(12) United States Patent (10) Patent No.: US 9.402,811 B2 Merkus (45) Date of Patent: Aug
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USOO9402811 B2 (12) United States Patent (10) Patent No.: US 9.402,811 B2 Merkus (45) Date of Patent: Aug. 2, 2016 (54) OROMUCOSAL LIQUIDESTRADIOL 8,647,665 B2 * 2/2014 Simes et al. .................. 424/449 COMPOSITIONS 2003/0077229 A1 4/2003 Dugger 2007/0219 171 A1* 9, 2007 Lulla et al. .................... 514,177 (71) Applicant: INNOTESTO BVBA, Kasterlee (BE) FOREIGN PATENT DOCUMENTS (72) Inventor: Franciscus Wilhelmus Henricus Maria JP HO6321771 A 11, 1994 Merkus, Kasterlee (BE) WO WO-97,38662 A2 10, 1997 WO WO-2005/041943 A1 5, 2005 (73) Assignee: INNOTESTO BVBA, Kasterlee (BE) WO WO-2005049026 A1 6, 2005 WO WO-2009036355 A1 3, 2009 (*) Notice: Subject to any disclaimer, the term of this WO WO-2010/089078 A1 8, 2010 patent is extended or adjusted under 35 U.S.C. 154(b) by 0 days. OTHER PUBLICATIONS Hassan et al., "Chemical permeation enhancers for transbuccal drug (21) Appl. No.: 14/370,435 delivery.” Expert Opon Drug Deliv Jan. 2010;7(1):97-112 (22) PCT Fled: Jan. 4, 2013 (Abstract).* Database Biosis Online Biosciences Information Service, Philadel (86) PCT NO.: PCT/EP2013/05O110 phia, PA, US; 1995, Goldberg-Cettina Melinda et al: “Enhanced transdermal delivery of estradiol in vitro using binary vehicles of S371 (c)(1), isopropyl myristate and short-chain alkanols', XP009 167205, Data (2) Date: Jul. 2, 2014 base accession No. PREV 199598097252 abstract & International Journal of Pharmaceutics (Amsterdam), vol. 114, No. 2, 1995, pp. (87) PCT Pub. No.: WO2013/102665 237-245, ISSN: 0378-5173. Database Biosis Online Biosciences Information Service, Philadel PCT Pub. Date: Jul. 11, 2013 phia, PA, US; Nov. 15, 1998, Kitano Manabu et al: “Buccal absorp tion through golden hambster cheek pouch in vitro and in vivo of (65) Prior Publication Data 17beta-estradiol from hydrogels containing three types of absorption enhancers'. XP009 167375, Database accession No. US 2014/O371191 A1 Dec. 18, 2014 PREV 199900000654 absract & International Journal of Pharmaceutics (Amsterdam), vol. 174, No. 1-2, Nov. 15, 1998, pp. (30) Foreign Application Priority Data 19-28, ISSN: 0378-5 173. International Search Report of PCT/EP2013/050110 filed Jan. 4, Jan. 4, 2012 (GB) ................................... 12OOO62.6 2013. Liu et al. “Effects of Isopropanol-Isopropyl Myristate Binary (51) Int. Cl. Enhancers on InVitro Transport of Estradiol in Human Epidermis: A A6 IK3I/56 (2006.01) Mechanistic Evaluation.” J. Pharma. Sci. 98.2(2009):565-572. A6 IK9/00 (2006.01) A6 IK9/08 (2006.01) * cited by examiner A6 IK3I/565 (2006.01) A6 IK 47/10 (2006.01) A6 IK 47/4 (2006.01) Primary Examiner — Jared D Barsky (52) U.S. C. (74) Attorney, Agent, or Firm — Mintz Levin Cohn Ferris CPC. A61 K9/006 (2013.01); A61 K9/08 (2013.01); Glovsky and Popeo, P.C.; Muriel Liberto, Esq. A6 IK3I/565 (2013.01); A61 K47/10 (2013.01); A61 K47/14 (2013.01) (58) Field of Classification Search (57) ABSTRACT None The present invention relates to low dose estradiol solutions See application file for complete search history. for oromucosal administration Suitable in replacement therapy or suppletion of low estradiol levels and also for (56) References Cited preventing, alleviating or treating symptoms associated with U.S. PATENT DOCUMENTS low endogenous levels of estradiol in female Subjects. 5,766,620 A * 6, 1998 Heiber et al. ................. 424/436 6,110,486 A * 8/2000 Dugger, III ................... 424/435 8 Claims, No Drawings US 9,402,811 B2 1. 2 OROMUCOSAL LIQUIDESTRADIOL comprising estradiol are disclosed in EP 0371466 and WO COMPOSITIONS 2010/089078. Medicated papers for oromucosal administra tion containing estradiol and a cyclodextrin are described in RELATED APPLICATION EP 1867 321. Formulations of dimethyl-3-cyclodextrin complexes of This application is a national stage application filed under 17B-estradiol and/or progesterone in an aqueous solution for 35 U.S.C. 371, of International Application No. PCT/ nasal application have been described in EP 0349091. One EP2013/050110, filed Jan. 4, 2013, which claims priority to Such formulation containing 17 B-estradiol complexed in GB 1200062.6 filed Jan. 4, 2012, the contents of which are methylated-B-cyclodextrin has been authorized for medical hereby fully incorporated by reference. 10 use under the trade name AerodiolTM. This nasal spray prod The present invention relates to low dose estradiol solu uct, administered in a low dose of 300 g/day, was as effective tions for oromucosal administration Suitable in replacement as a 2 mg oral tablet/day in treating menopausal symptoms. It therapy or suppletion of low estradiol levels and also for preventing, alleviating or treating symptoms associated with showed reduced adverse effects, i.e. fewer incidences of mas 15 talgia and withdrawal bleedings. Furthermore, beneficial low endogenous levels of estradiol in female Subjects. effects on Some lipid parameters, on markers of bone resorp BACKGROUND OF THE INVENTION tion, bone formation and bone mineral density were reported. Finally, less breast tenderness was