Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
  • A61K31/44—Non condensed pyridines; Hydrogenated derivatives thereof
  • A61K31/4427—Non condensed pyridines; Hydrogenated derivatives thereof containing further heterocyclic ring systems
  • A61K31/4439—Non condensed pyridines; Hydrogenated derivatives thereof containing further heterocyclic ring systems containing a five-membered ring with nitrogen as a ring hetero atom, e.g. omeprazole
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
  • A61K31/496—Non-condensed piperazines containing further heterocyclic rings, e.g. rifampin, thiothixene or sparfloxacin
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
  • A61K31/44—Non condensed pyridines; Hydrogenated derivatives thereof
  • A61K31/4412—Non condensed pyridines; Hydrogenated derivatives thereof having oxo groups directly attached to the heterocyclic ring
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
  • A61K31/505—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim
  • A61K31/506—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim not condensed and containing further heterocyclic rings
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K9/00—Medicinal preparations characterised by special physical form
  • A61K9/0012—Galenical forms characterised by the site of application
  • A61K9/0048—Eye, e.g. artificial tears
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P27/00—Drugs for disorders of the senses
  • A61P27/02—Ophthalmic agents

Definitions

• Pterygium is a non-malignant fibrovascular growth that originates from the nasal or temporal conjunctiva, then advances onto the comeal surface. Pterygium often causes ocular and psychological symptoms that significantly impact patients’ quality of life.
• Surgical excision is used to remove pterygia lesion due to vision impairment and/or unsightly eye appearance.
• a method of reducing worry or anxiety about appearance of an affected eye in a subject wherein the affected eye is affected with pterygium, hyperemia in pterygium, hyperemia, pinguecula, or pseudopterygium, the method including identifying a subject with worry or anxiety about eye appearance and administering a therapeutically effective amount of a multikinase inhibitor to the affected eye of the subject for a period of time.
• Implementations can include one or more of the following features.
• a rating of worry or anxiety about eye appearance, as determined by a patient questionnaire, by the subject can decrease between (a) before administering a therapeutically effective amount of a multikinase inhibitor to an affected eye of the subject to a period of time and (b) after administering a therapeutically effective amount of a multikinase inhibitor to an affected eye of the subject to a period of time.
• the rating can be on a numerical scale.
• the rating can decrease by at least about 25%.
• the rating can decrease by at least about 30%.
• the rating can decrease by at least about 35%.
• the rating can decrease by at least about 40%.
• the rating can decrease by at least about 45%.
• the rating can decrease by at least about 50%.
• the rating can decrease by at least about 55%.
• the rating can decrease by at least about 60%.
• the rating can decrease by at least about 65%.
• the rating can decrease by at least about 70%.
• the rating can decrease by at least about 75%.
• the numerical scale can be a five-point scale.
• the rating can decrease by at least about 0.5.
• the rating can decrease by at least about 0.7.
• the rating can decrease by at least about 0.9.
• the rating can decrease by at least about 1.0.
• the rating can decrease by at least about 1.1.
• the rating can decrease by at least about 1.3.
• the rating of worry or anxiety about eye appearance as determined by a patient questionnaire, can be based on a question regarding whether the worry about the appearance of the affected eye has impacted the quality of life of the subject in the last week.
• the rating of worry or anxiety about eye appearance can be solely based on a question regarding whether the worry about the appearance of the affected eye has impacted the quality of life of the subject in the last week.
• the rating of worry or anxiety about eye appearance can include the category, “Has the appearance of the affected eye impacted the quality of life during the last week?”, and the question “Worry about eye appearance?”.
• the rating of worry or anxiety about eye appearance can be solely based on the category, “Has the appearance of the affected eye impacted the quality of life during the last week?”, and the question “Worry about eye appearance?”.
• the questionnaire can be derived, at least in part, from the Visual Functioning Questionnaire-25 (VFQ-25) questionnaire.
