This invention relates to a multilayer drug delivery system. More particularly, the invention relates to a multilayer system that includes a barrier that separates layers in the system used in transdermal drug delivery.
Transdermal devices for the delivery of biologically active agents have been used for maintaining health and treating therapeutically a wide variety of ailments. For example, analgesics, steroids, etc., have been delivered with such devices. Such transdermal devices include patches in which a biologically active agent is delivered to the body tissue passively without the use of an additional energy source. Many such devices have been described, for example, in U.S. Pat. Nos. 3,598,122, 3,598,123, 4,379,454, 4,286,592, 4,314,557, 4,568,343, and U.S. Publication No. 20030026829, all of which are incorporated herein by reference.
A transdermal patch is typically a small adhesive bandage that contains the drug to be delivered. A simple type of such transdermal patches is an adhesive monolith including a drug-containing reservoir disposed on a backing. The reservoir is typically formed from a pharmaceutically acceptable pressure sensitive adhesive. In some cases, the reservoir can be formed from a non-adhesive material, with the skin-contacting surface having a thin layer of a suitable adhesive. The rate at which the drug is administered to the patient from these patches can vary due to normal person-to-person and skin site-to-skin site variations in the permeability of skin to the drug.
More complex patches can be a multilaminate or can include drug reservoir layers in the patches. Exemplary transdermal drug delivery systems are illustrated by the embodiments shown in
In the embodiment shown in
In an alternative prior device shown in
Although the transdermal delivery of therapeutic agents has been the subject of intense research and development for over 30 years, only a relatively small number of drug molecules are suitable for transdermal delivery. For effective delivery, a delivery rate that is therapeutically effective is needed. Many factors affect the delivery rate. The thickness and concentration of the drug reservoir and the layers adjacent to the drug reservoir, as well as the rheological properties of the layers are some of these factors.
Often, due to the chemical as well as physical characteristics (e.g., rheological parameters), a system may change over time, e.g., during a period of storage. For example, the matrix formulations typically cold flow over time. The extent of cold flow can be affected by the fluid characteristics of the reservoir matrix, as well as physical forces that may be applied on the device, for example, by the protective pouch pressing on the reservoir. Typically, the drug delivery patches are made by cutting multiple layers simultaneously, resulting in the layers having the same planer size and their edges being flush on the side of the patch. Thus, for typical patch devices like those shown in
Such cold flow is particularly troublesome for devices having an antagonist along with an agonist since the migration of antagonist into the agonist reservoir (or vice versa) is highly desirable. For example, in a narcotic analgesic delivery device, if an antagonist is present for deterring abuse, under normal use antagonist leakage to contact the agonist is unwanted.
Drugs such as narcotic analgesics are a staple for treatment and afford great benefit to patients, e.g., terminal cancer patients. However, the potential for abuse of narcotic analgesics by intranasal, oral or parenteral routes is well known. Diversion and abuse of opioids may take several different forms. For example the medication may be used by a person for whom it is not intended, i.e., diversion, or in amounts and/or frequency greater than prescribed, either by the originally prescribed route (e.g., oral or transdermal) or by an alternate route (e.g. parenteral, intravenous, or intranasal). In order to prevent abuse of these substances, it has been proposed to provide dosage forms which combine the abusable substance with an amount of an antagonist for the abusable substance sufficient to eliminate the “high” associated with abuse of the substance without eliminating the other therapeutic benefits for which the drugs are intended to be administered. See, for example, U.S. Pat. Nos. 3,773,955; 3,493,657; 4,464,378; 4,457,933; 4,626,539; 4,806,341; 4,935,428; 5,149,538; and 5,236,714; and International Publication No. WO 01/58451 A1, all of which are incorporated herein by reference. See also, Talwin; Levine J. D., et al, “Potentiation of pentazocine analgesia by low-dose naloxone”, J Clin Invest 1988; 82:1574-1577; Crain S M, Shen F-K, “Antagonist of excitatory opioid receptor function enhance morphine's analgesic potency and attenuate opioid tolerance/dependence liability”, Pain 2000; 84:121-131, which are incorporated herein by reference.
Notwithstanding some success, the existing dosage forms have not been entirely satisfactory for reducing the potential for abuse, since the agonist can be extracted from the dosage form for injection, inhalation or ingestion; or the agonist and antagonist may interact resulting in adverse physical and/or chemical interaction, such as undesirable ion exchange or permeation of the antagonist into the narcotic reservoir resulting in systemic delivery of the antagonist.
The exposure of a patient (who legitimately needs the agonist) to antagonist is undesirable. Upon prolonged periods of storage, the risk of antagonist leakage is increased due to the tendency of reservoirs to cold flow. What is needed is a multilayer drug delivery system that is more stable overtime, thus ensuring reliable, predictable delivery of the drug, even for systems that may have been stored for a long period of time.
The present invention provides a method and a device for delivery of biologically active agent or agents for therapeutic effects, especially delivery of the biologically active agents to a subject transdermally through the skin or other body surfaces, wherein the device has an antagonist to the agent or agents. An individual can wear the device adhesively over an extended period of time.
In one aspect, the present invention provides a device for administration of a pharmaceutical agent to an individual at a therapeutically effective rate through a body surface. The device has a reservoir having a matrix including at least one pharmaceutical agent in the matrix; a backing layer attached to the reservoir and is substantially impermeable to the agent. There is also a second matrix in which the agent is diffusible and a barrier layer disposed between the reservoir and at least part of the second matrix. The barrier layer has a barrier outer perimeter and the reservoir has a reservoir outer perimeter such that the barrier layer outer perimeter is larger than the reservoir outer perimeter. The barrier layer is made of a material that is substantially impermeable, preferably completely impermeable, to the agent. An antagonist-containing reservoir is present in the device.
The barrier layer, having an outer perimeter larger than the outer perimeter of a drug reservoir attached to it, advantageously prevents any migration of the drug reservoir from crossing over to another matrix layer.
The present invention is particularly useful in transdermal systems in which the reservoir material (matrix) is not so stiff that it is not flowable when pinched. In a method of making a patch with the reservoir material on the backing layer in which the two are cut to a desired size and shape, such as by die cutting, in which at least one (sometimes all) edge of the backing is flush with at least one edge of the reservoir matrix, some of the reservoir matrix material may attach to the edges of the backing layer. The edges of the reservoir and the backing layer are flush in
In an aspect, the barrier layer is a frame-shaped layer. The frame-shaped layer has a window through which a matrix layer having some adhesive property can attach to a different layer, for example, the backing layer of another matrix layer. Since the reservoir material is fluid, this window enables the reservoir layer to be smaller in outer perimeter than the barrier frame and still be transferable and processed in the manufacturing process. In this way, a mechanized production line in which rolls (or webs) of materials are processed into final products can be implemented.
