U.S. patent application number 13/973456 was filed with the patent office on 2014-11-27 for oral dosage forms of methyl hydrogen fumarate and prodrugs thereof.
This patent application is currently assigned to XenoPort, Inc.. The applicant listed for this patent is XenoPort, Inc.. Invention is credited to Ching Wah Chong, Mesut Ciper, Peter Robert Prinz Freed, Sami Karaborni, Stefanie Krenzlin, Sarina Grace Harris Ma, Chen Mao, Peter A. Virsik, David J. Wustrow.
Application Number | 20140348914 13/973456 |
Document ID | / |
Family ID | 49085232 |
Filed Date | 2014-11-27 |
United States Patent
Application |
20140348914 |
Kind Code |
A9 |
Karaborni; Sami ; et
al. |
November 27, 2014 |
Oral Dosage Forms of Methyl Hydrogen Fumarate and Prodrugs
Thereof
Abstract
Improved oral dosage forms of methyl hydrogen fumarate and
prodrugs thereof are disclosed. Methods of treating diseases such
as multiple sclerosis and psoriasis using such dosage forms are
also disclosed.
Inventors: |
Karaborni; Sami; (Cupertino,
CA) ; Ma; Sarina Grace Harris; (Santa Clara, CA)
; Mao; Chen; (Mountain View, CA) ; Chong; Ching
Wah; (Fremont, CA) ; Freed; Peter Robert Prinz;
(Downingtown, PA) ; Ciper; Mesut; (Oelde, DE)
; Krenzlin; Stefanie; (Muenster, DE) ; Wustrow;
David J.; (Los Gatos, CA) ; Virsik; Peter A.;
(Portola Valley, CA) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
XenoPort, Inc. |
Santa Clara |
CA |
US |
|
|
Assignee: |
XenoPort, Inc.
Santa Clara
CA
|
Prior
Publication: |
|
Document Identifier |
Publication Date |
|
US 20140065211 A1 |
March 6, 2014 |
|
|
Family ID: |
49085232 |
Appl. No.: |
13/973456 |
Filed: |
August 22, 2013 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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61692168 |
Aug 22, 2012 |
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61692174 |
Aug 22, 2012 |
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61692179 |
Aug 22, 2012 |
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61713897 |
Oct 15, 2012 |
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61713961 |
Oct 15, 2012 |
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61733234 |
Dec 4, 2012 |
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61769513 |
Feb 26, 2013 |
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61837796 |
Jun 21, 2013 |
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61841513 |
Jul 1, 2013 |
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Current U.S.
Class: |
424/465 ; 264/15;
514/239.2; 514/547 |
Current CPC
Class: |
A61K 31/215 20130101;
A61P 29/00 20180101; A61K 9/2886 20130101; A61K 9/4866 20130101;
A61P 25/14 20180101; A61P 25/16 20180101; A61K 9/284 20130101; A61P
17/06 20180101; Y02A 50/414 20180101; A61P 17/02 20180101; A61K
9/2866 20130101; A61P 1/04 20180101; A61K 31/5375 20130101; A61K
9/2054 20130101; A61K 9/2826 20130101; A61P 19/00 20180101; Y02A
50/30 20180101; A61K 9/1652 20130101; A61P 21/02 20180101; A61K
31/27 20130101; A61K 9/2095 20130101; A61K 31/225 20130101; A61K
9/146 20130101; A61P 19/02 20180101; A61P 25/28 20180101; A61K
9/4808 20130101; A61P 25/00 20180101 |
Class at
Publication: |
424/465 ;
514/239.2; 514/547; 264/15 |
International
Class: |
A61K 9/28 20060101
A61K009/28; A61K 31/225 20060101 A61K031/225; A61K 9/20 20060101
A61K009/20; A61K 31/5375 20060101 A61K031/5375 |
Claims
1. An oral dosage form comprising: a core comprising a
therapeutically effective amount of a compound selected from (i)
methyl hydrogen fumarate (MHF), (ii) a prodrug of MHF, (iii)
pharmaceutically acceptable salts of (i) or (ii), and (iv)
combinations of any of the foregoing; a barrier layer surrounding
said core, the barrier layer comprising a material that is (i) a
weakly acidic (proton-donating) material having a pKa of greater
than 8, (ii) a weakly basic (proton-accepting) material having a
pKa of less than 2, (iii) a natural gum or polysaccharide
derivative (iv) a neutral polymer salt, (v) a sugar, (vi) a lipid,
or (vii) combinations of any of the foregoing; the barrier layer
preventing direct contact between the core and an enteric coating;
and the enteric coating surrounding said barrier layer and
comprising an enteric polymer having carboxylic acid moieties, the
enteric polymer (i) being soluble in aqueous solutions having a pH
above 7.5, and (ii) starting to become soluble in an aqueous
solution at a pH in the range of 4.5 to 7.5.
2. The oral dosage form of claim 1, wherein the barrier layer
material is a non-ionizable polymer substantially free of
carboxylic acid moieties.
3. The oral dosage form of claim 1, wherein the barrier layer
material is selected from non-ionizable cellulosic polymers,
non-ionizable vinyl polymers, and non-ionizable polyvinyl alcohol
polymers.
4. The oral dosage form of claim 1, wherein the barrier layer
material is a sugar.
5. The oral dosage form of claim 1, wherein the barrier layer
comprises at least 5 wt % of the coated core for cores having a
size of 2 mm or less.
6. The oral dosage form of claim 1, wherein the barrier layer
comprises at least 0.5 wt % of the coated core for cores having a
size greater than 6 mm.
7. The oral dosage form of claim 1, wherein the barrier layer has
an average thickness of at least 5 .mu.m.
8. The oral dosage form of claim 1, wherein the barrier layer has
an average thickness of at least 15 .mu.m.
9. The oral dosage form of claim 1, wherein the barrier layer
material is either (i) a weakly acidic (proton-donating) material
having a pKa of greater than 10, or (ii) a weakly basic
(proton-accepting) material having a pKa of less than 0.
10. The oral dosage form of claim 1, wherein the compound comprises
methyl hydrogen fumarate.
11. The oral dosage form of claim 1, wherein the compound comprises
a prodrug of methyl hydrogen fumarate.
12. The oral dosage form of claim 11, wherein the prodrug of methyl
hydrogen fumarate is a compound of formula (I): ##STR00005## or a
pharmaceutically acceptable salt thereof, wherein: R.sup.1 and
R.sup.2 are independently chosen from hydrogen, C.sub.1-6 alkyl,
and substituted C.sub.1-6 alkyl; R.sup.3 and R.sup.4 are
independently chosen from hydrogen, C.sub.1-6 alkyl, substituted
C.sub.1-6 alkyl, C.sub.1-6 heteroalkyl, substituted C.sub.1-6
heteroalkyl, C.sub.3-11 cycloalkyl, substituted C.sub.3-11
cycloalkyl, C.sub.4-12 cycloalkylalkyl, substituted C.sub.4-12
cycloalkylalkyl, C.sub.7-12 arylalkyl, and substituted C.sub.7-12
arylalkyl; or R.sup.3 and R.sup.4 together with the nitrogen to
which they are bonded form a ring chosen from a C.sub.4-10
heteroaryl; substituted C.sub.4-10 heteroaryl, C.sub.4-10
heterocycloalkyl, and substituted C.sub.4-10 heterocycloalkyl; n is
an integer from 0 to 4; and X is independently chosen from a single
oxygen atom and a pair of hydrogen atoms; wherein each substituent
group is independently chosen from halogen, --OH, --CN, --CF.sub.3,
.dbd.O, --NO.sub.2, benzyl --C(O)NR.sup.11.sub.2, --R.sup.11,
--OR.sup.11, --C(O)R.sup.11, --COOR.sup.11, and --NR.sup.11.sub.2
wherein each R.sup.11 is independently chosen from hydrogen and
C.sub.1-4alkyl; and wherein when X is a single oxygen atom, the
oxygen atom is connected to the carbon to which it is bonded by a
double bond to form a carboxyl group and when X is a pair of
hydrogen atoms, each hydrogen atom is connected to the carbon to
which it is bonded to by single bond.
13. The oral dosage form of claim 11, wherein the prodrug of methyl
hydrogen fumarate is a compound of formula (II): ##STR00006## or a
pharmaceutically acceptable salt thereof, wherein: n is an integer
from 2 to 6; and R.sup.1 is methyl.
14. The oral dosage form of claim 12, wherein the prodrug of methyl
hydrogen fumarate is selected from dimethyl fumarate,
(N,N-Diethylcarbamoyl)methyl methyl (2E)but-2-ene-1,4-dioate,
(N,N-Dimethylcarbamoyl)methyl methyl (2E)but-2-ene-1,4-dioate, and
pharmaceutically acceptable salts thereof.
15. The oral dosage form of claim 14, wherein the prodrug of methyl
hydrogen fumarate comprises (N,N-Diethylcarbamoyl)methyl methyl
(2E)but-2-ene-1,4-dioate.
16. The oral dosage form of claim 13, wherein the compound is
selected from methyl 4-morpholin-4-ylbutyl
(2E)but-2-ene-1,4-dioate, methyl 5-morpholin-4-ylpentyl
(2E)but-2-ene-1,4-dioate HCl, and pharmaceutically acceptable salts
thereof.
17. The oral dosage form of claim 1, wherein the core is a
compressed tablet and the barrier layer and enteric coating are
each a coating on the tablet.
18. The oral dosage form of claim 17, wherein the tablet contains
from 100 to 1200 mg of the compound and one or more tableting
excipients.
19. The oral dosage form of claim 18, wherein the tableting
excipients are selected from binders, diluents, disintegrants,
glidants and lubricants.
20. The oral dosage form of claim 1, wherein the dosage form is a
capsule containing a multiplicity of said enteric coated cores.
21. The oral dosage form of claim 1, wherein the core comprises an
immediate release dosage form.
22. The oral dosage form of claim 1, wherein the core comprises a
sustained release dosage form.
23. The oral dosage form of claim 1, wherein the enteric polymer is
selected from methacrylic acid polymers, cellulose acetate
phthalate polymers, hydroxypropylmethyl cellulose acetate succinate
polymers, hydroxypropylmethyl cellulose phthalate polymers and
polyvinyl acetate phthalate polymers.
24. A method of treating a disease in a patient, comprising orally
administering to a patient in need thereof a dosage form of claim
1.
25. The method of claim 24, wherein the oral administration is
sufficient to obtain a therapeutic concentration of methyl hydrogen
fumarate in blood plasma of the patient of at least 0.7 .mu.g/ml at
a time within 24 hours after said oral administration.
26. The method of any one of claim 24, wherein the oral
administration is sufficient to obtain an area under a
concentration of methyl hydrogen fumarate in blood plasma versus
time curve (AUC) of at least 12.0 .mu.ghr/ml over 24 hours after
start of the oral administration.
27. The method of claim 24, wherein the disease is multiple
sclerosis.
28. The method of claim 24, wherein the disease is psoriasis.
29. The method of any one of claim 24, wherein the disease is
selected from Parkinson's disease, ALS, Huntington's disease,
Alzheimer's disease, lupus, Crohn's disease, psoriatic arthritis
and alkylosing spondilitis.
30. A method of making (N,N-Diethylcarbamoyl)methyl methyl
(2E)but-2-ene-1,4-dioate-containing pharmaceutical pellets
comprising: mixing the (N,N-Diethylcarbamoyl)methyl methyl
(2E)but-2-ene-1,4-dioate in an aqueous medium; adding acetic acid
to the aqueous medium; and maintaining the aqueous medium at a pH
at or below 3.8.
31. The method of claim 30, comprising maintaining the aqueous
medium at a pH at or below 3.5.
32. The method of claim 30, wherein the pellets are made by mixing
the (N,N-Diethylcarbamoyl)methyl methyl (2E)but-2-ene-1,4-dioate
with water and a binder to form a wet dough, extruding the wet
dough to form an extrudate, spheronizing the extrudate to form
pellets and drying the pellets.
33. The method of claim 32, wherein the extruding comprises forcing
the wet dough through a screen or a plate with holes.
34. The method of claim 30, wherein the pellets are made by mixing
the (N,N-Diethylcarbamoyl)methyl methyl (2E)but-2-ene-1,4-dioate
with water and a binder to form a wetted mass, introducing the
wetted mass onto a rotating friction plate to form pellets and
drying the pellets.
35. The oral dosage form according to claim 1, wherein the
pharmaceutically acceptable excipient is a polymeric excipient that
is (i) weakly acidic (proton-donating) having a pKa of greater than
8, or (ii) weakly basic (proton-accepting) having a pKa of less
than 2.
36. The dosage form of claim 35, wherein the polymer is selected
from non ionizable polymers that are substantially free of
carboxylic acid moieties.
37. The dosage form of claim 35, wherein the non-ionizable polymer
is selected from non-ionizable cellulosic polymers, non-ionizable
vinyl polymers, and non-ionizable polyvinyl alcohol polymers.
38. The oral dosage form of claim 35, wherein the polymers are
either (i) weakly acidic (proton-donating) having a pKa of greater
than 10, or (ii) weakly basic (proton-accepting) having a pKa of
less than 0.
39. The oral dosage form of claim 23, wherein the enteric coating
is selected from the group consisting of hydroxypropyl methyl
cellulose acetate succinate, hydroxypropyl methyl cellulose
succinate, hydroxypropyl cellulose acetate succinate, hydroxyethyl
methyl cellulose succinate, hydroxyethyl cellulose acetate
succinate, hydroxypropyl methyl cellulose phthalate, hydroxyethyl
methyl cellulose acetate succinate, hydroxyethyl methyl cellulose
acetate phthalate, carboxyethyl cellulose, carboxymethyl cellulose,
cellulose acetate phthalate, methyl cellulose acetate phthalate,
ethyl cellulose acetate phthalate, hydroxypropyl cellulose acetate
phthalate, hydroxypropyl methyl cellulose acetate phthalate,
hydroxypropyl cellulose acetate phthalate succinate, hydroxypropyl
methyl cellulose acetate succinate phthalate, hydroxypropyl methyl
cellulose succinate phthalate, cellulose propionate phthalate,
hydroxypropyl cellulose butyrate phthalate, cellulose acetate
trimellitate, methyl cellulose acetate trimellitate, ethyl
cellulose acetate trimellitate, hydroxypropyl cellulose acetate
trimellitate, hydroxypropyl methyl cellulose acetate trimellitate,
hydroxypropyl cellulose acetate trimellitate succinate, cellulose
propionate trimellitate, cellulose butyrate trimellitate, cellulose
acetate terephthalate, cellulose acetate isophthalate, cellulose
acetate pyridinedicarboxylate, salicylic acid cellulose acetate,
hydroxypropyl salicylic acid cellulose acetate, ethylbenzoic acid
cellulose acetate, hydroxypropyl ethylbenzoic acid cellulose
acetate, ethyl phthalic acid cellulose acetate, ethyl nicotinic
acid cellulose acetate, and ethyl picolinic acid cellulose
acetate.
40. A method of improving the yield of MHF-containing or MHF
prodrug-containing pellets within a predetermined pellet size range
during manufacture of said pellets, comprising: combining the MHF
or the MHF prodrug with water, an extrusion aid, and a binder, to
form a wet mixture; passing the mixture through a sieve, screen or
die to form an extrudate; and spheronizing the extrudate to form
pellets.
41. The method of claim 40, wherein the MHF prodrug is
(N,N-Diethylcarbamoyl)methyl methyl (2E)but-2-ene-1,4-dioate.
42. The method of claim 40, wherein the extrusion aid is
microcrystalline cellulose.
43. The method of claim 42, wherein the mixture contains about 10
to 90 wt % microcrystalline cellulose.
44. The method of claim 40, wherein the binder is hydroxypropyl
cellulose.
45. The method of claim 44, wherein the mixture contains about 2 to
10 wt % hydroxypropyl cellulose.
46. The method of claim 40, wherein the mixture also includes a
disintegrant.
47. The method of claim 46, wherein the disintegrant is
croscarmellose sodium.
48. The method of claim 47, wherein the mixture contains about 0.5
to 10 wt % croscarmellose sodium.
49. The method of claim 40, wherein the predetermined pellet size
range is +/-0.3 mm of the sieve, screen or die size.
Description
[0001] This application claims the benefit under 35 U.S.C.
.sctn.119(e) of U.S. Provisional Application Ser. Nos. 61/692,179
filed Aug. 22, 2012, 61/692,168, filed Aug. 22, 2012, 61/713,897
filed Oct. 15, 2012, 61/733,234 filed Dec. 4, 2012, 61/769,513
filed Feb. 26, 2013, 61/841,513 filed Jul. 1, 2013, 61/692,174
filed Aug. 22, 2012, and 61/713,961 filed Oct. 15, 2012, 61/837,796
filed Jun. 21, 2013 the contents of each of which are incorporated
by reference in their entirety.
TECHNICAL FIELD
[0002] The present disclosure relates to oral dosage forms of
methyl hydrogen fumarate (MHF) and prodrugs of MHF which are useful
in treating conditions such as multiple sclerosis (MS) and/or
psoriasis.
BACKGROUND
[0003] Fumaric acid esters, i.e., dimethylfumarate (DMF) in
combination with salts of ethylhydrogenfumarate, have been used in
the treatment of psoriasis for many years. The combination product,
marketed under the tradename Fumaderm.RTM., is in the form of oral
tablets and is available in two different dosage strengths
(Fumaderm.RTM. initial and Fumaderm.RTM.):
TABLE-US-00001 Fumaderm .RTM. Fumaderm .RTM. Fumarate Compound
Initial (mg) (mg) Dimethylfumarate 30 120 Ethyl hydrogen fumarate,
calcium salt 67 87 Ethyl hydrogen fumarate, magnesium salt 5 5
Ethyl hydrogen fumarate, zinc salt 3 3
[0004] The two strengths are intended to be applied in an
individually based dosing regimen starting with Fumaderm.RTM.
initial in an escalating dose, and then after, e.g., three weeks of
treatment, switching to Fumaderm.RTM.. Both Fumaderm.RTM. initial
and Fumaderm.RTM. are enteric coated tablets.
[0005] Another marketed composition is Fumaraat 120.RTM. containing
120 mg of DMF and 95 mg of calcium monoethyl fumarate (TioFarma,
Oud-Beijerland, Netherlands). The pharmacokinetic profile of
Fumaraat 120.RTM. in healthy subjects is described in Litjens et
al., Br. J. Clin. Pharmacol., 2004, vol. 58:4, pp. 429-432. The
results show that a single oral dose of Fumaraat 120.RTM. is
followed by a rise in serum MHF concentration and only negligible
concentrations of DMF and fumaric acid is observed. Thus, DMF is
thought to be a precursor or prodrug of MHF.
[0006] U.S. Pat. Nos. 6,277,882 and 6,355,676 disclose respectively
the use of alkyl hydrogen fumarates and the use of certain fumaric
acid monoalkyl ester salts for preparing microtablets for treating
psoriasis, psoriatic arthritis, neurodermatitis and enteritis
regionalis Crohn. U.S. Pat. No. 6,509,376 discloses the use of
certain dialkyl fumarates for the preparation of pharmaceutical
preparations for use in transplantation medicine or the therapy of
autoimmune diseases in the form of microtablets or micropellets.
U.S. Pat. No. 4,959,389 discloses compositions containing different
salts of fumaric acid monoalkyl esters alone or in combination with
a dialkyl fumarate. GB 1,153,927 relates to medical compositions
comprising dimethyl maleic anhydride, dimethyl maleate and/or
DMF.
[0007] Biogen Idec's BG12, an oral dosage form of DMF that is an
enteric coated capsule containing DMF in micropellet form, has been
in human clinical testing for the treatment of MS and has shown
promising results in reducing MS relapses and MS disability
progression. Unfortunately, DMF is highly irritating to the skin
and mucosal membranes with the result that oral administration of
DMF tends to cause serious digestive tract irritation with
attendant nausea, vomiting, abdominal pain and diarrhea. This
irritation problem is particularly problematic with the mucosal
tissue lining the stomach. For this reason, products such as
Fumaderm.RTM. and BG12 are made with enteric coatings that prevent
the DMF from being released from the dosage form until after the
dosage form passes out of the stomach and into the small
intestine.
