JP2013508381A - Control of the gelation temperature of formulations containing poloxamers - Google Patents

Abstract

Disclosed herein is a method for adjusting the gel temperature of a formulation comprising a poloxamer. It is also administered herein by gelling when in contact with the body and by applying these compositions and formulations directly onto the target structure or via perfusion to the target structure. Sustained release pharmaceutical formulations are described.
[Selection figure] None

Description

Cross-reference This patent application is filed in US provisional application 61 / 253,782 filed October 21, 2009; US provisional application 61 / 255,379 filed October 27, 2009; US Provisional Application No. 61 / 255,780 filed on October 28, 2009; US Provisional Application No. 61 / 255,783 filed on October 28, 2009; filed on January 21, 2010 US provisional application 61 / 297,138; US provisional application 61 / 297,170 filed on January 21, 2010; US provisional application 61/364 filed on July 14, 2010 288; and US Provisional Application No. 61 / 366,677, filed July 22, 2010, all of which are hereby incorporated by reference in their entirety.

  Sustained release formulations that gel on contact with the body are used in a variety of therapeutic applications.

  Described herein is a sustained release formulation comprising a heat sensitive polymer. Also included herein is a heat sensitive polymer by adding one or more gelling temperature modifiers (eg, a formulation that gels upon contact with the body) to achieve the desired therapeutically relevant gelling temperature. A method is described in which the gelation temperature of a formulation comprising is manipulated.

Provided herein are pharmaceutical formulations comprising, in some embodiments, a thermosensitive polymer comprising an active agent, polyoxyethylene and a polyoxypropylene copolymer,
And the pharmaceutical formulation is
a) having a viscosity suitable for administration with a 25-31 gauge needle and capable of being injected at the time of administration;
b) having a gelling temperature between about 14 ° C and about 42 ° C;
c) providing sustained release of a therapeutically effective amount of the active agent for at least 3 days in vivo; and
(D) having a microbial factor of less than 50 cfu per gram of formulation;
However,
(I) the formulation comprises less than 14.5% heat sensitive polymer by weight of the formulation and further comprises one or more gelling temperature raising agents; or (ii) the formulation is greater than 25% by weight of the formulation. And (iii) the formulation comprises between about 5% and about 20% of the thermosensitive polymer by weight of the formulation, wherein the thermosensitive polymer comprises: Has been purified and further comprises one or more gel temperature raising agents or gel temperature lowering agents; or
(Iv) The formulation comprises between about 14.5% and about 25% heat sensitive polymer by weight of the formulation, and further comprises one or more gel temperature raising agents or gel temperature lowering agents.

  In some embodiments, the formulation provides sustained release of a therapeutically effective amount of the active agent in vivo for at least 5 days. In some embodiments, the formulation provides sustained release of a therapeutically effective amount of the active agent in vivo for at least 7 days. In some embodiments, the formulation provides sustained release of a therapeutically effective amount of the active agent in vivo for at least 10 days. In some embodiments, the formulation provides sustained release of a therapeutically effective amount of the active agent in vivo for at least 14 days.

  In some embodiments, the formulation is administered at or around the round window membrane of the ear. In some embodiments, in vivo sustained release occurs in the inner ear.

  In some embodiments, the formulation is administered in the middle ear away from the round window membrane. In some embodiments, in vivo sustained release occurs in the middle ear.

  In some embodiments, the formulation is administered in the vicinity of or near one or more sinusoidal cavities. In some embodiments, in vivo sustained release occurs in one or more sinus cavities or in the vicinity of one or more sinus cavities.

  In some embodiments, the heat sensitive polymer is P407. In some embodiments, the formulation is substantially free of additional preservatives. In some embodiments, the formulation is substantially free of pyrogens. In some embodiments, the formulation comprises less than about 5 endotoxin units (EU) per kg body weight of the subject. In some embodiments, the formulation is substantially free of additional tonicity agents.

