WO2022129003A1

WO2022129003A1 - Multiparticulate solid oral dosage form comprising statin and vitamin e

Info

Publication number: WO2022129003A1
Application number: PCT/EP2021/085625
Authority: WO
Inventors: Elger Funda; Martin Thomas Kuentz; Denis Hug; Zdravka MISIC; Ralph SCHNEITER
Original assignee: Dsm Ip Assets B.V.
Priority date: 2020-12-15
Filing date: 2021-12-14
Publication date: 2022-06-23

Abstract

The present invention relates to a fixed-dose combination (FDC) of vitamin E and statin. The FDC of the invention is a solid oral dosage form that comprises multiple particles. Preferred particles are beadlets and minitablets. The multiparticulate solid oral dosage form of the invention may comprise high amounts of vitamin E and is for use in the treatment of patients that are haptoglobin 2-2 genotype. Vitamin E supplementation reduces cardiovascular disease in diabetes patients with haptoglobin 2-2 genotype.

Description

Multiparticulate solid oral dosage form comprising statin and vitamin E

Technical field

The present invention relates to the use of HMG-CoA reductase inhibitors for the treatment of patients suffering from diabetes mellitus (DM). It also relates to the tailoring of medical treatment to the characteristics of certain patient groups (precision medicine).

Background of the invention

HMG-CoA reductase inhibitors, also known as statins, are a class of lipid-lowering medications. An example is atorvastatin calcium, commercially available under the tradename LIPITOR®. LIPITOR® is indicated as an adjunct therapy to reduce the risk of myocardial infarction (Ml) and stroke in adult patients with type 2 diabetes without coronary heart disease (CHD), but with multiple risk factors. Known risk factors for coronary heart disease are retinopathy, albuminuria, smoking and hypertension.

Levy et al. have found that the haptoglobin genotype is predictive of risk of cardiovascular disease (CVD) in diabetic patients. EP 1 587 953 B1 discloses methods of predicting a benefit of antioxidant therapy for prevention of cardiovascular disease in hyperglycemic patients. Blum et al. determined the Hp genotype on diabetes mellitus (DM) participants from two trials (HOPE and ICARE) and assessed the effect of vitamin E by Hp genotype on their common prespecified outcome, the composite of stroke, myocardial infarction and cardiovascular death (Blum S, Vardi M, Brown JB, et al., “ Vitamin E reduces cardiovascular disease in individuals with diabetes mellitus and the haptoglobin 2-2 genotype”. Pharmacogenomics. 2010;11 (5):675-684). In both trials, the participants received a placebo or each day 400 IU (international units) vitamin E.

Whereas vitamin E supplementation reduces cardiovascular disease in diabetes patients with haptoglobin 2-2 genotype, vitamin E supplementation did not show any substantial benefit in genetically unselected populations (Levy et al. “The effect of vitamin E supplementation on cardiovascular risk in diabetic individuals with different haptoglobin phenotypes". Diabetes Care. 27(11 ):2767).

ELISA® is an Enzyme-Linked Immunoassay for the Qualitative Determination of Haptoglobin Phenotypes in Diabetic. It is commercially available at Savyon® Diagnostics Ltd. (St. Ashdod, Israel) and allows for the qualitative determination of Hp phenotypes (Hp 1 -1 , Hp 2-1 or Hp 2-2) in human serum/plasma of diabetic patients.

All elements needed for reducing the risk of cardiovascular disease in diabetic patients are easily available:

- kits for testing the haptoglobin genotype of diabetes patients

- statin tablets as an adjunct therapy for diabetes patients

- vitamin E for vitamin E supplementation

Nevertheless, most diabetes patients are still treated in the same manner as they were treated 10 or 20 years ago. This lacuna has its cost: the estimated total economic cost of diagnosed diabetes in 2017 is $327 billion (Economic Costs of Diabetes in the U.S. in 2017, American Diabetes Association, Diabetes Care 2018;41 :917-928).

There is a need to reduce the burden that diabetes and its sequelae impose on society.

Summary of the invention

The problems underlying the present invention are solved by a fixed-dose combination (FDC) of vitamin E and statin. The FDC of the invention is a solid oral dosage form that comprises multiple particles (“multiparticulate solid oral dosage form”).

The multiparticulate solid oral dosage form of the invention comprises (i) at least one source of vitamin E and (ii) statin or a pharmaceutically acceptable salt thereof. Preferably, the source of vitamin E is an ester of vitamin E. Preferred statins are rosuvastatin, atorvastatin and pharmaceutically acceptable salts thereof. The multiparticulate solid oral dosage form of the invention comprises preferably at least 300 IU (“International units”) vitamin E and is preferably for use in the treatment of a patient who is haptoglobin 2-2 genotype and/or haptoglobin 2-2 phenotype (“Hp 2-2 patient”). The treatment of the present invention is particularly promising if said Hp 2-2 patient is suffering from diabetes. The particles of the multiparticulate solid oral dosage form of the invention are preferably minitablets or beadlets. In case of minitablets, the multiparticulate solid oral dosage form of the invention is preferably a sachet. In case of beadlets, the multiparticulate solid oral dosage form of the invention may be a stick-pack, a sachet, a capsule or a Multiple-Unit Pellet System (MUPS) tablet. Sachets have a larger filling volume than stick-packs and are therefore preferred for minitablets. For filling particles into stick-packs or sachets, the particles must be flowable. Particles larger than 190 µm are usually relatively free flowing, but as the size falls below 190 µm, powders become cohesive and flow problems are likely to occur. The multiparticulate solid oral dosage form of the invention comprises particles which have an average particle size D(v, 0.5) of preferably at least 200 µm when measuring MIE volume distribution by laser diffraction using a Malvern Mastersizer® 2000 apparatus. Beadlets are larger than the usual, spray-dried particles. Therefore, beadlets show excellent flowability. A preferred embodiment of the invention relates to a stick-pack that comprises 2 g or less beadlets as herein described. Minitablets also show excellent flowability. And yet, minitablets are small enough to be easily swallowed. A preferred embodiment of the invention relates to a sachet that comprises at least 100 minitablets as herein described. The present invention also relates to the use of minitablets and/or beadlets for manufacturing a multiparticulate solid oral dosage form that comprises (i) at least 300 IU vitamin E and (ii) statin or a pharmaceutically acceptable salt thereof. Manufacturing cost and complexity of the manufacturing process is surprisingly low if the multiparticulate solid oral dosage form is a sachet that comprises a mixture of at least two different kinds (“two varieties”) of minitablets. A preferred embodiment of the invention relates to a sachet comprising two or more varieties of minitablets, wherein the minitablets of a first variety comprise a pharmaceutically acceptable salt of a statin, and wherein the minitablets of a second variety comprise an ester of vitamin E.

The present invention also relates to a method of manufacturing multiparticulate solid oral dosage forms comprising (i) an ester of vitamin E and (ii) statin or a pharmaceutically acceptable salt thereof statin, wherein particles which have an average particle size D(v, 0.5) of at least 200 pm when measuring MIE volume distribution by laser diffraction using a Malvern Mastersizer® 2000 apparatus are filled into sachets or stick-packs, such that each sachet or each stick-pack comprises at least 300 III vitamin E.

The present invention also relates to a multiparticulate solid oral dosage form as herein described for use as a medicament.

Figure

FIGURE 1 shows the compression profile of a MUPS tablet comprising beadlets. Each beadlet comprises both, vitamin E and atorvastatin calcium. Despite of the applied compression force, the particles in the tablet (i.e. the beadlets) remain intact. The tested MUPS tablet comprises 200 IU vitamin per tablet.

