Prevention and treatment of ocular side effects with a cyclosporin

Information

  • Patent Grant
  • 8501174
  • Patent Number
    8,501,174
  • Date Filed
    Monday, June 28, 2010
    13 years ago
  • Date Issued
    Tuesday, August 6, 2013
    10 years ago
Abstract
Therapeutic methods are disclosed herein.
Description
DESCRIPTION OF THE INVENTION

Patients undergoing treatment with certain therapeutically active agents can have certain ocular conditions as a result of that treatment. In particular, patients undergoing chemotherapy with a therapeutically active agent effective for treatment of a cancer often have ocular conditions as a result of that treatment.







One embodiment is a method comprising administering a cyclosporin, an analog or derivative thereof, or a combination thereof, to an eye of a mammal in combination with administration of a therapeutically active agent to said mammal, said therapeutically active agent being an chemotherapy agent or an antiviral agent, wherein said method is effective in preventing or treating an ocular condition associated with the use of said therapeutically active agent.


“Administration of a therapeutically active agent to said mammal” means administration of the therapeutically active agent to the mammal in any way that a therapeutically active agent may be administered. Thus, administration of the therapeutically active agent is not limited to the eye, but may include systemic administration via oral, intravenous, rectal, or other means; or administration locally to any part of the body by injection, implantation, topical administration, or other means.


Administration of the therapeutically active agent need not exactly overlap in time with the administration of the cyclosporin, an analog or derivative thereof, or a combination thereof. For example, the cyclosporin, analog or derivative thereof, or a combination thereof might be administered to a mammal before the mammal receives any of the therapeutically active agent to avoid the onset of the ocular condition. In another example, the cyclosporin, analog or derivative thereof, or a combination thereof, might be administered after the mammal has begun to receive the therapeutically active agent. In another example, the cyclosporin, analog or derivative thereof, or a combination thereof, might be administered after the mammal has ceased receiving the therapeutically active agent. Administration of the cyclosporin, analog or derivative thereof, or a combination thereof might also be simultaneous with the administration of the therapeutically active agent. Thus, any time relationship may exist between the mammal receiving the therapeutically active agent and the cyclosporin, analog or derivative thereof, or a combination thereof, provided that the use of the latter is reasonably related to treatment or prophylaxis of a condition associated with the former.


It may be convenient to provide a single pharmaceutical composition which comprises both (i) the cyclosporin, analog or derivative thereof, or a combination thereof and (ii) the therapeutically active agent when the agents are to be administered simultaneously.


It may be convenient to provide (i) the cyclosporin, analog or derivative thereof, or a combination thereof and (ii) the therapeutically active agent in form of a kit. For example, the agents may be packaged together. For example, (i) the cyclosporin, analog or derivative thereof, or a combination thereof and (ii) the therapeutically active agent may each be packaged in conventional pharmaceutical packaging such as boxes, jars, blister packs, vials, bottles, syringes etc., and the individually packaged components may then be combined to form a kit e.g. by the use of further packaging such as a box, or by joining up the individual packages. When in kit form, the agents can be taken independently of one another, thus allowing the user freedom to decide the temporal relationship between his use of each of the agents.


Use of a cyclosporin, or an analog or derivative thereof, including cyclosporin A, for the treatment of ocular conditions occurring in a person undergoing treatment with a therapeutically active agent for the treatment of cancer is contemplated. Accordingly, a particular patient group which may benefit from the present invention is that of persons having ocular conditions resulting from the use of a chemotherapy agent.


Also contemplated is use of a cyclosporin, or an analog or derivative thereof, including cyclosporin A, for the treatment of ocular conditions occurring in a person who is undergoing treatment with an antiviral agent. Accordingly, a particular patient group which may benefit from the present invention is that of persons having ocular conditions resulting from the use of an antiviral agent.


