Embodiments of the present disclosure relate to systems for manufacturing parenteral solutions, such as solutions for peritoneal dialysis for the treatment of renal insufficiency.
Patients suffering from acute or chronic renal insufficiency are treated using dialysis therapy. One such dialysis therapy is peritoneal dialysis, in which a dialysis solution is infused into the patient's peritoneal cavity. Metabolites diffuse across the peritoneal membrane into the dialysis solution, which is then removed from the patient to complete the therapy.
Limited access to dialysis may result in up to 7 million deaths annually, more than the number of deaths from HIV and tuberculosis combined. Less than one-third of patients needing dialysis in Asia and only 16% of the patients in Africa receive needed treatment. This is due in part to the lack of local production of dialysis fluid in the countries affected; importation leads to high costs that make the solution unaffordable to patients who usually have to pay out of pocket.
Dialysis fluid is part of a larger category of treatment solutions referred to as Large Volume Parenteral Solutions (LVPS); others include infusion solutions (plasma expanders, rehydration fluids, nutritional and electrolyte solutions) and irrigation solutions. These solutions, which are vital for routine medical care, are all generics formulated from similar ingredients. Water-for-Injection (WFI) forms 90% or more of the volume of most LVPS. Solutes (salts and sugars) make up the rest of the volume. The similarity in formulation is the reason some physicians improvise dialysis fluid by mixing other LVPS together in situations where shortages are extreme.
Besides the WFI required for producing LVPS, conventional systems require a controlled environment (e.g., clean room), in which the parenteral solutes (e.g., salts and sugars) may be mixed with the WFI and stored in containers.
New LVPS manufacturing techniques are needed to meet growing demands for LVPS globally and locally. For example, the global demand for LVPS is growing with an increasing number of surgeries and hospitalizations for chronic conditions—the global market is predicted to grow at a CAGR of 7.08% to $11.939 billion by the end of 2025. In contrast to the demand, the supply for LVPS even in developed markets like the US is becoming limited as pharmaceutical companies either offshore their production or discontinue manufacturing in pursuit of higher-margin drugs. This leads to shortages of these vital solutions with the slightest supply chain disturbances (e.g., 2018 saline shortage with Hurricane Maria, 2020 dialysis fluid shortage in the US due to increased demands from COVID-19 patients with kidney damage).
Additionally, there is a need to provide kidney care in developing countries and in disaster situations or military fields where supply chains for essential LVPS might be disrupted or non-existent.
Embodiments of the present disclosure relate to systems for manufacturing parenteral solutions, various components of the system, and methods performed by the systems. One embodiment of the system includes a drug dosage module and a mixing module. The drug dosage module includes a source of one or more parenteral drug solutes, and one or more metering devices configured to discharge a metered dosage of each of the parenteral drug solutes. The mixing module includes a container configured to receive water-for-injection (WFI) and the parenteral drug solutes discharged from the one or more metering devices, and a mixer configured to mix water-for-injection (WFI) and the parenteral drug solutes in the container to form a parenteral solution.
In one example, the mixing module includes at least one conductivity sensor, each configured to sense a conductivity of the parenteral solution in the container and produce a conductivity output that is indicative of the sensed conductivity. In one embodiment, the system may include a controller that is configured to control the discharge of the metered dosage of each of the parenteral drug solutes to the container by the one or more metering devices based on each conductivity output produced by the at least one conductivity sensor.
In one embodiment, the system includes a water module having a water pump that is configured to deliver a flow of the WFI to the container. The controller is configured to control the delivery of the flow of the WFI to the container by the water pump based on each conductivity output produced by the at least one conductivity sensor.
In yet another embodiment, the at least one conductivity sensor includes a plurality of the conductivity sensors. Each of the conductivity sensors is positioned at a different height within the container. The controller controls the discharge of the metered dosage of each of the parenteral drug solutes by the one or more metering devices and the flow of the WFI to the container by the water pump based on the conductivity outputs.
In one embodiment, the water module of the system includes a water purifier configured to filter or sterilize a flow of water to produce the flow of the WFI. The water purifier may include a water filter, through which the flow of water travels, and/or an ultraviolet (UV) sterilization device comprising one or more UV light sources configured to expose the flow of water to UV light.
Another example of the system includes a bagging module that is configured to deliver a flow of the parenteral solution into each of one or more fluid storage bags through a corresponding fluidic coupling. In embodiment, each of the fluidic couplings includes a first coupler configured to receive the flow of the parenteral solution and a second coupler attached to the fluid storage bag. The first and second couplers are configured to cooperate to form the fluidic coupling. In one embodiment, the first coupler includes a needle, and the second coupler includes a septum, the first and second couplers include cooperating tubing fittings, or the first and second couplers include cooperating Luer fittings.