In an embodiment, the antagonist layer is encircled laterally by at least one barrier frame. In this manner, even if the antagonist layer has any cold flow, the antagonist will not migrate to an area that can come into contact with patient body surface or to an agonist layer.
The present invention is illustrated by way of example in embodiments and not limitation in the figures of the accompanying drawings in which like references indicate similar elements. The figures are not shown to scale unless indicated otherwise in context.
The present invention relates to delivery of pharmaceutical agents through a body surface (e.g. skin) involving the use of an reservoir that incorporates pharmaceutical agent (or drug) and optionally other ingredients and having an adhesive layer to maintain the delivery system on a body surface of an individual. In the present invention, a barrier layer is used to prevent the reservoir material with drug in its matrix to come into contact with another matrix that contains an antagonist in the device.
In describing the present invention, the following terms are to be used as indicated below. As used in this specification and the appended claims, the singular forms “a,” “an” and “the” include plural references unless the content clearly dictates otherwise.
As used herein, the term “transdermal” refers to the use of skin, mucosa, and/or other body surfaces as a portal for the administration of drugs by topical application of the drug thereto for passage into the systemic circulation. Such passage can take place through intact surface (such as skin) without wounds or punctures.
“Biologically active agent” is to be construed in its broadest sense to mean any material that is intended to produce some biological, beneficial, therapeutic, or other intended effect, such as enhancing permeation, relief of pain.
As used herein, the term “drug” refers to any material that is intended to produce some biological, beneficial, therapeutic, or other intended effect, such as relief of pain.
As used herein, the term “therapeutically effective” refers to the amount of drug or the rate of drug administration needed to produce the desired therapeutic result.
For the sake of clarity and illustration the following will refer to the matrix layer 6 as an adhesive layer. A barrier frame 14 is disposed between the adhesive layer 6 and the backing layer 2 of the reservoir 3.
Medical devices and drugs typically have a time period before the expiration of which the device or drug is preferably to be used. For example, the regulatory filings for a medical device or drug at a relevant governmental agency would indicate such time periods. Such time periods can be considered to be the shelf life of a medical device or drug.
The overlay adhesive layer 6 is larger in area and in outer perimeter than the barrier frame 14. Thus, the overhang portion 8 outside of the frame 14 will provide adhesion to the body surface. The backing layer 10 is hidden by the overlay adhesive layer 6 and is therefore not shown. The figures are not shown to scale. In fact, the thicknesses of the various layers are relatively thin such that the device is flexible and generally flat when laid on a flat surface. Therefore, when pressure is applied to the flat surface of the device, either during manufacture or in use, the void area in the window is substantially filled so that the adhesive layer 6 attaches to the backing layer 2 within the window.
In
The second reservoir layer 28 has a ring of exposed area 40 encircling the outer perimeters of the first barrier frame 34 and the first reservoir layer 23 such that upon application to the body surface at least a portion of the ring of exposed area 40 will contact the body surface for delivery of an agent from the second reservoir layer 28 to the tissue through the body surface. The agent will migrate from the more central part of the second reservoir layer 28 to the exposed area as the drug concentration changes upon delivery of the agent.
A second barrier frame 42 is disposed between and attached to the backing layer 30 of the second reservoir layer 28 and the overlay adhesive layer 6. Again, the perimeters of theses layers have a cascading relationship similar to the cascading relationship between the second reservoir layer 28, the first barrier frame 34 and the first reservoir layer 23. The overlay adhesive layer 6 has the largest outer perimeter among the matrixes and adhesives.
A method of manufacture and construction for a system containing an occluded counter acting agent (antagonist) as shown in
Fentanyl base would be completely dissolved and mixed in a solution of solvent (such as ethyl acetate) and polyacrylate adhesive such as National Starch DURO-TACK 87-4287. The solution would be formulated so that the concentration of fentanyl would not exceed the solubility of fentanyl in the polymer (about 10%) once the solvent is removed. The solution would be coated to a uniform thickness on a 1-5 mil (0.025 mm-0.125 mm) thick silicone coated polyethylene terapthalate film (PET release coated liner) or similar. The liner and fentanyl polymer solution are passed through a series of ovens to remove the solvent forming a dry uniform film, typically less than 5 mils (0.125 mm) thick. The dried film would then be laminated to a second non-coated PET liner for further processing.
The antagonist layer would be produced by melting a polymer such as ethylene vinyl acetate (EVA-9, EVA-22, EVA-40, etc.), ethylene octene (ENGAGE), or similar elastomeric polymer, and blending in naltrexone-HCl at a concentration of 50-90%. The blend would be mixed to uniformity and extruded between two films such as PET liners, one of which would be release coated.
The two component films would be die cut and assembled on another polyisobutylene (PIB), polyacrylate, or similar adhesive (78) on a EVA/PET, polymer fiber woven, (80) or similar overlay film in a converting operation as follows: Barrier frames (84) would be die cut from a 0.5-5 mil (0.0125 mm-0.125 mm) thick PET film such that the inner (18) and outer edges (16) were respectively slightly larger and smaller than the target matrix area (23,26) and uniformly spaced on the overlay adhesive (78). The naltrexone-EVA (52) on PET film (54) would be die cut to the target size and placed on the adhesive (6) within the inner boundary of the frames (34). The release coated liner would be removed in this assembly step.
The matrix film would be cut to the appropriate length and width (23,26) and placed on top of the barrier frames (34), completely isolating the naltrexone component (52).
If desired, an additional barrier frame can be disposed between the second reservoir layer and the overlay adhesive layer. This is shown in
The drug (pharmaceutical agent) reservoir can be either a single phase polymeric composition or a multiple phase polymeric composition, as discussed earlier. In some embodiments, more than one component, e.g., a drug and a permeation enhancer, is present, and may be in amounts above saturation concentration. Preferably, the whole matrix, with drugs and other optional ingredients, is a material that has the desired adhesive properties, in which case, the reservoir 3 is formed using a pharmaceutically acceptable polymeric material that can provide adhesive property for application to the body surface.