Also contemplated is use of a cyclosporin, or an analog or derivative thereof, including cyclosporin A, for the treatment of ocular conditions occurring in a person who is undergoing treatment with an immunomodulator. Accordingly, a particular patient group which may benefit from the present invention is that of persons having ocular conditions resulting from the use of an immunomodulator.




embedded image


Cyclosporin A is a cyclic peptide with immunosuppressive properties having the structure shown above. It is also known by other names including cyclosporine, cyclosporine A, ciclosporin, and ciclosporin A.


Other cyclosporins include cyclosporine b, cyclosporine D, cyclosporine G, which are well known in the art. Cyclosporin derivatives and analogs are also known in the art. For example, U.S. Pat. Nos. 6,254,860 and 6,350,442, incorporated by reference herein, illustrate several examples.


The ocular conditions to be prevented or treated are well known in the art. In particular, nasolacrimal stenosis, chemotherapy induced ocular toxicity, lacrimal duct stenosis, punctal stenosis, lacrimation, abnormal lacrimation, increased tearing, nasolacrimal blockage, keratitis, keratoconjunctivitis, conjunctivitis, or a combination thereof may be prevented or treated.


Also contemplated is a method comprising administering cyclosporin A topically to the eye of a person, wherein docetaxel is also administered to said person, wherein said method is effective in preventing or treating an ocular condition associated with the administration of docetaxel.


Although the ocular condition may be associated with any antiviral agent, the following antiviral agents are contemplated in particular:

  • Zalcitabine, and
  • Rimantadine Hydrochloride.


Although the ocular condition may be associated with any chemotherapy agent, the following chemotherapy agents are contemplated in particular:

  • Paclitaxel and derivatives thereof, such as Docetaxel
  • Doxorubicin Hydrochloride,
  • Irinotecan Hydrochloride,
  • Fluorouracil,
  • Imatinib Mesylate, and
  • Rituximab.


Derivatives of paclitaxel generally include the macrocycle shown below, where derivatives are formed at a hydroxyl moiety.




embedded image


Chemotherapeutic compounds incorporating this structure are thus contemplated. For example, the structures of paclitaxel and docetaxel are shown below.




embedded image


In one embodiment, the chemotherapy agent is docetaxel.


Although the ocular condition may be associated with any immunomodulator, the following immunomodulators are contemplated in particular:

  • Interferon alfa-2 b, Recombinant
  • Mycophenolate Mofetil, and
  • Mycophenolate Mofetil Hydrochloride.


While not intending to limit the scope of the invention in any way, the following therapeutically active agents may cause lacrimal duct stenosis:

  • docetaxel.


While not intending to limit the scope of the invention in any way, the following therapeutically active agents may cause lacrimation:

  • interferon alfa-2b, recombinant,
  • doxorubicin hydrochloride,
  • irinotecan hydrochloride,
  • fluorouracil,
  • docetaxel, and
  • zalcitabine.


While not intending to limit the scope of the invention in any way, the following therapeutically active agents may cause abnormal lacrimation:

  • mycophenolate mofetil,
  • mycophenolate mofetil hydrochloride,
  • imatinib mesylate,
  • rituximab, and
  • rimantadine hydrochloride.


While not intending to limit the scope of the invention in any way, the following therapeutically active agents may cause keratitis:

  • Amantadine Hydrochloride,
  • Erlotinib,
  • Bexarotene, and
  • Voriconazole.


While not intending to limit the scope of the invention in any way, the following therapeutically active agents may cause keratoconjunctivitis:

  • Capecitabine.


While not intending to limit the scope of the invention in any way, the following therapeutically active agents may cause conjunctivitis:

  • Risedronate Sodium,
  • Leflunomide,
  • Mycophenolate Mofetil,
  • Oxaliplatin,
  • Cetuximab,
  • Ribavirin,
  • Rituximab,
  • Basiliximab,
  • Erlotinib,
  • Capecitabine,
  • Doxorubicin Hydrochloride,
  • Imiquimod,
  • Amphotericin B, liposomal,
  • Zolpidem Tartrate,
  • Glatiramer Acetate,
  • Epirubicin Hydrochloride,
  • Saquinavir,
  • Enfuvirtide,
  • Imatinib Mesylate,
  • Gefitinib,
  • Lamotrigine,
  • Delavirdine Mesylate,
  • Rituximab,
  • Ivermectin,
  • Palivizumab,
  • Oseltamivir Phosphate,
  • Bexarotene,
  • Docetaxel,
  • Abacavir Sulfate,
  • Lamivudine,
  • Zidovudine,
  • Voriconazole,
  • Nevirapine,
  • Ribavirin, and
  • Abacavir Sulfate.


