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
  • A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
  • A61K31/496—Non-condensed piperazines containing further heterocyclic rings, e.g. rifampin, thiothixene or sparfloxacin
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
  • A61K47/06—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite
  • A61K47/08—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite containing oxygen, e.g. ethers, acetals, ketones, quinones, aldehydes, peroxides
  • A61K47/10—Alcohols; Phenols; Salts thereof, e.g. glycerol; Polyethylene glycols [PEG]; Poloxamers; PEG/POE alkyl ethers
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
  • A61K47/06—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite
  • A61K47/08—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite containing oxygen, e.g. ethers, acetals, ketones, quinones, aldehydes, peroxides
  • A61K47/12—Carboxylic acids; Salts or anhydrides thereof
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K9/00—Medicinal preparations characterised by special physical form
  • A61K9/0012—Galenical forms characterised by the site of application
  • A61K9/0043—Nose
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K9/00—Medicinal preparations characterised by special physical form
  • A61K9/08—Solutions
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
  • A61M11/00—Sprayers or atomisers specially adapted for therapeutic purposes
  • A61M11/04—Sprayers or atomisers specially adapted for therapeutic purposes operated by the vapour pressure of the liquid to be sprayed or atomised
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P25/00—Drugs for disorders of the nervous system
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P25/00—Drugs for disorders of the nervous system
  • A61P25/06—Antimigraine agents
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
  • A61M11/00—Sprayers or atomisers specially adapted for therapeutic purposes
  • A61M11/006—Sprayers or atomisers specially adapted for therapeutic purposes operated by applying mechanical pressure to the liquid to be sprayed or atomised
  • A61M11/007—Syringe-type or piston-type sprayers or atomisers
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
  • A61M15/00—Inhalators
  • A61M15/08—Inhaling devices inserted into the nose
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
  • A61M2202/00—Special media to be introduced, removed or treated
  • A61M2202/04—Liquids
  • A61M2202/0468—Liquids non-physiological

Definitions

• the present invention relates to intranasal pharmaceutical compositions of calcitonin gene-related peptide (CGRP) antagonists and methods of their delivery.
• CGRP calcitonin gene-related peptide
• the compositions and methods may be used for treating CGRP -related disorders such as migraine.
• Migraine is a chronic and debilitating disorder characterized by recurrent attacks lasting four to 72 hours with multiple symptoms, including typically one-sided, pulsating headaches of moderate to severe pain intensity that are associated with nausea or vomiting, and/or sensitivity to sound (phonophobia) and sensitivity to light (photophobia).
• Migraines are often preceded by transient neurological warning symptoms, known as auras, which typically involve visual disturbances such as flashing lights, but may also involve numbness or tingling in parts of the body.
• Migraine is both widespread and disabling.
• the Migraine Research Foundation ranks migraine as the world's third most prevalent illness, and the Global Burden of Disease Study 2015 rates migraine as the seventh highest specific cause of disability worldwide.
• migraine attacks In the United States, approximately 36 million individuals suffer from migraine attacks. While most sufferers experience migraine attacks once or twice per month, more than 4 million people have chronic migraine, defined as experiencing at least 15 headache days per month, of which at least eight are migraine, for more than three months. Others have episodic migraine, which is characterized by experiencing less than 15 migraine days per month. People with episodic migraine may progress to chronic migraine over time. Migraine attacks can last four hours or up to three days. More than 90% of individuals suffering from migraine attacks are unable to work or function normally during a migraine attack, with many experiencing comorbid conditions such as depression, anxiety and insomnia. Also, those suffering from migraine often have accompanying nausea and have an aversion to consuming food or liquids during an attack.
• CGRP calcium phosphatidylcholine
• CGRP calcitonin gene-related peptide
• a -CGRP and b-CGRP two forms of CGRP exist and have similar activities. They vary by three amino acids and exhibit differential distribution. At least two CGRP receptor subtypes may also account for differential activities.
• the CGRP receptor is located within pain-signaling pathways, intracranial arteries and mast cells and its activation is thought to play a causal role in migraine pathophysiology.
• triptans ergotamine derivatives
• NSAIDs non-steroidal anti-inflammatory drugs
• opioids opioids
• combination medications The current standard of care for the acute treatment of migraine is prescription of triptans, which are serotonin 5-HT IB/ID receptor agonists.
• Triptans have been developed and approved for the acute treatment of migraine over the past two decades. The initial introduction of triptans represented a shift toward drugs more selectively targeting the suspected pathophysiology of migraine.
• triptans account for almost 80% of anti-migraine therapies prescribed at office visits by healthcare providers, issues such as an incomplete effect or headache recurrence remain important clinical limitations. In fact, only about 30% of patients from clinical trials are pain free at two hours after taking triptans. In addition, triptans are contraindicated in patients with cardiovascular disease, cerebrovascular disease, or significant risk factors for either because of potential systemic and cerebrovascular vasoconstriction from the 5-HT IB -mediated effects. Also, according to a January 2017 study published in the journal Headache, an estimated 2.6 million migraine sufferers in the United States have a cardiovascular event, condition or procedure that limits the potential of triptans as a treatment option. Accordingly, there remains a significant unmet medical need for a novel migraine-specific medication that provides enhanced patient benefits compared to existing therapies.
