Patent Grant
8663194
The present invention relates to systems, methods, and devices for the ocular delivery of an active agent into a subject's eye. Accordingly, the present invention involves the fields of chemistry, materials and polymer science, drug delivery, pharmaceutical sciences, and medicine, particularly ophthalmology.
Age-related macular degeneration and glaucoma are two of the leading causes of blindness in the United States and across the world. Present glaucoma therapies generally require polypharmacy, where subjects are often prescribed several topical agents that must be applied to the eye with varying frequencies, in some cases up to 3 or 4 times a day. These dosing regimens are often difficult for subjects to consistently follow, and many individuals progress to needing surgical treatments such as intraocular shunts or trabeculectomies, which have significant attendant complications.
Subjects having macular degeneration are often required to have monthly intravitreal injections. Such injections are painful and may lead to retinal detachment, endophthalmitis, and other complications. Furthermore, these injections are generally performed only by retinal surgeons, a small fraction of the ophthalmic community, producing a bottleneck in eye care delivery and increased expense. Other chronic eye diseases requiring indefinite injections include diabetic retinopathy, uveitis, and retinal vascular occlusions.
These drawings merely depict exemplary embodiments of the present invention and they are, therefore, not to be considered limiting of its scope. It will be readily appreciated that the components of the present invention, as generally described and illustrated in the figures herein, could be arranged, sized, and designed in a wide variety of different configurations.
The following detailed description of exemplary embodiments of the invention makes reference to the accompanying drawings, which form a part hereof and in which are shown, by way of illustration, exemplary embodiments in which the invention may be practiced. While these exemplary embodiments are described in sufficient detail to enable those skilled in the art to practice the invention, it should be understood that other embodiments may be realized and that various changes to the invention may be made without departing from the spirit and scope of the present invention. Thus, the following more detailed description of the embodiments of the present invention is not intended to limit the scope of the invention, as claimed, but is presented for purposes of illustration only and not limitation to describe the features and characteristics of the present invention, to set forth the best mode of operation of the invention, and to sufficiently enable one skilled in the art to practice the invention. Accordingly, the scope of the present invention is to be defined solely by the appended claims.
It must be noted that, as used in this specification and the appended claims, the singular forms “a,” “an,” and “the” include plural referents unless the context clearly dictates otherwise. Thus, for example, reference to “a drug” includes reference to one or more of such drugs, “an excipient” includes reference to one or more of such excipients, and “filling” refers to one or more of such steps.
In describing and claiming the present invention, the following terminology will be used in accordance with the definitions set forth below.
As used herein, “active agent,” “bioactive agent,” “pharmaceutically active agent,” and “drug,” may be used interchangeably to refer to an agent or substance that has measurable specified or selected physiologic activity when administered to a subject in a significant or effective amount. These terms of art are well-known in the pharmaceutical and medicinal arts.
As used herein, “formulation” and “composition” may be used interchangeably herein, and refer to a combination of two or more elements, or substances. In some embodiments a composition can include an active agent, an excipient, or a carrier to enhance delivery, depot formation, etc.
As used herein, “subject” refers to a mammal that may benefit from the administration of a composition or method as recited herein. Examples of subjects include humans, and can also include other animals such as horses, pigs, cattle, dogs, cats, rabbits, aquatic mammals, etc.
As used herein, the terms “reservoir” and “active agent reservoir” may be used interchangeably, and refer to a body, a mass, or a cavity that can contain an active agent. As such, a reservoir can include any structure that may contain a liquid, a gelatin, a sponge, a semi-solid, a solid or any other form of active agent known to one of ordinary skill in the art. In some aspects a reservoir can also contain an active agent matrix. Such matrixes are well known in the art.
As used herein, the term “intraocular lens” refers to a lens that is utilized to replace a lens in the eye of a subject. Such intraocular lenses can be synthetic or biological in nature. Furthermore, in some aspects the term “intraocular lens” can also refer to the original natural lens that is associated with the eye.
As used herein, the term “annular housing” can be used to describe a housing of a circular or semicircular nature. Thus an annular housing can be substantially annular, fully annular, fully circular, oval, partially circular, c-shaped, D-shaped, etc. In the present invention, typically the cross-section is also annular.
