U.S. patent application number 14/101198 was filed with the patent office on 2014-04-10 for methods of administering compositions comprising docosapentaenoic acid.
This patent application is currently assigned to Matinas BioPharma, Inc.. The applicant listed for this patent is Matinas BioPharma, Inc.. Invention is credited to George BOBOTAS, Abdel Aziz FAWZY.
Application Number | 20140100275 14/101198 |
Document ID | / |
Family ID | 49769263 |
Filed Date | 2014-04-10 |
United States Patent
Application |
20140100275 |
Kind Code |
A1 |
BOBOTAS; George ; et
al. |
April 10, 2014 |
METHODS OF ADMINISTERING COMPOSITIONS COMPRISING DOCOSAPENTAENOIC
ACID
Abstract
The present invention relates to compositions comprising
docosapentaenoic acid and methods of reducing lipid parameters,
such as triglycerides, total cholesterol, low density lipoprotein
(LDL) cholesterol, non-HDL cholesterol, free fatty acids, and other
lipids, comprising administration of omega-3 docosapentaenoic
acid.
Inventors: |
BOBOTAS; George; (Tarpon
Springs, FL) ; FAWZY; Abdel Aziz; (Boynton Beach,
FL) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
Matinas BioPharma, Inc. |
Bedminster |
NJ |
US |
|
|
Assignee: |
Matinas BioPharma, Inc.
Bedminster
NJ
|
Family ID: |
49769263 |
Appl. No.: |
14/101198 |
Filed: |
December 9, 2013 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
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PCT/US13/46176 |
Jun 17, 2013 |
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14101198 |
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61780948 |
Mar 13, 2013 |
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61734331 |
Dec 6, 2012 |
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61660757 |
Jun 17, 2012 |
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Current U.S.
Class: |
514/549 ;
514/560 |
Current CPC
Class: |
A61K 9/4825 20130101;
Y10S 514/893 20130101; A61K 9/4858 20130101; A61K 31/232 20130101;
A61P 3/06 20180101; A61K 31/202 20130101; A61K 31/201 20130101;
A61K 31/40 20130101; A61P 9/00 20180101; A61K 31/202 20130101; A61K
2300/00 20130101; A61K 31/40 20130101; A61K 2300/00 20130101 |
Class at
Publication: |
514/549 ;
514/560 |
International
Class: |
A61K 31/202 20060101
A61K031/202; A61K 31/232 20060101 A61K031/232; A61K 31/201 20060101
A61K031/201 |
Claims
1. A method of increasing a lipid parameter level in a subject from
a baseline lipid parameter level, wherein the lipid parameter is
selected from the group consisting of HDL cholesterol and
apolipoprotein A-I (apo A-I), comprising administering to the
subject a composition comprising a daily dosage of docosapentaenoic
acid (DPA) of about 120 mg/day to about 150 mg/day.
2. The method of claim 1, wherein the composition comprises a daily
dosage of DPA of about 150 mg/day to about 200 mg/day.
3. The method of claim 1, wherein the composition comprises a daily
dosage of DPA of about 200 mg/day to about 250 mg/day.
4. The method of claim 1, wherein the composition comprises a daily
dosage of DPA of about 250 mg/day to about 300 mg/day.
5. The method of claim 1, wherein the composition comprises a daily
dosage of DPA of about 300 mg/day to about 400 mg/day.
6. The method of claim 1, wherein the composition comprises a daily
dosage of DPA of about 400 mg/day to about 600 mg/day.
7. The method of claim 1, wherein the composition comprises a daily
dosage of DPA of about 600 mg/day to about 1000 mg/day.
8. The method of claim 1, wherein the composition further comprises
eicosapentaenoic acid (EPA) and, wherein the amount of EPA and DPA
is about 55% or more by weight of the total amount of fatty acids,
and wherein the ratio of DHA:DPA is no more than 2:1.
9. The method of claim 8, wherein the amount of EPA and DPA is
selected from the group consisting of about 60% or more, about 65%
or more, about 70% or more, about 75% or more, about 80% or more,
about 85% or more, and about 90% or more by weight of the total
amount of fatty acids.
10. The method of claim 1, wherein the composition comprises
further omega-6 fatty acids in an amount of no more than 6% of
total amount of fatty acids.
11. The method of claim 1, wherein the composition comprises no
more than about 30% docosahexaenoic acid (DHA) by weight of fatty
acids present in the composition.
12. The method of claim 1, wherein the composition comprises no
more than about 20% docosahexaenoic acid (DHA) by weight of fatty
acids present in the composition.
13. The method of claim 1, wherein the composition comprises no
more than about 10% docosahexaenoic acid (DHA) by weight of fatty
acids present in the composition.
14. The method of claim 1, wherein the composition comprises no
more than about 5% docosahexaenoic acid (DHA) by weight of fatty
acids present in the composition.
15. The method of claim 1, wherein the composition comprises DPA in
ethyl ester form.
16. The method of claim 1, wherein the composition comprises DPA in
free fatty acid form.
17. The method of claim 1, wherein the composition further
comprises docosahexaenoic acid (DHA), and the ratio of DHA:DPA is
no more than 2:1.
18. The method of claim 1, wherein the composition further
comprises docosahexaenoic acid (DHA), and the ratio of DHA:DPA is
no more than 1:1.
19. The method of claim 1, wherein the composition further
comprises docosahexaenoic acid (DHA), and the ratio of DHA:DPA is
no more than 1:2.
20. The method of claim 1, wherein the composition further
comprises docosahexaenoic acid (DHA), and the ratio of DHA:DPA is
no more than 1:3.
21. The method of claim 1, wherein the composition further
comprises docosahexaenoic acid (DHA), and the ratio of DHA:DPA is
no more than 1:4.
22. The method of claim 1, wherein the composition comprises at
least about 4% docosapentaenoic acid (DPA) by weight of fatty acids
present in the composition.
23. The method of claim 1, wherein the composition comprises at
least about 6% docosapentaenoic acid (DPA) by weight of fatty acids
present in the composition.
24. The method of claim 1, wherein the composition comprises at
least about 10% docosapentaenoic acid (DPA) by weight of fatty
acids present in the composition.
25. The method of claim 1, wherein the composition comprises at
least about 20% docosapentaenoic acid (DPA) by weight of fatty
acids present in the composition.
26. The method of claim 1, wherein the composition comprises at
least about 50% docosapentaenoic acid (DPA) by weight of fatty
acids present in the composition.
27. The method of claim 1, wherein the composition comprises at
least about 80% docosapentaenoic acid (DPA) by weight of fatty
acids present in the composition.
Description
RELATED APPLICATIONS
[0001] This application is a continuation-in-part (CIP) application
of PCT International Application No. PCT/US13/46176, filed on Jun.
17, 2013, which claims the benefit of U.S. Provisional Patent
Application No. 61/660,757, filed Jun. 17, 2012, U.S. Provisional
Patent Application No. 61/734,331, filed Dec. 6, 2012, and U.S.
Provisional Patent Application No. 61/780,948, filed Mar. 13, 2013,
the contents of which are incorporated herein by reference.
FIELD OF INVENTION
[0002] The present invention relates to a method comprising
administration of docosapentaenoic acid compositions for the
reduction of lipid parameters, such as triglycerides, total
cholesterol, low density lipoprotein (LDL) cholesterol, non-HDL
cholesterol, free fatty acids, and other lipids. The present
invention also relates to a method comprising administration of
docosapentaenoic acid compositions for the increase of high density
lipoprotein (HDL) cholesterol. The methods of the present invention
may be useful for the treatment of a condition selected from the
group consisting of: hypertriglyceridemia; hypercholesterolemia;
mixed dyslipidemia; coronary heart disease (CHD); vascular disease;
cardiovascular disease; acute coronary syndrome; atherosclerotic
disease and related conditions; heart failure; cardiac arrhythmias;
coagulatory conditions associated with cardiac arrhythmias;
ischemic dementia; vascular dementia; hypertension; coagulation
related disorders; nephropathy; kidney or urinary tract disease;
retinopathy; cognitive and other CNS disorders; autoimmune
diseases; inflammatory diseases; asthma or other respiratory
disease; dermatological disease; metabolic syndrome; diabetes,
diabetes mellitis or other form of metabolic disease; liver
disease; non-alcoholic fatty liver disease; disease of the
gastrointestinal tract; disease of the male or female reproductive
system or related secondary sexual organs; a cancer of any type,
including lymphomas and myelomas; an infection caused by a virus,
bacterium, fungus, protozoa or other organism; and the treatment
and/or prevention and/or reduction of cardiac events and/or
cardiovascular events and/or vascular events and/or symptoms. The
present invention also relates to treatment of such conditions in
with concomitant treatments regimes or combination products with
other active pharmaceutical ingredients.
BACKGROUND OF THE INVENTION
[0003] In humans, cholesterol and triglycerides are part of
lipoprotein complexes in the bloodstream, and can be separated via
ultracentrifugation into high-density lipoprotein (HDL),
intermediate-density lipoprotein (IDL), low-density lipoprotein
(LDL) and very-low-density lipoprotein (VLDL) fractions.
Cholesterol and triglycerides are synthesized in the liver,
incorporated into VLDL, and released into the plasma. High levels
of total cholesterol (total-C), LDL-cholesterol, and apolipoprotein
B (a membrane complex for LDL-cholesterol and VLDL-cholesterol, as
well as IDL-cholesterol in rare individuals suffering from a
disorder resulting in significant IDL-cholesterol levels) promote
human atherosclerosis; these elevated levels are often referred to
as hypercholesterolemia. Decreased levels of HDL-cholesterol and
its transport complex, apolipoprotein A, as well as elevated levels
of apolipoprotein C-III and serum triglycerides (TG) are also
associated with the development of atherosclerosis. Further,
cardiovascular morbidity and mortality in humans can vary directly
with the level of total-C, LDL-cholesterol and TG and inversely
with the level of HDL-cholesterol. In addition, researchers have
found that non-HDL-cholesterol is an important indicator of
hypertriglyceridemia (elevated triglycerides), vascular disease,
atherosclerotic disease and related conditions. Therefore,
non-HDL-cholesterol and fasting TG reduction has also been
specified as a treatment objective in NCEP ATP III. Fasting TG is
commonly used as a key measure for TG in lipid management, because
it minimizes the confounding factor of TG recently absorbed from
meals, including the high variability of the content of meals and
high variability of post-meal (post-prandial) spikes in TG. In some
preferred embodiments, we refer to fasting TG levels when we refer
to triglycerides or TG.
[0004] The NCEP ATPIII treatment guidelines identify HMG-CoA
reductase inhibitors ("statins") as the primary treatment option
for hypercholesterolemia. In patients with TG<500 mg/dL,
LDL-cholesterol is the primary treatment parameter. Many patients,
however, have increased LDL-cholesterol combined with high TG and
low HDL-cholesterol, a condition also known as mixed dyslipidemia.
Patients with hypercholesteremia or mixed dyslipidemia often
present with high blood levels of LDL-cholesterol (i.e. greater
than 190 mg/dl) and TG (i.e. levels of 200 mg/dl or higher). The
use of diet and single-drug therapy does not always decrease
LDL-cholesterol and TG adequately enough to reach targeted values
in patients with mixed dyslipidemia with or without a concomitant
increase in triglycerides. In these patients, a combined therapy
regimen of a statin and a second anti-dyslipidemic agent is often
desired. This second agent has historically been a fibrate (i.e.
gemfibrozil, bezafibrate, or fenofibrate) or extended release
niacin. Over the few years, the use omega-3 fatty acid concentrates
in combination with a statin has been growing rapidly due to
concerns about the lack of outcome benefits with fibrates (i.e. the
FIELD study) or extended release niacin (i.e. the AIM-HIGH study).
In patients with isolated hypertriglyceridemia, the use of omega-3
fatty acid concentrates has also grown versus fibrates and extended
release niacin.
[0005] Marine oils, also commonly referred to as fish oils, are a
good source of the two main omega-3 fatty acids, eicosapentaenoic
acid (EPA) and docosahexaenoic acid (DHA), which have been found to
regulate lipid metabolism. Omega-3 fatty acids have been found to
have beneficial effects on the risk factors for cardiovascular
diseases, especially mild hypertension, hypertriglyceridemia and on
the coagulation factor VII phospholipid complex activity. Omega-3
fatty acids lower serum triglycerides (TG), increase serum
HDL-cholesterol, lower systolic and diastolic blood pressure and
the pulse rate, and lower the activity of the blood coagulation
factor VII-phospholipid complex. Further, omega-3 fatty acids seem
to be well tolerated, without giving rise to any severe side
effects.
[0006] The table directly below lists the most common omega-3 fatty
acids, including their 3-letter abbreviation code. In this
application, the use of any of the 3-letter abbreviations shall
refer to the omega-3 fatty acid, unless otherwise indicated (e.g.
DPA or DPA 22:5 (n-3) or DPA 22:5-n3 or DPA 22:5n3 or DPA-n3, which
all refer to the omega-3 isomer of docosapentaenoic acid).
TABLE-US-00001 Common Name for Omega-3 Fatty Acid Codified
(+abbreviation) Lipid Name Chemical Name Hexadecatrienoic acid
(HTA) 16:3 (n-3) all-cis-7,10,13- hexadecatrienoic acid
.alpha.-Linolenic acid (ALA) 18:3 (n-3) all-cis-9,12,15-
octadecatrienoic acid Stearidonic acid (SDA) 18:4 (n-3)
all-cis-6,9,12,15- octadecatetraenoic acid Eicosatrienoic acid
(ETE) 20:3 (n-3) all-cis-11,14,17- eicosatrienoic acid
Eicosatetraenoic acid (ETA) 20:4 (n-3) all-cis-8,11,14,17-
eicosatetraenoic acid Eicosapentaenoic acid (EPA) 20:5 (n-3)
all-cis-5,8,11,14,17- eicosapentaenoic acid Heneicosapentaenoic
acid (HPA) 21:5 (n-3) all-cis-6,9,12,15,18- heneicosapentaenoic
acid Docosapentaenoic acid (DPA) or 22:5 (n-3)
all-cis-7,10,13,16,19- Clupanodonic acid docosapentaenoic acid
Docosahexaenoic acid (DHA) 22:6 (n-3) all-cis-4,7,10,13,16,19-
docosahexaenoic acid Tetracosapentaenoic acid (TPA) 24:5 (n-3)
all-cis-9,12,15,18,21- tetracosapentaenoic acid Tetracosahexaenoic
acid (THA) 24:6 (n-3) all-cis-6,9,12,15,18,21- or Nisinic acid
tetracosahexaenoic acid
[0007] One form of omega-3 fatty acids is a concentrate of omega-3,
long chain, polyunsaturated fatty acids from fish oil containing
DHA ethyl esters, EPA ethyl esters as well as ethyl esters of other
omega-3 fatty acids (described in USP35 for LOVAZA.RTM.) and is
sold under the trademarks OMACOR.RTM. and LOVAZA.RTM.. Such a form
of omega-3 fatty acid comprises at least 90% omega-3 fatty acids of
which at least 80% EPA+DHA (in a ratio of 1.2:1) and is described,
for example, in U.S. Pat. Nos. 5,502,077, 5,656,667 and 5,698,594.
LOVAZA.RTM. (omega-3-acid ethyl esters) is indicated for the
treatment of patients with hypertriglyceridemia with TG levels of
500 mg/dL or higher.
[0008] Another form of omega-3 fatty acid concentrate is sold under
the trademark EPADEL.RTM. for the treatment of dyslipidemia. This
product is described as 98% EPA ethyl ester in Lancet (Vol. 369;
Mar. 31, 2007; 1090-1098) reporting on a large outcome study with
EPADEL.RTM.. EPADEL.RTM. is known to contain less than 1% of any
fatty acid other than EPA.
[0009] Similar to EPADEL.RTM., another form of omega-3 fatty acid
concentrate also consists almost entirely of EPA ethyl ester and is
known under its developmental stage name AMR101 or its trade name
VASCEPA.RTM.. This product is described in US patent application
2010/0278879 as comprising at least 95% EPA (typically referred to
as 97% or at least 96% in company releases and references) and less
than 1% of any other fatty acid. AMR101 was previously under
development for the treatment of Huntingdon's Disease but failed in
phase III clinical development. Subsequently, AMR101 was entered in
a development program for hypertriglyceridemia and mixed
dyslipidemia.
[0010] Yet another concentrate of omega-3, long chain,
polyunsaturated fatty acids from fish oil containing approximately
75% DHA and EPA as free fatty acids is known under its
developmental stage name EPANOVA.TM.. This product is described as
comprising approximately 55% EPA and 20% DHA. EPANOVA.TM. was
previously under development for the treatment of Crohn's Disease
but failed in phase III clinical development. Subsequently,
EPANOVA.TM. was entered in a development program for
hypertriglyceridemia and mixed dyslipidemia.
[0011] Generally, the bioavailability and therapeutic effect of
omega-3 fatty acid compositions is dose dependent, i.e., the higher
the dose, the greater the therapeutic affect and bioavailability.
However, the effect of each specific omega-3 fatty acid composition
may be different, and therefore the level of therapeutic effect of
one composition at a given dose cannot necessarily be inferred from
the level of therapeutic effects of other omega-3 fatty acid
compositions at the same or similar dose.
[0012] For instance, in the MARINE study, it was found that four
1-gram capsules of AMR101/VASCEPA.RTM. significantly reduced
fasting TG in patients with very high triglycerides (TG>500
mg/dL) (March 2011, ACC poster reporting top-line results of the
MARINE study), similar to four 1-gram capsules of LOVAZA.RTM. but
in a less potent manner (LOVAZA.RTM. prescribing information,
December 2010). In this same study, AMR101 slightly and
non-significantly changed LDL-C while LOVAZA.RTM. shows a large
significant increase in this same population, putting the latter at
a disadvantage. Table A directly below compares these profiles.
TABLE-US-00002 TABLE A Comparison of therapeutic profile of Lovaza
and Vascepa in patients with very high triglycerides (>500
mg/dL) LOVAZA - 4 gram/day Vascepa - 4 gram/day Vascepa - 2
gram/day % change vs. Placebo p-value % change vs. Placebo p-value
% change vs. Placebo p-value TG -51.6 p < 0.05 -33.1 p < 0.05
-19.7 p < 0.05 Total-C -8.0 p < 0.05 -16.3 p < 0.0001 -6.8
p = 0.0148 LDL-C 49.3 p < 0.05 -2.3 NS 5.2 NS VLDL-C -40.8 p
< 0.05 -28.6 p = 0.0002 -15.3 p = .038 Non-HDL-C -10.2 p <
0.05 -17.7 p < 0.0001 -8.1 p = .0182 Apo-B NR -8.5 p = 0.0019
-2.6 NS HDL-C 9.1 p < 0.05 -3.6 NS 1.5 NS NR = Not Reported; NS
= Not Significant
[0013] In another study with AMR101/VASCEPA.RTM., the ANCHOR study,
it was found that four 1-gram capsules of AMR101 significantly
reduced fasting TG in patients on statin therapy with high
triglycerides (TG 200-499 mg/dL), similar to four 1-gram capsules
of LOVAZA.RTM. but in a less potent manner (Study in table 3,
LOVAZA.RTM. prescribing information, December 2010). In this same
study, AMR101 decreased LDL-C at 4 gr/day while LOVAZA.RTM. shows a
significant LDL-C increase in this same population. AMR101 is also
more potent than LOVAZA.RTM. in reducing non-HDL-cholesterol in
this population. Table B directly below compares these
profiles.
TABLE-US-00003 TABLE B Therapeutic profile comparison of Lovaza and
Vascepa in patients on statin with high triglycerides (TG 200-499
mg/dL) LOVAZA - 4 gram/day Vascepa - 4 gram/day Vascepa - 2
gram/day % change vs. Placebo p-value % change vs. Placebo p-value
% change vs. Placebo p-value TG -23.2 p < 0.0001 -21.5 p <
0.0001 -10.1 p = 0.0005 Total-C -3.1 p < 0.05 NR p < 0.0001
NR p = 0.0019 LDL-C 3.5 p = 0.05 -6.3 p = 0.0067 -3.6 NS VLDL-C
-20.3 p < 0.05 -24.4 p < 0.0001 -10.5 p = 0.0093 Non-HDL-C
-6.8 p < 0.0001 -13.6 p < 0.0001 -5.5 p = 0.0054 Apo-B -2.3 p
< 0.05 -9.3 p < 0.0001 -3.8 p = 0.0170 HDL-C 4.6 p < 0.05
-4.5 p = 0.0013 -2.2 NS NS = Not Significant
[0014] The resulting lipid profile of AMR101 versus LOVAZA.RTM. in
highly similar patient populations indicates that there are
significant benefits of using an almost pure EPA oil composition as
opposed to an omega-3 mixture as in LOVAZA.RTM.. These benefits
translate into better non-HDL- and LDL-Cholesterol reduction with
the pure EPA form, where these benefits are less or, in the case of
the LDL-C effect, the opposite.
[0015] The recently released results from Omthera's EVOLVE trial
with EPANOVA.TM. in patients with very high triglycerides
(TG.gtoreq.500 mg/dL), described a TG reduction of 31% versus
baseline for the 4 gram per day dose and 26% versus baseline for
the 2 gram per day dose, with 10% and 8% non-HDL reduction
respectively. It appears that the TG-reducing potency of
EPANOVA.TM. is similar to the potency of AMR101. No data were
reported by Omthera on the LDL-C effect in the EVOLVE trial.
[0016] The recently released results from Omthera's ESPRIT trial
with EPANOVA.TM., in patients with high triglycerides (TG 200-499
mg/dL) while on statin therapy, described a TG reduction of 21%
versus baseline for the 4 gram per day dose and 15% versus baseline
for the 2 gram per day dose, with 7% and 4% non-HDL reduction
respectively. It appears that the TG-reducing potency of
EPANOVA.TM. is similar to the potency of AMR101. No data were
reported by Omthera on the LDL-C effect in the ESPRIT trial.
[0017] From the comparison of LOVAZA.RTM. versus AMR101 data, there
appears to be a benefit of using pure EPA concentrates for
dyslipidemia treatment over omega-3 mixtures with regard to
LDL-Cholesterol and non-HDL-cholesterol effects. With the NCEP ATP
III guidelines placing LDL-cholesterol and non-HDL-cholesterol
reduction at the top of the treatment hierarchy for patients with
TG<500 mg/dL, AMR101 is clearly superior to LOVAZA.RTM. in this
patient category.
[0018] In another example, in the ECLIPSE Study, the
bioavailability of EPANOVA.TM. is compared to LOVAZA.RTM. under
high fat meal and low fat meal dosing conditions.
[0019] In the ECLIPSE study it is found that EPANOVA.TM. is
significantly more bioavailable than LOVAZA.RTM. after single dose
administration (four capsules of 1 gram for both products), both by
Cmax (maximum concentration) and AUC (area under curve) measures
(see Table C below, where Cmax and AUC are estimated from the data
points in FIGS. 1 and 2). Relative to LOVAZA.RTM. under high fat
meal conditions, EPANOVA.TM. is 1.17.times. more bioavailable by
Cmax and 1.27 by AUC comparison. Under low fat meal conditions,
LOVAZA.RTM. has only 15% AUC and 12% Cmax of the bioavailability
versus LOVAZA.RTM. under high fat meal conditions, whereas
EPANOVA.TM. under low fat meal conditions has 78% AUC and 53% Cmax
of the bioavailability versus LOVAZA.RTM. under high fat meal
conditions. EPANOVA.TM. under low fat meal conditions has 62% AUC
and 46% Cmax of the bioavailability versus EPANOVA.TM. under high
fat meal conditions.
TABLE-US-00004 TABLE C Comparison of bioavailability of EPA + DHA
in Plasma for Lovaza (4 g) and Epanova (4 g) under high-fat and
low-fat meal dosing conditions LOVAZA - LOVAZA - Epanova - Epanova
- High Fat Low Fat High Fat Low Fat Cmax EPA + DHA 385 nmol/ml 45
nmol/ml 450 nmol/ml 205 nmol/ml Est. AUC, 0-24 3080 nmol*hr/ml 465
nmol*hr/ml 3920 nmol*hr/ml 2415 nmol*hr/ml EPA + DHA Tmax EPA + DHA
5 hrs 10 hrs 5 hrs 5 hrs Multiple of Lovaza- 1.00 x 0.15 x 1.27 x
0.78 x HF AUC Multiple of LF vs. NA 0.15 x Lovaza- NA x 0.62 x
Epanova- HF AUC HF AUC HF AUC Multiple of Lovaza- 1.00 x 0.12 x
1.17 x 0.53 x HF Cmax Multiple of LF vs. NA 0.12 x Lovaza- NA x
0.46 x Epanova- HF Cmax HF Cmax HF Cmax Low fat meal - NA 1.00 x NA
5.19 x AUC vs. Lov. Low fat meal - NA 1.00 x NA 4.56 x Cmax vs.
