WO2002019995A2

WO2002019995A2 - Pharmaceutical combination containing salmeterol and fluticasone

Info

Publication number: WO2002019995A2
Application number: PCT/GB2001/004001
Authority: WO
Inventors: Smithkline Glaxo
Original assignee: Glaxo Group Ltd
Current assignee: Glaxo Group Ltd
Priority date: 2000-09-07
Filing date: 2001-09-06
Publication date: 2002-03-14
Anticipated expiration: 2003-03-07
Also published as: AU2001284287A1; WO2002019995A3; GB0021927D0

Abstract

The present invention relates to the use of salmeterol and fluticasone propionate combinations for the prophylaxis and treatment of rhinitis.

Description

Use of pharmaceutical combination

The present invention relates to the use of salmeterol and fluticasone propionate combinations for the treatment of rhinitis.

The combination of the beta-2 adrenergic agonist salmeterol or a physiologically acceptable salt thereof and the corticosteroid fluticasone propionate has been described in GB 2 235 627 for use in the treatment of asthma and other respiratory disorders.

Fluticasone propionate is itself known from GB 2 088 877 to have anu- inflammatory activity and to be useful for the treatment of allergic and inflammatory conditions of the nose, throat, or lungs such as asthma and rhinitis, including hay fever.

Salmeterol is known from GB 2 140 800 and is used clinically in the form of its xinafoate salt for the treatment of asthma. There is no precedent for the use of a beta-2 adrenergic agonist, in particular salmeterol in combination with a corticosteroid as an effective therapy for rhinitis.

Rhinitis is characterised by a combination of sneezing, nasal discharge and blockage lasting at least ah hour on most days. As used herein, the term "rhinitis" includes allergic rhinitis which may be seasonal as in hay fever, or perennial, and non-allergic rhinitis.

The present invention also relates to the treatment of sinusitis. As used herein the term "rhinitis" also includes sinusitis whether present as a complication of rhinitis or not. In a more particular aspect, the present invention relates to treatment of allergic rhinitis, meaning rhinitis caused by an allergen to which the patient is exposed such as pollen, dust, danders, food, and mould. Allergic rhinitis is characterised by sudden attacks of sneezing, swelling of the nasal mucosa with watery discharge, itching of the eyes and lacrimation.

We now propose that the use of a combination of salmeterol or a physiologically acceptable salt thereof and fluticasone propionate may have clinical advantages in the treatment of rhinitis over the use of fluticasone propionate alone.

Accordingly, the present invention provides a method for prophylaxis or treatment of rhinitis in a mammal, such as a human, which comprises administering an effective amount of a combination of salmeterol or a physiologically acceptable salt thereof, such as the xinafoate salt, and fluticasone propionate. In particular, there is provided a method for prophylaxis or treatment of allergic rhinitis in a mammal, such as a human, which comprises administering an effective amount of a combination^" of salmeterol or a physiologically acceptable salt thereof, such as the xinafoate salt, and fluticasone propionate.

In the alternative, there is provided the use of a combination of salmeterol or a physiologically acceptable salt thereof, such as the xinafoate salt, and fluticasone propionate for the manufacture of a medicament for the prophylaxis or treatment of rhinitis. In particular, there is provided the use of a combination of salmeterol or a physiologically acceptable salt thereof, such as the xinafoate salt, and fluticasone propionate for the manufacture of a medicament for prophylaxis or treatment of allergiς rhinitis. As used herein, the term "treatment" means the improvement of clinical outcome, for example, alleviation of the symptoms of rhinitis, in particular reduction of sneezing, itching nose, runny nose, nasal blockage, and/or itching eyes.

In a further aspect of the invention, treatment of rhinitis includes a reduction of complications such as sinusitis and otitis media.

Throughout the specification and the claims which follow, unless the context requires otherwise, the word 'comprise', and variations such as 'comprises' and

'comprising', will be understood to imply the inclusion of a stated integer or step or group of integers but not to the exclusion of any other integer or step or group of integers or steps.

It will be appreciated that the compounds of the salmeterol and fluticasone propionate combination may be administered simultaneously, either in the same or different pharmaceutical formulations, or sequentially. Where there is sequential administration, the delay in administering the second and any subsequent active ingredient should not be such as to lose the beneficial therapeutic effect of the combination of the active ingredients. In a preferred aspect of the invention, the salmeterol or its physiologically acceptable salt and the fluticasone propionate are administered as a combined pharmaceutical formulation. The weight/weight ratio of salmeterol to fluticasone administered according to the invention is preferably in the range 4:1 to 1 :20.