[0008] More recently, MHF prodrugs including
(N,N-Diethylcarbamoyl)methyl methyl (2E)but-2-ene-1,4-dioate and
(N,N-Dimethylcarbamoyl)methyl methyl (2E)but-2-ene-1,4-dioate are
disclosed in Gangakhedkar et al. U.S. Pat. No. 8,148,414.
Additional MHF prodrugs are disclosed in Cundy et al. U.S. Patent
Application 61/595,835 filed Feb. 7, 2012. Both of these disclose
the use of MHF prodrugs for treating a number of medical
conditions, including MS and psoriasis.
SUMMARY
[0009] Disclosed herein are orally administered enteric coated
tablet dosage forms of methyl hydrogen fumarate, or a prodrug of
methyl hydrogen fumarate, having improved prodrug stability and
shelf-life. The dosage forms are useful for treating conditions
such as multiple sclerosis and psoriasis.
[0010] Fumaric acid esters such as methyl hydrogen fumarate and
prodrugs of methyl hydrogen fumarate, e.g., dimethyl fumarate, have
certain physical and chemical properties that cause problems when
such compounds are used as therapeutic agents, particularly when
administered orally to a patient. First, such compounds have been
shown to cause skin irritation. Second, such compounds exhibit
degrees of chemical instability upon exposure to light, including
ultra violet light. Third, such compounds have been shown to cause
flushing in certain patients and/or at certain dosages. Fourth,
certain fumarate compounds (i.e., dimethyl fumarate) have been
shown to cause adverse interactions with the endothelial tissues
lining the stomach, causing severe tissue damage and attendant
gastrointestinal distress and symptoms such as nausea and abdominal
pain and diarrhea. Fifth such compounds tend to be chemically less
stable at low pH levels (e.g., pH 2), compared to near neutral pH
levels (e.g., pH of 3 to 6) with the result that the compounds can
chemically break down into non-therapeutic metabolites in the low
pH environs of the stomach. While enteric coatings have previously
been proposed for certain fumarate dosage forms, it has now been
discovered that these fumarate compounds tend to exhibit poor
chemical stability in the presence of such enteric coating
materials.
[0011] These and other problems are solved by an oral dosage form
containing a therapeutically effective amount of a compound
selected from (i) methyl hydrogen fumarate (MHF), (ii) a prodrug of
MHF, pharmaceutically acceptable salts thereof and combinations
thereof. The dosage form has a core containing the compound, and an
enteric coating surrounding the core. The enteric coating is
comprised of an enteric polymer having carboxylic acid moieties,
the enteric polymer (i) being soluble in aqueous solutions having a
pH above 7.5, and (ii) starting to become soluble in an aqueous
solution at a pH in the range of 4.5 to 7.5.
[0012] A barrier layer is disposed between the compound-containing
core and the enteric coating to prevent direct contact between the
compound-containing core and the enteric coating. In various
aspects, the barrier layer is composed of a material that is either
(i) a weakly acidic (proton-donating) material having a pKa of
greater than 8, (ii) a weakly basic (proton-accepting) material
having a pKa of less than 2, (iii) a natural gum or polysaccharide,
(iv) a neutral polymer salt, (v) a sugar, or (vi) a lipid.
[0013] In further aspects, the barrier layer comprises a polymer
that is either (i) weakly acidic (proton-donating) having a pKa of
greater than 10, or (ii) weakly basic (proton-accepting) having a
pKa of less than 0.
[0014] In certain embodiments, the barrier layer material is a
non-ionizable polymer. In other embodiments, the barrier layer
material is selected from non-ionizable cellulosic polymers,
non-ionizable vinyl polymers, and non-ionizable non-vinyl,
non-cellulosic polymer and/or sugars. In various other aspects, the
barrier layer can comprise a natural gum or polysaccharide, neutral
polymer salts, readily ionizable polymers lacking carboxylic acid
moieties, sugars, or lipids. In certain embodiments, the barrier
layer comprises at least 5 wt % of the coated core for cores having
a size of 2 mm or less. In other embodiments, the barrier layer
comprises at least 1 wt % of the coated core for cores having a
size greater than 6 mm. In certain embodiments, the barrier layer
has an average thickness of at least 5 .mu.m. In other embodiments,
the barrier layer has an average thickness of at least 15 .mu.m. In
still other embodiments, the barrier layer material is either (i) a
weakly acidic (proton-donating) material having a pKa of greater
than 10, or (ii) a weakly basic (proton-accepting) material having
a pKa of less than 0.
[0015] In various embodiments, the barrier layer material can be
substantially free of carboxylic acid moieties.
[0016] In certain embodiments, the fumarate compound comprises
methyl hydrogen fumarate. In other embodiments, the fumarate
compound comprises a prodrug of methyl hydrogen fumarate. In still
other embodiments, the fumarate compound is a prodrug of methyl
hydrogen fumarate selected from dimethyl fumarate,
(N,N-Diethylcarbamoyl)methyl methyl (2E)but-2-ene-1,4-dioate,
(N,N-Dimethylcarbamoyl)methyl methyl (2E)but-2-ene-1,4-dioate, and
combinations thereof.
[0017] In certain embodiments, the core is a compressed tablet and
the barrier layer and enteric coating are each a coating on the
tablet. In other embodiments, the dosage form is a capsule
containing a multiplicity of said enteric coated cores.
[0018] In certain embodiments, the core comprises an immediate
release dosage form. In other embodiments, the core comprises a
sustained release dosage form.
[0019] The enteric polymer can be selected from methacrylic acid
polymers, cellulose acetate phthalate polymers, hydroxypropylmethyl
cellulose acetate succinate polymers, hydroxypropylmethyl cellulose
phthalate polymers and polyvinyl acetate phthalate polymers.
[0020] Also provided is a method of treating a disease in a
patient, comprising orally administering to a patient in need
thereof a dosage form as described above. The dosage forms are
particularly useful for treating multiple sclerosis
and/psoriasis.
[0021] Also provided is a method of making
(N,N-Diethylcarbamoyl)methyl methyl
(2E)but-2-ene-1,4-dioate-containing pharmaceutical pellets. The
method includes providing the (N,N-Diethylcarbamoyl)methyl methyl
(2E)but-2-ene-1,4-dioate in an aqueous medium containing acetic
acid while maintaining the aqueous medium at a pH at or below 3.8
so that the acetic acid remains in a predominantly non-ionized
state. In certain embodiments, the aqueous medium is maintained at
a pH at or below 3.5. Upon drying, the pellets demonstrate a
greatly reduced tendency to agglomerate.
BRIEF DESCRIPTION OF THE DRAWINGS
[0022] FIG. 1 is a graph showing the in vitro MHF prodrug release
profile (percent MHF prodrug released over time) for the dosage
forms of Example 1, tested in accordance with Example 3;
[0023] FIG. 2 is a graph showing the in vitro MHF prodrug release
profile (percent MHF prodrug released over time) for the dosage
forms of Example 2, tested in accordance with Example 3;
[0024] FIG. 3 is a graph showing the percent of MHF prodrug
degradation over 3 months for the dosage forms of Example 2 and
Comparative Example 1, tested in accordance with Example 4;
[0025] FIG. 4 is a graph showing the concentration of MHF in the
blood of fed monkeys following administration of the oral dosage
forms similar to those of Examples 5 and 6;
[0026] FIG. 5 is a graph showing the concentration of MHF in the
blood of fasted monkeys following administration of the oral dosage
forms similar to those of Examples 5 and 6;
[0027] FIG. 6 is a graph showing the concentration of MMF in the
blood in fed and fasted healthy human patients following
administration of the oral dosage form of Example 1;
[0028] FIG. 7 is a graph showing the concentration of MMF in the
blood in fed and fasted healthy human patients following
administration of the oral dosage form of Example 2;
[0029] FIG. 8 is a graph showing the in vitro MHF prodrug release
profile (percent MHF prodrug released over time) for the dosage
forms of Example 9, tested in accordance with Example 12;
[0030] FIG. 9 is a graph showing the in vitro MHF prodrug release
profile (percent MHF prodrug released over time) for the dosage
forms of Example 10, tested in accordance with Example 12;
[0031] FIG. 10 is a graph showing the concentration of MHF in the
blood of fasted monkeys following administration of the oral dosage
forms of Example 9;
[0032] FIG. 11 is a graph showing the concentration of MHF in the
blood of fed monkeys following administration of the oral dosage
forms of Example 9;
[0033] FIG. 12 is an electron micrograph of
(N,N-Diethylcarbamoyl)methyl methyl
(2E)but-2-ene-1,4-dioate-containing pellets prepared at pH 4.1 as
described in Example 14;
[0034] FIG. 13 is an electron micrograph of
(N,N-Diethylcarbamoyl)methyl methyl
(2E)but-2-ene-1,4-dioate-containing pellets prepared at pH 3.5 as
described in Example 14;
[0035] FIG. 14 is a graph showing the concentration of MMF in the
blood in fed and fasted healthy human patients following
administration of the oral dosage form of Example 10;
[0036] FIG. 15 is a graph showing percent MHF prodrug degradation
as a function of enteric polymer carboxylic moiety content, as
tested in Example 16;
[0037] FIG. 16 is a graph showing the rate of degradation of two
MHF prodrugs as a function of acetate concentration as tested in
Example 17; and
[0038] FIG. 17 is a graph showing the amounts of MHF and another
primary degradant formed upon degradation of an MHF prodrug as a
function of acetate concentration, as tested in Example 17.
DEFINITIONS
[0039] A dash ("-") that is not between two letters or symbols is
used to indicate a point of attachment for a moiety or substituent.
For example, --CONH.sub.2 is bonded through the carbon atom.
[0040] "Alkyl" refers to a saturated or unsaturated, branched,
cyclic, or straight-chain, monovalent hydrocarbon radical derived
by the removal of one hydrogen atom from a single carbon atom of a
parent alkane, alkene, or alkyne. Examples of alkyl groups include,
for example, methyl; ethyls such as ethanyl, ethenyl, and ethynyl;
propyls such as propan-1-yl, propan-2-yl, prop-1-en-1-yl,
prop-1-en-2-yl, prop-2-en-1-yl (allyl), prop-1-yn-1-yl,
prop-2-yn-1-yl, etc.; butyls such as butan-1-yl, butan-2-yl,
2-methyl-propan-1-yl, 2-methyl-propan-2-yl, but-1-en-1-yl,
but-1-en-2-yl, 2-methyl-prop-1-en-1-yl, but-2-en-1-yl,
but-2-en-2-yl, buta-1,3-dien-1-yl, buta-1,3-dien-2-yl,
but-1-yn-1-yl, but-1-yn-3-yl, but-3-yn-1-yl, cyclopropyl,
cyclobutyl, cyclopentyl, etc.; and the like.
[0041] The term "alkyl" includes groups having any degree or level
of saturation, i.e., groups having exclusively single carbon-carbon
bonds, groups having one or more double carbon-carbon bonds, groups
having one or more triple carbon-carbon bonds, and groups having
combinations of single, double, and triple carbon-carbon bonds.
Where a specific level of saturation is intended, the terms
alkanyl, alkenyl, or alkynyl are used. The term "alkyl" includes
cycloalkyl and cycloalkylalkyl groups. In certain embodiments, an
alkyl group can have from 1 to 10 carbon atoms (C.sub.1-10), in
certain embodiments, from 1 to 6 carbon atoms (C.sub.1-6), in
certain embodiments from 1 to 4 carbon atoms (C.sub.1-4), in
certain embodiments, from 1 to 3 carbon atoms (C.sub.1-3), and in
certain embodiments, from 1 to 2 carbon atoms (C.sub.1-2). In
certain embodiments, alkyl is methyl, in certain embodiments,
ethyl, and in certain embodiments, n-propyl or isopropyl.
[0042] "Arylalkyl" refers to an acyclic alkyl radical in which one
of the hydrogen atoms bonded to a carbon atom, typically a terminal
or sp.sup.3 carbon atom, is replaced with an aryl group. Examples
of arylalkyl groups include, but are not limited to, benzyl,
2-phenylethan-1-yl, 2-phenylethen-1-yl, naphthylmethyl,
2-naphthylethan-1-yl, 2-naphthylethen-1-yl, naphthobenzyl,
2-naphthophenylethan-1-yl and the like. Where specific alkyl
moieties are intended, the nomenclature arylalkanyl, arylalkenyl,
or arylalkynyl is used. In certain embodiments, an arylalkyl group
is C.sub.7-30 arylalkyl, e.g., the alkanyl, alkenyl or alkynyl
moiety of the arylalkyl group is C.sub.1-10 and the aryl moiety is
C.sub.6-20, in certain embodiments, an arylalkyl group is
C.sub.6-18 arylalkyl, e.g., the alkanyl, alkenyl or alkynyl moiety
of the arylalkyl group is C.sub.1-8 and the aryl moiety is
C.sub.6-10. In certain embodiments, an arylalkyl group is
C.sub.7-12 arylalkyl.
[0043] "AUC" refers to the area under a curve on which time is
plotted on the X-axis and concentration of a substance (e.g., MHF)
in blood or blood plasma is plotted on the Y-axis over a particular
period of time (e.g., time zero to 24 hours). AUC is commonly
expressed in units of mghr/ml.
[0044] "Compounds" include MHF and MHF prodrugs. MHF products
include DMF and the compounds of Formula (I) or Formula (II)
including any specific compounds within these formulae. Compounds
may be identified either by their chemical structure and/or
chemical name. Compounds are named using Chemistry 4-D Draw Pro,
version 7.01c (ChemInnovation Software, Inc., San Diego, Calif.).
When the chemical structure and chemical name conflict, the
chemical structure is determinative of the identity of the
compound. The compounds described herein may comprise one or more
chiral centers and/or double bonds and therefore may exist as
stereoisomers such as double bond isomers (i.e., geometric
isomers), enantiomers, or diastereomers. Accordingly, any chemical
structures within the scope of the specification depicted, in whole
or in part, with a relative configuration are deemed to encompass
all possible enantiomers and stereoisomers of the illustrated
compounds including the stereoisomerically pure form (e.g.,
geometrically pure, enantiomerically pure, or diastereomerically
pure) and enantiomeric and stereoisomeric mixtures. Enantiomeric
and stereoisomeric mixtures may be resolved into their component
enantiomers or stereoisomers using separation techniques or chiral
synthesis techniques well known to those skilled in the art.
Compounds of Formula (I) or Formula (II) include, for example,
optical isomers of compounds of Formula (I) or Formula (II),
racemates thereof, and other mixtures thereof. In such embodiments,
a single enantiomer or diastereomer, i.e., optically active form,
can be obtained by asymmetric synthesis or by resolution of the
racemates. Resolution of the racemates may be accomplished, for
example, by methods such as crystallization in the presence of a
resolving agent, or chromatography using, for example, chiral
stationary phases. Notwithstanding the foregoing, in compounds of
Formula (I) or Formula (II) the configuration of the illustrated
double bond is only in the E configuration (i.e., trans
configuration).
[0045] MHF and MHF prodrug compounds also include isotopically
labeled compounds where one or more atoms have an atomic mass
different from the atomic mass conventionally found in nature.
Examples of isotopes that may be incorporated into the compounds
disclosed herein include, for example, .sup.2H, .sup.3H, .sup.11C,
.sup.13C, .sup.14C, .sup.15N, .sup.18O, .sup.17O, etc. Compounds
may exist in unsolvated forms as well as solvated forms, including
hydrated forms and as N oxides. In general, compounds disclosed
herein may be free acid, hydrated, solvated, or N oxides. Certain
compounds may exist in multiple crystalline, co-crystalline, or
amorphous forms. Compounds of Formula (I) or Formula (II) include
pharmaceutically acceptable salts thereof or pharmaceutically
acceptable solvates of the free acid form of any of the foregoing,
as well as crystalline forms of any of the foregoing.
[0046] MHF and MHF prodrug compounds also include solvates. A
solvate refers to a molecular complex of a compound with one or
more solvent molecules in a stoichiometric or non-stoichiometric
amount. Such solvent molecules include those commonly used in the
pharmaceutical art, which are known to be innocuous to a patient,
e.g., water, ethanol, and the like. A molecular complex of a
compound or moiety of a compound and a solvent can be stabilized by
non-covalent intra-molecular forces such as, for example,
electrostatic forces, van der Waals forces, or hydrogen bonds. The
term "hydrate" refers to a solvate in which the one or more solvent
molecules are water.
[0047] Further, when partial structures of the compounds are
illustrated, an asterisk (*) indicates the point of attachment of
the partial structure to the rest of the molecule.
[0048] "Controlled-release" refers to release of a drug from a
dosage form in which the drug release is controlled or modified
over a period of time. Controlled can mean, for example, sustained,
delayed, or pulsed-release at a particular time. Controlled can
also mean that release of the drug from the dosage form is extended
for longer than it would be in an immediate-release dosage form,
i.e., at least over several hours. In some embodiments, in vivo
release of the compound occurs over a period of at least 2 hours,
in some embodiments, over a period of at least about 4 hours, in
some embodiments, over a period of at least about 8 hours, in some
embodiments over a period of at least about 12 hours, in some
embodiments, over a period of at least about 16 hours, in some
embodiments, over a period of at least about 20 hours, and in some
embodiments, over a period of at least about 24 hours.
[0049] "Cycloalkyl" refers to a saturated or partially unsaturated
cyclic alkyl radical. Where a specific level of saturation is
intended, the nomenclature cycloalkanyl or cycloalkenyl is used.
Examples of cycloalkyl groups include, but are not limited to,
groups derived from cyclopropane, cyclobutane, cyclopentane,
cyclohexane, and the like. In certain embodiments, a cycloalkyl
group is C.sub.3-15 cycloalkyl, C.sub.3-12 cycloalkyl, and in
certain embodiments, C.sub.3-8 cycloalkyl.
[0050] "Cycloalkylalkyl" refers to an acyclic alkyl radical in
which one of the hydrogen atoms bonded to a carbon atom, typically
a terminal or sp.sup.3 carbon atom, is replaced with a cycloalkyl
group. Where specific alkyl moieties are intended, the nomenclature
cycloalkylalkanyl, cycloalkylalkenyl, or cycloalkylalkynyl is used.
In certain embodiments, a cycloalkylalkyl group is C.sub.4-30
cycloalkylalkyl, e.g., the alkanyl, alkenyl, or alkynyl moiety of
the cycloalkylalkyl group is C.sub.1-10 and the cycloalkyl moiety
is C.sub.3-20, and in certain embodiments, a cycloalkylalkyl group
is C.sub.3-20 cycloalkylalkyl, e.g., the alkanyl, alkenyl, or
alkynyl moiety of the cycloalkylalkyl group is C.sub.1-8 and the
cycloalkyl moiety is C.sub.3-12. In certain embodiments, a
cycloalkylalkyl group is C.sub.4-12 cycloalkylalkyl.
[0051] "Dosage form" refers to a form of a formulation that
contains an amount of active agent or prodrug of an active agent,
e.g. the compounds described herein, which can be administered to a
patient to achieve a therapeutic effect. An oral dosage form is
intended to be administered to a patient via the mouth and
swallowed. A dose of a drug may include one or more dosage forms
administered simultaneously or over a period of time.
[0052] "Disease" refers to a disease, disorder, condition, or
symptom of any of the foregoing.