• CGRP involvement in migraine has been the basis for the development and clinical testing of a number of compounds, including for example, advanced clinical candidates rimegepant (BHV-3000) and zavegepant (BHV-3500), which are developed by Biohaven Pharmaceutical Holding Company Ltd., New Haven, CT.
• Zavegepant (also known as vazegepant) is a third generation, high affinity, selective and structurally unique small molecule CGRP receptor antagonist having the following formula I:
• Zavegepant is described, for example, in WO 03/104236 published December 18, 2003 and US 8,481,546 issued July 9, 2013, which are incorporated herein in their entireties by reference.
• zavegepant is a highly soluble molecule, its bioavailability characteristics may render it challenging to prepare the drug in an oral dosage form. Enhancing the bioavailability of zavegepant and other CGRP inhibitors by different administration routes would therefore be desirable.
• the present invention is directed to the treatment of CGRP related conditions, e.g., migraine or non-migraine-related disorders, by intranasal administration of a pharmaceutical composition including a pharmaceutically active component including a CGRP inhibitor.
• a pharmaceutical composition including a pharmaceutically active component including a CGRP inhibitor.
• the pharmaceutical composition includes a therapeutically active component including an intranasally bioavailable CGRP inhibitor.
• apparatus including: (a) a reservoir having a sprayable liquid composition including a therapeutically active component including an intranasally bioavailable CGRP inhibitor, (b) an atomization device configured for insertion in a nostril, and (c) means for actuating the device to deliver droplets of the composition to the nostril.
• a method for delivering zavegepant to a subject includes intranasally administering to the subject a composition including a therapeutically active component including a CGRP inhibitor.
• a method for treatment or prevention of a condition associated with aberrant levels of CGRP in a subject in need thereof includes intranasally administering to the subject a therapeutically effective amount of a composition including a therapeutically active component including a CGRP inhibitor.
• kits for treating a condition associated with aberrant levels of CGRP in a patient wherein the kit includes: (a) the above pharmaceutical composition for intranasal delivery, and (b) instructions for administering the pharmaceutical composition.
• the kit may further include an apparatus for administering the pharmaceutical composition.
• FIG. 1 A is an image of the Aptar Pharma Unidose System for intranasal administration of the composition according to an embodiment
• FIG. IB is a cross-sectional image of the Aptar Pharma Unidose System for intranasal administration of the composition according to an embodiment
• FIGS. 2A-2F are graphs of mean plasma concentration (nanograms per milliliter, ng/mL) versus nominal time (hour, h) showing plasma concentration levels by day and treatment with the composition according to an embodiment.
• the term "about” as used herein refers to a value or composition that is within an acceptable error range for the particular value or composition as determined by one of ordinary skill in the art, which will depend in part on how the value or composition is measured or determined, i.e., the limitations of the measurement system. For example, “about” can mean within 1 or more than 1 standard deviation per the practice in the art. Alternatively, “about” can mean a range of up to 10% or 20% (i.e., ⁇ 10% or ⁇ 20%). For example, about 3 mg can include any number between 2.7 mg and 3.3 mg (for 10%) or between 2.4 mg and 3.6 mg (for 20%). Furthermore, particularly with respect to biological systems or processes, the terms can mean up to an order of magnitude or up to 5-fold of a value. When particular values or compositions are provided in the application and claims, unless otherwise stated, the meaning of "about” should be assumed to be within an acceptable error range for that particular value or composition.
• administering refers to the physical introduction of a composition including a therapeutic agent to a subject, using any of the various methods and delivery systems known to those skilled in the art. Administering can also be performed, for example, once, a plurality of times, and/or over one or more extended periods and can be a therapeutically effective dose or a subtherapeutic dose.
• AUC area under the curve
• AUC refers to a total amount of drug absorbed or exposed to a subject. Generally, AUC may be obtained from mathematical method in a plot of drug concentration in the subject over time until the concentration is negligible.
• AUC area under the curve
• AUQ[0-t ] refers to area under the concentration-time curve from time 0 to the last measurable concentration.
• AUQ[0- inf] refers to area under the concentration-time curve from time 0 to infinity.
• C max refers to a maximum concentration of a drug in blood, serum, a specified compartment or test area of a subject between administration of a first dose and administration of a second dose.
• Cmax could also refer to dose normalized ratios if specified.
• in combination with refers to administration of one treatment modality in addition to another treatment modality.
• in combination with refers to administration of one treatment modality before, during, or after administration of the other treatment modality to the subject.
• pharmaceutically acceptable salt refers to a salt form of one or more of the compounds or prodrugs described herein which are presented to increase the solubility of the compound in the gastric or gastroenteric juices of the patient's gastrointestinal tract in order to promote dissolution and the bioavailability of the compounds.
• Pharmaceutically acceptable salts include those derived from pharmaceutically acceptable inorganic or organic bases and acids, where applicable. Suitable salts include those derived from alkali metals such as potassium and sodium, alkaline earth metals such as calcium, magnesium and ammonium salts, among numerous other acids and bases well known in the pharmaceutical art.
• subject and patient refer any human or non-human animal.
• non-human animal includes, but is not limited to, vertebrates such as non-human primates, sheep, dogs, and rodents such as mice, rats and guinea pigs.
• the subject is a human.
• the terms, "subject” and “patient” are used interchangeably herein.