The amount of salmeterol or a physiologically acceptable salt thereof, such as the xinafoate salt, and fluticasone propionate which is required to achieve a therapeutic effect will, of course, vary with the particular salt form, the route of administration, the subject under treatment, and the particular disorder or disease being treated. The combination of the invention may be administered intranasally to an adult human at a dose of from 50μg to 2000μg per day, suitably 50μg to 500μg per day, more suitably 100μg to 400μg per day of fluticasone propionate and 50μg to 200μg per day, suitably 50μg to 10Oμg per day of salmeterol. The daily dose may be administered as several sub-doses, for example, twice daily, but will preferably be administered once daily

While it is possible for salmeterol or a physiologically acceptable salt thereof, such as the xinafoate salt, and fluticasone propionate to be administered as raw drugs, it is preferable to present each of them as a pharmaceutical formulation.

Thus according to a further aspect of the invention, there is provided a pharmaceutical formulation for the prophylaxis or treatment of rhinitis comprising salmeterol or a physiologically acceptable salt thereof, such as the xinafoate salt, and fluticasone propionate, and a pharmaceutically acceptable carrier or excipient, and optionally one or more other therapeutic agents. Preferably, the pharmaceutical formulation is in a form which is suitable for intranasal administration.

Hereinafter, the term "active ingredient" means salmeterol or a physiologically acceptable salt thereof, such as the xinafoate salt, and/or fluticasone propionate.

Suitable formulations include those suitable for oral, parenteral (including subcutaneous, intradermal, intramuscular, intravenous and intraarticular), inhalation (including fine particle dusts or mists which may be generated by means of various types of metered dose pressurised aerosols, nebulisers or insufflators), rectal and topical (including dermal, buccal, sublingual and intraocular) administration although the most suitable route may depend upon for example the condition and disorder of the recipient. The formulations may conveniently be presented in unit dosage form and may be prepared by any of the methods well known in the art of pharmacy. All methods include the step of bringing the active ingredient into association with the carrier which constitutes one or more accessory ingredients. In general the formulations are prepared by uniformly and intimately bringing into association the active ingredient with liquid carriers or finely divided solid carriers or both and then, if necessary, shaping the product into the desired formulation.

Preferably, the pharmaceutical formulations used in accordance with the present invention are suitable for intranasal administration. Intranasal formulations may be in the form of powder compositions which will preferably contain lactose, or spray compositions which may be formulated, for example, as aqueous solutions or suspensions or as aerosols delivered from pressurised packs, with the use of a suitable propellant, e.g. dichlorodifluoromethane, trichlorofluoromethane, dichlorotetra-fluoroethane, 1 ,1 ,1 ,2,3,3,3-heptafluoro- propane, 1 ,1 ,1 ,2-tetrafluoroethane, carbon dioxide or other suitable gas. Suitable aerosol spray compositions for use in accordance with the invention are described in WO 93/11743.

Intranasal sprays may be formulated with aqueous or non-aqueous vehicles with the addition of agents such as thickening agents, buffer salts or acid or alkali to adjust the pH, isotonicity adjusting agents or anti-oxidants.

Capsules and cartridges of for example gelatin, or blisters of for example laminated aluminium foil, for use in an inhaler or insuflator may be formulated containing a powder mix of a compound of the invention and a suitable powder base such as lactose or starch. Solutions for inhalation by nebulisation may be formulated with an aqueous vehicle with the addition of agents such as acid or alkali, buffer salts, isotonicity adjusting agents or antimicrobials. They may be sterilised by filtration or heating in an autoclave, or presented as a non-sterile product.

It should be Understood that in addition to the ingredients particularly mentioned above, the formulations used according to the invention may include other agents conventional in the art having regard to the type of formulation in question, for example those suitable for oral administration may include flavouring agents. Furthermore, the combination of salmeterol or a physiologically acceptable salt thereof, such as the xinafoate salt, and fluticasone propionate used according to the present invention may be used in combination with a further active ingredient, for example an antihistamine such as terfenidine, astemizole, cetirizine, loratidine, chlorpheniramine, clemastine, hydroxyzine, cyproheptadine, ketotifen, levocabastinem or azelastine, a decongestant such as ephidrine, pseudoephidrine, or phenylpropanolamine, an anticholinergic such as ipratropium, tiotropium or oxitropium, another anti- inflammatory agent such as cromoglycate, a leukotriene receptor antagonist, 5- lipoxygenase inhibitor or an inhibitor of phophodiesterase III and/or IV.

