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WO2010025126A1 - Comprimés à désintégration rapide renfermant de la lipase, de l'amylase et de la protéase - Google Patents

Comprimés à désintégration rapide renfermant de la lipase, de l'amylase et de la protéase Download PDF

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Publication number
WO2010025126A1
WO2010025126A1 PCT/US2009/054866 US2009054866W WO2010025126A1 WO 2010025126 A1 WO2010025126 A1 WO 2010025126A1 US 2009054866 W US2009054866 W US 2009054866W WO 2010025126 A1 WO2010025126 A1 WO 2010025126A1
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Prior art keywords
composition
lipase
protease
amylase
disintegration
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Ceased
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PCT/US2009/054866
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Inventor
Sergey Y. Pechenov
Sujit Kumar Basu
Shubhang Mishra
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Cystic Fibrosis Foundation
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Cystic Fibrosis Foundation Therapeutics Inc
Cystic Fibrosis Foundation
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Priority to EP09791877A priority Critical patent/EP2328609A1/fr
Publication of WO2010025126A1 publication Critical patent/WO2010025126A1/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
    • A61K47/30—Macromolecular organic or inorganic compounds, e.g. inorganic polyphosphates
    • A61K47/32—Macromolecular compounds obtained by reactions only involving carbon-to-carbon unsaturated bonds, e.g. carbomers, poly(meth)acrylates, or polyvinyl pyrrolidone
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K38/00—Medicinal preparations containing peptides
    • A61K38/16—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
    • A61K38/43—Enzymes; Proenzymes; Derivatives thereof
    • A61K38/46—Hydrolases (3)
    • A61K38/465—Hydrolases (3) acting on ester bonds (3.1), e.g. lipases, ribonucleases
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K38/00—Medicinal preparations containing peptides
    • A61K38/16—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
    • A61K38/43—Enzymes; Proenzymes; Derivatives thereof
    • A61K38/46—Hydrolases (3)
    • A61K38/47—Hydrolases (3) acting on glycosyl compounds (3.2), e.g. cellulases, lactases
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K38/00—Medicinal preparations containing peptides
    • A61K38/16—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
    • A61K38/43—Enzymes; Proenzymes; Derivatives thereof
    • A61K38/46—Hydrolases (3)
    • A61K38/48—Hydrolases (3) acting on peptide bonds (3.4)
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
    • A61K47/06—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite
    • A61K47/26—Carbohydrates, e.g. sugar alcohols, amino sugars, nucleic acids, mono-, di- or oligo-saccharides; Derivatives thereof, e.g. polysorbates, sorbitan fatty acid esters or glycyrrhizin
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00—Medicinal preparations characterised by special physical form
    • A61K9/0002—Galenical forms characterised by the drug release technique; Application systems commanded by energy
    • A61K9/0007—Effervescent
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00—Medicinal preparations characterised by special physical form
    • A61K9/0087—Galenical forms not covered by A61K9/02 - A61K9/7023
    • A61K9/0095—Drinks; Beverages; Syrups; Compositions for reconstitution thereof, e.g. powders or tablets to be dispersed in a glass of water; Veterinary drenches
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P1/00—Drugs for disorders of the alimentary tract or the digestive system
    • A61P1/18—Drugs for disorders of the alimentary tract or the digestive system for pancreatic disorders, e.g. pancreatic enzymes

Definitions

  • the present invention relates to orally administrable formulations of proteins, including their amorphous and crystalline phases, and cross-linked forms thereof.
  • the invention further relates to methods of preparing these formulations, as well as methods of administration and conditions of use.
  • pancreas affects a variety of exocrine and endocrine actions required for proper digestion, nutrition and metabolism.
  • Pancreatic exocrine activities include the secretion of proteins that function as enzymes in the small intestine to catalyze the hydrolysis of fat into glycerol and fatty acids, protein into peptides and amino acids and carbohydrates into dextrins, disaccharides and monosaccharides, such as glucose.
  • Exocrine pancreatic insufficiency results from a reduction in pancreatic function and can be caused by a number of clinical disorders.
  • pancreatic insufficiency is associated with cystic fibrosis, chronic pancreatitis, acute pancreatitis, pancreatic cancer and Shwachmann-Diamond Syndrome (E. P. DiMagno et al., in The Pancreas: Biology, Pathobiology and Disease, 2d Ed., V. Liang et al., eds., pp. 665-701 (1993)).