As used herein, the term “substantially” refers to the complete or nearly complete extent or degree of an action, characteristic, property, state, structure, item, or result. For example, an object that is “substantially” enclosed would mean that the object is either completely enclosed or nearly completely enclosed. The exact allowable degree of deviation from absolute completeness may in some cases depend on the specific context. However, generally speaking the nearness of completion will be so as to have the same overall result as if absolute and total completion were obtained. The use of “substantially” is equally applicable when used in a negative connotation to refer to the complete or near complete lack of an action, characteristic, property, state, structure, item, or result. For example, a composition that is “substantially free of” particles would either completely lack particles, or so nearly completely lack particles that the relevant effect would be the same as if it completely lacked particles. In other words, a composition that is “substantially free of” an ingredient or element may still actually contain such item as long as there is no measurable effect thereof.
As used herein, the term “about” is used to provide flexibility to a numerical range endpoint by providing that a given value may be “a little above” or “a little below” the endpoint.
As used herein, a plurality of items, structural elements, compositional elements, and/or materials may be presented in a common list for convenience. However, these lists should be construed as though each member of the list is individually identified as a separate and unique member. Thus, no individual member of such list should be construed as a de facto equivalent of any other member of the same list solely based on their presentation in a common group without indications to the contrary.
Concentrations, amounts, and other numerical data may be expressed or presented herein in a range format. It is to be understood that such a range format is used merely for convenience and brevity and thus should be interpreted flexibly to include not only the numerical values explicitly recited as the limits of the range, but also to include all the individual numerical values or sub-ranges encompassed within that range as if each numerical value and sub-range is explicitly recited. As an illustration, a numerical range of “about 1 to about 5” should be interpreted to include not only the explicitly recited values of about 1 to about 5, but also include individual values and sub-ranges within the indicated range. Thus, included in this numerical range are individual values such as 2, 3, and 4 and sub-ranges such as from 1-3, from 2-4, and from 3-5, etc. This same principle applies to ranges reciting only one numerical value. Furthermore, such an interpretation should apply regardless of the breadth of the range or the characteristics being described.
Any steps recited in any method or process claims may be executed in any order and are not limited to the order presented in the claims unless otherwise stated. Means-plus-function or step-plus-function limitations will only be employed where for a specific claim limitation all of the following conditions are present in that limitation: a) “means for” or “step for” is expressly recited; and b) a corresponding function is expressly recited. The structure, material or acts that support the means-plus function are expressly recited in the description herein. Accordingly, the scope of the invention should be determined solely by the appended claims and their legal equivalents, rather than by the descriptions and examples given herein.
Intraocular Drug Delivery Device
An intraocular drug delivery device can provide improved ophthalmic drug delivery by alleviating the need for multiple injections or complex eyedrop regimens by providing an intra-capsular reservoir which is implantable and refillable by a general ophthalmologist. Further, the device can deliver a variety or combination of different medicines.
A novel intraocular drug delivery device, system, and associated methods for providing sustained release of ocular active agents for extended periods of time are disclosed and described. One problem with many eye diseases such as Age-related Macular Degeneration (AMD) is the constant need for a subject to receive painful ocular injections, which have significant risks of retinal detachment, vitreous hemorrhage, and endophthalmitis. The intraocular drug delivery device allows for sustained release of an active agent over time, thus eliminating the need for frequent ocular injections. Additionally, the intraocular drug delivery device can be refillable, thus reducing the frequency of invasive ocular procedures for subjects having disorders such as AMD. Depending on the active agent being used and the configuration of the device, the time between refilling procedures can be extended to every 3 months, 6 months, a year or more.
In some aspects, the device can be implantable during cataract surgery, essentially “piggybacking” on the cataract extraction, and thus eliminating the need for additional surgical procedures. One benefit to “piggybacking” on the cataract extraction is the ability to deliver steroids, antibiotics, and various non-steroidal agents directly to the eye after surgery, thus helping to minimize complications such as cystoid macular edema. Such an annular housing can improve lens capsule stability in subjects having unstable capsules and prevent posterior capsule opacification and capsular fibrosis by inhibiting lens epithelial cell migration from the anterior to posterior capsule.