The bagging module may include a solution pump configured to drive the flow of the parenteral solution from the container into each of the one or more fluid storage bags through the corresponding fluidic coupling.
In one embodiment, the bagging module includes a fluidic coupling drive mechanism that is configured to move each of the first couplers relative to the second couplers between a retracted position, in which each of the first couplers is recessed from the corresponding second coupler, and a filling position, in which each of the first couplers cooperates with the corresponding second coupler to form the fluidic couplings.
In another embodiment, the bagging module further comprises a sterilizer configured to sterilize the first coupler and/or the second coupler. In one example, the sterilizer may include at least one sterilization chamber, wherein the first coupler and/or the second coupler of each fluidic coupling is contained in one of the sterilization chambers. One or more UV lamps are contained in each of the sterilization chambers and are configured to expose the first coupler and/or the second coupler of each fluidic coupling to UV light.
In another example, the sterilizer includes at least one sterilization chamber, each containing a sterilization fluid. The first coupler and/or the second coupler of each fluidic coupling is contained in one of the sterilization chambers and the sterilization fluid.
In one embodiment, the bagging module includes a plurality of the fluid storage bags and a plurality of the fluidic couplings. The first coupler of each fluidic coupling includes a needle, and the second coupler of each fluidic coupling includes a bag septum that is fluidically coupled to an interior cavity of the corresponding fluid storage bag. The fluidic coupling drive mechanism is configured to move the plurality of needles relative to the corresponding bag septa between a retracted position, in which each of the needles is recessed from the corresponding bag septum, and a filling position, in which each of the needles pierces the corresponding bag septum and is configured to deliver the flow of the parenteral solution to the interior cavity of the corresponding fluid storage bag.
In one embodiment, the parenteral solutes include solid drug solutes and/or liquid drug solutes.
One embodiment of the present disclosure is directed to a bagging module that is configured to fill one or more fluid storage bags with parenteral solution. In one example, the bagging module includes a source of parenteral solution, one or more fluid storage bags, each having an interior cavity, a fluidic coupling corresponding to each fluid storage bag to facilitate delivery of a flow of the parenteral solution from the source into the one or more fluid storage bags. Each fluidic coupling may include a first coupler configured to receive the flow of the parenteral solution and a second coupler attached to the fluid storage bag. The first and second couplers are configured to cooperate to form the fluidic coupling. In one example, the first coupler includes a needle, and the second coupler includes a septum. In another example, the first and second couplers include cooperating tubing fittings. In another example, the first and second couplers include cooperating Luer fittings.
The bagging module may include a solution pump that is configured to drive the flow of the parenteral solution from the source into each of the one or more fluid storage bags through the corresponding fluidic coupling.
In one embodiment, the bagging module includes a fluidic coupling drive mechanism configured to move each of the first couplers relative to the second couplers between a retracted position, in which each of the first couplers is recessed from the corresponding second coupler, and a filling position, in which each of the first couplers cooperates with the corresponding second coupler to form the fluidic couplings.
In one embodiment, the bagging module includes a sterilizer that is configured to sterilize the first coupler and/or the second coupler. In one example, the sterilizer includes at least one sterilization chamber, wherein the first coupler and/or the second coupler of each fluidic coupling is contained in one of the sterilization chambers. One or more UV lamps are contained in each of the sterilization chambers and are configured to expose the first coupler and/or the second coupler of each fluidic coupling to UV light.
In another example, the sterilizer includes at least one sterilization chamber, each containing a sterilization fluid. The first coupler and/or the second coupler of each fluidic coupling is contained in one of the sterilization chambers and the sterilization fluid.
Additional embodiments include methods for manufacturing the parenteral solution using embodiments of the system and a controller configured to control components of the system, and methods for delivering parenteral solution into one or more bags using a bagging module.
This Summary is provided to introduce a selection of concepts in a simplified form that are further described below in the Detailed Description. This Summary is not intended to identify key features or essential features of the claimed subject matter, nor is it intended to be used as an aid in determining the scope of the claimed subject matter. The claimed subject matter is not limited to implementations that solve any or all disadvantages noted in the Background.
Embodiments of the present disclosure are described more fully hereinafter with reference to the accompanying drawings. Elements that are identified using the same or similar reference characters refer to the same or similar elements. The various embodiments of the present disclosure may, however, be embodied in many different forms and should not be construed as limited to the embodiments set forth herein. Rather, these embodiments are provided so that this disclosure will be thorough and complete, and will fully convey the scope of the present disclosure to those skilled in the art.
Some embodiments of the present disclosure facilitate small-scale, decentralized production of dialysis fluid or other LVPS in a manner that can significantly improve accessibility and affordability of dialysis fluid and other LVPS. In some embodiments, the water-for-injection is produced at or near the point of care and is mixed with the required concentrates to form the LVPS without the need for a cleanroom facility. As a result, embodiments of the present disclosure may provide significant improvements to the accessibility and affordability of dialysis fluid and other LVPS by facilitating timely, local and affordable manufacture of LVPS.
