalose-based C16TR (treprostinil palmitil) dry powder batch SD-NNP-162 (C16TR (treprostinil palmitil)/DSPE-PEG2000/Treh/Leu, 1/0.5/80/20).
  • Figure 13 is a DVS isotherm plot showing moisture absorption of the trehalose-based C16TR (treprostinil palmitil) dry powder batch SD-NNP-163 (C16TR (treprostinil palmitil)/DSPE-PEG2000/Treh/Leu, 1/0.5/70/30).
  • Figure 14 is a graph showing the changes in MMAD in an accelerated stability study of the mannitol-based C16TR (treprostinil palmitil) dry powders.
  • Figures 15 A and 15B are SEM images of the mannitol-based Cl 6TR (treprostinil palmitil) dry powder batch SD-NNP-179 with 1 % of Cl 6TR (treprostinil palmitil) at TO and T3 (3 months), respectively.
  • Figures 16A and 16B are SEM images of the mannitol-based C16TR (treprostinil palmitil) dry powder batch SD-NNP-183 with 1.5 % of C16TR (treprostinil palmitil) at TO and T3 (3 months), respectively.
  • Figures 17A and 17B are SEM images of the mannitol-based Cl 6TR (treprostinil palmitil) dry powder batch SD-NNP-184 with 2 % of Cl 6TR (treprostinil palmitil) at TO and T3 (3 months), respectively.
  • Figures 18A and 18B are SEM images of the mannitol-based Cl 6TR (treprostinil palmitil) dry powder batches with 3% of C16TR (treprostinil palmitil) (SD-NNP-190) and 5 % of C16TR (treprostinil palmitil) (SD-NNP-191), respectively, at T5 (5 months).
  • Figure 19 is a graph showing the changes in MMAD in an accelerated stability study of the trehalose-based C16TR (treprostinil palmitil) dry powders.
  • Figure 20 is a graph showing the changes in FPF in an accelerated stability study of the trehalose-based C16TR (treprostinil palmitil) dry powders.
  • Figures 21 A and 21B are SEM images of the trehalose-based Cl 6TR (treprostinil palmitil) dry powder batch SD-NNP-162 with 1% of C16TR (treprostinil palmitil) at TO and T3.5 (3.5 months), respectively.
  • Figures 22A and 22B are SEM images of the trehalose-based C16TR (treprostinil palmitil) dry powder batch SD-NNP-163 with 1 % of C16TR (treprostinil palmitil) at TO and T3.5 (3.5 months), respectively.
  • Figures 23 A and 23B are SEM images of the trehalose-based Cl 6TR (treprostinil palmitil) dry powder batch SD-NNP-188 with 1.5 % of C16TR (treprostinil palmitil) at TO and T3.5 (3.5 months), respectively.
  • Figures 24A and 24B are SEM images of the trehalose-based Cl 6TR (treprostinil palmitil) dry powder batch SD-NNP-189 with 2 % of C16TR (treprostinil palmitil) at TO and T3.5 (3.5 months), respectively.
  • Figure 25 is a graph showing pressure titration of spray dried treprostinil palmitil dry powder formulations A, B, C, and D. For visibility, data points are offset in order (A, B, C and D), within each air pressure category (left to right).
  • Figure 26 is a graph showing particle size distributions of treprostinil palmitil dry powder formulations A, B, C, and D.
  • Figure 27 is an SEM image of treprostinil palmitil dry powder formulation A.
  • Figure 28 is an SEM image of treprostinil palmitil dry powder formulation B.
  • Figure 29 is an SEM image of treprostinil palmitil dry powder formulation C.
  • Figure 30 is an SEM image of treprostinil palmitil dry powder formulation D.
  • FPD fine particle doses
  • FPD fine particle doses
  • FPD fine particle doses
  • Figure 34 is a dynamic vapor sorption (DVS) isotherm plot of the trehalose-based C16TR (treprostinil palmitil) dry powder formulation.
  • Figure 36 is a graph showing the concentration of C16TR (treprostinil palmitil) equivalent (C16TR (treprostinil palmitil) plus treprostinil, ng/g) in the lung after inhalation of the trehalose- based C16TR (treprostinil palmitil) dry powder formulation and nebulized INS 1009.
  • Figure 37 is a graph showing the concentration of C16TR (treprostinil palmitil) equivalent (Cl 6TReq) in the lungs after inhaled treprostinil palmitil dry powder formulation D or formulation
  • Figure 38 is a graph showing the concentration of C16TR (treprostinil palmitil) in the lungs after inhaled treprostinil palmitil dry powder formulation D or formulation C.
  • Figure 39 is a graph showing the concentration of TRE in the lungs after inhaled treprostinil palmitil dry powder formulation D or formulation C.
  • Figure 40 is a graph showing the concentration of TRE in the plasma after inhaled treprostinil palmitil dry powder formulation D or formulation C.
  • Figure 41 is a graph showing the ARVPP response to hypoxic challenge in rats exposed to treprostinil palmitil dry powder formulation D or formulation C.
  • the term“about” may be used in conjunction with numerical values and/or ranges.
  • the term“about” is understood to mean those values near to a recited value.
  • “about 40 [units]” may mean within ⁇ 25% of 40 (e.g., from 30 to 50), within ⁇ 20%, ⁇ 15%, ⁇ 10%, ⁇ 9%, ⁇ 8%, ⁇ 7%, ⁇ 6%, ⁇ 5%, ⁇ 4%, ⁇ 3%, ⁇ 2%, ⁇ 1 %, less than ⁇ 1%, or any other value or range of values therein or there below.
  • pharmaceutically acceptable salt refers to salts prepared from pharmaceutically acceptable non-toxic bases or acids including inorganic or organic bases and inorganic or organic acids.
  • the nature of the salt is not critical, provided that it is pharmaceutically acceptable.
  • Suitable pharmaceutically acceptable acid addition salts may be prepared from an inorganic acid or from an organic acid.
  • Exemplary pharmaceutical salts are disclosed in Stahl, P.H., Wermuth, C.G., Eds. Handbook of Pharmaceutical Salts: Properties, Selection and Use ; Verlag Helvetica Chimica Acta/Wiley- VCH: Zurich, 2002, the contents of which are hereby incorporated by reference in their entirety.
  • inorganic acids are hydrochloric, hydrobromic, hydroiodic, nitric, carbonic, sulfuric and phosphoric acid.
  • Appropriate organic acids include, without limitation, aliphatic, cycloaliphatic, aromatic, arylaliphatic, and heterocyclyl containing carboxylic acids and sulfonic acids, for example formic, acetic, propionic, succinic, glycolic, gluconic, lactic, malic, tartaric, citric, ascorbic, glucuronic, maleic, fumaric, pyruvic, aspartic, glutamic, benzoic, anthranilic, mesylic, stearic, salicylic, p-hydroxy benzoic, phenylacetic, mandelic, embonic (pamoic), methanesulfonic, ethanesulfonic, benzenesulfonic, pantothenic, toluenesulfonic, 2-hydroxyethane
  • Suitable pharmaceutically acceptable salts of free acid-containing compounds disclosed herein include, without limitation, metallic salts and organic salts.
  • Exemplary metallic salts include, but are not limited to, appropriate alkali metal (group la) salts, alkaline earth metal (group Ha) salts, and other physiological acceptable metals.
  • Such salts can be made from aluminum, calcium, lithium, magnesium, potassium, sodium and zinc.
  • Exemplary organic salts can be made from primary amines, secondary amines, tertiary amines and quaternary ammonium salts, for example, tromethamine, diethylamine, tetra-JV-methylammonium, N,N'-dibenzylethylenediamine, chloroprocaine, choline, diethanolamine, ethylenediamine, meglumine ( N,-methylglucamine) and procaine.
  • ranges are provided for certain quantities. It is to be understood that these ranges comprise all subranges therein.
  • the range“50-80” includes all possible ranges therein (e.g., 51-79, 52-78, 53-77, 54-76, 55-75, 60-70, etc.).
  • all values within a given range may be an endpoint for the range encompassed thereby (e.g., the range 50-80 includes the ranges with endpoints such as 55-80, 50-75, etc.).
  • treating in one embodiment, includes: (1) preventing or delaying the appearance of clinical symptoms of the state, disorder or condition developing in the subject that may be afflicted with or predisposed to the state, disorder or condition but does not yet experience or display clinical or subclinical symptoms of the state, disorder or condition; (2) inhibiting the state, disorder or condition (e.g., arresting, reducing or delaying the develonce of the disease, or a relapse thereof in case of maintenance treatment, of at least one clinical or subclinical symptom thereof); and/or (3) relieving the condition (e.g., causing regression of the state, disorder or condition or at least one of its clinical or subclinical symptoms).
  • “treating” refers to inhibiting the state, disorder or condition (e.g., arresting, reducing or delaying the develonce of the disease, or a relapse thereof in case of maintenance treatment, of at least one clinical or subclinical symptom thereof). In another embodiment,“treating” refers to relieving the condition (for example, by causing regression of the state, disorder or condition or at least one of its clinical or subclinical symptoms).
  • the benefit to a subject to be treated is either statistically significant as compared to the state or condition of the same subject before the treatment, or as compared to the state or condition of an untreated control subject, or the benefit is at least perceptible to the subject or to the physician.
  • Effective amount means an amount of a dry powder composition of the present disclosure that is sufficient to result in the desired therapeutic response.
  • a dry powder composition of a treprostinil prodrug is provided.
  • the dry powder composition includes:
  • R 1 is tetradecyl, pentadecyl, hexadecyl, heptadecyl, or octadecyl, and the compound of Formula (I), or an enantiomer, diastereomer, or a pharmaceutically acceptable salt thereof is present at from about 0.1 wt% to about 3 wt% of the total weight of the dry powder composition;
  • the compound of Formula (I), or an enantiomer, diastereomer, or a pharmaceutically acceptable salt thereof is present at about 0.1 wt%, about 0.3 wt%, about 0.5 wt%, about 0.7 wt%, about 1 wt%, about 1.3 wt%, about 1.5 wt%, about 1.7 wt%, about 2.0 wt%, about 2.3 wt%, about 2.5 wt%, about 2.7 wt%, or about 3 wt% of the total weight of the dry powder composition.
  • the compound of Formula (I), or an enantiomer, diastereomer, or a pharmaceutically acceptable salt thereof is present at about 1.5 wt% of the total weight of the dry powder composition.
  • the compound of Formula (t) and pharmaceutically acceptable salts thereof are treprostinil prodrags as disclosed in International Application Publication WO 2015/061720, the disclosure of which is incorporated herein by reference in its entirety.
  • the leucine is present at about 10 wt%, about 15 wt%, about 20 wt%, about 25 wt%, about 30 wt%, about 35 wt%, about 40 wt%, about 45 wt%, or about 50 wt% of the total weight of the dry powder composition.
  • PEG refers to polyethylene glycol, also known as polyethylene oxide (PEO) or polyoxyethylene (POE), depending on its molecular weight
  • the DSPE-PEG2000 may include a branched or unbranched PEG molecule with an average PEG molecular weight of 2000 g/mol.
  • (b) is DSPE-PEG2000 present at from about 0.03 wt% to about 2.1 wt% of the total weight of the dry powder composition.
  • (b) is DSPE-PEG2000 present at from about 0.05 wt% to about 1.5 wt% of the total weight of the dry powder composition.
  • R 1 is tetradecyl. In a further embodiment, R 1 is linear tetradecyl.
  • R 1 is pentadecyl. In a further embodiment, R 1 is linear pentadecyl.
  • R 1 is heptadecyl. In a further embodiment, R 1 is linear heptadecyl.
  • R 1 is octadecyl. In a further embodiment, R 1 is linear octadecyl. [0098] In another embodiment of the compound of Formula (I), or an enantiomer, diaster eomer, or a pharmaceutically acceptable salt thereof, R 1 is hexadecyl.
