Patent Application
20230414519
The present disclosure relates to a rapidly infusing compositions, for oral mucosal uptake, formulated with methotrexate (MTX) for the treatment of autoimmune disorders/inflammatory conditions.
The “background” description provided herein is for the purpose of generally presenting the context of the disclosure. Work of the presently named inventors, to the extent it is described in this background section, as well as aspects of the description which may not otherwise qualify as prior art at the time of filing, are neither expressly or impliedly admitted as prior art against the present invention.
Methotrexate (MTX) is a drug that was originally developed in 1953 by US pediatrician Dr. Sidney Farber as a cancer treatment. It is classified as an anti-metabolite, meaning that it inhibits the metabolism of cells. It also exhibits anti-inflammatory properties making it very effective in treating diseases that exhibit abnormally rapid cell growth such as psoriasis and rheumatoid arthritis (RA). Today, it is used in the treatment of many types of cancers and auto-immune disorders. Methotrexate is one of the most versatile and successful drugs developed in the 20th century; for this reason, it is listed on the World Health Organization's list of Essential Medicines.
Methotrexate is a small hydrophilic molecule comprised of carbon, hydrogen, nitrogen and oxygen, with a molecular weight of 454. When administered parenterally, peak plasma concentrations are achieved after 1.3 hours. Oral doses are absorbed more slowly with peak concentrations being reached at 1.5 hours, longer in the presence of food. Methotrexate is labeled as a Class 3 drug in the Biopharmaceutics Classification System (BCS), meaning that it highly soluble with low permeability, i.e., methotrexate dissolves quickly in the stomach and absorbs into the system at a slower rate than Classes 1 and 2. Its bioavailability is highly variable when administered orally, averaging 60% with low doses, but oral bioavailability can be decreased by 30-70% compared to parenteral administration. Oral bioavailability is significantly reduced as the dose is increased, and this inconsistency makes predicting side effects difficult and causes patients who experience adverse effects to discontinue treatment. MTX therapy would be much more predictable and adherence rates would increase if its pharmacokinetic bioavailability were more consistent.
While methotrexate is known as one of the most versatile drugs in the world for its effectiveness against a wide range of conditions, it can be toxic in higher doses and even low dose treatment is often accompanied by serious side effects, which cause many patients to discontinue treatment and seek alternative therapies. Methotrexate is known to cause hepatotoxicity and ulcerative stomatitis, usually as a result of dosing errors since its tolerability varies by individual. Although MTX taken for autoimmune diseases is taken in lower doses than it is for cancer treatment, other side effects such as hair loss, nausea, fatigue, headaches, fever, skin pigmentation, and increased risk of infection are still relatively common. The rates of these adverse effects are decreased when doses are taken weekly rather than daily and are accompanied by folic acid supplements. Methotrexate treatment is generally regarded as safe provided that the patient adheres to their treatment regimen and are monitored by their physician.
Autoimmune Disorders. Methotrexate is used to treat various autoimmune diseases such as: rheumatoid arthritis (RA), juvenile dermatomyositis, psoriasis, lupus, sarcoidosis, and Crohn's disease. While MTX has been used to treat RA and psoriasis for a significant amount of time, it is considered to be underutilized in the treatment of Crohn's disease. MTX is one of the most flexible antirheumatic drugs, it can be used alone, or in conjunction with glucocorticoids, other disease modifying antirheumatic drugs (DMARD's), or biologic agents such as Humira® (adalimumab). Remicade® (infliximab), and others to enhance the effectiveness of the treatment regimen.
Rheumatoid Arthritis (RA). The treatment of rheumatoid arthritis is the second largest specialty drug market in the US, with blockbusters such as Humira® (adalimumab) and Enbrel® (etanercept) accounting for billions in global and US sales. While the presence of such successful new drugs would make older treatments obsolete in other segments, clinical studies have proven that a combination of these new biologics with methotrexate is superior to either treatment on their own. Due to advanced age and comorbidities, one third of RA sufferers experience dysphagia or trouble swallowing. Dysphagia can make taking pills orally very difficult and uncomfortable.
Crohn's Disease. Crohn's disease is a malabsorptive disorder which further impairs the effectiveness of orally ingested MTX, and as a result, Crohn's patients must have MTX administered via injection. This is one of the reasons why MTX is so underused as a therapy for Crohn's disease, as many patients prefer to opt for a drug that can be administered in pill form such as azathioprine rather than weekly MTX injections.
Psoriasis. Another condition that can be treated by methotrexate is psoriasis, specifically moderate to severe plaque psoriasis. There are over one million Americans that suffer from this condition, which is characterized by patches of inflamed, reddish skin covered in silvery-white scale covering more than 5% of skin surface area. Methotrexate is the leading non-biologic treatment for moderate to severe plaque psoriasis. According to the Journal of the American Academy of Dermatology, an MTX regimen that achieves a 75% reduction in the Psoriasis Area and Severity index (PASI 75 score) is the most cost-effective psoriasis treatment currently available. Studies show that the most effective treatment for moderate to severe plaque psoriasis is a combination of biologics and MTX, as it is with RA treatment.
The biggest challenge for physicians treating with MTX is patient adherence—39.6% of patients are non-adherent to their medication regimen. The number of non-adhering patients can be reduced by increasing the effectiveness of low doses of MTX and making the severity of side effects more predictable so that patients will have a better understanding of what to expect when taking MTX. As described in detail below, the Rapid Infusion Technology™ (RITe) platform of the present invention with methotrexate as the active therapeutic ingredient (ATI) accomplishes these goals.
Due to Methotrexate's low and often variable bioavailability in patients on oral methotrexate regimens, a RITe™ formulation of MTX, taken via the oral mucosa, would provide patients with the ability to take lower weekly doses with fewer and more predictable side effects. Additionally, patients taking MTX in combination with anti-inflammatory agents such as tumor necrosis factor (TNF) antagonists/inhibitors would be less likely to discontinue their MTX therapy as a result of adverse effects. While orally administered MTX therapy is often effective, adverse effects and variable bioavailability lead to non-adherence and discontinuation of therapy.
The RITe™ platform formulated with methotrexate, described below, is formulated for administration via the oral mucosae, for rapid infusion of MTX into systemic circulation, bypassing the GI tract and hepatic first pass metabolism, thereby greatly reducing the possibility of developing liver hepatotoxicity—a significant benefit to patients who require long-term therapy for moderate to severe cases of autoimmune diseases and/or inflammatory conditions (e.g., RA, psoriasis and Crohn's disease) as liver damage is generally regarded to be a result of duration of treatment rather than dosage.
Thus, the present invention provides:
In the following description, it is understood that other embodiments may be utilized and structural and operational changes may be made without departure from the scope of the present embodiments disclosed herein.