• the questionnaire can be derived, at least in part, from the Ocular Surface Disease Index (OSDI) questionnaire.
• the multikinase inhibitor can be selected from afatinib, amuvatinib, axitinib, cabozantinib, canertinib, cediranib, ceritinib, crenolanib, crizotinib, dabrafenib, dacomitinib, dasatinib, erlotinib, foretinib, gefitinib, golvatinib, ibrutinib, icotinib, idelalisib, imatinib, lapatinib, lenvatinib, neratinib, nilotinib, nintedanib, palbociclib, pazopanib,
• the multikinase inhibitor can be selected from axitinib, nintedanib, regorafenib, and pazopanib.
• the multikinase inhibitor can be axitinib.
• the multikinase inhibitor can be nintedanib.
• the multikinase inhibitor can be pazopanib.
• the multikinase inhibitor can be a free base.
• the multikinase inhibitor can be a pharmaceutically acceptable salt.
• a method of reducing one or more patient reported signs or symptoms in a patient having an eye affected with pterygium, hyperemia in pterygium, hyperemia, pinguecula, or pseudopterygium including administering a therapeutically effective amount of a multikinase inhibitor to the affected eye of the patient.
• Implementations can include one or more of the following features.
• the patient reported sign or symptom can be worry or anxiety about eye appearance in the patient.
• Reducing the one or more patient reported signs or symptoms can include a measured reduction in the one or more patient reported signs or symptoms of at least about 10%, at least about 20%, at least about 30%, at least about 40%, at least about 50%, at least about 60%, or at least about 70% as compared to a control, a non-treated patient, or a baseline of the patient prior to administration of the multikinase inhibitor.
• the therapeutically effective amount of a multikinase inhibitor can be administered to the affected eye of the subject for a period of time.
• Reducing the one or more patient reported signs or symptoms can include a measured reduction in the one or more patient reported signs or symptoms as compared to a control.
• Reducing the one or more patient reported signs or symptoms can include a measured reduction in the one or more patient reported signs or symptoms as compared to a non-treated patient. Reducing the one or more patient reported signs or symptoms can include a measured reduction in the one or more patient reported signs or symptoms as compared to a baseline of the patient prior to administration of the multikinase inhibitor. Reducing the one or more patient reported signs or symptoms can include a measured reduction in the one or more patient reported signs or symptoms of at least about 25%. Reducing the one or more patient reported signs or symptoms can include a measured reduction in the one or more patient reported signs or symptoms of at least about 30%. Reducing the one or more patient reported signs or symptoms can include a measured reduction in the one or more patient reported signs or symptoms of at least about 35%.
• Reducing the one or more patient reported signs or symptoms can include a measured reduction in the one or more patient reported signs or symptoms of at least about 40%. Reducing the one or more patient reported signs or symptoms can include a measured reduction in the one or more patient reported signs or symptoms of at least about 45%. Reducing the one or more patient reported signs or symptoms can include a measured reduction in the one or more patient reported signs or symptoms of at least about 50%. Reducing the one or more patient reported signs or symptoms can include a measured reduction in the one or more patient reported signs or symptoms of at least about 55%. Reducing the one or more patient reported signs or symptoms can include a measured reduction in the one or more patient reported signs or symptoms of at least about 60%.
• Reducing the one or more patient reported signs or symptoms can include a measured reduction in the one or more patient reported signs or symptoms of at least about 65%. Reducing the one or more patient reported signs or symptoms can include a measured reduction in the one or more patient reported signs or symptoms of at least about 70%. Reducing the one or more patient reported signs or symptoms can include a measured reduction in the one or more patient reported signs or symptoms of at least about 75%. Reducing the one or more patient reported signs or symptoms can include a measured reduction in the one or more patient reported signs or symptoms on a five-point numerical scale. Reducing the one or more patient reported signs or symptoms can include a measured reduction of least 0.5 in the one or more patient reported signs or symptoms on a numerical scale.