• an agent also sometimes referred to herein as a "drug” refers to any amount of the agent that, when used alone or in combination with another agent, protects a subject against the onset of a disease or promotes disease regression evidenced by a decrease in severity of disease symptoms, an increase in frequency and duration of disease symptom-free periods, or a prevention of impairment or disability due to the disease affliction.
• the therapeutically effective amount of an agent can be evaluated using a variety of methods known to the skilled practitioner, such as in human subjects during clinical trials, in animal model systems predictive of efficacy in humans, or by assaying the activity of the agent in in vitro assays.
• T max refers to a time or period after administration of a drug when the maximum concentration (Cmax) is reached in blood, serum, a specified compartment or test area of a subject.
• BID refers to a twice daily dosing.
• CV refers to a coefficient of variation.
• GM refers to a geometric mean.
• QD refers to a once a day dosing.
• t 1/2 el refers to apparent elimination half-life.
• treatment refers to any treatment of a condition or disease in a subject and may include: (i) preventing the disease or condition from occurring in the subject which may be predisposed to the disease but has not yet been diagnosed as having it; (ii) inhibiting the disease or condition, i.e., arresting its development; relieving the disease or condition, i.e., causing regression of the condition; or (iii) ameliorating or relieving the conditions caused by the disease, i.e., symptoms of the disease. Treatment could be used in combination with other standard therapies or alone.
• Treatment or "therapy” of a subject also includes any type of intervention or process performed on, or the administration of an agent to, the subject with the objective of reversing, alleviating, ameliorating, inhibiting, slowing down or preventing the onset, progression, development, severity or recurrence of a symptom, complication or condition, or biochemical indicia associated with a disease.
• beneficial or desired clinical results include, but are not limited to, one or more of the following: curing the disease or disorder, improvement in any aspect of a major symptom including lessening severity, alleviation of major symptom intensity, and other associated symptoms, reducing frequency of recurrence, increasing the quality of life of those suffering from the symptom, and decreasing dose of other medications required to treat the symptom.
• intranasally bioavailable CGRP inhibitor refers to a CGRP inhibitor having bioavailability of 1% or greater, 2% or greater, 3% or greater, 4% or greater, 5% or greater, 10% or greater, 15% or greater, 20% or greater, 25% or greater, 30% or greater, 35% or greater, 40% or greater, 45% or greater, 50% or greater, 55% or greater, 60% or greater, 65% or greater, 70% or greater, 75% or greater, 80% or greater, 85% or greater, 90% or greater, or 95% or greater, following intranasal administration.
• small molecule refers to a molecule having molar mass of 1000 g/mol or less, 950 g/mol or less, 900 g/mol or less, 850 g/mol or less, 800 g/mol or less,
• the invention encompasses compositions for intranasal administration that include an intranasally bioavailable CGRP inhibitor.
• the invention further encompasses methods for modulating CGRP and treating patients with medical conditions associated with aberrant levels of CGRP or CGRP receptor signaling by intranasally administering the composition.
• CGRP inhibitor refers to a chemical entity that may be an inhibitor of a CGRP ligand or CGRP receptor.
• CGRP inhibitor encompasses CGRP receptor inhibitors.
• the CGRP inhibitor may be a CGRP inhibitor or CGRP receptor inhibitor.
• CGRP (calcitonin gene-related peptide) is a 37 amino acid neuropeptide, which belongs to a family of peptides that includes calcitonin, adrenomedullin and amylin. Substantial evidence has been collected to show that CGRP is implicated in pathophysiology of migraine. Clinical trials were carried out to prove that CGRP inhibitors are effective for treating migraine.
• the CGRP inhibitor may be a CGRP antibody, a CGRP receptor antibody, an antigen binding fragment from a CGRP antibody or a CGRP receptor antibody, a CGRP infusion inhibitory protein, a CGRP bio-neutralizing agent, a small molecule CGRP receptor antagonist, a small molecule CGRP inhibitor, or a polypeptide CGRP inhibitor.
• CGRP inhibitor may be a small molecule CGRP receptor antagonist.
• An intranasally bioavailable CGRP inhibitor may be included in the composition in all pharmaceutically acceptable salt forms.
• Pharmaceutically acceptable salts are those in which the counter ions do not contribute significantly to the physiological activity or toxicity of the compounds and as such function as pharmacological equivalents. These salts can be made according to common organic techniques employing commercially available reagents.
• anionic salt forms include acetate, acistrate, besylate, bromide, chloride, citrate, fumarate, glucouronate, hydrobromide, hydrochloride, hydroiodide, iodide, lactate, maleate, mesylate, nitrate, pamoate, phosphate, succinate, sulfate, tartrate, tosylate, and xinofoate.
• Some cationic salt forms include ammonium, aluminum, benzathine, bismuth, calcium, choline, diethylamine, diethanolamine, lithium, magnesium, meglumine, 4-phenylcyclohexylamine, piperazine, potassium, sodium, tromethamine, and zinc.
• the invention is intended to include all isotopes of atoms occurring in the CGRP inhibitor.
• Isotopes include those atoms having the same atomic number but different mass numbers.
• isotopes of hydrogen include deuterium and tritium.
• Isotopes of carbon include 13 C and 14 C.