  • pancreatic insufficiency In patients afflicted with pancreatic insufficiency, the pancreas fails to produce and/or secrete sufficient amounts of digestive enzymes to support normal digestive processes, including digestion of fats, proteins and carbohydrates. As a result, those patients suffer from malabsorption of nutrients. Clinical manifestations of pancreatic insufficiency include abdominal cramping, bloating, diarrhea, steatorrhea, nausea and weight loss.
  • Pancreatic insufficiency is present in 89% of patients suffering from cystic fibrosis (D. Borowitz et al., "Use of Fecal Elastase-1 to Identify Misclassification of Functional Pancreatic Status in Patients with Cystic Fibrosis", J. Pediatr., 145, pp. 322-326 (2004)). Cystic fibrosis is an autosomal recessive genetic disorder that primarily affects the gastrointestinal and respiratory systems (S. M. Rowe et al., "Mechanisms of Disease: Cystic Fibrosis", N. Engl. J. Med., 352, pp. 1992-2001 (1995)).
  • cystic fibrosis patients with pancreatic insufficiency suffer from impaired digestion and experience significant malabsorption of fat and protein. For example, such patients typically absorb less than 60% of dietary fat (M. Kraisinger et al., "Clinical Pharmacology of Pancreatic Enzymes in Patients with Cystic Fibrosis and in vitro Performance of Microencapsulated Formulations", J. Clin.
  • DIOS Distal intestinal obstruction syndrome
  • pancreatic insufficiency This condition is characterized by the accumulation of viscous mucous and fecal material in the terminal ileum, caecum and ascending colon.
  • the syndrome is found to occur after the neonatal period and ranges from a few mild to several excrutiatingly painful episodes, increasing progressively from adolescence to adulthood.
  • Contributing factors may include fat malabsorption (Anderson et al., J.
  • DIOS DIOS
  • Chronic onset of the disease results in severe malnourishment if left untreated, followed by decreased energy and a cascade of events leading to anorexia, advanced pulmonary disease and eventually, death.
  • pancreatic insufficiency is also present in some patients suffering from type I and type Il diabetes.
  • the standard therapy for pancreatic insufficiency is pancreatic enzyme replacement therapy. This therapy is primarily orally-administered porcine pancrelipase, containing a mixture of lipases, trypsin, chymotrypsin, elastase and amylases.
  • the lipase, protease and amylase components of porcine pancreatic supplements are typically present in a 1 :3.5:3.5 ratio.
  • Pancreatic enzyme supplements are normally administered orally with meals. As these supplements pass through the low pH environment of the stomach, their enzyme activity diminishes rapidly. As a result, large quantities of enzyme concentrate (sometimes as many as 15 capsules or tablets per meal) have been required to ensure that sufficient active enzyme is present in the proximal intestine to relieve pancreatic insufficiency.
  • pancrelipase products Because protease and lipase can become irreversibly inactivated in the stomach's acidic environment, enteric-coating technologies have been applied to pancrelipase products, to enclose enzymes in microbeads or otherwise treat them with a protective enteric coating. While such enteric-coatings improved the product profile, large quantities of supplements were still required to yield therapeutic benefit (J. H. Meyer, in Pancreatic Enzymes in Health and Disease, P. G. Lankisch, ed., pp. 71-88 (1991 )). A high-strength pancrelipase product line (UltraseTM) was introduced, with the goal of reducing the quantities of tablets or capsules necessary to treat pancreatic insufficiency.
  • UltraseTM pancrelipase product line
  • pancreatic enzyme supplement Whether or not a given pancreatic enzyme supplement is enterically-coated, the bioavailability of such supplements varies widely, due to differentials in acidification of the intestine among patients. As a result, many patients take pH altering drugs, such as histamine-2 (H. sub.2) receptor blockers and proton pump inhibitors (PPI), to improve the clinical efficacy of the enzyme supplements (P. G. Lankish, "Enzyme Treatment of Exocrine Pancreatic Insufficiency in Chronic Pancreatitis 1 , Digestion, 54 (Supp. 2), pp. 21-29 (1993); D. Y. Graham, "Pancreatic Enzyme Replacement: the Effect of Antacids or Cimetidine", Dig. Dis.