Lov. High fat meal - 1.00 x NA 1.27 x NA AUC vs. Lov. High fat meal
- 1.00 x NA 1.17 x NA Cmax vs. Lov.
[0020] Omega-3 fatty acids are known to be "essential fatty acids".
There are two series of essential fatty acids (EFAs) in humans.
They are termed "essential" because they cannot be synthesized de
novo in mammals. These fatty acids can be interconverted within a
series, but the omega-6 (n-6) series cannot be converted to the
omega-3 series nor can the omega-3 (n-3) series be converted to the
omega-6 series in humans. The main EFAs in the diet are linoleic
acid of the omega-6 series and alpha-linolenic acid of the omega-3
series. However, to fulfill most of their biological effects these
"parent" EFAs must be metabolised to the other longer chain fatty
acids. Each fatty acid probably has a specific role in the body.
The scientific literature suggests that particularly important in
the n-6 series are dihomo-gammalinolenic acid (DGLA, 20:3-n6) and
arachidonic acid (ARA, 20:4-n6), while particularly important in
the n-3 series are eicosapentaenoic acid (EPA, 20:5-n3) and
docosahexaenoic acid (DHA, 22:6-n3).
[0021] U.S. Pat. No. 6,479,544 describes an invention in which it
is found that ARA is highly desirable rather than undesirable and
it may be helpful to administer ARA in association with EPA. This
invention provides pharmaceutical formulations containing
eicosapentaenoic acid or any appropriate derivative (hereinafter
collectively referred to as EPA) and arachidonic acid (ARA), as set
out in the granted claims for this patent. ARA may be replaced by
one or more of its precursors, DGLA or GLA. In this reference, the
ratio of EPA to ARA is preferably between 1:1 and 20:1.
[0022] Patent application PCT/GB 2004/000242 describes the
treatment or prevention of psoriasis with a formulation comprising
more than 95% EPA and less than 2% DHA. In another embodiment of
this invention the EPA is replaced with DPA.
[0023] Patent application PCT/NL 2006/050291 (WO/2007/058538, GB
0301701.9) describes combinations of indigestible oligosaccharides
and long chain poly-unsaturated fatty acids such as ARA, EPA, DA,
and combinations thereof to improve intestinal barrier integrity,
improving barrier function, stimulating gut maturation and/or
reducing intestinal barrier permeability.
[0024] Lindeborg et al. (Prostag Leukotr Ess, 2013, 88:313-319)
discloses a study evaluating postprandial metabolism of
docosapentaenoic acid (DPA) and eicosapentaenoic acid (EPA) in
humans.
[0025] Holub et al. (Lipids, 2011, 46:399-407) discloses a study
assessing the effect of oral supplementation with docosapentaenoic
acid (DPA) on levels of serum and tissue lipid classes and their
fatty acid compositions in rat liver, heart, and kidney
[0026] Given the highly beneficial efficacy and side-effect profile
of omega-3 fatty acid concentrates, these compositions are
increasingly popular for the treatment of patients with
dyslipidemias. However, with the increased popularity of omega-3
fatty acid concentrates, there is an unmet medical need for omega-3
fatty acid containing compositions with improved bioavailability
and a more optimal ratio of potency in reducing TG versus the
resulting cholesterol profile. Specifically, agents with both a
higher potency than AMR101/EPADEL.RTM. and lesser increase in LDL-C
or further decrease in LDL-C and non-HDL-C than LOVAZA.RTM. are
required.
[0027] Fasting triglyceride levels have been found to be correlated
with the risk of cardiovascular diseases and conditions. For
example, high fasting triglycerides levels have been associated
with an increased risk of myocardial infarction. Gaziano et al.
(Circulation, 1997; 96:2520-2525) discusses fasting triglyceride
levels as a risk factor for coronary heart disease. Love-Osborne et
al. (Pediatr Diabetes, 2006: 7:205-210) discloses the role of
elevated fasting triglyceride levels in the development of type 2
diabetes mellitus.
[0028] All references cited herein are incorporated by reference in
their entirety.
SUMMARY OF THE INVENTION
[0029] The present invention provides a pharmaceutical composition
comprising eicosapentaenoic acid (EPA) and docosapentaenoic acid
(DPA), wherein the amount of EPA and DPA is about 55% or more by
weight of the total amount of fatty acids, and wherein the ratio of
DHA:DPA is no more than 1:1. The present invention also provides a
pharmaceutical composition comprising eicosapentaenoic acid (EPA),
docosapentaenoic acid (DPA), and docosahexaenoic acid (DHA),
wherein the amount of EPA and DPA is about 55% or more by weight of
the total amount of fatty acids, and wherein the ratio of DHA:DPA
is no more than 1:1.
[0030] The present invention provides a method of reducing lipid
parameters, such as triglyceride levels, in a subject in need
thereof, comprising administering to the subject a composition
comprising docosapentaenoic acid (DPA) in an amount of at least
about 20 mg/day, alternatively at least about 30 mg/day,
alternatively at least about 40 mg/day, alternatively at least
about 50 mg/day, alternatively at least about 60 mg/day
alternatively, at least about 70 mg/day alternatively at least
about 75 mg/day, alternatively at least about 80 mg/day,
alternatively at least about 90 mg/day, alternatively at least
about 100 mg/day, alternatively at least about 120 mg/day,
alternatively at least about 150 mg/day, alternatively at least
about 200 mg/day, alternatively at least about 300 mg/day, or
alternatively at least about 400 mg/day.
[0031] The present invention also provides a method of reducing
triglyceride levels in a subject in need thereof, comprising
administering to the subject a composition comprising at least
about 45% docosapentaenoic acid (DPA) relative to the total amount
of fatty acids present in the composition. In some alternative
embodiments, the composition comprises at least about 45% or at
least about 50% or at least about 55% or at least about 60% or at
least about 65% or at least about 70% or at least about 75% or at
least about 80% or at least about 85% or at least about 90% or at
least about 95% of DPA. The present invention also provides a
method of reducing triglyceride levels in a subject in need
thereof, comprising administering to the subject a composition
comprising no more than about 20% docosahexaenoic acid (DHA)
relative to the total amount of fatty acids present in the
composition. In some alternative embodiments, the composition
comprises no more than about 15% or no more than about 12% or no
more than about 10% or no more than about 8% or no more than about
7%, no more than about 6%, no more than about 5%, no more than
about 4%, no more than about 3%, no more than about 2%, or no more
than about 1% DHA relative to the total amount of fatty acids
present in the composition.
[0032] Furthermore, the present invention also provides a method of
reducing triglyceride levels in a subject in need thereof,
comprising administering to the subject a composition comprising
docosapentaenoic acid (DPA) in a significant or higher relative
amount as compared to docosahexaenoic acid (DHA) such that the
DPA:DHA ratio in the composition is 1:2 or greater. In some
alternative embodiments, the ratio of DPA:DHA in the composition is
at least 1:1, or at least 2:1 or at least 3:1, or at least 4:1 or
at least 5:1.
[0033] The present invention also provides a method of reducing
other lipid parameters, such as total cholesterol, low density
lipoprotein cholesterol, non-HDL cholesterol, and free fatty acids,
in a subject in need thereof, comprising administering to the
subject an orally administrable composition comprising
docosapentaenoic acid (DPA) in an amount of at least about 20
mg/day, alternatively at least about 30 mg/day, alternatively at
least about 40 mg/day, alternatively at least about 50 mg/day,
alternatively at least about 60 mg/day alternatively, at least
about 70 mg/day alternatively at least about 75 mg/day,
alternatively at least about 80 mg/day, alternatively at least
about 90 mg/day, alternatively at least about 100 mg/day,
alternatively at least about 120 mg/day, alternatively at least
about 150 mg/day, alternatively at least about 200 mg/day,
alternatively at least about 300 mg/day, or alternatively at least
about 400 mg/day.
[0034] The present invention also provides a method of reducing
other lipid parameters, such as total cholesterol, non-HDL
cholesterol, low density lipoprotein cholesterol, and free fatty
acids in a subject in need thereof, comprising administering to the
subject a composition comprising at least about 45%
docosapentaenoic acid (DPA) relative to the total amount of fatty
acids present in the composition. In some alternative embodiments,
the composition comprises at least about 45% or at least about 50%
or at least about 55% or at least about 60% or at least about 65%
or at least about 70% or at least about 75% or at least about 80%
or at least about 85% or at least about 90% or at least about 95%
of DPA. The present invention also provides a method of reducing
other lipid parameters in a subject in need thereof, comprising
administering to the subject a composition comprising no more than
about 20% docosahexaenoic acid (DHA) relative to the total amount
of fatty acids present in the composition. In some alternative
embodiments, the composition comprises no more than about 15% or no
more than about 12% or no more than about 10% or no more than about
8% or no more than about 7%, no more than about 6%, no more than
about 5%, no more than about 4%, no more than about 3%, no more
than about 2%, or no more than about 1% DHA relative to the total
amount of fatty acids present in the composition.
[0035] Furthermore, the present invention also provides a method of
reducing other lipid parameters, such as total cholesterol, non-HDL
cholesterol, low density lipoprotein cholesterol, and free fatty
acids in a subject in need therefore, comprising administering to
the subject a composition comprising docosapentaenoic acid (DPA) in
a significant or higher relative amount as compared to
docosahexaenoic acid (DHA) such that the DPA:DHA ratio in the
composition is 1:2 or greater. In some alternative embodiments, the
ratio of DPA:DHA in the composition is at least 1:1, or at least
2:1 or at least 3:1, or at least 4:1 or at least 5:1.
[0036] The present invention provides methods of reducing one or
more lipid parameter levels from a baseline lipid parameter level,
wherein the lipid parameter is selected from the group consisting
of: triglycerides, total cholesterol, apolipoprotein B (apo B),
apolipoprotein C-III (apoC-III), and non-HDL cholesterol,
comprising administration of any of the compositions of the present
invention. The present invention provides methods of increase a
lipid parameter level from a baseline lipid parameter level,
wherein the lipid parameter is selected from the group consisting
of: non-HDL cholesterol and apolipoprotein A (apoA).
[0037] The methods may relate to lipid parameters measured in a
fasted state, or in a fed state.
BRIEF DESCRIPTION OF THE DRAWINGS
[0038] FIG. 1 shows the fasting plasma lipid values after seven
days of dosing, relating to the study described in Example 33.
[0039] FIG. 2 shows the fasting plasma insulin levels after 28 days
of administration, relating to the study described in Example
33.
[0040] FIG. 3 shows the relative liver gene expression following 28
days of administration, relating to the study described in Example
33.
DETAILED DESCRIPTION OF THE INVENTION
[0041] The present invention provides a method of reducing lipid
levels in a subject, preferably a human subject, comprising
administration of docosapentaenoic acid (DPA). The lipids include,
but are not limited to, triglycerides, total cholesterol, low
density (LDL) lipoprotein, free fatty acids, and other lipoproteins
that are not high-density lipoprotein (non-HDL). The present
invention provides a method of increasing high-density lipoprotein
(HDL) cholesterol in a subject, preferably a human subject,
comprising administration of docosapentaenoic acid (DPA). The
methods related to fasting or fed lipid levels. Fasting lipid
levels refer to levels of the lipids in the plasma of a subject
after a fasting period, which is a period of 8 to 12 hours without
food.
[0042] In some embodiments, the baseline fasting triglyceride level
in the subject prior to administration of DPA is greater than 150
mg/dL. In some embodiments, the baseline fasting triglyceride level
is 150 mg/dL to 199 mg/dl, alternatively 200-499 mg/dL,
alternatively over 500 mg/dL.
[0043] The DPA may be administered in an orally administrable
composition comprising DPA. In some embodiments, the compositions
comprise DPA in an amount between 1% and 99% relative to the total
amount of fatty acids present in the composition, alternatively
between 1% and 95%, alternatively between 1% and 90%, alternatively
between 1% and 85%, alternatively between 1% and 80%, alternatively
between 1% and 75%, alternatively between 1% and 70%, alternatively
between 1% and 65%, alternatively between 1% and 60%, alternatively
between 1% and 55%, alternatively between 1% and 50%, alternatively
between 1% and 45%, alternatively between 1% and 40%, alternatively
between 1% and 35%, alternatively between 1% and 30%, alternatively
between 1% and 25%, alternatively between 1% and 20%, alternatively
between 1% and 15%, alternatively between 1% and 10%, alternatively
between 1% and 5%, alternatively between 2% and 99%, alternatively
between 2% and 95%, alternatively between 2% and 90%, alternatively
between 2% and 85%, alternatively between 2% and 80%, alternatively
between 2% and 75%, alternatively between 2% and 70%, alternatively
between 2% and 65%, alternatively between 2% and 60%, alternatively
between 2% and 55%, alternatively between 2% and 50%, alternatively
between 2% and 45%, alternatively between 2% and 40%, alternatively
between 2% and 35%, alternatively between 2% and 30%, alternatively
between 2% and 25%, alternatively between 2% and 20%, alternatively
between 2% and 15%, alternatively between 2% and 10%, alternatively
between 2% and 5%, alternatively between 3% and 99%, alternatively
between 3% and 95%, alternatively between 3% and 90%, alternatively
between 3% and 85%, alternatively between 3% and 80%, alternatively
between 3% and 75%, alternatively between 3% and 70%, alternatively
between 3% and 65%, alternatively between 3% and 60%, alternatively
between 3% and 55%, alternatively between 3% and 50%, alternatively
between 3% and 45%, alternatively between 3% and 40%, alternatively
between 3% and 35%, alternatively between 3% and 30%, alternatively
between 3% and 25%, alternatively between 3% and 20%, alternatively
between 3% and 15%, alternatively between 3% and 10%, alternatively
between 3% and 5%, alternatively between 4% and 99%, alternatively
between 4% and 95%, alternatively between 4% and 90%, alternatively
between 4% and 85%, alternatively between 4% and 80%, alternatively
between 4% and 75%, alternatively between 4% and 70%, alternatively
between 4% and 65%, alternatively between 4% and 60%, alternatively
between 4% and 55%, alternatively between 4% and 50%, alternatively
between 4% and 45%, alternatively between 4% and 40%, alternatively
between 4% and 35%, alternatively between 4% and 30%, alternatively
between 4% and 25%, alternatively between 4% and 20%, alternatively
between 4% and 15%, alternatively between 4% and 10%, alternatively
between 4% and 5%, alternatively between 5% and 99%, alternatively
between 5% and 95%, alternatively between 5% and 90%, alternatively
between 5% and 85%, alternatively between 5% and 80%, alternatively
between 5% and 75%, alternatively between 5% and 70%, alternatively
between 5% and 65%, alternatively between 5% and 60%, alternatively
between 5% and 55%, alternatively between 5% and 50%, alternatively
between 5% and 45%, alternatively between 5% and 40%, alternatively
between 5% and 35%, alternatively between 5% and 30%, alternatively
between 5% and 25%, alternatively between 5% and 20%, alternatively
between 5% and 15%, alternatively between 5% and 12%, alternatively
between 5% and 10%, alternatively between 6% and 99%, alternatively
between 6% and 95%, alternatively between 6% and 90%, alternatively
between 6% and 85%, alternatively between 6% and 80%, alternatively
between 6% and 75%, alternatively between 6% and 70%, alternatively
between 6% and 65%, alternatively between 6% and 60%, alternatively
between 6% and 55%, alternatively between 6% and 50%, alternatively
between 6% and 45%, alternatively between 6% and 40%, alternatively
between 6% and 35%, alternatively between 6% and 30%, alternatively
between 6% and 25%, alternatively between 6% and 20%, alternatively
between 6% and 15%, alternatively between 6% and 12%, alternatively
between 6% and 11%, alternatively between 6% and 10%, alternatively
between 7% and 99%, alternatively between 7% and 95%, alternatively
between 7% and 90%, alternatively between 7% and 85%, alternatively
between 7% and 80%, alternatively between 7% and 75%, alternatively
between 7% and 70%, alternatively between 7% and 65%, alternatively
between 7% and 60%, alternatively between 7% and 55%, alternatively
between 7% and 50%, alternatively between 7% and 45%, alternatively
between 7% and 40%, alternatively between 7% and 35%, alternatively
between 7% and 30%, alternatively between 7% and 25%, alternatively
between 7% and 20%, alternatively between 7% and 15%, alternatively
between 7% and 12%, alternatively between 7% and 11%, alternatively
between 7% and 10%, alternatively between 8% and 99%, alternatively
between 8% and 95%, alternatively between 8% and 90%, alternatively
between 8% and 85%, alternatively between 8% and 80%, alternatively
between 8% and 75%, alternatively between 8% and 70%, alternatively
between 8% and 65%, alternatively between 8% and 60%, alternatively
between 8% and 55%, alternatively between 8% and 50%, alternatively
between 8% and 45%, alternatively between 8% and 40%, alternatively
between 8% and 35%, alternatively between 8% and 30%, alternatively
between 8% and 25%, alternatively between 8% and 20%, alternatively
between 8% and 15%, alternatively between 8% and 12%, alternatively
between 9% and 95%, alternatively between 9% and 90%, alternatively
between 9% and 85%, alternatively between 9% and 80%, alternatively
between 9% and 75%, alternatively between 9% and 70%, alternatively
between 9% and 65%, alternatively between 9% and 60%, alternatively
between 9% and 55%, alternatively between 9% and 50%, alternatively
between 9% and 45%, alternatively between 9% and 40%, alternatively
between 9% and 35%, alternatively between 9% and 30%, alternatively
between 9% and 25%, alternatively between 9% and 20%, alternatively
between 9% and 15%, alternatively between 9% and 12%, relative to
the total amount of fatty acids present in the composition. In some
embodiments, the compositions comprise DPA in an amount of at least
about 45% of DPA. In some alternative embodiments, the composition
comprises at least about 4% or at least about 8% or at least about
10% or at least about 20% or at least about 45% or at least about
50% or at least about 55% or at least about 60% or at least about
65% or at least about 70% or at least about 75% or at least about
80% or at least about 85% or at least about 90% or at least about
95% of DPA. In some embodiments, the composition comprises at least
20 mg of DPA, alternatively at least 30 mg, alternatively at least
40 mg, alternatively at least 50 mg, alternatively at least 60 mg,
alternatively at least 90 mg, alternatively at least 100 mg,
alternatively at least 120 mg, alternatively at least 150 mg,
alternatively at least 200 mg, alternatively at least 300 mg,
alternatively at least 400 mg of DPA. In some embodiments, the
composition comprises DPA in a daily dosage of about 120 mg/day to
about 150 mg/day, alternatively about 150 mg/day to about 200
mg/day, alternatively about 200 mg/day to about 250 mg/day,
alternatively about 250 mg/day to about 300 mg/day, alternatively
about 300 mg/day to about 400 mg/day, alternatively about 400
mg/day to about 600 mg/day, alternatively about 600 mg/day to about
1000 mg/day.
[0044] In some embodiments, the composition comprises DPA in ester
form or in free fatty acid form.
[0045] In other embodiments, the compositions comprise
docosapentaenoic acid (DPA) in a significant or higher relative
amount as compared to docosahexaenoic acid (DHA) such that the
DPA:DHA ratio in the composition is 1:2 or greater. In some
alternative embodiments, the ratio of DPA:DHA in the composition is
at least 1:1, or at least 2:1 or at least 3:1, or at least 4:1 or
at least 5:1. The methods of treatment provides a dose of at least
20 mg DPA-N3, alternatively at least 30 mg DPA-N3, alternatively at
least 40 mg DPA-N3, alternatively at least 50 mg DPA-N3,
alternatively at least 60 mg DPA-N3 per day, alternatively at least
70 mg DPA-N3 per day, alternatively at least 75 mg DPA-N3 per day,
alternatively at least 80 mg DPA-N3 per day, alternatively at least
90 mg DPA-N3 per day, alternatively at least 100 mg DPA-N3 per day,
alternatively at least 120 mg DPA-N3 per day, alternatively at
least 150 mg DPA-N3 per day, alternatively at least 160 mg DPA-N3
per day, alternatively at least 180 mg DPA-N3 per day,
alternatively at least 200 mg DPA-N3 per day, alternatively at
least 250 mg DPA-N3 per day, alternatively at least 300 mg DPA-N3
per day, alternatively at least 350 mg DPA-N3 per day,
alternatively at least 400 mg DPA-N3 per day, alternatively at
least 500 mg DPA-N3 per day, alternatively at least 600 mg DPA-N3
per day, alternatively at least 800 mg DPA-N3 or its glycerol or
ethyl esters per day. In some embodiments, the method of treatment
provides a daily dose of at least about at least 20 mg of DPA,
alternatively at least 30 mg, alternatively at least 40 mg,
alternatively at least 50 mg, alternatively at least 60 mg,
alternatively at least 90 mg, alternatively at least 100 mg,
alternatively at least 120 mg, alternatively at least 150 mg,
alternatively at least 200 mg, alternatively at least 300 mg,
alternatively at least 350 mg, alternatively at least 400 mg of
DPA. In some embodiments, the method of treatment provides a daily
dose of at least about 1,000 mg DPA-N3 per day, alternatively at
least about 1,500 mg DPA-N3 per day, alternatively at least about
2,000 mg DPA-N3 per day, alternatively at least about 2,500 mg
DPA-N3 per day, alternatively at least about 3,000 mg DPA-N3 per
day, alternatively at least about 3,500 mg DPA-N3 per day,
alternatively at least about 3,750 mg DPA-N3 per day, alternatively
at least about 4,000 mg DPA-N3 per day, alternatively at least
about 4,250 mg DPA-N3 per day.
[0046] In some embodiments, the method of treatment provides a dose
of at least about 1 mg/kg of DPA-N3 per day, alternatively about 2
mg/kg of DPA-N3 per day, alternatively about 3 mg/kg of DPA-N3 per
day, alternatively about 4 mg/kg of DPA-N3 per day, alternatively
about 6 mg/kg of DPA-N3 per day, alternatively about 8 mg/kg of
DPA-N3 per day, alternatively about 10 mg/kg of DPA-N3 per day,
alternatively about 20 mg/kg of DPA-N3 per day, alternatively about
30 mg/kg of DPA-N3 per day, and alternatively about 40 mg/kg
alternatively about 50 mg/kg of DPA-N3 per day, alternatively about
75 mg/kg of DPA-N3 per day, and alternatively about 100 mg/kg.
[0047] The present invention provides an administrable composition
comprising fatty acids, wherein at least 50% by weight of the fatty
acids comprise omega-3-fatty acids, salts, esters, or derivatives
thereof, wherein the omega-3 fatty acids comprise eicosapentaenoic
acid (EPA; C20:5-n3), docosapentaenoic acid (DPA; C22:5-n3), and
docosahexaenoic acid (DHA; C22:6-n3), wherein the ratio of DHA to
EPA (DHA:EPA) is less than 1:20, and wherein the ratio of DHA to
DPA (DHA:DPA) is less than 2:1.
[0048] In some embodiments, the compositions of the present
invention comprise at least 50% omega-3 fatty acids, alternatively
at least 55%, alternatively at least 60%, alternatively at least
65%, alternatively at least 70%, alternatively at least 75%,
alternatively at least 80%, alternatively at least 85%,
alternatively at least 95%, most preferably at least 90% omega-3
fatty acids of the total amount of fatty acids.
[0049] In other embodiments, EPA and DPA are jointly present in the
compositions of the present invention at between about 55% and
about 100% of total fatty acids, alternatively between about 60%
and about 100%, alternatively between about 65% and about 100%,
alternatively between about 70% and about 100%, alternatively
between about 75% and about 100%, alternatively between about 80%
and about 100%, alternatively between about 85% and about 95%,
alternatively about 85% to about 100%, alternatively between about
85% and about 97%, alternatively between about 88% and about 95%,
alternatively between about 88% and about 97%, alternatively about
88% to about 100%, alternatively between about 90% and about 95%,
alternatively between about 90% and about 97%, alternatively about
90% to about 100%, alternatively about 95% to about 100%,
alternatively about 97% to about 100% of the total amount of fatty
acids.