Detailed description of the invention

The present invention relates to a multiparticulate solid oral dosage form that comprises both, statin and vitamin E. Thus, the multiparticulate solid oral dosage form of the invention is fixed-dose combination (FDC) of vitamin E and statin. Definitions Vitamin E exists in a number of different kinds that have different biological activities. α-tocopherol has eight stereoisomers (RRR-, RSR-, RRS-, RSS-, SRR-, SSR-, SRS-, SSS-), but only RRR-α-tocopherol occurs naturally in food. The synthetic form, all-rac-α-tocopherol, contains all eight stereoisomers in equal amounts and is only present in fortified foods and supplements. Tocopheryl acetate is the acetate ester of tocopherol. Vitamin E activity is limited to the 2R-stereoisomers that have a higher biological activity than the 2S-stereoisomers. The biological activity of the chosen vitamin E can be summarized as the number of “International Units (IU)” of vitamin E. In the context of the present invention, the amount of vitamin E is preferably indicated in International Units (IU). For α-tocopherol, the following conversion factors are used: • 1 IU vitamin E is the biological equivalent of 0.67 mg d-α-tocopherol (also called RRR-α-tocopherol) • 1 IU vitamin E is the biological equivalent of 1 mg dl-α-tocopherol (i.e. a racemic mixture also called all-rac-α-tocopherol) • 1 IU vitamin E is the biological equivalent of 1 mg dl α tocopheryl acetate (i.e. a racemic mixture also called all-rac-α-tocopheryl acetate). The “Tolerable Upper Intake (TUI)” is the highest amount of an active that most people can take safely. The Tolerable Upper Intake (TUI) of vitamin E varies from region to region and also depends on age, gender and health state of a patient. In most cases, however, the TUI of vitamin E is higher than 1.000 IU per day. The typical multiparticulate solid oral dosage form of the invention comprises less than 1000 IU vitamin E. Esters of vitamin E are the preferred source of vitamin E. If other sources of vitamin E are used (e.g. RRR-α-tocopherol), the multiparticulate solid oral dosage form might not be sufficiently stable to reach a shelf-life of 1 year, 2 years or more. The preferred ester of vitamin E is vitamin E acetate. In the context of the present invention, the expression “vitamin E acetate” refers preferably to dl-α-tocopheryl acetate. Most sources of vitamin E are oils. To convert vitamin E oil into a solid particles, at least one excipient is needed. Consequently, “vitamin E acetate particles” comprises less than 100 weight-% vitamin E acetate, based on the total weight of the vitamin E acetate particles. A “dosage form” is pharmaceutical drug product in the form in which it is marketed for use, i.e. with a specific mixture of active ingredients and inactive components (excipients), and apportioned into a particular dose. A dosage form may be liquid or may be solid (e.g. tablet). An oral dosage form is to be administered orally. A “multiparticulate solid oral dosage form” is a solid oral dosage form that comprises multiple particles (such as pellets, beadlets, minitablets etc.). In one embodiment of the invention, the multiparticulate solid oral dosage form is a compressed tablet comprising particles. In another embodiment of the invention, the multiparticulate solid oral dosage form is a sachet comprising particles or a stick-pack comprising particles. In yet another embodiment of the invention, the multiparticulate solid oral dosage form is a capsule comprising particles. In the context of the present invention, the terms “particle” and “particles” encompass any kind of particle that is suitable to manufacture the herein described multiparticulate solid oral dosage form. Often, very small particles have poor flowability, have limited stability and/or contain a high amount of excipients (i.e. low loading of oil). Thus, very small particles are often not suitable to manufacture the herein described multiparticulate solid oral dosage form. In a preferred embodiment of the present invention, the terms “particle” and “particles” do not include particles that are characterized in that more than 50 weight-%, more than 30 weight-% or more than 20 weight-% of the total amount of particles pass through a sieve having a sieve opening of 149 µm (sieve No.100). Apart from sieving, the size of particles can also be determined by other well-known methods, such as (scanning) electron microscopy, laser diffraction following ISO 13320 or measuring MIE volume distribution by laser diffraction using Malvern Mastersizer® 2000. The latter is preferred. Particles as used in the context of the present invention have preferably an average particle size D(v, 0.5) of at least 200 µm. More preferably, they have an average particle size D(v, 0.5) in the range from 200 µm to 800 µm or, even more preferably, in the range from 200 µm to 400 µm. Beadlets are a specific kind of particles, prepared by a powder catch process. The principle of the powder catch process is known from the prior art. It can be found for example in US 6,444,227 or WO 04/062382, the content of which hereby incorporated by reference. In other words, beadlets are well-known to the person skilled in the art. They are generally in the shape of spherical or spheroidal particles that are typically coated with a layer of a powder catch medium. Consequently, beadlets are larger than conventional spray-dried particles. In the context of the present invention, the terms “beadlet” and “beadlets” refer preferably to particles that are characterized in that: ▪ at least 80 weight-%, at least 90 weight-% or at least 95 weight-% of the total amount of particles pass through a sieve having a sieve opening of 841 µm (sieve No.20), and/or ▪ at least 70 weight-%, at least 80 weight-% or at least 85 weight-% of the total amount of particles pass through a sieve having a sieve opening of 420 µm (sieve No.40), and/or ▪ less than 40 weight-%, less than 30 weight-% or less than 20 weight-% of the total amount of particles pass through a sieve having a sieve opening of 149 µm (sieve No.100) In the context of the present invention, the terms “Multiple-Unit Pellet System tablet” and “MUPS tablet” refer to a compressed tablet that comprises particles as herein described. Said particles may or may not be pellets. Preferably, the terms “Multiple-Unit Pellet System tablet” and “MUPS tablet” refer to a compressed tablet that comprises beadlets as herein described. Alternatively, the terms “Multiple-Unit Pellet System tablet” and “MUPS tablet” refer to a compressed tablet that comprises vitamin E acetate particles as herein described. Most preferably, the terms “Multiple-Unit Pellet System tablet” and “MUPS tablet” refer to a compressed tablet that comprises beadlets, wherein said beadlets comprise vitamin E acetate. Typically, the multiparticulate solid oral dosage form of the invention is obtained by apportioning particles into predetermined dosages. The particles may be a beadlets (i.e. a relatively coarse powder) or may be minitablets. The particles to be apportioned may comprise one kind of particles only (i.e. one variety of particles) or may comprise a blend of particles (i.e. more than one variety of particles). For apportionment, particles can be filled into sachets, stick-packs, two-piece hard shell capsules, or in any other suitable container.

Two-piece hard shell capsules are made of edible material such as gelatine. Thus, in case of a capsule, the multiparticulate solid oral dosage form of the invention is the capsule partially filled with particles (e.g. a capsule partially filled with beadlets). Although not preferred, it is technically possible to fill minitablets into two-piece hard shell capsule. Preferably, minitablets are filled into sachets.

For pharmaceutical usage, stick packs and sachets are often made from laminated polyethylene terephthalate (PET) aluminum foil or laminated aluminum paper foil. Foil is not meant for human consumption. Thus, in embodiments wherein the multiparticulate solid oral dosage form is a sachet or a stick-pack, the patient is meant to orally ingest what is in the sachet or stick-pack (i.e. not swallowing the packaging material). Stick-packs and sachets are a convenient, portable unit-dose solution for pharmaceutical products. Stick-packs and sachets differ in their size and shape. While sachets are bigger, often quadratic and are usually used for delivering larger volumes, stick-packs have elongated shape that makes them better suited for pouring the contents into the mouth and swallowing directly. Both sachets and stick-packs can be manufactured with or without tear notches for easy opening. Stick-packs are disclosed for example in WO 2016/085522.