• Isotopically-labeled compounds of the invention can generally be prepared by conventional techniques known to those skilled in the art or by processes analogous to those described herein, using an appropriate isotopically- labeled reagent in place of the non-labeled reagent otherwise employed. Such compounds may have a variety of potential uses, for example as standards and reagents in determining biological activity. In the case of stable isotopes, such compounds may have the potential to favorably modify biological, pharmacological, or pharmacokinetic properties.
• the therapeutically active component may include two or more compounds, each of which may be an intranasally bioavailable active pharmaceutical ingredient (“API”), for example, an anti-migraine drug.
• API active pharmaceutical ingredient
• the pharmaceutical composition is adapted for intranasal administration.
• the composition is in a form physically suitable for intranasal delivery of a therapeutically active component.
• the composition is in the form of a sprayable liquid.
• the composition is in a semi-solid form, for example, a cream, a gel or an ointment. Without being held to a particular theory, it is believed that most of the absorption of a CGRP inhibitor when administered intranasally is through the nasal mucosa.
• the CGRP inhibitor may be present in the composition at a concentration of at least about 1 mg/mL, at least about 2 mg/mL at least about 3 mg/mL, at least about 4 mg/mL, at least about 5 mg/mL, at least about 10 mg/mL, at least about 15 mg/mL, at least about 20 mg/mL, at least about 25 mg/mL, at least about 30 mg/mL, at least about 35 mg/mL, at least about 45 mg/mL, at least about 50 mg/mL, at least about 55 mg/mL, at least about 60 mg/mL, at least about 65 mg/mL, at least about 70 mg/mL, at least about 75 mg/mL, at least about 80 mg/mL, at least about 85 mg/mL, at least about 90 mg/mL, at least about 95 mg/mL, at least about 100 mg/mL, at least about 125 mg/mL, at least about 150 mg/mL, at least about 175 mg/m
• a concentration of the CGRP inhibitor may range between any of the above values.
• the CGRP inhibitor may be present at a concentration of about 1 to about 200 mg/mL, about 2 to about 100 mg/mL, about 5 to about 100 mg/mL, or about 5 to about 50 mg/mL.
• the CGRP inhibitor may be administered at a dose of about 1-1000 mg per day.
• the CGRP inhibitor may be administered at a dose of about 1, 5, 10, 15, 20, 25, 30, 40, 50, 60, 70, 80, 90, 100, 200, 250, 300, 400, 500, 750, or 1000 mg per day.
• the daily dose of the CGRP inhibitor may range between any of the above values.
• the composition including a CGRP inhibitor may be administered as a single dose.
• the CGRP inhibitor may be administered for at least one week and for as long as needed.
• the CGRP inhibitor may be administered for one week, two weeks, three weeks, four weeks, five weeks, six weeks, seven weeks, eight weeks, nine weeks, ten weeks, eleven weeks, or twelve weeks.
• an amount of the composition intranasally administrable as a single dose means a total volume of the composition that can suitably be administered to one or both nostrils of a human or non-human subject to provide a single dose of CGRP inhibitor. Such an amount is a practical volume; not so small as to be incapable of administration by any known device, but not so great that a substantial portion of the dose is not retained in the nostrils.
• a volume of about 0.05 to about 0.25 mL can suitably be administered to each nostril, for a total amount of about 0.1 mL to about 0.5 mL per dose.
• compositions are generally desirable to administer as low a volume as practicable, to reduce any tendency for the composition to be partially lost by drainage through the nasopharyngeal passage.
• particularly suitable volumes are typically about 0.05 to about 0.15 mL per nostril. If desired, however, an entire dose can be administered to one nostril.
• the pharmaceutical composition is useful for administration to subjects of any mammalian species, particularly to human subjects.
• the composition may include a solubilizing agent.
• the solubilizing agent may include a solvent or solvent system for CGRP inhibitor, and this solvent system, itself including one or more solvents, may form the bulk of the medium in which the CGRP inhibitor is dissolved. Regardless of the nature of the solubilizing agent and whether it includes one or more solvents, a sufficient quantity of the solubilizing agent is present to solubilize essentially all of the CGRP inhibitor.
• the solubilizing agent must be pharmaceutically acceptable when present in an amount needed to solubilize the CGRP inhibitor. For example, the solubilizing agent should not be toxic to nor cause excessive irritation of tissues lining the nasal cavity.
• the solvent may be water, alcohol, or a combination thereof. In another embodiment, the solvent may be water.
• the composition optionally further includes a receptivity agent.
• receptivity agent herein means an agent that, when included in a pharmaceutical composition administered to a subject, is capable of mitigating an undesirable response to the composition at or in proximity to the locus of administration in or on the subject.
• undesirable responses that can be mitigated may include an involuntary or reflex response such as sneezing, excessive nasal drip or irritation of nasal tissues, and/or a cognitive response, such as to unpleasant taste or odor.
• a cognitive response can include a conscious or subconscious decision to reduce or end use of the composition, and can thus affect patient compliance.
• a receptivity agent can mitigate one or more such undesirable responses.
• the receptivity agent includes an organoleptic enhancing agent.
• organoleptic enhancing agents include natural and/or synthetic sweeteners, flavorants, aromatics, taste-masking compounds, or combinations thereof.
• an organoleptic enhancing agent included as a receptivity agent includes a sweetener.