[0053] "Drug" as defined under 21 U.S.C. .sctn.321(g)(1) means "(A)
articles recognized in the official United States Pharmacopoeia,
official Homeopathic Pharmacopoeia of the United States, or
official National Formulary, or any supplement to any of them; and
(B) articles intended for use in the diagnosis, cure, mitigation,
treatment, or prevention of disease in man or other animals; and
(C) articles (other than food) intended to affect the structure or
any function of the body of man or other animals . . . "
[0054] "Heteroalkyl" by itself or as part of another substituent
refer to an alkyl group in which one or more of the carbon atoms
(and certain associated hydrogen atoms) are independently replaced
with the same or different heteroatomic groups. Examples of
heteroatomic groups include, but are not limited to, --O--, --S--,
--O--O--, --S--S--, --O--S--, --NR.sup.13, .dbd.N--N.dbd.,
--N.dbd.N--, --N.dbd.N--NR.sup.13--, --PR.sup.13--, --P(O).sub.2--,
--POR.sup.13--, --O--P(O).sub.2--, --SO--, --SO.sub.2--,
--Sn(R.sup.13).sub.2--, and the like, where each R.sup.13 is
independently chosen from hydrogen, C.sub.1-6 alkyl, substituted
C.sub.1-6 alkyl, C.sub.6-12 aryl, substituted C.sub.6-12 aryl,
C.sub.7-18 arylalkyl, substituted C.sub.7-18 arylalkyl, C.sub.3-7
cycloalkyl, substituted C.sub.3-7 cycloalkyl, C.sub.3-7
heterocycloalkyl, substituted C.sub.3-7 heterocycloalkyl, C.sub.1-6
heteroalkyl, substituted C.sub.1-6 heteroalkyl, C.sub.6-12
heteroaryl, substituted C.sub.6-12 heteroaryl, C.sub.7-18
heteroarylalkyl, or substituted C.sub.7-18 heteroarylalkyl.
Reference to, for example, a C.sub.1-6 heteroalkyl, means a
C.sub.1-6 alkyl group in which at least one of the carbon atoms
(and certain associated hydrogen atoms) is replaced with a
heteroatom. For example C.sub.1-6 heteroalkyl includes groups
having five carbon atoms and one heteroatom, groups having four
carbon atoms and two heteroatoms, etc. In certain embodiments, each
R.sup.13 is independently chosen from hydrogen and C.sub.1-3 alkyl.
In certain embodiments, a heteroatomic group is chosen from --O--,
--S--, --NH--, --N(CH.sub.3)--, and --SO.sub.2--; and in certain
embodiments, the heteroatomic group is --O--.
[0055] "Heteroaryl" refers to a monovalent heteroaromatic radical
derived by the removal of one hydrogen atom from a single atom of a
parent heteroaromatic ring system. Heteroaryl encompasses multiple
ring systems having at least one heteroaromatic ring fused to at
least one other ring, which can be aromatic or non-aromatic. For
example, heteroaryl encompasses bicyclic rings in which one ring is
heteroaromatic and the second ring is a heterocycloalkyl ring. For
such fused, bicyclic heteroaryl ring systems wherein only one of
the rings contains one or more heteroatoms, the radical carbon may
be at the aromatic ring or at the heterocycloalkyl ring. In certain
embodiments, when the total number of N, S, and O atoms in the
heteroaryl group exceeds one, the heteroatoms are not adjacent to
one another. In certain embodiments, the total number of
heteroatoms in the heteroaryl group is not more than two.
[0056] "Heterocycloalkyl" refers to a saturated or unsaturated
cyclic alkyl radical in which one or more carbon atoms (and certain
associated hydrogen atoms) are independently replaced with the same
or different heteroatom; or to a parent aromatic ring system in
which one or more carbon atoms (and certain associated hydrogen
atoms) are independently replaced with the same or different
heteroatom such that the ring system no longer contains at least
one aromatic ring. Examples of heteroatoms to replace the carbon
atom(s) include, but are not limited to, N, P, O, S, Si, etc.
Examples of heterocycloalkyl groups include, but are not limited
to, groups derived from epoxides, azirines, thiiranes,
imidazolidine, morpholine, piperazine, piperidine, pyrazolidine,
pyrrolidine, quinuclidine, and the like. In certain embodiments, a
heterocycloalkyl group is C.sub.4-10 heterocycloalkyl, C.sub.4-8
heterocycloalkyl, and in certain embodiments, C.sub.4-6
heterocycloalkyl.
[0057] "Immediate release" refers to formulations or dosage forms
that rapidly dissolve in vitro and in vivo and are intended to be
completely dissolved and absorbed in the stomach or upper
gastrointestinal tract. Immediate release formulations can release
at least 90% of the active ingredient or precursor thereof within
about 15 minutes, within about 30 minutes, within about one hour,
or within about two hours of administering an immediate release
dosage form.
[0058] "Leaving group" has the meaning conventionally associated
with it in synthetic organic chemistry, i.e., an atom or a group
capable of being displaced by a nucleophile and includes halogen
such as chloro, bromo, fluoro, and iodo; acyloxy, such as acetoxy
and benzoyloxy, alkoxycarbonylaryloxycarbonyl, mesyloxy, tosyloxy,
and trifluoromethanesulfonyloxy; aryloxy such as
2,4-dinitrophenoxy, methoxy, N,O-dimethylhydroxylamino,
p-nitrophenolate, imidazolyl, and the like.
[0059] "MHF" refers to methyl hydrogen fumarate, a compound having
the following chemical structure:
##STR00001##
This compound is also sometimes referred to as monomethyl
fumarate.
[0060] "MHF Prodrug" refers to a prodrug that is metabolized in
vivo to form methyl hydrogen fumarate as a pharmacologically active
metabolite.
[0061] "Parent heteroaromatic ring system" refers to an aromatic
ring system in which one or more carbon atoms (and any associated
hydrogen atoms) are independently replaced with the same or
different heteroatom in such a way as to maintain the continuous
.pi.-electron system characteristic of aromatic systems and a
number of out-of-plane .pi.-electrons corresponding to the Huckel
rule (4n+2). Examples of heteroatoms to replace the carbon atoms
include, for example, N, P, O, S, and Si, etc. Specifically
included within the definition of "parent heteroaromatic ring
systems" are fused ring systems in which one or more of the rings
are aromatic and one or more of the rings are saturated or
unsaturated, such as, for example, arsindole, benzodioxan,
benzofuran, chromane, chromene, indole, indoline, xanthene, etc.
Examples of parent heteroaromatic ring systems include, for
example, arsindole, carbazole, .beta.-carboline, chromane,
chromene, cinnoline, furan, imidazole, indazole, indole, indoline,
indolizine, isobenzofuran, isochromene, isoindole, isoindoline,
isoquinoline, isothiazole, isoxazole, naphthyridine, oxadiazole,
oxazole, perimidine, phenanthridine, phenanthroline, phenazine,
phthalazine, pteridine, purine, pyran, pyrazine, pyrazole,
pyridazine, pyridine, pyrimidine, pyrrole, pyrrolizine,
quinazoline, quinoline, quinolizine, quinoxaline, tetrazole,
thiadiazole, thiazole, thiophene, triazole, xanthene, thiazolidine,
oxazolidine, and the like.
[0062] "Patient" refers to a mammal, for example, a human.
[0063] "Pharmaceutically acceptable" refers to approved or
approvable by a regulatory agency of the Federal or a state
government or listed in the U.S. Pharmacopoeia or other generally
recognized pharmacopoeia for use in animals, and more particularly
in humans.
[0064] "Pharmaceutically acceptable salt" refers to a salt of a
compound that possesses the desired pharmacological activity of the
parent compound. Such salts include acid addition salts, formed
with inorganic acids such as hydrochloric acid, hydrobromic acid,
sulfuric acid, nitric acid, phosphoric acid, and the like; or
formed with organic acids such as acetic acid, propionic acid,
hexanoic acid, cyclopentanepropionic acid, glycolic acid, pyruvic
acid, lactic acid, malonic acid, succinic acid, malic acid, maleic
acid, fumaric acid, tartaric acid, citric acid, benzoic acid,
3-(4-hydroxybenzoyl) benzoic acid, cinnamic acid, mandelic acid,
methanesulfonic acid, ethanesulfonic acid, 1,2-ethane-disulfonic
acid, 2-hydroxyethanesulfonic acid, benzenesulfonic acid,
4-chlorobenzenesulfonic acid, 2-naphthalenesulfonic acid,
4-toluenesulfonic acid, camphorsulfonic acid,
4-methylbicyclo[2.2.2]-oct-2-ene-1-carboxylic acid, glucoheptonic
acid, 3-phenylpropionic acid, trimethylacetic acid, tertiary
butylacetic acid, lauryl sulfuric acid, gluconic acid, glutamic
acid, hydroxynaphthoic acid, salicylic acid, stearic acid, muconic
acid, and the like; and salts formed when an acidic proton present
in the parent compound is replaced by a metal ion, e.g., an alkali
metal ion, an alkaline earth ion, or an aluminum ion; or
coordinates with an organic base such as ethanolamine,
diethanolamine, triethanolamine, N methylglucamine, and the like.
In certain embodiments, a pharmaceutically acceptable salt is the
hydrochloride salt. In certain embodiments, a pharmaceutically
acceptable salt is the sodium salt.
[0065] "Pharmaceutically acceptable excipient" refers to a
pharmaceutically acceptable diluent, a pharmaceutically acceptable
adjuvant, a pharmaceutically acceptable vehicle, a pharmaceutically
acceptable carrier, or a combination of any of the foregoing with
which a compound provided by the present disclosure may be
administered to a patient, which does not destroy the
pharmacological activity thereof and which is non-toxic when
administered in doses sufficient to provide a therapeutically
effective amount of the compound or a pharmacologically active
metabolite thereof.
[0066] "Prodrug" refers to a compound administered in a
pharmacologically inactive (or significantly less active) form.
Once administered, the compound is metabolized in vivo into an
active metabolite. Prodrugs may be designed to improve oral
bioavailability, particularly in cases where the metabolite
exhibits poor absorption from the gastrointestinal tract. Prodrugs
can be used to optimize the absorption, distribution, metabolism,
and excretion (ADME) of the active metabolite.
[0067] A composition or material that is "substantially free of
carboxylic acid moieties" is a composition or material that has
less than 2% w/w of carboxylic acid moieties. In some embodiments,
a composition or material that is "substantially free of carboxylic
acid moieties" is a composition or material that has less than 1%
w/w of carboxylic acid moieties. In other embodiments, a
composition or material that is "substantially free of carboxylic
acid moieties" is a composition or material that has less than
0.01% w/w of carboxylic acid moieties.
[0068] "Substituent" refers to a group in which one or more
hydrogen atoms are independently replaced (or substituted) with the
same or substituent group(s). In certain embodiments, each
substituent group is independently chosen from halogen, --OH, --CN,
--CF.sub.3, .dbd.O, --NO.sub.2, benzyl, --C(O)NH.sub.2, --R.sup.11,
--OR.sup.11, --C(O)R.sup.11, --COOR.sup.11, and --NR.sup.11.sub.2
wherein each R.sup.11 is independently chosen from hydrogen and
C.sub.1-4 alkyl. In certain embodiments, each substituent group is
independently chosen from halogen, --OH, --CN, --CF.sub.3,
--NO.sub.2, benzyl, --R.sup.11, --OR.sup.11, and --NR.sup.11.sub.2
wherein each R.sup.11 is independently chosen from hydrogen and
C.sub.1-4 alkyl. In certain embodiments, each substituent group is
independently chosen from halogen, --OH, --CN, --CF.sub.3, .dbd.O,
--NO.sub.2, benzyl, --C(O)NR.sup.11.sub.2, --R.sup.11, --OR.sup.11,
--C(O)R.sup.11, --COOR.sup.11, and --NR.sup.11.sub.2 wherein each
R.sup.11 is independently chosen from hydrogen and C.sub.1-4 alkyl.
In certain embodiments, each substituent group is independently
chosen from --OH, C.sub.1-4 alkyl, and --NH.sub.2.
[0069] "Sustained-release" refers to release of a drug from a
dosage form in which the drug release occurs over a period of time.
Sustained release can mean that release of the drug from the dosage
form is extended for longer than it would be in an
immediate-release dosage form, i.e., at least over several hours.
In some embodiments, in vivo release of the compound occurs over a
period of at least 2 hours, in some embodiments, over a period of
at least about 4 hours, in some embodiments, over a period of at
least about 8 hours, in some embodiments over a period of at least
about 12 hours, in some embodiments, over a period of at least
about 16 hours, in some embodiments, over a period of at least
about 20 hours, and in some embodiments, over a period of at least
about 24 hours.
[0070] "Treating" or "treatment" of any disease refers to
reversing, alleviating, arresting, or ameliorating a disease or at
least one of the clinical symptoms of a disease, reducing the risk
of acquiring at least one of the clinical symptoms of a disease,
inhibiting the progress of a disease or at least one of the
clinical symptoms of the disease or reducing the risk of developing
at least one of the clinical symptoms of a disease. "Treating" or
"treatment" also refers to inhibiting the disease, either
physically, (e.g., stabilization of a discernible symptom),
physiologically, (e.g., stabilization of a physical parameter), or
both, and to inhibiting at least one physical parameter that may or
may not be discernible to the patient. In certain embodiments,
"treating" or "treatment" refers to protecting against or delaying
the onset of at least one or more symptoms of a disease in a
patient.
[0071] "Therapeutically effective amount" refers to the amount of a
compound that, when administered to a subject for treating a
disease, or at least one of the clinical symptoms of a disease, is
sufficient to effect such treatment of the disease or symptom
thereof. The "therapeutically effective amount" may vary depending,
for example, on the compound, the disease and/or symptoms of the
disease, severity of the disease and/or symptoms of the disease,
the age, weight, and/or health of the patient to be treated, and
the judgment of the prescribing physician. An appropriate amount in
any given compound may be ascertained by those skilled in the art
and/or is capable of determination by routine experimentation.
[0072] "Therapeutically effective dose" refers to a dose that
provides effective treatment of a disease in a patient. A
therapeutically effective dose may vary from compound to compound
and/or from patient to patient, and may depend upon factors such as
the condition of the patient and the severity of the disease. A
therapeutically effective dose may be determined in accordance with
routine pharmacological procedures known to those skilled in the
art.
[0073] Reference is now made in detail to certain embodiments of
compounds, dosage forms, compositions, and methods. The disclosed
embodiments are not intended to be limiting of the claims. To the
contrary, the claims are intended to cover all alternatives,
modifications, and equivalents.
DETAILED DESCRIPTION
[0074] The dosage forms disclosed herein have a core containing a
therapeutically effective amount of a compound selected from (i)
methyl hydrogen fumarate (MHF), (ii) a prodrug of MHF,
pharmaceutically acceptable salts of (i) or (ii), and combinations
of any of the foregoing. In various embodiments, the dosage form
can be a compound-containing pharmaceutical tablet or a plurality
of compound-containing pellets or granules contained in a capsule
or further compressed into a tablet. In either case, the core is
surrounded by a barrier layer that prevents direct contact between
the core and an enteric coating. It will be understood that
additional layers and/or materials optionally may be disposed
between the tablet core and the barrier layer. It will also be
understood that additional layers and/or materials optionally may
be disposed between the barrier layer and the tablet core.
[0075] Surprisingly, the fumarate compounds disclosed herein have
been found to exhibit varying degrees of chemical instability when
in direct contact with ionizable polymers of the type
conventionally found in enteric coatings. Without wishing to be
held to a particular theory or mechanism of action, the degree of
fumarate prodrug chemical instability can correspond to the
carboxylic acid moiety content of the enteric polymer. By
introducing a barrier layer between the tablet core and the enteric
coating, the instability of the fumarate compounds is surprisingly
reduced.
A. Barrier Layer
[0076] In various embodiments, the barrier layer disposed between
the tablet core and the enteric coating layer comprises a material
that is (i) a weakly acidic (proton-donating) material having a pKa
of greater than 8, (ii) a weakly basic (proton-accepting) material
having a pKa of less than 2, (iii) a natural gum or polysaccharide,
(iv) a neutral polymer salt, (v) a sugar, or (vi) a lipid. The pKa
values for various compounds may be calculated or measured as
understood in the art. A carboxylic acid enteric coating surrounds
the barrier layer such that the barrier layer prevents contact
between the core and the enteric coating.
[0077] The barrier layer comprises one or more materials that will
not cause premature breakdown of the fumarate compound during
product shelf life.
[0078] Surprisingly, MHF and MHF prodrugs have been found to have
poor stability when placed in contact with ionizable polymers
having carboxylic acid moieties of the type that are commonly used
in enteric coatings. Thus, in certain embodiments the barrier layer
is substantially free of ionizable polymers having carboxylic acid
moieties of the types mentioned above.
[0079] 1. Non-Ionizable Polymers
[0080] In various aspects, the barrier layer can comprise one or
more non-ionizable polymers. As used herein, non-ionizable polymers
are materials that are either (i) proton-donating acidic materials
having a pKa of greater than 8, (ii) proton-accepting basic
materials having a pKa of less than 2. Examples of suitable
non-ionizable polymers include non-ionizable cellulosic polymers,
non-ionizable vinyl and polyvinyl alcohol polymers, and/or
non-ionizable polymers that are not cellulose or vinyl-based.
[0081] In various embodiments, non-ionizable polymers are
substantially free of carboxylic acid moieties.
[0082] a. Non-Ionizable Cellulosic Polymers
[0083] In some variations, the barrier layer comprises a
non-ionizable cellulosic polymer. Specific examples of
non-ionizable cellulosic polymers include methylcellulose,
ethylcellulose, propylcellulose, butylcellulose, cellulose acetate,
cellulose propionate, cellulose butyrate, cellulose acetate
butyrate, cellulose acetate propionate, methyl cellulose, methyl
cellulose acetate, methyl cellulose propionate, methyl cellulose
butyrate, ethyl cellulose acetate, ethyl cellulose propionate,
ethyl cellulose butyrate, hydroxymethyl cellulose, hydroxyethyl
cellulose, hydroxyethyl methyl cellulose, hydroxypropyl cellulose,
hydroxybutyl cellulose, hydroxyethyl cellulose acetate,
hydroxyethyl ethyl cellulose, low-substituted hydroxypropyl
cellulose, hydroxypropyl methylcellulose, hydroxypropyl
methylcellulose acetate, hydroxypropyl methylcellulose propionate,
hydroxypropyl methylcellulose butyrate, and corresponding salts and
esters.
[0084] b. Non-Ionizable Vinyl-Based Polymers
[0085] In some variations, the barrier layer comprises a
non-ionizable vinyl-based polymer. Exemplary vinyl-based polymers
include polyvinyl alcohol, polyvinvyl acetate,
polyvinylpyrrolidone, and crospovidone (polymers of
N-vinyl-2-pyrrolidone). Exemplary vinyl-containing polymers further
include vinyl polymers and copolymers having hydroxyl-containing
repeat units, alkylacyloxy-containing repeat units, or
cyclicamido-containing repeat units. Further exemplary
vinyl-containing polymers also include polyvinyl alcohols that have
at least a portion of their repeat units in the unhydrolyzed (vinyl
acetate) form, polyvinylhydroxyethyl ether, polyvinyl alcohol
polyvinyl acetate copolymers, polyvinyl pyrrolidone,
polyvinylpyrrolidone-polyvinvylacetate copolymers, polyethylene
polyvinyl alcohol copolymers, and polyoxyethylene-polyoxypropylene
copolymers. In alternate embodiments, vinyl copolymers can include
a second polymer can having (1) substantially carboxy-free
hydroxyl-containing repeat units and (2) hydrophobic repeat
units.
[0086] In certain embodiments, the non-ionizable polyvinyl
materials show no degradation as an excipient. Non-limiting
examples of such materials include polyvinylpyrrolidone and
crospovidone.
[0087] c. Non-Ionizable Polymer that is Neither Cellulose Nor Vinyl
Based
[0088] In some variations, the barrier layer comprises
non-cellulosic non-vinyl-based non-ionizable polymers. Examples of
such polymers included poly(lactide) poly(glycolide),
poly(.epsilon.-caprolactone), poly(lactide-co-glycolide),
poly(lactide-co-.epsilon.-caprolactone), poly(ethylene
oxide-co-.epsilon.-caprolactone), poly(ethylene oxide-co-lactide),
poly(ethylene oxide-co-lactide-co-glycolide),
poly(isobutyl)cyanoacrylate, and poly(hexyl)cyanoacrylate,
polyethylene glycol, polyethylene glycol, polypropylene glycol
copolymers, polyoxyethylene-polyoxypropylene block copolymers,
polyethylene oxide, poly(ethyl acrylate-co-methyl methacrylate) 2:1
(Eudragit NE), polyethylene glycol, polyethylene glycol
polypropylene glycol copolymers, and
polyoxyethylene-polyoxypropylene block copolymers (i.e.
poloaxamers). In some variations, non-ionizable polymers such as
polyoxyethylene-polyoxypropylene block copolymers show no
degradation as an excipient. In certain variations, the
non-cellulosic non-vinyl based non-ionizable polymers do not
contain carboxylic acid moieties, or are substantially free of
carboxylic acid moieties.