  • R 1 is linear hexadecyl, i.e., the compound of Formula (I), or an enantiomer, diaster eomer, or a pharmaceutically acceptable salt thereof, is a compound of Formula (II):
  • the compound of Formula (I) or a pharmaceutically acceptable salt thereof is a compound of Formula (II): or a pharmaceutically acceptable salt thereof.
  • the compound of Formula (I) or a pharmaceutically acceptable salt thereof is a compound of Formula (II):
  • the compound of Formula (I) is a compound of Formula (II):
  • the compound of Formula (II): is also referred to herein as C16TR or treprostinil palmitil. In the present application, C16TR and treprostinil palmitil are used interchangeably and refer to the compound of Formula (II):
  • (a) is a compound of Formula (I) or a pharmaceutically acceptable salt thereof. In a further embodiment, (a) is a compound of Formula (I). In another embodiment, (a) is a compound of Formula (II) or a pharmaceutically acceptable salt thereof. In a further embodiment, (a) is a compound of Formula (II):
  • the compound of Formula (I) or (II), or an enantiomer, diaster eomer, or a pharmaceutically acceptable salt thereof is present at from about 0.5 wt% to about 2 wt % of the total weight of the diy powder composition, and the DSPE-PEG2000 is present at from about 0.05 wt% to about 2 wt% of the total weight of the dry powder composition. In a further embodiment, the DSPE-PEG2000 is present at from about 0.15 wt% to about 1.4 wt% of the total weight of the dry powder composition.
  • the DSPE-PEG2000 is present at from about 0.25 wt% to about 1 wt% of the total weight of the dry powder composition.
  • the compound of Formula (I) or (P), or a pharmaceutically acceptable salt thereof is present at from about 0.5 wt% to about 2 wt% of the total weight of the dry powder composition.
  • the compound of Formula (I) or (II) is present at from about 0.5 wt% to about 2 wt% of the total weight of the dry powder composition.
  • the compound of Formula (I) or (P), or an enantiomer, diastereomer, or a pharmaceutically acceptable salt thereof is present at from about 1 wt% to about 2 wt% of the total weight of the dry powder composition, and the DSPE-PEG2000 is present at from about 0.1 wt% to about 2 wt% of the total weight of the dry powder composition. In a further embodiment, the DSPE-PEG2000 is present at from about 0.3 wt% to about 1.4 wt% of the total weight of the dry powder composition. In a further embodiment, the DSPE-PEG2000 is present at from about 0.5 wt% to about 1 wt% of the total weight of the dry powder composition.
  • the compound of Formula (I) or (H), or a pharmaceutically acceptable salt thereof is present at from about 1 wt% to about 2 wt% of the total weight of the dry powder composition. In some embodiments, the compound of Formula (I) or (P) is present at from about 1 wt% to about 2 wt% of the total weight of the dry powder composition.
  • the compound of Formula (I) or (P), or an enantiomer, diastereomer, or a pharmaceutically acceptable salt thereof is present at from about 1.2 wt% to about 1.8 wt% of the total weight of the dry powder composition, and the DSPE-PEG2000 is present at from about 0.12 wt% to about 1.8 wt% of the total weight of the dry powder composition. In a further embodiment, the DSPE-PEG2000 is present at from about 0.36 wt% to about 1.26 wt% of the total weight of the diy powder composition.
  • the DSPE- PEG2000 is present at from about 0.6 wt% to about 0.9 wt% of the total weight of the diy powder composition.
  • the compound of Formula (I) or (P), or a pharmaceutically acceptable salt thereof is present at from about 1.2 wt% to about 1.8 wt% of the total weight of the dry powder composition.
  • the compound of Formula (I) or (P) is present at from about 1.2 wt% to about 1.8 wt% of the total weight of the dry powder composition.
  • the compound of Formula (I) or (P), or an enantiomer, diastereomer, or a pharmaceutically acceptable salt thereof is present at from about 1 wt% to about 1.5 wt% of the total weight of the dry powder composition, and the DSPE-PEG2000 is present at from about 0.1 wt% to about 1.5 wt% of the total weight of the dry powder composition. In a further embodiment, the DSPE-PEG2000 is present at from about 0.3 wt% to about 1.05 wt% of the total weight of the dry powder composition. In a further embodiment, the DSPE-PEG2000 is present at from about 0.5 wt% to about 0.75 wt% of the total weight of the dry powder composition.
  • the compound of Formula (I) or (P), or a pharmaceutically acceptable salt thereof is present at from about 1 wt% to about 1.5 wt% of the total weight of the dry powder composition. In some embodiments, the compound of Formula (I) or (II) is present at from about 1 wt% to about 1.5 wt% of the total weight of the dry powder composition.
  • the compound of Formula (I) or (P), or an enantiomer, diaster eomer, or a pharmaceutically acceptable salt thereof is present at from about 1.4 wt% to about 1.6 wt% of the total weight of the dry powder composition, and the DSPE-PEG2000 is present at from about 0.14 wt% to about 1.6 wt% of the total weight of the dry powder composition. In a further embodiment, the DSPE-PEG2000 is present at from about 0.42 wt% to about 1.12 wt% of the total weight of the dry powder composition.
  • the DSPE- PEG2000 is present at from about 0.7 wt% to about 0.8 wt% of the total weight of the dry powder composition.
  • the compound of Formula (I) or (P), or a pharmaceutically acceptable salt thereof is present at from about 1.4 wt% to about 1.6 wt% of the total weight of the dry powder composition. In some embodiments, the compound of Formula (I) or (P) is present at from about 1.4 wt% to about 1.6 wt% of the total weight of the dry powder composition.
  • the compound of Formula (I) or (P), or an enantiomer, diastereomer, or a pharmaceutically acceptable salt thereof is present at about 1 wt% of the total weight of the dry powder composition, and the DSPE-PEG2000 is present at from about 0.1 wt% to about 1 wt% of the total weight of the dry powder composition. In a further embodiment, the DSPE-PEG2000 is present at from about 0.3 wt% to about 0.7 wt% of the total weight of the dry powder composition. In a further embodiment, the DSPE-PEG2000 is present at about 0.5 wt% of the total weight of the dry powder composition.
  • the compound of Formula (I) or (P), or a pharmaceutically acceptable salt thereof is present at about 1 wt% of the total weight of the dry powder composition. In some embodiments, the compound of Formula (I) or (P) is present at about 1 wt% of the total weight of the dry powder composition. [00106] In one embodiment, the compound of Formula (I) or (P), or an enantiomer, diaster eomer, or a pharmaceutically acceptable salt thereof is present at about 1.5 wt% of the total weight of the dry powder composition, and the DSPE-PEG2000 is present at from about 0.15 wt% to about 1.5 wt% of the total weight of the dry powder composition.
  • the DSPE-PEG2000 is present at from about 0.45 wt% to about 1.05 wt% of the total weight of the dry powder composition. In a further embodiment, the DSPE-PEG2000 is present at about 0.75 wt% of the total weight of the dry powder composition. In some embodiments, the compound of Formula (I) or (P), or a pharmaceutically acceptable salt thereof is present at about 1.5 wt% of the total weight of the dry powder composition. In some embodiments, the compound of Formula (I) or (P) is present at about 1.5 wt% of the total weight of the dry powder composition.
  • the compound of Formula (I) or (P), or an enantiomer, diaster eomer, or a pharmaceutically acceptable salt thereof is present at from about 0.1 wt% to about 3 wt%, from about 0.5 wt% to about 2 wt%, from about 1 wt% to about 2 wt%, from about 1.2 wt% to about 1.8 wt%, from about 1 wt% to about 1.5 wt%, from about 1.4 wt% to about 1.6 wt%, about 1 wt%, or about 1.5 wt% of the total weight of the dry powder composition, and the weight ratio of the DSPE-PEG2000 to the compound of Formula (I) or (P), or an enantiomer, diastereomer, or a pharmaceutically acceptable salt thereof is in a range of from about 0.1:1 (DSPE-PEG2000 : compound of Formula (I) or (P)) to about 1 : 1 (DSPE
  • the weight ratio of the DSPE-PEG2000 to the compound of Formula (I) or (P), or an enantiomer, diastereomer, or a pharmaceutically acceptable salt thereof is in a range of from about 0.1: 1 (DSPE-PEG2000: compound of Formula (I) or (P)) to about 1:1 (DSPE- PEG2000: compound of Formula (I) or (P)).
  • the weight ratio of the DSPE-PEG2000 to the compound of Formula (I) or (P), or an enantiomer, diastereomer, or a pharmaceutically acceptable salt thereof is in a range of from about 0.3: 1 (DSPE-PEG2000: compound of Formula (I) or (P)) to about 0.7: 1 (DSPE-PEG2000: compound of Formula (I) or
  • the weight ratio of the DSPE-PEG2000 to the compound of Formula (I) or (P), or an enantiomer, diastereomer, or a pharmaceutically acceptable salt thereof is about 0.5:1 (DSPE-PEG2000: compound of Formula (I) or (II)).
  • the compound of Formula (I) or (II), or an enantiomer, diastereomer, or a pharmaceutically acceptable salt thereof is present at from about 1 wt% to about 2 wt% of the total weight of the dry powder composition, and the DSPE-PEG2000 is present at from about 0.5 wt% to about 1 wt% of the total weight of the dry powder composition.
  • the compound of Formula (I) or (P), or an enantiomer, diastereomer, or a pharmaceutically acceptable salt thereof is present at from about 1.2 wt% to about 1.8 wt% of the total weight of the dry powder composition, and the DSPE-PEG2000 is present at from about 0.6 wt% to about 0.9 wt% of the total weight of the dry powder composition.
  • the compound of Formula (I) or (P), or an enantiomer, diastereomer, or a pharmaceutically acceptable salt thereof is present at from about 1.4 wt% to about 1.6 wt% of the total weight of the dry powder composition, and the DSPE-PEG2000 is present at from about 0.7 wt% to about 0.8 wt% of the total weight of the dry powder composition.
  • the compound of Formula (I) or (P), or an enantiomer, diastereomer, or a pharmaceutically acceptable salt thereof is present at about 1.5 wt% of the total weight of the dry powder composition, and the DSPE-PEG2000 is present at about 0.75 wt% of the total weight of the dry powder composition.
  • the compound of Formula (I) or (P), or a pharmaceutically acceptable salt thereof is present at each of the above- mentioned weight percentages or weight percentage ranges in the dry powder composition. In some embodiments, the compound of Formula (I) or (P) is present at each of the above-mentioned weight percentages or weight percentage ranges in the dry powder composition.
  • the leucine is present at from about 15 wt% to about 40 wt% of the total weight of the dry powder composition. In a further embodiment, the leucine is present at from about 18 wt% to about 33 wt% of the total weight of the dry powder composition. In a further embodiment, the leucine is present at from about 20 wt% to about 30 wt%, e.g., about 20 wt%, about 25 wt%, or about 30 wt% of the total weight of the dry powder composition. In a further embodiment, the leucine is present at from about 25 wt% to about 30 wt% of the total weight of the dry powder composition.
  • the leucine is present at from about 27 wt% to about 30 wt% of the total weight of the dry powder composition. In one embodiment, the leucine is present at about 20 wt% of the total weight of the dry powder composition. In another embodiment, the leucine is present at about 30 wt% of the total weight of the dry powder composition.
  • the sugar in the dry powder composition is trehalose. In other embodiments, the sugar in the dry powder composition is mannitol.
  • the dry powder composition includes (a) about 1.5 wt% of the compound of Formula (I) or (II), or an enantiomer, diastereomer, or a pharmaceutically acceptable salt thereof, (b) about 0.7 wt% of the DSPE-PEG2000, (c) about 29.3 wt% of the leucine, and the balance being (d) trehalose.
  • (a) in the dry powder composition is about 1.5 wt% of the compound of Formula (I) or (P), or a pharmaceutically acceptable salt thereof.
  • (a) in the dry powder composition is about 1.5 wt% of the compound of Formula (I) or (II):
  • R 1 is hexadecyl in the compound of Formula (I).