• Illustrative sweeteners include saccharin, aspartame, neotame, cyclamates, glucose, fructose, sucrose, xylitol, tagatose, sucralose, maltitol, isomaltulose, hydrogenated isomaltulose, lactitol, sorbitol, mannitol, trehalose, maltodextrin, polydextrose, glycerin, erythritol, maltol, acesulfame, acesulfame potassium, alitame, neohesperidin dihydrochalcone, stevioside, thaumatin, sugars, or combinations thereof.
• the receptivity agent includes an agent that can inhibit sneezing, i.e., an anti-sternutatory agent.
• the pharmaceutical composition optionally further includes one or more pharmaceutically acceptable ingredients, for example, ingredients useful as carriers, preservatives, diluents, stabilizers, pH modulating agents, etc.
• the composition includes at least one preservative.
• Preservatives can have antimicrobial activity and/or can serve as antioxidants.
• Illustrative preservatives include but are not limited to butylated hydroxytoluene, butylated hydroxyanisole, or combinations thereof.
• composition is formulated in an aqueous medium, it may include one or more tonicity modulating agents, for example in an amount that renders the composition substantially isotonic.
• a saline solution may form the basis of such a composition.
• the apparatus may include: (a) a reservoir having a sprayable liquid composition including a therapeutically active component including an intranasally bioavailable CGRP inhibitor, (b) an atomization device configured for insertion in a nostril, and (c) means for actuating the device to deliver droplets of the composition to the nostril.
• the atomizing device can be any device capable of generating droplets of the liquid composition when the composition is supplied from the reservoir, so long as the device can be inserted in a nostril.
• the device includes a nozzle or constricted passage that, when the liquid composition passes through it under pressure, breaks the liquid up into droplets. Any means known in the art for actuating the atomization device can be employed, for example application of pressure as by squeezing the reservoir or depressing a plunger, or in the case of an electrically operated device, activating a switch.
• Droplets should generally not be so fine as to form an inhalable aerosol, but not so coarse as to fail to adhere readily to the nasal mucosa.
• the apparatus is operable to deliver a metered amount of the composition, for example an amount of about 0.05 to about 0.25 mL, more typically about 0.05 to about 0.15 mL, to a nostril.
• the apparatus is optionally adjustable to deliver different metered amounts.
• the apparatus includes a nasal spray device, or a modification thereof, that is commercially available, such as those sold by Aptar Pharma, which is part of AptarGroup, Inc. (Crystal Lake, Illinois, USA)
• the apparatus may be a unidose apparatus, a bi-dose apparatus, or a multi-dose apparatus.
• the condition may be a disease or disorder that is selected from acute migraine, chronic migraine, cluster headache, chronic tension type headache, medication overuse headache, post-traumatic headache, post-concussion syndrome, brain trauma, and vertigo.
• the condition may be a disease or disorder that is selected from chronic pain, neurogenic vasodilation, neurogenic inflammation, inflammatory pain, neuropathic pain, diabetic peripheral neuropathic pain, small fiber neuropathic pain, Morton’s neuroma, chronic knee pain, chronic back pain, chronic hip pain, chronic finger pain, exercise-induced muscle pain, cancer pain, chronic inflammatory skin pain, pain from burns, pain from scars, complex regional pain syndrome, burning mouth syndrome, alcoholic polyneuropathy, chronic inflammatory demyelinating polyradiculoneuropathy, human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS)-associated neuropathy, drug-induced neuropathy, industrial neuropathy, lymphomatous neuropathy, myelomatous neuropathy, multi-focal motor neuropathy, chronic idiopathic sensory neuropathy, carcinomatous, neuropathy, acute pain autonomic neuropathy, compressive neuropathy, vasculitic/ischaemic neuropathy, tempero- mandibular joint pain, post
• the condition may be medication overuse headache (MOH), and the subject having the condition may be undergoing treatment for pain, wherein the treatment for pain may include a medicament selected from acute pain medications and chronic pain medications.
• the treatment for pain includes a medicament selected from triptans, ergot alkaloids, analgesics and opioids.
• the triptans may be selected from rizatriptan, sumatriptan, naratriptan, eletriptan, donitriptan, almotriptan, frovatriptan, avitriptan, and zolmitriptan.
• the ergot alkaloids may be selected from clavines, lysergic acid amides and ergopeptines.
• the ergot alkaloid may also be selected from ergonovine, methylergonovine, methysergide, ergotamine, dihydroergotamine, bromocriptine, ergoloid mesylates and lysergic acid diethylamide, or a combination thereof.
• the MOH may result from the chronic use of one or more pain medications.
• the subject may have a primary headache disorder selected from migraine, cluster-type headache, or tension- type headache.
• the subject may be currently undergoing treatment or may have received treatment for the primary headache disorder.
• the treatment for pain may include a medicament selected from aspirin, diclofenac; diflunisal, etodolac, fenoprofen, flurbiprofen, ibuprofen, indomethacin, ketoprofen, ketorolac, meclofenamate, mefenamic acid, meloxicam, nabumetone, naproxen, oxaprozin, piroxicam, salsalate, sulindac, tolmetin, celecoxib, rofecoxib, etoricoxib, valdecoxib, parecoxib, meloxicam, lumiracoxib, or a combination thereof.