Additionally, one or more of the ocular conditions disclosed herein may be associated with the following therapeutically active agents: abacavir sulfate, amantadine hydrochloride, amphotericin B, basiliximab, bexarotene, capecitabine, cetuximab, delavirdine mesylate, docetaxel, doxorubicin hydrochloride, enfuvirtide, epirubicin hydrochloride, erlotinib, fluorouracil, gefitinib, glatiramer acetate, imatinib mesylate, imiquimod, interferon alfa-2b, irinotecan hydrochloride, ivermectin, lamivudine, lamotrigine, leflunomide, mycophenolate mofetil, mycophenolate mofetil hydrochloride, nevirapine, oseltamivir phosphate, oxaliplatin, palivizumab, ribavirin, rimantadine hydrochloride, risedronate sodium, rituximab, saquinavir, voriconazole, zalcitabine, zidovudine, and zolpidem tartrate.


The therapeutically active agent is administered in the usual manner known in the art for the condition being treated.


Alternatively, a therapeutically active agent and cyclosporin A may be administered in a single composition.


Useful compositions are disclosed in the following patent applications, each of which is expressly incorporated by reference herein: U.S. patent application Ser. No. 11/181, 409, filed on Jul. 13, 2005; U.S. patent application Ser. No. 11/181, 509, filed on Jul. 13, 2005; U.S. patent application Ser. No. 11/181, 187, filed on Jul. 13, 2005; U.S. patent application Ser. No. 11/181, 178, filed on Jul. 13, 2005; U.S. patent application Ser. No. 11/181, 428, filed on Jul. 13, 2005; U.S. patent application Ser. No. 11/255,821, filed on Oct. 19, 2005; U.S. patent application Ser. No. 11/161,218, filed on Jul. 27, 2005; and U.S. Provisional Patent Application Ser. No. 60/727,684, filed on Oct. 17, 2005.


In one embodiment, cyclosporin A is administered in the form of Restasis®, available from Allergan, Inc. The cyclosporin A is administered twice a day as indicated on the package insert.


Although there has been hereinabove described pharmaceutical compositions for the purpose of illustrating the manner in which the invention may be used to advantage, it should be appreciated that the invention is not limited thereto. Accordingly, any and all modifications, variations, or equivalent arrangements, which may occur to those skilled in the art, should be considered to be within the scope of the present invention as defined in the appended claims.

Claims
  • 1. A method comprising administering cyclosporin A to an eye of a mammal in combination with administration of rituximab, wherein said method is effective in treating abnormal lacrimation, keratitis, or conjunctivitis.
  • 2. The method of claim 1 wherein said method is effective in treating abnormal lacrimation.
  • 3. The method of claim 1 wherein said method is effective in treating keratitis.
  • 4. The method of claim 1 wherein said method is effective in treating conjunctivitis.
CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a divisional of U.S. patent application Ser. No. 11/548,631, filed on Oct. 11, 2006, now issued as U.S. Pat. No. 7,745,400, which claims the benefit of priority under 35 U.S.C. §119(e) of: U.S. Provisional Patent Application No. 60/596,709, filed on Oct. 14, 2005; U.S. Provisional Patent Application No. 60/597,431, filed on Nov. 30, 2005; and U.S. Provisional Patent Application No. 60/805,577, filed on Jun. 22, 2006; all of which are expressly incorporated by reference herein.