[0089] 2. Natural Gums and Polysaccharides
[0090] In some variations, the barrier layer comprises a natural
gum or polysaccharide. Suitable examples of such natural gums and
polysaccharides include starch, chitin, guar gum, tara gum, locust
bean gum, carrageenan, gellan gum, alginate, and xanthan gum.
[0091] In certain embodiments, the natural gums and polysaccharides
contain carboxylic acid moieties, including salts thereof.
Non-limiting examples of such materials include gellan gum,
Alginate, and xanthan gum.
[0092] In various embodiments, natural gum or polysaccharides are
substantially free of carboxylic acid moieties. Non-limiting
examples of such materials include starch, chitin, guar gum, tara
gum, locust bean gum, and carrageenan, among others.
[0093] 3. Neutral Polymer Salts
[0094] In some variations, the barrier layer comprises a neutral
polymer salt. Non-limiting examples of such neutral polymer salts
include poly(ethyl acrylate-co-methyl
methacrylate-co-trimethylammonioethyl methacrylate chloride)
1:2:0.1, Poly(ethyl acrylate-co-methyl
methacrylate-co-trimethylammonioethyl methacrylate chloride)
1:2:0.2, crosslinked sodium carboxymethyl cellulose (croscarmellose
sodium), crosslinked sodium carboxymethyl cellulose (sodium starch
glycolate), salts of carboxymethyl cellulose, salts of carboxyethyl
cellulose, salts of carboxypropyl cellulose, salts of carboxybutyl
cellulose, salts of carboxymethyl starch, and salts of carboxyethyl
starch. In certain embodiments, the neutral polymer salts do not
include a carboxylate group.
[0095] In certain embodiments, the neutral polymer salts do not
degrade as excipients. Non-limiting examples of such materials
include poly(ethyl acrylate-co-methyl
methacrylate-co-trimethylammonioethyl methacrylate chloride)
1:2:0.1, poly(ethyl acrylate-co-methyl
methacrylate-co-trimethylammonioethyl methacrylate chloride)
1:2:0.2, and croscarmellose sodium.
[0096] In certain embodiments, certain neutral polymer salts do not
include carboxyl groups. These materials include poly(ethyl
acrylate-co-methyl methacrylate-co-trimethylammonioethyl
methacrylate chloride) 1:2:0.1 and poly(ethyl acrylate-co-methyl
methacrylate-co-trimethylammonioethyl methacrylate chloride)
1:2:0.2
[0097] In certain embodiments, certain neutral polymer salts
include a carboxyl group that is neutralized with a counterion.
Such compounds include crosslinked croscarmellose, crosslinked
sodium carboxymethyl cellulose (sodium starch glycolate), salts of
carboxymethyl cellulose, salts of carboxyethyl cellulose, salts of
carboxypropyl cellulose, salts of carboxybutyl cellulose, salts of
carboxymethyl starch, and salts of carboxyethyl starch.
[0098] In certain other embodiments, the ionizable polymers do not
contain carboxylic acid groups. Such materials include poly(butyl
methacylate-co-(2-dimethylaminoethyl) methacrylate-co-methyl
methacrylate) 1:2:1 (Eudragit E), chitosan, and methyl methacrylate
diethylaminoethyl methacrylate copolymer. Eudragit E has polymer
free amino groups, and is neutral at pH>5 and prontonated at
pH<5.
[0099] 4. Sugars
[0100] In some variations, the barrier layer comprises a sugar.
Examples of suitable sugars include lactose, mannitol, sorbitol,
sucrose, and trehalose.
[0101] 5. Lipids
[0102] In some variations, the compression coating layer comprises
a lipid. Examples of suitable lipids are glyceryl behenate, castor
oil, hydrogenated vegetable oil, hydrogenated carnauba wax and
microcrystalline wax. In certain variations, the lipids are
substantially free of carboxylic acid moieties.
[0103] In various aspects, the barrier layer is sufficiently thick
and sufficiently continuous to prevent direct contact between the
enteric coating and the core. Typically this can be accomplished by
coating the cores to a target weight percent range. For cores
having a size (e.g., diameter) of 2 mm or less, the barrier layer
can comprise at least 5 wt % of the coated core. For cores having a
size (e.g., diameter) greater than 6 mm, the barrier layer
comprises at least 0.5 wt % of the coated core.
[0104] Alternatively, the barrier layer can be applied to a
specified average thickness. For example, the barrier layer can
have an average thickness of at least 5 .mu.m. In other
embodiments, the barrier layer has an average thickness of at least
15 .mu.m.
B. Enteric Coatings
[0105] Once the cores have been coated with the barrier layer, an
enteric coating is then applied. In various embodiments, the
enteric coating comprises an enteric polymer that is substantially
insoluble in aqueous solutions having a pH level below 4.5 but
which starts to become soluble at a pH between 4.5 and 7.5 and is
soluble in aqueous solutions having a pH above 7.5. The enteric
coating remains intact while the oral dosage form is in the low pH
environs of the stomach, which means that the fumarate compound
remains in the core while the dosage form is in the stomach.
[0106] Suitable enteric polymers include methacrylic acid polymers,
cellulose acetate phthalate polymers, hydroxypropylmethyl cellulose
acetate succinate polymers, hydroxypropylmethyl cellulose phthalate
polymers and polyvinyl acetate phthalate polymers. Other examples
of pH-sensitive polymers that can be used in the enteric coating
include methyl acrylate-methacrylic acid copolymers, cellulose
acetate succinate, hydroxy propyl methyl cellulose phthalate,
hydroxy propyl methyl cellulose acetate succinate (hypromellose
acetate succinate), polyvinyl acetate phthalate (PVAP), methyl
methacrylate-methacrylic acid copolymers and shellac. Specific
examples of enteric polymers include hydroxypropyl methyl cellulose
acetate succinate, hydroxypropyl methyl cellulose succinate,
hydroxypropyl cellulose acetate succinate, hydroxyethyl methyl
cellulose succinate, hydroxyethyl cellulose acetate succinate,
hydroxypropyl methyl cellulose phthalate, hydroxyethyl methyl
cellulose acetate succinate, hydroxyethyl methyl cellulose acetate
phthalate, carboxyethyl cellulose, carboxymethyl cellulose,
cellulose acetate phthalate, methyl cellulose acetate phthalate,
ethyl cellulose acetate phthalate, hydroxypropyl cellulose acetate
phthalate, hydroxypropyl methyl cellulose acetate phthalate,
hydroxypropyl cellulose acetate phthalate succinate, hydroxypropyl
methyl cellulose acetate succinate phthalate, hydroxypropyl methyl
cellulose succinate phthalate, cellulose propionate phthalate,
hydroxypropyl cellulose butyrate phthalate, cellulose acetate
trimellitate, methyl cellulose acetate trimellitate, ethyl
cellulose acetate trimellitate, hydroxypropyl cellulose acetate
trimellitate, hydroxypropyl methyl cellulose acetate trimellitate,
hydroxypropyl cellulose acetate trimellitate succinate, cellulose
propionate trimellitate, cellulose butyrate trimellitate, cellulose
acetate terephthalate, cellulose acetate isophthalate, cellulose
acetate pyridinedicarboxylate, salicylic acid cellulose acetate,
hydroxypropyl salicylic acid cellulose acetate, ethylbenzoic acid
cellulose acetate, hydroxypropyl ethylbenzoic acid cellulose
acetate, ethyl phthalic acid cellulose acetate, ethyl nicotinic
acid cellulose acetate, and ethyl picolinic acid cellulose
acetate.
C. Tablet Cores
[0107] As noted herein, the tablet cores can be in the form of
compressed tablets, or a plurality of compound-containing pellets
or granules contained in a capsule.
[0108] 1. Cores in the Form of Compressed Tablets
[0109] Compressed tablet cores containing a fumarate compound can
be made using well known techniques such as those described in
Remington: The Science and Practice of Pharmacy, 21.sup.st Edition,
University of the Sciences in Philadelphia Ed. (2005). Such tablets
can contain one or more known tableting excipients such as binders,
fillers, disintegrants, glidants, lubricants, surfactants,
plasticizers, anti-adherents, buffers, wetting agents, emulsifying
agents, thickening agents, coloring agents, or combinations of any
of the foregoing.
[0110] Binders may be included in the tablet core to hold the
components of the core together. Examples of binders useful in the
present disclosure include, for example, polyvinylpyrrolidone,
hydroxypropyl cellulose, hydroxypropyl methylcellulose,
methylcellulose, hydroxyethyl cellulose, sugars, dextran,
cornstarch, and combinations of any of the foregoing. In certain
embodiments, the binder is hydroxypropyl cellulose.
[0111] Fillers may be added to increase the bulk to make dosage
forms. Examples of fillers useful in the present disclosure include
dibasic calcium phosphate, dibasic calcium phosphate dihydrate,
calcium sulfate, dicalcium phosphate, tricalcium phosphate,
lactose, cellulose including microcrystalline cellulose, mannitol,
sodium chloride, dry starch, pregelatinized starch, compressible
sugar, mannitol, and combinations of any of the foregoing. In
certain embodiments, a filler is lactose monohydrate. Fillers may
be water insoluble, water soluble, or combinations thereof.
Examples of useful water insoluble fillers include starch, dibasic
calcium phosphate dihydrate, calcium sulfate, dicalcium phosphate,
tricalcium phosphate, powdered cellulose, microcrystalline
cellulose, and combinations of any of the foregoing. Examples of
water-soluble fillers include water soluble sugars and sugar
alcohols, such as lactose, glucose, fructose, sucrose, mannose,
dextrose, galactose, the corresponding sugar alcohols and other
sugar alcohols, such as mannitol, sorbitol, xylitol, and
combinations of any of the foregoing. In certain embodiments
wherein the filler is lactose, a tablet dosage form may comprise an
amount of filler ranging from about 25 wt % to about 60 wt %, and
in certain embodiments, from about 30 wt % to about 55 wt %.
[0112] Glidants may be included in the tablet core to reduce
sticking effects during processing, film formation, and/or drying.
Examples of useful glidants include talc, magnesium stearate,
glycerol monostearate, colloidal silicon dioxide, precipitated
silicon dioxide, fumed silicon dioxide, and combinations of any of
the foregoing. In certain embodiments, a glidant is colloidal
silicon dioxide. Tablet dosage forms may comprise less than about 3
wt % of a glidant, in certain embodiments, less than about 1 wt %
of a glidant as a flow aid. In certain embodiments, a glidant is
colloidal silicon dioxide.
[0113] Lubricants and anti-static agents may be included in a
pharmaceutically acceptable coating to aid in processing. Examples
of lubricants useful in coatings provided by the present disclosure
include calcium stearate, glycerol behenate, glyceryl monostearate,
magnesium stearate, mineral oil, polyethylene glycol, sodium
stearyl fumarate, sodium lauryl sulfate, stearic acid, talc,
vegetable oil, zinc stearate, and combinations of any of the
foregoing. In certain embodiments, the lubricant is magnesium
stearate. In certain embodiments, coatings may comprise an amount
of lubricant ranging from about 0.5 wt % to about 3 wt % based on
the total solids weight of the coating.
[0114] Disintegrants may be included in the tablet core to cause a
tablet core to break apart, for example, by expansion of a
disintegrants when exposed to water. Examples of useful
disintegrants include water swellable substances such as
croscarmellose sodium, sodium starch glycolate, cross-linked
polyvinyl pyrrolidone, and combinations of any of the foregoing. In
various embodiments, the disintegrants can be selected to be
substantially free of carboxylic acid moieties.
[0115] 2. Cores in the Form of Pellets/Powders/Granules
[0116] Cores can be in the form of pellets, powders, or granules.
Pellets, powders, and granules are known in the art.
[0117] a. Pharmaceutical Pellet Making
[0118] Also provided is a method of making
(N,N-Diethylcarbamoyl)methyl methyl
(2E)but-2-ene-1,4-dioate-containing pharmaceutical pellets.
Pharmaceutical pellets are conventionally made using either an
extrusion/spheronization process, or a process called
roto-pellitization. In both processes, a drug is mixed with a
binder, commonly microcrystalline cellulose, and a solvent,
typically water.
[0119] Thus, in the method, (N,N-Diethylcarbamoyl)methyl methyl
(2E)but-2-ene-1,4-dioate is mixed with water and a binder to form a
wet mass. The improvement disclosed herein is to add acetic acid to
the wet mass and maintain the mass at a pH at or below 3.8 so that
the acetic acid is predominantly in a non-ionizable state. In
certain embodiments, the wet mass is buffered at a pH at or below
3.5. When acetic acid is added within the above mentioned pH
ranges, one-dimensional crystal growth of
(N,N-Diethylcarbamoyl)methyl methyl (2E)but-2-ene-1,4-dioate during
the pellet drying step is reduced or eliminated, which prevents the
pellets from agglomerating.
[0120] The method can be used in pellet making via either (i) an
extrusion/spheronization process, or (ii) a roto-pelletization
process as described in more detail below.
[0121] In a further alternative embodiment, the present disclosure
is directed to a method of improving the yield of MHF-containing or
MHF produg-containing pellets within a predetermined pellet size
range during pellet manufacturing. The MHF or MHF prodrug is
combined with water, an extrusion aid, and a binder, and optionally
a disintegrant to form a wet mixture. The mixture is then passed
through a screen or die (i.e., the mixture is extruded) to form an
extrudate. The extrudate is then spheronized to form pellets. The
addition of a binder and optionally a disintegrant to the mixture
results in a significantly higher percent of pellets within a
specific target size being formed. For example, extrusion dies for
pharmaceutical pellet making typically have an opening ranging in
size from 1 to 2 mm. The method described herein is effective at
improving the yield of pellets within the size of the die
opening+/-0.3 mm. An example of increasing the pellet size
predictability is described in Example 11.
[0122] In various embodiments, the MHF prodrug is a prodrug
described herein, such as (N,N-Diethylcarbamoyl)methyl methyl
(2E)but-2-ene-1,4-dioate. In various further embodiments, the
extrusion aid is microcrystalline cellulose, for example in amounts
ranging from about 10 to 90 wt % of the wet mixture. In yet further
embodiments the binder is hydroxypropyl cellulose, for example in
amounts ranging from about 2 to 10 wt % of the wet mixture. In
additional embodiments, the disintegrant is croscarmellose sodium,
for example in amounts ranging from about 0.5 to 10 wt % of the wet
mixture.
[0123] (i) Extrusion/Spheronization
[0124] In the extrusion/spheronization process, the MHF prodrug,
binder, filler and water are generally mixed in either a high-shear
granulator or a planetary mixer. Next, the wet mass (also referred
to as a wet dough) is extruded to form cylindrical extrudates of a
constant diameter (e.g., 0.6 to 1.2 mm). The wet mass is passed
through the screen forming soft, pliable extrudates (similar to
pasta) which break by their own weight into shorter units. The size
of the final pellets (spheres) is principally determined by the
hole diameter of the screen used in the extrusion step.
Alternatively, the wet dough can be extruded through a die, i.e., a
plate with holes. For example, in order to obtain spheres with a
diameter of 1 mm, a 1 mm screen or die is used on the extruder,
although spheres with a distribution of 0.8 to 1.2 mm may often be
obtained. Next, the extrudates are charged to a spheronizer which
includes a spinning friction plate. During the first contact of the
cylindrical granules with the friction plate, the extrudates are
cut into segments with a length ranging from 1 to 1.2 times their
diameter. These segments then collide with the bowl wall and they
are thrown back to the inside of the friction plate. Centrifugal
force sends the material to the outside of the disc. The action of
the material being moved causes the extrudate to be broken down
into pieces of approximately equal length related to the diameter
of the extrudate. These cylindrical segments are gradually rounded
by the collisions with the bowl wall and the plate and each other.
The ongoing action of particles colliding with the wall and being
thrown back to the inside of the plate creates a "twisting rope
movement" of product along the bowl wall. The continuous collision
of the particles with the wall and with the friction plate
gradually converts the cylindrical segments into spheres, provided
that the extrudates are sufficiently pliable to allow the
deformation without being destroyed or sticking together. When the
particles have reached the desired level of sphericity, they are
then discharged from the spheronizer. Finally, the wet pellets are
collected and dried in a vertical fluid bed drier, or in some
instances a tray hot with a flow of hot air over the pellets.
[0125] (ii) Roto-Pelletization
[0126] In the roto-pellitization process, the powdered mixture of
MHF prodrug, filler and binder is introduced into the spheronizer
and mixed in situ with an aqueous/water spray to form pellets that
are rounded in a similar manner by contact with the spinning
friction plate and the side walls of the spheronizer. A more
detailed description of roto-pellitization is found in Vertommen et
al., "Influence of five selected processing and formulation
variables on the particle size, particle size distribution, and
friability of pellets produced in a rotary processor", Drug Dev Ind
Pharm. 1997; 23:39-46; Holm et al., "Pelletization by granulation
in a roto-processor RP-2. Part 1. Effects of process and product
variables on granule growth", Pharm Technol Eur. 1996; 8:22-36; and
Kristensen et al., "Direct pelletization in a rotary processor
controlled by torque measurements. I: Influence of process
variables", Pharm Dev Technol. 2000; 5:247-256, the disclosures of
which are incorporated herein by reference.
[0127] b. Powders and Granules
[0128] Alternatively, the formulation can be made as a powder or
granule. Powders and granules can be made by conventional
formulation methods understood in the art.
[0129] c. Drug Layering
[0130] In another variation, the formulation can be suspended or
dissolved in a binder solution and sprayed onto an inert substrate
such as nonpareil seeds. Such methods are performed as known in the
art.
Compounds; MHF and MHF Prodrugs
[0131] In certain embodiments, the active ingredient in the dosage
forms disclosed herein is methyl hydrogen fumarate or a
pharmaceutically acceptable salt thereof.
[0132] Alternatively, the active ingredient in the dosage forms
disclosed herein can be an MHF prodrug. One suitable MHF prodrug is
dimethyl fumarate. Other suitable MHF prodrugs are the compounds of
Formula (I):
##STR00002##
or a pharmaceutically acceptable salt thereof, wherein:
[0133] R.sup.1 and R.sup.2 are independently chosen from hydrogen,
C.sub.1-6 alkyl, and substituted O.sub.1-6 alkyl;
[0134] R.sup.3 and R.sup.4 are independently chosen from hydrogen,
C.sub.1-6 alkyl, substituted C.sub.1-6 alkyl, C.sub.1-6
heteroalkyl, substituted C.sub.1-6 heteroalkyl, C.sub.3-11
cycloalkyl, substituted C.sub.3-11 cycloalkyl, C.sub.4-12
cycloalkylalkyl, substituted C.sub.4-12 cycloalkylalkyl, C.sub.7-12
arylalkyl, and substituted C.sub.7-12 arylalkyl; or R.sup.3 and
R.sup.4 together with the nitrogen to which they are bonded form a
ring chosen from a C.sub.4-10 heteroaryl, substituted C.sub.4-10
heteroaryl, C.sub.4-10 heterocycloalkyl, and substituted C.sub.4-10
heterocycloalkyl;
[0135] n is an integer from 0 to 4; and
[0136] X is independently chosen from a single oxygen atom and a
pair of hydrogen atoms;
[0137] wherein each substituent group is independently chosen from
halogen, --OH, --CN, --CF.sub.3, .dbd.O, --NO.sub.2, benzyl,
--C(O)NR.sup.11.sub.2, --R.sup.11, --OR.sup.11, --C(O)R.sup.11,
--COOR.sup.11, and --NR.sup.11.sub.2 wherein each R.sup.11 is
independently chosen from hydrogen and C.sub.1-4 alkyl;
[0138] and wherein when X is a single oxygen atom, the oxygen atom
is connected to the carbon to which it is bonded by a double bond
to form a carboxyl group and when X is a pair of hydrogen atoms,
each hydrogen atom is connected to the carbon to which it is bonded
to by single bond.