As used herein, the terms “compound”, “complex”, and “product” are used interchangeably, and are intended to refer to a chemical entity, whether in the solid, liquid or gaseous phase, and whether in a crude mixture or purified and isolated. Throughout the specification and the appended claims, a given chemical formula or name shall encompass all stereo and optical isomers and racemates thereof where such isomers exist. Unless otherwise indicated, all chiral (enantiomeric and diastereomeric) and racemic forms are within the scope of the disclosure. Many geometric isomers of C═C double bonds, C═N double bonds, ring systems, and the like can also be present, and all such stable isomers are contemplated in the present disclosure. Cis- and trans- (or E- and Z-) geometric isomers, when present, may be isolated as a mixture of isomers or as separated isomeric forms. Compounds referenced in the disclosure can be isolated in optically active or racemic forms. Optically active forms may be prepared by resolution of racemic forms or by synthesis from optically active starting materials. All processes used to prepare these compounds and intermediates made therein are considered to be part of the present disclosure. When enantiomeric or diastereomeric products are prepared, they may be separated by conventional methods, for example, by chromatography, fractional crystallization, or through the use of a chiral agent. Depending on the process conditions, the end products referenced in the present disclosure are obtained either in free (neutral) or salt form. Both the free form and the salts of these end products are within the scope of the disclosure. If so desired, one form of a compound may be converted into another form. A free base or acid may be converted into a salt; a salt may be converted into the free compound or another salt; a mixture of isomeric compounds may be separated into the individual isomers. Compounds referenced in the present disclosure, free form and salts thereof may exist in multiple tautomeric forms, in which hydrogen atoms are transposed to other parts of the molecules and the chemical bonds between the atoms of the molecules are consequently rearranged. It should be understood that all tautomeric forms, insofar as they may exist, are included within the disclosure. Further, a given chemical formula or name shall encompass all conformers, rotamers, or conformational isomers thereof where such isomers exist. Different conformations can have different energies, can usually interconvert, and are very rarely isolatable. There are some molecules that can be isolated in several conformations. For example, atropisomers are isomers resulting from hindered rotation about single bonds where the steric strain barrier to rotation is high enough to allow for the isolation of the conformers. It should be understood that all conformers, rotamers, or conformational isomer forms, insofar as they may exist, are included within the present disclosure.
As used herein, the term “solvate” refers to a physical association of a referenced compound with one or more solvent molecules, whether organic or inorganic. This physical association includes hydrogen bonding. In certain instances, the solvate will be capable of isolation, for example when one or more solvent molecules are incorporated in the crystal lattice of the crystalline solid. The solvent molecules in the solvate may be present in a regular arrangement and/or a non-ordered arrangement. The solvate may comprise either a stoichiometric or nonstoichiometric amount of the solvent molecules. Solvate encompasses both solution phase and isolable solvates. Exemplary solvent molecules which may form the solvate include, but are not limited to, water, methanol, ethanol, n-propanol, isopropanol, n-butanol, isobutanol, tert-butanol, ethyl acetate and other lower alkanols, glycerin, acetone, dichloromethane (DCM), dimethyl sulfoxide (DMSO), dimethyl acetate (DMA), dimethylformamide (DMF), isopropyl ether, acetonitrile, toluene. N-methylpyrrolidone (NMP), tetrahydrofuran (THF), tetrahydropyran, other cyclic mono-, di- and tri-ethers, polvalkylene glycols (e.g., polyethylene glycol, polypropylene glycol, propylene glycol), and mixtures thereof in suitable proportions. Exemplary solvates include, but are not limited to, hydrates, ethanolates, methanolates, isopropanolates and mixtures thereof. Methods of solvation are generally known to those of ordinary skill in the art.
The phrase “pharmaceutically acceptable” is employed herein to refer to those compounds, materials, compositions, and/or dosage forms which are, within the scope of sound medical judgment, suitable for use in contact with the tissues of human beings without excessive toxicity, irritation, allergic response, or other problem or complication, commensurate with a reasonable benefit/risk ratio.
As used herein, “pharmaceutically acceptable salt” refers to derivatives of the disclosed compounds wherein the parent compound is modified by making acid or base salts thereof. Examples of pharmaceutically acceptable salts include, but are not limited to, mineral or organic acid salts of basic groups such as amines; and alkali or organic salts of acidic groups such as carboxylic acids and phenols (e.g., sodium, potassium, calcium, ammonium, quaternary ammonium salts, etc. of carboxylic acids and phenols). The pharmaceutically acceptable salts include the conventional non-toxic salts or the quaternary ammonium salts of the parent compound formed, for example, from non-toxic inorganic or organic acids. For example, such conventional non-toxic salts include those derived from inorganic acids such as hydrochloric, hydrobromic, sulfuric, sulfamic, phosphoric, and nitric; and the salts prepared from organic acids such as acetic, propionic, succinic, glycolic, stearic, lactic, malic, tartaric, citric, ascorbic, pamoic, maleic, hydroxymaleic, phenylacetic, glutamic, benzoic, salicylic, sulfanilic, 2-acetoxybenzoic, fumaric, toluenesulfonic, methanesulfonic, ethane disulfonic, oxalic, and isethionic, and the like. The pharmaceutically acceptable salts of the present disclosure can be synthesized from the parent compound that contains a basic or acidic moiety by conventional chemical methods. Generally, such salts can be prepared by reacting the free acid or base forms of these compounds with a stoichiometric amount of the appropriate base or acid in water or in an organic solvent, or in a mixture of the two; generally, non-aqueous media like ether, ethyl acetate, ethanol, isopropanol, or acetonitrile are preferred. Lists of suitable salts are found in Remington's Pharmaceutical Sciences, 18th Edition, Mack Publishing Company, Easton, Pa. (1990)—which is incorporated herein by reference in its entirety.
When referencing a particular composition/material, the phrase “consists essentially of”, means that the particular composition/material may include minor amounts of impurities so long as those impurities do not affect the basic and novel properties of the invention—the ability to treat autoimmune disorders, inflammatory conditions, and/or reduce inflammation.
As used herein, the terms “optional” or “optionally” means that the subsequently described event(s) can or cannot occur or the subsequently described component(s) may or may not be present (e.g., 0 wt. %).
As used herein, the terms “treat”, “treatment”, and “treating” in the context of the administration of a therapy to a subject in need thereof refers to the reduction or amelioration of severity of symptoms of the condition being treated; reduction of duration of symptoms of the condition being treated; reduction, inhibition, slowing, or arresting of the progression of symptoms associated with the condition; reduction of frequency of symptoms of the condition being treated; elimination of symptoms and/or underlying cause of the condition; prevention of the occurrence of symptoms of the condition, for example in a subject that may be predisposed to the condition but does not yet experience or exhibit symptoms of the condition; improvement or remediation or amelioration of damage following a condition, for example improving, remediating, or ameliorating inflammation; and/or causing regression of the condition.
The term “subject” and “patient” are used interchangeably. As used herein, they refer to any subject for whom or which therapy is desired. In most embodiments, the subject is a human.