US Referenced Citations (101)
Number Name Date Kind
4388229 Fu Jun 1983 A
4388307 Cavanak Jun 1983 A
4649047 Kaswan Mar 1987 A
4814323 Andrieu et al. Mar 1989 A
4839342 Kaswan Jun 1989 A
4996193 Hewitt et al. Feb 1991 A
5047396 Orban et al. Sep 1991 A
5051402 Kurihara et al. Sep 1991 A
5296158 MacGilp et al. Mar 1994 A
5342625 Hauer et al. Aug 1994 A
5411952 Kaswan May 1995 A
5474979 Ding et al. Dec 1995 A
5543393 Kim et al. Aug 1996 A
5589455 Woo Dec 1996 A
5614491 Walch et al. Mar 1997 A
5639724 Cavanak Jun 1997 A
5652212 Cavanak et al. Jul 1997 A
5753166 Dalton et al. May 1998 A
5759997 Cavanak Jun 1998 A
5766629 Cho et al. Jun 1998 A
5798333 Sherman Aug 1998 A
5827822 Floc'h et al. Oct 1998 A
5827835 Kabra Oct 1998 A
5834017 Cho et al. Nov 1998 A
5891846 Ishida et al. Apr 1999 A
5916589 Hauer et al. Jun 1999 A
5951971 Kawashima et al. Sep 1999 A
5962014 Hauer et al. Oct 1999 A
5962017 Hauer et al. Oct 1999 A
5962019 Cho et al. Oct 1999 A
5977066 Cavanak Nov 1999 A
5977067 Evers et al. Nov 1999 A
6007840 Hauer et al. Dec 1999 A
6024978 Hauer et al. Feb 2000 A
6057289 Mulye May 2000 A
6190691 Mak Feb 2001 B1
6197335 Sherman Mar 2001 B1
6245805 Broder et al. Jun 2001 B1
6254860 Garst Jul 2001 B1
6254885 Cho et al. Jul 2001 B1
6267985 Chen et al. Jul 2001 B1
6284268 Mishra et al. Sep 2001 B1
6294192 Patel et al. Sep 2001 B1
6306825 Cavanak Oct 2001 B1
6350442 Garst Feb 2002 B2
6420355 Richter et al. Jul 2002 B2
6468968 Cavanak et al. Oct 2002 B2
6475519 Meinzer et al. Nov 2002 B1
6486124 Olbrich et al. Nov 2002 B2
6569463 Patel et al. May 2003 B2
6582718 Kawashima et al. Jun 2003 B2
6638522 Mulye Oct 2003 B1
6656504 Bosch et al. Dec 2003 B1
6720001 Chen et al. Apr 2004 B2
6723339 Meinzer et al. Apr 2004 B2
6916785 Patel Jul 2005 B2
7141576 Lackey et al. Nov 2006 B2
7745400 Feinerman et al. Jun 2010 B2
20010003589 Neuer et al. Jun 2001 A1
20010036449 Garst Nov 2001 A1
20010041671 Napoli Nov 2001 A1
20020012680 Patel et al. Jan 2002 A1
20020013272 Cavanak et al. Jan 2002 A1
20020016290 Floc'h et al. Feb 2002 A1
20020016292 Richter et al. Feb 2002 A1
20020025927 Olbrich et al. Feb 2002 A1
20020045601 Kawashima et al. Apr 2002 A1
20020107183 Petswzulat et al. Aug 2002 A1
20020119190 Meinzer et al. Aug 2002 A1
20020165134 Richter et al. Nov 2002 A1
20030060402 Cavanak et al. Mar 2003 A1
20030108626 Benita et al. Jun 2003 A1
20030133984 Ambuhl et al. Jul 2003 A1
20030143250 Hauer et al. Jul 2003 A1
20030147954 Yang et al. Aug 2003 A1
20030166517 Fricker et al. Sep 2003 A1
20030211983 Petszulat et al. Nov 2003 A1
20030212090 Chen et al. Nov 2003 A1
20030215496 Patel et al. Nov 2003 A1
20030225011 David et al. Dec 2003 A1
20040048789 Patel Mar 2004 A1
20040092435 Peyman May 2004 A1
20040101552 Patel May 2004 A1
20040102366 Patel May 2004 A1
20040106546 Napoli Jun 2004 A1