  In some embodiments, the formulation comprises a suspension of one or more multiparticulate active agents. In some embodiments, the multiparticulate active agent is a micronized active agent that has been sterilized by dry heat, irradiation, or steam sterilization.

  In some embodiments, the formulation has impurities associated with any individual product of 1% or less by weight of the formulation. In some embodiments, the formulation has impurities related to the total product of 2% or less by weight of the formulation.

  In some embodiments, the active agent is a corticosteroid, or a salt or prodrug or solvate thereof.

  In some embodiments, the corticosteroid is 21-acetoxypregnenolone, alclomethasone, algestone, amsinonide, beclomethasone, betamethasone, budesonide, chloroprednisone, clobetasol, clobetasone, crocortron, clopredonol, corticosterone, cortisone, cortibazole, Deflazacort, Desonide, Desoxymethazone, Dexamethasone, Diflorazone, Diflucortron, Diflupredonate, Enoxolone, Fluazacort, Fluchloronide, Flumethasone, Flunisolide, Fluocinolone acetonide, Fluocoronide, Fluocortron butyl , Fluorometholone, fluperolone acetate, fluprednidene acetate, flupred Solone, flulandrenolide, fluticasone propionate, formocotal, halsinonide, halobetasol propionate, halometasone, halopredone acetate, hydrocortamate, hydrocortisone, loteprednol etabonate, madipredon, medrizone, meprednisone, methylprednisolone, mometasone furoate, Parameterzone, prednisocarbate, prednisolone, prednisolone 25-diethylamino-acetate, sodium prednisolone phosphate, prednisone, prednival, prednidene, rimexolone, thixocortol, triamcinolone, triamcinolone acetonide, triamcinolone venetonide, or triamcinolone Or a prodrug.

  In some embodiments, the corticosteroid is dexamethasone, prednisolone, methylprednisolone, triamcinolone, or a salt or prodrug or solvate thereof, or a combination thereof. In some embodiments, the corticosteroid is dexamethasone, or a salt or prodrug or solvate thereof. In some embodiments, the dexamethasone is dexamethasone sodium phosphate or dexamethasone acetate.

  In some embodiments, dexamethasone, or a salt or prodrug or solvate thereof, is present in an amount from about 0.05% to about 40% by weight of the formulation. In some embodiments, dexamethasone, or a salt or prodrug or solvate thereof, is present in an amount from about 0.1% to about 30% by weight of the formulation. In some embodiments, dexamethasone, or a salt or prodrug or solvate thereof, is present in an amount from about 0.5% to about 15% by weight of the formulation.

  In some embodiments, the formulation provides sustained release of a therapeutically effective amount of dexamethasone in vivo for at least 5 days. In some embodiments, the formulation provides sustained release of a therapeutically effective amount of dexamethasone in vivo for at least 7 days. In some embodiments, the formulation provides sustained release of a therapeutically effective amount of dexamethasone in vivo for at least 10 days. In some embodiments, the formulation provides sustained release of a therapeutically effective amount of dexamethasone in vivo for at least 14 days.

  In some embodiments, the active agent is an antimicrobial agent. In some embodiments, the antimicrobial agent is an antibiotic.