  • R 1 is linear hexadecyl in the compound of Formula (I), i.e., the compound of Formula (I) is a compound of Formula (II):
  • the dry powder composition includes (a) about 1 wt% of the compound of Formula (I) or (P), or an enantiomer, diastereomer, or a pharmaceutically acceptable salt thereof, (b) about 0.5 wt% of the DSPE-PEG2000, (c) about 29.6 wt% of the leucine, and the balance being (d) trehalose.
  • (a) in the dry powder composition is about 1 wt% of the compound of Formula (I) or (H), or a pharmaceutically acceptable salt thereof.
  • (a) in the dry powder composition is about 1 wt% of the compound of Formula (I) or (II).
  • R 1 is hexadecyl in the compound of Formula (I). In a further embodiment, R 1 is linear hexadecyl in the compound of Formula (I), i.e., the compound of Formula (I) is a compound of Formula (II):
  • the dry powder composition includes (a) about 1 wt% of the compound of Formula (I) or (P), or an enantiomer, diastereomer, or a pharmaceutically acceptable salt thereof, (b) about 0.5 wt% of the DSPE-PEG2000, (c) about 19.7 wt% of the leucine, and the balance being (d) trehalose.
  • (a) in the dry powder composition is about 1 wt% of the compound of Formula (I) or (P), or a pharmaceutically acceptable salt thereof.
  • (a) in the dry powder composition is about 1 wt% of the compound of Formula (I) or (II):
  • R 1 is hexadecyl in the compound of Formula (I).
  • R 1 is linear hexadecyl in the compound of Formula (I), i.e., the compound of Formula (I) is a compound of Formula (II):
  • the dry powder composition includes (a) about 1.5 wt% of the compound of Formula (I) or (II), or an enantiomer, diastereomer, or a pharmaceutically acceptable salt thereof, (b) about 0.7 wt% of the DSPE-PEG2000, (c) about 19.6 wt% of the leucine, and the balance being (d) trehalose.
  • (a) in the dry powder composition is about 1.5 wt% of the compound of Formula (I) or (P), or a pharmaceutically acceptable salt thereof.
  • (a) in the dry powder composition is about 1.5 wt% of the compound of Formula (I) or (II):
  • R 1 is hexadecyl in the compound of Formula (I).
  • R 1 is linear hexadecyl in the compound of Formula (I), i.e., the compound of Formula (I) is a compound of Formula (II):
  • the dry powder composition includes (a) about 1.5 wt% of the compound of Formula (I) or (P), or an enantiomer, diastereomer, or a pharmaceutically acceptable salt thereof, (b) about 0.7 wt% of the DSPE-PEG2000, (c) about 29.3 wt% of the leucine, and the balance being (d) mannitol.
  • (a) in the dry powder composition is about 1.5 wt% of the compound of Formula (I) or (P), or a pharmaceutically acceptable salt thereof.
  • (a) in the dry powder composition is about 1.5 wt% of the compound of Formula (I) or (II).
  • R 1 is hexadecyl in the compound of Formula (I). In a further embodiment, R 1 is linear hexadecyl in the compound of Formula (I), i.e., the compound of Formula (I) is a compound of Formula (II):
  • the dry powder composition includes (a) about 1.5 wt% of the compound of Formula (I) or (P), or an enantiomer, diastereomer, or a pharmaceutically acceptable salt thereof, (b) about 0.75 wt% of the DSPE-PEG2000, (c) about 29.30 wt% of the leucine, and (d) about 68.45 wt% of the mannitol.
  • (a) in the dry powder composition is about 1.5 wt% of the compound of Formula (I) or (P), or a pharmaceutically acceptable salt thereof.
  • the dry powder composition includes (a) about 1.5 wt% of the compound of Formula (I) or (II):
  • R 1 is hexadecyl in the compound of Formula (I).
  • R 1 is linear hexadecyl in the compound of Formula (I), i.e., the compound of Formula (I) is a compound of Formula (II):
  • the dry powder composition includes (a) about 1.5 wt% of the compound of Formula (P), (b) about 0.75 wt% of the DSPE-PEG2000, (c) about 29.30 wt% of the leucine, and (d) about 68.45 wt% of the mannitol.
  • the dry powder composition includes (a) about 1 wt% of the compound of Formula (I) or (II), or an enantiomer, diastereomer, or a pharmaceutically acceptable salt thereof, (b) about 0.5 wt% of the DSPE-PEG2000, (c) about 29.6 wt% of the leucine, and the balance being (d) mannitol.
  • (a) in the dry powder composition is about 1 wt% of the compound of Formula (I) or (II), or a pharmaceutically acceptable salt thereof.
  • (a) in the dry powder composition is about 1 wt% of the compound of Formula (I) or (II):
  • R 1 is hexadecyl in the compound of Formula (I).
  • R 1 is linear hexadecyl in the compound of Formula (I), i.e., the compound of Formula (I) is a compound of Formula (II):
  • the dry powder composition includes (a) about 1.5 wt% of the compound of Formula (I) or (P), or an enantiomer, diastereomer, or a pharmaceutically acceptable salt thereof, (b) about 0.7 wt% of the DSPE-PEG2000, (c) about 19.6 wt% of the leucine, and the balance being (d) mannitol.
  • (a) in the dry powder composition is about 1.5 wt% of the compound of Formula (I) or (P), or a pharmaceutically acceptable salt thereof.
  • (a) in the dry powder composition is about 1.5 wt% of the compound of Formula (I) or (II).
  • R 1 is hexadecyl in the compound of Formula (I). In a further embodiment, R 1 is linear hexadecyl in the compound of Formula (I), i.e., the compound of Formula (I) is a compound of Formula (II):
  • the dry powder composition includes (a) about 1 wt% of the compound of Formula (I) or (P), or an enantiomer, diastereomer, or a pharmaceutically acceptable salt thereof, (b) about 0.5 wt% of the DSPE-PEG2000, (c) about 19.7 wt% of the leucine, and the balance being (d) mannitol.
  • (a) in the dry powder composition is about 1 wt% of the compound of Formula (I) or (P), or a pharmaceutically acceptable salt thereof.
  • (a) in the dry powder composition is about 1 wt% of the compound of Formula (I) or (II):
  • R 1 is hexadecyl in the compound of Formula (I).
  • R 1 is linear hexadecyl in the compound of Formula (I), i.e., the compound of Formula (I) is a compound of Formula (II):
  • Mass median aerodynamic diameter (MMAD) is the value of aerodynamic diameter for which 50% of the mass in a given aerosol is associated with particles smaller than the median aerodynamic diameter (MAD), and 50% of the mass is associated with particles larger than the MAD.
  • the dry powder composition can be determined by impactor measurements, e.g., the Andersen Cascade Impactor (ACT) or the Next Generation Impactor (NGI).
  • the dry powder composition is in the form of an aerosol comprising particles with an MMAD of from about 1 gm to about 5 gm, from about 1 gm to about 3 gm, from about 1.3 gm to about 2.0 gm, or from about 1.7 gm to about 2.7 gm, as measured by NGI.
  • the sugar in the dry powder composition is mannitol.
  • the sugar in the dry powder composition is trehalose.
  • the sugar in the dry powder composition is mannitol, and the dry powder composition is in the form of an aerosol comprising particles with an MMAD of from about 1 mm to about 3 mm, as measured by NGI.
  • the sugar in the dry powder composition is mannitol, and the dry powder composition is in the form of an aerosol comprising particles with an MMAD of from about 1.7 mm to about 2.7 mm, as measured by NGI.
  • FPF protein particle fraction
  • the dry powder composition is in the form of an aerosol comprising particles with an FPF of at least 20%, at least 30%, at least 40%, at least 50%, from about 30% to about 60%, from about 35% to about 55%, or from about 40% to about 50%, as measured by NGI.
  • the sugar in the dry powder composition is mannitol. In another embodiment, the sugar is trehalose.
  • Tap density of a powder is the ratio of the mass of the powder to the volume occupied by the powder after it has been tapped for a defined period of time.
  • the tap density of a powder represents its random dense packing. Tap density can be determined using the method of USP Bulk Density and Tapped Density, United States Pharmacopeia convention, Rockville, Md., 10th Supplement, 4950-4951, 1999.
  • the dry powder composition comprises particles having a tap density of from about 0.2 g/ml to about 0.8 g/ml, or from about 0.3 g/ml to about 0.6 g/ml.
  • the sugar in the dry powder composition is mannitol. In another embodiment, the sugar in the dry powder composition is trehalose.
  • the dry powder compositions of the present disclosure may be produced from liquid compositions using lyophilization or spray-drying techniques.
  • lyophilization the lyophilized composition may be milled to obtain the finely divided dry powder containing particles within the desired size range described above.
  • spray-drying the process is carried out under conditions that result in a finely divided dry powder containing particles within the desired size range described above.
  • Exemplary methods of preparing dry powder forms of pharmaceutical compositions are disclosed in WO 96/32149, WO 97/41833, WO 98/29096, and U.S. Pat Nos. 5,976,574, 5,985,248, and 6,001,336; the disclosure of each of which is incorporated herein by reference in their entireties.
  • Exemplary spray drying methods are described in U.S. Pat. Nos. 6,848,197 and 8,197,845, the disclosure of each of which is incorporated herein by reference in their entireties.
  • the dry powder compositions of the present disclosure are prepared by the following process.
  • Stock solutions of a compound of Formula (I) or (P), or an enantiomer, diastereomer, or a pharmaceutically acceptable salt thereof and the DSPE-PEG2000 are prepared using an organic solvent, such as an alcohol (e.g., 1-propanol).
  • Aqueous stock solutions of a sugar (e.g., mannitol or trehalose) and leucine are also prepared. Afterwards required amounts of the above stock solutions are added to a mixture of water and the organic solvent to form a spray drying feed solution.
  • the volume ratio of water to the organic solvent may be from about 3:2 to about 1:1.
  • Spray drying is initiated by starting the drying gas flow and heating up the drying gas by setting the desired inlet temperature at, for example, from about 120 °C to aboutl60 °C, or from about 135 °C to about 150 °C.
  • the liquid skid inlet is set to allow blank solvents to be atomized with the aid of nitrogen into the spray dryer, and the system is allowed to cool and stabilize.
  • Product filter pulsing is initiated and product filter purge flow is set, for example, to 10 to 20 scfh. After the system stabilizes, the liquid skid inlet is switched to the feed solution prepared above and the process is continued till the feed solution runs out.
  • the liquid skid inlet is switched back to blank solvents which are allowed to spray for from about 5 to about 20 minutes. At this point, powder is collected at the bottom of the product filter. After spraying the blank solvent for from about 5 to about 20 minutes, the system is shut down by shutting down the liquid lines, atomization gas, drying gas heater, drying gas inlet and finally the exhaust
  • the dry powder compositions of the present disclosure are delivered to the lungs of a subject via inhalation using a dry powder inhaler (DPI).
  • the dry powder inhaler is a single dose dry powder inhaler.
  • a propellant-free device, a DPI delivers dry powder to the lungs of a subject using the subject’s inspiration.
  • the unit dose of a dry powder composition used in a DPI device is often a dry powder blister disc of hard capsule.
  • Exemplary DPI devices suitable for delivering the dry powder compositions of the present disclosure include the devices described in the following paragraphs, as well as the DPIs described in U.S. Patent Nos. 6,766,799, 7,278,425 and 8,496,002, the disclosure of each of which is herein incorporated by reference in their entireties.
  • the AIR® inhaler includes a small, breath-activated system that delivers porous powder from a capsule.
  • the porous particles have an aerodynamic diameter of 1- 5 mm. See International Patent Application Publication Nos. WO 99/66903 and WO 00/10541 , the disclosure of each of which is incorporated herein by reference in their entireties.
  • AerolizerTM (Novartis) is a single dose dry powder inhaler.