  • pH altering drugs such as histamine-2 (H. sub.2) receptor blockers and proton pump inhibitors (PPI)
  • pancreatic insufficiency therapy includes destruction of the replacement enzymes by gastric juice and/or intraluminal proteases, asynchronous gastric emptying of enzyme supplement and meal nutrients, and delayed liberation of enzyme from enteric-coated preparations (P. G. Lankish, Digestion, 54 supra; P. Regan et al., N. Eng. J. Med., 297, supra).
  • U.S. Pat. No. 6,051 ,220 describes compositions comprising one or more acid stable lipases and one or more acid stable amylases, both preferably of fungal origin.
  • United States patent application 2004/0057944 describes compositions comprising Rhizopus delemar lipase, Aspergillus melleus protease and Aspergillus oryzae amylase.
  • United States patent application 2001/0046493 describes compositions comprising crosslinked crystalline bacterial lipase, together with a fungal or plant protease and a fungal or bacterial amylase.
  • pancreatic insufficiency in certain populations has been unfortunately hindered by the reluctance and/or inability to swallow the above medication in traditional solid oral dosage forms, such as capsules, pills or tablets.
  • traditional solid oral dosage forms such as capsules, pills or tablets.
  • This is particularly true, for example, in the disabled, pediatric and geriatric populations, patients with esophageal occlusion, and those with autonomic complications (i.e., from Parkinson's disease, Multiple Sclerosis, Lou Gehrig's disease, etc.).
  • autonomic complications i.e., from Parkinson's disease, Multiple Sclerosis, Lou Gehrig's disease, etc.
  • efforts have been made in the past to formulate medications in forms which are easier to swallow. Examples of such efforts include coatings of tablets and pills; fast disintegrating tablets for sublingual or subbucchal administration.
  • Tablets and capsules are the preferred dosage forms of choice for oral administration, availing a number of different shapes and sizes for oral use. These range from 1.0 to 2.5 cm in height or less, and 0.25 to 1.5 cm in diameter or less, and can usually be self-administered by patients without the need for complex apparati, such as those used in parenteral, intranasal, ophthalmic or other administration systems.
  • complex apparati such as those used in parenteral, intranasal, ophthalmic or other administration systems.
  • capsules and tablets available today are relatively easy to swallow, sometimes even the smallest ones can pose significant challenges for disabled, pediatric and geriatric patient populations and those with esophageal or gastro-intestinal disorders.
  • Administration of the drug in these situations entails either crushing the tablets or opening the capsules, and resuspending the contents in suitable liquid or semi-liquid mediums (such as baby food, apple sauce) for oral delivery.
  • pancreatic enzymes for delivery to disabled, pediatric and geriatric patient populations.
  • these formulations will rapidly disintegrate in a variety of solutions while maintaining the protein therapeutics in an active form during disintegration and administration.
  • the present invention is the first preparation of a protein therapeutic in an formulation useful for disabled, pediatric and geriatric patient populations and those with esophageal or gastro-intestinal disorders.
  • the incorporation of protein therapeutics into a rapidly disintegrating formulation requires the manipulation of a significant number of parameters. While this approach may appear relatively simple, it is highly dependent on the chemical and physical compatibility of the therapeutic and the other components of the formulation, and, optionally, the disintegration media. Arbitrarily chosen excipients and disintegration media that are marginally compatible or not compatible at all with the therapeutic can result in an irrecoverable loss of therapeutic activity.
  • Proposed enzyme replacement therapy may be further complicated in critically ill patients suffering from DIOS who require enteral feedings or gastronomic administration of their medications in liquid or semi-solid media.
  • the present invention provides materials and methods for disintegration media and preparative techniques that are effective for such administration, maintaining the stability of the dispersed protein therapeutic during and after administration, while also preventing or minimizing unfavorable chemical or physical interaction with the gastric tubes and components thereof.
  • the methods and materials of the present invention are advantageous in reconditioning and maintaining the patency of gastric tubes and buttons that may become occluded due to formula and medicinal precipitation, inadequate flushing and drug-nutrient interactions.
  • the present invention relates to stable formulations of pharmaceutically active proteins, including their amorphous and crystalline phases, and cross-linked forms thereof.
  • compositions according to the present invention include those comprising crosslinked microbial lipase crystals, a microbial protease and a microbial amylase, such as those described in U.S. Publication No. 2006/0121017.