In the context of the present invention, a “stick-pack” is a flexible pouch containing a small amount of something solid (preferably beadlets), enough for only one occasion (preferably a single dosage). Stick packaging gets its name from its shape, which is long and skinny like a stick of gum. Stick-packs are typically sealed on two shorts ends and have a seal down the back. Typically, stick-packs have up to 60 cm³ filling volume, are 15 mm - 45 mm wide and 30 mm - 200 mm long. In embodiments wherein the multiparticulate solid oral dosage form of the invention is a stick-pack, the amount of particles (preferably beadlets) in the stick-pack does typically not exceed 2 g or 1 g. In the context of the present invention, a “sachet” is also a flexible pouch containing a small amount of something solid (preferably beadlets or minitablets), enough for only one occasion (preferably a single dosage). A typical sachet is not long and skinny like a stick of gum. It is larger than a stick-pack and may have more than 60 cm³ filling volume. Typical sachets (e.g. four side-seal sachets) are 40 mm - 150 mm wide and 50 mm - 200 mm long. In embodiments wherein the multiparticulate solid oral dosage form of the invention is a sachet, the amount of particles (preferably beadlets or minitablets) in the sachet does preferably not exceed 10 g or 5 g and is preferably from 2.1 g - 5 g or from 2.1 g - 10 g. A sachet for a pharmaceutical composition is disclosed for example in WO 2004/093883.

A “tablet press” is a mechanical device that compresses powder into tablets of uniform size and weight. The powder is a mixture that comprises at least one pharmaceutically acceptable excipient. In the context of the present invention, a “compressed tablet” is tablet obtained by compressing a powder in a tablet press. “Minitablets” are small compressed tablets with a diameter of preferably less than 4 mm, more preferably less than 3.5 mm, even more preferably less than 3 mm and most preferably less than 2.5 mm. To reach a prescribed dosage, more than one minitablet needs to be swallowed. For children and elderly people, it is often easier to swallow multiple small tablets instead of one big tablet. Thus, a unique advantage of minitablets is improvement of swallowability in children and elderly people. A “statin minitablet” is a compressed minitablet that comprises a tablet core, wherein said tablet core comprises at least one statin or a pharmaceutically acceptable salt thereof. Optionally, the tablet core also comprises at least one source of vitamin E. Thereby, the tablet core may or may not be coated.

The abbreviations “Hp 2-2” and “hp 2-2” are used interchangeably and refer to haptoglobin 2-2.

Haptoglobin genotype may be inherited. This explains prevalence of haptoglobin 2-2 genotype in the Chinese population and elsewhere. “Descent” as used in the term "Chinese descent” etc. is to be understood as biological derivation from a respective ancestor. In the context of the present invention, the term "prevalence of haptoglobin 2-2 genotype” refers to the number of individuals in a population who are haptoglobin 2-2 genotype, usually expressed as a percentage of the total population.

HP 2-2 genotype is also processed on the protein level. When testing has been done on protein level, the term “haptoglobin 2-2 phenotype” is used.

Vitamin E supplementation shows benefit in the herein described population, regardless whether members of the population have been tested on protein level, on DNA level, on both levels or not all. Therefore, unless indicated differently, the terms “haptoglobin 2-2 genotype” and “haptoglobin 2-2 phenotype” may be used interchangeably.

Type 2 diabetes is a disease that prevents the body from using insulin the way it should. People who are middle-aged or older are most likely to get this kind of diabetes. Therefore, it is sometimes called adult-onset diabetes. In the context of the present invention, “diabetes” refers preferably to diabetes mellitus (DM). Similarly, the term “diabetic patient” refers preferably to a patient suffering from type 2 diabetes.

Multiparticulate solid oral dosage form of the invention

The multiparticulate solid oral dosage form of the invention comprises particles. In case the multiparticulate solid oral dosage form of the invention comprises one variety of particles only, the particles comprise both, statin and vitamin E. In case the multiparticulate solid oral dosage form of the invention comprises more than one variety of particles, some particles may comprise statin only, other particles may comprise vitamin E only and yet other particles may comprise both, statin and vitamin E. In any case, the multiparticulate solid oral dosage form of the invention comprises (i) at least one source of vitamin E and (ii) statin or a pharmaceutically acceptable salt thereof. Thus, the multiparticulate solid oral dosage form of the invention is fixed-dose combination (FDC) of vitamin E and statin. Preferably, the multiparticulate solid oral dosage form of the invention comprises an ester of vitamin E, wherein said ester of vitamin E is preferably vitamin E acetate and is most preferably dl-α-tocopheryl acetate. Preferably, the multiparticulate solid oral dosage form of the invention comprises a pharmaceutically acceptable salt of a statin, wherein pharmaceutically acceptable salts of rosuvastatin and of atorvastatin are particularly preferred. Thus, a preferred embodiment of the present invention relates to a multiparticulate solid oral dosage form comprising (i) dl-α-tocopheryl acetate and (ii) a pharmaceutically acceptable salt of a statin being preferably a pharmaceutically acceptable salt of rosuvastatin or a pharmaceutically acceptable salt of atorvastatin. The particles comprised in the multiparticulate solid oral dosage form of the invention are preferably pellets, granules, beadlets or minitablets, wherein beadlets and minitablets are particularly preferred. In case of pellets, granules and beadlets, the multiparticulate solid oral dosage form of the invention may be a capsule, a Multiple Unit Pellet System (MUPS) tablet, a sachet or a stick- pack. In case of minitablets, the multiparticulate solid oral dosage form of the invention may be a capsule, a sachet or a stick-pack, wherein a sachet or a stick-pack are preferred and wherein a sachet is particularly preferred. One embodiment of the present invention relates to a multiparticulate solid oral dosage form comprising (i) dl-α-tocopheryl acetate and (ii) a pharmaceutically acceptable salt of a statin, characterized in that said multiparticulate solid oral dosage form is a capsule, a Multiple Unit Pellet System (MUPS) tablet, a sachet or a stick-pack and/or characterized in that the particles of said multiparticulate solid oral dosage form are beadlets. Gelatin hard shell capsules and other two-piece hard shell capsules have a limited volume. Similarly, a Multiple Unit Pellet System (MUPS) tablet cannot exceed a certain volume. Accordingly, the maximum amount of vitamin E in such dosage form is limited. One embodiment of the present invention relates to a two-piece hard shell capsule comprising pellets, granules, beadlets and/or minitablets, characterized in that said two piece hard shell capsule is a fixed-dose combination of dl-α-tocopheryl acetate and a pharmaceutically acceptable salt of a statin, and characterized in that said two piece hard shell capsule comprises less than 280 IU vitamin E, preferably less than 200 IU vitamin E. The present invention also relates to a Multiple Unit Pellet System (MUPS) tablet comprising pellets, granules and/or beadlets minitablets, characterized in that said Multiple Unit Pellet System (MUPS) tablet is a fixed-dose combination of dl-α-tocopheryl acetate and a pharmaceutically acceptable salt of a statin, and characterized in that said Multiple Unit Pellet System (MUPS) tablet comprises less than 280 IU vitamin E, preferably less than 200 IU vitamin E. Stick-packs may comprise minitablets. However, this is not preferred. Stick-packs of the present invention comprise preferably pellets, granules and/or beadlets and comprise more preferably beadlets. One embodiment of the present invention relates to a stick-pack comprising pellets, granules and/or beadlets, characterized in that said stick-pack is a fixed-dose combination of dl-α-tocopheryl acetate and a pharmaceutically acceptable salt of a statin, and characterized in that said pellets, granules and/or beadlets have an average particle size D(v, 0.5) of preferably at least 200 µm when measuring MIE volume distribution by laser diffraction using a Malvern Mastersizer® 2000 apparatus. A not preferred embodiment of the present invention relates to a stick-pack comprising minitablets, characterized in that said minitablets comprise dl-α-tocopheryl acetate and a pharmaceutically acceptable salt of a statin, and characterized in that said minitablets have a diameter of preferably less than 4 mm, more preferably less than 3.5 mm, even more preferably less than 3 mm and most preferably less than 2.5 mm. The filling volume of stick-packs is reasonably large. Thus, in case of stick-packs, the maximum amount of vitamin E is not limited to less than 280 IU vitamin E. A preferred embodiment of the present invention relates to a stick-pack comprising beadlets, characterized in that said beadlets comprise dl-α-tocopheryl acetate and a pharmaceutically acceptable salt of a statin, and characterized in that said beadlets comprise (in total) preferably at least 280 IU, more preferably at least 300 IU, even more preferably at least 350 IU vitamin E and most preferably at least 400 IU vitamin E. Sachets are larger than stick-packs. Therefore, sachets are preferred for apportioning minitablets. Nevertheless, sachets may also comprise other particles such as pellets, granules and/or beadlets. One embodiment of the present invention relates to a sachet comprising pellets, granules and/or beadlets, characterized in that said sachet is a fixed dose combination of dl-α-tocopheryl acetate and a pharmaceutically acceptable salt of a statin, and characterized in that said pellets, granules and/or beadlets have an average particle size D(v, 0.5) of preferably at least 200 µm when measuring MIE volume distribution by laser diffraction using a Malvern Mastersizer® 2000 apparatus. A preferred embodiment of the present invention relates to a sachet comprising minitablets, characterized in that said minitablets comprise dl-α-tocopheryl acetate and a pharmaceutically acceptable salt of a statin, and characterized in that said minitablets have a diameter of preferably less than 4 mm, more preferably less than 3.5 mm, even more preferably less than 3 mm and most preferably less than 2.5 mm, and further characterized in that said minitablets comprise (in total) preferably at least 280 IU, more preferably at least 300 IU, even more preferably at least 350 IU vitamin E and most preferably at least 400 IU vitamin E. The present invention also relates to a multiparticulate solid oral dosage form as described in the previous paragraphs for use as a medicament. Method of treatment The present invention also relates to a method of treating a patient that is haptoglobin 2-2 genotype and/or haptoglobin 2-2 phenotype. In case such patient is in need of an HMG-CoA reductase inhibitor and/or who is suffering from diabetes, the oral administration of the herein described multiparticulate solid oral dosage form is particularly beneficial. Thus, the present invention also relates to the use of the herein described multiparticulate solid oral dosage form in the treatment of a patient - who is in need of an HMG-CoA reductase inhibitor and/or who is suffering from diabetes and - who is haptoglobin 2-2 genotype and/or who haptoglobin 2-2 phenotype A preferred embodiment of the present invention relates to the use of the herein described multiparticulate solid oral dosage form in the treatment of a patient who is suffering from diabetes and whose genotype or phenotype has been determined as haptoglobin 2-2. The oral administration of up to 1000 IU vitamin E is safe for anybody, regardless of the patient’s haptoglobin phenotype/genotype. Therefore, determination of a patient’s haptoglobin phenotype/genotype before starting the treatment of the present invention it is not absolutely necessary. This applies in particular if a patient is member of a population group with high prevalence of haptoglobin 2-2 genotype/phenotype. A preferred embodiment of the present invention relates to the use of the herein described multiparticulate solid oral dosage form in the treatment of a patient who is suffering from diabetes and who is member of a population group whose prevalence of haptoglobin 2-2 genotype is at least 40%. Such high prevalence are known for Chinese descents, Malay descent and Indian descents. Dosage regimen Typically, statins such as rosuvastatin and atorvastatin are prescribed to patients that are in need of an HMG-CoA reductase inhibitor. The daily dosage of a given statin differs from one patient to another and is usually determined by the patient’s doctor. Due to various needs of patients, 4 dosages of atorvastatin are available in most countries (atorvastatin film-coated tablets; typically as atorvastatin calcium trihydrate). Similarly, 4 dosages of rosuvastatin are available in most countries (rosuvastatin tablets; typically as rosuvastatin calcium). Patients that are in need of statin often suffer from diabetes whereas research has shown that vitamin E supplementation reduces cardiovascular disease in diabetes patients that are haptoglobin 2-2 genotype. For this patient group, it is therefore particularly beneficial to switch from their current statin medication to a fixed-dose combination comprising statin and vitamin E. When switching, there is usually no need to alter the patient’s current statin dosage. Thus, the adapted medication comprises the patient’s previous statin dosage plus vitamin E.