The terms “administer”, “administering”, “administration”, and the like, as used herein, refer to the methods that may be used to enable delivery of the active therapeutic ingredient (ATI) to the desired site of biological action. Routes or modes of administration are as set forth herein.
The term “Rapid Infusion Technology™ (RITe) platform” or “rapidly infusing composition”, as used herein means a solid dosage form containing medicinal substances that disintegrates rapidly in the oral cavity (when contacted with saliva) with no need for chewing or drinking/swallowing liquids (e.g., water, liquid carriers, saliva, etc.) to ingest these medicinal substances, with an in-vitro disintegration time of 30 second or less according to the United States Pharmacopeia (USP)<701> Disintegration Test. The disclosed rapidly infusing compositions are thus a different dosage form than, for example, a chewable tablet, a lozenge intended to be dissolved slowly in the mouth, an orally disintegrating film or tablet designed to be dissolved/disintegrated in the mouth and swallowed (also called “orodispersible” formulations), a tablet that should be swallowed whole with food or liquid, or any other oral dosage form designed for absorption from the GI tract.
The dosage amount and treatment duration are dependent on factors, such as bioavailability of a drug, administration mode, toxicity of a drug, gender, age, lifestyle, body weight, the use of other drugs and dietary supplements, the disease stage, tolerance and resistance of the body to the administered drug, etc., and then determined and adjusted accordingly. The terms “effective amount” or “therapeutically effective amount” refer to a sufficient amount of an active therapeutic ingredient (ATI) being administered which provides the desired therapeutic or physiological effect or outcome, for example, the amount of ATI sufficient for reducing inflammation or causing the autoimmune disorder to go into remission. The result can be a reduction and/or alleviation of the signs, symptoms, or causes of a disease, or any other desired alteration of a biological system. Undesirable effects, e.g. side effects, are sometimes manifested along with the desired therapeutic effect; hence, a practitioner balances the potential benefits against the potential risks in determining what is an appropriate “effective amount”. The exact amount required will vary from subject to subject, depending on the age and general condition of the subject, mode of administration, and the like. An appropriate “effective amount” in any individual case may be determined by one of ordinary skill in the art using only routine experimentation, for example through the use of dose escalation studies.
Rapid Infusion Technology™ (RITe) Platform
The present disclosure provides a therapeutic formulation presented in the form of a rapidly infusing composition which is suitable for administration of active therapeutic ingredients (ATIs) such as methotrexate (MTX) via a non-gastric mucosal surface. As described in more detail below, the novel delivery platform allows ATIs—such as MTX—to be presented in unit dosage form for accurate and consistent dosing and in an easy-to-take format for high levels of patient compliance/adherence. For example, the rapidly infusing composition may be presented in tablet form and packaged in individual blister units.
In particular, the rapidly infusing composition enables oral mucosal administration of ATIs in a solid dosage form directly into systemic circulation via the sublingual mucosa or the buccal mucosa and avoidance of first pass metabolism. Through a combination of rapid disintegration and direct systemic introduction, the rapidly infusing composition presents ATIs such as MTX in a highly bioavailable dosage form, typically with a bioavailability of at least 60%, preferably at least 65%, preferably at least 70%, preferably at least 75%, preferably at least 80%, preferably at least 85%, preferably at least 90%, and up to 99%, preferably up to 98%, preferably up to 96%, preferably up to 95%, preferably up to 92%. Such high bioavailability allows the dosage amount of ATI to be reduced, thereby minimizing adverse events.
Additionally, the rapidly infusing composition enables a defined dose of ATI to be absorbed via the oral mucosae, prior to the gastric mucosa, thereby presenting a defined and consistent level of ATI into systemic circulation for consistent and reliable pharmacological effects. Consistency in pharmacological effects helps to improve patient adherence during treatment. The aforementioned high levels of bioavailability may be consistently achieved because the RITe™ platform reduces the tendency for enteral oral administration through voluntary or involuntary swallowing by shortening the residence time the ATI spends in the oral cavity. Any amount of ATI (e.g., MTX) that is swallowed would be subject to first-pass metabolism and thus overall lower bioavailability. Swallowing further results in greater variability in the effective amount of dosing, as a result of variability in the amount swallowed and the greater subject variability of bioavailability through first-pass metabolism for the amount swallowed. Furthermore, oral (enteral) formulations are dependent on the rate of absorption of ATI from the GI tract, these rates being known to vary depending upon whether a subject is in a fed or fasted state. Instead, the rapidly infusing compositions are designed for rapid disintegration in the oral cavity and rapid infusion of the ATI directly into systemic circulation via the oral mucosae, and as a result, are not subject to such gastrointestinal absorption variability, and thus consistent pharmacological outcomes are achieved.
Administration may be carried out by simply placing the rapidly infusing composition directly in the buccal cavity (between the cheek and gum) or over the sublingual mucous gland (under the ventral surface of the tongue). Preferred rapidly infusing compositions are those which are lyophilized products formulated for rapid disintegration when placed in such an oral environment for rapid release of the ATI. The rapidly infusing compositions of the present disclosure may have a disintegration time of from approximately 1 second to 30 seconds or less, preferably 25 seconds or less, preferably 20 seconds or less, preferably 15 seconds or less, preferably 10 seconds or less, preferably 5 seconds or less, preferably 3 seconds or less, according to the United States Pharmacopeia (USP) <701> Disintegration Test performed in deionized water maintained at 37° C.±2°. In particular, preferred rapidly infusing compositions are those formulated for oral disintegration in 5 seconds or less, preferably 4 seconds or less, preferably 3 seconds or less, preferably 2 seconds or less, preferably in approximately 1 second, according to the United States Pharmacopeia (USP) <701> Disintegration Test performed in deionized water maintained at 37° C.±2°. A disintegration profile no higher than the above-mentioned upper limit when in intimate contact with a non-gastric mucosal surface provides for rapid absorption of the ATI and short onset times to therapeutic relief. Also, patient compliance may be improved, particularly in terms of temporary abstinence from swallowing, which is often triggered when a patient is presented with foul-tasting oral medications. Any issues related to foul taste may be minimized with the above rapid disintegration times, which reduces the tendency for enteral oral administration through voluntary or involuntary swallowing, and as a result, the aforementioned high levels of bioavailability may be achieved.
The rapid disintegration profile disclosed herein, coupled with the direct introduction of the ATI into systemic circulation through the sublingual mucosa or the buccal mucosa, preferably through the buccal mucosa, provides a rapid onset of therapeutic effect. For example, the rapidly infusing composition may provide the desired pharmacological effects in (has an onset time of) under 1 hour, preferably under 45 minutes, preferably under 30 minutes, preferably under 15 minutes, preferably under 10 minutes, preferably under 5 minutes, preferably under 4 minutes, preferably under 3 minutes, preferably under 2 minutes, preferably under 1 minute, preferably under 45 seconds, preferably under 30 seconds, preferably under 20 seconds, preferably under 10 seconds, preferably approximately 5 seconds. Such short onset times are superior to those which can be obtained with traditional oral dosage forms such as tablets taken with food or liquids, as well as orodispersible dosage forms dissolved by mouth and then swallowed.
