U.S. patent application number 09/005262 was filed with the patent office on 2001-11-22 for formulations for amylin agonist peptides.
Invention is credited to L'ITALIEN, JAMES, MUSUNURI, SHANKAR, RUBY, KALE.
Application Number | 20010043934 09/005262 |
Document ID | / |
Family ID | 26674137 |
Filed Date | 2001-11-22 |
United States Patent
Application |
20010043934 |
Kind Code |
A1 |
L'ITALIEN, JAMES ; et
al. |
November 22, 2001 |
FORMULATIONS FOR AMYLIN AGONIST PEPTIDES
Abstract
The present invention is concerned with a pharmaceutical
formulation in a container, for example, a vial, prefilled
cartridge, prefilled syringe or disposable pen, comprising
approximately 0.01 to about 0.5% (w/v) amylin agonist, preferably
pramlintide, in an aqueous system along with approximately 0.02 to
about 0.5% (w/v) of an acetate, phosphate, citrate, or glutamate
buffer to a pH of the final composition of approximately 3.0 to
about 6.0 as well as approximately 1.0 to 10% (w/v) of a
carbohydrate or polyhydric alcohol tonicifier; and, optionally,
approximately 0.005 to 1.0% (w/v) of a preservative selected from
the group consisting of m-cresol, benzyl alcohol, parabens and
phenol. These formulations maintain stability upon storage under
refrigerated or room temperature conditions. Such formulations can
be further combined with insulin in the same syringe for
administration to a patient.
Inventors: |
L'ITALIEN, JAMES; (DEL MAR,
CA) ; MUSUNURI, SHANKAR; (EXTON, PA) ; RUBY,
KALE; (SAN DIEGO, CA) |
Correspondence
Address: |
EDWARD O. KREUSSER
BROBECK, PHILEGER & HARRISON LLP
12390 EL CAMINO REAL
SAN DIEGO
CA
92130
US
|
Family ID: |
26674137 |
Appl. No.: |
09/005262 |
Filed: |
January 9, 1998 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
|
60035140 |
Jan 8, 1997 |
|
|
|
Current U.S.
Class: |
424/400 |
Current CPC
Class: |
A61K 47/26 20130101;
A61K 9/0014 20130101; Y10S 514/884 20130101; A61K 47/02 20130101;
A61K 47/12 20130101; A61K 9/0019 20130101; A61K 9/19 20130101; A61K
38/22 20130101; Y10S 514/866 20130101; A61K 9/0024 20130101; A61K
47/10 20130101 |
Class at
Publication: |
424/400 |
International
Class: |
A61K 009/00 |
Claims
We claim:
1. A liquid, pharmaceutical formulation comprising about 0.01 to
about 0.5% (w/v) of an amylin agonist, about 1.0 to about 10% (w/v)
of a carbohydrate or a polyhydric alcohol, and about 0.02 to about
0.5% (w/v) of an acetate, phosphate, citrate or glutamate buffer,
and which has a pH about 3.0 to about 6.0.
2. The liquid, pharmaceutical formulation of claim 1 which is
substantially isotonic.
3. The liquid, pharmaceutical formulation of claim 1 which further
comprises a preservative.
4. The liquid, pharmaceutical formulation of claim 3 wherein said
preservative is selected from the group consisting of m-cresol,
benzyl alcohol, methyl, ethyl, propyl and butyl parabens and
phenol.
5. The liquid, pharmaceutical formulation of any of claims 1-4,
wherein said amylin agonist is pramlintide.
6. The liquid, pharmaceutical formulation of any of claims 1-4,
wherein said polyhydric alcohol is selected from the group
consisting of mannitol, sorbitol, inositol, glycerol, xylitol,
propylene/ethylene glycol copolymer, PEG 8000, PEG 400, PEG 4000,
PEG 200, PEG 1450 or PEG 3350.
7. The liquid, pharmaceutical formulation of any of claims 1-4,
wherein said polyhydric alcohol is mannitol.
8. The liquid, pharmaceutical formulation of any of claims 1-4,
wherein said carbohydrate is selected from the group consisting of
mannose, ribose, trehalose, maltose, glycerol, inositol and
lactose.
9. The liquid, pharmaceutical formulation of any of claims 1-4,
wherein said buffer is an acetate buffer.
10. The liquid, pharmaceutical formulation of any of claims 1-4,
wherein the pH of said formulation is about 3.5 to about 5.0.
11. The liquid, pharmaceutical formulation of any of claims 1-4,
wherein the pH of said formulation is about 3.8 to about 4.2.
12. The liquid, pharmaceutical formulation of any of claims 1-4,
wherein said preservative is approximately at least about 0.15%
(w/v) of m-cresol.
13. The liquid, pharmaceutical formulation of any of claims 1-4,
wherein said preservative is approximately about 0.1 to about 0.3
(w/v) of m-cresol.
14. The liquid, pharmaceutical formulation of any of claims 1-4,
wherein said formulation further comprises a surfactant.
15. The liquid, pharmaceutical formulation of any of claims 1-4,
wherein said surfactant is selected from the group consisting of
polyoxyethylene (20) sorbitan monooleate, 3-[(3-cholamidopropyl)
dimethylanmonio] 1-propanl sulfonate, polyoxyethylene (23) lauryl
ether, poloxamer or a non-ionic surfactant.
16. A formulation comprising an amylin agonist which is
biologically active, has a reduced tendency to form aggregates in
water or at a pressure of greater than 2 psi compared to human
amylin, and has a reduced tendency to precipitate in the presence
of NaCl compared to human amylin, admixed with one or more
compounds which reduce loss of activity of said amylin agonist, in
an amylin specific receptor binding assay or bioactivity assay or
HPLC assay compared to a composition consisting of said amylin
agonist in phosphate-buffered saline or saline, said compounds
comprising a tonicity agent and a buffer, said tonicity agent being
provided in an amount between 0.01% and 10% and said formulation
having a pH of about 3.0 to about 6.0.
17. The formulation of claim 14, further comprising a
preservative
18. A method for treating a patient with pramlintide, and insulin,
said method comprising admixing a formulation of pramlintide with
insulin and administering the mixture of said formulation and
insulin to a patient in need of such treatment, wherein said
formulation comprising a tonicifier, a buffer and a preservative,
said tonicifier comprising approximately 1.0 to 10% (w/v) of a
carbohydrate or a polyhydric alcohol, said buffer comprising
approximately 0.02 to 0.5% (w/v) of an acetate, phosphate, citrate
or glutamate buffer which allows a pH of the final formulation of
approximately 3.0 to 6.0, and said preservative comprising a
compound selected from the group consisting of m-cresol, benzyl
alcohol, methyl, ethyl, propyl and butyl parabens and phenol, and
wherein said pramlintide comprises about 0.01 to about 0.5% (w/v)
of the formulation.
19. A commercial package containing a liquid pharmaceutical
formulation containing pramlintide, for parenteral administration
to a patient, said package comprising a borosilicate glass vial
having an open end, a stopper intended for multiuse which is
compatible with the amylin and/or amylin agonist, fixed in the open
end of the vial, an aluminum band to retain the stopper in the far
end of the vial wherein said liquid pharmaceutical formulation
comprises a tonicifier, a buffer and a preservative, said
tonicifier comprising 1.0 approximately to 10% (w/v) of a
carbohydrate or a polyhydric alcohol, said buffer comprising
approximately 0.02 to 0.5% (w/v) of an acetate, phosphate or
glutamate buffer which allows a pH of the final formulation of
approximately 3.0 to 6.0, and said preservative is selected from
the group consisting of m-cresol, benzyl alcohol, methyl and ethyl
parabens and phenol and said pramlintide approximately 0.01 to 0.5%
(w/v) of the formulation.
20. A commercial package containing a liquid pharmaceutical
formulation containing pramlintide, for parenteral administration
to a patient, said package comprising a cartridge suitable for use
in a pen injector wherein said liquid pharmaceutical formulation
comprises a stabilizer, a buffer and a preservative, said
stabilizer comprising 1.0 approximately to 10% (w/v) of a
carbohydrate or a polyhydric alcohol, said buffer comprising
approximately 0.02 to 0.5% (w/v) of an acetate, phosphate, citrate
or glutamate buffer which allows a pH of the final formulation of
approximately 3.0 to 6.0, and said preservative is selected from
the group consisting of m-cresol, benzyl alcohol, methyl and ethyl
parabens and phenol and said pramlintide is approximately 0.01 to
0.5% (w/v) of the formulation.
21. A composition which comprises about 0.01 to about 0.5% (w/v) of
pramlintide, about 1.0 to about 10% (w/v) of mannitol, and about
0.02 to about 0.5% (w/v) of an acetate buffer.
22. The composition of claim 21 which is a liquid.
23. The composition of claim 21 which further comprises about 0.1
to about 0.3% (w/v) of m-cresol.
24. The composition of claim 23 which is a liquid.
25. The composition of either of claims 22 or 24 which has a pH of
from about 3.0 to about 6.0.
26. The composition of either of claims 22 or 24 which has a pH of
from about 3.5 to about 5.0.
27. The composition of either of claims 22 or 24 which has a pH of
from about 3.8 to about 4.2.