Whereas the statin dosage may differ from one patient to another, virtually all patients benefit from the same amount of vitamin E. Thus, the amount of vitamin E in the FDC is independent of the amount of statin in the same FDC.

This uniqueness is illustrated in below table, using atorvastatin as an example:

The same applies mutatis mutandis to other statins such as rosuvastatin, orally administered as rosuvastatin calcium:

Drug manufacturers selling atorvastatin tablets are obliged to manufacture 4 dosage strengths: 10 mg tablets, 20 mg tablets, 40 mg tablets and 80 mg tablets. The need for manufacturing 4 variants increases cost and complexity (manufacturing, storage, supply chain etc.). The same applies mutatis mutandis to rosuvastatin and any other statin.

When switching from single active ingredient statin tablets to the herein described FDC (i.e. multiparticulate solid oral dosage form), the number of dosage forms that need to be manufactured reduced. By way of example, it may be sufficient to manufacture 2 kinds of minitablets instead of 4 kinds of the statin tablets of the prior art. Reducing the number of variations (e.g. 2 kinds instead of 4 kinds) lowers cost and complexity of the manufacturing process, including storage and supply.

The number of dosage forms that need to be manufactured may be reduced if the multiparticulate solid oral dosage form of the present invention comprises more than one variety of particles. Instead of putting both, vitamin E and statin in each of the particles, some particles may comprise statin only or vitamin E only. By mixing suitable amounts of the at least two varieties of particles, all given statin dosages may be obtained whereas the vitamin E dosage is the same for all patients. This is extensively illustrated in the examples of the present document.