  In some embodiments, the antibiotic is amikacin, gentamicin, kanamycin, neomycin, netilmycin, streptomycin, tobramycin, paromycin, geldanamycin, herbimycin, loracarbef, ertapenem, doripenem, imipenem, meropenem, cefaclor, cefamandole, Cefotoxin, cefprozil, cefuroxime, cefixime, cefdinir, cefditoren, cefpodoxime, ceftazidime, ceftibutene, ceftizoxime, ceftriaxone, cefepime, ceftobiprolol, erythromycin Roxithromycin, troleandomycin, te Thromycin, spectinomycin, aztreonam, amoxicillin, ampicillin, azocillin, carbenicillin, cloxacillin, dicloxacillin, flucloxacillin, mezlocillin, methicillin, nafcillin, oxacillin, piperacillin, peperacillin Ciprofloxacin, clavulanic acid, enoxacin, gatifloxacin, levofloxacin, lomefloxacin, moxifloxacin, norfloxacin, ofloxacin, trovafloxacin, grepafloxacin, sparfloxacin, AL-15469A, AL-38905, OP-145, mafenide (afenide), professional Todyl, sulfacetamide, sulfamethizole, sulfanilamide, sulfasalazine, sulfisoxazole, trimethoprim, cotrimoxazole, demeclocycline, doxycycline, minocycline, oxytetracycline ne, tetracycline t , Arsogebanube chloramphenicol, clindamycin, lincomycin, ethambutol, fosfomycin, fusidic acid, furazolidone, isoniazid, linezolid, metronidazole, mupirocin, nitrofurantoin, platencimycin, pyrazineamide, quinupristin, Darhopristin, rifampicin, chi Amphenicol, tinidazole, amoxicillin + clavulanic acid, maximin H5, dermicidin, cecropin, andropine, moricin, seratotoxin, melittin, magainin, dermaceptin, bombinin, brevinin-1 Esculentins and buforin II, CAP18, LL37, abaecin, apidaesin, profenin, indolicidin, brevinin, protegrin, tachypressin, defensin, drosomycin, alamethicin, pexiganan or MSI-84, MSI-844, MS Polyfemcin, colicin, pyocin, crevicin, subtilin, epi Lumin, herbicolacin, brevicin, halocin, agrosin, albeicin, carnosine, curbaticin, giversin, enterocin, enterolysin, erwinicincin, erwinicincin lactococin, lacticin, leucoccin, mesentericin, pediocin, plantaricin, sakacin, sulforobicin, vibriocin, warnerinand and warnerinand Or co-crystal, or a prodrug or solvate or combination thereof.

  In some embodiments, the antibiotic is ciprofloxacin, amoxicillin, amoxicillin + clavulanic acid, moxifloxacin or ofloxacin. In some embodiments, the antibiotic is ciprofloxacin or ciprofloxacin hydrate. In some embodiments, ciprofloxacin or ciprofloxacin hydrate is present in an amount between about 0.1 and about 20% by weight of the formulation.

  In some embodiments, the formulation provides sustained release of a therapeutically effective amount of ciprofloxacin in vivo for at least 5 days. In some embodiments, the formulation provides sustained release of a therapeutically effective amount of ciprofloxacin in vivo for at least 7 days. In some embodiments, the formulation provides sustained release of a therapeutically effective amount of ciprofloxacin in vivo for at least 10 days. In some embodiments, the formulation provides sustained release of a therapeutically effective amount of ciprofloxacin in vivo for at least 14 days.

  In some embodiments, the gelling temperature increasing agent or gelling temperature decreasing agent is P188, P338, cyclodextrin, Tween 20, Tween 40, Tween 65, Tween 80, Tween 85, sodium oleate, sodium caprate, sodium caprylate and PEG. Selected from.

  Also provided herein is a kit comprising (a) a sterilized, multiparticulate active agent powder, and (b) a solution comprising a heat sensitive polymer, wherein (a) and (b) are combined To form the above formulation.

  In some embodiments, the formulation described above comprises a higher concentration of active agent than the actual dosage. In some of such embodiments, the formulation is diluted prior to administration. Thus, in some embodiments, the weight percent of active agent in the administered formulation is different from the weight percent amount of active agent in the prepared formulation.

In one aspect, the specification includes:
(A) less than 14.5% heat sensitive polymer by weight of the formulation, and one or more gelling temperature raising agents;
(B) water;
(C) between about 0.2% and about 20% micronized dexamethasone by weight of the formulation administered;
Including
(D) having a gelling temperature between about 14 ° C and about 42 ° C;
(E) having a microbial factor of less than 50 cfu per gram of formulation; and (f) having a viscosity suitable for injection via a 25-31 gauge needle upon administration
A pharmaceutical formulation is provided.