EXAMPLES

Example 1 : 25/50 salmeterol/fluticasone propionate metered dose inhaler

The micronised active ingredients are weighed into an aluminium can, 1 ,1 ,1 ,2- tetrafluoroethane is then added from a vacuum flask and a metering valve is crimped into place.

Similar methods may be used for the formulation of Example 2:

Example 2: 25/125 salmeterol/fluticasone propionate metered dose inhaler

Example 3

A randomised , placebo-controlled, double-blind, cross-over study was conducted which compared the effects of the nasal fluticasone propionate (FP, data not shown), fluticasone propionate and salmeterol combination (FSC) and placebo, on nasal clinical symptoms and nasal blockage following intranasal allergen challenge. The study was conducted in 47 subjects with a history of allergic rhinitis to grass pollen, outside the grass pollen season. Subjects were treated for 7 days with either FP (200mcg/day), FSC (200/1 OOmcg/day; FP/salmete^'rol) or placebo, delivered via a metered-dose inhaler (MDI) with a nasal actuator. On Day 7, subjects were challenged with timothy grass pollen extract.

Subject rated nasal symptoms of nasal blockage, rhinorrhoea and sneezing were recorded pre and post challenge using a categorical nasal symptom score (CAT) and a visual analogue score (VAS). The CAT score was measured on a 5 point scale as follows:

For the VAS, subjects were asked to rate the extent of each symptom by placing a vertical mark on a horizontal 10cm line with the left-hand end defined as "no symptoms" and the right-hand end defined as "worst ever symptoms". In addition, peak inspiratory nasal flow (PNIF) was measured pre and post challenge as a measure of nasal obstruction.

Nasal symptoms and PNIF were recorded at intervals over a 10.5h period post challenge and the mean total symptom score determined.

Nasal FSC reduced mean total nasal symptom scores and this was significant as determined by CAT score (Table 1). Consistent with this reduction in nasal clinical symptoms, FSC significantly increased PNIF indicating a reduction in nasal obstruction (Figure 1 ; Table 1). Figure 1 shows the mean PNIF on day 7. Ratio 95% Cl

Categorical FSC/Placebo 0.86 0.75, 0.99

VAS FSC/Placebo 0.86 0.71 , 1.05

PNIF FSC/Placebo 1.12 1.06, 1.19

(L/min)

Claims

ΘCLAIMS

1. A method for prophylaxis or treatment of rhinitis in a mammal, such as a human, which comprises administering an effective amount of a combination 5 of salmeterol or a physiologically acceptable salt thereof and fluticasone propionate.

2. A method according to claim 1 wherein the salmeterol or physiologically acceptable salt thereof and fluticasone propionate are administered as a 0 combined pharmaceutical formulation.

3. A method according to claim 1 or claim 2 in which the salmeterol or physiologically acceptable salt thereof and fluticasone propionate are administered intranasally.

4. A method according to any one of claims 1 to 3 in which the salmeterol is administered as the xinafoate salt.

5. Use of a combination of salmeterol or a physiologically acceptable salt thereof and fluticasone propionate for the manufacture of a medicament for the prophylaxis or treatment of rhinitis.

6. Use according to claim 5 wherein the medicament is a combined pharmaceutical formulation.

7. Use according to claim 5 or claim 6 in which the medicament is suitable for intranasal administration.

8. Use. according to any one of claims 5 to 7 in which the salmeterol is in the form of the xinafoate salt.

9. A pharmaceutical formulation for the prophylaxis or treatment of rhinitis comprising salmeterol or a physiologically acceptable salt thereof and fluticasone propionate, and a pharmaceutically acceptable carrier or excipient and optionally one or more other therapeutic agents.

10. A pharmaceutical formulation according to claim 9 which is in a form suitable for intranasal administration.

11. A pharmaceutical formulation according to claim 9 or claim 10 in which the . salmeterol is in the form of the xinafoate salt.