[0139] Compounds of Formula I are disclosed in (i) Gangakhedkar et
al., U.S. Pat. No. 8,148,414; and (ii) Virsik et al. U.S. Ser. No.
61/653,375, filed May 30, 2012, the disclosures of which are
incorporated herein by reference. The methods and schemes of
synthesis disclosed in Gangakhedkar et al., U.S. Pat. No. 8,148,414
are incorporated herein by reference.
[0140] In other embodiments, the MHF prodrug is dimethyl
fumarate.
[0141] In other embodiments, the MHF prodrug is a compound of
Formula (II):
##STR00003##
or a pharmaceutically acceptable salt thereof, wherein:
[0142] n is an integer from 2 to 6; and
[0143] R.sup.1 is methyl.
[0144] Compounds of Formula (II) are disclosed in Cundy et al.,
U.S. Patent Application No. 61/595,835 filed Feb. 7, 2012, the
disclosures of which are incorporated herein by reference.
Therapeutic Uses
[0145] The dosage forms disclosed herein may be administered to a
patient suffering from any disease including a disorder, condition,
or symptom for which MHF is known or hereafter discovered to be
therapeutically effective. Indications for which MHF has been
prescribed, and hence for which a dosage form disclosed herein is
also expected to be effective, include psoriasis. Other indications
for which the disclosed dosage forms may be therapeutically
effective include multiple sclerosis, an inflammatory bowel
disease, asthma, chronic obstructive pulmonary disease, and
arthritis.
[0146] Methods of treating a disease in a patient provided by the
present disclosure comprise administering to a patient in need of
such treatment a dosage form disclosed herein. The dosage forms
disclosed herein may provide therapeutic or prophylactic plasma
and/or blood concentrations of MHF following administration to a
patient.
[0147] The dosage forms disclosed herein may be administered in an
amount and using a dosing schedule as appropriate for treatment of
a particular disease. For example, daily doses of MHF or a MHF
prodrug may range from about 0.01 mg/kg to about 50 mg/kg, from
about 0.1 mg/kg to about 50 mg/kg, from about 1 mg/kg to about 50
mg/kg, and in certain embodiments, from about 5 mg/kg to about 25
mg/kg. In certain embodiments, the MHF or MHF prodrug may be
administered at a dose over time from about 1 mg to about 5 g per
day, from about 10 mg to about 4 g per day, and in certain
embodiments from about 20 mg to about 2 g per day. An appropriate
dose of MHF or a MHF prodrug may be determined based on several
factors, including, for example, the body weight and/or condition
of the patient being treated, the severity of the disease being
treated, the incidence and/or severity of side effects, the manner
of administration, and the judgment of the prescribing physician.
Appropriate dose ranges may be determined by methods known to those
skilled in the art.
[0148] MHF or a MHF prodrug may be assayed in vitro and in vivo for
the desired therapeutic or prophylactic activity prior to use in
humans. In vivo assays, for example using appropriate animal
models, may also be used to determine whether administration of MHF
or a MHF prodrug is therapeutically effective.
[0149] In certain embodiments, a therapeutically effective dose of
MHF or a MHF prodrug may provide therapeutic benefit without
causing substantial toxicity including adverse side effects.
Toxicity of MHF or a MHF prodrug and/or metabolites thereof may be
determined using standard pharmaceutical procedures and may be
ascertained by those skilled in the art. The dose ratio between
toxic and therapeutic effect is the therapeutic index. A dose of
MHF or a MHF prodrug may be within a range capable of establishing
and maintaining a therapeutically effective circulating plasma
and/or blood concentration of MHF or a MHF prodrug that exhibits
little or no toxicity.
[0150] The dosage forms disclosed herein may be used to treat
diseases, disorders, conditions, and symptoms of any of the
foregoing for which MHF is known to provide or is later found to
provide therapeutic benefit. MHF is known to be effective in
treating psoriasis, multiple sclerosis, an inflammatory bowel
disease, asthma, chronic obstructive pulmonary disease, and
arthritis. Hence, the dosage forms disclosed herein may be used to
treat any of the foregoing diseases and disorders. The underlying
etiology of any of the foregoing diseases being treated may have a
multiplicity of origins. Further, in certain embodiments, a
therapeutically effective amount of MHF and/or a MHF prodrug may be
administered to a patient, such as a human, as a preventative
measure against various diseases or disorders. Thus, a
therapeutically effective amount of MHF or a MHF prodrug may be
administered as a preventative measure to a patient having a
predisposition for and/or history of immunological, autoimmune,
and/or inflammatory diseases including psoriasis, asthma and
chronic obstructive pulmonary diseases, cardiac insufficiency
including left ventricular insufficiency, myocardial infarction and
angina pectoris, mitochondrial and neurodegenerative diseases such
as Parkinson's disease, Alzheimer's disease, Huntington's disease,
retinopathia pigmentosa and mitochondrial encephalomyopathy,
transplantation rejection, autoimmune diseases including multiple
sclerosis, ischemia and reperfusion injury, AGE-induced genome
damage, inflammatory bowel diseases such as Crohn's disease and
ulcerative colitis; and NF-.kappa.B mediated diseases.
Psoriasis
[0151] Psoriasis is characterized by hyperkeratosis and thickening
of the epidermis as well as by increased vascularity and
infiltration of inflammatory cells in the dermis. Psoriasis
vulgaris manifests as silvery, scaly, erythematous plaques on
typically the scalp, elbows, knees, and buttocks. Guttate psoriasis
occurs as tear-drop size lesions.
[0152] Fumaric acid esters are recognized for the treatment of
psoriasis and dimethyl fumarate is approved for the systemic
treatment of psoriasis in Germany (Mrowietz and Asadullah, Trends
Mol Med 2005, 11(1), 43-48; and Mrowietz et al., Br J Dermatology
1999, 141, 424-429).
[0153] Efficacy of MHF or a MHF prodrug for treating psoriasis can
be determined using animal models and in clinical trials.
Inflammatory Arthritis
[0154] Inflammatory arthritis includes diseases such as rheumatoid
arthritis, juvenile rheumatoid arthritis (juvenile idiopathic
arthritis), psoriatic arthritis, and ankylosing spondylitis, each
of which produce joint inflammation. The pathogenesis of
immune-mediated inflammatory diseases including inflammatory
arthritis is believed to involve TNF and NK-.kappa.B signaling
pathways (Tracey et al., Pharmacology & Therapeutics 2008, 117,
244-279). DMF has been shown to inhibit TNF and inflammatory
diseases including inflammatory arthritis, which are believed to
involve TNF and NK-.kappa.B signaling and therefore may be useful
in treating inflammatory arthritis (Lowewe et al., J Immunology
2002, 168, 4781-4787).
[0155] The efficacy of MHF or a MHF prodrug for treating
inflammatory arthritis can be determined using animal models and in
clinical trials.
Multiple Sclerosis
[0156] Multiple sclerosis (MS) is an inflammatory autoimmune
disease of the central nervous system caused by an autoimmune
attack against the isolating axonal myelin sheets of the central
nervous system. Demyelination leads to the breakdown of conduction
and to severe disease with destruction of local axons and
irreversible neuronal cell death. The symptoms of MS are highly
varied with each individual patient exhibiting a particular pattern
of motor, sensible, and sensory disturbances. MS is typified
pathologically by multiple inflammatory foci, plaques of
demyelination, gliosis, and axonal pathology within the brain and
spinal cord, all of which contribute to the clinical manifestations
of neurological disability (see e.g., Wingerchuk, Lab Invest 2001,
81, 263-281; and Virley, NeuroRx 2005, 2(4), 638-649). Although the
causal events that precipitate MS are not fully understood,
evidence implicates an autoimmune etiology together with
environmental factors, as well as specific genetic predispositions.
Functional impairment, disability, and handicap are expressed as
paralysis, sensory and octintive disturbances, spasticity, tremor,
a lack of coordination, and visual impairment, which impact on the
quality of life of the individual. The clinical course of MS can
vary from individual to individual, but invariably the disease can
be categorized in three forms: relapsing-remitting, secondary
progressive, and primary progressive.
[0157] Studies support the efficacy of FAEs for treating MS and are
undergoing phase II clinical testing (Schimrigk et al., Eur J
Neurology 2006, 13, 604-610; and Wakkee and Thio, Current Opinion
Investigational Drugs 2007, 8(11), 955-962).
[0158] Assessment of MS treatment efficacy in clinical trials can
be accomplished using tools such as the Expanded Disability Status
Scale and the MS Functional as well as magnetic resonance imaging
lesion load, biomarkers, and self-reported quality of life. Animal
models of MS shown to be useful to identify and validate potential
therapeutics include experimental autoimmune/allergic
encephalomyelitis (EAE) rodent models that simulate the clinical
and pathological manifestations of MS and nonhuman primate EAE
models.
Inflammatory Bowel Disease (Crohn's Disease, Ulcerative
Colitis)
[0159] Inflammatory bowel disease (IBD) is a group of inflammatory
conditions of the large intestine and in some cases, the small
intestine that includes Crohn's disease and ulcerative colitis.
Crohn's disease, which is characterized by areas of inflammation
with areas of normal lining in between, can affect any part of the
gastrointestinal tract from the mouth to the anus. The main
gastrointestinal symptoms are abdominal pain, diarrhea,
constipation, vomiting, weight loss, and/or weight gain. Crohn's
disease can also cause skin rashes, arthritis, and inflammation of
the eye. Ulcerative colitis is characterized by ulcers or open
sores in the large intestine or colon. The main symptom of
ulcerative colitis is typically constant diarrhea with mixed blood
of gradual onset. Other types of intestinal bowel disease include
collagenous colitis, lymphocytic colitis, ischaemic colitis,
diversion colitis, Behcet's colitis, and indeterminate colitis.
[0160] FAEs are inhibitors of NF-.kappa.B activation and therefore
may be useful in treating inflammatory diseases such as Crohn's
disease and ulcerative colitis (Atreya et al., J Intern Med 2008,
263(6), 59106).
[0161] The efficacy of MHF or a MHF prodrug for treating
inflammatory bowel disease can be evaluated using animal models and
in clinical trials. Useful animal models of inflammatory bowel
disease are known.
Asthma
[0162] Asthma is reversible airway obstruction in which the airway
occasionally constricts, becomes inflamed, and is lined with an
excessive amount of mucus. Symptoms of asthma include dyspnea,
wheezing, chest tightness, and cough. Asthma episodes may be
induced by airborne allergens, food allergies, medications, inhaled
irritants, physical exercise, respiratory infection, psychological
stress, hormonal changes, cold weather, or other factors.
[0163] As an inhibitor of NF-.kappa.B activation and as shown in
animal studies (Joshi et al., US 2007/0027076) FAEs may be useful
in treating pulmonary diseases such as asthma and chronic
obstructive pulmonary disorder.
[0164] The efficacy of MHF or a MHF prodrug for treating asthma can
be assessed using animal models and in clinical trials.
Chronic Obstructive Pulmonary Disease
[0165] Chronic obstructive pulmonary disease (COPD), also known as
chronic obstructive airway disease, is a group of diseases
characterized by the pathological limitation of airflow in the
airway that is not fully reversible, and includes conditions such
as chronic bronchitis, emphysema, as well as other lung disorders
such as asbestosis, pneumoconiosis, and pulmonary neoplasms (see,
e.g., Barnes, Pharmacological Reviews 2004, 56(4), 515-548). The
airflow limitation is usually progressive and associated with an
abnormal inflammatory response of the lungs to noxious particles
and gases. COPD is characterized by a shortness of breath that can
last for months or years, possibly accompanied by wheezing, and a
persistent cough with sputum production. COPD is most often caused
by tobacco smoking, although it can also be caused by other
airborne irritants such as coal dust, asbestos, urban pollution, or
solvents. COPD encompasses chronic obstructive bronchiolitis with
fibrosis and obstruction of small airways, and emphysema with
enlargement of airspaces and destruction of lung parenchyma, loss
of lung elasticity, and closure of small airways.
[0166] The efficacy of administering MHF or a MHF prodrug for
treating chronic obstructive pulmonary disease may be assessed
using animal models of chronic obstructive pulmonary disease and in
clinical studies. For example, murine models of chronic obstructive
pulmonary disease are known.
Neurodegenerative Disorders
[0167] Neurodegenerative diseases such as Parkinson's disease,
Alzheimer's disease, Huntington's disease and amyoptrophic lateral
sclerosis are characterized by progressive dysfunction and neuronal
death. NF-.kappa.B inhibition has been proposed as a therapeutic
target for neurodegenerative diseases (Camandola and Mattson,
Expert Opin Ther Targets 2007, 11(2), 123-32).
Parkinson's Disease
[0168] Parkinson's disease is a slowly progressive degenerative
disorder of the nervous system characterized by tremor when muscles
are at rest (resting tremor), slowness of voluntary movements, and
increased muscle tone (rigidity). In Parkinson's disease, nerve
cells in the basal ganglia, e.g., substantia nigra, degenerate, and
thereby reduce the production of dopamine and the number of
connections between nerve cells in the basal ganglia. As a result,
the basal ganglia are unable to properly control smooth muscle
movements and coordinate changes in posture as normal, leading to
tremor, incoordination, and slowed, reduced movement (bradykinesia)
(Blandini, et al., Mol. Neurobiol. 1996, 12, 73-94).
[0169] The efficacy of MHF or a MHF prodrug for treating
Parkinson's disease may be assessed using animal and human models
of Parkinson's disease and in clinical studies.
Alzheimer's Disease
[0170] Alzheimer's disease is a progressive loss of mental function
characterized by degeneration of brain tissue, including loss of
nerve cells and the development of senile plaques and
neurofibrillary tangles. In Alzheimer's disease, parts of the brain
degenerate, destroying nerve cells and reducing the responsiveness
of the maintaining neurons to neurotransmitters. Abnormalities in
brain tissue consist of senile or neuritic plaques, e.g., clumps of
dead nerve cells containing an abnormal, insoluble protein called
amyloid, and neurofibrillary tangles, twisted strands of insoluble
proteins in the nerve cell.
[0171] The efficacy of MHF or a MHF prodrug for treating
Alzheimer's disease may be assessed using animal and human models
of Alzheimer's disease and in clinical studies.
Huntington's Disease
[0172] Huntington's disease is an autosomal dominant
neurodegenerative disorder in which specific cell death occurs in
the neostriatum and cortex (Martin, N Engl J Med 1999, 340,
1970-80). Onset usually occurs during the fourth or fifth decade of
life, with a mean survival at age of onset of 14 to 20 years.
Huntington's disease is universally fatal, and there is no
effective treatment. Symptoms include a characteristic movement
disorder (Huntington's chorea), cognitive dysfunction, and
psychiatric symptoms. The disease is caused by a mutation encoding
an abnormal expansion of CAG-encoded polyglutamine repeats in the
protein, huntingtin.
[0173] The efficacy of MHF or a MHF prodrug for treating
Huntington's disease may be assessed using animal and human models
of Huntington's disease and in clinical studies.
Amyotrophic Lateral Sclerosis
[0174] Amyotrophic lateral sclerosis (ALS) is a progressive
neurodegenerative disorder characterized by the progressive and
specific loss of motor neurons in the brain, brain stem, and spinal
cord (Rowland and Schneider, N Engl J Med 2001, 344, 1688-1700).
ALS begins with weakness, often in the hands and less frequently in
the feet that generally progresses up an arm or leg. Over time,
weakness increases and spasticity develops characterized by muscle
twitching and tightening, followed by muscle spasms and possibly
tremors. The average age of onset is 55 years, and the average life
expectancy after the clinical onset is 4 years. The only recognized
treatment for ALS is riluzole, which can extend survival by only
about three months.
[0175] The efficacy MHF or a MHF prodrug for treating ALS may be
assessed using animal and human models of ALS and in clinical
studies.
Other Diseases
[0176] Other diseases and conditions for which MHF or a MHF prodrug
such as DMF or a compound of Formulae (I) or (II) can be useful in
treating include acute disseminated encephalomyelitis, Addison's
disease, adrenal leukodystrophy, Alexanders Disease, alopecia
greata, Alper's Disease, ankylosing spondylitis, antiphospholipid
antibody syndrome, autoimmune hemolytic anemia, autoimmune
hepatitis, autoimmune inner ear disease, autoimmune carditis, balo
concentric sclerosis, bullous pemphigoid, Behcet's disease, Canavan
disease, celiac disease, central nervous system vasculitis, Chagas
disease, Charcott-Marie-Tooth Disease, childhood ataxia with
central nervous system hypomyelination, dermatomyositis, diabetes
mellitus type I, eczema, endometriosis, Goodpasture's syndrome,
granuloma annulare, Graves' disease, Guillain-Barre syndrome,
Hashimoto's disease, hepatitis C viral infection, herpes simplex
viral infection, hidradenitis suppurativea, human immunodeficiency
viral infection, Kawasaki disease, Krabbe Disease, IgA neuropathy,
idiopathic thrombocytopenic purpura, interstitial cystitis, lupus,
lupus erythematosus, mixed connective tissue disease, monomelic
myotrophy, morphea, myasthenia gravis, narcolepsy,
neurodegeneration with brain iron accumulation, neuromyelitis
optica, neuromyotonia, neurosarcoidosis, optic neuritis,
pareneoplastic syndromes, Pelizaeus-Merzbacher disease, pemphigus
vulgaris, pernicious anaemia, primary biliary cirrhosis, primary
lateral sclerosis, psoriatic arthritis, polymyositis, progressive
supranuclear palsy, rheumatica, rheumatoid arthritis, sarcoidosis,
Schilders Disease, schizophrena, scleroderma, Sjogren's syndrome,
stiff person syndrome, subacute necrotizing myelopathy, susac
syndrome, temporal arteritis, transverse myelitis, tumors,
vasculitis, vitiligo, Wegener's granulomatosis and Zellweger's
syndrome.
Dosing
[0177] The dosage forms disclosed herein, and their use for
therapeutic treatment, are not limited to any particular oral
dosing regimen as long as the dosing regimen achieves therapeutic
blood plasma concentration levels and AUC levels. MHF or a MHF
prodrug may be administered at dosage levels of about 0.001 mg/kg
to about 50 mg/kg, from about 0.01 mg/kg to about 25 mg/kg, or from
about 0.1 mg/kg to about 10 mg/kg of subject body weight per day,
one, two, three, four or more times a day, to obtain the desired
concentrations and AUC for MHF in the blood plasma.
[0178] For the treatment of multiple sclerosis and/or psoriasis,
MHF concentrations in blood plasma of at least 0.5 .mu.g/ml during
the course of dosing is desired. In other embodiments, MHF
concentrations in blood plasma of at least 0.7 .mu.g/ml during the
course of dosing is desired. In other embodiments, MHF
concentrations in blood plasma of at least 1.2 .mu.g/ml during the
course of dosing is desired.
[0179] Similarly, for the treatment of multiple sclerosis and/or
psoriasis, an area under a concentration of MHF in blood plasma
versus time curve (AUC) of at least 4.0 .mu.ghr/ml over 24 hours of
dosing is desired. In other embodiments, an area under a
concentration of MHF in blood plasma versus time curve (AUC) of at
least 4.8 .mu.ghr/ml over 24 hours of dosing is desired. In other
embodiments, an area under a concentration of MHF in blood plasma
versus time curve (AUC) of at least 6.0 .mu.ghr/ml over 24 hours of
dosing is desired. In other embodiments, an area under a
concentration of MHF in blood plasma versus time curve (AUC) of at
least 7.0 .mu.ghr/ml over 24 hours of dosing is desired. In other
embodiments, an area under a concentration of MHF in blood plasma
versus time curve (AUC) of at least 9.0 .mu.ghr/ml over 24 hours of
dosing is desired. In other embodiments, an area under a
concentration of MHF in blood plasma versus time curve (AUC) of at
least 10.5 .mu.ghr/ml over 24 hours of dosing is desired. In still
other embodiments, an area under a concentration of MHF in blood
plasma versus time curve (AUC) of at least 12.0 .mu.ghr/ml over 24
hours of dosing is desired.