In one embodiment, the specification includes (a) 25% or more heat sensitive polymer by weight of the formulation, and one or more gelling temperature lowering agents;
(B) water;
(C) between about 0.2% and about 20% micronized dexamethasone by weight of the formulation administered;
Including
(D) having a gelling temperature between about 14 ° C and about 42 ° C;
(E) having a microbial factor of less than 50 cfu per gram of formulation; and (f) having a viscosity suitable for injection via a 25-31 gauge needle upon administration
A pharmaceutical formulation is provided.

In one aspect, the specification includes:
(A) between about 5% and about 20% of a purified thermosensitive polymer by weight of the formulation, and optionally further one or more gelling temperature raising agents;
(B) water;
(C) between about 0.2% and about 20% micronized dexamethasone by weight of the formulation administered;
Including
(D) having a gelling temperature between about 14 ° C and about 42 ° C;
(E) having a microbial factor of less than 50 cfu per gram of formulation; and (f) having a viscosity suitable for injection via a 25-31 gauge needle upon administration
A pharmaceutical formulation is provided.

In one aspect, the specification includes:
(A) between about 14.5% and about 25% heat sensitive polymer by weight of the formulation, and one or more gelling temperature raising agents or gel temperature lowering agents;
(B) water;
(C) between about 0.2% and about 20% micronized dexamethasone by weight of the formulation administered;
Including
(D) having a gelling temperature between about 14 ° C and about 42 ° C;
(E) having a microbial factor of less than 50 cfu per gram of formulation; and (f) having a viscosity suitable for injection via a 25-31 gauge needle upon administration
A pharmaceutical formulation is provided.

In one aspect, the specification includes:
(A) less than 14.5% heat sensitive polymer by weight of the formulation, and one or more gelling temperature raising agents;
(B) water;
(C) between about 0.2% and about 20% micronized ciprofloxacin by weight of the formulation administered;
Including
(D) having a gelling temperature between about 14 ° C and about 42 ° C;
(E) having a microbial factor of less than 50 cfu per gram of formulation; and (f) having a viscosity suitable for injection via a 25-31 gauge needle upon administration
A pharmaceutical formulation is provided.

In one aspect, the specification includes:
(A) 25% or more heat sensitive polymer by weight of the formulation, and one or more gelling temperature lowering agents;
(B) water;
(C) between about 0.2% and about 20% ciprofloxacin by weight of the formulation administered;
Including
(D) having a gelling temperature between about 14 ° C and about 42 ° C;
(E) having a microbial factor of less than 50 cfu per gram of formulation; and (f) having a viscosity suitable for injection via a 25-31 gauge needle upon administration
A pharmaceutical formulation is provided.

In one aspect, the specification includes:
(A) between about 5% and about 20% of a purified thermosensitive polymer by weight of the formulation, and optionally further one or more gelling temperature raising agents;
(B) water;
(C) between about 0.2% and about 20% micronized ciprofloxacin by weight of the formulation administered;
Including
(D) having a gelling temperature between about 14 ° C and about 42 ° C;
(E) having a microbial factor of less than 50 cfu per gram of formulation; and (f) having a viscosity suitable for injection via a 25-31 gauge needle upon administration
A pharmaceutical formulation is provided.

In one aspect, the specification includes:
(A) between about 14.5% and about 25% heat sensitive polymer by weight of the formulation, and one or more gelling temperature raising agents or gelling temperature lowering agents;
(B) water;
(C) between about 0.2% and about 20% micronized ciprofloxacin by weight of the formulation administered;
Including
(D) having a gelling temperature between about 14 ° C and about 42 ° C;
(E) having a microbial factor of less than 50 cfu per gram of formulation; and (f) having a viscosity suitable for injection via a 25-31 gauge needle upon administration
A pharmaceutical formulation is provided.