found with intranasal Current estradiol therapy includes oral, transdermal, administration of estradiol as compared to oral treatment. injectable and vaginal formulations. Transdermal delivery Because of the side effects of frequent nasal administra comprises patches, gels, lotions and sprays, while Vaginal tion, AerodiolTM is recommended for once daily administra products include Suppositories, creams, and rings. tion in a high dose resulting in high peak estradiol levels. Estradiol, when taken orally as tablets, pills or capsules, is These are reached within 10-30 min. and the levels return to converted for a large part to estrone after absorption in the 10% of the peak value in about two hours after administration gastrointestinal tract and metabolism in the liver (first-pass 25 (Devissaguet et al., Eur. J. Drug Metabol. Pharmacokinetics metabolism). This causes an imbalance in the estradiol/es 1999; 24; 265-271). This means that once daily intranasal trone ratio, which is normally 1:1 in premenstrual women. administration of AerodiolTM results in a “pulsatile' profile, This imbalance is mainly responsible for a change in lipids comprising one large peak per day, followed by a period and clotting factors. Non-oral products (transdermal, vaginal) during which estradiol levels remain at a low level. Peak avoid this hepatic first-pass metabolism and therefore are 30 levels after administration of 300 g estradiol by the required considered first choice in estradiol Suppletion. quantity of AerodiolTM nasal spray reach values of 1400 pg/l. In general, it is advisable to use the lowest dose of the Normal estradiol levels differ slightly per laboratory, but hormone estradiol possible, because overdosing may lead to range from 100-500 pg/ml during a menstrual cycle. This side effects related to unphysiological hormone levels. Low means that the peak level of 1400 pg/ml, obtained with nasal dose non-oral products are first choice because of (1) the 35 AerodiolTM, is about 3 times higher than the highest normal low-dose administered, (2) the physiological ratio between levels in premenopausal women. levels of estradiol and its metabolite estrone, and (3) as a A further disadvantage related to nasal administration is consequence the decreased risk of adverse effects. The use of that the access to the nasal mucosa can be compromised in very low doses may also be beneficial as opposed treatment instances such as common cold or allergy resulting in a run (continuous or cyclic co-administration of a progestogen) is 40 ning or blocked nose. This results in inconsistent or even no not an absolute requirement because the endometrium does nasal absorption. The product characteristics of AerodiolTM not proliferate upon administration of very low doses of estra teach that in that instance the patient, should administer a diol. double dose of AerodiolTM via the oromucosal route to reach In the research into new estradiol products, non-oral similar estradiol serum levels. administration has been considered, including products for 45 Moreover, nasal administration may give rise to local side nasal and oromucosal administration. U.S. Pat. No. effects in the nose. Such as local irritation, itching, rhinor 5.955,098 discloses a buccal aerosol spray, comprising a pro rhoea, Sneezing and nosebleeds. Multiple nasal administra pellant 50-95%, a non-polar solvent 5-50%, the active drug tions increase these undesired side effects. compound 0.001-15% (including estradiol), and a flavoring It is a first object of the invention to avoid nasal adminis agent 0.05-5%. U.S. Pat. No. 6,110,486 discloses a buccal 50 tration of estradiol and the side effects associated therewith. spray containing estradiol, dissolved in a pharmacologically It is a second object of the invention to provide an estradiol acceptable polar solvent, comprising in weight '% of total composition for oromucosal administration that does not composition: polar solvent 75-99.8%, active compound 0.68 require the administration of high doses of estradiol. Such as 40%. As solvents for the sprays there are used low molecular for example the double dose required for oromucosal admin weight polyethylene glycols (PEG) of 200-1000 MW (pref 55 istration of AerodioITM. erably 200-600) and also low molecular weight alcohols and Further, it is an object of the invention to provide a new polyols, such as glycerin and water. Illustrated is a spray dosage regimen for estradiol administration that provides a formulation containing estradiol and 85% polyethylene gly physiological pharmacokinetic profile approaching normal col. However, this solvent has a bitter, burning taste in the estradiol plasma levels. A particular object is the provision of mouth, making a spray, based mainly on Such an ingredient, 60 a dosage regimen with low estradiol peak levels, in particular poorly acceptable for chronic use. a regimen that keeps the highest estradiol levels under 500 US 2011/0097405 discloses an oromucosal estradiol prod pg/ml, and avoids the high peak serum levels seen with the uct, which is absorbed mainly in the oral cavity and not in the administration of existing nasal formulations.