One embodiment of the present invention relates to a sachet comprising two or more varieties of minitablets, wherein the minitablets of a first variety comprise statin or a pharmaceutically acceptable salt thereof, and wherein the minitablets of a second variety comprise an ester of vitamin E. In a preferred embodiment, the minitablets of the first variety comprise in addition to statin also vitamin E, preferably an ester of vitamin E. Thereby, the minitablets of the second variety may be free of statins and free of pharmaceutically acceptable salts thereof. In this preferred embodiment, the number of minitablets per sachet may be reduced (cf. examples 4 and 5). Another embodiment of the present invention relates to a capsule, to a sachet or to a stick-pack comprising two or more varieties of beadlets, wherein the beadlets of a first variety comprise statin or a pharmaceutically acceptable salt thereof, and wherein the beadlets of a second variety comprise an ester of vitamin E. Thereby, the beadlets of the first variety may further comprise an ester of vitamin E and/or the beadlets of the second variety may be free of statins and free of pharmaceutically acceptable salts thereof. Other than that, the above listed preferences apply. Thus, by way of example, the ester of vitamin E is preferably of dl-α-tocopheryl acetate whereas statin is preferably a pharmaceutically acceptable salt of a statin. Whereas the daily dosage of vitamin E is independent of the prescribed daily dosage of the respective statin, a daily dosage of 400 IU vitamin E is the preferred option only. In alternative embodiments of the present invention, the daily dosage of vitamin E for a patient (and thus the total amount of vitamin E per multiparticulate solid oral dosage form) is independent of the prescribed dosage of statin and is 190 IU, 200 IU, 210 IU, 220 IU, 230 IU, 240 IU, 250 IU, 260 IU, 270 IU, 280 IU, 290 IU, 300 IU, 310 IU, 320 IU, 330 IU, 340 IU, 350 IU, 360 IU, 370 IU, 380 IU, 390 IU or 400 IU vitamin E. Method of manufacturing the FDC of the invention The present invention also relates to a method of manufacturing the herein described multiparticulate solid oral dosage form. And it also relates to a multiparticulate solid oral dosage forms that is obtainable by the method of the present invention. A preferred embodiment of the present invention relates to a method of manufacturing a multiparticulate solid oral dosage form that comprises (i) at least 280 IU vitamin E and (ii) statin or a pharmaceutically acceptable salt thereof statin, wherein particles are filled into a sachet, and wherein said particles are preferably beadlets or minitablets and are more preferably minitablets. An also preferred embodiment of the present invention relates to a method of manufacturing a multiparticulate solid oral dosage form that comprises (i) at least 280 IU vitamin E and (ii) statin or a pharmaceutically acceptable salt thereof, wherein particles are filled into a stick-pack, and wherein said particles have an average particle size D(v, 0.5) of preferably at least 200 µm when measuring MIE volume distribution by laser diffraction using a Malvern Mastersizer® 2000 apparatus, and wherein the particles are preferably beadlets. An alternative embodiment of the present invention relates to a method of manufacturing a multiparticulate solid oral dosage form that comprises (i) from 100 IU to 250 IU vitamin E, preferably from 100 IU to 200 IU vitamin E and (ii) statin or a pharmaceutically acceptable salt thereof, wherein particles are filled into a two-piece hard shell capsule, and wherein said particles are beadlets or minitablets as herein described. A further alternative embodiment of the present invention relates to a method of manufacturing a multiparticulate solid oral dosage form that comprises (i) from 100 IU to 250 IU vitamin E, preferably from 100 IU to 200 IU vitamin E and (ii) statin or a pharmaceutically acceptable salt thereof, wherein a mixture comprising particles and at least one pharmaceutically acceptable excipient is compressed into a Multiple-Unit Pellet System (MUPS) tablet. The present invention also relates to the use of particles for manufacturing a multiparticulate solid oral dosage form that comprises (i) an ester of vitamin E and (ii) statin or a pharmaceutically acceptable salt thereof, wherein said particles have an average particle size D(v, 0.5) of at least 200 µm when measuring MIE volume distribution by laser diffraction using a Malvern Mastersizer® 2000 apparatus. A preferred embodiment of the present invention relates to the use of minitablets or beadlets for manufacturing a multiparticulate solid oral dosage form that comprises (i) an ester of vitamin E and (ii) statin or a pharmaceutically acceptable salt thereof. An also preferred embodiment of the present invention relates to the use of minitablets or beadlets for manufacturing a fixed-dose combination of (i) an ester of vitamin E and (ii) a pharmaceutically acceptable salt of a statin. The sachet to be manufactured comprises preferably at least 100 minitablets or at least 150 minitablets or at least 200 minitablets, wherein said minitablets have a diameter of preferably less than 4 mm, more preferably less than 3.5 mm, even more preferably less than 3 mm and most preferably less than 2.5 mm. Thereby, the sachet comprises preferably two or more varieties of minitablets as herein described. The sachet may be filled gravimetrically. Alternatively, the minitablets may be counted. For counting, a suitable device is preferably used, such as a dosing disc. Thus, a preferred method of manufacturing a multiparticulate solid oral dosage form that comprising (i) at least 280 IU vitamin E and (ii) statin or a pharmaceutically acceptable salt thereof statin comprises the steps: a) provision of a first variety minitablets, wherein the minitablets of said first variety comprise statin or a pharmaceutically acceptable salt thereof, and provision of a second variety minitablets, wherein the minitablets of said second variety comprises an ester of vitamin E b) filling minitablets of said first variety and minitablets of said second variety in sachets such that each sachet comprises at least 280 IU, preferably at least 300 IU, more preferably at least 350 IU vitamin E and most preferably at least 400 IU vitamin E characterized in that step b) is done gravimetrically or is done by counting minitablets of the first and the second variety, and wherein a device is preferably used for counting minitablets, and wherein said device is preferably a dosing disc, and/or characterized in that the minitablets of said first variety further comprise an ester of vitamin E, and/or wherein the minitablets of said second variety are free of statins and free of pharmaceutically acceptable salts thereof. The present invention also relates to sachets that are obtainable by this preferred method. The present invention also relates to a method of manufacturing minitablets which comprise a relatively high amount of vitamin E. A preferred embodiment relates to the manufacturing of a minitablet which comprises at least 0.5 IU vitamin E, more preferably at least 0.9 IU vitamin E, even more preferably at least 1.0 IU vitamin E and most preferably at least 1.2 IU vitamin E, characterized in that a mixture comprising vitamin E acetate particles and at least one co-processed, pharmaceutically acceptable excipient is compressed into minitablets having a diameter of preferably less than 4 mm, more preferably less than 3.5 mm, even more preferably less than 3 mm and most preferably less than 2.5 mm. Co-processed excipients are excipients which act at the same time as filler/binder, flow aid, disintegrant and/or lubricant. An example of such co-processed excipient is PROSOLV®, commercially available at JRS Pharma. An also preferred embodiment relates to the manufacturing of a minitablet which comprises at least 0.5 IU vitamin E, more preferably at least 0.9 IU vitamin E, even more preferably at least 1.0 vitamin E and most preferably at least 1.2 vitamin E, characterized in that a mixture comprising beadlets and at least one pharmaceutically acceptable excipient is compressed into minitablets having a a diameter of preferably less than 4 mm, more preferably less than 3.5 mm, even more preferably less than 3 mm and most preferably less than 2.5 mm. Thereby, said beadlets comprise vitamin E ester and optionally statin. The preferred at least one pharmaceutically acceptable excipient is again a co-processed excipient. Examples For manufacturing multiparticulate solid oral dosage forms, particles are needed. Exemplary particles are granules, pellets, beadlets and minitablets as herein described. Examples 1 to 7 relate to multiparticulate solid oral dosage forms that comprise minitablets. To receive the required dosage, more than one minitablet needs to be swallowed. In case the multiparticulate solid oral dosage form is a stick-pack or preferably a sachet, the stick-pack or sachet comprises the number of minitablets that are needed to achieve the required dosage. Remaining examples 8 to 11 relate to multiparticulate solid oral dosage forms that comprise beadlets. Such dosage forms may be a MUPS tablet, a capsule, a stick-packs or a sachet. The present invention is not limited to the embodiments of the examples. Granules and pellets that are as large as or larger than beadlets can also be filled into capsules, stick-packs or sachets or can be compressed into MUPS tablets. Example 1 (0.75 IU vitamin E per minitablet) In example 1, minitablets comprising atorvastatin calcium and Dry Vitamin E 50% CWS/S were manufactured. Dry Vitamin E 50% CWS/S is a spray-dried powder that comprises modified food starch and vitamin E acetate. It has a vitamin E content of 50 weight-%, based on the total weight of the powder. Dry Vitamin E 50% CWS/S is commercially available at DSM® Nutritional Products (Switzerland). As inactive ingredients were used: dicalcium phosphate anhydrous (DICAFOS A 150®, filler and binder), crospovidone (Polyplasdone, disintegrant), silicon dioxide (Aerosil 200, flowing aid), microcrystalline cellulose (Avicel PH 102, filler), stearic acid (Stearic acid Parteck LUB STA) and magnesium stearate (Magnesiumstearat-Parteck LUB MST, lubricant). DICAFOS is a co-processed excipient that is commercially available at Chemische Fabrik Budenheim (Germany). A mixture for 5000 minitablets (or 30 g of minitablets) was prepared by weighing and sieving through 1 mm sieve of Dry Vitamin E 50% CWS/S, Atorvastatin Calcium and all excipients except the lubricants. Both actives and excipients were then put in a glass bottle (200 ml) and mixed in Turbula mixer for 10 min at 23 rpm. To that mixture, stearic acid and magnesium stearate (both previously sieved thorough 1 mm sieve) were added and mixed for another 5 min at 23 rpm. Minitablets were compressed with a Korsch XP 1 single punch tablet press (Korsch AG, Berlin, Germany) using an upper/lower Punch Set with 19 inserted mini punches (2mm diameter). The minipunches were made of pharma steel (Afnor 55NCD12), concave R1.4, smooth surface; die with 19 cavities, 2 mm inner diameter, 38.1mm outer diameter, unilateral conical, with flat filling space, EU-D norm – supplier Mapag Maschinenbau AG, Berne, Switzerland. The minitablets were compressed using the compression force of 3.4-3.8 kN, upper punch was at 4.8 mm, lower punch at 5.2 mm and the ejection forces were 253-271 N. The composition of the minitablets is listed at the TABLE 1a.