The water module 102 is generally configured to supply purified water or water-for-injection (WFI) 110 to the mixing module 106. In one embodiment, the WFI 110 meets quality standards for injection, such as those defined by USP<1231> and/or other standards.
In some embodiments, the water module 102 may include a water purifier 112 that is configured to receive a supply of water from a water source 114. The water source 114 may be any suitable water source, such as line water from a community's supply of water, well water, or another suitable non-purified water source. The water purifier 112 purifies the water 113 received from the water source 114 using any suitable technique to form the WFI 110. In one example, the water purifier 112 includes one or more water filters, through which the water 113 travels, that remove impurities and sterilize the water 113 to form the WFI 110. Alternatively or additionally, the water purifier may include an ultraviolet (UV) sterilization or sanitization device having one or more UV light sources that expose the water 113 to UV light to sterilize the water 113 and form the WFI 110. The water purifier 112 may include other devices for sterilizing and sanitizing the water 113 from the water source 114 to form the WFI 110.
The water module 102 is configured to supply the WFI 110 to the container 116, as indicated in
The drug dosage module 104 is configured to supply the necessary sterile parenteral drug solutes or drug substances 118 to the container 116 of the mixing module 106 for mixing with the WFI 110 to form the desired parenteral solution 120, as indicated in
The mixing module 106 may include a mixer 121 (
Some embodiments of the mixing module 106 are configured to monitor the parenteral solution 120 within the container 116 using one or more sensing elements 123. In one embodiment, the sensing elements 123 are configured to sense one or more parameters (e.g., conductivity, glucose, etc.) of the solution within the container 116, from which a concentration of the drug solutes 118 may be determined. In one embodiment, two or more of the sensors 123 are used to confirm that the solution is “fully mixed” and meets product specifications. This confirmation may be made without the use of external composition analyses. In one example, the sensors 123 are located at different heights along the interior of the container 116, as indicated in
Some embodiments are directed to a process of forming the parenteral solution 120 using the water module 102, the drug dosage module 104 and the mixing module 106. In one example, the one or more sensors 123 comprise conductivity sensors that are configured to sense a conductivity of the solution 120 within the container 116. When the conductivity of the solution 120 within the container 116 detected by the one or more sensors 123 indicates that the concentration of the drug solutes 118 is less than the desired concentration, the drug dosage module 104 injects an incremental amount of one or more of the drug solutes 118 using the metering devices 122 and the solution 120 is retested using the sensors 123. When the concentration of the drug solutes 118 in the container 116 detected by the sensors 123 is greater than the desired concentration for the desired parenteral solution 120, the system 100 may inject an incremental amount of the WFI 110 using the dosage pump 117 of the water module 102. In this manner, the system 100 may produce a parenteral solution 120 within the container 116 having the desired concentration of the drug solutes 118, which may be output to the bagging module 108 using gravity or a pump, for example.
The bagging module 108 is generally configured to deliver a flow of the parenteral solution 120, such as from the mixing module 106, into one or more fluid storage bags, to produce a final product 130 (
The valve 137 may be set to a state in which a fluid pathway is formed between the port 150 connected to the primary bag 132 through the conduit 136 and the port 148 connected to the adapter 138 and catheter 142, while the port 152 connected to the drain bag 134 is closed to the fluid pathway. This allows the parenteral solution 120 in the form of dialysis fluid to flow from the bag 132 into the peritoneal cavity 144. After a suitable period of time has elapsed, the valve 137 may be set to a state that opens a fluid pathway between the port 148 connected to the adapter 138 and the catheter 142 and the port 152 connected to drain bag 134 through the conduit 136, while the port 150 connected to the primary bag 132 is closed to the fluid pathway. The fluid 154 within the peritoneal cavity 144 may then be drained through the catheter 142 and the tubing 136 to the drain bag 134 to complete the treatment. The product 130 may then be disposed of.
As mentioned above, the bagging module 108 is generally configured to deliver a flow of the parenteral solution 120 into one or more fluid storage bags 132.
In one embodiment, the bagging module 108 includes a solution pump 168 that may be used to drive a flow of the parenteral solution 120 (e.g., dialysis fluid), such as from the container 116 of the mixing module 106, into one or more fluid storage bags 132. Alternatively, the bagging module 108 may rely on gravity to deliver the flow of the parenteral solution 120 into the bags 132. While the bags 132 are generally shown as being in a horizontal orientation, embodiments of the bagging module 108 include orienting the bags 132 vertically to facilitate filing the bags 132 from above. Additionally, when multiple bags 132 are to be filled with the parenteral solution 120, the bagging module 108 may be configured to fill the bags 132 either in a serial or in a parallel manner.