The backing layers may be formed from any material suitable for making transdermal delivery patches, such as a breathable or occlusive material including fabric, polyvinyl acetate, polyvinylidene chloride, polyethylene, polypropylene, polyurethane, polyester, ethylene vinyl acetate (EVA), polyethylene terephthalate (PET), polybutylene terephthalate, coated paper products, aluminum sheet and the like, and a combination thereof. In preferred embodiments, the backing layer includes low density polyethylene (LDPE) materials, medium density polyethylene (MDPE) materials or high density polyethylene (HDPE) materials, e.g., SARANEX (Dow Chemical, Midland, Mich.). The backing layer may be a monolithic or a multilaminate layer. In preferred embodiments, the backing layer is a multilaminate layer including nonlinear LDPE layer/linear LDPE layer/nonlinear LDPE layer. The backing layer preferably has a thickness of about 0.012 mm (0.5 mil) to about 0.125 mm (5 mil); more preferably 0.025 mm (1 mil) to about 0.1 mm (4 mil); even more preferably 0.0625 mm (1.5 mil) to about 0.0875 mm (3.5 mil).
The purpose of the barrier frame is to separate materials, therefore the active compounds, excipients, and polymers within the system should have negligible solubility or permeability in the barrier material. It is desirable for the barrier material to serve as a processing web during assembly, thus mechanical strength (i.e. inelastic) in the web direction may be desirable. Further, the barrier frame may be used as a separating point in some system designs, therefore it may be release coated on one or both sides of the barrier frame. The barrier material can be used with another layer (e.g., as a laminate) of a material that is a less effective barrier without the barrier material.
The barrier material for making the barrier frame can be used for the backing for the antagonist layer and for the backing of the agonist layer. The barrier layer is impermeable to the antagonist and the analgesic; and comprises a material which is insoluble in water, alcohol and organic solvents. The barrier layer can be made from a polymer such as polyolefin laminates (Dow Chemical, Midland, Mich.), acrylonitrile copolymer films (BAREX, BP Chemicals, KoIn, Germany), polyethylnapthalene (PEN), polyethylene terephthalate (PET), polyimide, polyurethane, polyethylene, polyvinyl acetate, polyvinylidene chloride, polybutylene terephthalate, coated paper products, metallized films and glass coated films where these films can include ethylene copolymers such as ethylene-vinyl acetate copolymer (EVA), and combinations thereof. In preferred embodiments, the barrier layer comprises polyester such as PET laminated to a polymer such as polyurethane, polyethylene, and ethylene copolymers. In preferred embodiments, the barrier layer comprises polyester such as PET laminated to ethylene copolymers such as ethylene-vinyl acetate copolymer (EVA). The barrier layer as a single layer or as a multilaminate layer has a thickness of about 0.075 mm (0.3 mil) to about 0.125 mm (5 mil); preferably 0.025 mm (1 mil) to about 0.1 mm (4 mil); more preferably 0.0625 mm (1.5 mil) to about 0.0875 mm (3.5 mil); and even more preferably 0.025 mm (1 mil) to about 0.05 mm (2 mil). The polyethylene or EVA laminated layer of the preferred PET-PE laminates improves the adhesion of the antagonist reservoir to the backing, and serves to prevent the facile removal of the antagonist reservoir from the system by a drug abuse. Other materials can be used, as long as the active agent or permeation enhancers are insoluble in them.
The reservoir or matrix may be formed from drug (or biological active agent) reservoir materials as known in the art. For example, the drug reservoir is formed from a polymeric material in which the drug has reasonable solubility for the drug to be delivered within the desired range, such as, a polyurethane, ethylene/vinyl acetate copolymer (EVA), acrylate, styrenic block copolymer, and the like. In preferred embodiments, the reservoir 3 is formed from a pharmaceutically acceptable pressure sensitive adhesive, preferably an acrylate copolymer-based adhesive, as described in greater detail below.
The adhesive reservoir 3 may be formed from standard pressure sensitive adhesives. Examples of known pressure sensitive adhesives include, but are not limited to, acrylates, polysiloxanes, polyisobutylene (PIB), polyisoprene, polybutadiene, styrenic block polymers, and the like. Examples of styrenic block copolymer-based adhesives include, but are not limited to, styrene-isoprene-styrene block copolymer (SIS), styrene-butadiene-styrene copolymer (SBS), styrene-ethylenebutene-styrene copolymers (SEBS), and di-block analogs thereof. PIB generally has poorer solubility for drugs than acrylate adhesives. Thus, acrylate polymers are preferred as the matrix for drug reservoirs but either PIB or acrylates are preferred as an overlay adhesive layer. The drug reservoir or the matrix layer can have a thickness of 0.025-0.25 mm (1-10 mils), preferably 0.05-0.12 mm (2-5 mils), more preferably 0.05-0.075 mm (2-3 mils).
It is desired that the material for the matrix in the reservoir has a high solubility for the agent to be delivered through the body surface, either for therapeutic drug agents or permeation enhancers to facilitate the delivery. If the reservoir material does not provide adequate adhesiveness for multiple day use, the overlay adhesive layer should be made with an adhesive material that has stronger and sufficient adhesive and cohesive properties for multiple day application.