An injection to fill or refill the device could be accomplished through existing cataract surgical incisions for those subjects that received the device during a cataract surgery. Such a refilling procedure may thus reduce the level of pain and risk experienced by a subject as compared to traditional intravitreal injections. In other aspects, the device can be implanted in a surgery that is separate from a cataract procedure, e.g., subsequent to a previous cataract extraction with reopening of the lens capsule.
It should be noted that neovascularization is a key pathobiological process in a variety of eye diseases, such as AMD, proliferative diabetic retinopathy, vascular occlusive disease, and radiation retinopathy. Additionally, the incidence of glaucoma is increasing worldwide. Many other disorders, including severe uveitis and geographic atrophy in AMD, can be treated using such an intraocular drug delivery device. Such a refillable, generally sutureless, anterior segment drug delivery device thus has great potential to improve the quality of life for subjects.
Accordingly, the present invention provides systems, devices, and associated methods for the delivery of active agents into the eye of a subject. In one aspect, as is shown in
The device can further include a semipermeable membrane 16 operatively coupled to the active agent reservoir 14, where the semipermeable membrane 16 is configured to allow diffusion of an active agent from the active agent reservoir 14. Additionally, a valve 18 can be operatively coupled to the active agent reservoir 14 such as along a wall thereof. The valve 18 can be oriented, sized and designed to allow filling of the active agent reservoir 14 with an active agent. The reservoir or shell of the device can be rigid or inflatable and flexible In one specific aspect the active agent reservoir contains at least one active agent. In another aspect the active agent reservoir contains an active agent matrix. Furthermore, manipulation handles 19 such as eyelets or hooks can be optionally included in the housing to facilitate manipulation and placement of the delivery device.
In one aspect, the intraocular device can additionally include a radiofrequency transducer battery source coupled to a biosensor 39. Biosensors can include pressure or molecular biosensors. Such a biosensor 39 can be used to detect intraocular levels of analytes such as glucose, VEGF, disease biomarkers, and delivered active agent to name a few. The biosensor 39 can also be used to detect and monitor intraocular pressure using a pressure transducer. One example of such a pressure sensor transducer is a flexible structure that changes volume in response to changes in intraocular pressure. The transducer can include a parallel plate capacitor and a discrete inductor connected in series to form an L-C circuit. As pressure surrounding the plates changes, separation of the capacitor plates also changes which affects the resonant frequency of the L-C circuit. Other transducers can also be used.
The active agent delivery devices of the present invention can optionally contain additional/separated reservoirs for the delivery of additional active agents or other desired therapeutically beneficial substances. In one aspect, for example, the device can include at least one secondary active agent reservoir disposed within the annular housing. Corresponding refill valves can also be added for each reservoir. In one specific aspect, the at least one secondary active agent reservoir contains at least one active agent. It should be noted that the secondary active agent reservoir can contain an active agent that is the same or different from the active agent contained in the active agent reservoir. Individual reservoirs can be segregated by impermeable walls or merely by providing an adjacent drug matrix. Furthermore, in one optional aspect the device can include an osmotic pump 40 operatively coupled to the active agent reservoir, where the osmotic pump 40 is configured to facilitate delivery of an active agent from the active agent reservoir.
Numerous physical configurations for the annular housing can be suitable. In one aspect, for example, the annular housing 12 can form an incomplete circle such as a C-shape, as is shown in
Various materials are contemplated for use as the annular housing that can securely hold the various components of the device. It can be additionally beneficial to utilize materials that provide some level of flexibility to avoid damage or irritation to the eye surface. Any material having properties beneficial to the construction of such a device would be considered to be within the scope of the present invention. For example, the housing material can include, without limitation, plastics or polymers such as Teflon, nylons, polyesters, polyimides, polyurethanes, polyethylenes, polycarbonates, silicone, polymethylmethacrylate, acrylic polymers, polypropylene, metals such as titanium, composites, etc.