• a medicament selected from aspirin, diclofenac; diflunisal, etodolac, fenoprofen, flurbiprofen, ibuprofen, indomethacin, ketoprofen, ketorolac, meclofenamate,
• the MOH may result from treatment with a medicament selected from ketamine, esketamine, alfentanil, alimemazine, alprazolam, amphetamine, buprenorphine, butorphanol, clonazepam, codeine, cyclobenzaprine, diazepam, dihydrocodeine, dihydromorphine, dronabinol, estazolam, ezopiclone, fentanyl, flurazepam, hydrocodone, hydromorphone, lorazepam, methobarbital, methylphenidate, methadone, morphine, oxycodone, oxymorphone, phenobarbital, secobarbital, tempazepam, tramadol, triazolam, zaleplon, zopiclone, and zolpidem.
• a medicament selected from ketamine, esketamine, alfentanil, alimemazine, alprazol
• the MOH may result from the chronic use of a medicament selected from alimemazine, alprazolam, amphetamine, buprenorphine, butorphanol, clonazepam, codeine, cyclobenzaprine, diazepam, dihydrocodeine, dihydromorphine, dronabinol, estazolam, ezopiclone, fentanyl, flurazepam, hydrocodone, hydromorphone, lorazepam, methobarbital, methylphenidate, methadone, morphine, oxycodone, oxymorphone, phenobarbital, secobarbital, tempazepam, tramadol, triazolam, zaleplon, zopiclone, and zolpidem.
• a medicament selected from alimemazine, alprazolam, amphetamine, buprenorphine, butorphanol, clonazepam, codeine
• the MOH may result from the chronic use of a medicament selected from aspirin, ibuprofen, naproxen, acetaminophen, diclofenac, flurbiprofen, meclofenamate, isometheptene, indomethacin; codeine, morphine, hydrocodone, acetyldihydrocodeine, oxycodone, oxymorphone, papaverine, fentanyl, alfentanil, sufentanil, remifentanyl, tramadol, prochlorperazine, celecoxib, rofecoxib, meloxicam, piroxicam, JTE-522, L-745,337, NS388, deracoxib, valdecoxib, iumiracoxib, etoricoxib, parecoxib, 4-(4-cyclohexyl- 2-methyloxazol-5- yl)-2 fluorobenzenesul
• the condition may be post-traumatic headache (PTH) headache
• the subject having the condition may experience a PTH one, two, three, four, five, six or seven days after a traumatic incident.
• the traumatic incident may result a concussion or loss of consciousness.
• the subject may suffers from dizziness, insomnia, poor concentration, memory problems, photophobia, phonophobia, or fatigue, or a combination thereof.
• the condition may be a disease or disorder that is selected from non-insulin dependent diabetes mellitus, vascular disorders, inflammation, arthritis, thermal injury, circulatory shock, sepsis, alcohol withdrawal syndrome, opiate withdrawal syndrome, morphine tolerance, hot flashes in men and women, flushing associated with menopause, allergic dermatitis, psoriasis, encephalitis, ischaemia, stroke, epilepsy, neuroinflammatory disorders, neurodegenerative diseases, skin diseases, neurogenic cutaneous redness, skin rosaceousness, erythema, tinnitus, obesity, inflammatory bowel disease, irritable bowel syndrome, vulvodynia, polycystic ovarian syndrome, uterine fibroids, neurofibromatosis, hepatic fibrosis, renal fibrosis, focal segmental glomerulosclerosis, glomerulonephritis, IgA nephropathy, multiple myeloma, myasthenia gravis, Sjo
• the condition may be a disease or disorder that is selected from chronic obstructive pulmonary disease, pulmonary fibrosis, bronchial hyperreactivity, asthma, cystic fibrosis, chronic idiopathic cough, and a toxic injury.
• the toxic injury may be selected from chlorine gas injury, mustard gas injury, acrolein injury, smoke injury, ozone injury, warfare chemical exposure, and industrial chemical exposure.
• kits for treating a condition associated with aberrant levels of CGRP in a patient wherein the kit includes: (a) the above pharmaceutical composition including a therapeutically active component including an intranasally bioavailable CGRP inhibitor, and (b) instructions for administering the pharmaceutical composition.
• the kit may further include an apparatus for administering the pharmaceutical composition.
• compositions for intranasal administration that include (R)-N-(3 -(7 -methyl- 1 H-indazol-5 -yl)- 1 -(4-( 1 -methylpiperidin-4-yl)piperazin- 1 -yl)- l-oxopropan-2-yl)-4-(2-oxo-l,2-dihydroquinolin-3-yl)piperi dine- 1 -carboxamide (BHV-3500, zavegepant, or compound having formula I) as a small molecule CGRP receptor antagonist.
• I BHV-3500, zavegepant, or compound having formula I
• Zavegepant is also known under an alternative name “vazegepant”, wherein both “zavegepant” and “vazegepant” refer to the same molecule having formula I above.
• Compound I can be prepared according to Scheme 1. This synthesis is 14 chemical steps and highly convergent, coupling the three major fragments in the last three steps. As such, the synthesis begins with the preparation of major fragments A (Scheme 2) and B (Scheme 3).
• indazole amino acid B begins with the iodination of 2,6-dimethylaniline by the action of iodine monochloride (Scheme 3). This intermediate was temporarily set aside. N-CBZ-L-serine methyl ester undergoes a one-pot methanesulfonylation/elimination reaction to afford N-CBZ-dehydroalanine methyl ester. With the iodide and dehydroalanine in hand, they are efficiently coupled using palladium (II) acetate in a Heck coupling to afford the product in 65% yield.