Preferred materials for making the reservoir or overlay adhesive coating according to the present invention include acrylates, which can be a copolymer of various monomers (“soft” monomer, “hard” monomer, and “functional” monomer) or blends of copolymers. Acrylic polymers provide good solubility for many agents. The acrylic polymers can be composed of a copolymer or terpolymer including at least two or more exemplary components selected from the group including acrylic acids, alkyl acrylates, methacrylates, copolymerizable secondary monomers or monomers with functional groups. Functional monomers are often used to either provide needed functionality or improve cohesive properties through grafting or cross-linking. Examples of functional monomers are acids, e.g. acrylic acid, methacrylic acid and hydroxy-containing monomers such as hydroxyethyl acrylate, hydroxypropyl acrylate, acrylamides or methacrylamides that contain amino group and amino alcohols with amino group protected. Functional groups, such as acid and hydroxyl moieties can also help to increase the solubility of basic ingredients (e.g., drugs) in the polymeric material. Additional useful “soft” and “hard” monomers include, but are not limited to, methoxyethyl acrylate, ethyl acrylate, butyl acrylate, butyl methacrylate, hexyl acrylate, hexyl methacrylate, 2-ethylbutyl acrylate, 2-ethylbutyl methacrylate, isooctyl acrylate, isooctyl methacrylate, 2-ethylhexyl acrylate, 2-ethylhexyl methacrylate, decyl acrylate, decyl methacrylate, dodecyl acrylate, dodecyl methacrylate, tridecyl acrylate, tridecyl methacrylate, hydroxyethyl acrylate, hydroxypropyl acrylate, vinyl acetate, acrylamide, dimethylacrylamide, acrylonitrile, dimethylaminoethyl acrylate, dimethylaminoethyl methacrylate, tert-butylaminoethyl acrylate, tert-butylaminoethyl methacrylate, methoxyethyl acrylate, methoxyethyl methacrylate, and the like. Additional examples of appropriate acrylic adhesives suitable in the practice of the invention are described in Satas, “Acrylic Adhesives,” Handbook of pressure-Sensitive Adhesive Technology, 2nd ed., pp. 396-456 (D. Satas, ed.), Van Nostrand Reinhold, N.Y. (1989). The acrylic adhesives are commercially available (National Starch and Chemical Corporation, Bridgewater, N.J.; Solutia, Mass.). Further examples of acrylate-based adhesives are as follows, identified as product numbers, manufactured by National Starch (Product Bulletin, 2000): DURO-TAK® 87-4098, 87-2287, 87-4287, 87-2051, 87-2052, 87-2054, 87-2196, 87-9259, 87-9261, 87-2979, 87-2510, 87-2353, 87-2100, 87-2852, 87-2074, 87-2258, 87-9085, 87-2525, 87-2825, 87-200A, 87-201A, 87-2194, 87-2677, 87-900A, and 87-9301. DURO-TAK® 87-2287 and 87-4287 both are polymeric adhesive having similar monomer compositions: 5.2 wt % 2-hydroxyethyl acrylate monomer, about 20-40 wt % vinyl acetate, and about 55-75 wt % 2-ethylhexyl acrylate; and these two polymeric adhesives are provided solubilized in ethyl acetate in solids content of about 40-50 wt %. The DURO-TAK® 87-2287 adhesive is also mentioned in U.S. Pat. No. 5,693,335.
The acrylic polymers can include cross-linked and non-cross-linked polymers. The polymers can be cross-linked by known methods to provide the desired polymers. In some typical embodiments, the adhesive at the stage of application to the skin is an acrylate adhesive having a glass transition temperature (Tg) less than −10° C., preferably −10° C. to about −30° C., more preferably having a Tg of about −20° C. to about −40° C. The molecular weight of the acrylate adhesive, expressed as weight average (MW), preferably ranges from 25,000 to 10,000,000, further preferably from 50,000 to about 3,000,000 and more preferably from 100,000 to 1,000,000 prior to any cross-linking reactions. Upon cross-linking the MW can further increase, as known to those involved in the art of polymer chemistry.
As aforementioned, the reservoir(s) can include a multiple phase composition or a single phase polymeric composition, free of undissolved components, containing an amount of the drug sufficient to induce and maintain the desired therapeutic effect in a human for at least three days. The present invention has utility in connection with the delivery of agonists and additional drugs within the broad class normally delivered through body surfaces and membranes, including skin. In general, this includes therapeutic agents in all of the major areas, including, but not limited to, ACE inhibitors, adenohypophoseal hormones, adrenergic neuron blocking agents, adrenocortical steroids, inhibitors of the biosynthesis of adrenocortical steroids, alpha-adrenergic agonists, alpha-adrenergic antagonists, selective alpha-two-adrenergic agonists, analgesics, antipyretics and anti-inflammatory agents, androgens, local and general anesthetics, antiaddictive agents, antiandrogens, antiarrhythmic agents, antiasthmatic agents, anticholinergic agents, anticholinesterase agents, anticoagulants, antidiabetic agents, antidiarrheal agents, antidiuretic, antiemetic and prokinetic agents, antiepileptic agents, antiestrogens, antifingal agents, antihypertensive agents, antimicrobial agents, antimigraine agents, antimuscarinic agents, antineoplastic agents, antiparasitic agents, antiparkinson's agents, antiplatelet agents, antiprogestins, antischizophrenia agents, antithyroid agents, antitussives, antiviral agents, atypical antidepressants, azaspirodecanediones, barbituates, benzodiazepines, benzothiadiazides, beta-adrenergic agonists, beta-adrenergic antagonists, selective beta-one-adrenergic antagonists, selective beta-two-adrenergic agonists, bile salts, agents affecting volume and composition of body fluids, butyrophenones, agents affecting calcification, calcium channel blockers, cardiovascular drugs, catecholamines and sympathomimetic drugs, cholinergic agonists, cholinesterase reactivators, contraceptive agents, dermatological agents, diphenylbutylpiperidines, diuretics, ergot alkaloids, estrogens, ganglionic blocking agents, ganglionic stimulating agents, hydantoins, agents for control of gastric acidity and treatment of peptic ulcers, hematopoietic agents, histamines, histamine antagonists, hormones, 5-hydroxytryptamine antagonists, drugs for the treatment of hyperlipoproteinemia, hypnotics and sedatives, immunosupressive agents, laxatives, methylxanthines, moncamine oxidase inhibitors, neuromuscular blocking agents, organic nitrates, opiod analgesics and antagonists, pancreatic enzymes, phenothiazines, progestins, prostaglandins, agents for the treatment of psychiatric disorders, retinoids, sodium channel blockers, agents for spasticity and acute muscle spasms, succinimides, thioxanthines, thrombolytic agents, thyroid agents, tricyclic antidepressants, inhibitors of tubular transport of organic compounds, drugs affecting uterine motility, vasodilators, vitamins and the like, alone or in combination. Basic drugs such as opioids (e.g., fentanyl and analogs: alfentanil, carfentanil, lofentanil, remifentanil, sufentanil, trefentanil, and the like), galanthamine (or galantamine), and the salts of such basic drugs are well suited to be incorporated in the matrix with the acrylate polymer. Antagonist drugs for fentanyl, its analogs, and the salts thereof include amiphenazole, naltrexone, methylnaltrexone, naloxone, nalbuphine, nalorphine, nalorphine dinicotinate, nalmefene, nadide, levallorphan, cyclozocine and pharmaceutically acceptable salts thereof. Such antagonists can be included, for example, in a second reservoir layer in the present invention, in which the second reservoir is not in contact of the body surface.