  • dry powder medicament is stored in a capsule and released by piercing the capsule wall with TEFLON- coated steel pins. See U.S. Patent Nos. 6,488,027 and 3,991,761, the disclosure of each of which is incorporated herein by reference in their entireties.
  • Bang Olufsen provides a breath actuated inhaler using blister strips with up to sixty doses.
  • the dose is made available only during the inhalation by a novel trigger mechanism.
  • the device is equipped with a dose counter and can be disposed of after all doses have been used. See EP 1522325, the disclosure of which is incorporated herein by reference in its entirety.
  • Clickhaler® Innovata PLC
  • DirectHalerTM Direct-Haler A/S
  • U.S. Patent No. 5,797,392 the disclosure of which is incorporated herein by reference in its entirety.
  • DiskusTM (GlaxoSmithKline) is a disposable small DPI device that holds up to 60 doses contained in double foil blister strips to provide moisture protection. See GB2242134, the disclosure of which is incorporated herein by reference in its entirety.
  • EclipseTM is a breath actuated re-usable capsule device capable of delivering up to 20 mg of a dry power composition.
  • the powder is sucked from the capsule into a vortex chamber where a rotating ball assists in powder disaggregation as a subject inhales.
  • U.S. Pat 6,230,707 and WO 9503846 the disclosure of each of which is incorporated herein by reference in their entireties.
  • Flexhaler® is a plastic breath-activated dry powder inhaler and is amenable for use with the dry powder compositions provided herein.
  • FlowCaps® (Hovione) is a capsule-based, re-fillable, re-usable passive dry-powder inhaler that holds up to 14 capsules.
  • the inhaler itself is moisture-proof. See U.S. Pat. 5,673,686, the disclosure of which is incorporated herein by reference in its entirety.
  • Gyrohaler® (V ectura) is a passive disposable DPI containing a strip of blisters. See GB2407042, the disclosure of which is incorporated herein by reference in its entirety.
  • the HandiHaler® (Boehringer Ingelheim GmbH) is a single dose DPI device. It can deliver up to 30 mg of a dry powder composition in capsules. See International Patent Application Publication No. WO 04/024156, the disclosure of which is incorporated herein by reference in its entirety.
  • MicroDose DPI (Microdose Technologies) is a small electronic DPI device. It uses piezoelectric vibrator (ultrasonic frequencies) to deaggragate the drug powder in an aluminum blister (single or multiple dose). See U.S. Patent No. 6,026,809, the disclosure of which is incorporated herein by reference in its entirety.
  • Nektar Dry Powder Inhaler® (Nektar) is a palm-sized and easy-to-use device. It provides convenient dosing from standard capsules and flow-rate-independent lung deposition.
  • Nektar Pulmonary Inhaler® (Nektar) efficiently removes powders from the packaging, breaks up the particles and creates an aerosol cloud suitable for deep lung delivery. It enables the aerosolized particles to be transported from the device to the deep lung during a patient's breath, reducing losses in the throat and upper airways. Compressed gas is used to aerosolize the powder. See AU4090599 and U.S. Patent No. 5,740,794, the disclosure of each of which is incorporated herein by reference in their entireties.
  • NEXT DPITM is a device featuring multidose capabilities, moisture protection, and dose counting. The device can be used regardless of orientation (upside down) and doses only when proper aspiratory flow is reached. See EP 1196146, U.S. Patent No. 6,528,096, WO0178693, and W00053158, the disclosure of each of which is incorporated herein by reference in their entireties.
  • Neohaler® is a capsule-based plastic breath-activated dry powder inhaler.
  • OrielTM DPI is an active DPI that utilizes a piezoelectric membrane and nonlinear vibrations to aerosolize powder formulations. See International Patent Application Publication No. WO 0168169, the disclosure of which is incorporated herein by reference in its entirety.
  • RS01 monodose dry powder inhaler developed by Plastiape in Italy features a compact size and a simple and effective perforation system and is suited to both gelatin and HMPC capsules.
  • PressairTM is a plastic breath-activated dry powder inhaler.
  • Pulvinal® inhaler (Chiesi) is a breath-actuated multi-dose (100 doses) dry powder inhaler. The dry powder is stored in a reservoir which is transparent and clearly marked to indicate when the 100th dose has been delivered. See U.S. Patent No. 5,351,683, the disclosure of which is incorporated herein by reference in its entirety.
  • Rotohaler® (GlaxoSmithKline) is a single use device that utilizes capsules.
  • Rexam DPI (Rexam Pharma) is a single dose, reusable device designed for use with capsules. See U.S. Patent No. 5,651,359 and EP 0707862, the disclosure of each of which is incorporated herein by reference in their entireties.
  • S2 Innovata PLC
  • S2 is a re-useable or disposable single-dose DPI for the delivery of a dry powder composition in high concentrations. Its dispersion mechanism requires minimal patient effort to achieve excellent drug delivery to the patients' lungs. S2 is easy to use and has a passive engine so no battery or power source is required. See AU3320101, the disclosure of which is incorporated herein by reference in its entirety.
  • SkyeHaler® DPI (SkyePharma) is a multidose device containing up to 300 individual doses in a single-use, or replaceable cartridge. The device is powered by breath and requires no coordination between breathing and actuation. See U.S. Patent No. 6,182,655 and WO97/20589, the disclosure of each of which is incorporated herein by reference in their entireties.
  • Taifim® DPI (LAB International) is a multiple-dose (up to 200) DPI device. It is breath actuated and flow rate independent The device includes a unique moisture-balancing drug reservoir coupled with a volumetric dose metering system for consistent dosing. See U.S. Patent No. 6,132,394, the disclosure of which is incorporated herein by reference in its entirety.
  • the TurboHaler® (AstraZeneca) is described in U.S. Patent No. 5,983,893, the disclosure of which is incorporated herein by reference in its entirety.
  • This DPI device is an inspiratory flow-driven, multi-dose dry-powder inhaler with a multi-dose reservoir that provides up to 200 doses of a dry powder composition and a dose range from a few micrograms to 0.5 mg.
  • the Twisthaler® (Schering-Plough) is a multiple dose device with a dose counting feature and is capable of 14-200 actuations.
  • a dry powder composition is packaged in a cartridge that contains a desiccant. See U.S. Patent No. 5,829,434, the disclosure of which is incorporated herein by reference in its entirety.
  • Ultrahaler® (Aventis) combines accurate dose metering and good dispersion. It is an easy-to-use, discrete, pocket-sized device with a numerical dose counter, dose taken indicator and a lock-out mechanism. The device is capable of delivering up to 20 mg of a dry powder composition. Ultrahaler® is described in U.S. Patent No. 5,678,538 and W02004026380, the disclosure of each of which is incorporated herein by reference in their entireties.
  • XcelovairTM (Meridica/Pfizer) holds 60 pre-metered, hermetically sealed doses in the range of 5-20 mg.
  • the device provides moisture protection under accelerated conditions of 40°C/75% RH.
  • the dispersion system maximizes the fine particle fraction, delivering up to 50% fine particle mass.
  • a system comprising (i) one of the dry powder compositions described herein and (ii) a dry powder inhaler (DPI) for administration of the dry powder composition.
  • the DPI includes (a) a reservoir comprising the dry powder composition disclosed herein, and (b) a means for introducing the diy powder composition into the patient via inhalation.
  • the reservoir in one embodiment, comprises the dry powder composition of the present invention in a capsule or in a blister pack.
  • the material for the shell of a capsule can be gelatin, cellulose derivatives, starch, starch derivatives, chitosan, or synthetic plastics.
  • the DPI may be a single dose or a multidose inhaler.
  • the DPI may be pre-metered or device-metered.
  • the dry powder inhaler is a single dose dry powder inhaler.
  • the system in one embodiment, is used for treating pulmonary hypertension, portopulmonary hypertension, or pulmonary fibrosis.
  • the system includes the dry powder composition disclosed herein, i.e., a dry powder composition comprising a compound of Formula (I) or (P), or an enantiomer, diastereomer, or a pharmaceutically acceptable salt thereof, and a DPI.
  • the dry powder composition comprises a compound of Formula (I) or (H), or a pharmaceutically acceptable salt thereof.
  • the dry powder composition comprises a compound of Formula (I) or (II):
  • the dry powder inhaler may be one described above, may be a single dose or a multidose inhaler, and/or may be pre-metered or device-metered. In one embodiment, the dry powder inhaler is a single dose dry powder inhaler.
  • a method for treating pulmonary hypertension (PH) in a patient in need thereof includes administering an effective amount of the dry powder composition disclosed herein, i.e., a dry powder composition comprising a compound of Formula (I) or (P), or an enantiomer, diastereomer, or a pharmaceutically acceptable salt thereof, to the lungs of the patient by inhalation via a dry powder inhaler.
  • the dry powder composition comprises a compound of Formula (I) or (P), or a pharmaceutically acceptable salt thereof.
  • the dry powder composition comprises a compound of Formula (I) or (II):
  • the administering includes aerosolizing the dry powder composition via a DPI to provide an aerosolized dry powder composition, and administering the aerosolized dry powder composition to the lungs of the patient via inhalation by the DPI.
  • the aerosolized dry powder composition comprises particles with an MMAD 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, or from about 1 mm to about 3 mm, as measured by NG1.
  • the aerosolized dry powder composition comprises particles with an FPF of from about 40% to about 70%, from about 30% to about 60%, or from about 50% to about 60%, as measured by NGI.
  • Group 1 PH includes pulmonary arterial hypertension (PAH), idiopathic pulmonary arterial hypertension (IP AH), familial pulmonary arterial hypertension (FPAH), and pulmonary arterial hypertension associated with other diseases (APAH).
  • PAH pulmonary arterial hypertension
  • IP AH idiopathic pulmonary arterial hypertension
  • FPAH familial pulmonary arterial hypertension
  • APAH pulmonary arterial hypertension associated with other diseases
  • pulmonary arterial hypertension associated with collagen vascular disease e.g., scleroderma
  • congenital shunts between the systemic and pulmonary circulation portal hypertension and/or HIV infection are included in group 1 PH.
  • Group 2 PH includes pulmonary hypertension associated with left heart disease, e.g., atrial or ventricular disease, or valvular disease (e.g., mitral stenosis).
  • WHO group 3 pulmonary hypertension is characterized as pulmonary hypertension associated with lung diseases, e.g., chronic obstructive pulmonary disease (COPD), interstitial lung disease (ILD), and/or hypoxemia.
  • COPD chronic obstructive pulmonary disease
  • ILD interstitial lung disease
  • hypoxemia e.g., hypoxemia.
  • Group 4 pulmonary hypertension is pulmonary hypertension due to chronic thrombotic and/or embolic disease.
  • Group 4 PH is also referred to as chronic thromboembolic pulmonary hypertension.
  • Group 4 PH patients experience blocked or narrowed blood vessels due to blood clots.
  • Group 5 PH is the“miscellaneous” category, and includes PH caused by blood disorders (e.g., polycythemia vera, essential thrombocythemia), systemic disorders (e.g., sarcoidosis, vasculitis) and/or metabolic disorders (e.g., thyroid disease, glycogen storage disease).
  • blood disorders e.g., polycythemia vera, essential thrombocythemia
  • systemic disorders e.g., sarcoidosis, vasculitis
  • metabolic disorders e.g., thyroid disease, glycogen storage disease.
  • the methods provided herein can be used to treat group 1 (i.e., pulmonary arterial hypertension or PAH), group 2, group 3, group 4 or group 5 PH patients, as characterized by the WHO.
  • group 1 i.e., pulmonary arterial hypertension or PAH
  • group 2, group 3, group 4 or group 5 PH patients as characterized by the WHO.
  • the pulmonary hypertension treated is chronic thromboembolic pulmonary hypertension.
  • the pulmonary hypertension treated is pulmonary arterial hypertension (PAH).
  • PAH pulmonary arterial hypertension
  • the PAH treated is class I PAH, class P PAH, class III PAH, or class IV PAH, as characterized by the New York Heart Association
  • the PAH is class I PAH, as characterized by the NYHA.