The rapidly infusing composition herein generally contains (a) a pharmaceutically acceptable binder and/or excipient system that includes gelatin and a sugar alcohol e.g., mannitol, and optionally one or more of a sweetener, a flavorant, and a colorant; and (b) a therapeutically effective amount of an active therapeutic ingredient such as methotrexate (MTX), or a pharmaceutically acceptable salt, or solvate thereof.
Pharmaceutically Acceptable Carrier and/or Excipient System
Carriers and/or excipients are ingredients which do not provide a therapeutic effect themselves, but which are designed to interact with, and enhance the properties of, the active therapeutic ingredient. In particular, carriers and/or excipients may act as a vehicle for transporting the active therapeutic ingredient from one organ, or portion of the body, to another organ, or portion of the body. The selection of appropriate carrier/excipient ingredients may impact the solubility, distribution, release profile/kinetics, absorption, serum stability, therapeutic onset time, and ultimately the efficacy of the ATI, as well as the shelf-life, dosage forms, and processability of the drug product. Each ingredient in the pharmaceutically acceptable carrier and/or excipient system must be “pharmaceutically acceptable” in the sense of being compatible with the other ingredients of the rapidly infusing composition and not injurious to the patient.
In light of the above, particular preference is given herein to pharmaceutically acceptable carrier and/or excipient systems which include gelatin and a sugar alcohol (e.g., mannitol).
Gelatin is to be included in the pharmaceutically acceptable carrier and/or excipient system in order to effect matrix formation in the lyophilized product, i.e., gelatin may act primarily as a matrix former. During manufacture of the rapidly infusing composition, lyophilization from an aqueous suspension results in the removal of water thereby leaving behind a gelatin matrix/scaffolding upon which the ATI can be evenly dispersed or suspended. It has been found that gelatin has a propensity to establish a stable matrix in lyophilized form, yet allow for rapid disintegration when brought into contact with the aqueous oral environment, thereby providing efficient transfer of the ATI from the hydrophilic vehicle to the oral mucosa. In this regard, mammalian gelatins, such as bovine gelatin and porcine gelatin are preferred, with bovine gelatin being particularly preferred. In some embodiments, the rapidly infusing composition does not contain fish gelatin.
The amount of gelatin used may be varied. Generally, gelatin may be present in the rapidly infusing composition in an amount of at least 10 wt. %, preferably at least 12 wt. %, preferably at least 14 wt. %, preferably at least 16 wt. %, preferably at least 18 wt. %, preferably at least 20 wt. %, preferably at least 22 wt. %, and up to 50 wt. %, preferably up to 45 wt. %, preferably up to 40 wt. %, preferably up to 35 wt. %, preferably up to 32 wt. %, preferably up to 30 wt. %, preferably up to 28 wt. %, preferably up to 26 wt. %, preferably up to 24 wt. %, based on a total weight of the rapidly infusing composition on a dry basis.
The pharmaceutically acceptable carrier and/or excipient system is also formulated with one or more sugar alcohols, which may act primarily as a bulking agent. Examples of sugar alcohols include, but are not limited to, erythritol, xylitol, sorbitol, maltitol, mannitol, lactitol, and glycerin, which may be used singly or in combinations. Advantage can also be taken of the effect of certain sugar alcohols in terms of taste (sweetness and coolness due to endothermal heat of solution), as well as their ability to aid/speed tablet disintegration. In this regard, particular preference is given to mannitol.
The sugar alcohol, preferably mannitol, may be present in the rapidly infusing composition in any amount which provides the desired bulking/taste/disintegration effects. Generally, this amount will range from of at least 5 wt. %, preferably at least 10 wt. %, preferably at least 12 wt. %, preferably at least 14 wt. %, preferably at least 16 wt. %, preferably at least 18 wt. %, and up to 50 wt. %, preferably up to 45 wt. %, preferably up to 40 wt. %, preferably up to 35 wt. %, preferably up to 30 wt. %, preferably up to 28 wt. %, preferably up to 26 wt. %, preferably up to 24 wt. %, preferably up to 22 wt %, preferably up to 20 wt %, based on a total weight of the rapidly infusing composition on a dry basis.
In some embodiments, a weight ratio of gelatin to sugar alcohol ranges from 1:3, preferably from 1:2, preferably from 1:1, preferably from 1.1:1, and up to 3:1, preferably up to 2:1, preferably up to 1.5:1, preferably up to 1.2:1.
The pharmaceutically acceptable carrier and/or excipient system may also optionally include one or more of a sweetener, a flavorant, and a colorant.
The sweetener may be used in any amount which provides the desired sweetening effect, generally in amount of 0 to 10 wt. %, for example in an amount of up to 10 wt. %, preferably up to 8 wt. %, preferably up to 6 wt. %, preferably up to 5 wt %, preferably up to 4 wt. %, preferably up to 3 wt. %, preferably up to 2 wt. %, preferably up to 1.5 wt. %, preferably up to 1 wt. %, preferably up to 0.5 wt. %, preferably up to 0.1 wt. %, based on a total weight of the rapidly infusing composition on a dry basis. Suitable examples of sweeteners include, but are not limited to, aspartame, saccharin (as sodium, potassium or calcium saccharin), cyclamate (as a sodium, potassium or calcium salt), sucralose, acesulfame-K, thaumatin, neohisperidin, dihydrochalcone, ammoniated glycyrrhizin, dextrose, maltodextrin, fructose, levulose, sucrose, and glucose, which may be used singly or in combinations, with particular preference given to sucralose and acesulfame-K.
It is to be readily appreciated by those of ordinary skill in the art that one or more flavorants may be optionally included in the rapidly infusing composition to mask any unpleasant taste imparted by certain ingredients (e.g., an unpleasant tasting ATI) or to otherwise impart an acceptable taste profile to the composition, and the composition is not limited to any particular flavor. Suitable flavorants include, but are not limited to, oil of wintergreen, oil of peppermint, oil of spearmint, oil of sassafras, oil of clove, cinnamon, anethole, menthol, thymol, eugenol, eucalyptol, lemon, lime, lemon-lime, orange, and other such flavor compounds to add fruit notes (e.g., citrus, cherry etc.), spice notes, etc., to the composition. The flavorants may be constitutionally composed of aldehydes, ketones, esters, acids, alcohols (including both aliphatic and aromatic alcohols), as well as mixtures thereof. The flavorant may be used in any amount which provides the desired flavor, generally in an amount of 0 to 10 wt. %, for example in an amount of up to 10 wt. %, preferably up to 8 wt. %, preferably up to 6 wt. %, preferably up to 5 wt. %, preferably up to 4 wt. %, preferably up to 3 wt. %, preferably up to 2 wt. %, preferably up to 1.5 wt. %, preferably up to 1 wt. %, preferably up to 0.5 wt. %, preferably up to 0.1 wt. %, based on a total weight of the rapidly infusing composition on a dry basis.