As indicated in the above, in some embodiments, the reservoir or the adhesive may contain additional components such as, additives, permeation enhancers, stabilizers, dyes, diluents, plasticizer, tackifying agent, pigments, carriers, inert fillers, antioxidants, excipients, gelling agents, anti-irritants, vasoconstrictors and other materials as are generally known to the transdermal art. Typically, such materials are present below saturation concentration in the reservoir.
The protective layer (or release liner) can be made of a polymeric material that may be optionally metallized. Examples of the polymeric materials include polyurethane, polyvinyl acetate, polyvinylidene chloride, polypropylene, polycarbonate, polystyrene, polyethylene, polyethylene terephthalate, polybutylene terephthalate, paper, and the like, and a combination thereof. In preferred embodiments, the protective layer includes a siliconized polyester sheet.
As aforementioned, the device can include an antagonist layer protected from exposure and prevented from release until the device is subject to abuse, e.g., by chewing or by extraction. Agonist drugs and antagonist to such agonists are known in the art. Examples of such a device are shown in
Although a drug reservoir can contain solid drug (such as undissolved crystals), the drug reservoir preferably contains a single phase polymeric composition, free of undissolved components, containing an amount of the drug sufficient to induce and maintain analgesia in a human for at least three days. The drug is selected from a group consisting of fentanyl and analogs thereof, such as, alfentanil, carfentanil, lofentanil, remifentanil, sufentanil, trefentanil, and the like. In preferred embodiments, the drug reservoir comprises about 0.05 to about 1.75 mg/cm2 of the drug; preferably about 0.07 to about 1.50 mg/cm2 of the drug; preferably about 0.08 to about 1.25 mg/cm2 of the drug; more preferably about 0.09 to about 1.0 mg/cm2 of the drug; more preferably about 0.1 to about 0.75 mg/cm22 of the drug; and even more preferably about 0.12 to about 0.5 mg/cm2 of the drug. The drug should be soluble in the polymer forming reservoir 3 in a form that is as discussed below. In preferred embodiments, the drug is in the base form and the preferred drugs are fentanyl or sufentanil. In particularly preferred embodiments, the drug reservoir comprises about 0.05 to about 1.75 mg/cm2 of fentanyl; preferably about 0.07 to about 1.50 mg/cm2 of fentanyl; preferably about 0.08 to about 1.25 mg/cm2 of fentanyl; more preferably about 0.09 to about 1.0 mg/cm2 of fentanyl; more preferably about 0.1 to about 0.75 mg/cm2 of fentanyl; and even more preferably about 0.12 to about 0.5 mg/cm2 of fentanyl; wherein fentanyl is in a base form and is completely dissolved. In additionally preferred embodiments, the drug reservoir comprises about 0.05 to about 1.75 mg/cm2 of sufentanil; preferably about 0.07 to about 1.50 mg/cm2 of sufentanil; preferably about 0.08 to about 1.25 mg/cm2 of sufentanil; more preferably about 0.09 to about 1.0 mg/cm2 of sufentanil; more preferably about 0.1 to about 0.75 mg/cm2 of sufentanil; more preferably about 0.12 to about 0.5 mg/cm2 of sufentanil; and even more preferably about 0.25 to about 0.4 mg/cm2 of sufentanil; wherein sufentanil is in a base form and is completely dissolved.
For illustration, the application of a barrier window is described below related to narcotic analgesics. The material forming the agonist reservoir has a solubility for the drug of about 1 wt % to about 25 wt % of the total polymer composition; preferably about 2 wt % to about 15 wt %; more preferably about 4 wt % to about 12 wt % of the total polymer composition; and even more preferably about 6 wt % to about 10 wt % of the total polymer composition. The agonist reservoir, has a thickness of about 0.0125 mm (0.5 mil) to about 0.1 mm (4 mil); preferably about 0.025 mm (1 mil) to about 0.0875 mm (3.5 mil); more preferably 0.0375 mm (1.5 mil) to about 0.075 (3 mil); and even more preferably about 0.04 mm (1.6 mil) to about 0.05 mm (2 mil). In preferred embodiments, the drug is fentanyl, preferably in the base form, wherein the material forming the reservoir 3 has a solubility for fentanyl of about 1 wt % to about 25 wt % of the total polymer composition; preferably about 3 wt % to about 15 wt %; more preferably about 5 wt % to about 12 wt %; and even more preferably about 7 wt % to about 10 wt % of the total polymer composition. The reservoir 3, has a thickness of about 0.0125 mm (0.5 mil) to about 0.1 mm (4 mil); preferably about 0.025 mm (1 mil) to about 0.075 mm (3 mil); more preferably 0.0375 mm (1.5 mil) to about 0.0625 (2.5 mil); and even more preferably about 0.04 mm (1.6 mil) to about 0.05 mm (2 mil).
In another preferred embodiments, the drug is sufentanil, preferably in the base form, wherein the material forming the reservoir has a solubility for sufentanil of about 1 wt % to about 25 wt % of the total polymer composition; preferably about 3 wt % to about 15 wt %; more preferably about 5 wt % to about 12 wt %; and even more preferably about 7 wt % to about 10 wt % of the total polymer composition. The reservoir, has a thickness of about 0.0125 mm (0.5 mil) to about 0.1 mm (4 mil); preferably about 0.025 mm (1 mil) to about 0.075 mm (3 mil); more preferably 0.0375 mm (1.5 mil) to about 0.0625 (2.5 mil); and even more preferably about 0.04 mm (1.6 mil) to about 0.5 mm (2 mil). As mentioned before, the narcotic can be a salt. Other narcotics and their salts, for example, those mentioned above can also be used.
In other embodiments, the agonist reservoir may optionally contain additional components such as, additives, permeation enhancers, stabilizers, dyes, diluents, plasticizer, tackifying agent, pigments, carriers, inert fillers, antioxidants, excipients, gelling agents, anti-irritants, vasoconstrictors and other materials as are generally known to the transdermal art, provided that such materials are present below saturation concentration in the reservoir.