  • the PAH is class P PAH, as characterized by the NYHA.
  • the PAH is class III PAH, as characterized by the
  • the PAH is class IV PAH, as characterized by the
  • the present disclosure provides a method for treating portopulmonary hypertension (PPH) in a patient in need thereof
  • the method includes administering an effective amount of the dry powder composition disclosed herein, i.e., a dry powder composition comprising a compound of Formula (I) or (P), or an enantiomer, diastereomer, or a pharmaceutically acceptable salt thereof, to the lungs of the patient by inhalation via a dry powder inhaler.
  • the dry powder composition comprises a compound of Formula (I) or (II), or a pharmaceutically acceptable salt thereof.
  • the dry powder composition comprises a compound of Formula (I) or (II):
  • the administering includes aerosolizing the dry powder composition with a dry powder inhaler (DPI) to provide an aerosolized dry powder composition, and administering the aerosolized dry powder composition to the lungs of the patient via the DPI.
  • the aerosolized dry powder composition comprises particles with an MMAD 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, or from about 1 mm to about 3 mm, as measured by NGI.
  • the aerosolized dry powder composition comprises particles with an FPF of from about 40% to about 70%, from about 30% to about 60%, or from about 50% to about 60%, as measured by NGI.
  • the PH, PAH, or PPH patient treated by the disclosed methods manifests one or more of the following therapeutic responses: (1) a reduction in the pulmonaiy vascular resistance index (PVRI) from pretreatment value, (2) a reduction in mean pulmonary artery pressure from pretreatment value, (3) an increase in the hypoxemia score from pretreatment value, (4) a decrease in the oxygenation index from pretreatment values, (5) improved right heart function, as compared to pretreatment, and (6) improved exercise capacity (e.g., as measured by the six-minute walk test) compared to pretreatment [00169]
  • the PH, PAH, or PPH patient is administered the dry powder composition once daily.
  • the PH, PAH, or PPH patient is administered the dry powder composition twice daily. In still another embodiment of the disclosed methods, the PH, PAH, or PPH patient is administered the dry powder composition three or more times daily. In one embodiment, the administration is with food. In one embodiment, each administration comprises 1 to 5 doses (puffs) from a DPI, for example 1 dose (1 puff), 2 doses (2 puffs), 3 doses (3 puffs), 4 doses (4 puffs) or 5 doses (5 puffs).
  • the DPI in one embodiment, is small and transportable by the patient
  • the dry powder inhaler is a single dose dry powder inhaler.
  • the present disclosure provides a method for treating pulmonary fibrosis in a patient in need thereof.
  • the method includes administering an effective amount of the dry powder composition disclosed herein, i.e., a dry powder composition comprising a compound of Formula (I) or (P), or an enantiomer, diastereomer, or a pharmaceutically acceptable salt thereof, to the lungs of the patient by inhalation via a dry powder inhaler.
  • the dry powder composition comprises a compound of Formula (I) or (P), or a pharmaceutically acceptable salt thereof.
  • the dry powder composition comprises a compound of Formula (I) or (II):
  • the administering includes aerosolizing the dry powder composition with a DPI to form an aerosolized dry powder composition, and administering the aerosolized dry powder composition to the lungs of the patient via the DPI.
  • the aerosolized dry powder composition comprises particles with an MMAD 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, or from about 1 mm to about 3 mm, as measured by NGI.
  • the aerosolized dry powder composition comprises particles with an FPF of from about 40% to about 70%, from about 30% to about 60%, or from about 50% to about 60%, as measured by NCH.
  • the patient in one embodiment, is administered the dry power composition once daily, twice daily, or three or more times daily.
  • the administration is with food.
  • each administration comprises 1 to 5 doses (puffs) from a DPI, for example 1 dose (1 puff), 2 doses (2 puffs), 3 doses (3 puffs), 4 doses (4 puffs) or 5 doses (5 puffs).
  • the DPI in one embodiment, is small and transportable by the patient.
  • the dry powder inhaler is a single dose dry powder inhaler.
  • Example 1 Preparation and characterization of inhalable dry powder formulations comprising the compound of Formula (II (treprostinil palmitil)
  • This example describes mannitol and trehalose-based dry powder formulations comprising treprostinil palmitil represented by Formula (P), their preparations by spray drying using Buchi B-290 spray dryer equipped with Inert Loop Condenser B-295 and Dehumidifier B- 296, and the characterization and stability testing of the formulations.
  • Formula (P) treprostinil palmitil represented by Formula (P)
  • the feed stock was made by dissolving all components in l-propanol/H 2 O co-solvent system (50/50, v/v), without the addition of ammonium bicarbonate.
  • the spray drying yields for mannitol-based dry powder were above 90%.
  • the collected dry powder had spherical particles, crystalline XRD profile, and low moisture content.
  • the trehalose-based treprostinil palmitil dry powder formulations with components of treprostinil palmitil/DSPE-PEG2000/Trehalose/Leucine (1/0.5/80/20, 1/0.5/70/30, 1.5/0.75/80/20, 2/1/80/20, w/w), were created by spray drying the feed stock containing all components dissolved in l-propanol/H 2 O co-solvent system (50/50, v/v), without the addition of ammonium bicarbonate.
  • the trehalose-based dry powder contained collapsed particles, exhibiting crystalline leucine and amorphous trehalose. Trehalose-based dry powder showed good physical stability over 3 months.
  • Phosphate buffered saline PBS, PH 7.4, Cat. No. 10010 (Life technologies,), or equivalent
  • Sodium chloride ACS Reagent (JT Baker, Cat. No. 3628-05), or equivalent
  • DSPE-PEG2000 N-(Methylpolyoxy ethylene oxy carbonyl)-! ,2-distearoyl-sn- glycero-3-phosphoethanolamine, sodium salt, SUNBRIGHT®DSPE-020CN (NOF, Tokyo, Japan), or equivalent
  • NGI Next Generation Impactor
  • PSD RODOS/M, (Sympatec, Germany)
  • Magnetic stir plate 3 Preparation of dry powder formulation comprising treprostinil palmitil, DSPE-PEG2000, trehalose, and leucine at a weight ratio of 1:0.5:80:20
  • Trehalose 150 mg/mL in DI water
  • the spray drying feed solution was prepared at a 1:100 weight ratio of treprostinil palmitil to a total of trehalose and leucine.
  • Final feed solution had 50% of 1- propanol and 20.3 mg/mL of solid (Table 2).
  • Trehalose and leucine stock solutions were added into water phase first, followed by the addition of 1 -propanol and sonication in water bath. Then, treprostinil palmitil (Formula (P)) and DSPE-PEG2000 were added separately. Stirring was applied through the whole process.
  • Spray drying was performed using spray dryer Buchi B-290 under the following parameters: 150 °C inlet temperature, 64 °C outlet temperature, 414 L/h spray air flow (36 mm, height in rotameter), 35 % m 3 /h as aspiration rate, and a feed-rate of 7.5 mL/min (22%). Table 3 summarizes the process parameters.
  • Treprostinil palmitil 10 mg/mL in 1 -propanol
  • the spray drying feed solution was prepared at a 1 : 100 weight ratio of treprostinil palmitil to a total of mannitol and leucine.
  • Final feed solution had 50% of 1- propanol and 20.3 mg/mL of solid (Table 5).
  • Spray drying was performed using spray dryer Buchi B-290 under the following parameters: 135 °C inlet temperature, 60 °C outlet temperature, 414 L/h spray air flow (36 mm, height in rotameter), 35 % m 3 /h as aspiration rate, and a feed-rate of 7.5 mL/min (22%). Table 6 summarizes the process parameters.
  • Dry powder sample (as received) was poured on a carbon tape and then coated with 20 nm gold (Au) using an Electron Microscopy Sciences (EMS150T ES) sputter coater.
  • EMS150T ES Electron Microscopy Sciences
  • FE-SEM Field emission-scanning electron microscopy
  • the working distance was kept between 8 to 10 mm to obtain relatively high resolution.
  • the scanning range was between 4° to 40° degrees (2Q) with a time per step of 97.92 seconds and a step size of 0.0131°.
  • DSC Differential scanning calorimetry
  • Balance analytical balance capable of weighing up to 4-decimal places with an interface capable to connect to the Aquastar Titrator.
  • the density test was performed via the tapped density tester, JV 1000 (Coply Scientific, UK). The following procedures were followed. Clean glass tube, dry with compressed air; weigh glass tube, record as Wl; transfer dry powder into glass tube, mark the height as A, and record weight as W2; seal the top with parafilm; put the glass tube into a 5 mL graduated cylinder, tapping for 10 min; mark the height as B after tapping; remove powder from tube, clean and dry with compressed air; weight glass tube, record as W3; add water to level B, and record weight as W5; add water to level A, and record weight as W4. (assuming the density of water equals 1 g/mL)
  • Aerodynamic particle size distribution ( APSD using NGI [00215] Around 20 mg of powder, filled in the size 3 Vcaps HPMC capsule, were dispersed through a commercial inhaler (Plastiape RS01) into a next generation cascade impactor (NGI) (Copley Scientific, UK) operated at a volumetric flow rate of 60 L/min and actuated for 4 seconds. Drag content collected at each stage from the NGI apparatus was assessed by HPLC-MS. Fine particle fraction (FPF) was defined as the drag mass ( ⁇ 5 mm) deposited in the NGI divided by the emitted dose.
  • NGI next generation cascade impactor
  • Treprostinil (TRE) and treprostinil palmitil concentrations were determined using a Waters Alliance Model 2695 equipped with a PDA Detector (Waters 2996) and Corona Charged Aerosol Detector (Thermo Fisher Scientific).
  • Mobile phase A acetonitrile 25%, methanol 25%, water 50%, formic acid 0.1%, triethylamine 0.01%
  • Mobile phase B acetonitrile 50%, methanol 50%, formic acid 0.1%, triethylamine 0.01%
  • UV wavelength 270 ⁇ 2.4 nm.
  • Table 7A shows the compositions and the inlet temperatures for the different batches of mannitol-based treprostinil palmitil dry powders.
  • the amounts of treprostinil palmitil, DSPE-PEG2000, mannitol, and leucine are indicated by weight ratio.
  • the amounts of treprostinil palmitil and leucine are also indicated by their approximate weight percentages represented by their proportions in the weight ratio.
  • Table 7B shows the targeted weight percentages of treprostinil palmitil, DSPE-PEG2000, mannitol, and leucine in each batch calculated based on the weight ratio.
  • MMAD The value of MMAD was constant when there was 1 to 2 % of treprostinil palmitil in the dry powder, and it increased significantly when treprostinil palmitil was increased to 3 to 5 % ( Figure 4).
  • Mannitol-based treprostinil palmitil dry powders with the same component ratios were generated at different inlet temperatures, i.e., 150 °C, 135 °C, and 120 °C (Table 11).
  • the effect of the inlet temperature on the dry powder morphology was investigated first. SEM revealed that less surface breakage was present in the dry powder samples spray dried at lower inlet temperatures of 135 °C and 120 °C ( Figures 5A-5C). Since no significant difference was noticed between 135 °C and 120 °C ( Figures 5B and 5C), the inlet temperature of 135 °C was used in further investigations.
  • ABSC ammonium bicarbonate
  • the mannitol-based treprostinil palmitil dry powder was generated by spray drying a solution containing all the components. It was anticipated that the mannitol-based dry powder would show some amorphous properties, such as Tg in DSC test and broad peaks in powder X-ray diffraction test (XRD).
  • Figures 7A and 7B showed the DSC and XRD data, respectively, from batch SD-NNP-179 which had 1% of treprostinil palmitil and 20% of leucine. No Tg was detected and sharp peaks in powder XRD were observed from this batch. These two characteristics were also noticed from other batches, regardless of the difference in the composition and the spray drying condition. 2. Batches of trehalose-based treprostinil palmitil dry powder
  • Table 13A shows the compositions of the batches and the inlet temperatures used for the spray drying process.