28. The composition of claim 21 which is lyophilized.
29. A composition which comprises about 0.01 to about 0.5% (w/v) of
pramlintide and about 0.02 to about 0.5% (w/v) of an acetate
buffer.
30. The composition of claim 29 which is a liquid.
31. The composition of claim 29 which is lyophilized.
Description
[0001] This application claims the benefit of U.S. Provisional
Application No. 60/035,140, filed Jan. 8, 1997, the contents of
which are hereby incorporated by reference in their entirety.
FIELD OF INVENTION
[0002] This invention relates to pharmaceutical formulations of
amylin agonist peptides, preferably in liquid dosage form.
Additionally, this invention relates to amylin agonist
pharmaceutical formulations which are compatible upon mixing with
insulin.
BACKGROUND OF THE INVENTION
[0003] Deposition of amyloid in pancreatic islets is a common
feature in human Type II diabetic patients. The major protein
forming these amyloid particles, called amylin, has a propensity to
form fibril amyloid structures. National Academy of Sciences USA
8628, 1987. Amylin is a 37 amino acid protein which, in its fully
active form, is carboxy-amidated and has a disulfide bridge between
the cysteine residues found at positions 2 and 7. Amylin plays a
role in control of systemic concentrations of glucose, and has been
proposed as a useful therapeutic agent. See, e.g., Leighton and
Cooper, 15 TIBS 295, 1990. Human Amylin is described and claimed in
U.S. Pat. No. 5,367,052, entitled "Amylin Peptides," and U.S. Pat.
No. 5,124,314, entitled "Pharmaceutical Compositions Containing
Amylin," Amylin has been reviewed in the literature, for example,
in Gaeta, L. S. L. and Rink, T. J., 3 Med. Chem. Res. 483-490,
1994, Pittner, R. A. et al., 55S J. Cell. Biochem. 19-28, 1994, and
Rink, T. J. et al., 14 TIPS 113-118, 1993.
[0004] Therapeutic opportunities for insulin-using and other people
with diabetes who are deficient in amylin or for whom amylin
therapy would be of benefit, and hormone blockage for other people,
for example, the obese and Type II diabetics and those with insulin
resistance who may have elevated plasma amylin or undesired amylin
activity have been pursued. The use of amylin agonists, including
amylin itself, for the treatment of diabetes is described and
claimed in U.S. Pat. No. 5,175,145. The use of amylin antagonists
for the treatment of Type II diabetes mellitus, obesity and
essential hypertension, and insulin resistance, are described and
claimed in U.S. Pat. Nos. 5,266,561, 5,280,014, 5,281,581, and
5,364,841.
[0005] The most severe form of the disease is Type I
(juvenile-onset) diabetes. There are an estimated 1 million Type I
diabetics in the U.S. who need daily insulin injections for
survival. Their quality of life is often markedly affected by the
rigors of their daily metabolic imbalances, in particular
hypoglycemic attacks (dangerously low blood glucose) and by the
onset of serious long-term complications, including blindness,
kidney failure, impotence, ulcers, amputations and atherosclerosis
(NIH Diabetes Complications and Control Trial).
[0006] Type II (adult-onset) diabetes afflicts over 10 million
Americans, who are also subject to the same complications. Impaired
glucose tolerance, a risk factor for Type II diabetes and
cardiovascular disease, is thought to affect another 20 million
people in the U.S. and is not treatable by any known regimen. There
is also an alarming increase in the incidence of Type II diabetics
in groups of populations around the world, whose standard of living
is increasing through economic development or migration.
Sulfonylureas are the primary oral antihyperglycemic diabetic
medications sold in the U.S. Discovered in the 1940's, these
compounds do not address the underlying causes of Type II diabetes
and, in many cases, are not effective or lose their efficacy after
a few years of treatment. Type II diabetics do not lack insulin,
rather they are insulin resistant, so that insulin does not work
properly and the insulin secretory responses are disordered.
[0007] After a meal, the pancreas secretes insulin in response to a
rise in glucose. Insulin stimulates the uptake of glucose into
muscle and fat, and signals the liver to reduce glucose production;
this results in a return of blood glucose to normal levels. In
muscle, large amounts of glucose are stored as glycogen. Some of
the glycogen is broken down into lactate, which circulates to the
liver and can be converted back into glucose and stored as
glycogen. Between meals the liver breaks down these glycogen stores
to provide glucose to the brain and other tissues. This cycle in
which glycogen is effectively transferred from muscle to liver is
known as the Cori cycle. The stimulus for this flux from muscle to
liver under resting conditions remain unidentified; recent results
indicate that amylin provides a major stimulus to this pathway.
[0008] Amylin has been demonstrated to have direct metabolic
effects in both skeletal muscle and the pancreas. In skeletal
muscle, amylin acts as a non-competitive antagonist of insulin,
reducing insulin-stimulated incorporation of glucose into glycogen.
In vi tro studies indicate that amylin reduces glycogen synthase
activity and favors the formation of an active form of glycogen
phosphorylase, the enzyme that converts glycogen into glucose
6-phosphate. The actions of amylin on skeletal muscle promote
glycogen breakdown, thus stimulating lactate formation and
increasing turnover of the Cori cycle. Amylin is co-secreted with
insulin from pancreatic beta cells and has been demonstrated to
suppress insulin secretion. It appears to provide feedback
regulation of the beta-cell, in order to modulate insulin secretory
activity.
[0009] It is believed that amylin plays a role in the regulation of
glucose uptake from ingested food into blood, and that amylin or
amylin agonist therapy in diabetics, particularly insulin-using
diabetics, such as Type I diabetics and late-stage Type II
diabetics, will smooth the excessive glucose rises that these
patients typically experience after meals. Deficiency of an
important hormone such as amylin which has been reported to have
effects on carbohydrate, fat and bone metabolism, may also disrupt
other important physiological mechanisms. The co- administration of
amylin, or an amylin agonist which exerts the physiological effects
of amylin, will significantly improve existing insulin therapy by
restoring the appropriate metabolic balance.
[0010] Many factors affect the stability of a pharmaceutical
product, including the chemical reactivity of the active
ingredient(s), the potential interaction between active and
inactive ingredients, the manufacturing process, the dosage form,
the container-closure system, and the environmental conditions
encountered during shipment, storage, handling and length of time
between manufacture and usage. Pharmaceutical product stability is
determined by the chemical stability as well as the physical
stability of the formulation. Physical factors including heat and
light may initiate or accelerate chemical reactions.
[0011] Optimal physical stability of a formulation is very
important for at least three primary reasons. First, a
pharmaceutical product must appear fresh, elegant and professional,
when it is administered to a patient. Any changes in physical
appearance such as color changes or haziness can cause a patient or
consumer to lose confidence in the product. Second, because some
products are dispensed in multiple-dose containers, uniformity of
dose content of the active ingredient over time must be assured. A
cloudy solution or a broken emulsion can lead to a non-uniform
dosage pattern. Third, the active ingredient must be available to
the patient throughout the expected shelf life of the preparation.
A breakdown of the product to inactive or otherwise undesired forms
can lead to non-availability of the medicament to the patient.
[0012] Stability of a pharmaceutical product, then, may be defined
as the capability of a particular formulation to remain within its
physical, chemical, microbiological, therapeutic and toxicological
specifications. A stable solution retains its original clarity,
color and odor throughout its shelf life. Retention of clarity of a
solution is a main concern in maintaining physical stability.
Solutions should remain clear over a relatively wide temperature
range such as about 4.degree. C. to about 37.degree. C. At the
lower range an ingredient may precipitate due to a lower solubility
at that temperature, while at higher temperatures homogeneity may
be destroyed by extractables from the glass containers or rubber
closures. Thus, solutions of active pharmaceutical ingredients must
be able to handle cycling temperature conditions. Similarly, a
formulation should retain its color throughout this temperature
range, and its odor should be stably maintained.
[0013] Small peptides are typically unstable and are susceptible to
degradation in aqueous solution. In this regard, once a human
amylin agonist or amylin has less than approximately 90% of its
labeled potency, it is no longer considered to be suitable for
administration to a patient. Various types of molecules such as
sugars, surfactant, amino acids and fatty acids, used singly or in
combination, have been used in efforts to stabilize protein and
peptide products against degradation. See Wang and Hanson, J.
Parenteral Science and Technology Supplement, 1988, Technical
Report No. 10 (describing parenteral formulations of proteins and
peptides); Manning et al., 6 Pharmaceutical Research, 1989.
Examples of excipients such as buffers, preservatives, isotonic
agents, and surfactants are also known in the art. See 21 C.F.R.
.sctn.180.22 et seq. (defining recognized food additives); Wang and
Kowal, 34 J. Parenteral Drug Association 452, 1980 (describing
various excipients); A. R. Gennaro et al., 17th Remington's
"Pharmaceutical Sciences," 1985; Avis et al., Pharmaceutical Dosage
Forms: Parenteral Medications, Vol. 1, 1992, all of which,
including the definitions of various useful excipients, are hereby
incorporated by reference herein.