• Reducing the one or more patient reported signs or symptoms can include a measured reduction of at least 0.7 in the one or more patient reported signs or symptoms on a numerical scale. Reducing the one or more patient reported signs or symptoms can include a measured reduction of at least 0.9 in the one or more patient reported signs or symptoms on a numerical scale. Reducing the one or more patient reported signs or symptoms can include a measured reduction of at least 1.0 in the one or more patient reported signs or symptoms on a numerical scale. Reducing the one or more patient reported signs or symptoms can include a measured reduction of at least 1.0 in the one or more patient reported signs or symptoms on a numerical scale.
• Reducing the one or more patient reported signs or symptoms can include a measured reduction of at least 1.3 in the one or more patient reported signs or symptoms on a numerical scale.
• the patient reported sign or symptom can determined by a patient questionnaire that includes a question regarding whether worry about the appearance of the affected eye has impacted the quality of life of the subject in the last week.
• the patient reported sign or symptom can be determined by a patient questionnaire and can be solely based on a question regarding whether worry about the appearance of the affected eye has impacted the quality of life of the subject in the last week.
• the patient reported sign or symptom can be determined by a patient questionnaire that includes the category, “Has the appearance of the affected eye impacted the quality of life during the last week?”, and the question “Worry about eye appearance?”.
• the patient reported sign or symptom can be determined by a patient questionnaire and is solely based on the category, “Has the appearance of the affected eye impacted the quality of life during the last week?”, and the question “Worry about eye appearance?”.
• the patient reported sign or symptom can be determined by a patient questionnaire that is derived, at least in part, from the Visual Functioning Questionnaire-25 (VFQ-25) questionnaire.
• VFQ-25 Visual Functioning Questionnaire-25
• the patient reported sign or symptom can be determined by a patient questionnaire that is derived, at least in part, from the Ocular Surface Disease Index (OSDI) questionnaire.
• OSDI Ocular Surface Disease Index
• the multikinase inhibitor can be selected from afatinib, amuvatinib, axitinib, cabozantinib, canertinib, cediranib, ceritinib, crenolanib, crizotinib, dabrafenib, dacomitinib, dasatinib, erlotinib, foretinib, gefitinib, golvatinib, ibrutinib, icotinib, idelalisib, imatinib, lapatinib, lenvatinib, neratinib, nilotinib, nintedanib, palbocicbb, pazopanib, ponatinib, quizartinib, regorafenib, ruxobtinib, sorafenib, sunitinib, tandutinib, tivant
• the multikinase inhibitor is selected from axitinib, nintedanib, regorafenib, and pazopanib.
• the multikinase inhibitor can be axitinib.
• the multikinase inhibitor can be nintedanib.
• the multikinase inhibitor can be pazopanib.
• the multikinase inhibitor can be a free base.
• the multikinase inhibitor can be a pharmaceutically acceptable salt.
• Figure 1 is a plot of the comparison of change of score on a questionnaire of worry about eye appearance to subjects between nintedanib and placebo via topical ocular administration as a part of a Phase 2 clinical trial.
• the term “about”, when used in this context, can, in some embodiments, indicate that the numeric value or range of values may vary by 5%, 4%, 3%, 2%, 1%, 0.9%, 0.8%, 0.7%, 0.6%, 0.5%, 0.4%, 0.3%, 0.2% or 0.1% of the recited value or range of values.
• the numeric value or range of values may vary by 5%.
• Pterygium is an ocular surface disease, where a fibrovascular growth extends from the nasal or temporal conjunctiva across the limbus onto the cornea.
• the current understanding of the pathogenesis of pterygium is that multiple processes are involved and that these may include inherited factors, environmental triggers (UV light, viral infections), and factors that perpetuate its growth (cytokines, growth factors and matrix metalloproteinases).
• cytokines, growth factors and matrix metalloproteinases include cytokines, growth factors and matrix metalloproteinases.