  • Table 13B shows the targeted weight percentages of treprostinil palmitil, DSPE-PEG2000, trehalose, and leucine in each batch calculated based on the weight ratio.
  • the batches varied in the treprostinil palmitil content from 1 to 2 % (weight ratio, w/w), while the ratio of treprostinil palmitil to DSPE-PEG2000 was kept the same at 2 to 1.
  • the leucine content in the batches was 20% or 30% (w/w).
  • the inlet temperature varied from 110 °C to 155 °C.
  • the inlet temperature in spray drying process was expected to influence the properties of dry powder, such as moisture content, particle size and powder morphology.
  • Two inlet temperatures of 130 °C and 150 °C were investigated with the batches of trehalose-based vehicle dry powders shown in Table 16.
  • the trehalose-based treprostinil palmitil dry powder was produced by spray drying a solution containing all of the components. It was anticipated that the dry powder would show some amorphous properties, such as Tg in DSC and broad peaks in powder X-ray diffraction (XRD).
  • Moisture may be introduced into a dry powder formulation during spray drying, packaging, and storage, causing product instability and package issues. Upon spray drying, moisture in dry powder may be reduced via second drying. However, during packaging, powders may absorb moisture when they are exposed to the environment, even under a humidity control condition. Moisture absorption of the mannitol and trehalose-based treprostinil palmitil dry powders was examined.
  • the mannitol-based treprostinil palmitil dry powder could absorb up to 0.3% of moisture when the RH% was increased from 0 to 40%. Compared to a lactose- based treprostinil palmitil dry powder, the mannitol-based dry powder absorbed much less moisture, probably because the mannitol-based dry powder contained crystalline mannitol and leucine and the stable form for both are un-hydrated form.
  • Table 19 shows the details of the stability data of the mannitol-based treprostinil palmitil dry powder batches. In all the batches of mannitol-based dry powders containing 20% leucine, significant changes in MMAD and FPF were observed. Additionally, initial MMAD was lower for the dry powders with 1, 1.5, and 2 % of treprostinil palmitil, as compared to that for the dry powder with 3 and 5% of treprostinil palmitil.
  • Table 21 shows the details of the stability data of the trahalose-based treprostinil palmitil dry powder batches.
  • the MMAD increased significantly for batches SD-NNP-162 and SD-NNP-188 (Table 21 and Figure 19).
  • the FPF value decreased most notably for batch SD-NNP- 162 ( Figure 20).
  • Batch SD-NNP-163 (treprostinil palmitil 1%, leucine 30%) showed the lowest and stable MMAD and the highest stable FPF.
  • the inlet temperature varied from 120 °C to 150 °C did not impact the morphology of the mannitol-based treprostinil palmitil dry powder. Since the moisture content was around 1 % from the dry powder produced under 135 °C, the inlet temperature was set at 135 °C.
  • the MMAD rose sharply at 2-month time point for formulations with 1 to 2 % of treprostinil palmitil, and at 1 -month time point for formulations with higher treprostinil palmitil contents.
  • the MMAD dropped at later time points. All formulations showed fibers on the powder surface after storage.
  • the trehalose-based treprostinil palmitil dry powder containing 30% leucine had wrinkled surface and less powder deposited in the throat and pre-separator as compared to that containing 20% leucine. However, there was no significant difference in MMAD between the two.
  • the inlet temperature in the spray drying process was selected at 150 °C for achieving a lower moisture content in final dry powder.
  • Tg Glass transition temperature in the range of 64 to 80 °C was observed, indicating an amorphous state of trehalose in the dry powder.
  • the trehalose-based treprostinil palmitil dry powder showed higher absorption of moisture compared to the mannitol-based treprostinil palmitil dry powder.
  • Example 2 Manufacture, encapsulation, and characterization of inhalable mannitol and trehalose-based treprostinil palmitil dry powder formulations
  • This example describes the manufacture by spray drying and encapsulation of four treprostinil palmitil dry powder formulations, i.e., formulations A, B, C, and D.
  • Formulations A and D were mannitol-based and their compositions in both weight ratios and targeted weight percentages calculated based on the weight ratios are shown in Table 22.
  • Formulations B and C are trehalose-based and their compositions in both weight ratios and targeted weight percentages calculated based on the weight ratios are shown in Table 23.
  • This example also describes the characterization of formulations A-D for particle size, morphology, water content, solvent content, physical state, vapor sorption profile, thermal properties, and weight loss as a function of temperature.
  • Treprostinil palmitil dry powder formulations A, B, C, and D were manufactured using a BLD-200 spray dryer with in-going solids of approximately 55 grams each. Between each condition, a blank solvent solution was sprayed to ensure the previous formulation was cleared from the solution line. No additional cleaning of the spray dryer was conducted between conditions.
  • Leucine was dissolved in deionized water.
  • the aqueous solution was filtered through a 0.2 mm PVDF membrane.
  • Treprostinil palmitil was dissolved into 1 -propanol.
  • Manufacturing yields ranged from 54 to 80 % by mass.
  • Packaging of bulk diy powder of each formulation was conducted in a dry glove box.
  • capsules were made from a typical batch of formulation D (containing 1.50 wt% treprostinil palmitil, 0.75 wt% DSPE-PEG2000, 68.45 wt% mannitol, and 29.30 wt% leucine) by filling in each capsule 112.5 pg of treprostinil palmitil, 56.2 pg of DSPE-PEG2000, 5133.8 pg of mannitol, and 2197.5 pg of leucine.
  • formulation D containing 1.50 wt% treprostinil palmitil, 0.75 wt% DSPE-PEG2000, 68.45 wt% mannitol, and 29.30 wt% leucine
  • the target particle size was to be less than 5 mm.
  • each of the four formulations was imaged at 500, 1500, and 5000 magnifications using a Hitachi SU3500 scanning electron microscope. Images taken at 5000 magnification are shown in Figure 27 (formulation A), Figure 28 (formulation B), Figure 29 (formulation C) and Figure 30 (formulation D). All the formulations contained full and collapsed spherical particles approximately 3 mm or less in diameter, consistent with the laser diffraction results. Formulation C appeared to be the most corrugated while formulation A appeared to be the most“smooth”. The surface roughness may improve aerosol performance. For all the formulations, no significant crystalline surface formations or fusion of particles were observed.
  • Sample crystallinity was assessed using a Rigaku MiniFlex 600 Powder X-ray diffractometer. Samples were prepared on 0.2 mm Zero Background Holder (ZBH) discs and run on the instrument from 3 to 40 2Q. Formulations A and D exhibited crystalline mannitol (likely polymorphic mixture) and leucine while formulations B and C exhibited crystalline leucine with amorphous trehalose.
  • ZBH Zero Background Holder
  • Components may exhibit different diffraction intensities as neat material compared with a spray dried formulation.
  • Formulations containing mannitol appeared to have similar diffraction patterns.
  • Trehalose containing formulations also appeared to have similar amorphous diffraction patterns.
  • Thermal transitions can be used to predict stability of the formulation.
  • the four formulations were scanned on a TA Instruments Q2000 differential scanning calorimeter. Samples were equilibrated in a dry environment ( ⁇ 5 % RH) overnight before they were hermetically sealed and run on the instrument. The modulation was set to ⁇ 1.5 °C/min with a heating ramp rate of 2.5 °C/min from 0 to 180 °C. A thermal event at 64 °C was observed for all the samples, and this event may correspond with the melt of treprostinil palmitil or DSPE-PEG2000.
  • Thermal decomposition data for the formulations was measured using a TA Instruments Discovery Thermogravimetric Analyzer. Samples were run from 0 to 300 °C at a rate of 2.5 °C/min. The formulations began to rapidly decompose after 180 °C. Changes in weight were observed at around 100 °C, corresponding with water content.
  • Uptake rate for the trehalose formulation indicates that it took approximately 50 to 90 minutes (depending on the level of leucine content) to reach moisture equilibration at a relative humidity of 40%. A lower leucine content took moisture faster than one with a higher leucine content.
  • Treprostinil palmitil diy powder formulations A, C, and D were encapsulated, and the capsules were stored for 1 month, 2 months, or 3 months at 40 °C, or were stored for 3 months at 25 °C.
  • Treprostinil palmitil dry powder formulations A, C, and D were also stored as bulk for 3 months at 40 °C or 25 °C, and were then filled into capsules and dosed for FPD determination on the same day.
  • the FPD results for formulations A, C, and D are shown in Figures 31, 32, and 33, respectively.
  • formulation D had the least change in FPD (-3.7%) after stored in capsules for 3 months at 25 °C. Additionally, formulation D had a -5.2% change in FPD when stored as bulk for 3 months at 25 °C and filled into capsules and dosed on the same day. Furthermore, for each of formulations A, C, and D, storage at 40 °C did not appear predictive of long term storage at 25°C for aerosol performance as measured by FPD. Based on these data, no conditioning or pretreatment of powder or capsules to modify aerosol performance is needed.
  • formulation D displayed the least change in emitted dose after stored in capsules for 3 months at 25 °C, and after stored as bulk for 3 months at 25 °C and then filled into capsules and dosed on the same day. Taken together, based on the changes in the aerosol performance, formulation D appears stable for at least for 3 months at 25 °C. Additionally, the stability data up to date supports a 6 months shelf life when stored at 2-8 °C.
  • Example 3 Determination of aerosol performance of trahalose-based treprostinil palmitil drv powder formulation under accelerated storage condition and lung pharmacokinetic profile in rats following inhalation of the dry powder formulation
  • Trahalose-based treprostinil palmitil dry powder composed of treprostinil palmitil, DSPE-PEG2000, trehalose (Treh) and leucine (Leu) in the weight ratio of 1:0.5:70:30 was produced by spray drying using a Buchi B-290 system as described in Example 1.
  • the dry powder was stored in sealed glass vials at 40 °C and uncontrolled ambient humidity for an accelerated stability study.
  • the aerosol performance of the powder was measured after 1.5, 2.5, and 3.5 months of storage.
  • the moisture absorption curve was obtained using the Dynamic Vapor Sorption (DVS) automated gravimetric sorption system (DVS Intrinsic 1 Plus, Surface Measurement System, PA, USA). Approximately 20 mg of powder was loaded, and subjected to a cycle of sorption/desorption isotherm (from 0% relative humidity (RH) to 90% RH to 0% RH again, in increments of 10% RH) at 25 °C. The change in powder mass (%) with RH was determined and plotted.
  • DVD Dynamic Vapor Sorption
  • RS01 Mod.7 DPI Device High Resistance, code 239700002AA, Plastiape, Italy
  • Mass median aerodynamic diameter (MMAD) of the trehalose-based treprostinil palmitil dry powder was measured using the Next Generation Impactor (NGI) at 60 L/min.
  • the treprostinil palmitil dry powder was delivered through a 12-port nose-only inhalation chamber using a dry powder dispenser (Vilnius Aerosol Generator (VAG), CH Technologies, USA). Approximately 1 g of the dry powder was loaded into the VAG. The VAG had a flow rate of 8 L/min at 1.0 V for a total of 20 minutes.
  • VAG Volnius Aerosol Generator
  • the dry powder delivery system was described in more detail in Li et al.,“Inhaled INS 1009 Demonstrates Localized Pulmonary Vasodilation,” European Respiratory Society (ERS) International Congress, 3-7 September 2016, London, United Kingdom, Abstract No: 853952 (poster PA2845), the content of which is incorporated herein by reference in its entirety.
  • Rat lung tissues were harvested immediately post delivery (-0.5 hr), 6, 12, and 24 hrs after drug dosing. Lung tissue samples were analyzed for treprostinil palmitil and treprostinil (TRE) by LC-MS/MS. Results are reported in terms of“Treprostinil Palmitil Equivalents” to account for post-mortem hydrolysis of treprostinil palmitil.
  • Dynamic vapor sorption (DVS) of the treprostinil palmitil dry powder formulation is shown in Figure 34.