Two main strategies contribute to the taste masking success of the present disclosure. First, any issues related to foul taste are fundamentally mitigated by the short oral residence times provided by the rapid disintegration profile described heretofore. One “takes it and it's gone.” Second, when formulated with a flavorant, a robust mixture of flavors will hit the tongue at essentially the same time—the flavor of the MTX still hits the tongue, but the perception of the flavor is canceled or mitigated by the simultaneous arrival of other flavors. Even then, the robust mixture of flavors will quickly subside as the composition is rapidly absorbed through the oral mucosa.
Likewise, the rapidly infusing composition may be colored or tinted through the optional use of one or more colorants. Suitable colorants are those approved by appropriate regulatory bodies such as the FDA and those listed in the European Food and Pharmaceutical Directives and include both pigments and dyes such as FD&C and D&C dyes.
In addition to gelatin and a sugar alcohol (e.g., mannitol), and optionally one or more of a sweetener, a flavorant, and a colorant, the pharmaceutically acceptable carrier and/or excipient system may optionally include one or more other pharmaceutically acceptable carriers and/or excipients known to those of ordinary skill in art, in art appropriate levels. Examples of which include, but are not limited to,
Preferred rapidly infusing compositions are those which contain less than 1 wt %, preferably less than 0.5 wt. %, preferably less than 0.1 wt. %, preferably less than 0.05 wt. %, preferably less than 0.001 wt. %, preferably 0 wt. %, of other pharmaceutically acceptable carriers and/or excipients, such as those listed above, in particular alkaline buffering agents and/or surfactants.
The amount of active therapeutic ingredient (ATI) which can be combined with the pharmaceutically acceptable carrier and/or excipient system to produce the rapidly infusing composition may vary depending upon the subject being treated, the condition being treated, and other factors. The amount of ATI which can be combined with the pharmaceutically acceptable carrier and/or excipient system to produce a single dosage form will generally be that amount which produces a therapeutic effect. Generally, this amount will range from 0.1 to 90 wt. % of ATI, for example, at least 5 wt. %, preferably at least 10 wt. %, preferably at least 15 wt. %, preferably at least 20 wt. %, preferably at least 22 wt. %, preferably at least 24 wt. %, preferably at least 26 wt. %, preferably at least 28 wt. %, preferably at least 30 wt. %, preferably at least 32 wt. %, preferably at least 34 wt. %, preferably at least 36 wt. %, preferably at least 38 wt. %, preferably at least 40 wt. %, preferably at least 42 wt. %, preferably at least 44 wt. %, preferably at least 46 wt. %, preferably at least 48 wt. %, preferably at least 50 wt. %, preferably at least 52 wt. %, preferably at least 54 wt. %, and up to 70 wt. %, preferably up to 68 wt. %, preferably up to 66 wt %, preferably up to 64 wt. %, preferably up to 62 wt. %, preferably up to 60 wt %, preferably up to 58 wt. %, preferably up to 56 wt % of the ATI, based on a total weight of the rapidly infusing composition on a dry basis.
In terms of unit dose, the rapidly infusing composition is generally formulated with 1 to 100 mg of ATI per unit (e.g. tablet), for example at least 2 mg, preferably at least 4 mg, preferably at least 6 mg, preferably at least 8 mg, preferably at least 10 mg, preferably at least 12 mg, preferably at least 14 mg, preferably at least 16 mg, preferably at least 18 mg, preferably at least 20 mg, preferably at least 22 mg, preferably at least 24 mg, and up to 100 mg, preferably up to 75 mg, preferably up to 70 mg, preferably up to 65 mg, preferably up to 60 mg, preferably up to 55 mg, preferably up to 50 mg, preferably up to 45 mg, preferably up to 40 mg, preferably up to 35 mg, preferably up to 30 mg, preferably up to 25 mg of ATI per unit (e.g., tablet).
In preferred embodiments, the rapidly infusing composition is formulated with, as the active therapeutic ingredient, methotrexate (MTX), or any pharmaceutically acceptable salt, solvate, or stereoisomer thereof. In some preferred embodiments, MTX is the only active therapeutic ingredient in the rapidly infusing composition. In other embodiments, MTX may be combined with another active therapeutic ingredient(s). For example, MTX formulated as described below may be combined with an analgesic (e.g., NSAIDs) and/or another anti-inflammatory/antirheumatic agent.
Preferred rapidly infusing compositions are those which are formulated with a solid form of MTX. That is, the rapidly infusing composition is prepared through lyophilization from a drug product suspension in which the MTX is in the form of a solid. In particular, micronized particles of MTX are preferred. In some embodiments, the rapidly infusing composition is formulated with solid MTX in the form of micronized particles having a D50 particle size in the range of 1 μm to 50 μm, for example, those having a D50 particle size of at least 1 μm, preferably at least 10 μm, preferably at least 20 μm, preferably at least 30 μm, preferably at least 40 μm, and up to 50 μm, preferably up to 40 μm, preferably up to 30 μm, preferably up to 20 μm, preferably up to 10 μm.
Without being bound by theory, it is believed that during the manufacture of the rapidly infusing composition, when MTX is presented in solid form and particularly in micronized solid form, lyophilization from a drug product suspension generates a structured and robust matrix of gelatin as the water is removed via sublimation, and an even distribution of the solid form of MTX throughout the gelatin matrix. Such a structured assembly of MTX dispersed within a gelatin matrix is believed to afford the rapidly infusing composition with rapid disintegration properties and efficient transfer of ATI from the hydrophilic vehicle to the mucous membrane of the buccal cavity, or the ventral surface under the tongue, upon administration.
Even more preferred are those rapidly infusing compositions which are formulated with a solid form of MTX having a purity of at least 95 wt. %, preferably at least 96 wt. %, preferably at least 97 wt. %, preferably at least 98 wt. %, preferably at least 99 wt. %, and up to 99.1 wt. %, preferably up to 99.2 wt. %, preferably up to 99.3 wt. %, preferably up to 99.4 wt. %, preferably up to 99.5 wt. %, preferably up to 99.6 wt. %, preferably up to 99.7 wt. %, preferably up to 99.8 wt. %, preferably up to 99.9 wt. %, preferably up to 100% wt. %. The purity may be determined by methods known to those of ordinary skill in the art, for example, one or more of liquid chromatography such as high performance liquid chromatography (HPLC), liquid chromatography-mass spectrometry (LCMS), and liquid chromatography with tandem mass spectrometry (LCMSMS), gas chromatography such as headspace gas chromatography with flame ionization detection (HS-GC-FID), gas chromatography mass spectrometry (GC/MS), and headspace gas chromatography-mass spectrometry (HSGCMS); inductively coupled plasma-mass spectrometry (ICP-MS); and polymerase chain reaction (PCR). For clarity purposes, applicants consider any USP assay result greater than 100% to be effectively 100% purity within the measurement accuracy of the assay.