• chronic UV exposure is typically understood to be the single most significant factor in the pathogenesis of pterygium.
• Pterygium affects about 10 million individuals in the US.
• an ocular disease such as pterygium, hyperemia in pterygium, hyperemia, pinguecula, and/or pseudopterygium
• eye appearance e.g., changed eye appearance as a result of the disease
• Pterygium patients often experience symptoms and suffer from psychological stress and anxiety due to the disease and/or their altered eye appearances.
• pharmacologic therapy to treat pterygia.
• Pterygium excision with conjunctival autograft transplantation is often the procedure of choice for definitive treatment of both primary and recurrent pterygia. While many of these lesions can be readily removed to the initial satisfaction of both surgeon and patient, the recurrence of pterygium could occur.
• Pandey analyzed the most common pterygium risk factors leading to the decision for surgical removal of pterygium (Pandey, 2017, semanticscholar. org/ 60f4/ a88614fb8b 12f2dd9a0b50dde324ae50adf3. pdf).
• One conclusion from the study was that for younger patients, the predominant reason for choosing surgical removal was that the patients are not content with the external appearance caused by pterygium.
• a review article Karlman et al.
• Pterygium is a multifactorial disease and several growth factors such as vascular endothelial growth factor (VEGF) and platelet-derived growth factor (PDGF) are potential pathological factors.
• VEGF vascular endothelial growth factor
• PDGF platelet-derived growth factor
• VEGF vascular endothelial growth factor
• PDGF platelet-derived growth factor
• Nintedanib represents a class of multikinase inhibitors that confer anti-angiogenesis activity mainly by targeting VEGFR1 VEGFR2, VEGFR3, PDGFRalpha (PDGFRa) and PDGFRbeta (PDGFR ), and/or FGFR1, FGFR2, FGFR3, and/or FGFR4.
• VEGFR1 VEGFR2, VEGFR3, PDGFRalpha (PDGFRa) and PDGFRbeta (PDGFR ) and/or FGFR1, FGFR2, FGFR3, and/or FGFR4.
• One potential advantage of materials and methods disclosed herein can be to stop pterygium progression. Another potential advantage of materials and methods disclosed herein is to reduce the need for excision surgery, and possibly, lowering the risk of post- surgical disease recurrence. Yet another potential advantage of the materials and methods disclosed herein is the reduction of symptoms and/or signs of pterygium, hyperemia in pterygium, hyperemia, pinguecula, and/or pseudopterygium.
• One example of a symptom and/or sign is patients’ worry or anxiety about the disease and/or appearance of their eye (e.g., changed eye appearance as a result of the disease).
• Another potential advantage of the materials and methods disclosed herein is improvement in the patients’ quality of life.
• provided herein are methods of reducing worry or anxiety about an ocular disease and/or eye appearance (e.g., changed eye appearance as a result of the disease) of an affected eye in a subject, wherein the affected eye is affected with an ocular disease such as pterygium, hyperemia in pterygium, hyperemia, pinguecula, and/or pseudopterygium.
• an ocular disease such as pterygium, hyperemia in pterygium, hyperemia, pinguecula, and/or pseudopterygium.
• the method can include identifying a subject with worry or anxiety about a disease (e.g., an ocular disease such as pterygium, hyperemia in pterygium, hyperemia, pinguecula, and/or pseudopterygium) and/or eye appearance (e.g., changed eye appearance associated with the disease) and administering a therapeutically effective amount of a multikinase inhibitor to the affected eye of the subject.
• a disease e.g., an ocular disease such as pterygium, hyperemia in pterygium, hyperemia, pinguecula, and/or pseudopterygium
• eye appearance e.g., changed eye appearance associated with the disease
• the method can include identifying a subject with worry or anxiety about the ocular disease and/or the appearance of the affected eye, and administering a therapeutically effective amount of a multikinase inhibitor to the affected eye of the subject for a period of time.