[0014] It is understood that the development of a suitable
pharmaceutical formulation for administration to a suject is
complex. A need exists in the art for pharmaceutical formulations
of amylin agonist peptides, or amylins, designed to provide single
or multiple doses having substantial stability when refrigerated
and at room temperature. Further, a need exists in the art for a
liquid pharmaceutical formulation packaged with a container/closure
system that also minimizes the physical and chemical degradation of
such peptides. Finally, a need exists for a liquid pharmaceutical
formulation for amylin agonist peptides, or amylins, which can be
mixed with insulin prior to administration. The invention described
and claimed herein meets these needs.
SUMMARY OF THE INVENTION
[0015] The inventors have discovered novel pharmaceutical
formulations and dosage forms useful for the administration of
amylin agonist peptides to a patient in need of treatment with such
compounds. These dosage forms include approximately 0.01 to 0.5%
(w/v), respectively, of an amylin agonist, or amylin, as the active
ingredient in an aqueous system along with approximately 0.02 to
0.5% (w/v) of an acetate, phosphate, citrate or glutamate buffer to
obtain a pH of the final composition of approximately 3.0 to 6.0,
as well as approximately 1.0 to 10% (w/v) of a carbohydrate or
polyhydric alcohol tonicifier in an aqueous continuous phase,
provided, however, that if the amylin agonist or amylin has similar
physiochemical characteristics similar to those of human amylin, it
should be formulated and lyophilized for storage (and used
immediately upon reconstitution). Approximately 0.005 to 1.0% (w/v)
of an antimicrobial preservative selected from the group consisting
of m-cresol, benzyl alcohol, methyl, ethyl, propyl and butyl
parabens and phenol is also present in the formulation of product
designed to allow the patient to withdraw multiple doses.
Importantly, a stabilizer is not required in this amylin agonist
product formulation. A sufficient amount of water for injection is
used to obtain the desired concentration of solution. Sodium
chloride, as well as other excipients, may also be present, if
desired. Such excipients, however, must maintain the overall
stability of the amylin agonist or amylin peptide. The liquid
formulations of the invention should be substantially isotonic. An
isotonic solution may be defined as a solution that has a
concentration of electrolytes, non-electrolytes, or a combination
of the two that will exert equivalent osmotic pressure as that into
which it is being introduced, here, for example in the case of
parenteral injection of the formulation, a mammalian tissue. By
"substantially isotonic" is meant within +20% of isotonicity,
preferably within +10%. The formulated product is included within a
container, typically, for example, a vial, cartridge, prefilled
syringe or disposable pen.
[0016] We have found that this novel parenteral dosage form
surprisingly maintains the stability of the peptide for up to four
years at refrigerated temperatures, e.g., approximately 5.degree.
C., and over 30 days at room temperature, e.g., approximately
30.degree. C.
[0017] The inventors have further discovered that this
pharmaceutical formulation can be further mixed with insulin
product in a syringe and retain short term stability. This short
term mixing compatibility is extremely advantageous. This allows
administration of a single injection of an amylin agonist, or
amylin, along with insulin to a patient.
[0018] This invention describes formulations of amylin agonists, or
amylins, which are stabilized with respect to aggregation,
adsorption and degradation, and thus enhance preservation of their
biological activities, although formulations of either an amylin
agonist or an amylin which has physicochemical properties similar
to those of human amylin, which is poorly soluble and highly
unstable should also include a stabilizer, comprising 1.0 to 10%
(w/v) of a carbohydrate or a polyhydric alcohol, and a surfactant,
preferably about 0.1 to about 1.0% (w/v) of polysorbate 80 or other
non-ionic detergent, should be lyophilized promptly after
formulation, and must be used promptly upon reconstitution and are
therefore less preferred.
[0019] A further aspect of the invention features a formulation
including an amylin agonist, mixed with a stabilizing compound
which reduces loss of biological potency of the peptide in, for
example, an amylin specific receptor binding assay, reduces loss of
biological activity as measured in, for example, the in vitro
soleus muscle bioassay, and general loss of material by, for
example, an HPLC assay, as compared to a formulation consisting of
the amylin alone.
[0020] In a related aspect, the invention features a method for
formulating amylin agonists that retain short term (e.g., 24 hours)
mixing compatibility with insulin.
[0021] Other features and advantages of the invention will be
apparent from the following description of the preferred
embodiments thereof, and from the claims.
BRIEF DESCRIPTION OF THE DRAWINGS
[0022] FIG. 1 shows the degradation rates of pramlintide at various
pH formulations.
[0023] FIG. 2 shows the stability of the pramlintide formulation
over time at 30.degree. C.
[0024] FIG. 3 shows the stability of the pramlintide formulation
over time at 40.degree. C.
[0025] FIG. 4 shows the stability of the pramlintide formulation
over time at 50.degree. C.
[0026] FIG. 5 shows an Arrenhius plot of the Kob, values from FIGS.
2-4.
[0027] FIG. 6 shows plasma concentrations versus time for insulin
following mixing the amylin agonist peptide pramlintide formulated
according to Table A.
DETAILED DESCRIPTION
[0028] Peptide drugs undergo physical and chemical degradation in
solution, and lose their biological activity. The dosage form
reported in this invention minimizes the chemical degradation of
amylin, for example, pramlintide, through different pathways, for
example, deamidation and peptide bond hydrolysis, and keeps the
peptide biologically active for up to four years when stored at
approximately 5.degree. C. This dosage form is well-tolerated by
patients. The container/closure system used to store this
formulation also minimizes the physical loss of drug product
through adsorption onto the container surface or adsorption into
the rubber closure.
[0029] People with Type I diabetes must be treated with exogenous
insulin. Generally, persons who initially require insulin tend to
be younger than 30 years of age at the time of diagnosis, lean,
prone to developing ketoacidosis, and markedly hyperglycemic even
in the fasting state. Insulin is also indicated for Type II
diabetics who do not respond to diet and exercise therapy either
alone or in combination with oral hypoglycemic drugs. Insulin
therapy is also necessary in some Type II diabetic patients who are
subject to stresses such as infections, pregnancy, or surgery. In
Type II diabetics, doses of 10-20 units of intermediate-acting
insulins are occasionally needed to bring hyperglycemia under
control.
[0030] Any functional macromolecular component of a patient may
serve operationally as a drug receptor. A particularly important
group of drug receptors are proteins that normally serve as
receptors for endogenous regulatory ligands (e.g., hormones,
neurotransmitters). Many drugs act on such physiological receptors.
Those that mimic the effects of the endogenous regulatory compound
are termed agonists.
[0031] By "amylin agonist" is meant peptide analogues of human
amylin useful as agonists of amylin, including but not limited to
those amylin agonists which are represented by the formula
.sup.1Al--X--Asn--Thr--.sup.5Ala--Thr--Y--Ala--Thr--.sup.10Gln--Arg--Leu---
B.sub.1--Asn--15Phe--Leu--C.sub.1--D.sub.1--E.sub.1--.sup.20F.sub.1--G.sub-
.1--Asn--H.sub.1--Gly--.sup.25
I.sub.1--J.sub.1--Leu--K.sub.1-L.sub.1--.su-
p.30Thr--M.sub.1--Val--Gly--Ser--.sup.35Asn--Thr--Tyr--Z
[0032] wherein A.sub.1 is hydrogen Lys, Ser, Ala, des-.alpha.-amino
Lys, or acetylated Lys; B.sub.1 is Ala, Ser or Thr; C.sub.1 is Val,
Leu or Ile; D.sub.1 is His or Arg; E.sub.1 is Ser or Thr; F.sub.1
is Ser, Thr, Gln or Asn; G.sub.1 is Asn, Gln or His; H.sub.1 is
Phe, Leu or Tyr; I.sub.1 is Ala or Pro; J.sub.1 is Ile, Val, Ala or
Leu; K.sub.1 is Ser, Pro, Leu, Ile or Thr; L.sub.1 is Ser, Pro or
Thr; M.sub.1 is Asn, Asp or Gln; X and Y are independently selected
residues having side chains which are chemically bonded to each
other to form an intramolecular linkage; and Z is hydroxy, amino,
alkylamino, dialkylamino, cycloalkylamino, arylamino, aralkylamino,
alkyloxy, aryloxy or aralkyloxy; provided that (a) when A.sub.1 is
Lys, B.sub.1 is Ala, C.sub.1 is Val, D.sub.1 is His, E.sub.1 is
Ser, F.sub.1 is Ser, G.sub.1 is Asn, H.sub.1 is Phe, I.sub.1 is
Ala, J.sub.1 is Ile, K.sub.1 is Ser, L.sub.1 is Ser, and M.sub.1 is
Asn; (b) when A.sub.1 is Lys, B.sub.1 is Ala, C.sub.1 is Ile,
D.sub.1 is Arg, E.sub.1 is Ser, F.sub.1 is Ser, G.sub.1 is Asn,
H.sub.1 is Leu, I.sub.1 is Ala, J.sub.1 is Ile, K.sub.1 is Ser,
L.sub.1 is Pro, and M.sub.1 is Asn; (c) when A.sub.1 is Lys,
B.sub.1 is Ala, C.sub.1 is Val, D.sub.1 is Arg, E.sub.1 is Thr,
F.sub.1 is Ser, G.sub.1 is Asn, H.sub.1 is Leu, I.sub.1 is Ala,
J.sub.1 is Ile, K.sub.1 is Ser, L.sub.1 is Pro, and M.sub.1 is Asn;
(d) when A.sub.1 is Lys, B.sub.1 is Ala, C.sub.1 is Val, D.sub.1 is
Arg, E.sub.1 is Ser, F.sub.1 is Ser, G.sub.1 is Asn, H.sub.1 is
Leu, I.sub.1 is Pro, J.sub.1 is Val, K.sub.1 is Pro, L.sub.1 is
Pro, and M.sub.1 is Asn; (e) when A.sub.1 is Lys, B.sub.1 is Ala,
C.sub.1 is Val, D.sub.1 is His, E.sub.1 is Ser, F.sub.1 is Asn,
G.sub.1 is Asn, H.sub.1 is Leu, I.sub.1 is Pro, J.sub.1 is Val,
K.sub.1 is Ser, L.sub.1 is Pro and M.sub.1 is Asn; or (f) when
A.sub.1 is Lys, B.sub.1 is Thr, C, is Val, D.sub.1 is Arg, E.sub.1
is Ser, F.sub.1 is Ser, G.sub.1 is His, H.sub.1 is Leu, I.sub.1 is
Ala, J.sub.1 is Ala, K.sub.1 is Leu, L.sub.1 is Pro and M.sub.1 is
Asp; then one or more of any of A.sub.1 to M.sub.1 is not an
L-amino acid and Z is not amino, it being further noted that
single-proline substituted peptides at I.sub.1, K.sub.1, and
L.sub.1 are not preferred.