[0180] The amount of MHF or a MHF prodrug that will be effective in
the treatment of a disease in a patient will depend, in part, on
the nature of the condition and can be determined by standard
clinical techniques known in the art. In addition, in vitro or in
vivo assays may be employed to help identify optimal dosage ranges.
A therapeutically effective amount of MHF or a MHF prodrug to be
administered may also depend on, among other factors, the subject
being treated, the weight of the subject, the severity of the
disease, the manner of administration, and the judgment of the
prescribing physician.
[0181] For systemic administration, a therapeutically effective
dose may be estimated initially from in vitro assays. For example,
a dose may be formulated in animal models to achieve a beneficial
circulating composition concentration range. Initial doses may also
be estimated from in vivo data, e.g., animal models, using
techniques that are known in the art. Such information may be used
to more accurately determine useful doses in humans. One having
ordinary skill in the art may optimize administration to humans
based on animal data.
[0182] A dose may be administered in a single dosage form or in
multiple dosage forms. When multiple dosage forms are used the
amount of compound contained within each dosage form may be the
same or different. The amount of MHF or a MHF prodrug contained in
a dose may depend on whether the disease in a patient is
effectively treated by acute, chronic, or a combination of acute
and chronic administration.
[0183] In certain embodiments an administered dose is less than a
toxic dose. Toxicity of the compositions described herein may be
determined by standard pharmaceutical procedures in cell cultures
or experimental animals, e.g., by determining the LD50 (the dose
lethal to 50% of the population) or the LD100 (the dose lethal to
100% of the population). The dose ratio between toxic and
therapeutic effect is the therapeutic index. In certain
embodiments, a MHF prodrug may exhibit a high therapeutic index.
The data obtained from these cell culture assays and animal studies
may be used in formulating a dosage range that is not toxic for use
in humans. A dose of MHF or a MHF prodrug provided by the present
disclosure may be within a range of circulating concentrations in
for example the blood, plasma, or central nervous system, that
include the effective dose and that exhibits little or no toxicity.
A dose may vary within this range depending upon the dosage form
employed. In certain embodiments, an escalating dose may be
administered.
EXAMPLES
[0184] The following examples illustrate various aspects of the
disclosure. It will be apparent to those skilled in the art that
many modifications, both to materials and methods, may be practiced
without departing from the scope of the disclosure.
Example 1
[0185] Delayed release tablets containing
(N,N-Diethylcarbamoyl)methyl methyl (2E)but-2-ene-1,4-dioate were
made having the ingredients shown in Table 1:
TABLE-US-00002 TABLE 1 Quantity Quantity Component Manufacturer
Role (mg/tablet) (% w/w) (N,N- XenoPort (Santa Drug substance
200.00 78.38 Diethylcarbamoyl)methyl Clara, CA) methyl
(2E)but-2-ene- 1,4-dioate Hydroxypropyl Cellulose Ashland
(Hopewell, Binder 6.19 2.42 VA) Lactose Monohydrate Foremost
(Rothschild, Filler 38.28 15.00 WI) Croscarmellose Sodium FMC
BioPolymer Disintegrant 7.66 3.00 (Philadelphia, PA) Silicon
Dioxide Cabot (Tuscola, IL) Glidant 0.51 0.20 Magnesium Stearate
Mallinckrodt (St. Lubricant 2.55 1.00 Louis, MO) Total Core 255.19
100.00 Opadry 03O19184 Colorcon (West Point, Barrier coat 6.80 2.66
PA) Total Barrier 6.80 2.66 Coating Methacrylic Acid Co- Evonik
Industries Enteric polymer 21.10 8.27 polymer Dispersion (Essen,
Germany) Triethyl Citrate Vertellus Plasticizer 1.10 0.43
(Greensboro, NC) PlasACRYL .TM. T20 Emerson Resources Anti-tacking
2.10 0.82 (Norristown, PA) agent Total Enteric 24.30 9.52 Coating
Total Tablet 286.29 112.19
[0186] The tablets were made according to the following steps. The
core tablets were prepared using a wet granulation process. The
granulation was performed in two batches at 463.9 g per batch. The
(N,N-Diethylcarbamoyl)methyl methyl (2E)but-2-ene-1,4-dioate and
hydroxypropyl cellulose were passed through a conical mill with a
610 micron round holed screen. The (N,N-Diethylcarbamoyl)methyl
methyl (2E)but-2-ene-1,4-dioate and hydroxypropyl cellulose were
then combined in a Key KG-5 granulator bowl and mixed with water
addition for approximately 9 minutes. The wet granules were dried
in a Glatt GPCG-1 fluid bed dryer at 40.degree. C. The two portions
of dried granules were combined and blended with the silicon
dioxide in an 8 quart (7.6 liter) V-blender for 5 minutes and then
sized by passing through a conical mill with an approximately 1300
micron grater type screen. The milled granules were blended with
the croscarmellose sodium and lactose monohydrate for 10 minutes in
an 8 quart (7.6 l) V-blender. The magnesium stearate was passed
through a 600 micron mesh screen and blended with the additional
core materials in the V-blender for 5 minutes. Core tablets (254.87
mg) were compressed using a GlobePharma Minipress II rotary tablet
press with 11/32 inch (8.7 mm) round concave tooling. The core
tablets had a final mean hardness of approximately 15.5 kp. An
aqueous suspension was prepared by mixing with an impeller 68.85 g
Opadry 03019184 with 792.0 g of purified water. The water contained
in the suspension is removed during the film coating process and
therefore not included in the final formulation in Table 1. The
tablets were coated with the aqueous suspension in an O'Hara
Technologies Labcoat M coater with a 12'' (30.5 cm) diameter
perforated pan until the desired weight gain of barrier coat was
achieved. The coating process occurred at an inlet temperature of
approximately 52.degree. C. and an outlet temperature of 37.degree.
C. After coating, the tablets were dried for 2 hours at 40.degree.
C. An aqueous suspension was prepared by mixing with an impeller
578.7 g methacrylic acid copolymer dispersion, 9.0 g triethyl
citrate, 86.5 g PlasACRYL.TM. T20 with 325.8 g water. The water
contained in (i) the methacrylic acid copolymer dispersion and (ii)
the PlasACRYL.TM. T20 is removed during the film coating process
and therefore not included in the final formulation in Table 1. The
tablets were coated with the aqueous suspension in an O'Hara
Technologies Labcoat M coater with a 12'' (30.5 cm) diameter
perforated pan until the desired weight gain of enteric film was
achieved. The coating process occurred at an inlet temperature of
approximately 40.degree. C. and an outlet temperature of 30.degree.
C. After coating, the tablets were dried for 2 hours at 40.degree.
C.
Example 2
[0187] Delayed sustained release tablets containing
(N,N-Diethylcarbamoyl)methyl methyl (2E)but-2-ene-1,4-dioate were
made having the ingredients shown in Table 2:
TABLE-US-00003 TABLE 2 Quantity Quantity Component Manufacturer
Role (mg/tablet) (% w/w) (N,N- XenoPort (Santa Drug substance
200.00 66.74 Diethylcarbamoyl)methyl Clara, CA) methyl
(2E)but-2-ene- 1,4-dioate Hydroxypropyl Cellulose Ashland
(Hopewell, Binder 6.19 2.06 VA) Lactose Monohydrate Foremost
(Rothschild, Filler 44.95 15.00 WI) Hypromellose 2208 Dow Chemical
Sustained 44.95 15.00 (Midland, MI) release agent Silicon Dioxide
Cabot (Tuscola, IL) Glidant 0.60 0.20 Magnesium Stearate
Mallinckrodt (St. Lubricant 3.00 1.00 Louis, MO) Total Core 299.69
100.00 Opadry 03O19184 Colorcon (West Point, Barrier coat 7.13 2.38
PA) Total Barrier 7.13 2.38 Coating Methacrylic Acid Co- Evonik
Industries Enteric polymer 24.20 8.08 polymer Dispersion (Essen,
Germany) Triethyl Citrate Vertellus Plasticizer 1.25 0.42
(Greensboro, NC) PIasACRYL .TM. T20 Emerson Resources Anti-tacking
2.41 0.80 (Norristown, PA) agent Total Enteric 27.87 9.30 Coating
Total Tablet 334.69 111.68
[0188] The tablets were made according to the following steps. The
core tablets were prepared using a wet granulation process. The
granulation was performed in two batches at 456 g per batch. The
(N,N-Diethylcarbamoyl)methyl methyl (2E)but-2-ene-1,4-dioate and
hydroxypropyl cellulose were passed through a conical mill with a
610 micron round holed screen. The (N,N-Diethylcarbamoyl)methyl
methyl (2E)but-2-ene-1,4-dioate and hydroxypropyl cellulose were
then combined in a Key KG-5 granulator bowl and mixed with water
addition for approximately 7 minutes. The wet granules were dried
in a Glatt GPCG-1 fluid bed dryer at 40.degree. C. The two portions
of dried granules were sized by passing through a conical mill with
an approximately 1300 micron grater type screen. The milled
granules were blended with the hypromellose 2208, silicon dioxide,
and lactose monohydrate for 10 minutes in an 8 quart (7.6 l)
V-blender. This blend was passed through an 850 micron mesh screen.
The magnesium stearate was passed through a 600 micron mesh screen
and blended with the additional core materials in the V-blender for
5 minutes. Core tablets (299.69 mg) were compressed using a
GlobePharma Minipress II rotary tablet press with 8.6 mm round
concave tooling. The core tablets had a final mean hardness of
approximately 12 kp. An aqueous suspension was prepared by mixing
with an impeller 63.8 g Opadry 03019184 with 770.7 g of purified
water. The water contained in the suspension is removed during the
film coating process and therefore not included in the final
formulation in Table 2. The tablets were coated with the aqueous
suspension in an O'Hara Technologies Labcoat M coater with a 12''
(30.5 cm) diameter perforated pan until the desired weight gain of
barrier coat was achieved. The coating process occurred at an inlet
temperature of approximately 52.degree. C. and an outlet
temperature of 36.degree. C. After coating, the tablets were dried
for 2 hours at 40.degree. C. An aqueous suspension was prepared by
mixing with an impeller 405.1 g methacrylic acid copolymer
dispersion, 6.3 g triethyl citrate, 60.6 g PlasACRYL.TM. T20 with
228.1 g water. The water contained in the methacrylic acid
copolymer dispersion and the PlasACRYL.TM. T20 is removed during
the film coating process and therefore not included in the final
formulation in Table 1. The tablets were coated with the aqueous
suspension in the O'Hara Technologies Labcoat M coater until the
desired weight gain of enteric film was achieved. The coating
process occurred at an inlet temperature of approximately
40.degree. C. and an outlet temperature of 30.degree. C. After
coating, the tablets were dried for 2 hours at 40.degree. C.
Example 3
[0189] A two-stage dissolution method was used to determine the in
vitro dissolution profile of dosage forms prepared according to
Examples 1 and 2. The 2-stage dissolution test was used to better
approximate the pH conditions experienced by a dosage form after
swallowing by a patient, i.e., low pH of the stomach followed by
near neutral pH of the intestines. The dosage forms were first
placed into a dissolution vessel (USP, Type I, basket) containing
750 mL of 0.1N hydrochloric acid (pH 1.2). After 2 hours, 250 mL of
200 mM tribasic sodium phosphate was added to the vessel resulting
in a pH adjustment from 1.2 to 6.8. The dissolution medium was kept
at 37.degree. C. and was agitated at 100 rpm.
[0190] For the Example 1 dosage forms, samples of the dissolution
medium were withdrawn after 1 and 2 hours in the low pH stage, and
at 0.25, 0.5, 0.75, and 1 hours following buffer addition. For the
Example 2 dosage forms, samples of the dissolution medium were
withdrawn after 1 and 2 hours in the low pH stage, and at 0.5, 2,
4, 7, 10, and 14 hours following buffer addition. The released
amount of (N,N-Diethylcarbamoyl)methyl methyl
(2E)but-2-ene-1,4-dioate in the samples was determined by reverse
phase HPLC using a C18 column and a 7 minute gradient method
according to Table 3 where Mobile Phase A is water/0.1%
H.sub.3PO.sub.4 and Mobile Phase B is
water/acetonitrile/H.sub.3PO.sub.4 (10/90/0.1 by volume) with UV
detection at 210 nm.
TABLE-US-00004 TABLE 3 Time (minute) % Mobile Phase A % Mobile
Phase B 0 85 15 5 35 65 5.5 85 15 7 85 15
[0191] As shown in FIG. 1, for dosage forms prepared according to
Example 1, drug release is delayed for approximately 2 hours,
followed with near immediate release with >90% released between
2 and 3 hours.
[0192] As shown in FIG. 2, for dosage forms prepared according to
Example 2, drug release is delayed for approximately 2 hours,
followed by sustained release reaching>90% at 12 hours.
Comparative Example 1
No Barrier Coating
[0193] Delayed sustained release tablets having no barrier coating
were manufactured using substantially the same core components as
the tablets of Example 2. After tablet core compression, no barrier
layer coating was applied. Instead, the tablet cores were directly
coated with an enteric coating as follows. An aqueous enteric
coating suspension was prepared by mixing with an impeller 289.4 g
methacrylic acid copolymer dispersion, 4.5 g triethyl citrate,
43.25 g PlasACRYL.TM. T20 with 162.9 g water. The tablet cores were
coated with the aqueous suspension in the O'Hara Technologies
Labcoat M coater to achieve a enteric coating weight of 27.9 mg per
tablet. The coating process occurred at an inlet temperature of
approximately 42.degree. C. and an outlet temperature of 31.degree.
C. After coating, the tablets were dried for 2 hours at 40.degree.
C.
Example 4
[0194] Delayed sustained release tablets manufactured as in Example
2 (with a barrier coating) and tablets manufactured as in
Comparative Example 1 (with no barrier coating) were each packaged
for stability testing. The packaging configuration was fifteen
tablets in a 0.025 inch (0.6 mm) thick, 30 cm.sup.3 HDPE bottle
with child-resistant screw cap and foil induction seal, containing
a 1 g silica gel canister. The tablets were stored at 40.degree. C.
and 75% relative humidity and tested for assay/impurities at 3
months. The total degradants detected in the tablets at three
months are shown in FIG. 3.
Example 5
[0195] Delayed release tablets containing
(N,N-Diethylcarbamoyl)methyl methyl (2E)but-2-ene-1,4-dioate are
made having the ingredients shown in Tables 4A and 4B:
TABLE-US-00005 TABLE 4A Quantity Quantity (% w/w of Component
Manufacturer Role (mg/tablet) core) (N,N- XenoPort (Santa Drug
substance 200.00 78.47 Diethylcarbamoyl)methyl Clara, CA) methyl
(2E)but-2-ene- 1,4-dioate Hydroxypropyl Cellulose Aqualon
(Hopewell, Binder 6.19 2.43 VA) Lactose Monohydrate Foremost
(Rothschild, Filler 38.23 15.00 WI) Croscarmellose Sodium FMC
BioPolymer Disintegrant 7.65 3.00 (Philadelphia, PA) Silicon
Dioxide Cabot (Tuscola, IL) Glidant 0.25 0.10 Magnesium Stearate
Mallinckrodt (St. Lubricant 2.55 1.00 Louis, MO) Total Core 254.87
100.00 Opadry 03O19184 Colorcon (West Point, Barrier coat 6.78 2.66
PA) Total Barrier 6.78 2.66 Coating Methacrylic Acid Co- Evonik
Industries Enteric polymer 20.03 7.86 polymer Dispersion (Essen,
Germany) Triethyl Citrate Moreflex (Greensboro, Plasticizer 1.04
0.41 NC) PlasACRYL .TM. T20 Emerson Resources Anti-tacking 2.00
0.78 (Norristown, PA) agent Total Enteric 23.07 9.05 Coating Total
Tablet 284.72 111.71
TABLE-US-00006 TABLE 4B Quantity Quantity (% w/w of Component
Manufacturer Role (mg/tablet) core) (N,N- Cambridge Major Drug
substance 200.00 78.38 Diethylcarbamoyl)methyl (Germantown, WI)
methyl (2E)but-2-ene- 1,4-dioate Hydroxypropyl Cellulose Aqualon
(Hopewell, Binder 6.19 2.42 VA) Lactose Monohydrate Foremost
(Rothschild, Filler 38.28 15.00 WI) Croscarmellose Sodium FMC
BioPolymer Disintegrant 7.66 3.00 (Philadelphia, PA) Silicon
Dioxide Cabot (Tuscola, IL) Glidant 0.51 0.20 Magnesium Stearate
Mallinckrodt (St. Lubricant 2.55 1.00 Louis, MO) Total Core 255.19
100.00 Opadry 03O19184 Colorcon (West Point, Barrier coat 6.79 2.66
PA) Total Barrier 6.79 2.66 Coating Methacrylic Acid Co- Evonik
Industries Enteric polymer 17.30 6.78 polymer Dispersion (Essen,
Germany) Triethyl Citrate Moreflex (Greensboro, Plasticizer 0.89
0.35 NC) PlasACRYL .TM. T20 Emerson Resources Anti-tacking 1.74
0.68 (Norristown, PA) agent Total Enteric 19.93 7.81 Coating Total
Tablet 281.91 110.47
[0196] The cores of the Table 4A tablets are made according to the
following steps. The core tablets are prepared using a wet
granulation process. The granulation batch size is 680 g. The
(N,N-Diethylcarbamoyl)methyl methyl (2E)but-2-ene-1,4-dioate is
passed through a Quadro Comil U5 with an 813 micron screen at 2000
rpm. Hydroxypropyl cellulose is passed through a 600 micron mesh
screen. The (N,N-Diethylcarbamoyl)methyl methyl
(2E)but-2-ene-1,4-dioate and hydroxypropyl cellulose are granulated
with purified water using a Diosna P1/6 equipped with a 4 L bowl.
The wet granules are screened through an 1180 micron mesh screen
and are dried on trays in an oven at 30.degree. C. for 6 hours. The
core blend batch size is 15.0 g. The dried granules, lactose
monohydrate, croscarmellose sodium, and the silicon dioxide are
combined in a glass jar and are blended in a Turbula mixer for 2
minutes. The magnesium stearate is added and the entire blend is
then passed through a 600 micron mesh screen, returned to the glass
jar, and blended in a Turbula mixer for 2 additional minutes. Core
tablets are compressed using a Carver Press with 11/32 inch (8.7
mm) round standard concave tooling at 1.2 metric ton (MT) force.
The core tablets have a final hardness of approximately 13.1 kp
(.about.128 Newtons).
[0197] The cores of the Table 4B tablets are made according to the
following steps. The tablet cores are prepared using a wet
granulation process. Two granulations of batch size 170.0 g each
are prepared. The (N,N-Diethylcarbamoyl)methyl methyl
(2E)but-2-ene-1,4-dioate is passed through a Quadro Comil U5 with a
610 or 813 micron screen at 2000 rpm. Hydroxypropyl cellulose is
passed through a 500 micron mesh screen. The
(N,N-Diethylcarbamoyl)methyl methyl (2E)but-2-ene-1,4-dioate and
hydroxypropyl cellulose are granulated with purified water using a
Diosna P1/6 equipped with a 1 L bowl. The wet granules are dried on
trays in an oven at 30.degree. C. The core blend batch size is
300.0 g. The dried granules, lactose monohydrate, croscarmellose
sodium, and the silicon dioxide are screened through a 600 micron
mesh screen and then blended in a V-blender for 5 minutes. The
magnesium stearate is screened through a 425 micron mesh screen and
blended with the other tablet core formulation components in a
V-blender for 2 minutes. The tablet cores are compressed using a
Korsch XL100 rotary press with 11/32 inch (8.7 mm) round standard
concave tooling at approximately 6-7 kN force. The cores have a
final hardness of approximately 12 kp.