Examples of permeation enhancers include, but are not limited to, fatty acid esters of glycerin, such as capric, caprylic, dodecyl, oleic acids; fatty acid esters of isosorbide, sucrose, polyethylene glycol; caproyl lactylic acid; laureth-2; laureth-2 acetate; laureth-2 benzoate; laureth-3 carboxylic acid; laureth-4; laureth-5 carboxylic acid; oleth-2; glyceryl pyroglutamate oleate; glyceryl oleate; N-lauroyl sarcosine; N-myristoyl sarcosine; N-octyl-2-pyrrolidone; lauraminopropionic acid; polypropylene glycol-4-laureth-2; polypropylene glycol-4-laureth-5dimethy-1 lauramide; lauramide diethanolamine (DEA). Preferred enhancers include, but are not limited to, lauryl pyroglutamate (LP), glyceryl monolaurate (GML), glyceryl monocaprylate, glyceryl monocaprate, glyceryl monooleate (GMO) and sorbitan monolaurate. Additional examples of suitable permeation enhancers are described, for example, in U.S. Pat. Nos. 5,785,991; 5,843,468; 5,882,676; and 6,004,578.
The antagonist reservoir may be formed from standard materials as known in the art. For example, the antagonist reservoir is formed from a hydrophobic, a lipophilic and/or a non-polar polymeric material, such as, ethyleneoctene copolymers, ethylene-vinyl acetate copolymer (EVA), low density polyethylene (LDPE), high density polyethylene (HDPE), medium density polyethylene (MDPE), styrenic block copolymer thermoplastic elastomers, and the like. In preferred embodiments, the antagonist reservoir 3 is formed from EVA, ethyleneoctene copolymers, as described in greater detail below.
The antagonist reservoir contains an antagonist in a substantially non-releasable form when the transdermal analgesic system is used as recommended and/or during incidental exposure to water (e.g., sweat, showering, high humidity etc.), the antagonist being releasable from the analgesic system when analgesic system is abused, i.e. upon being ingested or substantially immersed in a solvent. Preferably, the antagonist is present in a form that is substantially impermeable to the skin to which the transdermal analgesic system of the invention is to be applied. Although the antagonist can be dissolved in the antagonist reservoir, preferably the antagonist reservoir comprises an antagonist dispersed within a polymer, wherein the antagonist is substantially insoluble in the antagonist reservoir polymer. In preferred embodiments, the antagonist is present as a salt, preferably as a hydrochloride salt of an antagonist base. The low solubility of the antagonist in skin and polymer has several advantages, substantially minimizing undesirable interactions between the antagonist and the analgesic, improved stability/shelf life of the transdermal analgesic system, and substantially minimizing skin sensitization response from antagonist exposure.
In certain embodiments, the antagonist is dispersed in a matrix comprising a polymeric material which substantially prevents release of the antagonist, preferably a thermoformable material; or the antagonist is complexed with an ionic resin. In additional embodiments, the antagonist reservoir comprises the antagonist in a multiparticulate form, wherein each particle is individually coated with a polymeric material which substantially prevents release of the antagonist, wherein the polymeric material is preferably a thermoformable material. In additional embodiments, the antagonist reservoir comprises beads coated with the antagonist, wherein the beads may be formed from glass or an inert or non-dissolvable polymer, and further wherein the coated beads are optionally coated with or dispersed in a polymeric material which substantially prevents release of the antagonist, wherein the polymeric material is preferably a thermoformable material. For narcotic agonists, the above mentioned antagonist can be used (e.g., naltrexone, methylnaltrexone, naloxone, nalbuphine, nalorphine, nalorphine dinicotinate, nalmefene, nadide, levallorphan, cyclozocine and pharmaceutically acceptable salts thereof).
As discussed above, the antagonist reservoir contains the antagonist dispersed within a polymer. Preferably, the antagonist is dispersed in a matrix comprising a thermoformable material that substantially prevents release of the antagonist. Alternatively, the antagonist is present in a multiparticulate form, wherein each particle is individually coated with a polymeric material that substantially prevents release of the antagonist. Preferably, the polymeric material which substantially prevents release of the antagonist is hydrophobic—i.e., substantially prevents release of the antagonist during normal use, minimizes the amount of antagonist during incidental/casual exposure to solvents (moisture, e.g., sweat, during a shower), and when the dosage form is subject to abuse, e.g., upon ingestion or immersion in a solvent, releases the antagonist in abuse limiting amounts. Preferably, the polymeric material has a low melting point to allow processing of the antagonist in solid phase and to prevent degradation of the antagonist. Examples of a polymeric material which substantially prevents release of the antagonist include, but are not limited to, polyethylene, polyoctene, polyvinyl acetate, polymethyl acrylate, polymethyl acrylate, polyethyl acrylate, polystyrene polymers and copolymers and mixtures thereof, polystyrene copolymers such as styrenic block copolymers (SIS, SBS, SEBS), ethylene copolymers such as polyethyleneoctene copolymers, ethylene-vinyl acetate copolymer (EVA), ethylenemethyl acrylate copolymers (EMA), ethylene-acrylic acid copolymer, ethylene-ethylacrylate copolymer, and the like, and combinations thereof.
In other embodiments, the antagonist is complexed with an ionic resin. Examples of ionic resins include, but are not limited to sulfonated polystyrene resins, and the like. Preferably the resin contains a sulfonic acid functionality which when neutralized with the antagonist base forms the sulfonate salt of the antagonist.
In additional embodiments, the antagonist reservoir contains beads coated with the antagonist, wherein the spheres or beads may be formed from glass, metals or an inert or non-dissolvable polymer, and further wherein the coated beads are optionally coated with or dispersed in a polymeric material which substantially prevents release of the antagonist, as described above. The beads may be in any shape, size or form, but are preferably small sized, preferably less than 10 microns. Examples of an inert or non-dissolvable polymer include, but are not limited to polymethylmethacrylate, polycarbonate and polystyrene.
The antagonist reservoir contains an amount of the antagonist sufficient to counter analgesic and euphoric effects of the analgesic when the transdermal analgesic system is abused. Preferably, the antagonist reservoir comprises about 0.2 to about 15 mg/cm2 of the antagonist; more preferably about 0.6 to about 5 mg/cm2 of the antagonist; and even more preferably about 0.75 to about 1.5 mg/cm2 of the antagonist. Preferably, the antagonist reservoir comprises about 20 to about 90 wt % of the antagonist, preferably 20 to about 70 wt % of the antagonist; more preferably about 40 to about 65 wt % of the antagonist; even more preferably about 50 to about 60 wt % of the antagonist; and even more preferably about 52 to about 56 wt % of the antagonist.