• the ocular is disease selected from the group consisting of pterygium, hyperemia in pterygium, hyperemia, pinguecula, pseudopterygium, and a combination thereof.
• a rating of worry or anxiety about a disease e.g., an ocular disease such as pterygium, hyperemia in pterygium, hyperemia, pinguecula, and/or pseudopterygium
• eye appearance e.g., changed eye appearance as a result of the disease
• a rating of worry or anxiety about a disease e.g., an ocular disease such as pterygium, hyperemia in pterygium, hyperemia, pinguecula, and/or pseudopterygium
• eye appearance e.g., changed eye appearance as a result of the disease
• a rating of worry or anxiety about a disease e.g., an ocular disease such as pterygium, hyperemia in pterygium, hyperemia, pinguecula, and/or pseudopterygium
• eye appearance e.g., changed eye appearance as a result of the disease
• a rating of worry or anxiety about a disease e.g., an ocular disease such as pterygium, hyperemia in pterygium, hyperemia, pinguecula, and/or pseudopterygium
• eye appearance e.g., changed eye appearance as a result of the disease
• the method can include administering a therapeutically effective amount of a multikinase inhibitor to the affected eye of the patient.
• methods of reducing one or more patient reported signs or symptoms in a patient having an eye affected with an ocular disease comprising administering a therapeutically effective amount of a multikinase inhibitor to the affected eye of the patient.
• the ocular disease is selected from the group consisting of pterygium, hyperemia in pterygium, hyperemia, pinguecula, pseudopterygium or a combination thereof.
• the patient reported sign or symptom is worry or anxiety about a disease (e.g., an ocular disease such as pterygium, hyperemia in pterygium, hyperemia, pinguecula, and/or pseudopterygium) and/or eye appearance (e.g., changed eye appearance as a result of the disease) in the patient.
• the one or more patient reported signs or symptoms can decrease between two evaluation points.
• the one or more patient reported signs or symptoms can decrease compared to a control. In some embodiments, the one or more patient reported signs or symptoms can decrease compared to a non-treated subject. In some embodiments, the one or more patient reported signs or symptoms can decrease compared to a baseline of the subject prior to administration of the multikinase inhibitor.
• Any of the evaluations of a sign or symptom e.g., worry or anxiety about a disease (e.g., an ocular disease such as pterygium, hyperemia in pterygium, hyperemia, pinguecula, and/or pseudopterygium) and/or eye appearance (e.g., changed eye appearance as a result of the disease) can be reported as a rating on a numerical scale.
• a disease e.g., an ocular disease such as pterygium, hyperemia in pterygium, hyperemia, pinguecula, and/or pseudopterygium
• eye appearance e.g., changed eye appearance as a result of the disease
• the reduction of a sign or a symptom can be at least about 10%, at least about 20%, at least about 30%, at least about 40%, at least about 50%, at least about 60%, or at least about 70% (e.g., as compared to a different evaluation point, a control, a non-treated patient, or a baseline of the patient prior to administration of the multikinase inhibitor).
• the reduction of a sign or a symptom can be at least about 25%, at least about 30%, at least about 35%, at least about 40%, at least about 45%, at least about 50%, at least about 55%, at least about 60%, at least about 65%, at least about 70%, or at least about 75% (e.g., as compared to a different evaluation point, a control, a non-treated patient, or a baseline of the patient prior to administration of the multikinase inhibitor).
• a numerical scale can be any appropriate numerical scale. In some embodiments, the numerical scale can be a five-point scale (e.g., 0 to 4 or 1 to 5).
• the numerical scale can be a ten-point scale (e.g., 0 to 9 or 1 to 10). In some embodiments, a numerical scale can be normalized to a five-point scale, e.g., for purposes of comparison to an evaluation using a five-point numerical scale.