  • the invention relates to a composition
  • a composition comprising from about 4.0 to about 50.0 weight percent of a mixture of lipase, protease, and amylase; from about 30 to about 90 weight percent excipients; and from about 2.0 to about 30.0 weight percent effervescent agent, wherein the composition is capable of rapidly disintegrating in the oral cavity.
  • the composition is a tablet.
  • the lipase, the protease and the amylase of liprotamase are each recombinantly produced.
  • the lipase is crystallized.
  • the crystallized lipase is cross-linked.
  • the lipase crystals remain undissolved at gastric pH levels of 2.8 to 4.0.
  • the composition disintegrates in water in about 30 seconds to 2 minutes.
  • the lipase, amylase, and protease maintain about 50-100% of their initial biological activity after disintegration in water.
  • the lipase, amylase, and protease maintain at least about 25%, 35%, 45%, 55%, 65%, 75%, 85%, 95%, or 100% of their initial biological activity after disintegration in water.
  • the effervescent agent is an effervescent couple.
  • the effervescent couple is sodium bicarbonate and citric acid.
  • the effervescent agent is sodium bicarbonate.
  • the invention relates to a method of providing a composition of lipase, protease, and amylase to a patient in need of same comprising combining the rapidly disintegrating dosage form of claim 1 with a suitable disintegration media.
  • the disintegration media is cranberry apple juice, water, or apple juice.
  • the invention relates to a method for reducing gastric tube occlusions, the method comprising treating a gastric tube with the compositions of the invention.
  • the invention relates to the use of the compositions of the invention for the preparation of a medicament for the treatment of pancreatic insufficiency. In other embodiments, the invention relates to the use of the compositions of the invention for the prevention of gastric tube occlusions.
  • Lipase and protease are preferably present in a ratio of from about 1.0:0.5 to about 1.0:1.5 USP units of enzyme activity, more preferably about 1.0:0.7 to 1.0:1.0 USP units.
  • Lipase and amylase are preferably present in a ratio of from about 1.0:0.05 to 1.0:0.3 USP units of enzyme activity, more preferably from about 1.0:0.10 to about 1.0:0.20 USP units.
  • the lipase is a bacterial lipase and the protease and amylase are of fungal origin.
  • the composition comprises Burkholderia lipase crystals crosslinked with bis(sulfosuccini-midyl) suberate (“BS 3 ”) crosslinker, Aspergillus melleus protease crystals and soluble Aspergillus oryzae amylase; in a ratio of about 1.0:1.0:0.15 USP units of enzyme activity; or about 1.0:0.77:0.12 USP units of enzyme activity.
  • the active ingredients may be formulated together with one or more excipients.
  • the crosslinking of the lipase component of the compositions of this invention provides added stability at pH extremes and protection under proteolysis, while the protease and amylase components maintain maximum solubility for effective dissolution. More particularly, the crystallization and cross-linking of the lipase component helps provide a composition with enhanced enzyme activity at lower dosages. The crystal form of the protease also helps to provide enhanced enzyme stability, purity and potency.
  • the lipase may be in any stabilized form, and either or both of the protease and amylase components of the compositions may be in crystal, amorphous or semi-crystalline form. Alternatively, either or both may be in lyophilized form. And, regardless of their form, either or both may be crosslinked.
  • the lipase component of the compositions of the present invention is preferably a microbial lipase. More preferably, the lipase is bacterial, rather than fungal or of plant origin.
  • the lipase is preferably one that is stable in an acidic pH environment and/or that is resistant to proteolytic degradation.
  • the lipase may also be employed in a form that renders enhances its stability to acidic pH and/or its resistance to proteolytic degradation. To that end, the lipase is preferably in the form of crosslinked crystals.
  • the lipase is of Pseudomonas or Burkholderia origin.
  • the protease component of the compositions of the present invention is a microbial protease.
  • the protease is of fungal, rather than bacterial or plant origin. More preferably, the protease is an Aspergillus protease. Most preferably, the protease is Aspergillus melleus protease.
  • the protease component of the compositions of the present invention is in crystallized, non-crosslinked form.
  • the amylase component of the compositions of the present invention is a microbial amylase.
  • the amylase is of fungal, rather than bacterial or plant origin. More preferably, the amylase is an Aspergillus amylase. Most preferably, the amylase is Aspergillus oryzae.
  • the amylase component of the compositions of the present invention is in amorphous form.