[0050] The fatty acids, such as EPA and DPA, may be present in free
fatty acid form, or as a salt, ester, or derivative. The fatty
acids are preferably composed as a triglyceride, an ester (such as
an ethyl ester) or free fatty acid. Other forms of the fatty acids
which may be useful include salts, esters of any type, amides,
mono-, di- or triglycerides, phospholipids or any other form which
can lead to metabolization of the fatty acids (such as EPA and/or
DPA), or the incorporation of the fatty acids (such as EPA and/or
DPA) into body fluids, tissues or organs.
[0051] In some embodiments, the compositions of the present
invention comprise at least 0.01% HPA of total fatty acids in the
composition, alternatively at least 0.05% HPA, alternatively at
least 0.10% HPA, alternatively at least 0.15% HPA, alternatively at
least 0.2% HPA, alternatively at least 0.3% HPA, alternatively at
least 0.4% HPA, alternatively at least 0.5% HPA, alternatively at
least 0.75% HPA, alternatively at least 1% HPA, alternatively at
least 1.5% HPA, alternatively at least 2% HPA, alternatively at
least 2.5% HPA, alternatively at least 3% HPA, alternatively at
least 3.5% HPA, alternatively at least 4% HPA, alternatively at
least 4.5% HPA, alternatively at least 5% HPA, alternatively at
least 6% HPA, alternatively at least 7% HPA, alternatively the
compositions of the present invention comprise at least 9% HPA of
total fatty acids in the composition.
[0052] In some embodiments, the compositions of the present
invention comprise no more than 20% HPA of total fatty acids in the
composition, alternatively no more than 15% HPA, alternatively no
more than 12% HPA, alternatively no more than 10% HPA,
alternatively no more than 8% HPA, alternatively no more than 7%
HPA, alternatively no more than 6% HPA, alternatively no more than
5% HPA, alternatively no more than 4% HPA, alternatively no more
than 3% HPA, alternatively no more than 2% HPA, alternatively no
more than 1.5% HPA, alternatively the compositions of the present
invention comprise at least 1% HPA of total fatty acids in the
composition. In some embodiments, the compositions of the present
invention comprise 1% to 20% of the total fatty acids in the
composition.
[0053] In the embodiments of the present invention, the
compositions comprise EPA and DPA in an EPA:DPA ratio between 99:1
and 1:99 EPA:DPA, alternatively between 90:1 and 1:90,
alternatively between 60:1 and 1:60, alternatively between 60:1 and
1:20, alternatively between 60:1 and 1:4, alternatively between
40:1 and 1:20, alternatively between 30:1 and 1:20, alternatively
between 30:1 and 1:10, alternatively between 30:1 and 1:5,
alternatively between 40:1 and 1:4, alternatively between 30:1 and
1:4, alternatively between 30:1 and 1:2, alternatively between 30:1
and 1:1, alternatively between 30:1 and 2:1, alternatively between
30:1 and 5:1, alternatively between 20:1 and 1:20, alternatively
between 20:1 and 1:10, alternatively between 20:1 and 1:5,
alternatively between 20:1 and 1:2, alternatively between 20:1 and
1:1, alternatively between 20:1 and 2:1, alternatively between 20:1
and 5:1, alternatively between 20:1 and 10:1, alternatively between
20:1 and 10:1, alternatively between 30:1 and 10:1, alternatively
between 60:1 and 10:1, alternatively comprise EPA and DPA in an
EPA:DPA ratio between 40:1 and 10:1. In some embodiments, the ratio
of EPA:DPA is greater than 1:1, preferably greater than 2:1, and
more preferably greater than 5:1. In some embodiments, the ratio of
EPA:DPA is 1:1 to 25:1, preferably 5:1 to 20:1, more preferably 8:1
to 15:1, even more preferably 9:1 to 13:1, even more most
preferably about 10:1 to 11:1, and most preferably about 10:1.
[0054] In some embodiments, a relatively small amount of DHA
relative to the total amount of fatty acids present in the
composition is present. In some embodiments, the compositions of
the present invention comprise no more than about 30% DHA,
alternatively no more than about 20% DHA, alternatively no more
than about 15% DHA, alternatively no more than about 12% DHA,
alternatively no more than about 10% DHA, alternatively no more
than about 8% DHA, alternatively no more than about 7% DHA,
alternatively no more than about 6% DHA, alternatively no more than
about 5% DHA, alternatively no more than about 4% DHA,
alternatively no more than about 3% DHA, alternatively no more than
about 2% DHA, alternatively no more than about 1% DHA relative to
the total amount of fatty acids present in the composition.
[0055] In some embodiments, the ratio of DPA:HPA is about 250:1 to
1:1, alternatively 200:1 to 2:1, alternatively 150:1 to 3:1,
alternatively 100:1 to 4:1, alternatively 50:1 to 5:1,
alternatively 25:1 to 6:1, and alternatively 10:1 to 7:1. In some
preferred embodiments, the ratio of DPA:HPA is about 8:1. In some
embodiments, the ratio of DPA:HPA is about 3:0.
[0056] In other embodiments, a relatively small amount of DHA as
compared to DPA is present. In these embodiments, the compositions
of the present invention comprise no more than 15:1 of DHA:DPA,
alternatively no more than 12:1 of DHA:DPA, alternatively no more
than 10:1 of DHA:DPA, alternatively no more than 8:1 of DHA:DPA,
alternatively no more than 5:1 of DHA:DPA, alternatively no more
than 3:1 of DHA:DPA, alternatively no more than 2:1 of DHA:DPA,
alternatively no more than 1:1 of DHA:DPA, alternatively no more
than 1:2 of DHA:DPA, alternatively no more than 1:3 of DHA:DPA,
alternatively no more than 1:4 of DHA:DPA, alternatively no more
than 1:5 of DHA:DPA, alternatively no more than 1:6 of DHA:DPA,
alternatively no more than 1:7 of DHA:DPA, alternatively no more
than 1:8 of DHA:DPA, alternatively no more than 1:10 of DHA:DPA,
alternatively no more than 1:12 of DHA:DPA, alternatively no more
than 1:15 of DHA:DPA, alternatively no more than 1:20 of DHA:DPA,
alternatively no more than 1:25 of DHA:DPA, alternatively no more
than 1:50 of DHA:DPA, alternatively no more than 1:75 of DHA:DPA,
alternatively no more than 1:90 of DHA:DPA, alternatively no more
than 1:95 of DHA:DPA, alternatively no more than 1:100 of DHA:DPA.
In some embodiments, the ratio of DHA:DPA is preferably less than
2:1.
[0057] In yet other embodiments, the compositions of the present
invention comprise no more than 10% omega-6 fatty acids relative to
the total amount of fatty acids, alternatively no more than 9%,
alternatively no more than 8%, alternatively no more than 7%,
alternatively no more than 6%, alternatively no more than 5%,
alternatively no more than 4.5%, alternatively no more than 4%,
alternatively no more than 3.5%, alternatively no more than 3%,
alternatively no more than 2.5%, alternatively no more than 2%,
alternatively no more than 1.7%, alternatively no more than 1.5%,
alternatively no more than 1.2%, alternatively no more than 1%,
alternatively no more than 0.5% omega-6 fatty acids versus the
total amount of fatty acids comprised by the compositions of the
present invention.
[0058] Omega-6 fatty acids include, but are not limited to:
linoleic acid (LA; C18:2-n6); gamma-linoleic acid (GLA; C18:3-n6);
eicosadienoic acid (C20:2-n6); dihomo-gamma-linoleic acid (DGLA;
C20:3-n6); arachidonic acid (ARA; C20:4-n6); and omega-6
docosapentaenoic acid (DPA; C22:5-n6).
[0059] In further embodiments, the compositions of the present
invention comprise no more than 10% omega-6 fatty acids relative to
the total amount of omega-3 fatty acids plus omega-6 fatty acids,
alternatively no more than 9%, alternatively no more than 8%,
alternatively no more than 7%, alternatively no more than 6%,
alternatively no more than 5%, alternatively no more than 4.5%,
alternatively no more than 4%, alternatively no more than 3.5%,
alternatively no more than 3%, alternatively no more than 2.5%,
alternatively no more than 2%, alternatively no more than 1.7%,
alternatively no more than 1.5%, alternatively no more than 1.2%,
alternatively no more than 1%, alternatively no more than 0.5%
omega-6 fatty acids versus the total amount of omega-3 fatty acids
plus omega-6 fatty acids comprised by the compositions of the
present invention.
[0060] In yet other embodiments, the compositions of the present
invention comprise no more than 8% arachidonic acid (ARA; C20:4-n6)
relative to the total amount of omega-3 fatty acids plus omega-6
fatty acids, alternatively no more than 7%, alternatively no more
than 6%, alternatively no more than 5%, alternatively no more than
4.5%, alternatively no more than 4%, alternatively no more than
3.5%, alternatively no more than 3%, alternatively no more than
2.5%, alternatively no more than 2%, alternatively no more than
1.7%, alternatively no more than 1.5%, alternatively no more than
1.2%, alternatively no more than 1%, alternatively no more than
0.5% arachidonic acid (ARA; C20:4-n6) versus the total amount of
omega-3 fatty acids plus omega-6 fatty acids comprised by the
compositions of the present invention.
[0061] In some embodiments, a relatively small amount of omega-3
fatty acids in aggregate other than EPA, ETA, HPA and DPA
(alternatively indicated as non-EPA, non-ETA, non-HPA and non-DPA
omega-3 fatty acids in aggregate) relative to the total amount of
fatty acids present in the composition is present. In some
embodiments, the compositions of the present invention comprise no
more than 20% non-EPA, non-ETA, non-HPA and non-DPA omega-3 fatty
acids, alternatively no more than 15% non-EPA, non-ETA, non-HPA and
non-DPA omega-3 fatty acids, alternatively no more than 12%
non-EPA, non-ETA, non-HPA and non-DPA omega-3 fatty acids,
alternatively no more than 10% non-EPA, non-ETA, non-HPA and
non-DPA omega-3 fatty acids, alternatively no more than 8% non-EPA,
non-ETA, non-HPA and non-DPA omega-3 fatty acids, alternatively no
more than 7% non-EPA, non-ETA, non-HPA and non-DPA omega-3 fatty
acids, alternatively no more than 6% non-EPA, non-ETA, non-HPA and
non-DPA omega-3 fatty acids, alternatively no more than 5% non-EPA,
non-ETA, non-HPA and non-DPA omega-3 fatty acids, alternatively no
more than 4% non-EPA, non-ETA, non-HPA and non-DPA omega-3 fatty
acids, alternatively no more than 3% non-EPA, non-ETA, non-HPA and
non-DPA omega-3 fatty acids, alternatively no more than 2% non-EPA,
non-ETA, non-HPA and non-DPA omega-3 fatty acids, alternatively no
more than 1% non-EPA, non-ETA, non-HPA and non-DPA omega-3 fatty
acids in aggregate relative to the total amount of fatty acids
present in the composition.
[0062] In some embodiments, a relatively small amount of the sum of
ALA, SDA and DHA relative to the total amount of fatty acids
present in the composition is present, while at the same time large
amounts of the sum of EPA, DPA-n3, HPA and ETA are present. In some
embodiments, the compositions of the present invention comprise no
more than 20% of the sum of ALA, SDA and DHA, alternatively no more
than 15% of the sum of ALA, SDA and DHA, alternatively no more than
12% of the sum of ALA, SDA and DHA, alternatively no more than 10%
of the sum of ALA, SDA and DHA, alternatively no more than 8% of
the sum of ALA, SDA and DHA, alternatively no more than 7% of the
sum of ALA, SDA and DHA, alternatively no more than 6% of the sum
of ALA, SDA and DHA, alternatively no more than 5% of the sum of
ALA, SDA and DHA, alternatively no more than 4% of the sum of ALA,
SDA and DHA, alternatively no more than 3% of the sum of ALA, SDA
and DHA, alternatively no more than 2% of the sum of ALA, SDA and
DHA, alternatively no more than 1% of the sum of ALA, SDA and DHA
relative to the total amount of fatty acids present in the
composition, while at the same time contain more than 40% the sum
of EPA, DPAn-3, HPA and ETA, alternatively more than 50% the sum of
EPA, DPAn-3, HPA and ETA, alternatively more than 60% the sum of
EPA, DPAn-3, HPA and ETA, alternatively more than 70% the sum of
EPA, DPAn-3, HPA and ETA, alternatively more than 75% the sum of
EPA, DPAn-3, HPA and ETA, alternatively more than 80% the sum of
EPA, DPAn-3, HPA and ETA, alternatively more than 85% the sum of
EPA, DPAn-3, HPA and ETA, alternatively more than 90% the sum of
EPA, DPAn-3, HPA and ETA, alternatively more than 95% the sum of
EPA, DPAn-3, HPA and ETA, alternatively between 80% and 98% the sum
of EPA, DPAn-3, HPA and ETA, alternatively between 80% and 96% the
sum of EPA, DPAn-3, HPA and ETA, alternatively between 85% and 98%
the sum of EPA, DPAn-3, HPA and ETA, alternatively between 85% and
96% the sum of EPA, DPAn-3, HPA and ETA, alternatively between 90%
and 98% the sum of EPA, DPAn-3, HPA and ETA, alternatively between
90% and 97% the sum of EPA, DPAn-3, HPA and ETA, alternatively
between 90% and 96% the sum of EPA, DPAn-3, HPA and ETA,
alternatively between 90% and 95% the sum of EPA, DPAn-3, HPA and
ETA, relative to the total amount of fatty acids present in the
composition is present.
[0063] In further embodiments, the compositions of the present
invention comprise no more than 8% arachidonic acid (ARA; C20:4-n6)
relative to the total amount of fatty acids, alternatively no more
than 7%, alternatively no more than 6%, alternatively no more than
5%, alternatively no more than 4.5%, alternatively no more than 4%,
alternatively no more than 3.5%, alternatively no more than 3%,
alternatively no more than 2.5%, alternatively no more than 2%,
alternatively no more than 1.7%, alternatively no more than 1.5%,
alternatively no more than 1.2%, alternatively no more than 1%,
alternatively no more than 0.5% arachidonic acid (ARA; C20:4-n6)
relative the total amount of fatty acids comprised by the
compositions of the present invention.
[0064] In other embodiments, the compositions of the present
invention comprise no more than 2.5% arachidonic acid (ARA;
C20:4-n6), no more than 0.4% omega-6-docosapentaenoic acid (DPA;
C22:5-n6) and no more than 0.2% gamma-linoleic acid (GLA; C18:3-n6)
relative the total amount of fatty acids comprised by the
compositions of the present invention.
[0065] Further embodiments provide fatty acid compositions
comprising no more than 2.5% arachidonic acid (ARA; C20:4-n6), no
more than 0.3% omega-6 docosapentaenoic acid (DPA; C22:5-n6) and no
more than 0.1% gamma-linoleic acid (GLA; C18:3-n6) relative the
total amount of fatty acids comprised by the compositions of the
present invention.
[0066] In yet other embodiments, the active ingredient of the
formulations of the present invention consists essentially wholly
of the EPA and DPA or precursors thereof (ethyl ester,
triglyceride, or any other pharmaceutically acceptable salt or
derivative thereof). In that case, no large amounts (preferably
less than 15%, alternatively less than 12%, alternatively less than
10%, alternatively less than 9%, alternatively less than 8%,
alternatively less than 7%, alternatively less than 6%,
alternatively less than 5%, alternatively less than 4%,
alternatively less than 3%, alternatively less than 2%,
alternatively less than 1%, alternatively less than 0.5%,
alternatively less than 0.25%) of any other fatty acids are
present.
[0067] The fatty acid percentage is determined on a weight/weight,
mol/mol, or chromatography area percent basis relative to all fatty
acids present in the composition as determined by methods such as
disclosed in the European Pharmacopeia monograph for omega-3 fatty
acid concentrates, European Pharmacopeia monograph for omega-3-acid
ethyl esters 90%, or European Pharmacopeia monograph method 2.4.29,
USP monograph for fish oil dietary supplements, USP 35 omega-3-acid
ethyl esters (LOVAZA.RTM.) monograph, or any essentially equivalent
methods (whether by gas chromatography, HPLC, FPLC or any other
chromatographic method).
[0068] In some embodiments, the fatty acid percentage is determined
not as a percentage of all fatty acids present in the composition
but as a specific type of fatty acid ethyl esters as percentage of
all fatty acid ethyl esters present in the composition, thus
excluding from the fatty acid percentage determination such fatty
acids present as, for instance: free fatty acids; mono-, di-, and
tri-glycerides; or fatty acids present in phospholipids (such as
phosphatidylserine or phosphatidylcholine) or polysorbates (such as
Tween 80, Tween 20, or polysorbate 40).
[0069] In other embodiments, the fatty acid percentage is
determined not as a percentage of all fatty acids present in the
composition but as a specific type of free fatty acid as percentage
of all free fatty acids present in the composition, thus excluding
from the fatty acid percentage determination such fatty acids
present as, for instance: fatty acid ethyl esters; mono-, di-, and
tri-glycerides; or fatty acids present in phospholipids (such as
phosphatidylserine or phosphatidylcholine) or polysorbates (such as
Tween 80, Tween 20, or polysorbate 40).
[0070] In yet other embodiments, the fatty acid percentage is
determined not as a percentage of all fatty acids present in the
composition but as a specific type of glycerol fatty acid ester as
percentage of all glycerol fatty acid esters present in the
composition, thus excluding from the fatty acid percentage
determination such fatty acids present as, for instance: fatty acid
ethyl esters; free fatty acids; or fatty acids present in
phospholipids (such as phosphatidylserine or phosphatidylcholine)
or polysorbates (such as Tween 80, Tween 20, or polysorbate
40).
[0071] In further embodiments, the fatty acid percentage is
determined not as a percentage of all fatty acids present in the
composition but as di- or tri-fatty acid esters with glycerol as
percentage of all glycerol di- and tri-fatty acid esters present in
the composition, thus excluding from the fatty acid percentage
determination such fatty acids present as, for instance:
glycerol-mono-fatty acid esters; fatty acid ethyl esters; free
fatty acids; or fatty acids present in phospholipids (such as
phosphatidylserine or phosphatidylcholine) or polysorbates (such as
Tween 80, Tween 20, or polysorbate 40).
[0072] In yet other embodiments, the fatty acid percentage is
determined not as a percentage of all fatty acids present in the
composition but as a tri-fatty acid esters with glycerol as
percentage of all glycerol tri-fatty acid esters present in the
composition, thus excluding from the fatty acid percentage
determination such fatty acids present as, for instance: mono- and
di-fatty acid esters of glycerol; fatty acid ethyl esters; free
fatty acids; or fatty acids present in phospholipids (such as
phosphatidylserine or phosphatidylcholine) or polysorbates (such as
Tween 80, Tween 20, or polysorbate 40).
[0073] The EPA, HPA, DPA, or omega-3-pentaenoic acids may be
derived from any appropriate source including plant seed oils,
microbial oils from algae or fungal or marine oils from fish or
other marine animals. Certain species are a particular good source
of oils containing DPA, for example seal oil. They may be used in
the form of the natural oil, if that oil meets the required purity
requirements of the present invention, or may be purified to give
products containing the fatty acid composition of the present
invention.
[0074] The compositions of the present invention may be produced
through a range of the methods. Such methods may include:
distillation, including short path distillation; urea
precipitation; enzymatic conversion concentration; conventional
chromatography; HPLC/FPLC; supercritical carbondioxide extraction;
supercritical carbondioxide chromatography; simulated moving bed
chromatography; supercritical carbondioxide simulated moving bed
chromatography; or chemical conversion methods such as
iodolactonization. Such methods are generally known to those
skilled in the art of purifying and isolating omega-3 fatty
acids.
[0075] Typically, the omega-3 fatty acid concentration/purification
process is initiated by esterifying the fatty acids comprised by
the marine oil raw material (such as crude fish oil) with ethanol
(to form fatty acid ethyl esters) in order to separate omega-3
fatty acids from other fatty acids covalently bound together in the
natural triglyceride molecules of the source oil. Subsequently, the
material may be distilled once or several times to achieve
omega-3-acid ethyl ester concentrations above 60%-70%.
Alternatively, enzymatic concentration, urea precipitation or
supercritical extraction may be used alone or in conjunction with
distillation to reach omega-3 levels above 70%-90%. In order to
prepare a highly pure concentrate of a single omega-3 fatty acid,
methods such as chromatography, supercritical chromatography,
simulated moving bed chromatography, supercritical simulated moving
bed chromatography, or chemical conversion methods such as
iodolactonization are typically most practical to reach levels
above 50%, alternatively above 60%, alternatively above 70%,
alternatively above 80%, alternatively above 90%, alternatively
above 95%, of a single omega-3 fatty acid such as ETA, EPA, HPA,
DPA, TPA, or DHA.
[0076] Those skilled in the art will be able to design processes
suited to prepare a certain omega-3 fatty acid composition as
desired, based on the methods described above. Such processes are
flexible enough to affect the relative proportions between the long
chain C18, C20, C21 and C22 fatty acids which occur naturally in
available fish oil raw materials and other marine oils. It provides
not only for the concentration of the individual omega-3 fatty
acids, but the ratio between them will remain within a pattern of
variation caused by variations in nature. However, suitable methods
compensate for sometimes extreme variations which may occur
naturally. Thus, for those skilled in the art, it will be possible
to make a product with a constant and predetermined
composition.
[0077] EPA is relatively abundant in fish oils or other marine oils
and can be relatively easy obtained through the application of
concentration and purification technologies from such fish or
marine oils. DPA and HPA are present at much lower concentrations.
In order to prepare the compositions of the present invention, DPA
or HPA may be concentrated and purified from fish or other marine
oils according to the methods referred to above, either alone or
DPA combined with EPA and/or HPA. Alternatively, the DPA or HPA may
be chemically prepared from a high purity EPA concentrate by
elongation of the EPA fatty-acid chain with two or one
hydrogen-saturated carbons (C2-elongation or C1-elongation) on the
carboxyl side of the molecule (for instance with a method similar
to or alternate methods with equivalent results such as described
by Kuklev D V and Smith W L in Chem Phys Lipids, 2006; 144(2):
172-177). In another alternative approach, a high purity EPA
concentrate may be partially converted to DPA (or HPA) using a
method for C2-elongation (or C1-elongation) of EPA similar to those
described above, thus directly yielding compositions of the present
invention or intermediates therefore.
[0078] Once the oils containing one or more of the desired fatty
acids have been obtained, and purified as necessary, these oils may
be blended to give the desirable relative amounts of EPA, DPA, HPA,
DHA, TPA, other omega-3 fatty acids and omega-6 fatty acids to
obtain the compositions of the present invention described in
detail above.
[0079] Fish oils may also contain by-products and contaminants such
as pesticides, chlorinated or brominated hydrocarbons, heavy
metals, cholesterol and vitamins. During the production of the
concentrate, the concentrations of these components are
significantly reduced compared to untreated fish oils. Such
reduction is inherent due to the nature of purification methods and
their ability to concentrate of several or specific omega-3 fatty
acids, thus removing other compounds.
[0080] Triglycerides comprising more than 60% of the omega-3 fatty
acids in the composition may be produced from ethyl esters and
glycerol by well known, published, or alternative chemical
synthetic or enzymatic procedures. The free acids may be produced
from ethyl esters by well known hydrolization or saponification
procedures. Methods for converting ethyl esters to triglycerides,
free fatty acids, and other molecular forms comprising fatty acids,
are generally known to those skilled in the art chemically or
enzymatically converting omega-3 fatty acids from one form to
another.
[0081] The compositions of the present invention may be used for
the treatment of patients by administering an effective amount of
such compositions to a subject in need thereof, such as a subject
prone to or afflicted with a disease or condition or in need of
treatment for a disease or condition. The present invention
provides methods of treating, preventing, and reducing symptoms
associated with a disease or condition comprising administration of
a composition of the present invention. Exemplary diseases or
conditions include, but are not limited to: hypertriglyceridemia
(for example, by those skilled in the art typically established by
assessing fasting triglyceride (TG) levels); hypertriglyceridemia
with TG.gtoreq.500 mg/dL (VHTG); hypertriglyceridemia with TG
200-499 mg/dL; hypertriglyceridemia with TG 200-499 mg/dL while on
statin treatment (HTG); hypercholesterolemia; mixed dyslipidemia;
coronary heart disease (CHD); vascular disease; atherosclerotic
disease and related conditions; heart failure; cardiac arrhythmias;
blood coagulatory conditions associated with cardiac arrhythmias;
hypertension; coagulation related disorders, including
post-surgical deep vein thrombosis or other high risk thrombosis
conditions; nephropathy; kidney or urinary tract disease;
retinopathy; cognitive, psychiatric, neurological and other CNS
disorders, including but not limited to schizophrenia, depression,
bipolar disorder and any form of dementia (including ischemic
dementia and vascular dementia); autoimmune diseases; inflammatory
diseases; asthma, COPD or other respiratory disease; dermatological
disease; metabolic syndrome; diabetes or other forms of metabolic
disease; liver diseases including fatty liver disease; diseases
affecting the senses, including those affecting vision and hearing;
diseases of the gastrointestinal tract; diseases of the male or
female reproductive system or related secondary sexual organs; a
cancer of any type, including lymphomas, myelomas and solid tumor
cancers; any infections caused by a virus, bacterium, fungus,
protozoa or other organism. The present invention also provides for
the treatment and/or prevention of cardiac events and/or
cardiovascular events and/or vascular events and/or symptoms. The
present invention also provides for the reduction of number of such
events, as well as a reduction or amelioration of symptoms
associated with such events.