• the reduction of a sign or a symptom can be at least 0.3 points, 0.5 points, 0.7 points, 0.9 points, 1.0 points, 1.1 points, 1.3 points, or 1.5 points on the numerical scale (e.g., a five- point numerical scale, or normalized to a five-point numerical scale) (e.g., as compared to a different evaluation point, a control, a non-treated patient, or a baseline of the patient prior to administration of the multikinase inhibitor).
• the numerical scale e.g., a five- point numerical scale, or normalized to a five-point numerical scale
• any two appropriate evaluation points can be used.
• the evaluation points (a) before administering a therapeutically effective amount of a multikinase inhibitor to an affected eye of the subject for a period of time and (b) after administering a therapeutically effective amount of a multikinase inhibitor to an affected eye of the subject to a period of time can be used.
• the evaluation points (a) before administering one or more doses of a multikinase inhibitor to an affected eye of the subject for a period of time and (b) after administering one or more doses of a multikinase inhibitor to an affected eye of the subject can be used.
• the evaluation points (a) before administering one or more doses of a multikinase inhibitor to an affected eye of the subject and (b) after administering one or more doses of a multikinase inhibitor to an affected eye of the subject, can be used.
• an evaluation of a sign or symptom can occur following administration of one or more doses of a multikinase inhibitor.
• a disease e.g., an ocular disease such as pterygium, hyperemia in pterygium, hyperemia, pinguecula, and/or pseudopterygium
• eye appearance e.g., changed eye appearance as a result of the disease
• One or more doses of a multikinase inhibitor can include any appropriate number of doses or dosing duration (which can also be called ‘a period of time’ for administration).
• a period of time can be about 1 week, about 2 weeks, about 3 weeks, about 1 month, about 2 months, about 3 months, about 4 months, about 5 months, about 6 months, about 8 months, about 9 months, about 10 months, about 11 months, about 12 months (about 1 year), or longer. In some cases, a period of time can be about 3 months. In some cases, a period of time can be about 12 months.
• Dosing can occur with any appropriate frequency. For example, dosing can occur once per day, twice per day, three times per day, four times per day, five times per day, or six times per day.
• a multikinase inhibitor can be administered twice per day. In some embodiments, a multikinase inhibitor can be administered three times per day.
• Any of the evaluations of a sign or symptom can be based on a questionnaire (e.g., a patient questionnaire).
• the questionnaire can be any appropriate questionnaire.
• a questionnaire can include a question regarding whether the worry about a disease (e.g., an ocular disease such as pterygium, hyperemia in pterygium, hyperemia, pinguecula, and/or pseudopterygium) and/or the appearance of the affected eye (e.g., changed eye appearance as a result of the disease) has impacted the quality of life of the subject in the last week.
• a disease e.g., an ocular disease such as pterygium, hyperemia in pterygium, hyperemia, pinguecula, and/or pseudopterygium
• the appearance of the affected eye e.g., changed eye appearance as a result of the disease
• the evaluation of a sign or symptom can be solely based on the question of whether the worry about a disease (e.g., an ocular disease such as pterygium, hyperemia in pterygium, hyperemia, pinguecula, and/or pseudopterygium) and/or the appearance of the affected eye has impacted the quality of life of the subject in the last week.
• the questionnaire can include the category, “Has the appearance of the affected eye impacted the quality of life during the last week?”, and the question “Worry about eye appearance?”.
• the question “Worry about eye appearance?” can be in the context of whether the subject’s eye appearance has impacted the quality of life of the subject in the past week.
• Options can include: All of the time (e.g., associated with a numerical score of 5 on a 5-point scale from 1 to 5), most of the time (e.g., associated with a numerical score of 4 on a 5-point scale from 1 to 5), half of the time (e.g., associated with a numerical score of 3 on a 5-point scale from 1 to 5), some of the time (e.g., associated with a numerical score of 2 on a 5-point scale from 1 to 5), none of the time (e.g., associated with a numerical score of 1 on a 5-point scale from 1 to 5), or not applicable (e.g., “NA”).