[0033] Suitable side chains for X and Y include groups derived from
alkyl sulfhydryls which may form disulfide bonds; alkyl acids and
alkyl amines which may form cyclic lactams; alkyl aldehydes or
alkyl halides and alkylamines which may condense and be reduced to
form an alkyl amine bridge; or side chains which may be connected
to form an alkyl, alkenyl, alkynyl, ether or thioether bond.
Preferred alkyl chains include lower alkyl groups having from about
1 to about 6 carbon atoms.
[0034] As used herein, the following terms have the following
meanings unless expressly stated to the contrary: The term "alkyl"
refers to both straight- and branched-chain alkyl groups. The term
"lower alkyl" refers to both straight- and branched-chain alkyl
groups having a total of from 1 to 6 carbon atoms and includes
primary, secondary and tertiary alkyl groups. Typical lower alkyls
include, for example, methyl, ethyl, n-propyl, isopropyl, n-butyl,
isobutyl, t-butyl, n-pentyl, n-hexyl, and the like. The term "aryl"
refers to carbocyclic aromatic groups of 6 to 14 carbon atoms such
as phenyl and naphthyl, as well as heterocyclic aromatic groups
containing 1 to 3 heteroatoms (nitrogen, oxygen, sulfur, etc.) such
as pyridyl, triazolopyrazine, pyrimidine and the like. The term
"aralkyl" refers to an "aryl" group of 6 to 10 carbon atoms
directly attached to an "alkyl" group of 1 to 4 carbon atoms and
includes for example benzyl, p-chlorobenzyl, p-methylbenzyl, and
2-phenylethyl. The term "cycloalkyl" refers to cyclic alkyl groups
of 5 to 8 carbon atoms.
[0035] Biologically active derivatives of the above formula agonist
analogues are also included in which the stereochemistry of
individual amino acids may be inverted from (L)/S to (D)/R at one
or more specific sites. Also included are the agonist analogues
modified by glycosylation of Asn, Ser and/or Thr residues.
[0036] Biologically active agonist analogues of amylin are included
which contain less peptide character. Such peptide mimetics may
include, for example, one or more of the following substitutions
for --CO--NH-- amide bonds: depsipeptides (--CO--O--),
iminomethylenes (--CH.sub.2--NH--), trans-alkenes (--CH.dbd.CH--),
-enaminonitriles (--C(.dbd.CH--CN)--NH--), thioamides (--CS--NH--),
thiomethylenes (--S--CH.sub.2-- or --CH.sub.2--S--), methylenes
(CH.sub.2--CH.sub.2--) and retro-amides (NH--CO--).
[0037] Amylin agonist compounds form salts with various inorganic
and organic acids and bases. Such salts include salts prepared with
organic and inorganic acids, for example, HCl, HBr,
H.sub.2SO.sub.4, H.sub.3PO.sub.4, trifluoroacetic acid, acetic
acid, formic acid, methanesulfonic acid, toluenesulfonic acid,
maleic acid, fumaric acid and camphorsulfonic acid. Salts prepared
with bases include, for example, ammonium salts, alkali metal salts
(such as sodium and potassium salts) and alkali earth salts (such
as calcium and magnesium salts). Acetate, hydrochloride, and
trifluoroacetate salts are preferred.
[0038] The salts may be formed by conventional means, as by
reacting the free acid or base forms of the product with one or
more equivalents of the appropriate base or acid in a solvent or
medium in which the salt is insoluble, or in a solvent such as
water which is then removed in vacuo or by freeze-drying or by
exchanging the ions of an existing salt for another ion on a
suitable ion exchange resin.
[0039] Amylin agonist compounds include various stereoisomers. In
the preferred compounds of this invention, the chiral centers on
the peptide backbone are all S. Amylin agonists may be prepared by
those of ordinary skill in the art, as described in "Amylin Agonist
Peptides and Uses Therefor," U.S. Pat. No. 5,686,411, the contents
of which is hereby incorporated by reference in its entirety.
[0040] By "human amylin" is meant the 37 amino acid amylin set
forth in U.S. Pat. No. 5,357,052.
[0041] The nomenclature of the compounds of the present invention
can be used to indicate both the peptide that the sequence is based
on and the modifications made to any basic peptide amylin sequence,
such as human amylin. An amino acid preceded by a superscript
number indicates that the named amino acid replaces the amino acid
normally present at the amino acid position of the superscript in
the basic amino acid sequence. For example,
".sup.18Arg.sup.25,28Pro-h-amylin" refers to a peptide based on the
sequence of "h-amylin" or "human-amylin" having the following
substitutions: Arg replacing His at residue 18, Pro replacing Ala
at residue 25 and Pro replacing Ser at residue 28. The term
"des-.sup.1Lys-h-amylin" refers to a peptide based on the sequence
of human amylin, with the first, or N-terminal, amino acid
deleted.
[0042] In addition to the description of compounds pursuant to the
above formula, certain preferred compounds may be identified,
including .sup.25,28,29Pro-h-amylin,
.sup.18Arg.sup.25,28Pro-h-amylin,
des-.sup.1Lys.sup.18Arg.sup.25,28Pro-h-amylin,
des-.sup.1Lys-h-amylin and
.sup.25Pro.sup.26Val.sup.28,29Pro-h-amylin. These peptides
preferably have a reduced tendency to form aggregates or to
precipitate under pressure compared to human amylin.
[0043] Compounds described herein which are especially preferred
include .sup.18Arg.sup.25,28Pro-h-amylin,
des-.sup.1Lys.sup.18Arg.sup.25,28pro-h-- amylin, .sup.18Arg
25,28,29Pro-h-amylin, des-.sup.1Lys.sup.18Arg.sup.25,28-
,29Pro-h-amylin, .sup.25,28,29Pro-h-amylin,
des-.sup.1Lys.sup.25,28,29Pro-- h-amylin, and
.sup.25Pro.sup.26Val.sup.25,28Pro-h-amylin. Still further amylin
agonist peptide compounds include:
[0044] .sup.23Leu.sup.25Pro.sup.26Val.sup.28,29Pro-h-amylin;
[0045] .sup.23LeU.sup.25Pro.sup.26Val.sup.28Pro-h-amylin;
[0046]
des-.sup.1Lys.sup.23Leu.sup.25Pro.sup.26Val.sup.28Pro-h-amylin;
[0047]
.sup.18Arg.sup.23Leu.sup.25Pro.sup.26Val.sup.28Pro-h-amylin;
[0048] .sup.18Arg.sup.23Leu.sup.25,28,29Pro-h-amylin;
[0049] .sup.18Arg.sup.23Leu.sup.25,28Pro-h-amylin;
[0050] .sup.17Ile.sup.23Leu.sup.25,28,29Pro-h-amylin;
[0051] .sup.17Ile.sup.25,28,29Pro-h-amylin;
[0052]
des-.sup.1Lys.sup.17Ile.sup.23Leu.sup.25,28,29Pro-h-amylin;
[0053] .sup.17Ile.sup.18Arg.sup.23Leu-h-amylin;
[0054]
.sup.17Ile.sup.18Arg.sup.23Leu.sup.26Val.sup.29Pro-h-amylin;
[0055]
.sup.17Ile.sup.18Arg.sup.23Leu.sup.25Pro.sup.26Val.sup.28,29Pro-h-a-
mylin;
[0056]
.sup.13Thr.sup.21His.sup.23Leu.sup.26Ala.sup.28Leu.sup.29Pro.sup.31-
Asp-h-amylin;
[0057]
.sup.13Thr.sup.21His.sup.23Leu.sup.26Ala.sup.29Pro.sup.31Asp-h-amyl-
in;
[0058]
des-.sup.1Lys.sup.13Thr.sup.21His.sup.23Leu26Ala.sup.28Pro.sup.31As-
p-h-amylin;
[0059]
.sup.13Thr.sup.18Arg.sup.21His.sup.23Leu.sup.26Ala.sup.29Pro.sup.31-
Asp-h- amylin;
[0060]
.sup.13Thr.sup.18Arg.sup.21His.sup.23Leu.sup.28,29Pro.sup.31Asp-h-a-
mylin; and,
[0061]
.sup.13Thr.sup.18Arg.sup.21His.sup.23Leu25Pro.sup.26Ala.sup.28,29Pr-
o.sup.31Asp-h-amylin.