In preferred embodiments, the rapidly infusing composition comprises, consists essentially of, or consists of gelatin, mannitol, sweetener, flavorant, colorant, and as the ATI, MTX.
Manufacturing of the rapidly infusing compositions may be accomplished generally by i) dissolving gelatin, sugar alcohol (e.g., mannitol), and any optional component of the pharmaceutically acceptable carrier and/or excipient system in water to form a solution, ii) adding the ATI to the solution, followed by the flavorant, to form a drug product suspension, and iii) lyophilizing the drug product suspension to remove water and form the rapidly infusing composition.
One exemplary process is presented below, although it should be understood that numerous modifications and variations are possible, and the rapidly infusing composition may be produced using processes or techniques otherwise than as specifically described.
Purified water, gelatin, and sugar alcohol (e.g., mannitol) may be charged to a mixer, for example a pot equipped with an overhead stirrer, and heated (e.g., 40 to 80° C.) with agitation until complete solvation. Any desired sweetener (e.g., a mixture of sucralose and acesulfame-K) may then be added and allowed to dissolve.
Upon cooling, for example to 20 to 35° C., ATI (e.g., MTX) is added to the solution, preferably in micronized form, and dispersed to form a drug product suspension. The flavorant and any desired colorant may be added at this point with continued mixing. The drug product suspension may be transferred to a second mixer whilst maintaining a cooled temperature (e.g., 20 to 35° C.).
In a blistering machine equipped with a dosing system, blister pockets may next be filled with the drug product suspension until achieving a target dose weight, followed by freezing in a suitable cryochamber. The blister trays may be transferred from the cryochamber to a suitable refrigerated storage cabinet (e.g., at a temperature below 0° C.) to keep the product frozen prior to lyophilization. Then, the frozen blisters may be loaded into a lyophilizer and subject to lyophilization to sublimate the water and form the rapidly infusing compositions. Finally, when the lyophilization cycle is deemed complete, final sealing (e.g., heat sealing of blister lidding) may be performed to provide the rapidly infusing compositions in single dose units in individual blister units.
The present disclosure provides a method of treating an autoimmune disease and/or inflammatory condition by administering to a subject in need thereof the disclosed rapidly infusing composition, in one or more of its embodiments.
Examples of such autoimmune diseases and/or inflammatory conditions include, but are not limited to, systemic autoimmune diseases (previously referred to as collagen diseases) such as rheumatoid arthritis including juvenile RA, psoriasis (e.g., moderate to severe plaque psoriasis), eczema, systemic lupus erythematosus (lupus), Sharp's syndrome, CREST syndrome (calcinosis, Raynaud's syndrome, esophageal dysmotility, telangiectasia), dermatomyositis (e.g., juvenile dermatomyositis), vasculitis (e.g., Morbus Wegener's), T cell-mediated collagen-induced arthritis, and Sjogren's syndrome; renal diseases such as Goodpasture's syndrome, rapidly-progressing glomerulonephritis, and membranoproliferative glomerulonephritis type II; endocrine diseases such as type-II diabetes, autoimmune diabetes, autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED), autoimmune parathyroidism, pernicious anemia, gonad insufficiency, idiopathic Morbus Addison's, hyperthyreosis. Hashimoto's thyroiditis, and primary myxedema; skin diseases such as pemphigus vulgaris, bullous pemphigoid, herpes gestationis, epidermolysis bullosa, and erythema multiforme major; liver diseases such as primary biliary cirrhosis, autoimmune cholangitis, autoimmune hepatitis type-1, autoimmune hepatitis type-2, and primary sclerosing cholangitis; neuronal diseases such as multiple sclerosis, myasthenia gravis, myasthenic Lambert-Eaton syndrome, acquired neuromyotomy, Guillain-Barre syndrome (Muller-Fischer syndrome), stiff-man syndrome, cerebellar degeneration, ataxia, opsoclonus, sensoric neuropathy, and achalasia; blood diseases such as autoimmune hemolytic anemia and idiopathic thrombocytopenic purpura (Morbus Werlhof); infectious diseases with associated autoimmune reactions such as AIDS, malaria, and Chagas disease; inflammatory bowel diseases/conditions such as Crohn's disease and ulcerative colitis; sarcoidosis; cancers with inflammatory components such as mycosis fungoides; and arthritis or other inflammatory joint conditions such as polyarticular juvenile arthritis, psoriatic arthritis, and osteoarthritis.
Specific mention is made herein to the treatment of refractory autoimmune diseases and/or inflammatory conditions of those listed above, such as refractory inflammatory bowel disease, e.g., refractory Crohn's disease. Such conditions are considered to be “refractory” herein when they present as persistent acute symptomatic disease despite anti-inflammatory therapy (e.g., therapy using glucocorticoids and/or other disease modifying antirheumatic drugs (DMARD's)), or as chronically active disease requiring continuous treatment for relief of symptoms.
With respect to administration, the rapidly infusing composition is preferably administered to the subject via one or more of the oral mucosae, preferably via the buccal mucosa (buccally) or the sublingual mucosa (sublingually). Advantages of oral mucosal delivery include the ease of administration, the ability to bypass first pass metabolic processes thereby enabling higher bioavailability than through enteral delivery via the gastrointestinal tract, less variability between patients, sustained drug delivery, and extensive drug absorption and rapid onset of therapeutic action due to either a large surface area in the case of sublingual administration or high-levels of vascularization in the case of buccal administration. Administration may be carried out by simply placing the rapidly infusing composition directly in the buccal cavity (between the cheek and gum) or over the sublingual mucous gland (under the ventral surface of the tongue). While the sublingual mucosa has a large surface area and extremely good permeability, the blood supply (blood flow) is lesser than that of the buccal cavity. Furthermore, sublingual administration tends to stimulate the flow of saliva more than buccal administration, and the increased saliva production may make it more difficult for patients to avoid swallowing. Any amount of ATI that is swallowed would be subject to first pass metabolism and thus overall lower bioavailability. Swallowing further results in greater variability in the effective amount of dosing, as a result of, including but not limited to, the variability in the amount swallowed and the greater patient variability of bioavailability through first-pass metabolism for the amount swallowed and whether the subject is in a fasted or fed state. Therefore, in preferred embodiments, the rapidly infusing composition is administered buccally (through the buccal mucosa). The rapid disintegration of the rapidly infusing composition, approximately in 1-5 seconds in preferred embodiments, and buccal administration together combine to provide optimal dosing control by limiting the time for potential swallowing and ensuring that the vast majority of the ATI is absorbed through the buccal mucosa. Administration may be performed by the subject (self-administered) or by someone other than the subject, for example, a healthcare provider, family member, etc.