[0198] The tablet cores from Tables 4A and 4B are film-coated
according to the following process. An aqueous suspension is
prepared by mixing with an impeller 68.85 g Opadry 03O19184 with
792.0 g of purified water. The water contained in the suspension is
removed during the film coating process and is therefore not
included in the formulations in Tables 4A and 4B. The tablets are
coated with the aqueous suspension in an O'Hara Technologies
Labcoat M coater with a 12'' (30.5 cm) diameter perforated pan
until the desired weight gain of barrier coat is achieved. The
coating process occurs at an inlet temperature of approximately
52.degree. C. and an outlet temperature of 37.degree. C. After
coating, the tablets are dried for 2 hours at 40.degree. C. An
aqueous suspension is prepared by mixing with an impeller
methacrylic acid copolymer dispersion, triethyl citrate,
PlasACRYL.TM. T20 with water. The water contained in the
methacrylic acid copolymer dispersion and the PlasACRYL.TM. T20 is
removed during the film coating process and therefore is not
included in the formulations in Tables 4A and 4B. The tablets are
coated with the aqueous suspension in an O'Hara Technologies
Labcoat M coater with a 12 inch (30.5 cm) diameter perforated pan
until the desired weight gain of enteric film is achieved. The
coating process occurs at an inlet temperature of approximately
36.degree. C. and an outlet temperature of 29.degree. C.
Example 6
[0199] Delayed sustained release tablets containing
(N,N-Diethylcarbamoyl)methyl methyl (2E)but-2-ene-1,4-dioate are
made having the ingredients shown in Table 5:
TABLE-US-00007 TABLE 5 Quantity Quantity (% w/w of Component
Manufacturer Role (mg/tablet) core) (N,N- XenoPort (Santa Drug
substance 200.00 66.93 Diethylcarbamoyl)methyl Clara, CA) methyl
(2E)but-2-ene- 1,4-dioate Hydroxypropyl Cellulose Aqualon
(Hopewell, Binder 6.19 2.07 VA) Lactose Monohydrate Foremost
(Rothschild, Filler 44.83 15.00 WI) Hypromellose 2208 Dow Chemical
Sustained 44.83 15.00 (Midland, MI) release agent Magnesium
Stearate Mallinckrodt (St. Lubricant 2.99 1.00 Louis, MO) Total
Core 298.84 100.00 Opadry 03O19184 Colorcon (West Point, Barrier
coat 7.11 2.38 PA) Total Barrier 7.11 2.38 Coating Methacrylic Acid
Co- Evonik Industries Enteric polymer 20.27 6.78 polymer Dispersion
(Essen, Germany) Triethyl Citrate Moreflex (Greensboro, Plasticizer
1.05 0.35 NC) PlasACRYL .TM. T20 Emerson Resources Anti-tacking
2.02 0.68 (Norristown, PA) agent Total Enteric 23.34 7.81 Coating
Total Tablet 329.29 110.19
[0200] The tablets are made according to the following steps. The
core tablets are prepared using a wet granulation process. The
granulation batch size is 170 g. The (N,N-Diethylcarbamoyl)methyl
methyl (2E)but-2-ene-1,4-dioate is passed through a Quadro Comil U5
with an 813 micron screen at 2000 rpm. Hydroxypropyl cellulose is
passed through a 500 micron mesh screen. The
(N,N-Diethylcarbamoyl)methyl methyl (2E)but-2-ene-1,4-dioate and
hydroxypropyl cellulose are granulated with purified water using a
Diosna P1/6 equipped with a 1 L bowl. The wet granules are screened
through an approximately 1180 micron mesh screen and are dried on
trays in an oven at 30.degree. C. for approximately 4 hours. The
core blend batch size is 80.0 g. The tablet core materials are
blended in a Turbula mixer. Core tablets (298.84 mg) are compressed
using a Manesty Flexitab with 11/32'' round standard concave
tooling at approximately 15 kN force. The core tablets have a final
hardness of approximately 11 kp. An aqueous suspension is prepared
by mixing with an impeller 68.85 g Opadry 03O19184 with 792.0 g of
purified water. The water contained in the suspension is removed
during the film coating process and is therefore not included in
the formulation in Table 5. The tablets are coated with the aqueous
suspension in an O'Hara Technologies Labcoat M coater with a 12''
(30.5 cm) diameter perforated pan until the desired weight gain of
barrier coat is achieved. The coating process occurs at an inlet
temperature of approximately 52.degree. C. and an outlet
temperature of 37.degree. C. After coating, the tablets are dried
for 2 hours at 40.degree. C. An aqueous suspension is prepared by
mixing with an impeller 405.1 g methacrylic acid copolymer
dispersion, 6.3 g triethyl citrate, 60.6 g PlasACRYL.TM. T20 with
228.1 g water. The water contained in the methacrylic acid
copolymer dispersion and the PlasACRYL.TM. T20 is removed during
the film coating process and therefore not included in the
formulation in Table 5. The tablets are coated with the aqueous
suspension in an O'Hara Technologies Labcoat M coater with a 12
inch (30.5 cm) diameter perforated pan until the desired weight
gain of enteric film is achieved. The coating process occurs at an
inlet temperature of approximately 36.degree. C. and an outlet
temperature of 29.degree. C.
Example 7
[0201] The concentration.+-.1 SD of MHF in the blood of
Cynomologous monkeys following oral dosing of delayed release
enteric coated tablets, which have the same formulation as the
tablets of Examples 5 and 6, except that no Opadry barrier layer
was present in the tested tablets, is shown in FIGS. 4 and 5. The
data in FIG. 4 is from animals that were dosed in a fed state and
the data in FIG. 5 is from animals that were dosed in a fasted
state. Two groups of tablets were tested. Tablets having the same
formulation as described in Table 4A tablets, except that the
Opadry barrier layer was not present, produced the pharmacokinetic
curve shown with - symbols in FIG. 4. Tablets having the same
formulation as described in Table 4B, except that the Opadry
barrier layer was not present, produced the pharmacokinetic curve
shown with - symbols in FIG. 5. In these Figures, the MHF
concentrations following dosing with tablets having the formulation
of Example 6 tablets are shown with o-o symbols. It is believed
that tablets made according to the exact formulations of Examples 5
and 6, with the Opadry barrier layer present, would exhibit
substantially the same pharmacokinetic profiles as are shown in
FIGS. 4 and 5 since the Opadry barrier layer is quickly dissolved
in the gut and does not substantially affect the rate or timing of
MHF prodrug release from the tablet core.
Administration Protocol
[0202] Tablets having the same formulations as the tablets
disclosed in Examples 5 and 6 (200 mg of
(N,N-Diethylcarbamoyl)methyl methyl (2E)but-2-ene-1,4-dioate per
tablet), but without any Opadry barrier layer present, were
administered by oral dosing to groups of four adult male
Cynomologous (Macaca fascicularis) monkeys (each monkey weighs
about 4 to 5 kg). Each monkey was administered one tablet while in
a fasted state or while in a fed state. All animals were fasted
overnight before the study. For the fed leg, animals were
administered blended food via oral gavage in the morning 30 minutes
prior to administration of each test formulation. For the fasted
leg, the animals remain fasted for 4 hours post-dosing. Blood
samples (1.0 mL) were obtained from all animals via the femoral
vein at pre-dose and intervals over 24 hours after oral dosing.
Blood was collected in pre-chilled K.sub.2EDTA, quenched with
acetonitrile and stored at -50.degree. C. to -90.degree. C. until
analysis. There was a minimum of 7 day wash out period between
dosing sessions.
Sample Preparation for Absorbed Drug
[0203] 300 .mu.L of acetonitrile was added to 1.5 mL Eppendorf
tubes for the preparation of samples and standards.
[0204] Sample Preparation: Blood was collected at different time
points and immediately 100 .mu.L of blood was added into Eppendorf
tubes containing 300 .mu.L of methanol and mixed by vortexing.
[0205] Standard Preparation: One hundred .mu.L of blood was added
to 290 .mu.L of acetonitrile in Eppendorf tubes. 10 .mu.IL of MHF
standard solution (0.2, 0.5, 1, 2.5, 5, 10, 25, 50 and 100
.mu.g/mL) was added to each tube to make up the final calibration
standards (0.02, 0.05, 0.1, 0.25, 0.5, 1, 2.5, 5 and 10
.mu.g/mL).
[0206] A 150 .mu.L aliquot of supernatant from quenched blood
standards, QCs and samples was transferred to a 96-well plate and
20 .mu.L of the internal standard solution was added to each well,
the plate was capped and vortexed well. The supernatant was
injected onto the API 4000 LC/MS/MS system for analysis
LC/MS/MS Analysis
[0207] The concentration of MHF in monkey blood was determined
using an API 4000 LC/MS/MS instrument equipped with Agilent Binary
pump and autosampler. The column was a Luna C8 (2) 4.6.times.150
mm, 5.mu. column operating at 2 to 8.degree. C. temperature. The
mobile phases were (A) 0.1% formic acid in water, and (B) 0.1%
formic acid in acetonitrile. The gradient condition was: 2% B for 1
min, increasing to 95% B in 3.5 min and maintained for 2 min, then
decreasing to 2% B in 5.6 min and maintained for 2.3 min. 30 .mu.L
of sample was injected into the column. A Turbo-Ion Spray source
was used, and was detected in negative ion mode for the MRM
transition of 128.95/84.8. Peaks were integrated using Analyst 1.5
quantitation software.
Example 8
[0208] A randomized, double-blind crossover, food effect,
single-dose study of the safety, tolerability, and pharmacokinetics
of two oral dosage forms of (N,N-Diethylcarbamoyl)methyl methyl
(2E)but-2-ene-1,4-dioate in healthy adult subjects was conducted.
Twenty-four healthy adult volunteers (males and females)
participated in the study. Twelve of the subjects received a dosage
form of Example 1, once in a fed condition and once in a fasted
condition, with a two-week washout between treatments. Twelve other
subjects received a dosage form of Example 2, once in a fed
condition and once in a fasted condition, with a two-week washout
between treatments. The fasted dosing was achieved by dosing the
subject following an overnight fast while the fed dosing was
achieved by dosing the subject after consuming a high fat-content
breakfast. Each of the two tested dosage forms contained 200 mg of
(N,N-Diethylcarbamoyl)methyl methyl (2E)but-2-ene-1,4-dioate (107
mg equivalents of methyl hydrogen fumarate).
[0209] Blood samples were collected from all subjects prior to
dosing, and at 0.5, 1, 1.5, 2, 3, 4, 5, 6, 7, 8, 10, 12, 16, 24,
30, 36, 48, 60, 72, 84, 96, 108 and 120 hours after dosing. Urine
samples were collected from all subjects prior to dosing, and
complete urine output was obtained at the 0-4, 4-8, 8-12, 12-24,
24-36, 36-48, 48-72, 72-96 and 96-120 hour intervals after dosing.
Blood samples were quenched immediately with acetonitrile and
frozen. Sample aliquots were prepared for analysis of (i) methyl
hydrogen fumarate, (ii) (N,N-Diethylcarbamoyl)methyl methyl
(2E)but-2-ene-1,4-dioate, (iii) N,N diethyl-2-hydroxy acetamide and
(iv)
(2S,3S,4S,5R,6R)-6-[(N,N-diethylcarbamoyl)methoxy]-3,4,5-trihydroxy-2H-3,-
4,5,6-tetrahydropyran-2-carboxylic acid, the latter two being other
potential metabolites of (N,N-Diethylcarbamoyl)methyl methyl
(2E)but-2-ene-1,4-dioate, using sensitive and specific LC/MS/MS
methods.
[0210] The plasma concentration of MMF following oral dosing of the
formulation prepared according to Example 1 to fasted and fed
healthy adult patients is shown in FIG. 6. Table 6 shows the
preliminary mean (SD) pharmacokinetic data for
(N,N-Diethylcarbamoyl)methyl methyl (2E)but-2-ene-1,4-dioate in fed
and fasted patients.
TABLE-US-00008 TABLE 6 C.sub.max Tmax AUC.sub.inf N Food (ng/mL)
(hr) (ng hr/mL) 12 Fasted 529 2.83 762 (233) (0.84) (248) 12*/11**/
Fed 366* 8.82** 807*** 7*** (320) (4.40) (445)
[0211] The formulation produced mean (SD) maximum MMF
concentrations (Cmax) of 529 (233) ng/mL fasted and 366 (320) ng/mL
fed. MMF AUC was 762 (248) ng*h/mL fasted and 807 (445) ng*h/mL
fed. The time to peak concentration (Tmax) was 2.83 (0.84) hr
fasted and 8.82 (4.40) hr fed. (N,N-Diethylcarbamoyl)methyl methyl
(2E)but-2-ene-1,4-dioate was well tolerated during the trial. All
12 subjects completed the dosing period. All adverse events were
mild. Adverse events reported in more than one subject and more
frequently for (N,N-Diethylcarbamoyl)methyl methyl
(2E)but-2-ene-1,4-dioate than for placebo were flushing and feeling
hot. A comparison of these adverse events of the formulation to
placebo is shown in Table 7.
TABLE-US-00009 TABLE 7 Flushing Feeling Hot Fasted Fed Fasted Fed
Placebo 0 1 0 0 Example 1 7 5 0 3 Formulation
[0212] The plasma concentration of MMF following oral dosing of the
formulation prepared according to Example 2 to fasted and fed
healthy adult patients is shown in FIG. 7. Table 8 shows the
preliminary mean (SD) pharmacokinetic data for
(N,N-Diethylcarbamoyl)methyl methyl (2E)but-2-ene-1,4-dioate in fed
and fasted patients.
TABLE-US-00010 TABLE 8 C.sub.max T.sub.max AUC.sub.inf N Food
(ng/mL) (hr) (ng hr/mL) 12*/8** Fasted 95* 4.17* 400** (26) (0.84)
(166) 12*/5*** Fed 80* 9.92* 377*** (39) (5.50) (132)
[0213] The formulation produced mean (SD) maximum MMF
concentrations (Cmax) of 95 (26) ng/mL fasted and 80 (39) ng/mL
fed. MMF AUC was 400 (160) ng*h/mL fasted and 377 (132) ng*h/mL
fed. The time to peak concentration (Tmax) was 4.17 (0.84) hr
fasted and 9.92 (5.50) hr fed. Promoiety was cleared from blood
with a half life around 3 hours.
[0214] The (N,N-Diethylcarbamoyl)methyl methyl
(2E)but-2-ene-1,4-dioate was well tolerated during the trial. All
12 subjects completed the dosing period. All adverse events were
mild. One subject in the (N,N-Diethylcarbamoyl)methyl methyl
(2E)but-2-ene-1,4-dioate fed group reported flushing more
frequently than in the fed placebo group. No subjects in the fasted
(N,N-Diethylcarbamoyl)methyl methyl (2E)but-2-ene-1,4-dioate group
reported flushing, and no subjects in either the fed or fasted
(N,N-Diethylcarbamoyl)methyl methyl (2E)but-2-ene-1,4-dioate groups
reported feeling hot more than for placebo. A comparison of these
adverse events of the formulation to placebo is shown in Table
9.
TABLE-US-00011 TABLE 9 Flushing Feeling Hot Fasted Fed Fasted Fed
Placebo 0 1 0 0 Example 2 1 1 0 0 Formulation
Example 9
[0215] Size 00 gelatin capsules containing 477 mg of
extended-release (N,N-Diethylcarbamoyl)methyl methyl
(2E)but-2-ene-1,4-dioate-containing pellets were manufactured with
the formulation shown in Table 10:
TABLE-US-00012 TABLE 10 Quantity Quantity Component Manufacturer
Role (mg/capsule) (% w/w) (N,N- Cambridge Drug 200.00 60.00
Diethylcarbamoyl)methyl (Germantown, substance methyl
(2E)but-2-ene-1,4- WI) dioate Microcrystalline FMC Filler 133.33
40.00 Cellulose (Newark, DE) Total 333.33 100.00 Pellet Core
Ethylcellulose Ashland Water- 20.56 6.17 (Hopewell VA) insoluble
coating agent Hydroxypropyl Cellulose Ashland Water 5.00 1.50
(Hopewell VA) soluble coating agent Talc Luzenac Anti-tacking 5.00
1.50 (Houston TX) agent Dibutyl sebacate Vertellus Plasticizer 2.78
0.83 (Greensboro, NC) Total 33.33 10.00 Barrier/ Sustained Release
Coating Methacrylic Acid Co- Evonik Enteric 88.55 24.15 polymer
Dispersion (Darmstadt, coating Germany) agent Triethyl Citrate
Vertellus Plasticizer 14.30 3.90 (Greensboro, NC) PlasACRYL T20
Emerson Anti-tacking 7.15 1.95 (Norristown, agent PA) Total 110.00
30.00 Enteric Coating VCaps Plus Size 00 Capsugel Capsule 111-125
23.29-26.22 Capsule (Puebla, Mexico)
[0216] The capsules were manufactured according to the following
process. An extrusion/spheronization process was selected for the
manufacture of the core pellets for the capsules. The
(N,N-Diethylcarbamoyl)methyl methyl (2E)but-2-ene-1,4-dioate was
first screened then mixed with microcrystalline cellulose. This
blend was then formed into a wet mass with the addition of aqueous
acetate buffer (pH 3.5) and the mass then extruded through a 1.0 mm
screen and the extrudates were spheronized (at 1200 rpm for 3
minutes) to form the core pellets. These core pellets are then
classed to retain the pellets within 0.85 mm to 1.4 mm before the
next processing step. The pellets were then coated with the target
amount of the sustained release membrane using a hydroalcoholic
mixture of ethylcellulose and hydroxypropyl cellulose. This coating
was performed in a Wurster-type coater (product temperature at
30.degree. C. and spray rate at 10 g/minute). The overall coating
time was approximately 2 hours. The coated pellets were dried
further in an oven to remove any residual solvent. The dried
sustained release film-coated pellets were then enteric coated to
the target amount by aqueous film coating in a Wurster-type coater
(product temperature at 30.degree. C. and a spray rate at 10
g/min). The overall coating time was approximately 2 hours. The
capsules were then filled with the appropriate amount of pellets to
achieve the desired dose strength.
Example 10
[0217] Size 0 gelatin capsules containing 469 mg of
extended-release (N,N-Diethylcarbamoyl)methyl methyl
(2E)but-2-ene-1,4-dioate-containing pellets were manufactured
according to the formulation shown in Table 11:
TABLE-US-00013 TABLE 11 Quantity Quantity Component Manufacturer
Role (mg/capsule) (% w/w) (N,N- Cambridge Drug substance 200.00
60.00 Diethylcarbamoyl)methyl (Germantown, methyl (2E)but- WI)
2-ene-1,4- dioate Microcrystalline FMC Filler 112.47 33.74
Cellulose (Little Island, Ireland) Hydroxypropyl Ashland Binder
16.67 5.00 Cellulose (Hopewell VA) Croscarmellose FMC Disintegrant
4.20 1.26 Sodium (Little Island, Ireland) Total Pellet Core 333.33
100.00 Ethylcellulose Dow Chemical Water-insoluble 25.00 7.50
(Midland, MI) coating agent Hydroxypropyl Ashland Water soluble
8.33 2.50 Cellulose (Hopewell VA) coating agent Talc Imerys
Anti-tacking agent 6.67 2.00 (Porte, Italy) Dibutyl Vertellus
Plasticizer 1.67 0.50 sebacate (Greensboro, NC) Total Barrier/
41.67 12.50 Sustained Release Coating Hypromellose ShinEtsu Enteric
coating 93.75 25.00 Acetate (Niigata, agent Succinate Japan) Total
Enteric 93.75 25.00 Coating VCap Plus Size Capsulgel Capsule 88-104
18.8-22.2 0 Capsule (Colmar, France)
[0218] An extrusion/spheronization process was selected for the
manufacture of the core active drug substance pellets. The
manufacturing process consisted of first screening or milling the
(N,N-Diethylcarbamoyl)methyl methyl (2E)but-2-ene-1,4-dioate API.