[0062] .sup.25,28,29Pro-h-amylin which is also referred to as
"pramlintide," is a most preferred agonist of human amylin.
.sup.25,28,29Pro-h- amylin will be referred to as "pramlintide"
hereafter. Pramlintide is substantially different from and better
than human amylin, retaining the desired biological properties of
human amylin with superior attributes, including superior
pharmaceutical properties (L. S. L. Gaeta and T. J. Rink, Medicinal
Chemistry Research, 1994). Pramlintide and other amylin agonists
set forth herein are described and claimed in U.S. Pat. No.
5,686,411, issued Nov. 11, 1997.
[0063] Amylin agonists must be formulated into a stable, safe
pharmaceutical composition for administration to a patient. The
novel pharmaceutical formulations of the present invention comprise
approximately 0.01 to 0.5% (w/v) of an amylin agonist, or amylin,
approximately 0.02 to 0.5% (w/v) of an acetate, phosphate, citrate
or glutamate buffer allowing a pH of the final composition of from
3.0 to 6.0; approximately 1.0 to 10% (w/v) of a carbohydrate or
polyhydric alcohol tonicifier and, optionally, approximately 0.005
to 1.0% (w/v) of a preservative selected from the group consisting
of m-cresol, benzyl alcohol, methyl, ethyl, propyl and butyl
parabens and phenol. Such a preservative is generally included if
the formulated peptide is to be included in a multiple use product.
A sufficient amount of water for injection is used to obtain the
desired concentration of solution. Additional tonicifying agents
such as sodium chloride, as well as other excipients, may also be
present, if desired. Such excipients, however, must maintain the
overall tonicity of the amylin agonist, or amylin, and are
generally not preferred for this formulation except as may be
needed.
[0064] The terms buffer, buffer solution and buffered solution,
when used with reference to hydrogen-ion concentration or pH, refer
to the ability of a system, particularly an aqueous solution, to
resist a change of pH on adding acid or alkali, or on dilution with
a solvent. Characteristic of buffered solutions, which undergo
small changes of pH on addition of acid or base, is the presence
either of a weak acid and a salt of the weak acid, or a weak base
and a salt of the weak base. An example of the former system is
acetic acid and sodium acetate. The change of pH is slight as long
as the amount of hydronium or hydroxyl ion added does not exceed
the capacity of the buffer system to neutralize it.
[0065] The stability of the peptide formulation of the present
invention is enhanced by maintaining the pH of the formulation in
the range of approximately 3.0 to 6.0. Preferably, the pH of the
formulation is maintained in the range of approximately 3.5 to 5.0
or 3.5 to 5.5, most preferably from 3.7 to 4.3 or 3.8 to 4.2. An
especially preferred pH is 4.0. It presently understood that where
the pH of the pharmaceutical formulation exceeds 5.5, chemical
degradation of the peptide may be accelerated such that the shelf
life is less than about two years.
[0066] The buffer used in the practice of the present invention is
an acetate buffer (preferably at a final formulation concentration
of from about 1-5 to about 60 mM), phosphate buffer (preferably at
a final formulation concentration of from about 1-5 to about to
about 30 mM) or glutamate buffer (preferably at a final formulation
concentration of from about 1-5 to about to about 60 mM). The most
preferred buffer is acetate (preferably at a final formulation
concentration of from about 5 to about 30 mM).
[0067] A stabilizer may be included in the present formulation but,
and importantly, is not needed. If included, however, a stabilizer
useful in the practice of the present invention is a carbohydrate
or a polyhydric alcohol. The present inventors have discovered that
a suitable stabilizer useful in the practice of the present
invention is approximately 1.0 to 10% (w/v) of a carbohydrate or
polyhydric alcohol. The polyhydric alcohols and carbohydrates share
the same feature in their backbones, i.e., --CHOH--CHOH--, which is
responsible for stabilizing the proteins. The polyhydric alcohols
include such compounds as sorbitol, mannitol, glycerol, and
polyethylene glycols (PEGs). These compounds are straight-chain
molecules. The carbohydrates, such as mannose, ribose, trehalose,
maltose, inositol, and lactose, on the other hand, are cyclic
molecules that may contain a keto or aldehyde group. These two
classes of compounds have been demonstrated to be effective in
stabilizing protein against denaturation caused by elevated
temperature and by freeze-thaw or freeze-drying processes. Suitable
carbohydrates include: galactose, arabinose, lactose or any other
carbohydrate which does not have an adverse affect on a diabetic
patient, i.e., the carbohydrate is not metabolized to form large
concentrations of glucose in the blood. Such carbohydrates are well
known in the art as suitable for diabetics.
[0068] Preferably, if a stabilizer is included, the peptide of the
present invention is stabilized with a polyhydric alcohol such as
sorbitol, mannitol, inositol, glycerol, xylitol, and
polypropylene/ethylene glycol copolymer, as well as various
polyethylene glycols (PEG) of molecular weight 200, 400, 1450,
3350, 4000, 6000, and 8000). Mannitol is the preferred polyhydric
alcohol. Another useful feature of the lyophilized formulations of
the present invention is the maintenance of the tonicity of the
lyophilized formulations described herein with the same formulation
component that serves to maintain their stability. Mannitol is the
preferred polyhydric alcohol used for this purpose.
[0069] The United States Pharmacopeia (USP) states that
anti-microbial agents in bacteriostatic or fungistatic
concentrations must be added to preparations contained in multiple
dose containers. They must be present in adequate concentration at
the time of use to prevent the multiplication of microorganisms
inadvertently introduced into the preparation while withdrawing a
portion of the contents with a hypodermic needle and syringe, or
using other invasive means for delivery, such as pen injectors.
Antimicrobial agents should be evaluated to ensure compatibility
with all other components of the formula, and their activity should
be evaluated in the total formula to ensure that a particular agent
that is effective in one formulation is not ineffective in another.
It is not uncommon to find that a particular agent will be
effective in one formulation but not effective in another
formulation.
[0070] A preservative is, in the common pharmaceutical sense, a
substance that prevents or inhibits microbial growth and may be
added to pharmaceutical formulation for this purpose to avoid
consequent spoilage of the formulation by microorganisms. While the
amount of the preservative is not great, it may nevertheless effect
the overall stability of the peptide. Thus, even selection of a
preservative can be difficult.
[0071] While the preservative for use in the practice of the
present invention can range from 0.005 to 1.0% (w/v), the preferred
range for each preservative, alone or in combination with others,
is: benzyl alcohol (0.1-1.0%), or m-cresol (0.1-0.6%), or phenol
(0.1-0.8%) or combination of methyl (0.05-0.25%) and ethyl or
propyl or butyl (0.005%- 0.03%) parabens. The parabens are lower
alkyl esters of para-hydroxybenzoic acid.
[0072] A detailed description of each preservative is set forth in
"Remington's Pharmaceutical Sciences" as well as Pharmaceutical
Dosage Forms: Parenteral Medications, Vol. 1, 1992, Avis et al.
[0073] Pramlintide (previously referred to as "AC-137") does E not
have a tendency to adsorb onto the glass in a glass container when
in a liquid form, therefore, a surfactant is not required to
further stabilize the pharmaceutical formulation. However, with
regard to amylin agonists or amylins which do have such a tendency,
a surfactant should be used in their formulation which formulations
should then be lyophilized. Surfactants frequently cause
denaturation of protein, both of hydrophobic disruption and by salt
bridge separation. Relatively low concentrations of surfactant
exert a potent denaturing activity, because of the strong
interactions between surfactant moieties and the reactive sites on
proteins. However, judicious use of this interaction can stabilize
proteins against interfacial or surface denaturation. Surfactants
which could further stabilize the peptide may optionally be present
in the range of about 0.001 to 0.3% (w/v) of the total formulation
and include polysorbate 80 (i.e., polyoxyethylene(20) sorbitan
monooleate), CHAPSO (i.e., 3-[(3-cholamidopropyl) dimethylammonio]
1-propanesulfonate), Brijo (e.g., Brij 35, which is
(polyoxyethylene (23) lauryl ether), poloxamer, or another
non-ionic surfactant.
[0074] It may also be desirable to add sodium chloride or other
salt to adjust the tonicity of the pharmaceutical formulation,
depending on the tonicifier selected. However, this is optional and
depends on the particular formulation selected. Parenteral
formulations must be isotonic or substantially isotonic otherwise
significant irritation and pain would occur at the site of
administration.
[0075] The vehicle of greatest importance for parenteral products
is water. Water of suitable quality for parenteral administration
must be prepared either by distillation or by reverse osmosis. Only
by these means is it possible to separate adequately various
liquid, gas and solid contaminating substances from water. Water
for injection is the preferred aqueous vehicle for use in the
pharmaceutical formulation of the present invention.