Preferably, the antagonist is substantially insoluble in the polymer forming the antagonist reservoir. In particular, the material forming the antagonist reservoir has a solubility for the antagonist of about 0 wt % to about 1 wt % of the total polymer composition; more preferably about 0 wt % to about 0.8 wt %; and even more preferably about 0 wt % to about 0.5 wt % of the total polymer composition. The antagonist reservoir has a thickness of about 0.0125 mm (0.5 mil) to about 0.1 mm (4 mil); preferably about 0.015 mm (0.6 mil) to about 0.0875 mm (3.5 mil); more preferably 0.025 mm (1 mil) to about 0.08 mm (3.3 mil); and even more preferably about 0.025 mm (1 mil) to about 0.075 (3 mil).
Other than narcotic analgesics, other agonist drugs and their antagonists can be formulated into the multilayered system with barrier layers in a similar fashion. Generally antagonist is present in an amount sufficient to counteract the agonist. The amount of agonist to antagonist in the device is about 1:1 to 1:20; preferably about 1:1 to 1:10; more preferably 1:1 to 1:4. For example, fentanyl to naltrexone loading ratio in the system is preferably 1:2 to 1:4. In sufentanil containing systems, the sufentanil to naltrexone loading ratio in the system is preferably 1:4 to 1:16, because sufentanil is more potent than fentanyl.
A wide variety of materials that can be used for fabricating the various layers of the drug delivery patches according to this invention have been described above. This invention therefore contemplates the use of materials other than those specifically disclosed herein, including those which may hereafter become known to the art to be capable of performing the necessary functions.
Administration of the Drug
On application to the skin, the drug in the drug reservoir of the transdermal patch diffuses into the skin where it is absorbed into the bloodstream to produce a systemic therapeutic effect. The onset of the therapeutic depends on various factors, such as, potency of the drug, the solubility and diffusivity of the drug in the skin, thickness of the skin, concentration of the drug within the skin application site, concentration of the drug in the drug reservoir, and the like (see e.g., U.S. Pat. No. 4,588,580 for a discussion of relative permeabilities and potencies of fentanyl and analogs thereof). Typically, it is preferable that a patient experiences an adequate effect within a few hours (e.g., 3-6 hours) of initial application. However, this is significant only on the initial application. On repeated sequential application, the residual drug in the application site of the patch is absorbed by the body at approximately the same rate as the drug from the new patch is absorbed into the new application area. Thus the patient should not experience any interruption of the therapeutic effect, such as analgesia.
When continuous therapeutic effect is desired the depleted patch would be removed and a fresh patch is applied to a new location. For example, the patch would be sequentially removed and replaced with a fresh patch at the end of the administration period to provide continual therapeutic effect, such as in the use of analgesics for the relief of chronic pain. Since absorption of the drug from the fresh patch into the new application area usually occurs at substantially the same rate as absorption by the body of the residual drug within the previous application site of the patch, blood levels will remain substantially constant. Additionally, it is contemplated that doses may be increased over time and that concurrent use of other drugs may occur to deal with a need for increased relief.
Administration of a patch can be maintained for a short time to a few days, e.g., one day, at least three days, and up to 14 days, preferably to 3-7 days, the 3-4 day regimen being considered more preferable. In certain preferred embodiments, at least 3%, but not more than 40%, of the total amount of the drug in the patch is administered during approximately the first 24 hours of use; at least 6%, but not more than 50%, of the total amount of the drug is administered during approximately the first 48 hours of use; and at least 10%, but not more than 75%, of the total amount of the drug is administered during the administration period.
Methods of Manufacture
The transdermal devices are made from laminates which are manufactured according to known methodology. In general, in an embodiment, a solution of the polymeric reservoir material, as described above, is added to a mixer, with the desired amounts of the drug, permeation enhancers, and other ingredients that may be needed. Preferably, the polymeric reservoir material is an acrylate material to provide adhesive property to the transdermal delivery device. Typically, the acrylate material is solubilized in an organic solvent, e.g., ethanol, ethyl acetate, hexane, and the like. The mixer is then activated for a period of time to achieve acceptable uniformity of the ingredients. The mixer is attached by means of connectors to a suitable casting die located at one end of a casting/film drying line. The mixer is pressurized using nitrogen to feed solution to the casting die. Optionally the solution is transferred to a pressurizable tank. Solution is cast as a wet film onto a moving siliconized polyester web. The web is drawn through a series of ovens to evaporate the casting solvent to acceptable residual limits. The dried reservoir film is then laminated to a selected backing membrane and the laminate is wound into rolls. However, the materials may also be dry blended and extruded to produce a similar laminate. In subsequent operations, the laminate is further processes in conjunction with other laminate(s) to result in individual patches that are die-cut, separated and unit-packaged using suitable pouchstock. Laminates of other reservoir materials can be made by people skilled in the art.
The present invention is particularly adapted for mass manufacturing practices using mechanized automated machineries. In such manufacture practices, long rolls (can be considered to be long strips) or webs of laminate materials are fed through roller nips for further lamination to complete the assembly and dies for cutting and alignment. For practical mechanical handling, such webs can be considered to be continuous. Thus, a reservoir, or matrix material needs to have a backing or some kind of flexible but strong (tough and not easily torn) material attached to it for ease of transfer. In this way, rolls of materials can be processed without tearing.
FIGS. 11 to 14 illustrate how mass production by machines involving repetitive mechanical die-cutting and pressing processes are used to make exemplary patches such as those of
Typically, the manufacture of a product of an embodiment similar to that shown in
An adhesive laminate (which includes siliconized PET temporary liner protecting an adhesive on a backing layer) is paid out from payout #2 and the temporary release liner is stripped to result in just a continuous strip of adhesive on a backing. The scrap release liner is removed by take up #2 (not shown).
As shown in
A lamination roller 98 applies the drug reservoir units on the final liner 100 to the adhesive overlay 86. The system webs (i.e., the webs with the drug reservoir) and overlay web are joined such that the system edges fall within the center of the “frames” on the overlay. Since the barrier frames 84 are discrete units spaced apart on the adhesive overlay 86 the slit strip 94 has to similarly space the drug reservoirs on the final liner 100 from payout #4. This is accomplished by having only intermittent contact between the slit strip and the final liner at die 96. The final liner web is accelerated when not in contact with the die 96, and decelerated to match the die speed for the duration of the contact, creating the spacing. This results in a web 102 with discrete units 103 of drug reservoirs 3 attached to backing layers 2 and barrier frames 84, which are shown in
Although much of the description in the present disclosure is focused on narcotics and their antagonists, the barrier invention is equally application to other agonist antagonist pairs, e.g., nicotine/mecamylamine, etc., known to those skilled in the art.