The actual amount of ATI administered to the subject may be vaned so as to achieve the desired therapeutic response for a particular subject, composition, and mode of administration, without being toxic to the subject. The selected amount of ATI administered to the subject will depend upon a variety of factors including the condition being treated, the activity of the ATI employed, the route of administration, the time of administration, the rate of excretion or metabolism of the particular compound being employed, the rate and extent of absorption, the duration of the treatment, other drugs, compounds, and/or materials used in combination with the rapidly infusing composition, the age, sex, weight, condition, general health, and prior medical history of the subject being treated, and like factors well known in the medical arts.
A physician having ordinary skill in the art can readily determine and prescribe the effective amount of the ATI required. For example, the physician could start doses of the ATI at levels lower than that required in order to achieve the desired therapeutic effect and gradually increase the dosage until the desired effect is achieved. In general, a suitable dose of the ATI will be that amount which is the lowest dose effective to produce a therapeutic effect, which will generally depend upon the factors described above. Typically, when the ATI is MTX, the therapeutically effective amount of MTX will range from at least 1 mg, preferably 2 mg, preferably at least 3 mg, preferably at least 4 mg, preferably at least 5 mg, preferably at least 10 mg, preferably at least 15 mg, preferably at least 20 mg, preferably at least 25 mg, preferably at least 30 mg, preferably at least 35 mg, preferably at least 40 mg, preferably at least 45 mg, preferably at least 50 mg, and up to 100 mg, preferably up to 95 mg, preferably up to 90 mg, preferably up to 85 mg, preferably up to 80 mg, preferably up to 75 mg, preferably up to 70 mg, preferably up to 65 mg, preferably up to 60 mg, preferably up to 55 mg of MTX per dose.
Relative to subject body weight, the therapeutically effective amount of the rapidly infusing composition may be that which provides MTX to the subject in an amount of at least 0.01 mg/kg, preferably at least 0.05 mg/kg, preferably at least 0.1 mg/kg, preferably at least 0.15 mg/kg, preferably at least 0.2 mg/kg, preferably at least 0.25 mg/kg, preferably at least 0.3 mg/kg, preferably at least 0.35 mg/kg, preferably at least 0.4 mg/kg, and up to 3 mg/kg, preferably up to 2 mg/kg, preferably up to 1 mg/kg, preferably up to 0.9 mg/kg, preferably up to 0.8 mg/kg, preferably up to 0.6 mg/kg, preferably up to 0.5 mg/kg, preferably up to 0.45 mg/kg, per dose.
In order to achieve the above described therapeutically effective amount per dose, the methods herein may involve administering one, or more than one, unit of the rapidly infusing composition per dose (dosing event). For example, in circumstances where each unit of the rapidly infusing composition contains 10 mg of ATI (e.g., MTX), and it has been determined that the subject requires a therapeutically effective amount of 20 mg of ATI per dose, then the subject may be given two (2) units (e.g., tablets) to achieve the desired therapeutically effective amount of 20 mg ATI per dose. Accordingly, depending on the unit dose of ATI in each unit of the rapidly infusing composition, the therapeutically effective amount of ATI prescribed, etc., 1, 2, 3, 4, 5, or more units (e.g., tablets) may be adminstered to the subject per dose. Accordingly, the phrases “administering to the subject in need thereof a rapidly infusing composition”, “the rapidly infusing composition is administered”, etc., are intended herein to include administration of a single unit (e.g., tablet), or multiple units (e.g., tablets), to the subject in order to provide the therapeutically effective amount of ATI, e.g., MTX. While it may be possible to administer partial (e.g., half) tablets to the subject, for practical reasons, it is preferred that one or more whole tablets are administered to the subject.
In preferred embodiments, the subject may be prescribed a dosage regimen that involves multiple, separate dosing events at regular time intervals. Typically, MTX will be administered on a weekly basis, for example 1 time, 2 times, 3 times, or 4 times, at appropriate intervals, throughout the week. Preferred dosing regimens involve administration on the same day(s) of each week. A particularly preferred dosing schedule involves administration of the rapidly infusing composition once per week, preferably on the same day each week. The maximum weekly dosage of MTX can be determined by a physician using skill routine in the art. Treatment may involve administration until desired effects are achieved, for example for weeks, months, or even years, or throughout the subjects life-span. Preferred dosing regimens are those involving a consistent dosing amount and schedule.
In one example, a subject suffering from mycosis fungoides may be administered the rapidly infusing composition in an amount which provides 20-75 mg of MTX once per week.
In another example, a subject suffering from rheumatoid arthritis may be administered the rapidly infusing composition in an amount which provides 5-10 mg of MTX once per week.
In another example, a subject suffering from psoriasis may be administered the rapidly infusing composition in an amount which provides 5-25 mg of MTX once per week.
In yet another example, a subject suffering from Crohn's disease may be administered the rapidly infusing composition in an amount which provides 1-25 mg of MTX once per week.
Upon being administered buccally (between the cheek and gum) or sublingually (under the ventral surface of the tongue), the rapidly infusing composition preferably disintegrates in 5 seconds or less, preferably 4 seconds or less, preferably 3 seconds or less, preferably 2 seconds or less, preferably about 1 second. Further, this route of administration may provide a single dose bioavailability of at least 60%, preferably at least 65%, preferably at least 70%, preferably at least 75%, preferably at least 80%, preferably at least 85%, preferably at least 90%, and up to 99%, preferably up to 98%, preferably up to 96%, preferably up to 95%, preferably up to 92%.
Using the platform, the rapidly infusing composition may be used as a stand-alone therapeutic agent for the treatment of autoimmune diseases and/or inflammatory conditions or may be used in combination therapy—wherein the rapidly infusing composition is used in combination with one or more other forms of therapy such as one or more second therapeutic agents. The combination therapy may be applied to treat the autoimmune disorder/inflammatory condition, or a combination of the autoimmune disorder/inflammatory condition and a different condition such as pain.
Combination therapy may involve administering the rapidly infusing composition formulated with MTX and a second therapeutic agent for the treatment of an autoimmune disorder/inflammatory condition. Examples of such second therapeutic agents include, but are not limited to, glucocorticoids and/or other disease modifying antirheumatic drugs (DMARD's) to enhance the effectiveness of the treatment regimen. Examples of glucocorticoids include, but are not limited to, beclomethasone, betamethasone, budesonide, cortisone, dexamethasone, hydrocortisone, methylprednisolone, prednisolone, prednisone, and triamcinolone. Examples of DMARD's may include, but are not limited to, gold preparations (e.g., auranofin, gold salts, gold sodium thiomalate), interleukin receptor antagonists (e.g., anakinra, canakinumab, rilonacept, sarilumab, tocilizumab), immunosuppressive agents (e.g., cyclosporine, mycophenylate, sirolimus, tacrolimus), biologics including tumor necrosis factor (TNF) antagonists/inhibitors (e.g., adalimumab, canakinumab, certolizumab, golimumab, infliximab, rituximab, sarilumab, tocilizumab, ustekinumab, etanercept), thiopurines (e.g., azathioprine, mercaptopurine, thioguanine), tyrosine (janus) kinase inhibitors (e.g., baricitinib, tofacitinib), and others such as abatacept, flavocoxid, hydroxychloroquine, leflunomide, and penicillamine.