Additionally, semipermeable membranes are well known in the art, and numerous materials can be suitable for use depending on the nature of the annular housing material and the active agent(s) being used. In one aspect, however, the semipermeable membrane can include materials such as, but without limitation, polyvinyl alcohols, ethylvinyl alcohols, cellulose esters, polypropylenes, and other semipermeable materials that exhibit ocular biocompatibility. In one specific aspect, the semipermeable membrane can be a cellulose ester. Additionally, the semipermeable membranes can be hydrophilic or amphiphilic or hydrophobic. In one specific aspect, the semipermeable membrane can be hydrophilic.
The pore size of a semipermeable membrane can vary depending on the semipermeable membrane material, active agent being utilized, and the desired permeability kinetics. In one aspect, for example, the pore size can be from about 5 nm to about 200 nm. In another aspect, the pore size can be from about 10 nm to about 100 nm. In yet another aspect, the pore size can be from about 10 nm to about 40 nm. In a further aspect, the pore size can be from about 20 nm to about 100 nm. In yet a further aspect, the pore size can be from about 20 nm to about 30 nm, and in one specific aspect the pore size can be about 25 nm. Further, larger pores of 100 nm to 10 microns can also be made. Such pores can be formed, for example, using lasers.
The semipermeable membrane can be formed and designed for a given use. For example, the pore size and exposed surface area over which the membrane covers the housing can be varied based on desired rates of delivery, active agent size, and other factors. In one aspect, the semipermeable membrane can be a “window” portion of the device housing as is shown in
As has been described, in one aspect the reservoir can contain the active agent in the active agent reservoir in a substantially liquid or viscous form. In another aspect, the active agent can reside in a drug matrix within the active agent reservoir. Drug matrixes are well known in the art, and can include a variety of polymeric and non-polymeric materials. Specific non-limiting examples of suitable matrix materials include biodegradable polymers (e.g. PLGA, albumin), colloidal suspensions, nanoparticles, microparticles, microspheres, nanospheres, hydrogels, purites, polycarbophil, solid matrix, and the like. Additionally, the active agent can be included in the reservoir in any form, including, without limitation, a liquid, a sponge, a gelatinous, a semi-solid, or a solid form. Although numerous active agents are known for the treatment of various eye conditions, a few examples used in the treatment or prophylaxis of eye diseases such as AMD (neovascular form or atrophic form), glaucoma, diabetic retinopathy, Retinopathy of Prematurity, uveitis, corneal transplant rejection, capsular fibrosis, posterior capsule opacification, retinal vein occlusions, infections, and the like, can be treated with non-limiting active agents such as bevacizumab (Avastin®), Timolol, Latanoprost, Brimonidine, Nepafenac, and ranibizumab (Lucentis®). Other non-limiting examples of active agents include antibiotics, prednisolone, fluocinolide, and the like. Treatment regimens can additionally include anti-VEGF aptamers such as pegaptanib (Macugen®), anti-VEGF Fab fragments such as ranibizumab (Lucentis®), integrin antagonists, various photodynamic therapies, and the like.
A variety of valve devices are contemplated and any such material or device that allows filling of a drug reservoir while also preventing undesirable egress of material through the valve should be considered to be within the present scope. In one aspect, for example, the valve can be configured as a slit in a membrane that functions to contain the active agent within the reservoir while allowing a needle to be inserted through the slit. In another aspect, the valve can be an elastomeric material that allows access of a needle and reseals once the needle is withdrawn, e.g. silicone elastomer or polyurethane rubber. In this embodiment, the device can be entirely made of an elastomeric material such that the annular housing also serves as the valve. The location of filling can then be chosen by considerations of convenience regardless of the orientation of the device and/or patient. Further, this option can be particularly desirable for single use bioerodible configurations. In such cases, the drug reservoir can be filled during manufacture, before insertion or after insertion. Alternatively, the elastomeric material can form a portion of the annular housing surface as with other valve options described herein. In yet another aspect, the valve can be a one-way tricuspid valve that allows a reservoir to be easily refilled. In a further aspect, the valve can be a hinged valve. Such passive microvalves can be beneficial in easing manufacturing complications and provide sufficient barrier to loss of materials from within the reservoir. In yet another aspect, the valve can incorporate a hinged door design to allow access for filling the reservoir. Furthermore, the valve can be of a variety of sizes, depending on the intended use and configuration of a filling apparatus, such as a needle or a cannula. In one aspect, the valve diameter can be about 0.016 inches to allow access of a standard ophthalmic cannula. The valve can incorporate a docking system to enable capture and stabilization of the device by a cannulation system immediately prior to filling or refilling.