[0082] Cardiovascular and/or cardiac events may include, but are
not limited to: myocardial infarction, ischemic cardiac attack,
ischemic attack, acute angina, hospitalization due to acute angina,
stroke, transient ischemic cerebral attack, cardiac
revascularization, cardiac revascularization with stent placement,
carotid artery revascularization, carotid artery revascularization
with stent placement, peripheral artery revascularization,
peripheral artery revascularization with stent placement, plaque
rupture, death due to cardiovascular event, and hospitalization due
to cardiovascular event. Cardiovascular and/or cardiac events may
also include other events deemed to fall in such category by those
skilled in the art.
[0083] The present invention provides methods of treatment for
hypertriglyceridemia (either TG.gtoreq.500 mg/dL, TG.gtoreq.200
mg/dL, TG.gtoreq.150 mg/dL, TG200-499 mg/dL, TG300-499 mg/dL,
TG350-499 mg/dL, or TG150-199 mg/dL), mixed dyslipidemia, or any
other diseases or medical conditions as specified above, by dosing
to a subject in need thereof omega-3 docosapentaenoic acid (DPA-n3)
or its glycerol or ethyl esters. The present invention also
provides for a method for reducing fasting lipid parameters, such
as triglycerides, low-density lipoprotein (LDL) cholesterol, total
cholesterol, non-HDL cholesterol, free fatty acids, and total
non-high-lipoprotein cholesterol (non-HDL) cholesterol. The present
invention also provides method for increasing high-lipoprotein
(HDL) cholesterol levels. The methods of treatment provides a dose
of at least 60 mg DPA-N3 per day, alternatively at least 80 mg
DPA-N3 per day, alternatively at least 90 mg DPA-N3 per day,
alternatively at least 100 mg DPA-N3 per day, alternatively at
least 120 mg DPA-N3 per day, alternatively at least 150 mg DPA-N3
per day, alternatively at least 160 mg DPA-N3 per day,
alternatively at least 180 mg DPA-N3 per day, alternatively at
least 200 mg DPA-N3 per day, alternatively at least 250 mg DPA-N3
per day, alternatively at least 300 mg DPA-N3 per day,
alternatively at least 350 mg DPA-N3 per day, alternatively at
least 400 mg DPA-N3 per day, alternatively at least 500 mg DPA-N3
per day, alternatively at least 600 mg DPA-N3 per day,
alternatively at least 800 mg DPA-N3 or its glycerol or ethyl
esters per day. In some embodiments, the method of treatment
provides a dose of at least about 1,000 mg DPA-N3 per day,
alternatively at least about 1,500 mg DPA-N3 per day, alternatively
at least about 2,000 mg DPA-N3 per day, alternatively at least
about 2,500 mg DPA-N3 per day, alternatively at least about 3,000
mg DPA-N3 per day, alternatively at least about 3,500 mg DPA-N3 per
day, alternatively at least about 3,750 mg DPA-N3 per day,
alternatively at least about 4,000 mg DPA-N3 per day, alternatively
at least about 4,250 mg DPA-N3 per day.
[0084] In other embodiments, the compositions comprise
docosapentaenoic acid (DPA) in a significant or higher relative
amount as compared to docosahexaenoic acid (DHA) such that the
DPA:DHA ratio in the composition is 1:2 or greater. In some
alternative embodiments, the ratio of DPA:DHA in the composition is
at least 1:1, or at least 2:1 or at least 3:1, or at least 4:1 or
at least 5:1.
[0085] In some embodiments, the method of treatment provides a dose
of at least about 1 mg/kg of DPA-N3 per day, alternatively about 2
mg/kg of DPA-N3 per day, alternatively about 3 mg/kg of DPA-N3 per
day, alternatively about 4 mg/kg of DPA-N3 per day, alternatively
about 6 mg/kg of DPA-N3 per day, alternatively about 8 mg/kg of
DPA-N3 per day, alternatively about 10 mg/kg of DPA-N3 per day,
alternatively about 20 mg/kg of DPA-N3 per day, alternatively about
30 mg/kg of DPA-N3 per day, and alternatively about 40 mg/kg
alternatively about 50 mg/kg of DPA-N3 per day, alternatively about
75 mg/kg of DPA-N3 per day, and alternatively about 100 mg/kg.
[0086] In some embodiments, the compositions of the present
invention, which may comprise significant amounts of omega-3
docosapentaenoic acid (DPA-n3) or its glycerol or ethyl esters, may
be used for the treatment of hypertriglyceridemia (either
TG.gtoreq.500 mg/dL, TG.gtoreq.200 mg/dL, TG.gtoreq.150 mg/dL,
TG200-499 mg/dL, TG300-499 mg/dL, TG350-499 mg/dL, or TG150-199
mg/dL), mixed dyslipidemia, or any other diseases or medical
conditions specified above. Such method of treatment provides to a
subject in need thereof a dose of at least 20 mg DPA-N3 per day,
alternatively at least 25 mg DPA-N3 per day, alternatively at least
30 mg DPA-N3 per day, alternatively at least 40 mg DPA-N3 per day,
alternatively at least 50 mg DPA-N3 per day, alternatively at least
60 mg DPA-N3 per day, alternatively at least 70 mg DPA-N3 per day,
alternatively at least 80 mg DPA-N3 per day, alternatively at least
90 mg DPA-N3 per day, alternatively at least 100 mg DPA-N3 per day,
alternatively at least 120 mg DPA-N3 per day, alternatively at
least 150 mg DPA-N3 per day, alternatively at least 160 mg DPA-N3
per day, alternatively at least 180 mg DPA-N3 per day,
alternatively at least 200 mg DPA-N3 per day, alternatively at
least 250 mg DPA-N3 per day, alternatively at least 300 mg DPA-N3
per day, alternatively at least 350 mg DPA-N3 per day,
alternatively at least 400 mg DPA-N3 per day, alternatively at
least 500 mg DPA-N3 per day, alternatively at least 600 mg DPA-N3
per day, alternatively at least 800 mg DPA-N3 or its glycerol or
ethyl esters per day. In some embodiments, the methods of the
present invention relate to decreasing plasma lipid parameters in a
subject in need thereof. The lipid parameters may be measured in a
fasting state or a fed state. In some embodiments, the methods
comprise administration of DPA in the free fatty acid form or an
ester form. In some embodiments, the methods comprise a reduction
in triglyceride levels of at least 10%, alternatively at least 15%,
alternatively at least 20%, alternatively at least 25%,
alternatively at least 30%, alternatively at least 35%,
alternatively at least 40%, alternatively at least 45%, and
alternatively at least 50% compared to baseline. In some
embodiments, the methods comprise a reduction in total cholesterol
levels of at least 1%, alternatively at least 2%, alternatively at
least 3%, alternatively at least 4%, alternatively at least 5%,
alternatively at least 6%, alternatively at least 7%, alternatively
at least 8%, alternatively at least 9%, alternatively at least 10%
compared to baseline. In some embodiments, the methods comprise a
reduction in low-density lipoprotein (LDL) levels of at least 10%,
alternatively at least 15%, alternatively at least 20%,
alternatively at least 25%, alternatively at least 30%,
alternatively at least 35%, alternatively at least 40%,
alternatively at least 45%, and alternatively at least 50% compared
to baseline. In some embodiments, the methods comprise a reduction
in free fatty acid levels of at least 5%, alternatively at least
7%, alternatively at least 10%, alternatively at least 15%,
alternatively at least 20% compared to baseline. In some
embodiments, the methods comprise a reduction in non-HDL
cholesterol levels of at least 1%, alternatively at least 2%,
alternatively at least 3%, alternatively at least 4%, alternatively
at least 5%, alternatively at least 6%, alternatively at least 7%,
alternatively at least 8%, alternatively at least 9%, alternatively
at least 10% compared to baseline. In some embodiments, the methods
comprise an increase in high density lipoprotein (HDL) cholesterol
levels of at least 1%, alternatively at least 2%, alternatively at
least 3%, alternatively at least 4%, alternatively at least 5%,
alternatively at least 6%, alternatively at least 7%, alternatively
at least 8%, alternatively at least 9%, alternatively at least 10%
compared to baseline. In some embodiments, this change in lipid
parameters can be achieved after a period of daily administration,
such as one week, alternatively one month, alternatively two
months, alternatively three months or more.
[0087] In other embodiments, the compositions of the present
invention, which may comprise significant amounts of omega-3
docosapentaenoic acid (DPA-n3) or its glycerol or ethyl esters and
which comprise relatively small amounts of omega-3 docosahexaenoic
acid (DHA-n3), may be used for the treatment of
hypertriglyceridemia (either TG.gtoreq.500 mg/dL, TG.gtoreq.200
mg/dL, TG.gtoreq.150 mg/dL, TG200-499 mg/dL, TG300-499 mg/dL,
TG350-499 mg/dL, or TG150-199 mg/dL), mixed dyslipidemia, or any
other diseases or medical conditions specified above. Such method
of treatment provides to a subject in need thereof a dose of at
least 20 mg DPA-N3 per day, alternatively at least 25 mg DPA-N3 per
day, alternatively at least 30 mg DPA-N3 per day, alternatively at
least 40 mg DPA-N3 per day, alternatively at least 50 mg DPA-N3 per
day, alternatively at least 60 mg DPA-N3 per day, alternatively at
least 80 mg DPA-N3 per day, alternatively at least 90 mg DPA-N3 per
day, alternatively at least 120 mg DPA-N3 per day, alternatively at
least 150 mg DPA-N3 per day, alternatively at least 160 mg DPA-N3
per day, alternatively at least 180 mg DPA-N3 per day,
alternatively at least 200 mg DPA-N3 per day, alternatively at
least 250 mg DPA-N3 per day, alternatively at least 300 mg DPA-N3
per day, alternatively at least 350 mg DPA-N3 per day,
alternatively at least 400 mg DPA-N3 per day, alternatively at
least 500 mg DPA-N3 per day, alternatively at least 600 mg DPA-N3
per day, alternatively at least 800 mg DPA-N3 or its glycerol or
ethyl esters per day, while providing less than 1500 mg of DHA,
alternatively less than 1200 mg of DHA, alternatively less than
1000 mg of DHA, alternatively less than 800 mg of DHA,
alternatively less than 700 mg of DHA, alternatively less than 600
mg of DHA, alternatively less than 500 mg of DHA, alternatively
less than 400 mg of DHA, alternatively less than 350 mg of DHA,
alternatively less than 300 mg of DHA, alternatively less than 250
mg of DHA, alternatively less than 200 mg of DHA alternatively less
than 150 mg of DHA, alternatively less than 120 mg of DHA,
alternatively less than 100 mg of DHA, alternatively less than 80
mg of DHA, alternatively less than 60 mg of DHA, alternatively less
than 40 mg of DHA, alternatively less than 30 mg of DHA,
alternatively less than 25 mg of DHA, alternatively less than 20 mg
of DHA or its glycerol or ethyl esters per day. In further
embodiments, the compositions of the present invention, which may
comprise significant amounts of omega-3 docosapentaenoic acid
(DPA-n3) or its glycerol or ethyl esters and which comprise
relatively small amounts of omega-3 docosahexaenoic acid (DHA-n3),
may be used for the treatment of hypertriglyceridemia (either
TG.gtoreq.500 mg/dL, TG.gtoreq.200 mg/dL, TG.gtoreq.150 mg/dL,
TG200-499 mg/dL, TG300-499 mg/dL, TG350-499 mg/dL, or TG150-199
mg/dL), mixed dyslipidemia, or any other diseases or medical
conditions specified above. Such method of treatment provides to a
subject in need thereof a dose of at least 30 mg DPA-N3 per day,
alternatively at least 40 mg DPA-N3 per day, alternatively at least
50 mg DPA-N3 per day, alternatively at least 60 mg DPA-N3 per day,
alternatively at least 80 mg DPA-N3 per day, alternatively at least
90 mg DPA-N3 per day, alternatively at least 120 mg DPA-N3 per day,
alternatively at least 150 mg DPA-N3 per day, alternatively at
least 160 mg DPA-N3 per day, alternatively at least 180 mg DPA-N3
per day, alternatively at least 200 mg DPA-N3 per day,
alternatively at least 250 mg DPA-N3 per day, alternatively at
least 300 mg DPA-N3 per day, alternatively at least 350 mg DPA-N3
per day, alternatively at least 400 mg DPA-N3 per day,
alternatively at least 500 mg DPA-N3 per day, alternatively at
least 600 mg DPA-N3 per day, alternatively at least 800 mg DPA-N3
per day, alternatively at least 1000 mg DPA-N3 per day,
alternatively at least 1200 mg DPA-N3 per day, alternatively at
least 1500 mg DPA-N3 or its glycerol or ethyl esters per day, while
providing a relatively small amount of DHA-N3 such that the DHA:DPA
dose ratio is no more than 15:1 of DHA:DPA, alternatively no more
than 12:1 of DHA:DPA, alternatively no more than 10:1 of DHA:DPA,
alternatively no more than 8:1 of DHA:DPA, alternatively no more
than 5:1 of DHA:DPA, alternatively no more than 3:1 of DHA:DPA,
alternatively no more than 2:1 of DHA:DPA, alternatively no more
than 1:1 of DHA:DPA, alternatively no more than 1:2 of DHA:DPA,
alternatively no more than 1:3 of DHA:DPA, alternatively no more
than 1:5 of DHA:DPA, alternatively no more than 1:8 of DHA:DPA,
alternatively no more than 1:10 of DHA:DPA, alternatively no more
than 1:15 of DHA:DPA, alternatively a relative daily dose of no
more than 1:20 of DHA:DPA.
[0088] In some embodiments, the improved profile of the
compositions of the present invention may be demonstrated upon
treatment of a subject by differentially altering the ration
between blood platelets and fragments thereof (also known as
platelet microparticles). Such fragments may be evaluated as a
whole or examined and described as fragment sub-categories.
[0089] In other embodiments, the improved profile of the
compositions of the present invention may be demonstrated upon
treatment of a subject by differentially altering the surface
charge of blood platelets and fragments thereof, either in resting
state (non-activated platelets) or activated stage.
[0090] In yet other embodiments, treatment of a subject or patient
with compositions of the present invention affect the coagulatory
cascade and differentially alter coagulation or bleeding times or
platelet aggregation times and density.
[0091] In further embodiments, treatment with compositions of the
present invention improves the vascular healing process in response
to atherogenic disease. Such healing may be demonstrated by reduced
stenosis and/or restenosis over time, reduced or lesser increase in
intima-media thickness (IMT) of the arterial wall, larger lumen
size and/or larger vascular diameter at vascular sites with
stenosis or clot built-up, as determined by either by intravascular
ultrasound (IVUS), radiographic, radiologic, non-invasive
ultrasound, tomography, magnetic resonance interference (MRI), or
other acceptable methods. In other embodiments, such improved
healing may be demonstrated by the vascular wall composition, such
as a reduced foam cell presence or fibrillated tissue in the vessel
wall. In yet other embodiments, such improved vascular healing is
demonstrated by improved inflammatory markers in the vascular
wall.
[0092] The improved profile resulting from treatment with the
compositions of the present invention may also be demonstrated by a
differentiated impact on blood/serum/plasma lipid and lipoprotein
levels in a mammal; these include, but are not limited to:
Triglycerides (TG), total-cholesterol, non-HDL-cholesterol,
LDL-cholesterol, VLDL-cholesterol, apolipoprotein B, apolipoprotein
A, apolipoprotein C-III, HDL-cholesterol, and Lp-PLA2. The
compositions of the present invention may also be used to provide a
beneficial impact on the one or more of the following:
apolipoprotein A-I (apo A-I), apolipoprotein B (apo B), apo A-I/apo
B ratio, lipoprotein(a) (Lp[a]), lipoprotein-associated
phospholipase A2 (Lp-PLA2), low density lipoprotein (LDL) particle
number and size, oxidized LDL, C-reactive protein (CRP), high
sensitivity C-reactive protein (HSCRP), intracellular adhesion
molecule-1 (ICAM-1), E-selectin, P-selectin, vascular cell adhesion
molecule 1 (VCAM-1) or cluster of differentiation 106 (CD106),
interleleukin-1.beta. (IL-1.beta.), interleukin-2 (IL-2),
interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-10 (IL-10),
interleukin-12 (IL-12), interleukin-15 (IL-15), interleukin-18
(IL-18), tumor necrosis factor-alpha (TNF-.alpha.), tumor necrosis
factor-beta (TNF-.beta.), plasminogen activator inhibitor-1
(PAI-1), homocysteine, thromboxane B2 (TXB2), thromboxane A2
(TXA2), 2,3-dinor thromboxane B2, free fatty acids (FFA), serum
amyloid A1, serum amyloid A2, serum amyloid A3, serum amyloid A4,
thiobarbituric acid (TBA) reacting material, adiponectin (GBP-28),
hemoglobin A1c (HbA1c), macrophage colony stimulating factor
(M-CSF), granulocyte macrophage colony stimulating factor (GM-CSF),
fibrinogen, fibrin D-dimer, platelet derived-microparticles, mean
platelet volume (MPV), platelet subpopulations, heart rate,
systolic and diastolic blood pressure, nuclear factor
kappa-light-chain enhancer of activated B cells (NF-.kappa..beta.),
adenosine diphosphate induced platelet aggregation, platelet
endothelial cell adhesion molecule (PECAM-1), vitronectin receptor
(.alpha..sub.v.beta..sub.v), and glycoprotein IIb/IIIa
(gpIIIb/IIIa). The compositions of the present invention may also
be used in methods of treating, preventing, and reducing symptoms
associated with conditions associated with the above.
[0093] Methods to determine comparative blood/serum/plasma lipid
and lipoprotein levels and therapeutic effects on these levels in
mammals are generally know to those skilled in the art and are
typically based on fasting lipid and lipoprotein levels.
Differences of active treatment versus placebo are generally
assessed on a group of subjects versus another group of subjects
basis, with significant changes noted if the p-value for the
appropriate statistical comparison is equal to or less than 0.05.
P-values larger than 0.05 but equal to or less than 0.10 may be
considered borderline significant (BS). P-values larger than 0.10
are generally considered not significant (NS). In one embodiment,
treatment with the compositions of the present invention is more
potent than other omega-3 compositions known in the prior art (such
as LOVAZA.RTM., EPANOVA.TM. or AMR101) in reducing as compared to
placebo or baseline: TG levels, Total-cholesterol levels,
non-HDL-cholesterol levels, VLDL-cholesterol levels,
LDL-cholesterol levels, apolipoprotein B levels, apolipoprotein
C-III levels, Lp-PLA2 levels, or any combinations thereof. In other
embodiments, such more potent effects in reducing these parameters
are achieved in patients with baseline TG over 500 mg/dL, in
patients on statin treatment with baseline TG in the 200-499 mg/dL
range, in patients not on statin treatment with baseline
LDL-cholesterol of 190 mg/dL or higher and with TG in the 300-700
mg/dL range, in patients not on statin treatment with baseline
LDL-cholesterol of 190 mg/dL or higher and with TG in the 350-700
mg/dL range, in patients not on statin treatment with baseline
LDL-cholesterol of 190 mg/dL or higher and with TG in the 300-750
mg/dL range, in patients not on statin treatment with baseline
LDL-cholesterol of 190 mg/dL or higher and with TG in the 350-750
mg/dL range, or in patients not on statin treatment with baseline
non-HDL-cholesterol of 200 mg/dL or higher and with TG in the
300-700 mg/dL range, or in patients not on statin treatment with
baseline non-HDL-cholesterol of 200 mg/dL or higher and with TG in
the 350-700 mg/dL range, or in patients not on statin treatment
with baseline non-HDL-cholesterol of 200 mg/dL or higher and with
TG in the 300-750 mg/dL range, or in patients not on statin
treatment with baseline non-HDL-cholesterol of 200 mg/dL or higher
and with TG in the 350-750 mg/dL range.
[0094] In a further embodiment, treatment with the compositions of
the present invention together with statin therapy is more potent
than other omega-3 compositions known in the prior art (such as
LOVAZA.RTM., EPANOVA.TM. or AMR101) in reducing as compared to
placebo or baseline: TG levels, Total-cholesterol levels,
non-HDL-cholesterol levels, VLDL-cholesterol levels,
LDL-cholesterol levelsapolipoprotein B levels, apolipoprotein C-III
levels, Lp-PLA2 levels, or any combinations thereof. In other
embodiments, such more potent effects in reducing these parameters
are achieved in patients with baseline TG over 500 mg/dL, in
patients on statin treatment with baseline TG in the 200-499 mg/dL
range, in patients not on baseline statin treatment with baseline
LDL-cholesterol of 190 mg/dL or higher and with TG in the 300-700
mg/dL range, in patients not on baseline statin treatment with
baseline LDL-cholesterol of 190 mg/dL or higher and with TG in the
350-700 mg/dL range, in patients not on baseline statin treatment
with baseline LDL-cholesterol of 190 mg/dL or higher and with TG in
the 300-750 mg/dL range, in patients not on baseline statin
treatment with baseline LDL-cholesterol of 190 mg/dL or higher and
with TG in the 350-750 mg/dL range, or in patients not on baseline
statin treatment with baseline non-HDL-cholesterol of 200 mg/dL or
higher and with TG in the 300-700 mg/dL range, or in patients not
on baseline statin treatment with baseline non-HDL-cholesterol of
200 mg/dL or higher and with TG in the 350-700 mg/dL range, or in
patients not on baseline statin treatment with baseline
non-HDL-cholesterol of 200 mg/dL or higher and with TG in the
300-750 mg/dL range, or in patients not on baseline statin
treatment with baseline Non-HDL-cholesterol of 200 mg/dL or higher
and with TG in the 350-750 mg/dL range.
[0095] The present invention also provides methods of reducing
triglycerides levels in a subject, wherein the non-HDL cholesterol
levels, such as LDL-cholesterol levels, of the subject are reduced
or not significantly increased from, for example, baseline levels
before treatment. In some embodiments, treatment with the
compositions of the present invention results in a minor (less than
10% change from baseline, alternatively less than 5%) and/or
non-significant change in non-HDL cholesterol levels (such as
LDL-cholesterol levels) as compared to placebo in patients with
baseline TG levels above 500 mg/dL. In a further embodiment,
treatment with the compositions of the present invention results in
reductions of LDL-cholesterol levels as compared to placebo in
patients with baseline TG levels above 500 mg/dL. In some
embodiments, the methods involve coadministration of a statin.
[0096] In another embodiment, treatment with the compositions of
the present invention as compared to placebo does not increase
LDL-cholesterol levels in patients with baseline TG levels of
200-499 mg/dL while on statin therapy.
[0097] In yet another embodiment, treatment with the compositions
of the present invention as compared to placebo results in
significant reductions in LDL-cholesterol levels in patients with
baseline TG levels of 200-499 mg/dL while on statin therapy.
[0098] In a further embodiment, the compositions of the present
invention as compared to placebo result in significant reductions
in LDL-cholesterol levels in patients not on statin treatment with
LDL-cholesterol of 190 mg/dL or higher and with TG in the 300-700
mg/dL range, in patients not on statin treatment with
LDL-cholesterol of 190 mg/dL or higher and with TG in the 350-700
mg/dL range, in patients not on statin treatment with
LDL-cholesterol of 190 mg/dL or higher and with TG in the 300-750
mg/dL range, or in patients not on statin treatment with
LDL-cholesterol of 190 mg/dL or higher and with TG in the 350-750
mg/dL range. Finally, another embodiment, the compositions of the
present invention as compared to placebo result in significant
reductions in LDL-cholesterol levels in patients not on statin
treatment with non-HDL-cholesterol of 200 mg/dL or higher and with
TG in the 300-700 mg/dL range, in patients not on statin treatment
with Non-HDL-cholesterol of 200 mg/dL or higher and with TG in the
350-700 mg/dL range, in patients not on statin treatment with
non-HDL-cholesterol of 200 mg/dL or higher and with TG in the
300-750 mg/dL range, or in patients not on statin treatment with
Non-HDL-cholesterol of 200 mg/dL or higher and with TG in the
350-750 mg/dL range.