Combination therapy may involve administering the rapidly infusing composition formulated with e.g., MTX, in combination with one or more second therapeutic agents that provides an analgesic effect for the treatment of pain. For example, rapidly infusing compositions formulated with MTX may be used in combination with analgesics such as opioid analgesics and non-steroidal anti-inflammatory drugs (NSAIDs) or other Standard of Care for pain management such as antidepressants or anticonvulsants.
Opioids suitable for use in combination therapy may include natural opiates, esters/ethers of morphine opiates, semi-synthetic opioids, synthetic opioids, and endogenous opioid peptides.
NSAIDs suitable for use in combination therapy may include, but are not limited to, oxicams, salicylates, acetic acid derivatives, fenamates, propionic acid derivatives, pyrazoles/pyrazolones, coxibs, and sulfonanilides, with specific mention being made to piroxicam, isoxicam, tenoxicam, sudoxicam, salicylic acid, ethyl salicylate, methyl salycilate, aspirin, disalcid, benorylate, trilisate, safapryn, solprin, diflunisal, fendosal, diclofenac, fenclofenac, indomethacin, sulindac, tolmetin, isoxepac, furofenac, tiopinac, zidometacin, acematacin, fentiazac, zomepirac, clindanac, oxepinac, felbinac, ketorolac, mefenamic, meclofenamic, flufenamic, niflumic, tolfenamic acids, ibuprofen, naproxen, benoxaprofen, flurbiprofen, ketoprofen, fenoprofen, fenbufen, indopropfen, pirprofen, carprofen, oxaprozin, pranoprofen, miroprofen, tioxaprofen, suprofen, alminoprofen, tiaprofenic, phenylbutazone, oxyphenbutazone, feprazone, azapropazone, trimethazone, ramifenazone, lonazolac, meloxicam, celecoxib, and the like. Other analgesics without anti-inflammatory activity such as paracetamol (acetaminophen) may also be used.
Antidepressants suitable for use in combination therapy may include, but are not limited to, tricyclic antidepressants such as amitriptyline, doxepin, imipramine, desipramine, and nortriptyline; selective serotonin reuptake inhibitors such as paroxetine and citalopram; venlafaxine; bupropion; and duloxetine.
Anticonvulsants suitable for use in combination therapy may include, but are not limited to, voltage-gated ion channel blockers, ligand-gated ion channel blockers, antagonists of the excitatory receptors for glutamate and N-methyl-D-aspartate, and enhancers of the γ-aminobutyric acid, with specific mention being made to, carbamazepine, gabapentin, lamotrigine, pregabalin, baclofen, phenytoin, and the like.
Combination therapy may involve administering the rapidly infusing composition formulated with e.g., MTX, in combination with two or more second therapeutic agents that provides an analgesic effect, with specific mention being made to oxycodone/paracetamol, propoxyphene/paracetamol, codeine/paracetamol, hydrocodone/paracetamol, and the like.
Combination therapy may also involve administering the rapidly infusing composition formulated with e.g., MTX, in combination a supplement designed to reduce the side effects associated with MTX. A non-limiting example of such a supplement is folic acid or derivative thereof (e.g., salt forms).
Combination therapy is intended to embrace administration of these therapies in a sequential manner, that is, wherein the rapidly infusing composition and one or more other therapies are administered at a different time, as well as administration of these therapies, or at least two of the therapies, in a substantially simultaneous manner. Substantially simultaneous administration can be accomplished, for example, by administering to the subject multiple, single dosage forms for each of the therapeutic agents. Sequential or substantially simultaneous administration of each therapeutic agent can be effected by any appropriate route including, but not limited to, oral routes, intravenous routes, intramuscular routes, and direct absorption through mucous membrane tissues. The therapeutic agents can be administered by the same route or by different routes. For example, the rapidly infusing composition formulated with MTX may be administered via buccal administration while a second therapeutic agent of the combination may be administered intravenously. Alternatively, for example, all therapeutic agents may be administered buccally. Combination therapy also can embrace the administration of the rapidly infusing composition in further combination with other biologically active ingredients and non-drug therapies. Where the combination therapy further comprises a non-drug treatment, the non-drug treatment may be conducted at any suitable time so long as a beneficial effect from the co-action of the combination of the therapeutic agent(s) and non-drug treatment is achieved. For example, in appropriate cases, the beneficial effect is still achieved when the non-drug treatment is temporally removed from the administration of the therapeutic agents, perhaps by days or even weeks.
Where a numerical limit or range is stated herein, the endpoints are included. Also, all values and subranges within a numerical limit or range are specifically included as if explicitly written out.
As used herein the words “a” and “an” and the like carry the meaning of “one or more.”
The present disclosure also contemplates other embodiments “comprising”, “consisting of” and “consisting essentially of”, the embodiments or elements presented herein, whether explicitly set forth or not.
All patents and other references mentioned above are incorporated in full herein by this reference, the same as if set forth at length.
Obviously, numerous modifications and variations of the present invention are possible in light of the above teachings. It is therefore to be understood that, within the scope of the appended claims, the invention may be practiced otherwise than as specifically described herein.
This application claims priority to U.S. patent application Ser. No. 17/225,738 filed Apr. 8, 2021, which claims priority to U.S. Provisional Application No. 63/114,194 filed Nov. 16, 2020; U.S. Provisional Application No. 63/114,181 filed Nov. 16, 2020; U.S. Provisional Application No. 63/147,453 filed Feb. 9, 2021; U.S. Provisional Application No. 63/172,343 filed Apr. 8, 2021; U.S. Provisional Application No. 63/172,362 filed Apr. 8, 2021; U.S. Provisional Application No. 63/172,386 filed Apr. 8, 2021; U.S. Provisional Application No. 63/172,368 filed Apr. 8, 2021; and U.S. Provisional Application No. 63/180,193 filed Apr. 27, 2021; which are each incorporated herein by reference in their entirety.
| Filing Document | Filing Date | Country | Kind |
|---|---|---|---|
| PCT/US2021/059088 | 11/12/2021 | WO |
| Number | Date | Country | |
|---|---|---|---|
| 63180193 | Apr 2021 | US | |
| 63172386 | Apr 2021 | US | |
| 63172368 | Apr 2021 | US | |
| 63172362 | Apr 2021 | US | |
| 63172343 | Apr 2021 | US | |
| 63147453 | Feb 2021 | US | |
| 63114194 | Nov 2020 | US | |
| 63114181 | Nov 2020 | US |
| Number | Date | Country | |
|---|---|---|---|
| Parent | 17225738 | Apr 2021 | US |
| Child | 18252735 | US |