There are several optional embodiments for manufacture of the delivery system. As previously mentioned, the semipermeable membrane can also serve as the housing. The valve can be placed in the interior of the device and bonded, molded and/or melted to the membrane in a desired location. If the semipermeable membrane is not the housing, the valve can be attached to either the semipermeable membrane or the housing chemical and/or photoactivated bonding, molding, lamination, and/or melting. Bonding can include a biocompatible adhesive or a chemical activation step to encourage covalent attachment between the components. The semipermeable membrane can be placed in windows of the housing and bonded, melted and/or molded to the housing. The housing can be created either by molding it around a preformed structure (such as a wire), or by creating two mirror-image half structures (such as a sandwich structure) and then bonding them together to form a hollow interior structure. Techniques such computer controlled knife plotters, hot embossing, laser ablation, soft lithography, injection molding, and the like can be used to form a suitable mold and/or the housing. One optional manufacturing method is a PDMS tape method which involves cutting PDMS coated double-sided tape with a knife plotter. The membrane can be integrated and sealed to the housing any number of techniques including, but not limited to, glue or clamping with micro stereo lithography, electrochemical wet etching, deep reactive ion etching, ion beam lithography, and the like.
Another aspect of the present invention provides a system for delivering an active agent into an eye of a subject. As is shown in
Yet another aspect of the present invention provides a method of delivering an active agent into an eye of a subject. Such a method can include performing a cataract removal surgery on the eye of the subject, further including removing an existing lens from the eye of the subject, inserting an intraocular lens into the eye of the subject, and associating a device as described herein with the intraocular lens such that the annular housing at least partially encircles a line of sight of the intraocular lens. The delivery device may be attached or detached from an intraocular lens. The delivery device can be associated by actual contact or sufficient proximity to allow effective diffusion of active agent to target areas of the eye. The delivery device can itself be a biodegradable matrix or a reservoir system. A biodegradable system would have value in routine cataract surgery to enable short-term/time-limited delivery of postoperative medicines which would other require eyedrop usage by the patient. The lens that is removed can be the original natural lens of the eye, or it can be a lens that was previously inserted into the eye as a result of a prior procedure.
Numerous methods of associating the device into the eye are contemplated. For example, in one aspect, the annular housing can be associated with the intraocular lens prior to inserting the intraocular lens into the eye. In such cases it would be necessary to configure the annular housing to comply with any requirements of the surgical procedure. For example, cataract surgeries are often performed through a small incision. One standard size incision is about 2.75 mm; although this device can be compatible with smaller or larger incision sizes as well. As such, the intraocular lens assembly can be shaped to allow insertion through this small opening. Thus the active agent delivery device must also be configured to be inserted with the intraocular lens assembly, e.g. by shape and choice of resilient and flexible material for the housing. Additionally, the active agent delivery device can also be physically coupled or decoupled to the intraocular lens assembly prior to insertion of the assembly into the eye. In another aspect, the annular housing can be associated with the intraocular lens assembly following insertion of the lens into the eye. The capsular bag can be readily reopened for a patient having prior cataract surgery. Thus, the insertion of the delivery device can be performed immediately prior to insertion of an intraocular lens or later in time as a separate procedure.
In another aspect, the method can further include orienting the valve with respect to the eye to allow external access for filling the active agent reservoir. The active agent reservoir can be filled prior to insertion into the eye, or the reservoir can be filled following insertion into the eye. Regarding the initial insertion, certain configurations of annular housings can preclude inserting an annular housing having a filled reservoir into the eye due to folding limitations associated with a full active agent reservoir. In such circumstances, it can be beneficial to fill the reservoir following insertion into the eye. Additionally, a depleted active agent reservoir can be refilled through the valve for reuse of the device. As such, it can be beneficial to orient the valve into a configuration that allows easy access for filling. In particular, the devices of the present invention can allow for refilling via through an edge of the cornea anterior segment of the eye rather than via the vitreous or posterior segment of the eye. Depending on the size of the reservoir and the nature of the active agent, an active agent delivery device can deliver a drug for up to 6 months or up to a year before refilling is required. The specific delivery rate and time can be affected by the size of the reservoir, the type of membrane, choice of drug matrix, and/or a variety of other factors. Refill cannulas and/or pre-packaged drug-matrix-reservoir materials can also be prepared to compliment extended use of the inserted delivery device.