  • the amylase component of the compositions of this invention may be in crystalline forms, including crosslinked and non-crystalline forms, or coated, or encapsulated or otherwise formulated so that it retains its activity after oral administration.
  • a taste masking substances, or taste modifiers such as flavoring components or sweeteners can be included in the compositions of the present invention, wherein the said flavors may be, but not limited to, cherry-berry, bubble-gum.
  • One aspect of the invention comprises one or more formulations with specific properties that enable controlled disintegrations of the aforementioned solid oral dosage forms.
  • the said formulations may be pretreated prior to disintegration or administration to delay or accelerate the onset of therapeutic activity
  • solution or liquid state stability of pharmaceutical agents, especially proteins are generally less compared to the solid state stability of the pharmaceutical agents. This is due to greater mobility of the pharmaceutical agents and increased possibility of their interactions with each other, with the excipients in the formulation and with the container closure system.
  • the duration of stability post disintegration in a media for administration prior to dose administration also need to be established.
  • a variety of factors needs to be considered for the safe and efficacious administration. These include, but are not limited to, pH-solubility profile; pH-activity profile; pH-stability profile; solubility-activity profile; and proteolytic stability profile.
  • the compositions comprise rapidly disintegrating tablets (RDTs) comprising active ingredients, such as those described above for liprotamase, i.e., a combination of lipase, such as a cross-linked crystallized lipase, protease and amylase.
  • RDTs rapidly disintegrating tablets
  • active ingredients such as those described above for liprotamase, i.e., a combination of lipase, such as a cross-linked crystallized lipase, protease and amylase.
  • FDDTs fast- dissolving/disintegrating tablets
  • Some of the more popular ones include effervescent dosage forms such as Alka-Seltzer ® that are disintegrated in a disintegration media prior to administration.
  • FDDTs include tablets that are formulated to dissolve or disintegrate in the mouth or buccal cavities. These orally-dissolving tablets (ODTs) may also be designed to have variable sub-lingual dissolution/disintegration times.
  • ODTs ODTs
  • US Patent 7,282,217 discusses an ODT formulation that has a variable disintegration time of 2 to 120 seconds in the mouth, or R. P. Scherer Corp's fast dissolving drug delivery system, Zydis ® , that has a total dissolution/disintegration time of 3 to 5 seconds.
  • Eurand Corporation's AdvaTabTM technology provides another example, which combines taste-masking and controlled-release technologies.
  • OraSolv ® is an orally disintegrating tablet that combines taste masked active drug ingredients with a low effervescence system.
  • DuraSolv® is a durable orally disintegrating tablet that combines taste masked active drug ingredients, and can be blistered-packed or bottled.
  • OraVescent ® is an enhanced-absorption drug delivery system intended to improve the transport of active drug ingredients across mucosal membranes. OraVescent ® can be administered buccally or sublingually. This technology may improve bioavailability and accelerate the onset of action of some active drug ingredients.
  • compositions of the invention all contain at least an active protein therapeutic and an effervescent agent.
  • the effervescent agent may be an effervescent couple or it may be a single agent that is induced to effervesce in disintegration media or in the body.
  • An effervescent couple is an acid and a carbonate salt, such as citric acid and sodium bicarbonate.
  • An alternative acid is fumaric acid.
  • An alternative salt is sodium carbonate.
  • the formulation contains the salt but not the acid, and the effervescence is induced by adding the formulation to an acidic disintegration media, such as juice.
  • compositions of the invention may contain some or all of the following excipients: binders, diluents, disintegrants, sweeteners, flavors, and lubricants. Binders hold the ingredients in a tablet together.
  • Binders ensure that tablets and granules can be formed with required mechanical strength, and give volume to low active dosis tablets. Binders are usually starches, sugars, cellulose or modified cellulose such as microcrystalline cellulose, hydroxypropyl cellulose, lactose, cellulose, methyl cellulose, polyvinylpyrrolidone, and polyethylene glycol, or sugar alcohols like xylitol, sorbitol or maltitol,. [050] Diluents fill out the size of a tablet, making it practical to produce and convenient for the consumer to use. By increasing the bulk volume, the diluents make it possible for the final product to have the proper volume for patient handling.
  • a good diluent must be inert, compatible with the other components of the formulation, non-hygroscopic, soluble, relatively cheap, compactible, and preferably tasteless or pleasant tasting.