Table 1 a In example 1 , each minitablet (weight approx. 6 mg) contained 1.5 mg of Dry Vitamin E 50% CWS/S, which corresponds to 0.75 International Units (IU) of vitamin E and 0.253 mg of Atorvastatin Calcium, which corresponds to 0.24 mg of Atorvastatin. Thus, a sachet comprising 334 minitablets (or 2 g of minitablets) equals a Vitamin E dose of 250 IU and an Atorvastatin dose of 80 mg. Produced minitablets were tested for their weight variation, hardness, friability and disintegration. The analyses were done as follows:

Tablet hardness

The breaking strengths of tablets were measured as described in USP <1217> and EP <2.9.8.> with a Sotax ST 50 tester (Sotax AG, Switzerland). We measured the force needed to break a tablet axially. The average values of 10 measurements were then calculated.

Tablet friability Friability, that is closely related to tablet hardness, refers to the extent of weight loss during mechanical abrasion. A maximum loss of no more than 1% of the initial tablet weight is considered acceptable (USP <1216>, EP < 2.9.7.>). 30 tablets in an AE-1 Friabiliator (Charles Ischi AG Pharma Prüftechnik, Zuchwil, Switzerland) were tested at a rotation speed of 25 rpm for around 4 minutes. The weight loss of the tablets was recorded. Tablet weight Tablet weight was measured according to USP <901>. 10 tablets were measured with a SOTAX ST50 tester (SOTAX AG, Aesch, Switzerland). Presented are average values of these measurements. Tablet disintegration Tablet disintegration was characterized according USP<701, 2040> by using a SOTAX DT50 disintegration tester (SOTAX AG, Aesch, Switzerland) in 800 mL demineralized water at 37°C. Six parallel measurements were carried out. Upper limit of disintegration time is 30 min for uncoated tablets (USP <2040>). A slight modification of the equipment was applied: the mesh diameter of the 6 baskets (Sotax-device) was too big for the minitablets. Therefore, a PE- precision-sieve-tissue piece (mesh diameter 150 µm), was cut and attached at the outside of the basket sieve to prevent that the minitablets fall through the original basket sieve (Sotax device). TABLE 1b summarizes the properties of the minitablets (n=number of samples). It is important to note that there was no sticking to the punches and the tablets were of adequate hardness and friability for further packaging process. g %

Example 2 (0.9 IU vitamin E per minitablet) In example 2, a process similar to the process of example 1 was done. The minitablets of example 2 had 300 IU of Vitamin E per 334 minitablets (or per 2 g of minitablets). Thus, the minitablets of example 2 contained a higher content of Vitamin E compared to previous example 1. In example 2, PRUV® (sodium stearyl fumarate, purchased from JRS®, Switzerland) was used as lubricant. This avoided sticking of the tableting mixture to the punches and allowed higher loading of Vitamin E per minitablet. Such sticking may happen when tableting high concentrations of oily actives. For the minitablets of example 2, all other excipients were the same as for the example 1. The composition of the minitablets of example 2 is listed in T^ABLE 2a. )

abe a The processes as well as the equipment for the production and analysis of minitablets were also the same as in example 1. The minitablets were compressed using the compression force of 3.2-3.5 kN, upper punch was at 4.9 mm, lower punch at 5.5 mm and the ejection forces were 295-307 N. The properties of the minitablets of example 2 are listed in the TABLE 2b. It can be seen that the friability of the minitablets of example 2 was slightly higher than for the minitablets of example 1. Nevertheless, friability of the high loaded minitablets of example 2 is still acceptable (friability below 1 %). During processing, no sticking to the mini punches was observed.

Table 2b

Example 3 (minitablets comprising vitamin E only; 1.251 U per minitablet)

In example 3, minitablets comprising Dry Vitamin E 50% CWS/S at an even higher concentration were manufactured. The minitablets of example 3 did not comprise any atorvastatin calcium.

Each minitablet (weight approx. 6 mg) contained 2.5 mg of Dry Vitamin E 50% CWS/S, which corresponds to 1.25 International Units (IU) of vitamin E. When calculated for 334 minitablets (or 2 g of minitablets) to be packed in a sachet, the dose of Vitamin E was 400 IU (+5% overage = 420 IU). As inactive ingredient was used only Prosolv EASYtab SP commercially available at JRS pharma, Switzerland. Prosolv EASYtab SP is an all-in-one, ready-to-use, homogenous lubricant-coated high functionality excipient composite. It is comprised of four individual components: a binder-filler (Microcrystalline Cellulose), a glidant (Colloidal Silicon Dioxide), a superdisintegrant (Sodium Starch Glycolate), and a lubricant (Sodium Stearyl Fumarate).

The composition of the minitablets is listed in TABLE 3a.

Table 3a

A mixture for 5000 minitablets (or 30 g of minitablets) was prepared by weighing and sieving through 1 mm sieve of Dry Vitamin E 50% CWS/S and Prosolv EASYtab SP. After that they were put in a glass bottle (200 ml) and mixed in Turbula mixer for 15 min at 23 rpm.

Minitablets were compressed with a Korsch XP 1 single punch tablet press (Korsch AG, Berlin, Germany) using an upper/lower Punch Set with 19 inserted mini punches (2 mm diameter), the same as in the previous examples. The minitablets were compressed using the compression force of 3.3-3.5 kN, upper punch was at 3.7 mm, lower punch at 4.0 mm and the ejection forces were 225-241 N.

The properties of the minitablets of example 3 are in TABLE 3b. There was some minimal sticking to the mini punches observed after a few minutes of the production, however, the results of the weight variation and tablet hardness show there were no technical issues.

not tested

Table 3b Example 4 In example 4, a multiparticulate solid oral dosage form is manufactured. The multiparticulate solid oral dosage form of example 4 is a sachet that comprises two varieties of particles. The particles of both varieties comprise one active ingredient only: the particles of a first variety comprise rosuvastatin whereas the particles of a second variety comprise vitamin E. Thereby, vitamin E is dl-α- tocopheryl acetate.1 mg dl-α-tocopherol acetate corresponds to 1 IU vitamin E. Various kinds of particles may be filled into sachets or stick-packs. In example 4, the particles are minitablets. Alternatively, beadlets could be used. In example 4, multiparticulate solid oral dosage forms are manufactured by combining minitablets of the two varieties in sachets. Four different kinds of sachets are produced. The vitamin E dosage is the same for each kind of sachet (400 mg vitamin E per sachet). The rosuvastatin dosage is different for each kind of sachet (5 mg, 10 mg, 20 mg and 40 mg respectively). TABLE 4 reveals that only two varieties of particles (e.g. minitablets) need to be manufactured to fulfill the needs of four different patient groups (patient 1, patient 2, patient 3 and patient 4). Patient 1 is in need of 5 mg rosuvastatin per day and 400 mg vitamin E per day. The needs of patient 1 can be met by one sachet per day which comprises 10 minitablets of the first variety and 320 minitablets of the second variety. Thus, in total patient 1 needs to swallow 330 minitablets per day. Patient 2 is also in need of 400 mg vitamin E per day. However, instead of only 5 mg rosuvastatin per day, he is in need of 10 mg rosuvastatin per day. The needs of patient 2 can be met by one sachet per day which comprises 20 minitablets of the first variety and 320 minitablets of the second variety. Thus, in total patient 2 needs to swallow 340 minitablets per day. The same principle applies mutatis mutandis to patients 3 and 4. Thus, the needs of patient 3 can be met by one sachet per day which comprises 40 minitablets of the first variety and 320 minitablets of the second variety. Thus, in total patient 3 needs to swallow 360 minitablets per day. Similarly, the needs of patient 4 can be met by one sachet per day which comprises 80 minitablets of the first variety and 320 minitablets of the second variety. Thus, in total patient 4 needs to swallow 400 minitablets per day.