[0076] It is possible that other ingredients may be present in the
peptide pharmaceutical formulation of the present invention. Such
additional ingredients may include wetting agents, emulsifiers,
antioxidants, bulking agents, tonicity modifiers, chelating agents,
metal ions, oleaginous vehicles, proteins (e.g., human serum
albumin, gelatin or proteins) and a zwitterion (e.g., an amino acid
such as betaine, taurine, arginine, glycine, lysine and histidine).
Such additional ingredients, of course, should not adversely affect
the overall stability of the pharmaceutical formulation of the
present invention.
[0077] Containers are also an integral part of the formulation of
an injection and may be considered a component, for there is no
container that is totally insoluble or does not in some way affect
the liquid it contains, particularly if the liquid is aqueous.
Therefore, the selection of a container for a particular injection
must be based on a consideration of the composition of the
container, as well as of the solution, and the treatment to which
it will be subjected. Adsorption of the peptide to the glass
surface of the vial can also be minimized, if necessary, by use of
borosilicate glass, for example, Wheaton Type I borosilicate glass
#33 (Wheaton Type I-33) or its equivalent (Wheaton Glass Co.).
Other vendors of similar borosilicate glass vials and cartridges
acceptable for clinical manufacture include Kimbel Glass Co., West
Co., Bunder Glas GMBH and Forma Vitrum. The biological and chemical
properties of amylin may be stabilized by formulation and
lyophilization in a Wheaton Type I-33 borosilicate serum vial to a
final concentration of 1.0 mg/ml and 10 mg/ml of amylin in the
presence of 5% mannitol, and 0.02% Tween 80.
[0078] In order to permit introduction of a needle from a
hypodermic syringe into a multiple-dose vial and provide for
resealing as soon as the needle is withdrawn, each vial is sealed
with a rubber closure held in place by an aluminum band.
[0079] Stoppers for glass vials, such as, West 4416/50, 4416/50
(Teflon faced) and 4406/40, Abbott 5139 or any equivalent stopper
can be used as the closure for pharmaceutical for injection. These
stoppers are compatible with the peptide as well as the other
components of the formulation. The inventors have also discovered
that these stoppers pass the stopper integrity test when tested
using patient use patterns, e.g., the stopper can withstand at
least about 100 injections.
[0080] Each of the components of the pharmaceutical formulation
described above is known in the art and is described in
Pharmaceutical Dosage Forms: Parenteral Medications, Vol. 1, 2nd
ed., Avis et al. Ed., Mercel Dekker, New York, N.Y. 1992, which is
incorporated by reference in its entirety herein.
[0081] The manufacturing process for the above formulation involves
compounding, sterile filtration and filling steps. The compounding
procedure involves dissolution of ingredients in a specific order
(preservative followed by stabilizer/tonicity agents, buffers and
pramlintide) or dissolving at the same time.
[0082] Any sterilization process can be used in developing the
peptide pharmaceutical formulation of the present invention.
Typical sterilization processes include filtration, steam (moist
heat), dry heat, gases (e.g., ethylene oxide, formaldehyde,
chlorine dioxide, propylene oxide, beta-propiolacctone, ozone,
chloropicrin, peracetic acid methyl bromide and the like), radiant
exposure and aseptic handling. Filtration is the preferred method
of sterilization in the practice of the present invention. The
sterile filtration involves filtration through 0.45 .mu.m and 0.22
.mu.m (1 or 2) connected in a series. After filtration, the
solution is filled into appropriate vials as described above.
[0083] The pharmaceutical formulation of the present invention is
intended for parenteral administration. Suitable routes of
administration include intramuscular, intravenous, subcutaneous,
intradermal, intraarticular, intrathecal and the like. The
subcutaneous route of administration is preferred. Mucosal delivery
is also permissible.
[0084] The formulations of the present invention are especially
advantageous because they retain short term mixing compatibility
with insulin. Currently, there are over thirty insulin products
available in the United States. All regular insulin preparations in
the United States are now supplied at neutral pH. This has resulted
in improved stability of the hormone, and patients need no longer
refrigerate the vial of insulin in use. Furthermore, neutral
regular insulin can be mixed in any desired proportion with other,
modified insulin preparations since all marketed insulin
preparations will be at the same pH. Preparations of insulin have
been divided into three general categories according to promptness,
duration, and intensity of action following subcutaneous
administration. They are classified as fast-, intermediate-, and
long-acting insulins. There are also various types of insulins
within these categories. They include regular insulins, protamine
zinc insulins, NPH insulins, semilente insulins (prompt insulin
zinc suspensions), lente insulins (insulin zinc suspensions) and
ultralente insulins (extended insulin zinc suspensions).
[0085] Crystalline insulin is prepared by the precipitation of the
hormone in the presence of zinc (as zinc chloride) in a suitable
buffer medium. Crystalline insulin when dissolved in water is also
known as regular insulin. Following subcutaneous injection it is
rapidly absorbed (15-60 minutes). Its action is prompt in onset and
relatively short in duration, i.e., it reaches its peak effect in
about 1.5 to 4 hours, and lasts for about 5-9 hours.
[0086] By permitting insulin and zinc to react with the basic
protein protamine, Hagedorn and associates prepared a protein
complex, protamine zinc insulin. When this complex is injected
subcutaneously in an aqueous suspension, it dissolves only slowly
at the site of deposition, and the insulin is absorbed at a
retarded but steady rate. Protamine zinc suspension insulin has
largely been replaced by isophane insulin suspension, also known as
NPH insulin; the N denotes a neutral solution (pH 7.2), the P
refers to the protamine zinc insulin content, and the H signifies
the origin in Hagedorn's laboratory. It is a modified protamine
zinc insulin suspension that is crystalline. The concentrations of
insulin, protamine, and zinc are so arranged that the preparation
has an onset and a duration of action intermediate between those of
regular insulin and protamine zinc insulin suspension. Its effects
on blood sugar are indistinguishable from those of an
extemporaneous mixture of 2 to 3 units of regular insulin and 1
unit of protamine zinc insulin suspension.
[0087] Chemical studies have revealed that the solubility of
insulin is determined in important measure by its physical state
(amorphous, crystalline, size of the crystals) and by the zinc
content and the nature of the buffer in which it is suspended.
Insulin can thus be prepared in a slowly absorbed, slow-acting form
without the use of other proteins, such as protamine, to bind it.
Large crystals of insulin with high zinc content, when collected
and resuspended in a solution of sodium acetate-sodium chloride (pH
7.2 to 7.5), are slowly absorbed after subcutaneous injection and
exert an action of long duration. This crystal preparation is named
extended insulin zinc suspension (ultralente insulin). Amorphous
insulin precipitated at high pH is almost as rapid in onset as
regular insulin, but has a somewhat longer duration of action. This
amorphous preparation is named prompt insulin zinc suspension
(semilente insulin). These two forms of insulin may be mixed to
yield a stable mixture of crystalline (7 parts) and amorphous (3
parts) insulin--called insulin zinc suspension (lente
insulin)--that is intermediate in onset and duration of action
between semilente and ultralente preparations and is similar to NPH
insulin.
[0088] In summary, the fast-acting insulins include the regular
insulins and the prompt insulin zinc suspensions (semilente
insulins). The intermediate-acting insulins include the isophane
insulin suspensions (NPH insulins, isophane insulin) and the
insulin zinc suspensions (lente insulins). The long-acting insulins
include protamine zinc insulin suspensions, and extended insulin
zinc suspensions (ultralente insulins) Most of these preparations
are available as either porcine or bovine insulins. Human insulins
of recombinant DNA origin are available as regular and isophane
insulins and as insulin zinc suspensions. Recently, a modified
insulin (Lys(B28), Pro(B29) human insulin analog, created by
reversing the amino acids at positions 28 and 29 on the insulin
B-chain) has been introduced. It is a fast-acting insulin, with a
more rapid onset of glucose lowering action, an earlier peak
action, and a shorter duration of action than regular human
insulin.
[0089] Many insulins are available from a number of companies.
These include Eli Lilly & Company and Novo Nordisk, two of the
largest suppliers of insulin in the world. Fast-acting insulins
available from Eli Lilly include (1) Iletin.RTM. I (Regular); (2)
Regular Iletin.RTM. II (Pork, 100 Units); (3) Regular Iletin.RTM.
II (Concentrated, Pork, 500 Units); (4) Humalog.RTM. Injection
(insulin lyspro, recombinant DNA origin); and (5) Humulin.RTM. R
(regular insulin, recombinant DNA origin, 100 Units). Fast-acting
insulins available from Novo Nordisk include (1) Novolin.RTM. R
(Regular, Human Insulin Injection (recombinant DNA origin) 100
Units); (2) Novolin.RTM. R PenFill 1.5 ml Cartridges (Regular,
Human Insulin Injection (recombinant DNA origin) 100 Units); (3)
Novolin.RTM. R Prefilled.TM. (Regular, Human Insulin Injection
(recombinant DNA origin) in a 1.5 ml Prefilled Syringe, 100
units/ml); (4) Regular Purified Pork Insulin (100 Units/ml); and
(5) Velosulin.RTM. BR (Buffered Regular Human Insulin Injection,
100 Units/ml). Intermediate-acting insulins available from Eli
Lilly include (1) Humulin.RTM. 50/50 (50% human insulin isophane
suspension and 50% human insulin injection (rDNA origin), 100
Units); (2) Humulin.RTM. 70/30 (70% human insulin isophane
suspension and 30% human insulin injection (rDNA origin), 100
Units); (3) Humulin.RTM. L (lente; human insulin (rDNA origin) zinc
suspension, 100 Units); ); (4) Humulin.RTM. N (NPH; human insulin
(rDNA origin) isophane suspension, 100 Units); (5) Lente.RTM.