[0099] In another embodiment, treatment with the compositions of
the present invention together with statin therapy results in
significant reductions in LDL-cholesterol levels as compared to
placebo in patients not on statin treatment at baseline with
baseline LDL-cholesterol of 190 mg/dL or higher and with TG in the
300-700 mg/dL range, in patients not on baseline statin treatment
with baseline LDL-cholesterol of 190 mg/dL or higher and with TG in
the 350-700 mg/dL range, in patients not on baseline statin
treatment with baseline LDL-cholesterol of 190 mg/dL or higher and
with TG in the 300-750 mg/dL range, or in patients not on baseline
statin treatment with baseline LDL-cholesterol of 190 mg/dL or
higher and with TG in the 350-750 mg/dL range.
[0100] Finally, another embodiment, treatment with the compositions
of the present invention together with statin therapy results in
significant reductions in LDL-cholesterol levels as compared to
placebo in patients not on baseline statin treatment with baseline
non-HDL-cholesterol of 200 mg/dL or higher and with TG in the
300-700 mg/dL range, in patients not on baseline statin treatment
with baseline non-HDL-cholesterol of 200 mg/dL or higher and with
TG in the 350-700 mg/dL range, in patients not on baseline statin
treatment with baseline non-HDL-cholesterol of 200 mg/dL or higher
and with TG in the 300-750 mg/dL range, or in patients not on
baseline statin treatment with baseline Non-HDL-cholesterol of 200
mg/dL or higher and with TG in the 350-750 mg/dL range.
[0101] In another embodiment, the compositions of the present
invention are more potent than other omega-3 compositions known in
the prior art (such as LOVAZA.RTM., EPANOVA.TM. or AMR101) in
increasing as compared to placebo or baseline HDL-cholesterol
levels, apolipoprotein-A levels, or a combination thereof.
[0102] In yet another embodiment, the compositions of the present
invention are more potent than other omega-3 compositions known in
the prior art (such as LOVAZA.RTM., EPANOVA.TM. or AMR101) in
decreasing as compared to placebo or baseline Apolipoprotein-B
(Apo-B) levels, Apolipoprotein-CIII levels, Lp-PLA2 levels or any
combination thereof.
[0103] In further embodiments, the compositions of the present
invention as compared to placebo or baseline are more potent than
other omega-3 compositions known in the prior art (such as
LOVAZA.RTM., EPANOVA.TM. or AMR101) in reducing TG while causing a
lesser increase in LDL-cholesterol, a lesser non-significant
increase in LDL-cholesterol, no increase in LDL-cholesterol at all,
or a more potent reduction in LDL-cholesterol at in patients with
baseline TG levels above 500 mg/dL.
[0104] In some embodiments, the use of the compositions of the
present invention may allow for a reduction in the dose of the
statin required for a subject. For example, the coadministration of
the composition of the present invention in a subject receiving
statin therapy may allow for the reduction of the dose of the
statin, compared to subject not being co-administered a composition
of the present invention. In some embodiments, the dose of the
statin may be reduced by at least 10%, alternatively at least 25%,
alternatively at least 50%, or alternatively at least 75%.
[0105] In some embodiments, the use of the compositions of the
present invention may reduce the time needed for a subject to reach
the recommended blood levels. For example, the administration of
compositions of the present invention may allow a subject to reach
goal lipid levels, for example, those described in the NCEP ATP III
Guidelines, or any levels recommended by a health care
practitioner. In some embodiments, the reduction of time is greater
than 5%, alternatively greater than 15%, alternatively greater than
25%, alternatively greater than 50%, and alternatively greater than
75%.
[0106] The compositions of the present invention are also useful to
treat coronary heart disease (CHD), vascular disease,
atherosclerotic disease or related conditions. The compositions of
the present invention may also be use for the treatment and/or
prevention and/or reduction of cardiac events and/or cardiovascular
events and/or vascular events and/or symptoms. Determination of
such cardiovascular diseases/conditions and prevention of
events/symptoms in mammals and methods to determine treatment and
preventative/therapeutic effects therefore are generally know to
those skilled in the art.
[0107] The present invention also relates to treatment of such
conditions in with concomitant treatments regimes or combination
products with other active pharmaceutical ingredients. Such
concomitant or fixed combination treatments may include a statin,
an anticoagulant (such as aspirin or clopidogrel), an
antihypertensive (such as a diuretic, beta-blocker, calcium channel
blocker, ACE-inhibitor, angiotensin II receptor (ARB) antagonist),
or other treatments for cardiovascular diseases.
[0108] The present invention also includes pharmaceutical
compositions, for example, a unit dosage, comprising one or more
HMG-CoA reductase inhibitors ("statins") and the omega-3 fatty acid
composition of the present invention. The present invention may
incorporate now known or future known statins in an amount
generally recognized as safe. There are currently seven statins
that are widely available: atorvastatin, rosuvastatin, fluvastatin,
lovastatin, pravastatin, pitavastatin, and simvastatin. An eight
statin, cerivastatin, has been removed from the U.S. market at the
time of this writing. However, it is conceivable to one skilled in
the art that cerivastatin may be used in conjunction with some
embodiments of the present invention if cerivastatin is ultimately
determined to be safe and effective in certain treatment regimens.
Such statins are typically used at their common daily doses, which
include, but are not limited to lovastatin 10 mg, 20 mg, 40 mg;
pravastatin 10 mg, 20 mg, 40 mg, 80 mg; simvastatin 5 mg, 10 mg, 20
mg, 40 mg, 80 mg; fluvastatin 20 mg, 40 mg, 80 mg; atorvastatin 10
mg, 20 mg, 40 mg, 80 mg; rosuvastatin 5 mg, 10 mg, 20 mg, 40 mg;
and pitavastatin 1 mg, 2 mg, 4 mg, 8 mg.
[0109] Generally, the effect of statins is dose dependent, i.e.,
the higher the dose, the greater the therapeutic affect. However,
the effect of each statin is different, and therefore the level of
therapeutic effect of one statin cannot be necessarily be directly
correlated to the level of therapeutic effects of other statins.
For example, bioavailability varies widely among the statins.
Specifically, it has been shown that simvastatin is less than 5%
bioavailable, while fluvastatin is approximately 24% bioavailable.
Statins are absorbed at rates ranging from about 30% with
lovastatin to 98% with fluvastatin. First-pass metabolism occurs in
all statins except pravastatin. Pravastatin is also the least
protein-bound of the statins (about 50%), compared with the others,
which are more than 90% protein-bound. Accordingly, the statins
possess distinct properties from one another. The combination
products of this invention involving each statin or a plurality of
statins are also distinct.
[0110] The present invention also includes methods of treatment,
comprising dosing of one or more statins and the omega-3 fatty acid
composition of the present invention, either as concomitant therapy
or in a fixed dose combination product comprising both a statin and
the composition of the present invention. This method of treatment
combines the administration of one or more statins at its common
dose or an alternative dose with the composition of the present
invention.
[0111] In some embodiments, the compositions of the present
invention, which comprise significant amounts of omega-3
docosapentaenoic acid (DPA-n3) or its glycerol or ethyl esters,
together with a common or alternative statin dose, may be used for
the treatment of hypertriglyceridemia (either TG.gtoreq.500 mg/dL,
TG.gtoreq.200 mg/dL, TG.gtoreq.150 mg/dL, TG 200-499 mg/dL, or TG
150-199 mg/dL), mixed dyslipidemia, or any other diseases or
medical conditions specified above. Such methods of treatment
provide to a subject in need thereof a dose of at least 30 mg
DPA-N3 per day, alternatively at least 40 mg DPA-N3 per day,
alternatively at least 50 mg DPA-N3 per day, alternatively at least
60 mg DPA-N3 per day, alternatively at least 70 mg DPA-N3 per day,
alternatively at least 80 mg DPA-N3 per day, alternatively at least
90 mg DPA-N3 per day, alternatively at least 100 mg DPA-N3 per day,
alternatively at least 120 mg DPA-N3 per day, alternatively at
least 150 mg DPA-N3 per day, alternatively at least 160 mg DPA-N3
per day, alternatively at least 180 mg DPA-N3 per day,
alternatively at least 200 mg DPA-N3 per day, alternatively at
least 250 mg DPA-N3 per day, alternatively at least 300 mg DPA-N3
per day, alternatively at least 350 mg DPA-N3 per day,
alternatively at least 400 mg DPA-N3 per day, alternatively at
least 500 mg DPA-N3 per day, alternatively at least 600 mg DPA-N3
per day, alternatively at least 800 mg DPA-N3 or its glycerol or
ethyl esters per day together with a common or alternative statin
dose.
[0112] In other embodiments, the compositions of the present
invention, which comprise significant amounts of omega-3
docosapentaenoic acid (DPA-n3) or its glycerol or ethyl esters and
which comprise relatively small amounts of omega-3 docosahexaenoic
acid (DHA-n3), together with a common or alternative statin dose,
may be used for the treatment of hypertriglyceridemia (either
TG.gtoreq.500 mg/dL, TG.gtoreq.200 mg/dL, TG.gtoreq.150 mg/dL, TG
200-499 mg/dL, or TG 150-199 mg/dL), mixed dyslipidemia, or any
other diseases or medical conditions specified above. Such method
of treatment provides to a subject in need thereof a common or
alternative statin dose together with a dose of at least 30 mg
DPA-N3 per day, alternatively at least 40 mg DPA-N3 per day,
alternatively at least 50 mg DPA-N3 per day, alternatively at least
60 mg DPA-N3 per day, alternatively at least 80 mg DPA-N3 per day,
alternatively at least 90 mg DPA-N3 per day, alternatively at least
120 mg DPA-N3 per day, alternatively at least 150 mg DPA-N3 per
day, alternatively at least 160 mg DPA-N3 per day, alternatively at
least 180 mg DPA-N3 per day, alternatively at least 200 mg DPA-N3
per day, alternatively at least 250 mg DPA-N3 per day,
alternatively at least 300 mg DPA-N3 per day, alternatively at
least 350 mg DPA-N3 per day, alternatively at least 400 mg DPA-N3
per day, alternatively at least 500 mg DPA-N3 per day,
alternatively at least 600 mg DPA-N3 per day, alternatively at
least 800 mg DPA-N3 or its glycerol or ethyl esters per day, while
providing less than 2000 mg of DHA, alternatively less than 1900 mg
of DHA, alternatively less than 1500 mg of DHA, alternatively less
than 1200 mg of DHA, alternatively less than 1000 mg of DHA,
alternatively less than 800 mg of DHA, alternatively less than 700
mg of DHA, alternatively less than 600 mg of DHA, alternatively
less than 500 mg of DHA, alternatively less than 400 mg of DHA,
alternatively less than 350 mg of DHA, alternatively less than 300
mg of DHA, alternatively less than 250 mg of DHA, alternatively
less than 200 mg of DHA, alternatively less than 150 mg of DHA,
alternatively less than 120 mg of DHA, alternatively less than 100
mg of DHA, alternatively less than 80 mg of DHA, alternatively less
than 60 mg of DHA, alternatively less than 50 mg of DHA,
alternatively less than 40 mg of DHA, alternatively less than 30 mg
of DHA, alternatively less than 25 mg of DHA, alternatively less
than 20 mg of DHA or its glycerol or ethyl esters per day.
[0113] In further embodiments, the compositions of the present
invention, which comprise significant amounts of omega-3
docosapentaenoic acid (DPA-n3) or its glycerol or ethyl esters and
which comprise relatively small amounts of omega-3 docosahexaenoic
acid (DHA-n3), together with a common or alternative statin dose,
may be used for the treatment of hypertriglyceridemia (either
TG.gtoreq.500 mg/dL, TG.gtoreq.200 mg/dL, TG.gtoreq.150 mg/dL, TG
200-499 mg/dL, or TG 150-199 mg/dL), mixed dyslipidemia, or any
other diseases or medical conditions specified above. Such method
of treatment provides to a subject in need thereof a common or
alternative statin dose together with a dose of at least 30 mg
DPA-N3 per day, alternatively at least 40 mg DPA-N3 per day,
alternatively at least 50 mg DPA-N3 per day, alternatively at least
60 mg DPA-N3 per day, alternatively at least 70 mg DPA-N3 per day,
alternatively at least 80 mg DPA-N3 per day, alternatively at least
90 mg DPA-N3 per day, alternatively at least 100 mg DPA-N3 per day,
alternatively at least 120 mg DPA-N3 per day, alternatively at
least 150 mg DPA-N3 per day, alternatively at least 160 mg DPA-N3
per day, alternatively at least 180 mg DPA-N3 per day,
alternatively at least 200 mg DPA-N3 per day, alternatively at
least 250 mg DPA-N3 per day, alternatively at least 300 mg DPA-N3
per day, alternatively at least 350 mg DPA-N3 per day,
alternatively at least 400 mg DPA-N3 per day, alternatively at
least 500 mg DPA-N3 per day, alternatively at least 600 mg DPA-N3
per day, alternatively at least 800 mg DPA-N3 per day,
alternatively at least 1000 mg DPA-N3 per day, alternatively at
least 1200 mg DPA-N3 per day, alternatively at least 1500 mg DPA-N3
or its glycerol or ethyl esters per day, while providing a
relatively small amount of DHA-N3 such that the DHA:DPA dose ratio
is no more than 15:1 of DHA:DPA, alternatively no more than 12:1 of
DHA:DPA, alternatively no more than 10:1 of DHA:DPA, alternatively
no more than 8:1 of DHA:DPA, alternatively no more than 5:1 of
DHA:DPA, alternatively no more than 3:1 of DHA:DPA, alternatively
no more than 2:1 of DHA:DPA, alternatively no more than 1:1 of
DHA:DPA, alternatively no more than 1:2 of DHA:DPA, alternatively
no more than 1:3 of DHA:DPA, alternatively no more than 1:5 of
DHA:DPA, alternatively no more than 1:8 of DHA:DPA, alternatively
no more than 1:10 of DHA:DPA, alternatively no more than 1:15 of
DHA:DPA, alternatively a relative daily dose of no more than 1:20
of DHA:DPA.
[0114] In some embodiments, the composition of the present
invention further comprises TPA at concentration of at least 0.05%.
In some embodiments, the TPA concentration is about 0.01% to about
5%, alternatively about 0.05% to about 2%, alternatively about 0.1%
to about 1%, alternatively about 0.2% to about 0.8%, alternatively
about 0.4% to about 0.6%, alternatively about 0.5%.
[0115] The compositions of the present invention may also be taken
as a general nutritional supplement.
[0116] On a EPA+DPA daily dose basis, the compositions of the
present invention are preferably provided in a dose of between 100
mg and 10,100 mg/day, alternatively between 200 mg and 8,100
mg/day, alternatively between 300 mg and 6,100 mg/day,
alternatively between 400 mg and 5,100 mg/day, alternatively
between 500 mg and 4,100 mg/day.
[0117] On a EPA+HPA+DPA daily dose basis, the compositions of the
present invention are preferably provided in a dose of between 100
mg and 10,100 mg/day, alternatively between 200 mg and 8,100
mg/day, alternatively between 300 mg and 6,100 mg/day,
alternatively between 400 mg and 5,100 mg/day, alternatively
between 500 mg and 4,100 mg/day.
[0118] The formulation may be a single daily dose preparation to
give in one dose the above intakes, or may be in convenient divided
doses, for example, a daily dose formed of two to four soft gelatin
or other dosage forms, each containing 300-1500 mg of EPA+DPA or
EPA+DPA+HPA in any form embodied in the present invention.
[0119] Flavourants or emulsifiers may be included, for instance, to
make the preparation palatable. Other conventional additives,
diluents and excipients may be present. The preparation for
ingestion may be in the form of a capsule, a dry powder, a tablet,
a solution, an oil, an emulsion or any other appropriate form. The
capsules may be hard or soft gelatin capsules, agar capsules, or
any other appropriate capsule.
[0120] Use of the formulations of the invention in the manufacture
of a medicament for the treatment or prevention of any disease or
disorder, including those mentioned above, is included in the
present invention.
[0121] The omega-3 fatty acid composition optionally includes
chemical antioxidants, such as alpha tocopherol, which are
administered in pure form or suspended in a vegetable oil, such as
soybean oil or corn oil.
[0122] The blended fatty acid compositions may then be incorporated
into any appropriate dosage form for oral, enteral, parenteral,
rectal, vaginal, dermal or other route of administration. Soft or
hard gelatin capsules, flavoured oil blends, emulsifiers or other
liquid forms, and microencapsulate powders or other dry form
vehicles are all appropriate ways of administering the
products.
[0123] The formulated final drug product containing the omega-3
fatty acid composition may be administered to a mammal or patient
in need thereof in a capsule, a tablet, a powder that can be
dispersed in a beverage, or another solid oral dosage form, a
liquid, a soft gel capsule or other convenient dosage form such as
oral liquid in a capsule, as known in the art. In some embodiments,
the capsule comprises a hard gelatin. The combination product may
also be contained in a liquid suitable for injection or
infusion.
[0124] Example pharmaceutical grade finished dosage forms: (a) Soft
or hard gelatin capsules each containing 500 mg or 1000 mg of a mix
20 parts of EPA as a free fatty acid to 1 parts of DPA as a free
fatty acid; (b) As in (a) but where the EPA and DPA free fatty
acids are replaced with the fatty acids in any other appropriate
bioassimilable form such as the ethyl esters; (c) As in (a)-(b) but
where the material is in the form of a microencapsulated powder
which can be used as a powder or compressed into tablets. Such
powders may be prepared by a variety of technologies known to those
skilled in the art; (d) As in (a)-(b) but where the formulation is
a liquid or emulsion, appropriately flavoured for palatable oral
administration; (e) As in (a)-(b) but where the material is
formulated into a pharmaceutically acceptable vehicle appropriate
for topical application such as a cream or ointment.
[0125] The omega-3 compositions of the present invention may also
be administered with a combination of one or more non-active
pharmaceutical ingredients (also known generally herein as
"excipients"). Non-active ingredients, for example, serve to
solubilize, suspend, thicken, dilute, emulsify, stabilize,
preserve, protect, color, flavor, and fashion the active
ingredients into an applicable and efficacious preparation that is
safe, convenient, and otherwise acceptable for use. Thus, the
non-active ingredients may include colloidal silicon dioxide,
crospovidone, lactose monohydrate, lecithin, microcrystalline
cellulose, polyvinyl alcohol, povidone, sodium lauryl sulfate,
sodium stearyl fumarate, talc, titanium dioxide and xanthum
gum.
[0126] The term "pharmaceutically acceptable vehicle," as used
herein, includes any of the following: a solution where the first
API and optional other ingredients are wholly dissolved in a
solubilizer (e.g., a pharmaceutically acceptable solvent or mixture
of solvents), wherein the solution remains in clear liquid form at
about room temperature; a suspension; an oil; or a semi-solid,
wherein the first API and optionally other ingredients are
dissolved wholly or partially in a solubilizer (an emulsion, cream,
etc.).
[0127] A "pharmaceutical grade finished dosage form" as used herein
may be construed as a unit dose form suitable for administration
to, for example, human or animal subjects, and having content
uniformity acceptable to regulatory authorities. For example, under
the USP requirements for content uniformity, a pharmaceutical grade
finished dosage form should have an amount of API within the range
of 85% to 115% of the desired dosage and an RSD less than or equal
to 6.0%. In addition, a pharmaceutical grade finished dosage form
must be stable (i.e., have a "shelf life") for a pharmaceutically
acceptable duration of time, preferably at least six months,
alternatively at least one year, or at least two years, when stored
at room temperature (about 23 degree Celcius to 27 degree Celcius,
preferably about 25 degree Celcius) and 60% relative humidity.
Typically, stability is determined by physical appearance and/or
chemical modification of the ingredients, in accordance with
standards well-known in the pharmaceutical arts, including those
documented in ICH guidelines.
[0128] The omega-3 fatty acid dosage form optionally includes
chemical antioxidants, such as alpha tocopherol, oils, such as
soybean oil and partially hydrogenated vegetable oil, and
lubricants such as fractionated coconut oil, lecithin and a mixture
of the same.
EXAMPLES
Example 1
[0129] A composition according to the present prevention is
prepared by mixing and homogenizing in a ratio of 98:2 the
intermediates MEGAPEX E90D00EE (90% EPA ethyl ester,) and MAXOMEGA
DPA95 FFA (.gtoreq.95% DPA synthetic fatty acid produced from EPA
ethyl ester concentrate) converted to ethyl ester, respectively.
These intermediates were prepared and commercially offered for sale
by Chemport Korea (MEGAPEX) and Equateq Ltd from Scotland, UK
(MAXOMEGA). The relative amounts of fatty acids present in the
starting intermediates and in the resulting novel composition are
listed in Table 1 below. The resulting novel composition comprises
89.10% EPA, 1.95% DPA, 0.19% HPA, 91.24% omega-3-pentaenoic acids,
less than 0.01% DHA, 91.24% omega-3-pentaenoic acids, 93.09% total
omega-3 fatty acids, 3.15% ARA and 3.57% omega-6 fatty acids (all
Area %).
TABLE-US-00005 TABLE 1 Fatty acid Composition (Area %) of
intermediates and novel composition according to Example 1 98.0%
2.0% Megapex Maxomega Novel Fatty Acid E90D00EE DPA95FFA => EE
Composition c18:0 0.05 0 0.05 c18:1n9 0.06 0 0.06 c18:1n7 0.02 0
0.02 c18:2n6 0.01 0 0.01 c18:3n6 0.02 0 0.02 c18:3n3 0.03 0 0.03
c18:4n3 0.42 0 0.41 c18:4n1 0.07 0 0.07 c20:0 0 0 0.00 c20:1n11 0 0
0.00 c20:1n9 0 0 0.00 c20:1n7 0 0 0.00 c20:2n6 0.25 0 0.25 c20:3n9
0 0 0.00 c20:3n6 0.15 0 0.15 c21:0 0 0 0.00 c20:4n6 3.21 0 3.15
c20:3n3 0 0 0.00 c20:4n3 1.44 0 1.41 c20:5n3 90.92 0 89.10 c22:0
0.3 0 0.29 c22:1n11 0.07 0 0.07 c22:1n9 0.18 0 0.18 c22:1n7 0.19 0
0.19 c21:5n3 0.19 0 0.19 c22:5n6 0 0 0.00 c22:5n3 0 97.27 1.95
c22:6n3 0 0 0.00 c24:0 0 0.33 0.01 OTHER 2.42 2.4 2.42 100 100
100
Example 2
[0130] A composition according to the present prevention is
prepared by mixing and homogenizing in a ratio of 96:4 the
intermediates MEGAPEX E90D00EE (90% EPA ethyl ester,) and MAXOMEGA
DPA95 FFA (.gtoreq.95% DPA synthetic fatty acid produced from EPA
ethyl ester concentrate), converted to ethyl ester, respectively.
These intermediates were prepared and commercially offered for sale
by Chemport Korea (MEGAPEX) and Equateq Ltd from Scotland, UK
(MAXOMEGA). The relative amounts of fatty acids present in the
starting intermediates and in the resulting novel composition is
listed in Table 2 below. The resulting novel composition comprises
87.28% EPA, 3.89% DPA, 0.18% HPA, 91.35% omega-3-pentaenoic acids,
less than 0.01% DHA, 93.17% total omega-3 fatty acids and 3.49%
omega-6 fatty acids (all Area %).