  • exemplary diluents include plant cellulose, dibasic calcium phosphate, lactose, sucrose, glucose, mannitol, sorbitol, calcium carbonate, and magnesium stearate.
  • Disintegrants expand and dissolve when wet causing the tablet to break apart in the digestive tract, releasing the active ingredients for absorption. They ensure that when the tablet is in contact with water, it rapidly breaks down into smaller fragments, thereby facilitating dissolution.
  • disintegrants include: crosslinked polyvinyl pyrrolidone, sodium starch glycolate, crosslinked sodium carboxymethyl cellulose (crosscarmellose), and crospovidone.
  • Lubricants prevent ingredients from clumping together and from sticking to the tablet punches or capsule filling machine. Lubricants also ensure that tablet formation and ejection can occur with low friction between the solid and die wall.
  • Exemplary lubricants include common minerals like talc or silica, and fats, such as vegetable stearin, magnesium stearate or stearic acid.
  • Sweeteners are added to make the ingredients more palatable, especially in chewable or dissolvable tablets.
  • exemplary sweeteners include, sucrose, fructose, sucralose, and aspartame.
  • Flavors can be used to mask unpleasant tasting active ingredients and improve the likelihood that the patient will complete a course of medication. Flavorings may be natural (e.g. fruit extract) or artificial. For example, to improve: a bitter product, mint, cherry or anise may be used. Exemplary flavors include cherry berry, orange, mint, grape, and cherry.
  • excipients are inactive ingredients, and lipase, protease and amylase are active ingredients.
  • the ratio of active to inactive ingredients in the compositions of this invention, on a w/w basis, may between about 1 :24 to about 24:1 ; preferably from about 1 :9 to about 9:1 , most preferably between about 1 :6 to about 6:1.
  • the formulations of the invention comprise the following ingredients: Table 1
  • compositions of the invention comprise the following properties: Table 2
  • a major aspect of the invention contemplates methods and techniques for selecting the appropriate disintegration media for disintegrating and dispersing the aforementioned oral dosage forms so that the protein therapeutic maintains all or some of its therapeutic activity before, during, and after the disintegration and also throughout the entire or partial administration of the disintegrated and dispersed products and media.
  • the choice of disintegration media is very important for delivery and function of active ingredients in the composition. Because uncrystallized lipase is quickly degraded by protease, it is important that the lipase remain in crystallized form, which is impervious to protease activity, through the stomach, until it reaches the area in which it is intended to be functional - the (duodenum, jejunum, ileum). Thus, cross-linked crystallized forms of lipase are preferred because the crystals remain undissolved at gastric pH levels of (2.8 to 4.0). The crystallized lipase is impervious to protease activity. At higher pH levels typical of the lower digestive tract - i.e., the duodenum and the small intestine, the lipase crystals become solubilized and can act.
  • the disintegration media may comprise of one or more solids, semi-solids, liquids, or combinations thereof (i.e., juices (e.g., apple juice) , milk, yogurt, puddings (e.g., rice pudding), cereal, carbonated beverages, etc.) that are possible for consumption.
  • juices e.g., apple juice
  • milk yogurt
  • puddings e.g., rice pudding
  • cereal e.g., cereal
  • carbonated beverages e.g., etc.
  • compositions of this invention are useful in methods for treating pancreatic insufficiency in any subject, including those suffering from cystic fibrosis.
  • the compositions of this invention are useful in methods for treating malabsorption in a subject.
  • the compositions of the invention may be used to improve the nutritional status of a subject as measured by weight, height, and/or BMI of the subject.
  • Further embodiments of this invention include use of the compositions of this invention for increasing the coefficient of fat absorption, or for increasing the coefficient of nitrogen absorption in a subject.
  • Another embodiment of this invention includes use of those compositions to increase both the coefficient of fat absorption and the coefficient of nitrogen absorption in a subject, optionally by the same amount.
  • the compositions of this invention are useful in methods for increasing carbohydrate absorption in a subject.
  • the patients treated with the compositions of the invention are useful for the treatment of patients with the inability to swallow capsules (infants and children), patients with difficulty swallowing capsules (older children, adolescents, and the elderly), and patients on Gl tubes.
  • compositions according to this invention comprise the step of administering to a subject a therapeutically effective amount of such a composition. Any of the methods of this invention may be used to treat any subject suffering from pancreatic insufficiency, including cystic fibrosis patients.