Iletin.RTM. I, (insulin zinc suspension, beef-pork); (6) NPH
Iletin.RTM. I (isophane insulin suspension, beef-pork); (7) Lente
Iletin.RTM. II NPH (insulin zinc suspension, purified pork); and
(8) NPH Iletin.RTM. II, (isophane insulin suspension, purified
pork). Intermediate-acting insulins available from Novo Nordisk
include (1) Novolin.RTM. L (Lente, Human Insulin Zinc Suspension
(recombinant DNA origin), 100 Units/ml); (2) Novolin.RTM. N (NPH,
Human Insulin Isophane Suspension (recombinant DNA origin), 100
Units/ml); (3) Novolin.RTM. N PenFill.RTM. 1.5 ml Cartridges; (4)
Novolin.RTM. N Prefilled.TM. (NPH, Human Insulin Isophane
Suspension (recombinant DNA origin) in a 1.5 ml Prefilled Syringe,
100 Units/ml); (5) Novolin.RTM. 70/30 (70% NPH, Human Insulin
Isophane Suspension and 30% Regular, Human Insulin Injection
(recombinant DNA origin), 100 Units/ml); (6) Novolin.RTM. 70/30
PenFill.RTM. 1.5 ml Cartridges; (7) Novolin.RTM. 70/30
Prefilled.TM. (70% NPH, Human Insulin Isophane Suspension and 30%
Regular, Human Insulin Injection (recombinant DNA origin) in a 1.5
ml Prefilled Syringe, 100 Units/ml); (8) Lente Purified Pork
Insulin (Zinc Suspension, USP 100 Units/ml); and (9) NPH Purified
Pork Isophane Insulin Suspension (100 Units/ml). Long acting
insulins include Eli Lilly's Humulin.RTM. U (Ultralente.RTM. human
insulin (recombinant DNA origin) extended zinc suspension).
[0090] This invention provides unique peptide formulations,
preferably pramlintide peptide formulations, which facilitate the
short-term mixing compatibility of all types of insulin products
including regular insulin products (e.g., Humulin.RTM. R and
Novolin.RTM. R), intermediate-acting insulin products (e.g.,
Humulin.RTM. 70/30 and Novolin.RTM. 70/30) and long-acting insulin
products (e.g., Humulin.RTM. U) with the peptide formulation before
injection. The desired bioavailability of insulin and amylin
agonist peptide or amylin is maintained. This results in a
significant reduction in the number of injections per day in
patients who are undergoing treatment with insulin and an amylin
agonist (e.g., pramlintide) or amylin.
[0091] Insulin as well as insulin analogs are useful in the
practice of the present invention. Monomeric insulin analogs have
been developed, e.g., Lys28 Pro.sup.29-human insulin, which is also
referred to as "LysPro insulin" or "insulin lispro." These analogs
are said to be advantageous because they can be stabilized by
ligands which induce the otherwise monomeric analog to associate
under pharmaceutically useful conditions. This stabilized analog
remains fast acting in an associated state.
[0092] Thus, any type of insulin may be drawn into a syringe along
with the peptide formulation of the present invention. Any order of
mixing or introduction of peptide and insulin into a syringe is
also possible, but the preferred order is to place the insulin in
the syringe first, followed by peptide in order to reduce the
potential for cross-contamination and precipitation.
[0093] The amount of insulin and peptide formulation in the syringe
depends on the individual needs of a particular patient.
Accordingly, the amount present in a syringe is an amount
sufficient to maintain a proper insulin level for a patient. The
pharmaceutical formulations of the present invention can be
administered to any human or mammal in need of such treatment.
[0094] As has been demonstrated with pramlintide, and depending
upon the type of insulin and the volume ratio of the mixture, the
insulin and peptide formulation can remain in the same syringe for
at least about 24 hours and the insulin and the peptide will retain
their activity and stability.
[0095] For instance, regular insulin products can be mixed with a
peptide, e.g., pramlintide, at a pH of approximately 4.0 with 20 or
30 mM acetate buffer to maintain the solubility of the insulin. The
pH of the mixture would then be less than 4.5. A preferred peptide
formulation of pramlintide with a higher buffer capacity (30 mM
acetate) and at low label strength, e.g., 0.1 mg/ml, forms a clear
solution instantaneously (under a minute) when mixed with regular
insulin products in the range of five to 20 units. This low label
strength of pramlintide results in a high dose volume, 300 .mu.L.
This increased volume may be advantageous for bringing the pH down
to less than 4.5 almost immediately by increasing insulin dilution
factor and facilitating the transition of insulin from hexamer to
monomer before injection. This modulation of insulin is believed to
be advantageous in permitting increased rate of absorption and
causing rapid-time action without affecting bioavailability of
insulin. This effect may approach the rapid-time action observed in
LysB.sup.28ProB.sup.29 human insulin.
[0096] Peptide formulations, e.g., pramlintide, at a pH from 4.0 to
5.5, 2 to 30 mM buffer concentration and high potency, can be mixed
with regular insulin products before injection to yield solutions
with a pH greater than 6.8 so that the properties of insulin are
not affected. These mixtures would not affect the rate of
absorption or bioavailability of insulin nor the bioavailability of
the peptide.
[0097] Formulations of the invention are generally described above.
Below are provided examples of various formulations useful in the
invention. These examples are not limiting to the invention and
those of ordinary skill in the art can readily construct other
formulations within the ambit of the claims.
[0098] The invention will now be described in greater detail by
reference to the following non-limiting examples.
EXAMPLE 1
Liquid Pramlintide Formulation
[0099] This example describes two preferred liquid formulations for
pramlintide. Major degradation pathways for the peptide are
deamidation and peptide bond hydrolysis. Therefore, the stability
of the peptide was investigated in the pH region of 4.0-5.5 at
45.degree. C. The pH-rate profile for the peptide in 60 mM acetate
buffer, 4.1% mannitol, 0.3% m-cresol is shown in FIG. 1. It can be
observed from this figure that Pro.sup.25,28,29h-amylin over the pH
range studied is most stable at pH 4.0. The following formulation
was developed:
1 TABLE A INGREDIENT Weight (%)/Range Pramlintide 0.01-0.2 Acetate
(30 mM, pH 4.0 .+-. 0.1): sodium acetate trihydrate 0.061 glacial
acetic acid 0.153 mannitol 4.3 m-cresol 0.225 Water For Injection
(qs) 100 mL
[0100] The above formulation with 0.01% drug showed an acceptably
low irritancy in rabbit subcutaneous irritancy study. The placebo
of this formulation when tested in humans also showed an acceptably
high level of tolerability and low irritancy. The preservative used
in the formulation meets BP criteria for preservative efficacy at
m-cresol levels as low as 0.15%.
[0101] The stability of the above formulation with 0.01% peptide
was evaluated at 4.degree. C. and accelerated conditions,
30.degree. C., 40.degree. C. and 50.degree. C. Based on strong
cation exchange and HPLC analysis for purity and potency,
semi-logarithmic plots of % Initial purity or potency versus time
for the peptide were constructed as shown in FIGS. 2, 3 and 4. It
can be observed from this plot that the degradation of the peptide
follows first order kinetics and that the degradation rate
(represented by slopes of these plots), increases significantly
with an increase in temperature. FIG. 5 shows plot of ln(k.sub.obs)
versus 1/Temperature, constructed based on the Arrhenius
relationship. It can be observed from this plot that the
degradation of pramlintide in the formulation follows Arrhenius
kinetics. By extrapolation of the plot to 5.degree. C. rate
constant was calculated and shelf-life of up to four years for the
peptide was predicted using this rate constant. Approximately 10%
loss of potency and/or 5% to 7% degradation was considered
acceptable. The shelf-life of the pharmaceutical formulation at
30.degree. C. based on direct measurement is at least 60 days.
EXAMPLE 2
Liquid Pramlintide Formulation
[0102] Table B describes second the peptide formulation with a
shelf-life of greater than 4 years at 4.degree. C. and greater than
60 days at 30.degree. C. This formulation differs from the one in
Table A in acetate buffer concentration. This formulation also
showed no irritancy in a rabbit subcutaneous irritancy study.
Additionally, the placebo did not show significant irritancy in
humans. The shelf-lives of this formulation are at least as great
as the formulation given in Table A, both formulations being novel
parenteral peptide dosage forms with substantial shelf-lives.