• II palladium
• the chiral center is installed using a catalytic asymmetric hydrogenation utilizing (-)- 1 ,2-bi s((2R, 5R)-2, 5 -diethylphospholano)bezene(cyclooctadiene) rhodium(I) tetrafluorob orate and hydrogen (60 psi) to give the chiral amino acid in -96% ee.
• the indazole ring is then formed by the action of iso-amyl nitrite.
• the resulting indazole is highly crystalline.
• One recrystallization from acetone/hexanes affords the indazole amino acid in excellent purity and with an improved 99.8% ee. Removal of the CBZ protecting group under hydrogenation conditions completes the preparation of fragment B.
• Indazole amino acid B can also be prepared using enzymatic resolution of the racemic amino acid or keto acid (Hanson, Ronald L.; Davis, Brian L.; Goldberg, Steven L.; Johnston, Robert M.; Parker, William L.; Tully, Thomas P ; Montana, Michael A.; Patel, Ramesh N. Process Research and Development, Bristol-Myers Squibb, New Brunswick, NJ, USA. Organic Process Research & Development ( 2008), 12(6), 1119-1129.).
• Fragments A and B are efficiently coupled using N,N' -disuccinimidyl carbonate to install the urea moiety in 78% yield (Scheme 4). Saponification of the methyl ester with lithium hydroxide gives a nearly quantitative yield of the carboxylic acid.
• TBTU ® mediated coupling of acid with 1-(1-methylpiperidin-4-yl)piperazine completes the synthesis of Comp chromatography affords the product as an amorphous powder which can be crys acetone to afford Compound I as a fine white crystalline powder.
• the solid was recrystallized from warm methanol (210 mL) and water (100 mL). The mixture was held at room temperature overnight, then at 0°C for 2 h, and finally at -15°C for 2 h. The resulting solid was filtered, washed with ice cold 1 : 1 methanol/water, and df ed under high vacuum overnight to give 44.7 g (65%) as a light tan solid which was a mixture of Z/E isomers (73:27).
• Analytical HPLC showed 99.0 % UV purity at 230 nm.
• the enantiomeric excess (ee) was determined to be >99.9% (conditions: Chiralpak AD column, 4.6 c 250 mm, 10 pm; eluent: 70% (0.05% diethylamine) /heptane/ 30%ethanol; @1.0 mL/min. for 45 min.
• the retention times were 18.7 min for R and 28.1 min for S).
• zavegepant (BHV-3500) drug substance mono-hydrochloride salt form are provided in Table 1.
• the drug product includes BHV-3500 compounded at 1 mg/mL to 200 mg/mL in 50 mM succinate solution and containing 1.25% (w/w) dextrose at pH 6.0 (preservative free). Manufacturing involves solubilizing excipients in a portion of the required Water for Injection (WFI) USP and adjusting the pH to 6.0 ⁇ 0.2 with sodium hydroxide or hydrochloric acid. The batch is brought to the target volume with WFI, sampled for bioburden, and filtered through a 0.22 pm filter to afford bioburden reduction.
• WFI Water for Injection
• the filtered solution is then filled (125 pL) into Type 1 glass vials and sealed with rubber stoppers to deliver 100 pL of drug product.
• the sealed vials are then assembled into the Aptar Pharma UDS (Unidose System) device ( Figure 2) and then placed in appropriate secondary packaging.
• the device and secondary packaging are both labeled with information on one or both sides including study number, product name, strength, storage conditions, manufacturer and FDA required cautionary statements regarding investigational use and restricting access by children.
• each BHV-3500 product will be further packaged in a single blister with a peel off lid, which, in turn, will be packaged in other tertiary packaging (e.g ., carton) for commercial distribution.
• BHV-3500 nasal solution should be stored at 20°C to 25°C (68°F to 77°F) to designate room temperature storage. Excursions to 15°C to 30°C are permitted in the provided secondary packaging, protected from light. BHV-3500 is a ready -to-use, unit dose, disposable nasal spray drug-device combination product.
• the device constituent part of the combination product includes a clear glass vial (Unit- Dose, Clear, USP Type I Glass Vial - sourced either from Nipro Glass or Ompi) with a rubber stopper (Black Chlorobutyl stopper, siliconized - sourced from West Pharmaceutical Services) (i.e., primary packaging components), assembled with an actuator subassembly (Subassembly of Polypropylene molded components with Steel cannula - sourced from Aptar Pharma) and a vial holder (Polypropylene molded component - sourced from Aptar Pharma) (i.e., secondary packaging components).
• a clear glass vial Unit- Dose, Clear, USP Type I Glass Vial - sourced either from Nipro Glass or Ompi
• a rubber stopper Black Chlorobutyl stopper, siliconized - sourced from West Pharmaceutical Services
• an actuator subassembly Subassembly of Polypropylene molded components with Steel cannula
• BHV-3500 nasal spray device consists of the following subassemblies and subcomponents:
• Actuator ASM (subassembly), which is composed of:
• Spray pin Polypropylene - natural color - sourced from Aptar Pharma
• Vial holder Polypropylene - White color - sourced from Aptar Pharma
• the material of construction for vials from both suppliers is USP type I clear glass.