TABLE-US-00006 TABLE 2 Fatty acid Composition (Area %) of
intermediates and novel composition according to Example 2 96.0%
4.0% Megapex Maxomega Novel Fatty Acid E90D00EE DPA95FFA => EE
Composition c18:0 0.05 0 0.05 c18:1n9 0.06 0 0.06 c18:1n7 0.02 0
0.02 c18:2n6 0.01 0 0.01 c18:3n6 0.02 0 0.02 c18:3n3 0.03 0 0.03
c18:4n3 0.42 0 0.40 c18:4n1 0.07 0 0.07 c20:0 0 0 0.00 c20:1n11 0 0
0.00 c20:1n9 0 0 0.00 c20:1n7 0 0 0.00 c20:2n6 0.25 0 0.24 c20:3n9
0 0 0.00 c20:3n6 0.15 0 0.14 c21:0 0 0 0.00 c20:4n6 3.21 0 3.08
c20:3n3 0 0 0.00 c20:4n3 1.44 0 1.38 c20:5n3 90.92 0 87.28 c22:0
0.3 0 0.29 c22:1n11 0.07 0 0.07 c22:1n9 0.18 0 0.17 c22:1n7 0.19 0
0.18 c21:5n3 0.19 0 0.18 c22:5n6 0 0 0.00 c22:5n3 0 97.27 3.89
c22:6n3 0 0 0.00 c24:0 0 0.33 0.01 OTHER 2.42 2.4 2.42 100 100
100
Example 3
[0131] A composition according to the present prevention is
prepared by mixing and homogenizing in a ratio of 94:6 the
intermediates MEGAPEX E90D00EE (90% EPA ethyl ester,) and MAXOMEGA
DPA95 FFA (0.95% DPA synthetic fatty acid produced from EPA ethyl
ester concentrate) converted to ethyl ester, respectively. These
intermediates were prepared and commercially offered for sale by
Chemport Korea (MEGAPEX) and Equateq Ltd from Scotland, UK
(MAXOMEGA). The relative amounts of fatty acids present in the
starting intermediates and in the resulting novel composition are
listed in table 3 below. The resulting novel composition comprises
85.46% EPA, 5.84% DPA, 0.18% HPA, 91.48% omega-3-pentaenoic acids,
less than 0.01% DHA, 93.26% total omega-3 fatty acids, 3.02% ARA,
and 3.42% omega-6 fatty acids (all Area %).
TABLE-US-00007 TABLE 3 Fatty acid Composition (Area %) of
intermediates and novel composition according to Example 3 94.0%
6.0% Megapex Maxomega Novel Fatty Acid E90D00EE DPA95FFA => EE
Composition c18:0 0.05 0 0.05 c18:1n9 0.06 0 0.06 c18:1n7 0.02 0
0.02 c18:2n6 0.01 0 0.01 c18:3n6 0.02 0 0.02 c18:3n3 0.03 0 0.03
c18:4n3 0.42 0 0.39 c18:4n1 0.07 0 0.07 c20:0 0 0 0.00 c20:1n11 0 0
0.00 c20:1n9 0 0 0.00 c20:1n7 0 0 0.00 c20:2n6 0.25 0 0.24 c20:3n9
0 0 0.00 c20:3n6 0.15 0 0.14 c21:0 0 0 0.00 c20:4n6 3.21 0 3.02
c20:3n3 0 0 0.00 c20:4n3 1.44 0 1.35 c20:5n3 90.92 0 85.46 c22:0
0.3 0 0.28 c22:1n11 0.07 0 0.07 c22:1n9 0.18 0 0.17 c22:1n7 0.19 0
0.18 c21:5n3 0.19 0 0.18 c22:5n6 0 0 0.00 c22:5n3 0 97.27 5.84
c22:6n3 0 0 0.00 c24:0 0 0.33 0.02 OTHER 2.42 2.4 2.42 100 100
100
Example 4
[0132] A composition according to the present prevention is
prepared by mixing and homogenizing in a ratio of 75:25 the
intermediates MEGAPEX E90D00EE (90% EPA ethyl ester,) and MAXOMEGA
DPA95 FFA (.gtoreq.95% DPA synthetic fatty acid produced from EPA
ethyl ester concentrate, converted to ethyl ester, respectively.
These intermediates were prepared and commercially offered for sale
by Chemport Korea (MEGAPEX) and Equateq Ltd from Scotland, UK
(MAXOMEGA). The relative amounts of fatty acids present in the
starting intermediates and in the resulting novel composition is
listed in table 4 below. The resulting novel composition comprises
68.10% EPA, 24.32% DPA, 0.19% HPA, 92.65% omega-3-pentaenoic acids,
less than 0.01% DHA, 94.07% total omega-3 fatty acids, 2.41% ARA
and 2.73% omega-6 fatty acids (all Area %).
TABLE-US-00008 TABLE 4 Fatty acid Composition (Area %) of
intermediates and novel composition according to Example 4 75.0%
25.0% Megapex Maxomega Novel Fatty Acid E90D00EE DPA95FFA => EE
Composition c18:0 0.05 0 0.04 c18:1n9 0.06 0 0.05 c18:1n7 0.02 0
0.02 c18:2n6 0.01 0 0.01 c18:3n6 0.02 0 0.02 c18:3n3 0.03 0 0.02
c18:4n3 0.42 0 0.32 c18:4n1 0.07 0 0.05 c20:0 0 0 0.00 c20:1n11 0 0
0.00 c20:1n9 0 0 0.00 c20:1n7 0 0 0.00 c20:2n6 0.25 0 0.19 c20:3n9
0 0 0.00 c20:3n6 0.15 0 0.11 c21:0 0 0 0.00 c20:4n6 3.21 0 2.41
c20:3n3 0 0 0.00 c20:4n3 1.44 0 1.08 c20:5n3 90.92 0 68.19 c22:0
0.3 0 0.23 c22:1n11 0.07 0 0.05 c22:1n9 0.18 0 0.14 c22:1n7 0.19 0
0.14 c21:5n3 0.19 0 0.14 c22:5n6 0 0 0.00 c22:5n3 0 97.27 24.32
c22:6n3 0 0 0.00 c24:0 0 0.33 0.08 OTHER 2.42 2.4 2.42 100 100
100
Example 5
[0133] A composition according to the present prevention is
prepared by mixing and homogenizing in a ratio of 60:40 the
intermediates KD-PharmaKD-PUR 900EE and MAXOMEGA DPA95 FFA
converted to ethyl ester, respectively. These intermediates were
prepared and commercially offered for sale by KD-Pharma Germany
(KD-Pharma) and Equateq Ltd from Scotland, UK (MAXOMEGA). The
relative amounts of fatty acids present in the starting
intermediates and in the resulting novel composition is listed in
table 5 below. The resulting novel composition comprises 55.74%
EPA, 39.26% DPA, 2.39% HPA, 97.44% omega-3-pentaenoic acids, and
98.06% total omega-3 fatty acids (all Area %).
TABLE-US-00009 TABLE 5 Fatty acid Composition (Area %) of
intermediates and novel composition according to Example 5 60.0%
40.0% KD-Pur Maxomega Novel Fatty Acid 900EE DPA95FFA => EE
Composition c18:0 0 0 0.00 c18:1n9 0 0 0.00 c18:1n7 0 0 0.00
c18:2n6 0 0 0.00 c18:3n6 0 0 0.00 c18:3n3 0 0 0.00 c18:4n3 0 0 0.00
c18:4n1 0 0 0.00 c20:0 0 0 0.00 c20:1n11 0 0 0.00 c20:1n9 0 0 0.00
c20:1n7 0 0 0.00 c20:2n6 0 0 0.00 c20:3n9 0 0 0.00 c20:3n6 0 0 0.00
c21:0 0 0 0.00 c20:4n6 0 0 0.00 c20:3n3 0 0 0.00 c20:4n3 1.04 0
0.62 c20:5n3 92.99 0 55.79 c22:0 0 0 0.00 c22:1n11 0 0 0.00 c22:1n9
0 0 0.00 c22:1n7 0 0 0.00 c21:5n3 3.98 0 2.39 c22:5n6 0 0 0.00
c22:5n3 0.58 97.27 39.26 c22:6n3 0 0 0.00 c24:0 0 0.33 0.13 OTHER
1.41 2.4 1.81 100.00 100 100.00
Example 6
[0134] A composition according to the present prevention is
prepared by mixing and homogenizing in a ratio of 96:4 the
intermediates KD-PUR 900EE KD-Pharma and MAXOMEGA DPA95 FFA
converted to ethyl ester, respectively. These intermediates were
prepared and commercially offered for sale by KD-Pharma Germany
(KD-Pharma) and Equateq Ltd from Scotland, UK (MAXOMEGA). The
relative amounts of fatty acids present in the starting
intermediates and in the resulting novel composition is listed in
table 6 below. The resulting novel composition comprises 89.27%
EPA, 4.45% DPA, 3.82% HPA, 97.54% omega-3-pentaenoic acids, and
98.54% total omega-3 fatty acids (all Area %).
TABLE-US-00010 TABLE 6 Fatty acid Composition (Area %) of
intermediates and novel composition according to Example 6 96.0%
4.0% KD-Pur Maxomega Novel Fatty Acid 900EE DPA95FFA => EE
Composition c18:0 0 0 0.00 c18:1n9 0 0 0.00 c18:1n7 0 0 0.00
c18:2n6 0 0 0.00 c18:3n6 0 0 0.00 c18:3n3 0 0 0.00 c18:4n3 0 0 0.00
c18:4n1 0 0 0.00 c20:0 0 0 0.00 c20:1n11 0 0 0.00 c20:1n9 0 0 0.00
c20:1n7 0 0 0.00 c20:2n6 0 0 0.00 c20:3n9 0 0 0.00 c20:3n6 0 0 0.00
c21:0 0 0 0.00 c20:4n6 0 0 0.00 c20:3n3 0 0 0.00 c20:4n3 1.04 0
1.00 c20:5n3 92.99 0 89.27 c22:0 0 0 0.00 c22:1n11 0 0 0.00 c22:1n9
0 0 0.00 c22:1n7 0 0 0.00 c21:5n3 3.98 0 3.82 c22:5n6 0 0 0.00
c22:5n3 0.58 97.27 4.45 c22:6n3 0 0 0.00 c24:0 0 0.33 0.01 OTHER
1.41 2.4 1.45 100.00 100 100.00
Example 7
[0135] The ethyl ester composition of Example 4 may be converted
into a free fatty acid composition with essentially the same fatty
acid composition according to "Conversion Method EE to FFA" below.
This method is indiscriminate with respect to the type, degree of
saturation or length of fatty acid if performed for an adequate
amount of time under the described conditions.
[0136] Conversion Method EE to FFA [0137] 1. Fatty Acid Ethyl Ester
(FAEE GMP, approx. 3 mmol/g) oil is brought into a closed
heated/cooled reaction chamber under nitrogen atmosphere
(preferably with pressure control), and heated to 50-60 degree
Celcius under stirring. [0138] 2. 2M NaOH solution in water is
added under firm stirring to ensure phase mixing (est.
2-3.times.FAEE w/w) and stir until no ethyl ester is presence (est.
2-4 hrs). Test ethyl ester presence at lab scale/in process with
TLC (hexanes/EtOAc 9:1) and with EP GC method to confirm reaction
completion under GMP. [0139] 3. Under cooling (keep mixture below
70 degree Celcius), add 6M HCl in water (est. <1 hr) until
slightly acid (.about.pH3-4). It may be necessary to control
pressure to prevent excessive foaming. Then halt stirring, give
time to let phases separate, and remove water phase from bottom
(keep oil protected from oxygen, apply nitrogen atmosphere
blanket). [0140] 4. Add demineralized water (est. 2-3.times.FAEE
w/w) and wash out NaCl and ethanol from oil under firm stirring
(est. .about.1 hr). Halt stirring, give time to let phases
separate, and remove water phase from bottom (keep oil protected
from oxygen, apply nitrogen atmosphere blanket). [0141] 5. Repeat
Step 4 several times (.about.2.times.) to remove ethanol and NaCl.
[0142] 6. Remove water and remaining ethanol [determine in-process
controls], confirm under GMP with USP residual solvent method
(target: ethanol <100 ppm) by stirring oil while applying vacuum
10-50 mbar (with solvent trap) and heat oil (70-80 degree celcius)
until water/ethanol target is met (est. 2-4 hrs). [0143] 7. Add
anti-oxidants (i.e. alpha-D-tocopherol, USP, target 4 mg/g) and/or
other excipients. [0144] 8. All reagents and excipients USP
grade.
Example 8
[0145] The ethyl ester composition of Example 3 is converted into a
free fatty acid composition with essentially the same fatty acid
composition according to "Conversion Method EE to FFA" above. This
method is indiscriminate with respect to the type, degree of
saturation or length of fatty acid if performed for an adequate
amount of time under the described conditions.
Example 9
[0146] The ethyl ester composition of Example 6 is converted into a
free fatty acid composition with essentially the same fatty acid
composition according to "Conversion Method EE to FFA" above. This
method is indiscriminate with respect to the type, degree of
saturation or length of fatty acid if performed for an adequate
amount of time under the described conditions.
Example 10
[0147] The composition of Example 4 is formulated into a soft
gelatin capsule. Prior to encapsulation, an anti-oxidant
preparation (composed of 4000 mg alpha-D-tocopherol in one liter of
corn oil; corn oil is a triglyceride low in omega-3) is added to
the composition of Example 4, by mixing and homogenizing 100 mL of
this anti-oxidant preparation into 100 liters of the oil
composition of Example 4 followed by thorough homogenization. The
resulting pre-encapsulation formulated oil contains approximately 4
mg/gram alpha-D-tocopherol. Subsequently, the formulated oil is
encapsulated into soft gelatin capsules with printed logo according
to general methods typically used by Accucaps in Canada for fish
oils or by any other documented and operational encapsulation
method. The fill mass of the oil is approximately 1.08
gram/capsule, providing a dose of approximately 1000 mg
omega-3-pentaenoic-acids ethyl esters per capsule. Finally, the
capsules are bottled in HDPE bottles with induction seal and child
resistant cap.
Example 11
[0148] The composition of Example 8 is formulated into a soft
gelatin capsule. Prior to encapsulation, an anti-oxidant
preparation (composed of 4000 mg alpha-D-tocopherol in one liter of
corn oil; corn oil is a triglyceride low in omega-3) is added to
the composition of Example 4, by mixing and homogenizing 100 mL of
this anti-oxidant preparation into 100 liters of the oil
composition of Example 4 followed by thorough homogenization. The
resulting pre-encapsulation formulated oil contains approximately 4
mg/gram alpha-D-tocopherol. Subsequently, the formulated oil is
encapsulated into soft gelatin capsules with printed logo according
to general methods typically used by Banner in High Point, N.C.,
for fish oils or by any other documented and operational
encapsulation method. The fill mass of the oil is approximately
1.09 gram/capsule, providing a dose of approximately 1000 mg
omega-3-pentaenoic-acids per capsule. Finally, the capsules are
bottled in HDPE bottles with induction seal and child resistant
cap.
Example 12
[0149] The composition of Example 5 is formulated into a soft
gelatin capsule. Prior to encapsulation, an anti-oxidant
preparation (composed of 4000 mg alpha-D-tocopherol in one liter of
corn oil; corn oil is a triglyceride low in omega-3) is added to
the composition of Example 4, by mixing and homogenizing 100 mL of
this anti-oxidant preparation into 100 liters of the oil
composition of Example 4 followed by thorough homogenization. The
resulting pre-encapsulation formulated oil contains approximately 4
mg/gram alpha-D-tocopherol. Subsequently, the formulated oil is
encapsulated into soft gelatin capsules with printed logo according
to general methods typically used by Catalent in St. Petersburg,
Fla., for fish oils or by any other documented and operational
encapsulation method. The fill mass of the oil is approximately
1.05 gram/capsule, providing a dose of approximately 1000 mg
omega-3-pentaenoic-acids ethyl esters per capsule. Finally, the
capsules are bottled in HDPE bottles with induction seal and child
resistant cap.
Example 13
[0150] The composition of Example 9 is formulated into a soft
gelatin capsule. Prior to encapsulation, an anti-oxidant
preparation (composed of 4000 mg alpha-D-tocopherol in one liter of
corn oil; corn oil is a triglyceride low in omega-3) is added to
the composition of Example 4, by mixing and homogenizing 100 mL of
this anti-oxidant preparation into 100 liters of the oil
composition of Example 4 followed by thorough homogenization. The
resulting pre-encapsulation formulated oil contains approximately 4
mg/gram alpha-D-tocopherol. Subsequently, the formulated oil is
encapsulated into soft gelatin capsules with printed logo according
to general methods typically used by Banner in High Point, N.C.,
for fish oils or by any other documented and operational
encapsulation method. The fill mass of the oil is 1.06
gram/capsule, providing a dose of approximately 1000 mg
omega-3-pentaenoic-acids per capsule. Finally, the capsules are
bottled in HDPE bottles with induction seal and child resistant
cap.
Example 14
[0151] A patient is diagnosed with severe hypertriglyceridemia
(TG>500 mg/dL). Thereupon, the patient may be initiated on daily
treatment with one of the encapsulated compositions according to
Examples 10, 11, 12 or 13. Four capsules per day are administered
to this patient (4 g/d).
Example 15
[0152] A patient is treated as per Example 14. The treatment
results in significant reduction of TG as well as non-HDL- and
VLDL-cholesterol levels while the LDL-cholesterol level changes
insignificantly.
Example 16
[0153] A patient is treated as per Example 14. The treatment
results in significant reduction of TG as well as non-HDL-, LDL-
and VLDL-cholesterol levels.
Example 17
[0154] A patient already undergoing treatment with a statin is
diagnosed with high triglycerides (TG between 200 and 500 mg/dL).
Thereupon, the patient is initiated on daily treatment with one of
the encapsulated compositions according to Examples 10, 11, 12 or
13. Four capsules per day are administered to this patient (4
g/d).
Example 18
[0155] A patient is treated as per Example 17. The treatment
results in significant reduction of TG as well as non-HDL-, VLDL-
and LDL-cholesterol levels.
Example 19
[0156] A patient is diagnosed with mixed dyslipidemia (TG between
200 and 700 mg/dL and LDL-cholesterol above 190 mg/dL). Thereupon,
the patient is initiated on concomitant daily treatment with a
statin and one of the encapsulated compositions according to
Examples 10, 11, 12 or 13. Four capsules per day are administered
to this patient (4 g/d).
Example 20
[0157] A patient is treated as per Example 19. The treatment
results in significant reduction of TG as well as non-HDL-, VLDL-
and LDL-cholesterol levels.
Example 21
[0158] A patient is diagnosed with mixed dyslipidemia (TG between
200 and 700 mg/dL and non-HDL-cholesterol above 200 mg/dL).
Thereupon, the patient is initiated on concomitant daily treatment
with a statin and one of the encapsulated compositions according to
Examples 10, 11, 12 or 13. Four capsules per day are administered
to this patient (4 g/d).
Example 22
[0159] A patient is treated as per Example 21. The treatment
results in significant reduction of TG as well as non-HDL-, VLDL-
and LDL-cholesterol levels.
Example 23
[0160] A patient is diagnosed to be at significant risk for a
cardiovascular event according to the NCEP guidelines and has TG
levels above 150 mg/dL. Thereupon, the patient is initiated on
daily treatment with one of the encapsulated compositions according
to Examples 10, 11, 12 or 13. Four capsules per day are
administered to this patient (4 g/d).
Example 24
[0161] A patient is treated as per Example 23. The treatment
results in significant reduction of TG as well as non-HDL-, VLDL-
and LDL-cholesterol levels.
Example 25
[0162] A patient diagnosed as per Example 14, 17, 19, 21 or 23 is
treated with 3 capsules per day (instead of 4) of one of the
encapsulated compositions according to Examples 10, 11, 12 or 13.
The treatment results in significant reduction of TG as well as
non-HDL- and VLDL-cholesterol levels.
Example 26
[0163] A patient diagnosed as per Example 14, 17, 19, 21 or 23 is
treated with 3 capsules per day (instead of 4) of one of the
encapsulated compositions according to Examples 10, 11, 12 or 13.
The treatment results in significant reduction of TG as well as
non-HDL-, VLDL- and LDL-cholesterol levels.
Example 27
[0164] A patient diagnosed as per Example 14, 17, 19, 21 or 23 is
treated with 2 capsules per day (instead of 3 or 4) of one of the
encapsulated compositions according to Examples 10, 11, 12 or 13.
The treatment results in significant reduction of TG as well as
non-HDL- and VLDL-cholesterol levels.
Example 28
[0165] A patient diagnosed as per Example 14, 17, 19, 21 or 23 is
treated with 2 capsules per day (instead of 3 or 4) of one of the
encapsulated compositions according to Examples 10, 11, 12 or 13.
The treatment results in significant reduction of TG as well as
non-HDL-, VLDL- and LDL-cholesterol levels.
Example 29
[0166] The following is an example of an embodiment of the present
invention.
TABLE-US-00011 COMPOSITION 1 Minimum Maximum Target Composition
(mg/g) (mg/g) (mg/g) Omega-3 pentaenoic acid 870 990 920
Eicosapentaenoic acid (EPA) 750 950 830 Heneicosapentaenoic acid
(HPA) 5 70 40 Docosapentaenoic acid (DPA) 50 130 90 Docosahexaenoic
acid (DHA) 40 20
In COMPOSITION 1, the EPA:HPA ratio is between 13 and 190, the
EPA:DPA ratio is between 8 and 15, the HPA:DPA ration between 0.05
and 1, the DPA:DHA ratio more than 2.4, preferably more than 4,
more preferably more than 6, most preferably more than 10, and the
EPA:DHA ratio more than 32, preferably more than 38, more
preferably more than 80, most preferably more than 95. The EPA,
HPA, DPA and DHA may be composed as a glyceride (such as
triglyceride), an ester (such as ethyl ester), or a free fatty
acid.
Example 30
[0167] The following is an example of an embodiment of the present
invention.
TABLE-US-00012 COMPOSITION 2 Minimum Maximum Target Composition
(mg/g) (mg/g) (mg/g) Omega-3 pentaenoic acid 900 980 940
Eicosapentaenoic acid (EPA) 15 60 30 Heneicosapentaenoic acid (HPA)
5 60 30 Docosapentaenoic acid (DPA) 800 950 880 Docosahexaenoic
acid (DHA) 25 <10
In COMPOSITION 2, the EPA:HPA ratio is between 0.25 and 12, the
DPA:EPA ratio is between 13 and 63, the DPA:HPA ration between 13
and 190, the DPA:DHA ratio more than 32, preferably more than 38,
more preferably more than 80, most preferably more than 95, and the
EPA:DHA ratio more than 00.6, preferably more than 1.5, more
preferably more than 2.4, most preferably more than 6. The EPA,
HPA, DPA and DHA may be composed as a glyceride (such as
triglyceride), an ester (such as ethyl ester), or a free fatty
acid.
Example 31
[0168] The following is an example of an embodiment of the present
invention.
TABLE-US-00013 COMPOSITION 3 Minimum Maximum Target Composition
(mg/g) (mg/g) (mg/g) Docosapentaenoic acid (DPA n-3) 800 990
920
The DPA may be composed as a glyceride (such as triglyceride), an
ester (such as ethyl ester), or a free fatty acid.
Example 32
[0169] A mixture of DPA and EPA was prepared by combining 1 g DPA
Ethyl Ester
[0170] (SE-133-III) with 10 g EPA Ethyl Ester, 914 mg/g (KD Pharma
FM13001) in 150 ml of 95% ethanol/water containing 35 ml of 2M
sodium hydroxide. This reaction mixture was stirred overnight at
ambient temperature. Tlc analysis showed complete conversion of the
ethyl esters to the corresponding acids. The reaction mixture was
cooled in an ice bath, acidified with 6N hydrochloric acid and
concentrated on a rotavap under reduced pressure. Water and ethyl
acetate were added, the phases separated and the aqueous residue
extracted with ethyl acetate. The ethyl acetate extracts were
combined, dried over sodium sulfate and concentrated to dryness on
a rotavap under reduced pressure. Yield: 9.83 g. The ethyl ester
mixture was then converted to the free fatty acids as described in
example 7.
[0171] A representative sample of this ethyl ester composition was
analysed using split inject by capillary gas chromatography by a 30
meter.times.0.25 mm Restek Stabil wax column using temperature
programming.
Example 33
[0172] The following describes a study to determine the effect of
compositions of the present invention.
[0173] Study #1--Zucker Rats
[0174] A DPA testing batch containing roughly 87% DPA ethyl ester
was used to study pharmacodynamic effects in the Charles River
Zucker fa/fa non-diabetic rat (strain code 185), which is known to
display characteristics of insulin resistance, glucose intolerance,
hyperinsulinemia, obesity and dyslipidemia. Male, eight to nine
week old animals were used, with eight rats (n=8) per group. At the
initiation of daily dosing, all animals were placed on chow+0.5%
cholesterol diet (D13022002: Research Diets, New Brunswick, N.J.).