2 TABLE B INGREDIENT Weight (%)/Range Pramlintide 0.01-0.2 Acetate
(20 mM, pH 4.0 .+-. 0.1): sodium acetate trihydrate 0.049 glacial
acetic acid 0.0985 mannitol 4.3 m-cresol 0.225 Water for injection
(qs) 100 mL
EXAMPLE 3
Liquid Pramlintide Formulation And Insulin
[0103] The formulations reported in Tables A and B are also
compatible when mixed in a syringe with commercially available
insulin products. Table C provides results of insulin compatibility
study with Humulin.RTM. R. The results indicate the time to form a
clear solution and criteria for compatibility, when the peptide
formulation is mixed with Humulin R in a specific ratio in a
syringe. As outlined by Brange et al, "Insulin Structure and
Stability," in Stability and Characterization of Protein and
Peptide Drugs: Case Histories, 1993, Wang et al. (Ed), Plenum
Press, NY, insulin has an isoelectric precipitation zone pH range
of 4.5-6.5, within 1 pH unit from isoelectric point. Therefore, if
the pH of the insulin product drops from 7.2.+-.0.2 to pH in the
isoelectric precipitation range it may cause insulin to
precipitate. Thus, clarity of the solution mixture was used as a
criteria for compatibility studies. The insulin volumes used in
this study (Table C) cover the maximum and minimum ranges typical
for Type I diabetic patients. The formulation with higher buffer
capacity (Table C) forms a clear solution faster than the lower
buffer capacity formulation. However, at 0.01% of the peptide label
strength both formulations form a clear solution with insulin
within approximately one minute. In a syringe, one minute can be
considered to be instantaneous mixing. The higher label strengths
of the peptide (0.015% or higher) results in lower dose volume and
causes longer than a minute to form a clear solution. The final pH
of all solution mixtures fall outside of insulin isoelectric
precipitation range (pH 4.5-6.5).
3TABLE C Insulin: Pramlintide Pramlintide Formulation Variants
Mixing Time to Form Label Volume pH of Clear Strength Acetate Ratio
the Solution (%) (mM) (.mu.L:.mu.L) Mixture (sec) 0.01 30 50(5 4.03
0 units):300 150:300 4.10 15 200:300 4.13 35 20 50:300 4.09 0
150:300 4.15 22 200:300 4.20 60 0.015 30 50:200 4.05 0 150:200 4.12
99 200:200 4.24 192 20 50:200 4.13 10 150:200 4.27 197 200:200 4.30
300
[0104] The formulation with 0.03% label strength (Table A) was
subjected to in vivo compatibility study in rats. FIG. 6 shows the
plasma concentration versus time for insulin. The study indicated
no significant differences in the bioavailability of either insulin
or peptide when injected together after mixing or separately as
individual injections. Therefore, these novel formulations are not
only stable but also compatible with regular insulin products such
as, Humulin.RTM. R and Novolin.RTM. R.
[0105] The preferred formulations (Tables A and B) were also tested
for compatibility with intermediate acting (Humulin.RTM. 70/30) and
long acting (Humulin.RTM. N) insulin products. These two insulin
products are suspensions and they both contain soluble and
insoluble insulin portions in specific ratios, and these ratios are
required to achieve targeted bioavailability. Therefore, when mixed
with the peptide formulation the ratio of soluble to insoluble
insulin should be maintained. The sample preparation to separate
soluble to insoluble portions from peptide/insulin mixtures was
adopted from Arakawa et al., Diabetes Research and Clinical
Practice, 1989. Samples were analyzed using a reverse phase HPLC
assay. Table D summarizes the results of the study. Both
formulations maintain the soluble to insoluble ratios as in control
formulations when Humulin.RTM. 70/30 and Pro.sup.25,28,29 h-amylin
formulations are mixed in a 3:1 ratio. Therefore, in a preferred
formulation the dose volume should be maintained by choosing an
appropriate peptide label strength. For example, using 0.6 mg/mL or
0.06% label strength formulation to mix with 15 units of Humulin
70/30.
4TABLE D Pramlintide Formulation Variants (Label Strength: 0.3
Insulin: mg/mL or 0.03%) Pramlintide pH of Percent Acetate Ratio
the Soluble % Soluble pH (mM) (.mu.L:.mu.L) Mixture Insulin
Pramlintide 4.0 20 300(30 6.77 12 101 Units):100 150:100 5.74 4 100
4.0 30 300:100 6.41 10 97 150:100 5.15 4 98 Humulin N/A 7.12 11 N/A
N:Humulin R (70:30) (control) Premixed 100:0 7.46 16 N/A Humulin
70/30 (control)
[0106] Table E shows compatibility data for formulations with long
acting insulin product, Humulin.RTM. N. The Humulin.RTM. N covers a
normal dosage range for Type I diabetic patients. The soluble to
insoluble ratios do not change significantly compared to the
control when preferred formulations, in Tables A and B, are mixed
with Humulin.RTM. N. The preferred peptide dose volume is 100
.mu.L.
[0107] The formulations described in Tables A and B of Example 1
are preferred formulations with necessary stability and insulin
compatibility requirements.
5TABLE E Pramlintide Formulation Variants (Label Strength: 0.3
Insulin: mg/mL or 0.03%) Pramlintide pH of Percent Acetate Ratio
the Soluble % Soluble pH (mM) (.mu.L:.mu.L) Mixture Insulin
Pramlintide 4.0 20 160(16 5.51 2 100 Units):100 120:100 5.10 4 105
4.0 30 160:100 5.06 3 99 120:100 4.82 4 97 Humulin N 100:0 7.20 2
N/A (control)
EXAMPLE 4
Liquid Peptide Formulation and Insulin
[0108] The formulation in this example is the preferred formulation
for mixing with intermediate acting (Humulin.RTM. 70/30 &
Novolin.RTM. 70/30) and long acting (Humulin.RTM. N and
Novolin.RTM. N) insulin products.
6 TABLE F INGREDIENT Weight (%)/Range Pramlintide 0.03 Acetate (12
mM, pH 4.4) sodium acetate trihydrate 0.0555 glacial acetic acid
0.0476 mannitol 4.4 m-cresol 0.225 Water for injection (qs) 100
mL
[0109] The stability of this formulation is 3.3 years at 5.degree.
C., calculated by extrapolation using accelerated stability data,
and found to be 33 days at 30.degree. C. using the real time data.
The insulin compatibility studies with Humulin.RTM. 70/30 and
Humulin.RTM. N were conducted following the procedure outlined in
Example 3. The formulation maintains insulin soluble to insoluble
ratios in the range of controls when mixed with Humulin.RTM. 70/30
(Table G) or Humulin.RTM. N (Table H). The pH of the mixture does
not deviate from the control samples.
7TABLE G Pramlintide Formulation Variants (Label Strength: 0.3
Insulin: mg/mL or 0.03%) Pramlintide pH of Percent Acetate Ratio
the Soluble % Soluble pH (mM) (.mu.L:.mu.L) Mixture Insulin
Pramlintide 4.4 12 300:100 7.02 13 88 150:100 6.82 11 92 Humulin
.RTM. N/A 7.12 11 N/A N:Humulin .RTM. R (70:30) (Control) Premixed
100:0 7.46 16 N/A Humulin .RTM. 70/30 (Control)
[0110]
8TABLE H Pramlintide Formulation Variants (Label Strength: 0.3
Insulin: mg/mL or 0.03%) Pramlintide pH of Percent Acetate Ratio
the Soluble % Soluble pH (mM) (.mu.L:.mu.L) Mixture Insulin
Pramlintide 4.4 12 160:100 6.54 3 99 120:100 6.26 1 99 Humulin
.RTM. N 100:0 7.20 2 N/A (Control)
EXAMPLE 5
Liquid Pramlintide Formulation
[0111] This is a formulation with low buffer concentration, 10 mM
of acetate buffer and pH closer to physiological pH compared to the
formulations in examples 1-4. The stability of this formulation is
calculated by extrapotation to be 2.76 years 5.degree. C. based on
accelerated stability data and found to be 32 days at 30.degree. C.
using real time data.
9 TABLE I INGREDIENT Weight (%)/Range Pramlintide 0.01-0.4 Acetate
(10 mM, pH 4.7) sodium acetate trihydrate 0.066 glacial acetic acid
0.0309 mannitol 4.5 m-cresol 0.225-0.3 Water for injection (qs) 100
mL
EXAMPLE 6
Lyophilized Peptide Formulation
[0112] Amylin agonists may be stabilized by lyophilization of the
formulation listed in Table J. This formulation is intended for
amylin agonists or amylins having physicochemical characteristics
that include lower solubility and/or higher instability.
[0113] Pramlintide, however, a superior amylin agonist peptide, may
also be lyophilized in the formulation listed in Table J.
10 TABLE J INGREDIENT WEIGHT (%)/RANGE Amylin Agonist 0.03-1.0
Mannitol 5.0 Polysorbate 80 0.02 Water for Injection 100 ml
(qs)
EXAMPLE 7
Liquid Peptide Formulation
[0114] Amylin agonists such as pramlintide may be minimally
formulated with 30mM acetate butter as described in Table K
11 TABLE K INGREDIENT WEIGHT (%)/RANGE Pramlintide 0.01-0.5 Glacial
Acetic 0.153 Acid Sodium Acetate 0.061 Trihydrate
* * * * *