• the vials from both suppliers comply with the requirements set in USP 660: Glass Containers; USP 211 : Arsenic; and USP 1660: Evaluation of the Inner Surface Durability of Glass Containers.
• Rubber stopper manufactured and supplied by West Pharmaceutical Services, Inc.
• the material of construction is chlorobutyl rubber (does not use natural rubber latex), and color is black.
• the stopper complies with the physiochemical tests as described in USP 381 “Elastomeric Closures for Injections”.
• Actuator subassemblies are received as preassembled from Aptar Pharma. Both subassemblies and component are received and released by Renaissance (manufacturer for BHV- 3500 product) based on vendor's Certificate of Conformity and incoming component inspections covering the visual appearance, identity and dimensional inspections, which provides assurance that all performance requirements are met.
• BHV3500-101 is a completed Phase 1, single-center, placebo-controlled, randomized, double-blind, sequential SAD study. This study consisted of up to 11 cohorts. In each cohort, subjects were randomly assigned to receive either a single dose of zavegepant or placebo in a 3 to 1 ratio, for a total of 8 subjects. The primary objective of the study was to evaluate the safety and tolerability of zavegepant following IN administration of single ascending doses ranging from 0.1 mg to 40 mg, in healthy subjects.
• the secondary objectives were to characterize the PK profile of zavegepant following a single dose; identify maximum tolerated dose (MTD) of zavegepant if less than 40 mg; and describe the effect zavegepant on ECG parameters (i.e., QTc, PR interval, QRS complex, heart rate [HR], and T wave morphology).
• MTD maximum tolerated dose
• BHV3500-101 was the first clinical study conducted with zavegepant to gather safety, tolerability, and PK information to support subsequent clinical studies with the compound.
• Zavegepant was administered using the Aptar Pharma UDS, a disposable device that delivers a single 100 ⁇ L spray. All subjects who received zavegepant 0.1 mg and 0.3 mg, as well as subject from the zavegepant 1 mg cohort were excluded from the PK analyses as these subjects had no detectable plasma concentrations (below lower limit of quantification [LLOQ]) at all time points measured. In total, 41 subjects were included in the PK analyses.
• a summary of the PK descriptive statistics is presented in Table 10 and an overview of the results is summarized below:
• the mean residual area for zavegepant was less than 20% at all doses except the 1 mg (31.66%) indicating that a sampling period of 96 hours was sufficient to characterize the PK profile of zavegepant. This is equivalent to a mean AUC [0-t] to AUC [0-inf] ratio above 80%.
• a Phase 1, single-center, randomized, double-blind, placebo-controlled, sequential multiple ascending dose (MAD) study with 2 alternate dosing arms was conducted.
• Zavegepant (and placebo) was administered using the Aptar Pharma UDS, a disposable device that delivers a single 100 ⁇ L spray.
• the MAD portion of the study consists of 4 cohorts, with a maximum dose of 20 mg administered once daily for up to 14 days in 3 cohorts, and 20 mg administered twice daily for up to 8 days in the fourth cohort.
• the first alternate dosing cohort assessed the effect of 2 sequential administrations of 20 mg (20 mg spray [100 ⁇ L of 200 mg/mL] in alternate nostrils); with a 30 minute interval between administrations.
• a 2 nd alternate dosing cohort assessed the effect of 2 sequential administrations of 20 mg (20 mg spray [100 ⁇ L of 200 mg/mL] in alternate nostrils); with a nose blow and 5 minute interval between administrations.
• PK data were collected from subjects in Cohorts 1 to 4. All 36 subjects who received zavegepant in Cohorts 1 to 4 were included in the PK analyses. A summary of the PK descriptive statistics is presented in Table 4 and the results are summarized below:
• the geometric mean of Cmax is 7.58, 12.98 and 40.93 ng/mL, respectively for the 5, 10 and 20 mg dose level.
• the geometric mean of AUC tau is 20.66, 32.85 and 90.98 ng •h/mL, respectively.
• T max occurred approximately 30 minutes after IN administration independent of the dose administered.
• NC Not Calculated The plasma concentration data are depicted in FIGS. 2A to 2F.
• zavegepant were durable and sustained without rescue medication out to 48 hours (nominal p ⁇ 0.05), including: sustained pain freedom 2 to 24 hours (5, 10 and 20 mg); sustained pain freedom 2 to 48 (5, 10 and 20 mg); sustained pain relief 2 to 24 hours (5, 10 and 20 mg); sustained pain relief 2 to 48 (5 and 10 mg).
• Zavegepant was also superior to placebo on multiple secondary endpoints demonstrating early activity (nominal p ⁇ 0.05).
• Zavegepant showed rapid onset with pain relief at 15 minutes postdose (10 and 20 mg), sustained pain relief from 2 to 24 hours postdose (all three zavegepant groups), sustained pain freedom from 2 to 24 hours postdose (all three zavegepant groups), sustained pain relief from 2 to 48 hours postdose (zavegepant 5 mg and 10 mg), sustained freedom from 2 to 48 hours postdose (all three zavegepant groups), and return to normal function as early as 30 minutes (20 mg).
• the 10 and 20 mg doses showed therapeutic benefits on both pain relief and return to normal function at 2 hours (Table 8).

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