• All of the time e.g., associated with a numerical score of 5 on a 5-point scale from 1 to 5
• most of the time e.g., associated with a numerical score of 4 on a 5-point scale from 1 to 5
• half of the time e.g., associated with a numerical score of 3 on a 5-point scale from 1 to 5
• the questionnaire can include the category, “Has the appearance of the affected eye impacted the quality of life during the last week?”, and the question “Worry about eye appearance?”, and the evaluation of a sign or symptom (e.g., worry or anxiety about eye appearance) can be solely based on this question.
• questionnaire can be derived, at least in part, from the Visual Functioning Questionnaire-25 (VFQ-25) questionnaire (National Eye Institute, 2000).
• VFQ-25 Visual Functioning Questionnaire-25
• the questionnaire can be derived, at least in part, from the Ocular Surface Disease Index (OSDI) questionnaire (Schiffman RM, Christianson MD, Jacobsen G, Hirsch JD, Reis BL. Reliability and validity of the Ocular Surface Disease Index. Arch Ophthalmol. 2000; 118 (5): 615-621. doi: lO.lOOl/archopht.118.5.615).
• OSDI Ocular Surface Disease Index
• the multikinase inhibitor is selected from afatinib, amuvatinib, axitinib, cabozantinib, canertinib, cediranib, ceritinib, crenolanib, crizotinib, dabrafenib, dacomitinib, dasatinib, erlotinib, foretinib, gefitinib, golvatinib, ibrutinib, icotinib, idelalisib, imatinib, lapatinib, lenvatinib, neratinib, nilotinib, nintedanib, palbociclib, pazopanib, ponatinib, quizartinib, regorafenib, ruxolitinib, sorafenib, sunit
• the multikinase inhibitor is selected from axitinib, nintedanib, regorafenib, and pazopanib. In some cases, the multikinase inhibitor is axitinib. In some cases, the multikinase inhibitor is nintedanib. In some cases, the multikinase inhibitor is regorafenib. In some case, the multikinase inhibitor is pazopanib. In some cases, multikinase inhibitor is a free base. In some cases, the multikinase inhibitor is a pharmaceutically acceptable salt.
• the multikinase inhibitor e.g., nintedanib or axitinib or pazopanib
• the multikinase inhibitor can be administered in any appropriate concentration. In some cases, the multikinase inhibitor can be administered in an amount from about 0.001% to about 10.0% (w/w).
• the multikinase inhibitor can be administered in an amount of from about 0.005% to about 2% (w/w), from about 0.001 % to about 1 % (w/w), from about 0.001% to about 0.005% (w/w), from about 0.005% to about 0.01% (w/w), from about 0.01% to about 0.05% (w/w), from about 0.05% to about 0.1% (w/w), from about 0.01 % to about 1 % (w/w), from about 0.05% to about 0.5%, from about 0.01 % to about 0.8 % (w/w), from about 0.3 % to about 0.7 % (w/w), from about 0.4 % to about 0.6 % (w/w), from about 0.1 % to about 10 % (w/w), from about 0.1% to about 0.5% (w/w), from about 0.2 % to about 8 % (w/w), from about 0.4 % to about 5 % (w/w), or from about 0.4 % to about
• the present disclosure includes data from a Phase 2, randomized clinical trial.
• the disclosure focused on the relevant questionnaire endpoint that included 15 questions regarding the ocular symptoms, vision related functioning and the impact on life quality in patients.
• the questionnaire was derived from the validated Visual Functioning Questionnaire-25 (VFQ-25) (National Eye Institute, 2000) and the validated Ocular Surface Disease Index (OSDI) questionnaire (Schiffman RM, Christianson MD, Jacobsen G, Hirsch JD, Reis BL. Reliability and validity of the Ocular Surface Disease Index. Arch Ophthalmol. 2000; 118 (5): 615-621.).
• the patients were asked to rate severity using a 5-point scale, with 5 being the most severe.

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