  • Example 1 Formulation of rapidly disintegration tablets [064] The following ingredients (Table 3) were weighed individually and screened through a 20 mesh hand sieve. These ingredients, except for the magnesium stearate, were then added to a V blender where they were mixed for 30 minutes. The magnesium stearate was then added to the blended mixture and mixing continued for an additional 5 minutes. The composition was then formed into tablets by compression using conventional rotary tableting equipment. Table 3
  • Flavor cherry berry 2.50 0.83
  • Cross-linked lipase crystals were insoluble in apple cranberry juice (pH 2.8); citrate buffer (pH 6.0); and milk (pH 6.8).
  • Cross-linked lipase crystals had limited solubility in Simulated Intestinal Fluid (SIF; 200 mM KCI; pH 7.5); and was readily soluble in Tris (pH 8.5).
  • SIF Simulated Intestinal Fluid
  • Tris pH 7.5
  • Protease was immediately soluble in all dissolution media.
  • Amylase protein was readily soluble in all dissolution media.
  • Tablet disintegration was tested in a variety of media and the time of tablet disintegration was measured and is shown in Table 5.

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  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Organic Chemistry (AREA)
  • Biochemistry (AREA)
  • Molecular Biology (AREA)
  • Oil, Petroleum & Natural Gas (AREA)
  • Medicinal Preparation (AREA)
  • Medicines That Contain Protein Lipid Enzymes And Other Medicines (AREA)

Abstract

La présente invention concerne des formulations, administrables par voie orale, de protéines, y compris en phase amorphe et cristalline, ainsi que sous forme réticulée. Ces formulations renferment, en particulier, un mélange de lipase, de protéase et d'amylase, ainsi qu'un agent effervescent. L'invention concerne, en outre, des procédés d'administration de ces formulations, ainsi que leur préparation et leurs conditions d'utilisation. L'invention concerne, plus précisément, des procédés de préparation et d'administration de formulations se révélant intéressantes en pédiatrie et chez des patients souffrant de troubles associés à la déglutition comme fréquemment observé chez les personnes âgées et les personnes handicapées, ou encore pour des patients souffrant d'occlusions oesophagiennes ou de complications atteignant le système nerveux central autonome (par exemple dans le cas de la maladie de Parkinson, de la sclérose en plaques ou de la sclérose latérale amyotrophique, etc.).
PCT/US2009/054866 2008-08-26 2009-08-25 Comprimés à désintégration rapide renfermant de la lipase, de l'amylase et de la protéase Ceased WO2010025126A1 (fr)

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EP09791877A EP2328609A1 (fr) 2008-08-26 2009-08-25 Comprimés à désintégration rapide renfermant de la lipase, de l'amylase et de la protéase

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US61/091,773 2008-08-26

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US8163278B2 (en) 1999-12-17 2012-04-24 Curemark Llc Methods for treating pervasive development disorders
WO2012056024A1 (fr) * 2010-10-29 2012-05-03 Imarko Research S.A. Composition comprenant en association au moins une enzyme protéolytique et au moins une enzyme lipolytique pour son utilisation pour empêcher la synthèse des triglycérides
US8268305B1 (en) 2011-09-23 2012-09-18 Bio-Cat, Inc. Method and compositions to reduce serum levels of triacylglycerides in human beings using a fungal lipase
US8318158B2 (en) 2008-04-18 2012-11-27 Curemark, Llc Pharmaceutical preparation for the treatment of the symptoms of addiction and method of diagnosing same
WO2012170899A3 (fr) * 2011-06-10 2013-01-31 Prothera Inc. Compositions pharmaceutiques contenant des protéases et procédés pour le traitement de maladies liées au stockage lysosomal
US8580522B2 (en) 2000-11-16 2013-11-12 Curemark, Llc Methods for diagnosing pervasive development disorders, dysautonomia and other neurological conditions
US8658163B2 (en) 2008-03-13 2014-02-25 Curemark Llc Compositions and use thereof for treating symptoms of preeclampsia
US8673877B2 (en) 2005-08-30 2014-03-18 Curemark, Llc Use of lactulose in the treatment of autism