In example 3, minitablets comprising 1 .25 III vitamin E per minitablet have been manufactured. These minitablets correspond to the second variety minitablets of example 4. Each minitablet has a weight of approx. 6 mg. Thus, one sachet for patient 4 comprises approx. 400 minitablets * 6 mg/minitablet = 2.4 g. The minitablets of example 3 have a diameter of approx. 2 mm. Considering this small size, swallowing 360 minitablets is acceptable. In example 3, 19 minitablets were simultaneously compressed for each lowering of the punch set.

Tablets comprising rosuvastatin only have been on the market since many years. Currently, 4 dosages are available: 5 mg, 10 mg, 20 mg and 40 mg rosuvastatin. Thus, pharmaceutical companies currently manufacture 4 different kinds of tablets (5 mg/tablet, 10 mg/tablet, 20 mg/tablet and 40 mg/tablet). Surprisingly, two varieties of minitablets only need to be manufactured when following the technical solution of example 4. Despite of a reduction to two different kinds, the needs of all patients can be met. Any reduction in the number of different kinds of tablets that need to be manufactured lowers cost and complexity.

Example 5 In example 5, the approach of example 4 is repeated. Similar to example 4, multiparticulate solid oral dosage form comprising two varieties of particles are manufactured. However, in contrast to example 4, the particles of the first variety comprise two active ingredients: rosuvastatin and vitamin E (see examples 1 and 2). The particles of the second variety comprise one active ingredient only being vitamin E (see example 3). Other than that, example 5 is similar to example 4: vitamin E is dl-α-tocopheryl acetate, and the particles of both varieties are minitablets. Four different kinds of sachets are produced in example 5, as in example 4. Below TABLE 5 Illustrates the benefits of including both, rosuvastatin and vitamin E into the first variety of particles. Patient 1 is in need of 5 mg rosuvastatin per day and 400 mg vitamin E per day. The needs of patient 1 can be met by one sachet per day which comprises 10 minitablets of the first variety and 310 minitablets of the second variety. Thus, in total patient 1 needs to swallow 320 minitablets per day. Patient 2 is also in need of 400 mg vitamin E per day. However, instead of only 5 mg rosuvastatin per day, he is in need of 10 mg rosuvastatin per day. The needs of patient 2 can be met by one sachet per day which comprises 20 minitablets of the first variety and 300 minitablets of the second variety. Thus, in total patient 2 also needs to swallow 320 minitablets per day. The same principle applies mutatis mutandis to patients 3 and 4. Thus, the needs of patient 3 can be met by one sachet per day which comprises 40 minitablets of the first variety and 280 minitablets of the second variety. Thus, in total patient 3 also needs to swallow 320 minitablets per day. Similarly, the needs of patient 4 can be met by one sachet per day which comprises 80 minitablets of the first variety and 240 minitablets of the second variety. Thus, in total patient 4 also needs to swallow 320 minitablets per day. Regardless of the patient’s dosage, each patient needs to swallow the same number of minitablets (i.e. 320). This makes manufacturing of sachets easier because one size of sachet can be used for all 4 dosage strengths. Furthermore, the number of minitablets that the patient needs to swallow is lower than in example 4. This is expected to increase patient compliance.

Example 6

Traditionally, a separate kind of tablet is manufactured for each dosage strength. Example 6 illustrates the conventional approach of pharmaceutical drug manufacturers.

In contrast to examples 4 and 5, each sachet of example 6 comprise one variety of particles only. Thereby, each variety comprises two active ingredients: rosuvastatin and vitamin E. The patient is meant to swallow the content of one sachet per day.

Other than that, example 6 is similar to examples 4 and 5: the manufactured particles are minitablets. The vitamin E dosage is the same for each kind of sachet (400 mg vitamin E). The rosuvastatin dosage is different for each kind of sachet (5 mg, 10 mg, 20 mg and 40 mg respectively). Four different kinds of sachets are produced.

Below TABLE 6 shows that the number of minitablets that the patient needs to swallow is lower than in example 4. Similar to example 5, each patient needs to swallow the same number minitablets, regardless of the dosage that has bee prescribed by the doctor.

TABLE 6 also shows that the disadvantage of the approach of example 6: four varieties of particles need to be manufactured instead of two only. This increases cost and complexity significantly.

Patient 1 is in need of 5 mg rosuvastatin per day and 400 mg vitamin E per day. The needs of patient 1 can be met by one sachet per day which comprises 320 minitablets of the first variety. Thus, in total patient 1 needs to swallow 320 minitablets per day.

Patient 2 is also in need of 400 mg vitamin E per day. However, instead of only 5 mg rosuvastatin per day, he is in need of 10 mg rosuvastatin per day. The needs of patient 2 can be met by one sachet per day which comprises 320 minitablets of the of the second variety. Thus, in total patient 2 also needs to swallow 320 minitablets per day.

The same principle applies mutatis mutandis to patients 3 and 4. Thus, the needs of patient 3 can be met by one sachet per day which comprises 320 minitablets of the third variety. Thus, in total patient 3 also needs to swallow 320 minitablets per day.

Similarly, the needs of patient 4 can be met by one sachet per day which comprises 320 minitablets of the fourth variety. Thus, in total patient 4 also needs to swallow 320 minitablets per day.

When following the technical solution of example 6, four different kinds of minitablets need to be manufactured.

Example 7 (filling minitablets in sachets/stick-packs)

Example 7 illustrates how minitablets of examples 1 -5 can be filled into sachets and/or stick packs.

In example 7, FlexDose® Services as provided by Catalent is used. Catalent is a full-service toll manufacturer with facilities in Germany and USA. Sachets having a filling volume of approx. 3 g can be used. Laminates for pharmaceutical stick packs/sachets are commercially available at Amcor (Head office in Zurich, Switzerland). Minitablets have excellent flowability. Thus, in case of minitablets, filing is particularly easy. Preferably, filling is done gravimetrically. Alternatively, counting using an automated counting device is also possible.

Example 7 shows that sachets and stick-packs are ideal packaging for the required number of minitablets. Each sachet comprises a daily dosage for a selected patient.

Example 8 (manufacturing/characterization of beadlets)

Instead of minitablets, beadlets may be used to manufacture the multiparticulate dosage form of the invention. Beadlets may comprise statin, vitamin E or both.

Beadlets comprising vitamin E only are commercially available at DSM® Nutritional Products (Switzerland, designation “Dry vitamin E 75 HP”). It is a flowable powder consisting of beadlets that comprise fish gelatin and vitamin E acetate. It has a vitamin E content of 75 weight-%.

In example 8, beadlets comprising atorvastatin and vitamin E acetate were manufactured. Said beadlets were manufactured as follows:

40 g porcine gelatin Bloom 200 PS 8 30 (Rousselot) was dissolved in 70 ml demineralized water in a vessel equipped with stirrer, dissolver disc and heater.