In one embodiment, the bagging module 108 includes a fluidic coupling 170 that facilitates the formation of a fluid pathway for delivering the flow of the solution 120 into the bags 132. The fluidic coupling 170 generally comprises a first coupler 170A that receives the flow of the solution 120 and a second coupler 170B that is connected to a fluid pathway to the interior of the bag 132. The first and second couplers 170A and 170B cooperate with each other (e.g., connect, engage, etc.) to form the fluidic coupling 170. While only two fluidic couplings 170 and corresponding bags 132 are shown, it is understood that the bagging module 108 may be configured with one or several of the fluidic couplings 170 to meet bag filling requirements.
The fluidic couplings 170 may be formed using any suitable conventional couplings. In one example, the first coupler 170A includes a needle and the second coupler 170B comprises a suitable septum or sealable port. The needle form of the coupler 170A may be inserted into the septum or port form of the coupler 170B to open a fluid pathway for the delivery of the flow of the solution 120 into the bag 132.
In another example, the first and second couplers 170A and 170B may comprise cooperating tubing fittings. The tubing fittings may be conventional tubing fittings, such as suction connectors, rigid tubing sections, etc. For example, the first and second couplers 170A and 170B may comprise rigid tubing sections that allow one of the tubing sections to be received within the other to form the fluidic coupling 170 and the desired fluid pathway. Thus, the tubing section forming the first coupler 170A may have a diameter that is less than the tubing section forming the second coupler 170B to allow the first coupler 170A to be inserted into the second coupler 170B and form the fluidic coupling 170. Here, the tubing section forming the second coupler 170B and the bag 132 may be oriented vertically to allow the solution 120 to be pumped or gravity-fed into the bag 132 through the fluidic coupling 170.
In yet another example, the first and second couplers 170A and 170B may comprise conventional cooperating Luer components or fittings. For example, the first coupler 170A or the second coupler 170B may include a Luer fitting while the other includes a Luer activated valve. The fluidic coupling 170 that is completed when the Luer fitting is received in the valve forms the fluid pathway for the delivery of the solution 120 into the bag 132.
In some embodiments, the bagging module 108 may include a fluidic coupling drive mechanism 174, as illustrated in the simplified diagram of
The drive mechanism 174 may take on any suitable form. In one example, the drive mechanism 174 may include a motor that drives a screw drive actuator, a rack and pinion actuator, or another suitable actuating mechanism for driving the structure 178 along the axis 176 relative to the structure 180. Alternatively, the drive mechanism 174 may be manually driven by a user.
In some embodiments, the bagging module 108 includes a sterilizer 182, as shown in
In one embodiment, the housing 184 includes a wall 191 containing sealable ports 192, such as septa, each corresponding to one of the needles 170A. The wall 190 may be UV transparent to allow for the sterilization of the ports 192 and the bag septa or ports forming the coupler 170B.
The drive mechanism 174 may be configured to move the structure or wall 178 relative to the housing 184 to transition the needles 170A from their retracted position shown in
The housing 184 may include one or more sterilization chambers 186 that each contain the sterilization fluid 195. Thus, the housing 184 may contain a single chamber 186 filled with the sterilization fluid 195, or the housing may include walls 196 (phantom lines) that form multiple sterilization chambers 186, each of which may accommodate one or more of the first couplers 170A and/or the second couplers 170B. The one or more chambers 186 may be filled with the sterilization fluid 195 through a port 197. The chambers 186 may be sealed by the sealable ports or septa 170B and housing ports or septa 198.
The drive mechanism 174 may move the structure 178 supporting the needles 170A relative to the housing 184 supporting the ports or septa 170B between the retracted position (needles 170A shown in solid lines) to the filling position (needles 170A shown in phantom lines). During this movement and/or while in the retracted position, the distal ends of the needles 170A extend through the corresponding housing ports or septa 198 and into the sterilization chamber 186, in which they are sterilized by the sterilization fluid 195. The ports or septa 170B may also be sterilized by the sterilization fluid 195.
As the needles 170 are moved further by the drive mechanism 174 toward the ports or septa 170B, the distal ends of the needles 170A pierce the ports or septa 170B and ultimately reach the filling position, in which the parenteral solution 120 may be delivered into the bags 132. After the bags 132 have been filled to a desired volume, they may be disconnected and packaged as discussed above to form the final product 130.
In some embodiments, the system 100 includes a controller 200 (
Although the embodiments of the present disclosure have been described with reference to preferred embodiments, workers skilled in the art will recognize that changes may be made in form and detail without departing from the spirit and scope of the present disclosure.
Filing Document | Filing Date | Country | Kind |
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PCT/US2023/017403 | 4/4/2023 | WO |
Number | Date | Country | |
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63327059 | Apr 2022 | US |