US8778335B2 (en) 2000-08-14 2014-07-15 Curemark, Llc Methods of treating and diagnosing Parkinson's disease and related dysautonomic disorders
US8980252B2 (en) 2011-04-21 2015-03-17 Curemark Llc Methods of treatment of schizophrenia
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US9061033B2 (en) 2008-10-03 2015-06-23 Curemark Llc Methods and compositions for the treatment of symptoms of prion diseases
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US9107419B2 (en) 2009-01-06 2015-08-18 Curelon Llc Compositions and methods for treatment or prevention of Staphylococcus aureus infections and for the eradication or reduction of Staphylococcus aureus on surfaces
US9320780B2 (en) 2008-06-26 2016-04-26 Curemark Llc Methods and compositions for the treatment of symptoms of Williams Syndrome
WO2016126970A1 (fr) * 2015-02-04 2016-08-11 Abbvie Inc. Compositions pharmaceutiques et méthodes d'utilisation de celles-ci pour traiter une insuffisance liée aux enzymes pancréatiques
US9511125B2 (en) 2009-10-21 2016-12-06 Curemark Llc Methods and compositions for the treatment of influenza
US9670163B2 (en) 2005-12-28 2017-06-06 Vertex Pharmaceuticals Incorporated Solid forms of N-[2,4-bis(1,1-dimethylethyl)-5-hydroxyphenyl]-1,4-dihydro-4-oxoquinoline-3-carboxamide
US9701639B2 (en) 2014-10-07 2017-07-11 Vertex Pharmaceuticals Incorporated Co-crystals of modulators of cystic fibrosis transmembrane conductance regulator
US9751839B2 (en) 2009-03-20 2017-09-05 Vertex Pharmaceuticals Incorporated Process for making modulators of cystic fibrosis transmembrane conductance regulator
EP2818160B1 (fr) 2010-10-01 2017-11-08 Aptalis Pharma Limited Formulations pancrelipase à faible résistance, enrobage entérique
DE102017104472A1 (de) 2017-03-03 2018-09-06 Nordmark Arzneimittel Gmbh & Co. Kg Schmelztablette enthaltend Burlulipase und daraus hergestellte pharmazeutische Zusammensetzung
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US11016104B2 (en) 2008-07-01 2021-05-25 Curemark, Llc Methods and compositions for the treatment of symptoms of neurological and mental health disorders
WO2021202363A1 (fr) * 2020-03-30 2021-10-07 Wall Jai Enzymothérapie de remplacement pancréatique combinée d'origine animale et d'origine synthétique
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US4079125A (en) * 1975-06-10 1978-03-14 Johnson & Johnson Preparation of enteric coated digestive enzyme compositions
EP0093784A1 (fr) * 1982-04-23 1983-11-16 Dr. Thilo & Co. GmbH Produit enzymatique à action contrôlée par le pH pour le nettoyage des lentilles de contact
US5750104A (en) * 1996-05-29 1998-05-12 Digestive Care Inc. High buffer-containing enteric coating digestive enzyme bile acid compositions and method of treating digestive disorders therewith
WO2006044529A1 (fr) * 2004-10-14 2006-04-27 Altus Pharmaceuticals Inc. Compositions contenant de la lipase, de la protease et de l'amylase pour le traitement de l'insuffisance pancreatique

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US8613918B2 (en) 1999-12-17 2013-12-24 Curemark Llc Method for treating pervasive development disorders
US9624526B2 (en) 1999-12-17 2017-04-18 Curemark Llc Method for treating pervasive development disorders
US8211661B2 (en) 1999-12-17 2012-07-03 Curemark, Llc Method for identifying individuals having a pervasive development disorder amenable to digestive enzyme therapy
US8163278B2 (en) 1999-12-17 2012-04-24 Curemark Llc Methods for treating pervasive development disorders
US9624525B2 (en) 1999-12-17 2017-04-18 Curemark, Llc Method for treating pervasive development disorders
US8815233B2 (en) 1999-12-17 2014-08-26 Curemark Llc Method for treating pervasive development disorders
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US10209253B2 (en) 2000-11-16 2019-02-19 Curemark, Llc Methods for diagnosing pervasive development disorders, dysautonomia and other neurological conditions
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WO2016126970A1 (fr) * 2015-02-04 2016-08-11 Abbvie Inc. Compositions pharmaceutiques et méthodes d'utilisation de celles-ci pour traiter une insuffisance liée aux enzymes pancréatiques
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