20040161458 Meinzer et al. Aug 2004 A1
20040167063 Cavanak et al. Aug 2004 A1
20040185068 Yu et al. Sep 2004 A1
20040198645 Ambuhl et al. Oct 2004 A1
20050013854 Mannino et al. Jan 2005 A1
20050025810 Peyman Feb 2005 A1
20050043258 Bennett et al. Feb 2005 A1
20050048087 Posanski Mar 2005 A1
20050059583 Acheampong et al. Mar 2005 A1
20050085438 Cardozo et al. Apr 2005 A1
20050118254 Choi et al. Jun 2005 A1
20050129718 Sherman Jun 2005 A1
20050147659 Carli et al. Jul 2005 A1
20050196370 Yu et al. Sep 2005 A1
20050272758 Bayever et al. Dec 2005 A1
20100166699 Thompson et al. Jul 2010 A1
Foreign Referenced Citations (7)
Number Date Country
0146341 Dec 1984 EP
0471293 Feb 1992 EP
0547229 Jun 1992 EP
956853 May 1999 EP
WO0000179 Jan 2000 WO
WO0008085 Feb 2000 WO
WO0132142 May 2001 WO
Non-Patent Literature Citations (15)
Entry
“Questions and Answers About Taxotere Injection Concentrate”, Patient Information Leaflet by Aventis Pharmaceuticals Inc., Rev. May 2004.
Pijpe et al. Rituximab Treatment in Patients With Primary Sjogren's Syndrome. Arthritis & Rheumatism. Sep. 2005, vol. 52, No. 9, pp. 2740-2750.
Kuwano et al., “Cyclosporine A Formulation Affects its Ocular Distribution in Rabbits”, Pharmaceutical Research, vol. 19, No. 1, Jan. 2002, 108-111.
Castillo, et al., “Influence of topical Cyclosporine A and dissolvent on corneal epithelium permeability of fluorescein,” Documenta Ophthalmologica, 1995, 91, 49-55.
Restasis® Package Insert, (cyclosporine ophthalmic emulsion)0.05%, Sterile, Preserviatve-Free, 2 pages, (2004).
Uniqema, Tween™ Series. Polyoxyethylene derivatives of sorbitan esters, 2 pages, (2004).
RITA, Ritabate 40, INCI Nomenclature (formerly CTFA) . . . Polysorbate 40, 1 page, (1994).
RITA, Ritabate 60, INCI Nomenclature (formerly CTFA) . . . Polysorbate 60, 1 page.
RITA, Ritabate 20, INCI Nomenclature (formerly CTFA) . . . Polysorbate 20, 1 page, (1994).
TheMerckIndex Results-Form View, Monograph No. 07664, Titles: Polysorbates, 1 page, and Polyoxyethylene, 1 page, (2006).
Sandimmue® Package Insert, (cyclosporine oral solution), RxList, The Internet Drug Index, 3 pages, (2006).
Benitez, et al., “Influence of topical Cyclosporine A and dissolvent on corenal epithelium permeability of flurorescein,” Ophthalmologica 91: 49-55, 1995.
http:/thornleycompany.com/Products/PEGsters.htm, (2006).
www.lipochemicals.com document on Emulsifiers and Emulsifying systems (Aug. 20, 2002), pp. 1-5.
Schmid et al. Update on Ocular Complications of Systemic Cancer Chemotherapy. Survey of Ophthalmology, Jan.-Feb. 2006, vol. 51, No. 1, pp. 19-40.
Related Publications (1)
Number Date Country
20100266622 A1 Oct 2010 US
Provisional Applications (3)
Number Date Country
60596709 Oct 2005 US
60597431 Nov 2005 US
60805577 Jun 2006 US
Divisions (1)
Number Date Country
Parent 11548631 Oct 2006 US
Child 12825116 US