The screened API was then mixed with microcrystalline cellulose,
croscarmellose sodium and hydroxypropyl cellulose. These materials
were then formed into a wet mass with the addition of purified
water. The wet mass was extruded through a 1.0 mm screen and the
extrudates were spheronized (800 rpm for 2 minutes) to form the
core pellets. These core pellets were then classed to retain the
pellets with particle size within 0.71 mm to 1.25 mm before the
next processing step. The pellets were then coated with the target
amount of the sustained release membrane which was based on a
mixture of ethylcellulose and hydroxypropyl cellulose. This coating
was performed in a Wurster-type coater (product temperature at
31.degree. C. and spray rate at 12 g/min. The total coating time
was approximately 3 hours. The dried sustained release film-coated
pellets were then enteric coated to the target amount by film
coating in a Wurster-type coater (product temperature at 34.degree.
C. and spray rate at 7 g/min). The total coating time was
approximately 12 hours. The coated pellets were dried in an oven to
remove any residual solvent. Capsules were then filled with the
appropriate amount of pellets to achieve the desired dose
strength.
Example 11
11a Pellets
[0219] Pellets having the same formulation as those described in
Example 9, but which do not contain hydroxypropyl cellulose nor
croscarmellose sodium in the core formulation, were manufactured
according to the method described in Example 9. The particle size
distribution was measured by passing approximately 100 g of raw
pellets through sieves with mesh size range from 0.50 mm to 1.4 mm.
The amount of pellets retained on each screen was then calculated.
A pellet yield of 53% was observed in a formulation that contains
only (N,N-Diethylcarbamoyl)methyl methyl (2E)but-2-ene-1,4-dioate
and microcrystalline cellulose.
TABLE-US-00014 Undersized Target-sized Pellets (%) Oversized
Pellets (%) (0.85 to 1.4 mm size range) Pellets (%) 15 53 32
11b Pellets
[0220] Pellets having the same formulation as those described in
Example 10 were manufactured according to the method described in
Example 10. The particle size distribution was measured by passing
approximately 100 g of raw pellets through sieves with mesh size
range from 0.5 mm to 1.4 mm. The amount of pellets retained on each
screen was then calculated. A yield of 93% was observed in a
formulation that contains a binder (hydroxypropyl cellulose) and a
disintegrant (croascarmellose sodium) in addition to the
(N,N-Diethylcarbamoyl)methyl methyl (2E)but-2-ene-1,4-dioate and
microcrystalline cellulose.
TABLE-US-00015 Undersized Target-sized Pellets (%) Oversized
Pellets (%) (0.71 to 1.25 mm size range) Pellets (%) 2 93 5
[0221] Comparing the pellet size distribution of the 11b pellets
with that of 11a pellets shows that the presence of hydroxypropyl
cellulose provides a higher percentage of target-sized pellets,
which gives a more consistent total surface area, which leads to a
more uniform coating and prodrug release.
Example 12
[0222] A two-stage dissolution method was used to determine the in
vitro dissolution profile of dosage forms prepared according to
Examples 9 and 10 in order to mimic the conditions of a dosage form
as it transits the gastrointestinal tract. Thus, the dosage forms
were first placed into a dissolution medium having a pH of 1.2, to
mimic the conditions of the stomach, and then placed into a
dissolution medium of pH 6.8, to mimic the conditions of the
intestines. The dissolution vessel (USP, Type I, basket) initially
contained 750 mL of 0.1 N hydrochloric acid (pH 1.2). After 2 hours
of dissolution, 250 mL of 200 mM tribasic sodium phosphate was
added to the vessel resulting in a pH adjustment from 1.2 to 6.8.
The dissolution medium was kept at 37.degree. C. and was agitated
at 100 rpm.
[0223] Samples of the dissolution medium were withdrawn at 1 and 2
hours following the start of the low pH stage, and at 0.5, 2, 4, 7,
10, 14, and 20 hours (only the Example 10 dosage forms were tested
at time 20 hours) following start of the near-neutral pH stage. The
concentration of (N,N-Diethylcarbamoyl)methyl methyl
(2E)but-2-ene-1,4-dioate in solution was determined using reverse
phase HPLC using a C18 column and a phosphoric
acid/acetonitrile/water isocratic mobile phase with photodiode
detection at 210 nm.
[0224] The percent of prodrug released from the Example 9 dosage
forms over time is shown in FIG. 8. These dosage forms showed no
prodrug release in the first 2 hours (acid stage) of testing. Slow
prodrug release was observed after the dissolution medium pH was
adjusted to 6.8. Full prodrug release was achieved after about 20
hours in pH 6.8.
[0225] The percent of prodrug released from the Example 10 dosage
forms over time is shown in FIG. 9. These dosage forms showed 9%
prodrug release in the first 2 hours (acid stage) of testing. The
prodrug release rate increased after the pH of the dissolution
medium was adjusted to 6.8. Full prodrug release was achieved in
about 9 hours.
Example 13
[0226] The concentration.+-.1 SD of MHF in the blood of
Cynomologous monkeys following oral dosing of delayed release
dosage forms (enteric coated pellets loaded into a capsule)
prepared according to Examples 9 and 10 is shown in FIGS. 10 and
11. In these Figures, the MHF concentrations following dosing with
the Example 10 dosage forms are shown with - symbols and the MHF
concentrations following dosing with the Example 9 dosage forms are
shown with o-o symbols. The data in FIG. 10 is from animals dosed
in a fasted state and the data in FIG. 11 is from animals dosed in
a fed state.
Administration Protocol
[0227] Capsules prepared according to Example 9 (200 mg
(N,N-Diethylcarbamoyl)methyl methyl (2E)but-2-ene-1,4-dioate per
capsule) were administered by oral dosing to groups of four adult
male Cynomologous (Macaca fascicularis) monkeys (each monkey
weighed about 4 to 5 kg). Each monkey was administered one tablet
in either a fasted or in a fed state. All animals were fasted
overnight before the study. For the fed leg, animals were
administered blended food via oral gavage in the morning 30 minutes
prior to administration of each test formulation. For the fasted
leg, the animals remained fasted for 4 hours post-dosing. Blood
samples (1.0 mL) were obtained from all animals via the femoral
vein at pre-dose and intervals over 24 hours after oral dosing.
Blood was collected in pre-chilled K.sub.2EDTA, quenched with
acetonitrile and stored at -50.degree. C. to -90.degree. C. until
analyzed. There was a minimum 7 day wash out period between dosing
sessions.
Sample Preparation for Absorbed Drug
[0228] 300 .mu.L of acetonitrile was added to 1.5 mL Eppendorf
tubes for the preparation of samples and standards.
[0229] Sample Preparation: Blood was collected at different time
points and immediately 100 .mu.L of blood was added into Eppendorf
tubes containing 300 .mu.L of methanol and mixed by vortexing.
[0230] Standard Preparation: One hundred .mu.L of blood was added
to 290 .mu.L of acetonitrile in Eppendorf tubes. 10 .mu.L of MMF
standard solution (0.2, 0.5, 1, 2.5, 5, 10, 25, 50 and 100
.mu.g/mL) was added to each tube to make up the final calibration
standards (0.02, 0.05, 0.1, 0.25, 0.5, 1, 2.5, 5 and 10
.mu.g/mL).
[0231] A 150 .mu.L aliquot of supernatant from quenched blood
standards, QCs and samples was transferred to a 96-well plate and
20 .mu.L of the internal standard solution was added to each well,
the plate was capped and vortexed well. The supernatant was
injected onto the API 4000 LC/MS/MS system for analysis.
LC/MS/MS Analysis
[0232] The concentration of MHF in monkey blood was determined
using an API 4000 LC/MS/MS instrument equipped with Agilent Binary
pump and autosampler. The column was a Luna C8 (2) 4.6.times.150
mm, 5.mu. column operating at 2 to 8.degree. C. temperature. The
mobile phases were (A) 0.1% formic acid in water, and (B) 0.1%
formic acid in acetonitrile. The gradient condition was: 2% B for 1
min, increasing to 95% B in 3.5 min and maintained for 2 min, then
decreasing to 2% B in 5.6 min and maintained for 2.3 min. 30 .mu.L
of sample was injected into the column. A Turbo-Ion Spray source
was used, and was detected in negative ion mode for the MRM
transition of 128.95/84.8. Peaks were integrated using Analyst 1.5
quantitation software.
Example 14
[0233] This example describes the use of certain buffers to control
surface crystallization of (N,N-Diethylcarbamoyl)methyl methyl
(2E)but-2-ene-1,4-dioate on prodrug-containing pellets made in
accordance with a process similar to that disclosed in Example 10,
but where the acetate buffer is at pH 4.1. When the wet
(N,N-Diethylcarbamoyl)methyl methyl
(2E)but-2-ene-1,4-dioate-containing pellets are dried, it was
observed that large crystals of (N,N-Diethylcarbamoyl)methyl methyl
(2E)but-2-ene-1,4-dioate appear on the surface of the pellets as
shown in FIG. 12. It was observed that large crystals migrate to
the surface of the pellets and through drying and handling, these
prodrug crystals tend to fall off the pellets, thereby reducing the
prodrug content of the final product. Also, the crystals can serve
to bridge individual pellets, leading to pellet agglomeration,
which can compromise the subsequent coating processes.
[0234] In order to alter the crystallization condition, the pH of
the acetate buffer was reduced from 4.1 to 3.5 (used in Example
10), so that a vast majority of the buffer existed as neutral
acetic acid form, which can serve as a good hydrogen bonding donor
to disrupt the intermolecular hydrogen bonding pattern of the
crystal.
##STR00004##
[0235] Change of the acetate buffer from pH 4.1 to 3.5 was shown to
significantly reduce the presence of large prodrug crystals on the
surface of the resulting pellets as demonstrated in FIG. 13.
Example 15
[0236] A randomized, double-blind crossover, food effect,
single-dose study of the safety, tolerability, and pharmacokinetics
of a sustained release oral dosage form of
(N,N-Diethylcarbamoyl)methyl methyl (2E)but-2-ene-1,4-dioate in
healthy adult subjects was conducted. Twelve healthy adult
volunteers (males and females) participated in the study. All
twelve subjects received a dosage form of Example 9, once in a fed
condition and once in a fasted condition, with a two-week washout
between treatments. The fasted dosing was achieved by dosing the
subject following an overnight fast while the fed dosing was
achieved by dosing the subject after consuming a high fat-content
breakfast. The dosage form contains 200 mg of
(N,N-Diethylcarbamoyl)methyl methyl (2E)but-2-ene-1,4-dioate (107
mg equivalents of methyl hydrogen fumarate).
[0237] Blood samples were collected from all subjects prior to
dosing, and at 0.5, 1, 1.5, 2, 3, 4, 5, 6, 7, 8, 10, 12, 16, 24,
30, 36, 48, 60, 72, 84, 96, 108 and 120 hours after dosing. Urine
samples were collected from all subjects prior to dosing, and
complete urine output was obtained at the 0-4, 4-8, 8-12, 12-24,
24-36, 36-48, 48-72, 72-96 and 96-120 hour intervals after dosing.
Blood samples were quenched immediately with acetonitrile and
frozen. Sample aliquots were prepared for analysis of (i) methyl
hydrogen fumarate, (ii) (N,N-Diethylcarbamoyl)methyl methyl
(2E)but-2-ene-1,4-dioate, (iii) N,N diethyl-2-hydroxy acetamide and
(iv)
(2S,3S,4S,5R,6R)-6-[(N,N-diethylcarbamoyl)methoxy]-3,4,5-trihydroxy-2H-3,-
4,5,6-tetrahydropyran-2-carboxylic acid, the latter two being other
potential metaboliltes of (N,N-Diethylcarbamoyl)methyl methyl
(2E)but-2-ene-1,4-dioate, using sensitive and specific LC/MS/MS
methods.
[0238] The plasma concentration of MMF following oral dosing of the
formulation prepared according to Example 10 to fasted and fed
healthy adult patients is shown in FIG. 14. Table 12 shows the
preliminary mean (SD) pharmacokinetic data for
(N,N-Diethylcarbamoyl)methyl methyl (2E)but-2-ene-1,4-dioate in fed
and fasted patients.
TABLE-US-00016 TABLE 12 C.sub.max T.sub.max AUC.sub.inf N Food
(ng/mL) (hr) (ng hr/mL) 12*/10** Fasted 64* 3.08* 257** (34) (0.79)
(116) 12 Fed 106 6.42 398 (37) (1.98) (123)
[0239] The formulation produced mean (SD) maximum MMF
concentrations (Cmax) of 64 (34) ng/mL fasted and 106 (37) ng/mL
fed. MMF AUC was 257 (116) ng*h/mL fasted and 398 (123) ng*h/mL
fed. The time to peak concentration (Tmax) was 3.08 (0.79) hr
fasted and 6.42 (1.98) hr fed. Promoiety was cleared from blood
with a half life around 3 hours. (N,N-Diethylcarbamoyl)methyl
methyl (2E)but-2-ene-1,4-dioate was well tolerated during the
trial. All 12 subjects completed the dosing period. All adverse
events were mild. Two subjects in the (N,N-Diethylcarbamoyl)methyl
methyl (2E)but-2-ene-1,4-dioate fed group reported flushing more
frequently than in the fed placebo group. No subjects in the fasted
(N,N-Diethylcarbamoyl)methyl methyl (2E)but-2-ene-1,4-dioate group
reported flushing, and no subjects in either the fed or fasted
(N,N-Diethylcarbamoyl)methyl methyl (2E)but-2-ene-1,4-dioate groups
reported feeling hot more than for placebo. A comparison of these
adverse events of the formulation to placebo is shown in Table
13.
TABLE-US-00017 TABLE 13 Flushing Feeling Hot Fasted Fed Fasted Fed
Placebo 0 1 0 0 Example 10 2 0 0 0 Formulation
Example 16
[0240] This example studied the degradation of an MHF prodrug
((N,N-Diethylcarbamoyl)methyl methyl (2E)but-2-ene-1,4-dioate) in
the presence of eighteen potential dosage form polymeric excipients
in order to assess their compatibilities. The polymeric excipients
were grouped into carboxylic acid-containing (acidic) and
carboxylic acid-free (non-acidic) categories, The excipients tested
were four sustained release polymers (methyl cellulose (Methocel
K4M), carbomer homopolymer type A (Carbopol 971P), ethylcellulose
(Ethocel 10) and polyethylene oxide (Polyox WSR--N10)), two
granulation binders (hydroxypropyl cellulose (HPC EXF) and
polyvinylpyrrolidone (Plasdone K.sub.29/32), a diluent
(microcrystalline cellulose (Avicel PH102)), two disintegrants
(cross-linked sodium carboxymethylcellulose (Crosscarmellose
sodium) and cross-linked polyvinylpyrrolidone (Polyplasdone
XL-10)), eight polymers for enteric coating and sustained release
coating (copolymer of methacrylic acid and methyl methacrylate
(Eudragit L100), anionic copolymer of methacrylic acid and ethyl
acrylate (Eudragit L100-55), polyvinyl acetate phthalate (PVA-P),
cellulose acetate, copolymers of ethyl acrylate, methyl
methacrylate and a low content of methacrylic acid ester with
quaternary ammonium groups (Eudragit RSPO and Eudragit RLPO,
hydroxypropylmethyl cellulose acetate succinate (HPMC-AS) and
hydroxypropylmethyl cellulose phthalate (HPMC-P)), and a
plasticizer/pore former (Pluronic F68). Approximately 5 mg of
(N,N-Diethylcarbamoyl)methyl methyl (2E)but-2-ene-1,4-dioate was
weighed into each 4 ml glass vial and mixed with the individual
excipient at a ratio of 1:1 or 1:5, as listed in the table below.
All acidic polymers were mixed with drug in 1:1 wt/wt ratio, except
Carbopol 971P which was mixed in a 5:1 wt ratio.
[0241] The acid content of each of the acidic polymers tested is
based on the reported acid content of the polymer (reported in US
Pharmacopeia), corrected for the portion of the acid content that
is the carboxylic acid moiety.
[0242] Each sample was stored under open-dish condition with loose
caps at 35.degree. C. and 65% relative humidity. This storage
condition was selected to expose the samples to elevated
temperature and humidity without causing deliquescence of the drug
and excipient mixtures. The chemical and physical stability were
tested at initial, 1 week, 2 weeks, and 4 weeks.
[0243] The percent prodrug degradation data in Table 14 was from
the 4-week time point. This data is also plotted in FIG. 15 The
percent prodrug degradation was determined as the sum of the
fumaric acid, N,N diethyl-2hydroxy acetamide, methyl hydrogen
fumarate and
(2E)-3-{[(N,N-diethylcarbamoyl)methyl]oxycarbonyl}prop-2-enoic acid
contents, expressed as a weight percent of the total initial weight
of prodrug.
TABLE-US-00018 TABLE 14 Polymer Prodrug Type Polymer Name Acid
Content (%) Degradation (%) Acidic Carbopol 971P 62.0 34.8 Eudragit
L100-55 24.2 23.0 Eudragit L100 24.2 9.0 PVA-P 17.7 12.5 HPMC-P 8.5
4.9 HPMC-AS 6.7 2.0 Non-Acidic Polyox WSR-N10 0.0 4.5 Pluronic F68
0.0 1.2 Ethocel 10 0.0 1.2 Methocel K4M 0.0 1.0 Eudragit RLPO 0.0
1.0 Eudragit RSPO 0.0 1.0 Crosscarmellose Na 0.0 1.0 Avicel PH102
0.0 0.9 Plasdone K39/32 0.0 0.9 Polyplasdone XL10 0.0 0.9 HPC EXF
0.0 0.8 Cellulose acetate 0.0 0.8
Example 17
[0244] This example studied the degradation of two MHF prodrugs,
(N,N-Diethylcarbamoyl)methyl methyl (2E)but-2-ene-1,4-dioate and
DMF, in the presence of varying quantities of acetic acid. Each
prodrug was placed in a pH 6.0 phosphate buffer with multiple
concentrations of sodium acetate (0.0 M, 0.1 M, 0.5 M, 2.0 M, 3.0
M, and 4.0 M) at 40.degree. C. The presence of prodrug was measured
over time up to 42 hours. The rate of prodrug degradation can be
expressed according to the following formula: In (A)=ln
(A.sub.0)-K.sub.obst, wherein A is the prodrug concentration,
A.sub.0 is the prodrug concentration at time zero and K.sub.obs is
the observed slope of the curve plotting In (A) versus time (t).
Thus, the higher the K.sub.obs, the more quickly the prodrug is
degrading. Thus, K.sub.obs is a measure of prodrug stability, with
prodrugs having a lower K.sub.obs being more stable than prodrugs
having a higher K.sub.obs. The K.sub.obs for
(N,N-Diethylcarbamoyl)methyl methyl (2E)but-2-ene-1,4-dioate and
DMF are plotted as a function of acetate concentration in FIG.
16.
[0245] The amounts of the two primary degradation products for
prodrug (N,N-Diethylcarbamoyl)methyl methyl
(2E)but-2-ene-1,4-dioate were measured after a 14.6 hour exposure
to acetate solutions of varying concentrations, all at pH 6.0 and
40.degree. C. The data are shown in FIG. 17. Thus, FIG. 17 depicts
the amount of each of the two primary degradation products of
(N,N-Diethylcarbamoyl)methyl methyl (2E)but-2-ene-1,4-dioate as a
mole % of the initial amount of prodrug, at the varying acetate
concentrations.
[0246] The degradation rates of both MHF prodrugs increased with
increasing concentrations of acetate. Without wishing to be limited
to a specific mechanism or mode of action, increased carboxyl
concentration independent of pH causes increased degradation of the
MHF prodrugs. It is believed that selection of pharmaceutical
excipient and barrier layer components that are substantially free
of carboxylic acid moieties reduces the degradation of the MHF
prodrugs.
[0247] Finally, it should be noted that there are alternative ways
of implementing the subject matter of the present disclosure.
Accordingly, the present embodiments are to be considered as
illustrative and not restrictive, and the present disclosure is not
to be limited to the details given herein, but may be modified
within the scope and equivalents of the claim(s) issuing here
from.
* * * * *