Below are examples of specific embodiments for carrying out the present invention. The examples are offered for illustrative purposes only, and are not intended to limit the scope of the present invention in any way.
A fentanyl (API) containing adhesive solution is mixed. The adhesive is a National Starch DURO-TAK® 87-4287 adhesive. The solution is film cast to approximately 4 mils (0.1 mm) thick on a 3 mil (0.075 mm) Si-PET film and dried according to conventional technology. Once the solvent is removed, the resulting film is approximately 2 mils (0.05 mm) thick and consists of approximately 8% fentanyl. The adhesive film is then laminated to a 2 mil uncoated PET film.
A second adhesive film (PIB) is prepared in a similar manner to the previous example and laminated to a 1 mil (0.025 mm) release liner. The 1 mil liner is then removed and the adhesive is laminated to the 2 mil liner of the drug matrix laminate.
An antagonist film is prepared separately by melting and extruding a mixture of naltrexone and EVA. The components are continuously added at the correct weight ratio to an extruder that heats and mixes the blend into a homogenous fluid. The liquid is passed through a slot die onto a moving web of 3 mil Si-PET, a 1 mil (0.025 mm) Si-PET web is laminated and the film is cooled and calendared to a solid of the desired thickness.
Both the drug matrix film and the antagonist films are simultaneously mounted on a web converting machine along with an uncoated 1-2 mil (0.025 mm to 0.05 mm) PET film from which the barrier frames are cut and a 2 mil PET/EVA film which will be used as the final system liner.
The following steps describe the order of assembly of an individual system. However all steps occur continuously in various locations throughout the machine in a web converting process. The system assembled in this example has an active area of 40 cm2, centered on a barrier frame containing a 20 cm2 antagonist area covered with a PET/EVA backing film.
A system containing an occluded counteracting agent (antagonist) as shown in
The antagonist layer is produced by melting a polymer ethylene vinyl acetate EVA-9 (although ethylene vinyl acetate EVA-22, EVA-40, etc., ethylene octene (Engage), or similar elastomeric polymer can also be used), and blending in naltrexone-HCl at a concentration of 50 wt %. The blend would be mixed to uniformity, extruded between two films such as PET liners, one of which is release coated, and calendared to a thickness which corresponds to approximately a 4:1 to 5:1 total loading of the antagonist to the agonist active component in the final assembled system. Thus, for a system with fentanyl dissolved in a 5 mil (0.125 mm) thick polyacrylate matrix at 5 wt %, a 2 mil (0.05 mm) thick antagonist layer is used.
The two component film is die cut and assembled on another polyisobutylene (PIB), polyacrylate, or similar adhesive (78) on a EVA/PET, polymer fiber woven overlay film (80) or similar overlay film in a converting operation (see
Barrier frames (84) would be die cut from a 0.5 mil (0.0125 mm)-5 mil (0.125 mm) thick PET film such that the inner (18) and outer edges (16) (see.
The agonist fentanyl matrix film is cut to the appropriate length and width (23,26) and placed on top of the barrier frames (34), completely isolating the antagonist component (52). Thus, no part of the antagonist layer is exposed to the exterior environment. The matrix layer release coated liner is removed in this assembly step and replaced with a larger final system release liner (not shown in the figure), covering all the system components, the assembled system is then die cut to the appropriate size.
The result is an abuse-deterring transdermal fentanyl delivery system in which the antagonist layer is encircled laterally by at least one barrier frame. In this manner, even if the antagonist layer has cold flow, the antagonist will not migrate to an area that can come into contact with patient body surface. In this device, no antagonist material or layer is observable and that the antagonist layer is isolated by solid or semisolid material exterior. For the purpose of isolation, backing layers are considered to be solid and adhesives and matrixes are considered to be at least “semisolid” herein because they prevent exposure to the exterior environment, e.g., even water during a shower.
Monolithic transdermal analgesic reservoirs to
Antagonist reservoir-containing intermediates were prepared as follows. A thermoformable polymer (460 g), such as ENGAGE ethylene-octene copolymer, (DuPont-Dow Elastomers, Midland, Mich.), was placed within the bowl of a high torque blender. The bowl was heated (150° C.) and the polymer pellets were blended until the polymer pellets were sufficiently masticated to provide a molten mass (10 minutes). The antagonist (naltrexone hydrochloride USP, 540 g) was added to the mixing bowl, and the mixture was blended for about 30 minutes.
The polymer melt is to be emptied from the blending bowl and extruded between two moving webs: an upper layer of 0.05 mm (2 mil) PET barrier material and a lower layer of 0.075 mm (3 mil) siliconized polyester film. The three-layer film structure is passed through calendar rolls to size the antagonist reservoir disposed on the barrier layer to about 0.025 mm (1 mil) thickness. The moving web is taken up in roll form at the end of the extrusion line.
The analgesic reservoir-containing intermediate having the PET/EVA barrier layer and the antagonist reservoir on PET film are to be made into a device as in
Antagonist reservoir-containing intermediates were prepared as in Example 3.
Monolithic transdermal analgesic reservoirs containing 1.0 mg of sufentanil per 2.54 cm2, in a polacrylate adhesive (National Starch DURO-TAK 87-4287) are made into analgesic reservoir-containing intermediates, as described in Example 3 above. The analgesic reservoir-containing intermediate having the PET/EVA barrier layer and the antagonist reservoir on PET film are to be made into a device as in
The practice of the present invention will employ, unless otherwise indicated, conventional methods used by those in pharmaceutical product development within the knowledge of those skilled in the art. Embodiments of the present invention have been described with specificity. The embodiments are intended to be illustrative in all respects, rather than restrictive, of the present invention. It is to be understood that various combinations and permutations of various parts and components of the schemes disclosed herein can be implemented by one skilled in the art without departing from the scope of the present invention. For example, although the figures show the barrier frame to be a closed ring, gaps can be made in the ring. All U.S. patents and U.S. patent publications cited herein are incorporated by reference herein in their entireties.
The present application claims the benefit of provisional application 60/680,905 filed May 13, 2005 and provisional application 60/790,338 filed Apr. 7, 2006, both of which are incorporated by reference herein.
Number | Date | Country | |
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60680905 | May 2005 | US | |
60790338 | Apr 2006 | US |