26.1 g atorvastatin calcium (=24.8 g atorvastatin) was dispersed in 60 ml demineralized water. The mixture was added to the porcine gelatin solution and the beaker was rinsed with another 20 ml of water. The mixture was heated to 65°C. Rotor speed of the dissolver disc was increased to 5000 rpm and 124 g dl-α-tocopherol acetate (heated to 65°C) was added. Homogenization was continued for 2h at 7000 rpm and 30 min at 8000 rpm. Droplet diameter D[3,2] was 533 nm (measured with a Malvern Mastersizer 2000). 369 g of the emulsion was sprayed into a fluidized bed of 300 g corn starch and 300 g silica Sipernat 50. Excessive starch was removed by sieving with a 160 µm sieve. Beadlets were dried in fluid bed for 2 h at ambient temperature.200 g beadlets were obtained having particle size between 180 µm – 800 µm (determined using sieving). Content of vitamin E acetate was 57.8 weight-%. Example 9 (MUPS with beadlets) In example 9, beadlets of example 8 containing both, atorvastatin and vitamin E, are used to manufacture MUPS tablets. MUPS tablets were manufactured using beadlets that comprise both, statin and vitamin E. Each tablet contained 380.6 mg of the beadlets, which corresponds to 200 IU of Vitamin E acetate /tablet (label claim) with 10 weight-% overage (total 220 IU/tablet). Total tablet weight was 1200 mg. As the inactive ingredients were used: dicalcium phosphate anhydrous (DICAFOS A 150®, filler and binder), microcrystalline cellulose (Avicel PH 102, filler) and magnesium stearate (Magnesiumstearat-Parteck LUB MST, lubricant). DICAFOS is a co-processed excipient that is commercially available at Chemische Fabrik Budenheim (Germany). Tablet mixture for 250 tablets was prepared by weighing of the beadlets and weighing and sieving of through 1 mm sieve all excipients. Afterwards, the beadlets, dicalcium phosphate anhydrous and microcrystalline cellulose were mixed in Turbula mixer (1 L) for 10 min at 23 rpm. To that mixture magnesium stearate was added and mixed for another 5 min at 23 rpm. Tablets were compressed with a Korsch XP 1 single punch tablet press (Korsch AG, Berlin, Germany) using an oblong punch of 21x8.8 mm. Compaction data were recorded with the Pharma Research® data recording system. During tableting, the tablet mixture was compressed with different compression forces (10 – 40 kN) and breaking force of tablets was measured. Tablet hardness vs. compression force was plotted to construct a compression profile. Tablet hardness The breaking strengths of tablets were measured as described in USP <1217> and EP <2.9.8.> with a Sotax ST 50 tester (Sotax AG, Switzerland). We measured the force needed to break a tablet axially. The average values of 10 measurements were then calculated. Figure 1 shows a compression profile of MUPS tablets with one type of beadlets containing both Vitamin E (200 IU/tablet) and atorvastatin calcium. By increasing the compression force during tableting, tablet hardness continuously increased and no plateau was reached. This result confirms that interparticulate binding happened as the compression force increased. This assumption was in line with the visual observation of the tablets. The surface of the tablets was not oily, indicating that there was no Vitamin E oil squeezed from the beadlets due to the high compression forces. If the Vitamin E oil would be squeezed out from the beadlets, it would hinder the interparticulate binding and the tablet hardness would not increase with the increased compression force. Example 10 (filling beadlets into capsules) In example 10, a two-piece hard gelatin capsule is partially filled with beadlets that comprise both, statin and vitamin E. To do so, the beadlets of example 8 may be used. For a dosage of 200 IU vitamin E, approx.380 mg of these beadlets are needed. Their powder density is approx.0.5 g/cm³. Coni-Snap® hard gelatin capsules available at Capsugel® (a Lonza® company) in the size 00, that can accommodate 470 mg of these beadlets, can be used. In case 400 IU vitamin E are to be administered, two hard gelatin capsules of the size 00 are needed. Also vegetarian two-piece hard gelatin (e.g. Vcaps® from Capsugel, produced from hydroxypropylmethylcellulose) can be used. Preferably, the beadlets are filled gravimetrically into the capsules. Optionally, beadlet comprising vitamin E only can also be filled into two-piece hard gelatin capsule. Commercially available beadlets comprising vitamin E as only active ingredient are commercially available at DSM® Nutritional Products (Switzerland, designation “Dry vitamin E 75 HP”). Example 11 (filling beadlets in stick-packs)

In example 10, beadlets of example 8 are filled into stick-packs or sachets.

Similar to example 9, beadlets comprising vitamin E only can optionally also be filled into stick packs or sachets.

Sachets have a larger filling volumes than stick-packs and may comprise up to 5 g or up to 10 g beadlets. In case 1 -2 grams beadlets or less is sufficient, stick-packs may be used.

When using beadlets, filling is preferably done gravimetrically. Counting of beadlets is also possible, although not preferred. For counting beadlets, more sophisticated equipment is needed.

Claims

Claims 1. Multiparticulate solid oral dosage form comprising (i) an ester of vitamin E and (ii) statin or a pharmaceutically acceptable salt thereof.

2. Multiparticulate solid oral dosage form according to claim 1, wherein said multiparticulate solid oral dosage form is a capsule or a Multiple-Unit Pellet System (MUPS) tablet, with the proviso that said multiparticulate solid oral dosage form comprises less than 280 IU vitamin E, preferably less than 200 IU vitamin E.

3. Multiparticulate solid oral dosage form according to claim 2, wherein said multiparticulate solid oral dosage form comprises particles which have an average particle size D(v, 0.5) of at least 200 µm when measuring MIE volume distribution by laser diffraction using a Malvern Mastersizer® 2000 apparatus, and/or wherein the particles of said multiparticulate solid oral dosage form are beadlets.

4. Multiparticulate solid oral dosage form according to claim 1, wherein said multiparticulate solid oral dosage form comprises at least 280 IU, preferably at least 300 IU, more preferably at least 350 IU vitamin E and most preferably at least 400 IU vitamin E, with the proviso that said multiparticulate solid oral dosage form is neither a capsule nor a Multiple-Unit Pellet System (MUPS) tablet. 5. Multiparticulate solid oral dosage form according to claim 4, wherein said multiparticulate solid oral dosage form is a stick-pack that comprises particles which have an average particle size D(v, 0.

5) of at least 200 µm when measuring MIE volume distribution by laser diffraction using a Malvern Mastersizer® 2000 apparatus, and/or wherein said multiparticulate solid oral dosage form is a stick-pack that comprises beadlets.

6. Multiparticulate solid oral dosage form according to claim 4, wherein said multiparticulate solid oral dosage form is a sachet that comprises minitablets, and wherein said sachet comprises preferably at least 100 minitablets, and wherein said minitablets have a diameter of preferably less than 4 mm, more preferably less than 3.5 mm, even more preferably less than 3 mm and most preferably less than 2.5 mm.

7. Multiparticulate solid oral dosage form according to claim 6, wherein said sachet comprises two or more varieties of minitablets, and wherein the minitablets of a first variety comprise statin or a pharmaceutically acceptable salt thereof, and wherein the minitablets of a second variety comprise an ester of vitamin E.

8. Multiparticulate solid oral dosage form according to claim 7, wherein the minitablets of said first variety further comprise an ester of vitamin E, and/or wherein the minitablets of said second variety are free of statins and free of pharmaceutically acceptable salts thereof.

9. Multiparticulate solid oral dosage form according to any one of the preceding claims, wherein said ester of vitamin E is vitamin E acetate and is preferably dl-α-tocopheryl acetate, and/or wherein said multiparticulate solid oral dosage form comprises a pharmaceutically acceptable salt of a statin being preferably rosuvastatin or atorvastatin.

10. Multiparticulate solid oral dosage form according to any one of the preceding claims for use in the treatment of a patient who is in need of an HMG-CoA reductase inhibitor and/or who is suffering from diabetes.

11. Multiparticulate solid oral dosage form for use according to claim 10, wherein said patient is haptoglobin 2-2 genotype and/or haptoglobin 2-2 phenotype.

12. Multiparticulate solid oral dosage form for use according to claim 10 or 11, wherein said patient is member of a population group whose prevalence of haptoglobin 2-2 genotype is at least 40%, and/or wherein said patient is of Chinese descent or is of Malay descent or is of Indian descent.

13. Use of minitablets or beadlets for manufacturing a multiparticulate solid oral dosage form that comprises (i) an ester of vitamin E and (ii) statin or a pharmaceutically acceptable salt thereof.

14. Method of manufacturing a multiparticulate solid oral dosage form that comprises (i) at least 280 IU vitamin E and (ii) statin or a pharmaceutically acceptable salt thereof statin, wherein minitablets are filled into a sachet.

15. Method according to claim 14, wherein a device is used for counting minitablets, and wherein said device is preferably a dosing disc.