In another aspect, the device may be rigid or inflatable, i.e., the device can be collapsed prior to insertion into the lens capsule and then inflated with the drug matrix in situ.
A standard clear-corneal phacoemulsification with intraocular lens (Acrysof® SA60AT; Alcon®) implantation was performed on 35 rabbits. At the time of each surgery, an intraocular device containing an active agent was inserted into a lens capsule of each rabbit. The rabbits were divided into 4 groups, depending on the active agent in the intraocular device. Devices were loaded with 5-15 mg of either bevacizumab (Avastin®), Timolol, Brimonidine, or Latanoprost. Each group was evaluated to determine the intraocular device and lens stability, capsular fibrosis, and healing of cataract wounds and anterior segment. A subgroup of eyes was evaluated weekly for 4 weeks for inflammation and harvested at 1 month for histopathologic evaluation of capsular and CDR integrity.
The surgery and setup as described in Example 1 was repeated, with the exception that aqueous and vitreous taps were performed biweekly and assayed for drug concentrations with HPLC and/or ELISA. In each drug group, half of the eyes were harvested at one month and the other half at two months. This was accomplished as follows: immediately after sacrificing the rabbit and enucleating the eye, the eye was frozen in liquid nitrogen to prevent perturbation and redistribution of drug in eye tissues. The eye was then dissected into 3 parts (aqueous humor, vitreous and retina/choroid layer) to evaluate anatomic toxicity and tissue drug concentration. The intraocular device was retrieved and assessed for remaining drug amounts. The distribution profile of the intraocular device was compared with the conventional intravitreal injection of 2.5 mg/0.1 cc Avastin® (bevacizumab) for direct comparison of the different delivery methods.
At 2 and 4 months, eyes from the remaining subgroups of rabbits were enucleated, fixed by 10% formalin, embedded in paraffin, step sectioned, stained by hematoxyline and eosin (H & E), and examined for histological changes.
Three intraocular devices were implanted into eyes of New Zealand white rabbits under general anesthesia after lens extraction (phacoemulsification technique). Two of the devices were loaded with Avastin® (bevacizumab) and one was loaded with the contrast agent gadolinium-labeled albumin (Galbumin™) as a control. Proper intraocular device position was verified by MRI as well as clinical examination.
The rabbits were sacrificed and the eyes are removed and assayed after 1 week post implantation. Bevacizumab (Avastin®) was detected by ELISA in the retina and vitreous at concentrations of 24-48 mcg/mL, and was not present in the control rabbit eye.
It should be understood that the above-described arrangements are only illustrative of application of the principles of the present invention. Numerous modifications and alternative arrangements may be devised by those skilled in the art without departing from the spirit and scope of the present invention. Thus, while the present invention has been described above with particularity and detail in connection with what is presently deemed to be the most practical and preferred embodiments of the invention, it will be apparent to those of ordinary skill in the art that numerous modifications, including, but not limited to, variations in size, materials, shape, form, function and manner of operation, assembly and use may be made without departing from the principles and concepts set forth herein.
This application is a continuation-in-part of International Application No. PCT/US2009/043566, filed May 12, 2009, which claims priority to U.S. Provisional Application No. 61/052,507, filed May 12, 2008, which are each incorporated herein by reference.
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| Number | Date | Country |
|---|---|---|
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| WO 2007035473 | Mar 2007 | WO |
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| Entry |
|---|
| PCT Application PCT/US2009/043566; filed May 12, 2009; Balamurali K. Ambati; ISR mailed Dec. 23, 2009. |
| Number | Date | Country | |
|---|---|---|---|
| 20110282328 A1 | Nov 2011 | US |
| Number | Date | Country | |
|---|---|---|---|
| 61052507 | May 2008 | US |
| Number | Date | Country | |
|---|---|---|---|
| Parent | PCT/US2009/043566 | May 2009 | US |
| Child | 12945428 | US |