Corn oil was used as a diluent for the omega-3 compounds, and
methylcellulose to prepare the statin (atorvastatin) for dosing. A
separate group of animals receiving corn oil alone was used as the
untreated control group. Animals received daily doses of respective
solutions by oral gavage. The study was conducted in 2 phases. In
the first phase, DPA solution was administered at 50 mg/kg, 200
mg/kg, 400 mg/kg, and 1000 mg/kg. Animals were dosed daily for 14
days. For reference, a rat dose of 400 mg/kg would be equivalent to
a human daily dose of approximately 4 grams (as shown in
Reagan-Shaw et al. "Dose translation from animal to human studies
revisited," FASEB J. 22, 659-661 (2007), which is incorporated by
reference in its entirety).
[0175] The second phase was initiated on day 15, with the group
receiving DPA 400 mg/kg solution being co-administered statin at 10
mg/kg. Another group, previously dosed with corn oil vehicle,
receive atorvastatin to serve as an appropriate control. This
second phase consisted of 14 days of daily, oral
administration.
[0176] Plasma total cholesterol, LDL, HDL, VLDL, triglycerides and
NEFA (non-esterified free fatty acids) are measured in the fasting
state on day 0, 7 and 14; and for those groups included in the
second phase on days 21 and 28. Levels of lipid parameters are
determined in a 96-well multiplexed system using standard clinical
chemistry techniques. Non-HDL cholesterol is calculated by
subtracting the HDL value from the total cholesterol value. In
addition, for the groups included in the second phase, insulin
levels are determined at day 28. FIG. 1 shows the fasting plasma
lipid values after seven days of dosing. FIG. 2 shows the fasting
plasma insulin levels after 28 days of administration.
[0177] Expression of genes for HMGCoA
(3-hydroxy-3-methylglutaryl-coenzyme A; key regulatory enzyme for
new cholesterol biosynthesis), PCSK9 (pro-protein convertase
subtilisin kexin 9; associated with LDL receptor functioning and
increased levels of LDL), and SREB-2 (sterol regulatory enhancing
binding protein 2; regulates transcription of a wide variety of
genes involved with new cholesterol synthesis) are evaluated in
liver from groups included in the second phase. The mRNA (messenger
RNA) is isolated from samples previously frozen at -70.degree. C.s,
and cDNA (complementary DNA) is derived for further study using
standard molecular biology technique. Samples and corresponding
probes for genes of interest are loaded onto a Life Science TLDA
card. The level of gene expression is quantified using real time
RT-PCR (reverse transcriptase polymerase chain reaction) and
calculated using the .DELTA..DELTA.Ct technique relative to the
vehicle group in accordance to methodology recommended and as
described by Applied Biosystems (Guide to Performing Relative
Quantitation of Gene Expression Using Real-Time Quantitative PCR).
FIG. 3 shows the relative liver gene expression following 28 days
of administration.
Example 34
[0178] The following describes a study to determine the effect of
compositions of the present invention.
[0179] Study #2--Humans
[0180] The overall pharmacokinetics of one of COMPOSITION 1, 2 or 3
are evaluated versus a reference compound after administration
under fasting or fed conditions in normal, mostly healthy
volunteers in a standard, 4-way cross-over trial design format.
VASCEPA.RTM., EPANOVA.TM., LOVAZA.RTM., or EPADEL.RTM. are used as
a reference compound. A total of 48 subjects are separated into 2
groups of 24. Each subject serves as his or her own internal
control for comparison purposes under this 4-way crossover design.
Inclusion criteria for tested subjects include volunteers between
ages 18-65, with a BMI of 30-35 (alternatively a BMI of 27-35) and
triglyceride levels less than 350 mg/dL, who consume no more than 1
fish meal per week and who are not currently prescribed
pharmaco-therapy for lowering triglycerides, including but not
limited to fibrates, omega-3 agents, and niacin. Volunteers on
stable anti-hypertensive, anti-diabetic and thyroid therapy re
allowed for consideration. Any person on stable statin therapy is
considered if their triglyceride levels are less than 350 mg/dL.
However, the total composition of subjects in the study with this
particular profile is limited to no more than 30%.
[0181] Volunteers self-administering omega-3 non-prescription
dietary supplements are asked to refrain from their use 2 weeks
prior to the initiation of the study until study completion.
[0182] Pharmacokinetic Study#2 Design
[0183] The effect of oral administration of the compounds tested in
this study is evaluated under fed versus fasting administration
conditions, in order to determine drug pharmacokinetics, as well as
to understand the effects of food on drug pharmacokinetics.
COMPOSITION 1 or the reference compound are dosed at approximately
4 grams/day in the morning by administration of 4 capsules
containing approximately 1 gram of each compound. Several days
prior to pharmacokinetic evaluations, volunteers are housed at the
testing facility in order to ensure well-controlled experimental
conditions.
[0184] Compounds are given to volunteers following an overnight
fast, with plasma samples obtained prior to dosing and at various
time points after day 1 and day 14 dosing. Volunteers are allowed
access to water, and well-defined meals at certain times.
Afterwards, compound administration is stopped for a 2-4 week
washout period, and the groups are switched with respect to which
compound they would receive, meaning that the group initially
receiving COMPOSITION 1 is switched to receive the reference
compound, and vice versa. Fasting pharmacokinetics are determined
using the procedure described above. Following completion of the
second 14-day dosing cycle, compound dosing is stopped for a
2-4-week washout period prior to the initiation of the a similar
cycle as above, now with COMPOSITION 1 and the reference compound
are administered together with a meal.
[0185] Plasma levels of omega-3 fatty acids of interest from the
study are determined utilizing an analytical LC/MS technique under
GLP laboratory conditions in order to determine Cmax, Tmax and AUC
for the omega-3 fatty acids of interest, including EPA, DPA, HPA,
DHA, and other omega-3 fatty acids.
[0186] Results
[0187] The results of the study show that COMPOSITION 1 has a
better bioavailability (as measured by AUC and Cmax) than the
reference compound. This effect is seen under fasting and/or fed
administration conditions.
[0188] In an alternate study design, this Study #2 is conducted
with a certain dose level of COMPOSITION 20R COMPOSITION 3 instead
of COMPOSITION 1.
Example 35
[0189] The following describes a study (STUDY #3) to determine the
effect of compositions of the present invention.
[0190] A Multi-Center, Placebo-Controlled, Randomized,
Double-Blind, 12-Week Study to Evaluate the Efficacy and Safety of
COMPOSITION 1, 2, or 3 in Patients With Fasting Triglyceride Levels
.gtoreq.500 mg/dL and .ltoreq.52000 mg/dL:
[0191] This Phase 3, multi-center study consists of a 6- to 8-week
screening/washout period (to include a diet and lifestyle
stabilization period), which includes a fasting triglyceride (TG)
qualifying period of 2-3 weeks, followed by a 12-week double-blind
treatment period. Patients on statin therapy (with or without
ezetimibe) at screening are evaluated by the investigator as to
whether this therapy could be safely discontinued at screening, or
if it is to be continued. Patients on any other dyslipidemia
therapy need to discontinue these in order to qualify for the
study. If statin therapy (with or without ezetimibe) is to be
continued, dose(s) must be stable for weeks prior to the fasting TG
baseline qualifying measurements for randomization. The screening
visit is to occur at either 6 weeks before randomization for
patients not on lipid-altering therapy at screening or for patients
who do not need to discontinue their current dyslipidemia therapy,
or at 8 weeks before randomization for patients who require washout
of their current dyslipidemia therapy at screening.
[0192] The population for this study is men and women >18 years
of age with a body mass index (BMI) .ltoreq.45 kg/m2. Patients on
lipid-lowering therapy and patients not on lipid-lowering therapy
are eligible to enroll in the study. Patients had to have an
average TG level .gtoreq.500 mg/dL and .ltoreq.2000 mg/dL during
the screening period to be eligible for randomization.
[0193] After confirmation of qualifying fasting TG values, eligible
patients will enter a 12-week randomized, double-blind treatment
period. At Week 0, patients will be randomly assigned to 1 of the
following treatment groups: COMPOSITION 1 (approximately 2 g
daily), COMPOSITION 1 (approximately 3 g daily), COMPOSITION 1
(approximately 4 g daily), or placebo. The daily dose may be taken
as either a single dose or distributed over two doses per day.
[0194] Approximately 80 patients per treatment group will be
randomized in this study. Stratification will be by baseline
fasting TG level (.ltoreq.750 mg/dL or >750 mg/dL, gender, and
the use of statin therapy at randomization. During the double-blind
treatment period, patients return to the site at Week 4, Week 11,
and Week 12 for efficacy and safety evaluations.
[0195] The primary objective of the study is to determine the
efficacy of COMPOSITION 1 at a approximately 2 g daily dose,
approximately 3 g daily dose and approximately 4 g daily dose,
compared to placebo, in lowering fasting TG levels in patients with
fasting TG levels .gtoreq.500 mg/dL and .ltoreq.2000 mg/dL
[0196] The secondary and exploratory objectives of the study are as
follows:
[0197] 1. To determine the safety and tolerability of COMPOSITION 1
at approximately 2 g daily, approximately 3 g daily and
approximately 4 g daily;
[0198] 2. To determine the effect of COMPOSITION 1 on lipid
profiles, including total cholesterol (TC), non-high-density
lipoprotein cholesterol (non-HDL-C) low-density lipoprotein
cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C),
and very low-density lipoprotein cholesterol (VLDL-C);
[0199] 3. To determine the effect of COMPOSITION 1 on
apolipoprotein A-I (apo A-I), apolipoprotein B (apo B), apo A-I/apo
B ratio, lipoprotein(a) (Lp[a]), and lipoprotein-associated
phospholipase A2 (Lp-PLA2);
[0200] 4. To determine the effect of COMPOSITION 1 on low-density
lipoprotein (LDL) particle number and size, on oxidized LDL and on
C-reactive protein (CRP).
[0201] 5. To determine the effect of COMPOSITION 1 on intracellular
adhesion molecule-1 (ICAM-1) vascular cell adhesion molecule 1
(VCAM.sub.--1), interleleukin-1.beta. (IL-1.beta.), interleukin-2
(IL-2), interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-10
(IL-10), interleukin-12 (IL-12), interleukin-15 (IL-15),
interleukin-18 (IL-18), tumor necrosis factor-alpha (TNF-.alpha.),
tumor necrosis factor-beta (TNF-.beta.) and plasminogen activator
inhibitor-1 (PAI-1);
[0202] 6. To determine the effects of COMPOSITION 1 on nuclear
factor kappa-light-chain-enhancer of activated B cells
(NE-.kappa.B), vitronectin receptor (.alpha.v.beta.3), glycoprotein
IIb/IIIa (gpIIb/IIIa and other platelet and thrombogenic
factors.
[0203] 7. To determine the effects of COMPOSITION 1 on E-selectin,
P-selectin, homocysteine, thromboxane B2 (TXB2), thromboxane A2
(TXA2), thromboxane B23 (TXB3), thromboxane A3 (TXA3), 2,3-dinor
thromboxane B2, free fatty acids (FFA or NEFA), serum amyloid A1,
serum amyloid A2, serum amyloid A3, serum amyloid A4,
thiobarbituric acid (TBA) reacting material, adiponectin (GBP-28),
hemoglobin A1c (HbA1c), fasting insulin, fasting glucagon, fasting
plasma glucose, fasting plasma fructosamine, macrophage colony
stimulating factor (M-CSF) and granulocyte macrophage colony
stimulating factor (GM-CSF).
[0204] 8. To determine the effects of COMPOSITION 1 on fibrinogen,
fibrin D-dimer, platelet derived-microparticles, mean platelet
volume (MPV), platelet subpopulations, adenosine diphosphate
induced platelet aggregation, platelet endothelial cell adhesion
molecule (PECAM-1), heart rate, and systolic and diastolic blood
pressure.
[0205] 9. To investigate the relationship between changes in fatty
acid concentrations (including EPA, DHA and DPA) in plasma and red
blood cell membranes and the reduction in fasting TG levels;
[0206] 10. To investigate the relationship between changes in fatty
acid concentrations (including EPA, DHA and DPA) in plasma and red
blood cell membranes and the reduction in fasting TG levels.
[0207] The primary efficacy variable for the double-blind treatment
period is percent change in fasting TG from baseline to the Week 12
endpoint.
[0208] The secondary efficacy variable for the double-blind
treatment period includes the following: Percent changes in fasting
Non-HDL-C, LDL-C, VLDL-C, HDL-C, Lp-PLA2, and apo B from baseline
to Week 12 endpoint.
[0209] Statistical methods for efficacy evaluations will be
conducted on the intent-to-treat (ITT) and on the per-protocol
population. Descriptive statistics for the baseline and
post-baseline measurements, the percent changes, or changes from
baseline are to be presented by treatment group and by visit for
all efficacy variables.
[0210] The primary and secondary efficacy analyses will be
performed using an analysis of covariance (ANCOVA) model with
treatment, gender, and the use of statin therapy at randomization
as factors and baseline fasting TG value as a covariate.
[0211] In an alternate study design, this Study #3 is conducted
with one or more dose levels of COMPOSITION 20R 3 instead of
COMPOSITION 1.
Example 36
[0212] The following describes a study (STUDY #4) to determine the
effect of compositions of the present invention.
[0213] A Multi-Center, Placebo-Controlled, Randomized,
Double-Blind, 6- to 12-Week Study to Evaluate the Efficacy and
Safety of COMPOSITION 1, 2 or 3 in Statin-Treated Patients With
High Fasting Triglyceride Levels .gtoreq.200 mg/dL and .ltoreq.499
mg/dL.
[0214] This multi-center study consists of a 4- to 6-week screening
and washout period (to include a diet and lifestyle stabilization
period, and to wash-out any non-statin/ezetimibe dyslipidemia
medications), which also includes a 2-3 week fasting triglyceride
(TG) level qualifying period, followed by a 6- to 12-week
double-blind treatment period. Patients on statin therapy (with or
without ezetimibe) at screening are evaluated by the investigator
as to whether this therapy does maintain low-density lipoprotein
(LDL) levels of .gtoreq.40 mg/dl and <100 mg/dl. At screening,
statin therapy (with or without ezetimibe) is to be initiated, in
those patients who are not on statin therapy in order to achieve
LDL levels of .gtoreq.40 mg/dl and <100 mg/dl. Dose(s) of statin
therapy must be stable for .gtoreq.4 weeks prior to the TG baseline
qualifying measurements for randomization.
[0215] The population for this study is men and women >18 years
of age with a body mass index (BMI) .ltoreq.45 kg/m2. Patients on
lipid-lowering therapy and patients not on lipid-lowering therapy
are eligible to enroll in the study. Patients had to have an
average fasting TG level .gtoreq.200 mg/dL and .ltoreq.499 mg/dL
during the qualifying period to be eligible for randomization.
[0216] After confirmation of qualifying fasting TG values, eligible
patients will enter a 6- to 12-week randomized, double-blind
treatment period. At Week 0, patients will be randomly assigned to
one of the following treatment groups: COMPOSITION 1 at an
approximately 2 gram daily dose, COMPOSITION 1 at an approximately
3 gram daily dose, COMPOSITION 1 at an approximately 4 gram daily
dose, or placebo. The daily dose may be taken as either a single
dose or distributed over two doses per day.
[0217] Approximately 100 to 250 patients per treatment group will
be randomized in this study. Stratification will be by gender.
During the double-blind treatment period, patients will return to
the site at Week 3 or 4, one week prior to the last week of
randomized treatment period, and at the end or the randomized
treatment period for efficacy and safety evaluations.
[0218] The primary objective of the study is to determine the
efficacy of COMPOSITION 1 at approximately 2 grams daily,
approximately 3 grams daily and approximately 4 grams daily,
compared to placebo, in lowering fasting TG levels in
statin-treated patients with fasting TG levels .gtoreq.200 mg/dL
and .ltoreq.499 mg/dL.
[0219] The secondary and exploratory objectives of the study may
include but are not limited to the following objectives:
[0220] 1. To determine the safety and tolerability of COMPOSITION 1
at approximately 2 g daily, approximately 3 g daily and
approximately 4 g daily;
[0221] 2. To determine the effect of COMPOSITION 1 at on lipid
profiles, including total cholesterol (TC), non-high-density
lipoprotein cholesterol (non-HDL-C) low-density lipoprotein
cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C),
and very low-density lipoprotein cholesterol (VLDL-C);
[0222] 3. To determine the effect of COMPOSITION 1 on
apolipoprotein A-I (apo A-I), apolipoprotein B (apo B), apo A-I/apo
B ratio, lipoprotein(a) (Lp[a]), and lipoprotein-associated
phospholipase A2 (Lp-PLA2);
[0223] 4. To determine the effect of COMPOSITION 1 on low-density
lipoprotein (LDL) particle number and size, on oxidized LDL,
high-sensitivity C-reactive protein (HSCRP). and on C-reactive
protein (CRP).
[0224] 5. To determine the effect of COMPOSITION 1 on intracellular
adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule 1
(VCAM.sub.--1), interleleukin-1.beta. (IL-1.beta.), interleukin-2
(IL-2), interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-10
(IL-10), interleukin-12 (IL-12), interleukin-15 (IL-15),
interleukin-18 (IL-18), tumor necrosis factor-alpha (TNF-.alpha.),
tumor necrosis factor-beta (TNF-.beta.) and plasminogen activator
inhibitor-1 (PAI-1);
[0225] 6. To determine the effects of COMPOSITION 1 on nuclear
factor kappa-light-chain-enhancer of activated B cells
(NF-.kappa.B), vitronectin receptor (.alpha.v.beta.3), glycoprotein
IIb/IIIa (gpIIb/IIIa and other platelet and thrombogenic
factors.
[0226] 7. To determine the effects of COMPOSITION 1 on E-selectin,
P-selectin, homocysteine, thromboxane B2 (TXB2), thromboxane A2
(TXA2), thromboxane B23 (TXB3), thromboxane A3 (TXA3), 2,3-dinor
thromboxane B2, free fatty acids (FFA or NEFA), serum amyloid A1,
serum amyloid A2, serum amyloid A3, serum amyloid A4,
thiobarbituric acid (TBA) reacting material, adiponectin (GBP-28),
hemoglobin A1c (HbA1c), fasting insulin, fasting glucagon, fasting
plasma glucose, fasting plasma fructosamine, macrophage colony
stimulating factor (M-CSF) and granulocyte macrophage colony
stimulating factor (GM-CSF).
[0227] 8. To determine the effects of COMPOSITION 1 on fibrinogen,
fibrin D-dimer, platelet derived-microparticles, mean platelet
volume (MPV), platelet subpopulations, adenosine diphosphate
induced platelet aggregation, platelet endothelial cell adhesion
molecule (PECAM-1), heart rate, and systolic and diastolic blood
pressure.
[0228] 9. To determine the effects of COMPOSITION 1 on fatty acid
concentrations (including EPA, DHA and DPA) in plasma and red blood
cell membranes;
[0229] 10. To investigate the relationship between changes in fatty
acid concentrations (including EPA, DHA and DPA) in plasma and red
blood cell membranes and the reduction in fasting TG levels.
[0230] The primary efficacy variable for the double-blind treatment
period is percent change in fasting TG from baseline to the Week 6
to 12 endpoint.
[0231] The secondary efficacy variable for the double-blind
treatment period include but are not limited to the following:
Percent changes in fasting Non-HDL-C, LDL-C, VLDL-C, HDL-C,
Lp-PLA2, and apo B from baseline to Week 6 to 12 endpoint.
[0232] Statistical methods for efficacy evaluations will be
conducted on the intent-to-treat (ITT) and on the per-protocol
population. Descriptive statistics for the baseline and
post-baseline measurements, the percent changes, or changes from
baseline are to be presented by treatment group and by visit for
all efficacy variables.
[0233] The primary and secondary efficacy analyses will be
performed using an analysis of covariance (ANCOVA) model with
treatment, gender, the type of statin therapy and diagnosis of
diabetes at randomization as factors and baseline fasting TG value
as a covariate.
[0234] In an alternate study design, this Study #4 is conducted
with one or more dose levels of COMPOSITION 20R 3 instead of
COMPOSITION 1. In an alternative study design, Study #4 is
conducted, enrolling patients with a baseline triglyceride level of
about 300 to 499 mg/dL or about 350 too 400 mg/dL, instead of 200
to 499 mg/dL.
Example 37
[0235] The following describes a study (STUDY #5) to determine the
effect of compositions of the present invention.
[0236] The impact on fasting triglyceride levels and other
pharmacodynamic endpoints of one of COMPOSITION 1, 2 or 3 are
evaluated versus a reference compound after administration under
fasting or fed conditions in normal, mostly healthy volunteers in a
standard, 4-way cross-over trial design format. VASCEPA.RTM.,
EPANOVA.TM., LOVAZA.RTM., or EPADEL.RTM. are used as a reference
compound. A total of 48 subjects are separated into 2 groups of 24.
Each subject serves as his or her own internal control for
comparison purposes under this 4-way crossover design. Inclusion
criteria for tested subjects include volunteers between ages 18-65,
with a BMI of 30-35 (alternatively a BMI of 27-35) and triglyceride
levels less than 350 mg/dL, who consume no more than 1 fish meal
per week and who are not currently prescribed pharmaco-therapy for
lowering triglycerides, including but not limited to fibrates,
omega-3 agents, and niacin. Volunteers on stable anti-hypertensive,
anti-diabetic and thyroid therapy re allowed for consideration. Any
person on stable statin therapy is considered if his or her
triglyceride levels are less than 350 mg/dL. However, the total
composition of subjects in the study with this particular profile
is limited to no more than 30%.
[0237] Volunteers self-administering omega-3 non-prescription
dietary supplements are asked to refrain from their use 2 weeks
prior to the initiation of the study until study completion.
Subjects using any other non-steroidal anti-inflammatory agents
other than acetaminophen are asked to abstain and switch to
acetaminophen for relief of pain, or are excluded from study
consideration. Subjects are excluded if they receive any type of
hormone therapy, weight loss agents, HIV therapy, beta-blockers, or
are diagnosed with known cardiovascular disease, including heart
failure, arrhythmia, any incidence of acute coronary syndrome,
myocardial infarct, coronary artery bypass graft surgery, and/or
angioplasty.
[0238] Study #5 Design
[0239] The effect of oral administration of the compounds tested in
this study is evaluated under fed versus fasting administration
conditions, in order to determine drug pharmacodynamics and effects
on lipids. COMPOSITION 1 or the reference compound are dosed at
approximately 4 grams/day in the morning by administration of 4
capsules containing 1 gram of each compound.
[0240] Compounds are given to volunteers following an overnight
fast, with plasma samples obtained prior to dosing on day 1 and day
14 dosing. Volunteers are allowed access to water, and well-defined
meals at certain times. Afterwards, compound administration is
stopped for a 2-4 week washout period, and the groups are switched
with respect to which compound they would receive, meaning that the
group initially receiving COMPOSITION 1 is switched to receive the
reference compound, and vice versa. Following completion of the
second 14-day dosing cycle, compound dosing is stopped for a
2-4-week washout period prior to the initiation of the a similar
cycle as above, now with COMPOSITION 1 and the reference compound
are administered together with a meal.
[0241] Baseline plasma levels of fasting serum triglycerides are
determined on day 1 and just prior to initiation and completion of
either the fasting or fed multi-dosing period. Additional lipid and
other parameters (see below under "Results") that are analyzed
included total cholesterol, LDL, HDL, VLDL, non-HDL, and NEFA as
previously described.
[0242] Effects on platelet function, such as clotting time and
PAF-induced aggregation are also determined. Standard
physiological, plasma and urinary safety markers, including but not
limited to electrolytes, ALT, AST, BUN, glucose, blood pressure,
weight etc. are monitored in accordance with standard good clinical
trial guidelines.