  • the dry powder was exposed to an increase in RH up to 50%, the absorbed moisture increased from 0% to more than 8% and was not completely reversible with desorption, remaining at or above 5.5%.
  • the RH exposure for this powder may be controlled to ⁇ 30% during manufacture.
  • the fine particle fraction (FPF), MMAD and geometric standard deviation (GSD) values of the aerosolized dry powder after storage at 40 °C and uncontrolled ambient humidity for up to 3.5 months are summarized in Table 32.
  • the FPF values ranged from 54.6% to 58.7%.
  • the MMAD values ranged from 1.25 mm to 1.44 mm.
  • the GSD values ranged from 3.5 to 4.1.
  • Rat lung PK results [00286] The concentration of treprostinil palmitil equivalent (treprostinil palmitil plus treprostinil) in the lung after inhalation of nebulized INS 1009 or the aerosolized treprostinil palmitil dry powder is summarized in Table 33 and Figure 36.
  • the nebulized INS 1009 contained treprostinil palmitil and the excipients squalane and DSPE-PEG2000 at a molar ratio of 45:45: 10, suspended in PBS (see Corboz et al.,“Preclinical Pharmacology and Pharmacokinetics of Inhaled Hexadecyl-Treprostinil (C16TR), a Pulmonary Vasodilator Prodrug,” J Pharmacol Exp Ther. 363:348-357 (2017), the content of which is incorporated herein by reference in its entirety). Both nebulized INS 1009 and the C16TR (treprostinil palmitil) dry powder had similar lung PK profiles following inhalation in rats. The statistical comparison of these two profiles is summarized in Table 34, demonstrating comparable slopes for both profiles.
  • the delivered drug dose was calculated from the concentration of drug inhaled (from filter data), the duration of exposure, respiratory minute volume and body weight with a deposition fraction of 1.0 used for the drug delivered at the nose, and a deposition fraction of 0.1 used for the drug delivered to the lungs. Doses are expressed per kg body weight.
  • the lung treprostinil palmitil equivalent and plasma TRE data were used to derive the following PK parameters: lambda z (terminal elimination rate constant), T1 ⁇ 2, T max , Cmax and AUCo-inf using the PK Solver program in Microsoft Excel.
  • inhalation of treprostinil palmitil dry powder formulations D and C results in low treprostinil plasma Cmax values and sustained levels of treprostinil in the plasma and lungs as compared to inhalation of treprostinil.
  • Typical lung treprostinil palmitil equivalent plasma TRE C max ratio for nebulized INS 1009 is -800, while the ratio for the treprostinil palmitil dry powder formulations ranges from -1,600 - 13,000. See Corboz et al., J Pharmacol Exp Ther 363: 1-10 (2017), the content of which is incorporated herein by reference in its entirety. Since pulmonary vasodilation is associated more with local activity of TRE within the lungs and less with the level of TRE in the plasma ⁇ see Chamman RW et al., Pulm. Pharmacol. Ther.
  • the unexpected difference in the lung treprostinil palmitil equivalent : plasma TRE Cmax ratio indicates that administration of the treprostinil palmitil dry powder formulations beneficially leads to lower systemic exposure to TRE and thus minimizes potential systemic adverse events, such as reductions in systemic blood pressure.
  • Example 5 Evaluations of efficacy of mannitol and trehalose-based treprostinil palmitil dry powder formulations in hvnoxia challenged telemetered rats
  • This example describes the in vivo efficacy evaluations of two different treprostinil palmitil dry powder formulations: the mannitol-based formulation D and the trehalose-based formulation C described in Example 2 and Example 4 (Tables 35 A and 35B). Efficacy was determined in rats that were prepared with a telemetry probe implanted in the right ventricle to measure the inhibition of the increase in right ventricular pulse pressure (RVPP) that was induced by exposure to an inhaled hypoxic gas mixture.
  • RVPP right ventricular pulse pressure
  • the drug formulations were given with a Vilinius Aerosol Generator (VAG) at an output of 1 Volt (V) and delivered into a 12-port nose-only inhalation chamber for 20 min.
  • VAG Vilinius Aerosol Generator
  • the aerosols were dispersed from the VAG with a bias flow of 8 L/min and delivered to the bottom of the nose-only inhalation chamber.
  • a filter was connected to one of the nose-only ports and attached to a vacuum flow of 0.5 L/min for 5 min.
  • the amount of treprostinil palmitil deposited on the filter was measured by LC-MS/MS. Plasma and respiratory tissue samples of the rats were analyzed for their concentration(s) of treprostinil palmitil and/or TRE.
  • the delivered dose of formulation D was 78 pg/kg body weight (lung treprostinil palmitil equivalent concentration of 3072 ng/g) and the delivered dose of formulation C was 58 pg/kg body weight (lung treprostinil palmitil equivalent concentration of 1711 ng/g), based upon the concentration of drug inhaled, the duration of exposure, body weight, respiratory minute volume and a deposition fraction of 1.0. See Alexander D.J. et al., Inhal. Toxicol. 20:1179-1189 (2008), the content of which is incorporated herein by reference in its entirety.
  • Example 6 Assessment of mannitol and trehalose-based treprostinil palmitil dry powder formulations on cough and ventilation in guinea nigs
  • This example describes studies on the effects of the mannitol-based treprostinil palmitil dry powder formulation D and the trehalose-based treprostinil palmitil dry powder formulation C (described in Example 2 and Example 4; see the formulation compositions in Tables 35 A and 35B) to produce cough, change ventilation and change in Penh, a dimensionless index of altered breathing pattern typically seen during bronchoconstriction in conscious male guinea pigs.
  • Cough was measured from plethysmograph recordings showing a large inspiration followed by a large expiration and confirmed by manual observations, video recordings and cough sounds.
  • the ventilation, Penh and cough data were measured during a 15-min baseline period before the exposure to the dry powder aerosol.
  • test articles which included formulation D, formulation C and their respective vehicles, i.e., the mannitol vehicle (containing mannitol at the targeted weight percent of 69.48 wt%, leucine at the targeted weight percent of 29.78 wt%, and DSPE- PEG2000 at the targeted weight percent of 0.74 wt%), and the trehalose vehicle (containing trehalose at the targeted weight percent of 69.48 wt%, leucine at the targeted weight percent of 29.78 wt%, and DSPE-PEG2000 at the targeted weight percent of 0.74 wt%), were then delivered as dry powders for 15 min followed by a 120 min observation period after the aerosol compounds were administered.
  • the mannitol vehicle containing mannitol at the targeted weight percent of 69.48 wt%, leucine at the targeted weight percent of 29.78 wt%, and DSPE- PEG2000 at the targeted weight percent of 0.74 wt%
  • trehalose vehicle
  • the air for the aerosol delivery for all steps of the experiment was supplied by an air compressor. Typical humidity of the supplied air was around 30%, as measured. Ventilation, Penh and cough were measured before, during and after exposure to the test articles. Aerosolized test articles were produced with a Vilnius Aerosol generator (VAG). The air flow rate through the VAG was set at 4.5 L/min to disperse the aerosol and combined with 1 L/min of humidified air (30% humidification) to facilitate aerosol delivery to the plethysmograph and minimize problems with static adhesion. The total inflow of air was therefore 5.5 L/min.
  • the generator output from the VAG was 1, 0.75 and 0.5 Volts with each VAG output given for 15 min to deliver 3 different doses of the drugs, with a higher dose being delivered at the higher voltage.
  • a vacuum flow of 8 L/min was established at the bottom of the plethysmograph such that the air and aerosols entered the top and exited the bottom of the system.
  • a separate vacuum source of 0.5 L/min was connected to the filter that was attached to a port in the plethysmograph to sample the drug (treprostinil palmitil) concentration. The filter sampling was maintained for the full duration of the study; i.e.
  • Aerosolized formulation D generated at 1 V and administered for 15 min produced cough in 4 of 6 guinea pigs. The average number of coughs for this exposure was 24 ⁇ 12 coughs.
  • the mannitol vehicle aerosol generated at a setting of 1 V administered for 15 min did not produce cough in 4 of 4 guinea pigs (Table 38). There were no consistent changes in ventilation with formulation D or the mannitol vehicle and the small increase in Penh observed with this drug did not reach statistical significance compared to the mannitol vehicle.
  • Aerosolized formulation C generated at a setting of 1 V and administered for 15 min produced cough in 3 of 6 guinea pigs with an average cough count of 10 ⁇ 5 coughs.
  • formulation C did not cause cough in 4 of 4 guinea pigs in either group.
  • the trehalose vehicle at a voltage of 1 V administered for 15 min did not produce cough in 4 of 4 guinea pigs (Table 38). There were no consistent changes in ventilation or Penh with formulation C or the trehalose vehicle.
  • Sugen-Hypoxia (SuHx)-induced PAH model in rats is a well-documented model.
  • the model replicates much of the pathology seen in the clinical disease.
  • treprostinil palmitil dry powder formulation D (described in Example 2 and Example 4; see the formulation composition in Table 35 A) as well as inhaled treprostinil (TRE), intravenous treprostinil (TRE), and oral Selexipag, on an 8-week SuHx-induced pulmonary arterial hypertension (PAH) model in rats, including pulmonary arterial pressure (PAP) and other cardiovascular parameters, right ventricular hypertrophy, lung and cardiac histopathology and biomarkers associated with PAH, are assessed.
  • PAP pulmonary arterial pressure
  • Normoxic control group (Group 1) receives one subcutaneous injection of 100% DMSO at 2 mL/kg (vehicle for sugen) and no treatment.
  • the vehicle for treprostinil palmitil dry powder formulation D has a targeted composition of 70 wt% mannitol and 30 wt% leucine. Rats in this vehicle treatment group (Group 2) are weighed and put in the cup of a Vilnius Aerosol Generator (VAG) (170 mg of the vehicle is loaded) and administered in a nose-cone chamber at 1 volt, once per day until all the material has been aerosolized. The duration of aerosolization is measured. In parallel with Groups 3 and 4, the vehicle treatment for this group is conducted for 35 days.
  • VOG Vilnius Aerosol Generator
  • Groups 3 and 4 - Treatment groups with treprostinil palmitil dry powder formulation D [00317] For Groups 3 and 4, treprostinil palmitil dry powder formulation D is weighed and put in the cup of a VAG (90 mg is used and generated at 0.5 Volts (V) for the targeted dose of 57 pg/kg, and 170 mg is used and generated at 1 V for the targeted dose of 138 pg/kg). The dry powder formulation is given once per day for 35 days and, for each administration, the VAG is left on until all the material is aerosolized. The duration of aerosolization is measured. The Dry powder formulation is stored at 4 ⁇ 2°C.
  • the nebulized vehicle for inhaled treprostinil is phosphate buffered saline (PBS).
  • rats in this nebulized vehicle treatment group receive nebulized PBS in a nose cone chamber 4 times over a 12-hour period each day for 35 days.
  • the nebulized treprostinil (TRE) solution contains 0.5 mM TRE in PBS at a pH of 7.4. The solution is stored at 4 ⁇ 2°C and expiration date is set 7 days after preparation. The solution is used to deliver a targeted dose of 110 pg/kg TRE, and administered to rats in Group 6 by inhalation 4 times over a 12-hour period each day for 35 days.
  • the vehicle for intravenous treprostinil is an aqueous solution containing 3.0 mg/mL m-Cresol, 5.3 mg/mL NaCl, and 6.3 mg/mL sodium citrate, with a pH of 6.0-7.2.
  • Rats in this group (Group 7) are each implanted with an osmotic pump filled with the vehicle and subject to continuous infusion at an infusion rate as specified for Group 8 below. In parallel with Group 8, the continuous vehicle infusion for Group 7 is to last 35 days.
  • Two solutions are prepared for the intravenous administration of TRE to Group 8. They differ only in the concentration of TRE.
  • the first solution is an aqueous solution containing 8.75 mg/mL TRE, 3.0 mg/mL m-Cresol, 5.3 mg/mL NaCl, and 6.3 mg/mL sodium citrate, with a pH of 6.0-7.2.
  • the second solution is an aqueous solution containing 10.7 mg/mL TRE, 3.0 mg/mL m-Cresol, 5.3 mg/mL NaCl, and 6.3 mg/mL sodium citrate, with a pH of 6.0- 7.2.
  • Each rat of this group receives an intravenous infusion of TRE using an implanted osmotic pump (ALZET pump).
  • Each ALZET pump is first filled with 2 niL of the first solution with 8.75 mg/mL TRE, which is sufficient to achieve continuous infusion over a 28-day period (based on an infusion rate of 2.5 mL/h) for a 450 g rat and achieve a targeted dose of TRE of 810 ng/kg/min.
  • the ALZET pump is replaced on Day 19 of the infusion (Day 40 of the whole study) and filled with 2 mL of the second solution with 10.7 mg/mL TRE, based on an increase in rat weight to approximately 550 g. Derivations of the TRE concentrations in the first and second solutions are shown below.
  • the continuous IV TRE infusion is to last 35 days.
  • the vehicle for Selexipag is an aqueous solution containing 0.5% (w/v) methylcellulose with a pH of 7.5-8.0.
  • rats of this group are dosed with the vehicle by oral gavage twice a day for 35 days.
  • a Selexipag solution containing 3.0 mg/mL Selexipag in 0.5% (w/v) methyl cellulose with a pH of 7.5 is prepared.
  • the solution is stored at room temperature and expiration date is set 7 days after preparation.
  • the solution is administrated to this group of rats (Group 10) by oral gavage twice a day for a targeted dose of 30 mg/kg at a volume of 10 mL/kg at each administration.
  • the Selexipag treatment is to last 35 days.
  • the rats are randomized into the treatment groups based on their body weight as described above on Day 21.
  • Rats in Groups 2-10 are placed in cages for which the controlled air is adjusted to receive a FiO 2 equivalent to 0.10 (10%) using a mixture of nitrogen and ambient air controlled by the ventilated cage system. They are kept under these hypoxic conditions for 21 days. While in hypoxia, cages are cleaned and changed once a week, exposing the rats to ambient oxygen levels for less than 10 minutes. They are exposed to ambient oxygen levels from Day 22 to Day 56. Group 1 rats remain in cages exposed to ambient oxygen (normoxic) levels for 56 days. The rats are observed on a daily basis for any changes in their behavior and general health status.
  • Treatment with the test articles or vehicles is administrated from Day 22 to Day 56.
  • Venous blood (0.5 ml, anticoagulated with EDTA) is sampled from all rats (including the normoxic and vehicle groups), at Day 23 (just before the second dosing), at Day 38 (just before the next dosing) and at Day 57 (24 hours after the last dose).
  • Blood is sampled from the saphenous vein for rats with ALZET pumps, and by the jugular vein for all other rats. Whole blood is centrifuged to yield plasma, which is stored frozen at -80°C for analysis.
  • each rat is placed into a nose-cone restraint chamber, which is connected to a 12-port nose-only inhalation chamber (CH Technologies).
  • Treprostinil palmitil dry powder formulation D or its vehicle is delivered using a VAG. Airflow is introduced into the VAG at a flow rate of 7 L/min and connected to the nose-only inhalation chamber.
  • 90 mg of treprostinil palmitil dry powder formulation D is weighed and loaded to the VAG de-agglomerator.
  • the VAG is set to a voltage of 0.5 V, which corresponds to 0.5 mg/L powder concentration ( ⁇ 7 pg/L treprostinil palmitil).
  • a voltage of 0.5 V corresponds to 0.5 mg/L powder concentration ( ⁇ 7 pg/L treprostinil palmitil).
  • 170 mg of treprostinil palmitil dry powder formulation D is weighed and loaded to the VAG de-agglomerator, and is delivered at a voltage of 1 V, which corresponds to 1.0 mg/L powder concentration ( ⁇ 14.7 pg/L treprostinil palmitil).
  • the powder aerosol output concentration is continuously monitored by a portable aerosol monitor (Casella MicroDust Pro). The exact delivery time is recorded.
  • Dry powder left inside the VAG de-agglomerator is weighed to calculate the actual amount of the test dry powder aerosolized.
  • a glass fiber filter which is connected to a vacuum source at 0.5 L/min vacuum flow, is placed on one of the exposure ports at 5 min after start of aerosolization to collect aerosol from chamber on filter for a period of 5 minutes. All the filter samples are kept at 4°C until analysis.
  • Rats from Group 2 receive 170 mg of the vehicle for treprostinil palmitil dry powder formulation D, administrated at 1.0 V set up.
  • Treprostinil and its vehicle PBS are administered using a nebulizer and a controller (Aeroneb Pro) from Aerogen, which is manufactured to deliver a mass mean aerosol diameter (MMAD) between 2.5 to 4 mm and a range of 0.2-0.4 mL/min of flow rate.
  • MMAD mass mean aerosol diameter
  • each rat is placed into a nose-cone restraint chamber, which is connected to a 12-port nose- only inhalation chamber (CH Technologies).
  • the volume of the solution to be nebulized is 6 mL with airflow of 6 L/min and the concentration of treprostinil is 0.5 mM.
  • a glass fiber filter is placed on one of the exposure ports and connected to a vacuum source at 0.5 L/min vacuum flow for a period of 5 minutes, i.e. starting at 5 min after the start of the nebulization and ending at 10 min.
  • Cleaning of the nebulizer is performed by sequentially running an aqueous solution of 0.5% SDS, tap water and distilled water through the nebulizer and by nebulizing PBS between each use to wash out any residual drug from the medication cup and through the aperture plate.
  • the nebulization tower tubing and other materials used in the nebulization process are also cleaned with the agents described above once a day. Additionally, the aerosolization tower tubing and other materials used in the aerosolization process are cleaned with the agents described above after each chamber dosing.
  • Rats from Group 8 are anesthetized with isoflurane 2% and medical grade air. An incision is made on the back of each rat to place an ALZET pump filled with the first solution with 8.75 mg/mL TRE. A catheter is implanted in the jugular vein and connected to the ALZET pump. For continuous infusion over a 35-days period, on day 19 of the infusion, the catheter is temporarily clamped and the ALZET pump is replaced by a new one filled with the second solution with 10.7 mg/mL TRE. Each rat from Group 7 is implanted with a vehicle-filled ALZET pump. 7. Oral administration (Groups 9 and 10)
  • Rats from Group 10 receive the reference compound, Selexipag by oral gavage twice a day from Day 22 to Day 56 (35 days). Care is taken to maintain a uniform suspension of Selexipag by stirring continuously, whilst doses are being drawn up into gavage syringes, filling one gavage syringe at a time and administering that dose before filling the next syringe. Doses are given by oral gavage at 10 mL/kg of body weight at each administration. Rats from Group 9 are dosed with the vehicle twice a day by oral gavage from Day 22 to Day 56 (35 days).
  • rats are anaesthetized with a mixture of 2 to 2.5 % isoflurane USP (Abbot Laboratories) in oxygen, and placed on a heating pad to maintain body temperature.
  • isoflurane USP Abbot Laboratories
  • Rats are tracheotomized and immediately ventilated by means of a positive- pressure rodent respirator set at ⁇ 10 ml/kg body weight at a frequency of 90 strokes/min.
  • a cannula connected to a pressure transducer is inserted into the left femoral artery to measure the systemic arterial blood pressure (SAP).
  • SAP systemic arterial blood pressure
  • the left lung is flushed with 0.9% NaCl.
  • the left lung is inflated using a 10 mL syringe filled with fixative, 10% neutral buffered formalin (NBF) with an attached blunt tip needle (23 g).
  • NBF neutral buffered formalin
  • the needle tip is inserted into the trachea, held in place with tied suture while another syringe is tied to the pulmonary artery.
  • the lung is inflated gently at physiological pressure until the lung is fully, uniformly, and consistently expanded (not allowing fixative to ooze through lung surface). This provides optimal vascular and airway expansion without causing excessive tissue disruption.
  • the needle is then removed, suture around trachea tied, and the lung immersed in 10% NBF at a 1:20 tissue to fixative ratio.
  • the heart is rinsed in PBS and then immersed in 10% NBF at a 1:20 tissue to fixative ratio.
  • the tissues are kept in formalin for 24-48 hrs.
  • the left lung and heart are then cut
  • H&E Hematoxylin and Eosin
  • VWF von Willebrand Factor
  • the heart is dissected to separate the right ventricle from the left ventricle with septum, and then weighed separately. After collection of the data for the Fulton index, the cardiac tissue is stored at -80°C for biomarker analysis.
  • SAP systemic arterial pressure
  • the right and left ventricle including the septum and the lung lobes are excised to determine wet weights.
  • molecules indicative of heart biochemistry including biomarkers of oxidative stress, collagen (Sircol assay) and hydroxyproline content, uric acid, natriretic peptides: BNP, NT-proBNP (biomarkers of heart muscle stress), endothelin-1 (heart failure), angiopoetin (neovascularization), von Willebrand factor (endothelial cells), interleukin-6 (biomarker of heart attack, stroke), Toll receptor C (biomarker of cardiac diseases), plasma cytokines, atrial natriuretic peptide ANP (biomarkers for stroke, coronary artery disease, myocardial infarction and heart failure), Toponin T/I (biomarker of heart ischemia), and CPK-MB (cardiac biomarker for myocardial infarction), are examined.
  • genes linked to PAH such as bone morphogenetic type 2 (BMPR1), BMP-9, ABCC8, TBX4, ACVRL, SMAD 4/9, KCNA5 and TET2.
  • BMPR1 bone morphogenetic type 2
  • BMP-9 bone morphogenetic type 2
  • ABCC8 ABCC8
  • ACVRL ACVRL
  • SMAD 4/9 SMAD 4/9
  • KCNA5 KCNA5
  • TET2 tissue morphogenetic type 2
  • genes such as collagen type 1 alpha 1 (COL1 Al), collagen type 1 alpha 2 (COL1 A2), and collagen type 3 alpha 1 (COL3 Al) are associated with the formation and secretion of collagen.
  • P4HA1 a key enzyme in collagen biosynthesis.
  • ACTG2 is a gene associated with myofibroblast differentiation. Changes in the expression of those genes are investigated as well.
  • treprostinil palmitil dry powder formulation D will ameliorate the pathophysiology and histopathology in the pulmonary blood vessels and heart of Su/Hx challenged rats.
  • Patents, patent applications, patent application publications, journal articles and protocols referenced herein are incorporated by reference in their entireties, for all purposes.

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MX2021013329A MX2021013329A (es) 2019-04-29 2020-04-28 Composiciones de polvo seco de los profarmacos de treprostinil y métodos de uso de las mismas.
JP2021564297A JP7455144B2 (ja) 2019-04-29 2020-04-28 トレプロスチニルプロドラッグの乾燥粉末組成物およびその使用方法
CA3138530A CA3138530A1 (en) 2019-04-29 2020-04-28 Dry powder compositions of treprostinil prodrugs and methods of use thereof
CN202411615109.6A CN119632930A (zh) 2019-04-29 2020-04-28 曲前列素前药的干粉组合物及其使用方法
BR112021021775A BR112021021775A2 (pt) 2019-04-29 2020-04-28 Composições de pó seco de pró-fármacos de treprostinil e métodos de uso destas
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CN202080047360.0A CN114072136B (zh) 2019-04-29 2020-04-28 曲前列素前药的干粉组合物及其使用方法
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JP2024510930A (ja) * 2021-03-03 2024-03-12 ユナイテッド セラピューティクス コーポレイション トレプロスチニル及びそのプロドラッグの乾燥粉末組成物、及び、さらに（ｅ）－３，６－ビス［４－（ｎ－カルボニル－２－プロペニル）アミドブチル］－２，５－ジケトピペラジン（ｆｄｋｐ）を含む乾燥粉末組成物
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