[0243] Results
[0244] The results of the study show that COMPOSITION 1 has a
better fasting triglyceride lowering effect than the reference
compound. This effect is seen under fasting and/or fed
administration conditions. Administration of COMPOSITION 1 have a
beneficial effect, versus baseline and versus the reference
compound, on other lipid parameters (such as HDL cholesterol, total
cholesterol, non-HDL cholesterol, VLDL cholesterol), on platelet
function, and one or more of the following: apolipoprotein A-I (apo
A-I), apolipoprotein B (apo B), apo A-I/apo B ratio, lipoprotein(a)
(Lp[a]), lipoprotein-associated phospholipase A2 (Lp-PLA2), low
density lipoprotein (LDL) particle number and size, oxidized LDL,
C-reactive protein (CRP), high sensitivity C-reactive protein
(HSCRP), intracellular adhesion molecule-1 (ICAM-1), E-selectin,
P-selectin, vascular cell adhesion molecule 1 (VCAM-1) or cluster
of differentiation 106 (CD106), interleleukin-1.beta. (IL-1.beta.),
interleukin-2 (IL-2), interleukin-6 (IL-6), interleukin-8 (IL-8),
interleukin-10 (IL-10), interleukin-12 (IL-12), interleukin-15
(IL-15), interleukin-18 (IL-18), tumor necrosis factor-alpha
(TNF-.alpha.), tumor necrosis factor-beta (TNF-.beta.), plasminogen
activator inhibitor-1 (PAI-1), homocysteine, thromboxane B2 (TXB2),
thromboxane A2 (TXA2), 2,3-dinor thromboxane B2, free fatty acids
(FFA), serum amyloid A1, serum amyloid A2, serum amyloid A3, serum
amyloid A4, thiobarbituric acid (TBA) reacting material,
adiponectin (GBP-28), hemoglobin A1c (HbA1c), macrophage colony
stimulating factor (M-CSF), granulocyte macrophage colony
stimulating factor (GM-CSF), fibrinogen, fibrin D-dimer, platelet
derived-microparticles, mean platelet volume (MPV), platelet
subpopulations, heart rate, systolic and diastolic blood pressure,
nuclear factor kappa-light-chain enhancer of activated B cells
(NF-.kappa..beta.), adenosine diphosphate induced platelet
aggregation, platelet endothelial cell adhesion molecule (PECAM-1),
vitronectin receptor (.alpha..sub.v.beta..sub.v), and glycoprotein
IIb/IIIa (gpIIIb/IIIa). This effect is more beneficial than that
observed with VASCEPA.RTM.. Administration of COMPOSITION 1 has a
beneficial impact, or a minimal impact, or no impact, on other
non-HDL lipid parameters, such as LDL cholesterol versus baseline
and the reference compound. In an alternate study design, this
Study #5 is conducted with a certain dose level of COMPOSITION 20R
COMPOSITION 3 instead of COMPOSITION 1.
Description of the Preferred Embodiments
[0245] 1. A fatty acid composition comprising at least 50%
omega-3-fatty acids, salts or derivatives thereof, while comprising
eicosapentaenoic acid (EPA; C20:5-n3) and docosapentaenoic acid
(DPA; C22:5-n3) and wherein the EPA:DHA ratio is higher than 20:1.
[0246] 2. A fatty acid composition comprising at least 60%
omega-3-fatty acids, salts or derivatives thereof, while comprising
eicosapentaenoic acid (EPA; C20:5-n3) and docosapentaenoic acid
(DPA; C22:5-n3) and wherein the EPA:DHA ratio is higher than 20:1.
[0247] 3. A fatty acid composition comprising at least 70%
omega-3-fatty acids, salts or derivatives thereof, while comprising
eicosapentaenoic acid (EPA; C20:5-n3) and docosapentaenoic acid
(DPA; C22:5-n3) and wherein the EPA:DHA ratio is higher than 20:1.
[0248] 4. A fatty acid composition comprising at least 75%
omega-3-fatty acids, salts or derivatives thereof, while comprising
eicosapentaenoic acid (EPA; C20:5-n3) and docosapentaenoic acid
(DPA; C22:5-n3) and wherein the EPA:DHA ratio is higher than 20:1.
[0249] 5. A fatty acid composition comprising at least 80%
omega-3-fatty acids, salts or derivatives thereof, while comprising
eicosapentaenoic acid (EPA; C20:5-n3) and docosapentaenoic acid
(DPA; C22:5-n3) and wherein the EPA:DHA ratio is higher than 20:1.
[0250] 6. A fatty acid composition comprising at least 85%
omega-3-fatty acids, salts or derivatives thereof, while comprising
eicosapentaenoic acid (EPA; C20:5-n3) and docosapentaenoic acid
(DPA; C22:5-n3) and wherein the EPA:DHA ratio is higher than 20:1.
[0251] 7. A fatty acid composition comprising at least 90%
omega-3-fatty acids, salts or derivatives thereof, while comprising
eicosapentaenoic acid (EPA; C20:5-n3) and docosapentaenoic acid
(DPA; C22:5-n3) and wherein the EPA:DHA ratio is higher than 20:1.
[0252] 8. A fatty acid composition comprising at least 95%
omega-3-fatty acids, salts or derivatives thereof, while comprising
eicosapentaenoic acid (EPA; C20:5-n3) and docosapentaenoic acid
(DPA; C22:5-n3) and wherein the EPA:DHA ratio is higher than 20:1.
[0253] 9. A composition according to one of the preferred
embodiments 1 through 8, comprising at least 2% docosapentaenoic
acid (DPA; C22:5-n3). [0254] 10. A composition according to one of
the preferred embodiments 1 through 8, comprising at least 4%
docosapentaenoic acid (DPA; C22:5-n3). [0255] 11. A composition
according to one of the preferred embodiments 1 through 8,
comprising at least 5% docosapentaenoic acid (DPA; C22:5-n3).
[0256] 12. A composition according to one of the preferred
embodiments 1 through 8, comprising at least 6% docosapentaenoic
acid (DPA; C22:5-n3). [0257] 13. A composition according to one of
the preferred embodiments 1 through 8, comprising at least 7%
docosapentaenoic acid (DPA; C22:5-n3). [0258] 14. A composition
according to one of the preferred embodiments 1 through 8,
comprising at least 8% docosapentaenoic acid (DPA; C22:5-n3).
[0259] 15. A composition according to one of the preferred
embodiments 1 through 8, comprising at least 10% docosapentaenoic
acid (DPA; C22:5-n3). [0260] 16. A composition according to one of
the preferred embodiments 1 through 8, comprising at least 12%
docosapentaenoic acid (DPA; C22:5-n3). [0261] 17. A composition
according to one of the preferred embodiments 1 through 8,
comprising at least 15% docosapentaenoic acid (DPA; C22:5-n3).
[0262] 18. A composition according to one of the preferred
embodiments 1 through 17, comprising no more than 95% EPA. [0263]
19. A composition according to one of the preferred embodiments 1
through 17, comprising no more than 10% omega-6 fatty acids. [0264]
20. A composition according to one of the preferred embodiments 1
through 17, comprising no more than 7% omega-6 fatty acids. [0265]
21. A composition according to one of the preferred embodiments 1
through 17, comprising no more than 5% omega-6 fatty acids. [0266]
22. A composition according to one of the preferred embodiments 1
through 17, comprising no more than 3% omega-6 fatty acids. [0267]
23. A composition according to one of the preferred embodiments 1
through 22, comprising no more than 5% arachidonic acid (C22:4-n6).
[0268] 24. A composition according to one of the preferred
embodiments 1 through 22, comprising no more than 4% arachidonic
acid (C22:4-n6). [0269] 25. A composition according to one of the
preferred embodiments 1 through 22, comprising no more than 3%
arachidonic acid (C22:4-n6). [0270] 26. A composition according to
one of the preferred embodiments 1 through 22, comprising no more
than 2% arachidonic acid (C22:4-n6). [0271] 27. A composition
according to one of the preferred embodiments 1 through 22,
comprising no more than 1% arachidonic acid (C22:4-n6). [0272] 28.
A composition according to one of the preferred embodiments 1
through 27, also comprising heneicosapentaenoic acid (C21:5-n3).
[0273] 29. A composition according to one of the preferred
embodiments 1 through 27, comprising at least 0.01%
heneicosapentaenoic acid (C21:5-n3). [0274] 30. A composition
according to one of the preferred embodiments 1 through 27,
comprising at least 0.1% heneicosapentaenoic acid (C21:5-n3).
[0275] 31. A composition according to one of the preferred
embodiments 1 through 27, comprising at least 0.3%
heneicosapentaenoic acid (C21:5-n3). [0276] 32. A composition
according to one of the preferred embodiments 1 through 27,
comprising at least 0.5% heneicosapentaenoic acid (C21:5-n3).
[0277] 33. A composition according to one of the preferred
embodiments 1 through 27, comprising at least 1%
heneicosapentaenoic acid (C21:5-n3). [0278] 34. A composition
according to one of the preferred embodiments 1 through 27,
comprising at least 2% heneicosapentaenoic acid (C21:5-n3). [0279]
35. A composition according to one of the preferred embodiments 1
through 27, comprising at least 3% heneicosapentaenoic acid
(C21:5-n3). [0280] 36. A composition according to one of the
preferred embodiments 1 through 27, comprising at least 4%
heneicosapentaenoic acid (C21:5-n3). [0281] 37. A composition
according to one of the preferred embodiments 1 through 27,
comprising at least 5% heneicosapentaenoic acid (C21:5-n3). [0282]
38. A composition according to one of the preferred embodiments 1
through 37, comprising no more than 5% omega-3 fatty acids that are
not omega-3-pentaenoic acids. [0283] 39. A composition according to
one of the preferred embodiments 1 through 37, comprising no more
than 4% omega-3 fatty acids that are not omega-3-pentaenoic acids.
[0284] 40. A composition according to one of the preferred
embodiments 1 through 37, comprising no more than 3% omega-3 fatty
acids that are not omega-3-pentaenoic acids. [0285] 41. A
composition according to one of the preferred embodiments 1 through
37, comprising no more than 2% omega-3 fatty acids that are not
omega-3-pentaenoic acids. [0286] 42. A composition according to one
of the preferred embodiments 1 through 37, comprising no more than
1.5% omega-3 fatty acids that are not omega-3-pentaenoic acids.
[0287] 43. A composition according to one of the preferred
embodiments 1 through 37, comprising no more than 1.25% omega-3
fatty acids that are not omega-3-pentaenoic acids. [0288] 44. A
composition according to one of the preferred embodiments 1 through
37, comprising no more than 1% omega-3 fatty acids that are not
omega-3-pentaenoic acids. [0289] 45. A composition according to one
of the preferred embodiments 1 through 44, wherein the EPA:DPA
ratio is between 99:1 and 1:99. [0290] 46. A composition according
to one of the preferred embodiments 1 through 44, wherein the
EPA:DPA ratio is between 60:1 and 1:60. [0291] 47. A composition
according to one of the preferred embodiments 1 through 44, wherein
the EPA:DPA ratio is between 50:1 and 1:10. [0292] 48. A
composition according to one of the preferred embodiments 1 through
44, wherein the EPA:DPA ratio is between 40:1 and 1:3. [0293] 49. A
composition according to one of the preferred embodiments 1 through
44, wherein the EPA:DPA ratio is between 40:1 and 1:2. [0294] 50. A
composition according to one of the preferred embodiments 1 through
44, wherein the EPA:DPA ratio is between 40:1 and 1:1. [0295] 51. A
composition according to one of the preferred embodiments 1 through
44, wherein the EPA:DPA ratio is between 30:1 and 1:1. [0296] 52. A
composition according to one of the preferred embodiments 1 through
44, wherein the EPA:DPA ratio is between 20:1 and 1:1. [0297] 53. A
composition according to one of the preferred embodiments 1 through
44, wherein the EPA:DPA ratio is between 10:1 and 1:1. [0298] 54. A
composition according to one of the preferred embodiments 1 through
44, wherein the EPA:DPA ratio is between 5:1 and 1:1. [0299] 55. A
composition according to one of the preferred embodiments 1 through
44, wherein the EPA:DPA ratio is between 10:1 and 2:1. [0300] 56. A
composition according to one of the preferred embodiments 1 through
44, wherein the EPA:DPA ratio is between 20:1 and 2:1. [0301] 57. A
composition according to one of the preferred embodiments 1 through
44, wherein the EPA:DPA ratio is between 30:1 and 2:1. [0302] 58. A
composition according to one of the preferred embodiments 1 through
44, wherein the EPA:DPA ratio is between 40:1 and 2:1. [0303] 59. A
composition according to one of the preferred embodiments 1 through
44, wherein the EPA:DPA ratio is between 50:1 and 2:1. [0304] 60. A
composition according to one of the preferred embodiments 1 through
44, wherein the EPA:DPA ratio is between 10:1 and 3:1. [0305] 61. A
composition according to one of the preferred embodiments 1 through
44, wherein the EPA:DPA ratio is between 20:1 and 3:1. [0306] 62. A
composition according to one of the preferred embodiments 1 through
44, wherein the EPA:DPA ratio is between 30:1 and 3:1. [0307] 63. A
composition according to one of the preferred embodiments 1 through
44, wherein the EPA:DPA ratio is between 40:1 and 3:1. [0308] 64. A
composition according to one of the preferred embodiments 1 through
44, wherein the EPA:DPA ratio is between 50:1 and 3:1. [0309] 65. A
composition according to one of the preferred embodiments 1 through
44, wherein the EPA:DPA ratio is between 60:1 and 3:1. [0310] 66. A
composition according to one of the preferred embodiments 1 through
44, wherein the EPA:DPA ratio is between 10:1 and 5:1. [0311] 67. A
composition according to one of the preferred embodiments 1 through
44, wherein the EPA:DPA ratio is between 20:1 and 5:1. [0312] 68. A
composition according to one of the preferred embodiments 1 through
44, wherein the EPA:DPA ratio is between 30:1 and 5:1. [0313] 69. A
composition according to one of the preferred embodiments 1 through
44, wherein the EPA:DPA ratio is between 40:1 and 5:1. [0314] 70. A
composition according to one of the preferred embodiments 1 through
44, wherein the EPA:DPA ratio is between 50:1 and 5:1. [0315] 71. A
composition according to one of the preferred embodiments 1 through
44, wherein the EPA:DPA ratio is between 60:1 and 5:1. [0316] 72. A
composition according to one of the preferred embodiments 1 through
44, wherein the EPA:DPA ratio is between 20:1 and 10:1. [0317] 73.
A composition according to one of the preferred embodiments 1
through 44, wherein the EPA:DPA ratio is between 30:1 and 10:1.
[0318] 74. A composition according to one of the preferred
embodiments 1 through 44, wherein the EPA:DPA ratio is between 40:1
and 10:1. [0319] 75. A composition according to one of the
preferred embodiments 1 through 44, wherein the EPA:DPA ratio is
between 50:1 and 10:1. [0320] 76. A composition according to one of
the preferred embodiments 1 through 44, wherein the EPA:DPA ratio
is between 60:1 and 10:1. [0321] 77. A composition according to one
of the preferred embodiments 1 through 44, wherein the EPA:DPA
ratio is between 100:1 and 10:1. [0322] 78. A composition according
to one of the preferred embodiments 1 through 44, comprising
between 55% and 95% EPA. [0323] 79. A composition according to one
of the preferred embodiments 1 through 44, comprising between 60%
and 95% EPA. [0324] 80. A composition according to one of the
preferred embodiments 1 through 44, comprising between 65% and 95%
EPA. [0325] 81. A composition according to one of the preferred
embodiments 1 through 44, comprising between 70% and 95% EPA.
[0326] 82. A composition according to one of the preferred
embodiments 1 through 44, comprising between 75% and 95% EPA.
[0327] 83. A composition according to one of the preferred
embodiments 1 through 44, comprising between 80% and 95% EPA.
[0328] 84. A composition according to one of the preferred
embodiments 1 through 44, comprising between 85% and 95% EPA.
[0329] 85. A composition according to one of the preferred
embodiments 1 through 44, comprising between 90% and 95% EPA.
[0330] 86. A composition according to one of the preferred
embodiments 1 through 44, comprising between 1% and 3% DPA. [0331]
87. A composition according to one of the preferred embodiments 1
through 44, comprising between 1% and 5% DPA. [0332] 88. A
composition according to one of the preferred embodiments 1 through
44, comprising between 2% and 10% DPA. [0333] 89. A composition
according to one of the preferred embodiments 1 through 44,
comprising between 3% and 20% DPA. [0334] 90. A composition
according to one of the preferred embodiments 1 through 44,
comprising between 3% and 30% DPA. [0335] 91. A composition
according to one of the preferred embodiments 1 through 44,
comprising between 3% and 50% DPA. [0336] 92. A composition
according to one of the preferred embodiments 1 through 44,
comprising between 3% and 75% DPA. [0337] 93. A composition
according to one of the preferred embodiments 1 through 44,
comprising between 3% and 90% DPA. [0338] 94. A fatty acid
composition according to one of the preferred embodiments 1 through
93, in which the fatty acids are present as ethyl esters. [0339]
95. A fatty acid composition according to one of the preferred
embodiments 1 through 93, in which the fatty acids are present as
free fatty acids. [0340] 96. A fatty acid composition according to
one of the preferred embodiments 1 through 93, in which the fatty
acids are present as esters in di-glyceride form. [0341] 97. A
fatty acid composition according to one of the preferred
embodiments 1 through 93, in which the fatty acids are present as
esters in triglyceride form. [0342] 98. A fatty acid composition
according to one of the preferred embodiments 94 through 97, also
comprising a suitable anti-oxidant in a concentration sufficient to
protect the fatty acids of the composition from oxidation. [0343]
99. A pharmaceutically suitable formulation comprising one of the
compositions according to preferred embodiments 94 through 98, in
which the amount of eicosapentaenoic acid plus docosapentaenoic
acid is present in an amount between 100 and 10,000 mg. [0344] 100.
A pharmaceutically suitable formulation or dosage form comprising
one of the compositions according to preferred embodiments 94
through 98, in which the amount of eicosapentaenoic acid plus
docosapentaenoic acid is present in an amount between 250 and 1,250
mg.
[0345] 101. A pharmaceutically suitable formulation or dosage form
comprising one of the compositions according to preferred
embodiments 94 through 98, in which the amount of eicosapentaenoic
acid plus docosapentaenoic acid is present in an amount between 500
and 1,100 mg. [0346] 102. A pharmaceutically suitable formulation
or dosage form comprising one of the compositions according to
preferred embodiments 94 through 98, in which the amount of
eicosapentaenoic acid plus docosapentaenoic acid is present in an
amount between 100 and 10,000 mg. [0347] 103. A method of
administration or treatment to a subject of a formulation or dosage
form according to one of the preferred embodiments 94 through 102
at a daily dose between 100 and 10,000 mg. [0348] 104. A method of
administration or treatment to a subject of a formulation or dosage
form according to one of the preferred embodiments 94 through 102
at a daily dose between 500 and 5,000 mg. [0349] 105. A method of
administration or treatment to a subject of a formulation or dosage
form according to one of the preferred embodiments 94 through 102
at a daily dose between 1,500 and 4,100 mg. [0350] 106. A method of
treatment according to preferred e embodiments 103 through 105, in
which the subject is a patient diagnosed with very high
triglycerides (equal or more than 500 mg/dL). [0351] 107. A method
of treatment according to preferred embodiments 103 through 105, in
which the subject is a patient diagnosed with high triglycerides
(equal to or more than 200 mg/dL but less than 500 mg/dL). [0352]
108. A method of treatment according to preferred embodiments 103
through 105, in which the subject is a patient already undergoing
treatment with a statin and then diagnosed with high triglycerides
(equal to or more than 200 mg/dL but less than 500 mg/dL). [0353]
109. A method of treatment according to preferred embodiments 103
through 105, in which the subject is a patient diagnosed with mixed
dyslipidemia with TG 200-499 mg/dL and LDL-cholesterol equal to or
more than 190 mg/dL. [0354] 110. A method of treatment according to
preferred embodiments 103 through 105, in which the subject is a
patient diagnosed with mixed dyslipidemia with TG 300-700 mg/dL and
LDL-cholesterol equal to or more than 190 mg/dL. [0355] 111. A
method of treatment according to preferred embodiments 103 through
105, in which the subject is a patient diagnosed with mixed
dyslipidemia with TG 200-499 mg/dL and non-HDL-cholesterol equal to
or more than 200 mg/dL. [0356] 112. A method of treatment according
to preferred embodiments 103 through 105, in which the subject is a
patient diagnosed with mixed dyslipidemia with TG 300-700 mg/dL and
non-HDL-cholesterol equal to or more than 200 mg/dL. [0357] 113. A
method of treatment according to preferred embodiments 103 through
105, in which the subject is a patient diagnosed with mixed
dyslipidemia with TG 200-499 mg/dL and LDL-cholesterol equal to or
more than 160 mg/dL. [0358] 114. A method of treatment according to
preferred embodiments 103 through 105, in which the subject is a
patient diagnosed with mixed dyslipidemia with TG 300-700 mg/dL and
LDL-cholesterol equal to or more than 160 mg/dL. [0359] 115. A
method of treatment according to preferred embodiments 103 through
105, in which the subject is a patient diagnosed with mixed
dyslipidemia with TG 200-499 mg/dL and non-HDL-cholesterol equal to
or more than 160 mg/dL. [0360] 116. A method of treatment according
to preferred embodiments 103 through 105, in which the subject is a
patient diagnosed with mixed dyslipidemia with TG 300-700 mg/dL and
non-HDL-cholesterol equal to or more than 160 mg/dL. [0361] 117. A
method of treatment according to preferred embodiments 103 through
105, in which the subject is a patient diagnosed with mixed
dyslipidemia with TG 200-499 mg/dL and LDL-cholesterol equal to or
more than 130 mg/dL. [0362] 118. A method of treatment according to
preferred embodiments 103 through 105, in which the subject is a
patient diagnosed with mixed dyslipidemia with TG 300-700 mg/dL and
LDL-cholesterol equal to or more than 130 mg/dL. [0363] 119. A
method of treatment according to preferred embodiments 103 through
105, in which the subject is a patient diagnosed with mixed
dyslipidemia with TG 200-499 mg/dL and non-HDL-cholesterol equal to
or more than 130 mg/dL. [0364] 120. A method of treatment according
to preferred embodiments 103 through 105, in which the subject is a
patient diagnosed with mixed dyslipidemia with TG 300-700 mg/dL and
non-HDL-cholesterol equal to or more than 130 mg/dL. [0365] 121. A
method of treatment according to preferred embodiments 103 through
105, in which the subject is a patient diagnosed/assessed to be at
substantially elevated risk for cardiovascular events. [0366] 122.
A method of treatment according to preferred embodiments 103
through 105, in which the subject is a patient diagnosed with
diabetes. [0367] 123. A method of treatment according to preferred
embodiments 103 through 105, in which the subject is a patient
diagnosed with pre-diabetes or metabolic syndrome. [0368] 124. A
method of treatment according to one of the preferred embodiments
103 through 123, in which the treatment results in significant
reduction of blood, serum or plasma triglyceride levels. [0369]
125. A method of treatment according to one of the preferred
embodiments 103 through 123, in which the treatment results in
significant reduction of blood, serum or plasma triglyceride levels
while not significantly increasing blood, serum or plasma
LDL-cholesterol levels. [0370] 126. A method of treatment according
to one of the preferred embodiments 103 through 123, in which the
treatment results in significant reduction of blood, serum or
plasma total-cholesterol levels. [0371] 127. A method of treatment
according to one of the preferred embodiments 103 through 123, in
which the treatment results in significant reduction of blood,
serum or plasma non-HDL-cholesterol levels. [0372] 128. A method of
treatment according to one of the preferred embodiments 103 through
123, in which the treatment results in significant reduction of
blood, serum or plasma LDL-cholesterol levels. [0373] 129. A method
of treatment according to one of the preferred embodiments 103
through 123, in which the treatment results in significant
reduction of blood, serum or plasma VLDL-cholesterol levels. [0374]
130. A method of treatment according to one of the preferred
embodiments 103 through 123, in which the treatment results in
significant reduction of blood, serum or plasma VLDL-cholesterol
levels while not significantly increasing blood, serum or plasma
LDL-cholesterol levels. [0375] 131. A method of treatment according
to one of the preferred embodiments 103 through 123, in which the
treatment results in significant reduction of blood, serum or
plasma apo-B levels. [0376] 132. A method of treatment according to
one of the preferred embodiments 103 through 123, in which the
treatment results in significant reduction of blood, serum or
plasma apo-C-III levels. [0377] 133. A method of treatment
according to one of the preferred embodiments 103 through 123, in
which the treatment results in significant reduction of blood,
serum or plasma LP-PLA2 levels. [0378] 134. A method of treatment
according to one of the preferred embodiments 103 through 123, in
which the treatment results in significant reduction of blood,
serum or plasma hs-CRP levels. [0379] 135. A method of treatment
according to one of the preferred embodiments 103 through 123, in
which the treatment results in significant increase of blood, serum
or plasma HDL-cholesterol levels. [0380] 136. A method of treatment
according to one of the preferred embodiments 103 through 123, in
which the treatment results in significant increase of blood, serum
or plasma apo-A levels. [0381] 137. A method of treatment according
to one of the preferred embodiments 103 through 123, in which the
treatment results in significant reduction of the risk of suffering
certain cardiovascular events.
* * * * *