In one aspect, the specification includes:
(A) less than 14.5% heat sensitive polymer by weight of the formulation, and one or more gelling temperature raising agents;
(B) water;
(C) between about 0.001% and about 5% micronized dexamethasone by weight of the formulation administered;
(D) between about 0.1% and about 10% ciprofloxacin, moxifloxacin or ofloxacin by weight of the formulation administered;
Including
(E) having a gelling temperature between about 14 ° C and about 42 ° C;
(F) having a microbial factor of less than 50 cfu per gram of the formulation; and (g) having a viscosity suitable for injection by a 25-31 gauge needle upon administration,
A pharmaceutical formulation is provided.

In one aspect, the specification includes:
(A) 25% or more heat sensitive polymer by weight of the formulation, and one or more gelling temperature lowering agents;
(B) water;
(C) between about 0.001% and about 5% micronized dexamethasone by weight of the formulation administered;
(D) between about 0.1% and about 10% ciprofloxacin, moxifloxacin or ofloxacin by weight of the formulation administered;
Including
(E) having a gelling temperature between about 14 ° C and about 42 ° C;
(F) having a microbial factor of less than 50 cfu per gram of the formulation; and (g) having a viscosity suitable for injection by a 25-31 gauge needle upon administration,
A pharmaceutical formulation is provided.

In one aspect, the specification includes:
(A) between about 5% and about 20% of a purified thermosensitive polymer by weight of the formulation, and optionally further one or more gelling temperature raising agents;
(B) water;
(C) between about 0.001% and about 5% micronized dexamethasone by weight of the formulation administered;
(D) between about 0.1% and about 10% ciprofloxacin, moxifloxacin or ofloxacin by weight of the formulation administered;
Including
(E) having a gelling temperature between about 14 ° C and about 42 ° C;
(F) having a microbial factor of less than 50 cfu per gram of the formulation; and (g) having a viscosity suitable for injection by a 25-31 gauge needle upon administration,
A pharmaceutical formulation is provided.

In one aspect, the specification includes:
(A) between about 14.5% and about 25% heat sensitive polymer by weight of the formulation, and one or more gelling temperature raising agents or gelling temperature lowering agents;
(B) water;
(C) between about 0.001% and about 5% micronized dexamethasone by weight of the formulation administered;
(D) between about 0.1% and about 10% ciprofloxacin, moxifloxacin or ofloxacin by weight of the formulation administered;
Including
(E) having a gelling temperature between about 14 ° C and about 42 ° C;
(F) having a microbial factor of less than 50 cfu per gram of the formulation; and (g) having a viscosity suitable for injection by a 25-31 gauge needle upon administration,
A pharmaceutical formulation is provided.

  Further provided herein is the use of any of the formulations described above in the manufacture of a medicament for the treatment of any otic and / or sinus and / or nasopharyngeal disorder.

  Herein, in some embodiments, Meniere's disease, sudden hearing loss, noise-induced hearing loss, age-related hearing loss, dizziness, tinnitus, otosclerosis, autoimmune ear disease (AIED), otitis media, and Provided is a method of treating an otic disorder selected from otitis externa, the method comprising administering to an individual in need thereof any formulation described herein.

  Herein, in some embodiments, sinus polyposis, allergic fungal sinusitis, nasal polyp, sinus cancer, nasopharyngeal cancer, nasal bleeding, olfactory sensation, respiratory papillomatosis, nipple Tumor-induced tumors (eg, inverting papillomas), recurrent respiratory papillomas, worsening post-operative complications related to sinus surgery (removal of the lower turbinates), chronic sinusitis Is provided for treating a sinus or nasopharyngeal disorder selected from chronic sinusitis and / or chronic rhinosinusitis, comprising any of the formulations described herein. Administering to an individual in need thereof.

FIG. 1 is an exemplary comparison of a non-sustained release formulation and a sustained release formulation. FIG. 2 is an exemplary predicted tunable release of active agent from the four compositions. FIG. 3 is an exemplary inner ear pharmacokinetics with increasing concentrations of steroids in sustained release formulations. FIG. 4 is an illustration of the in vitro mean dissolution time with increasing concentrations of steroids in sustained release formulations. FIG. 5 is an illustration of high solubility versus low solubility formulation ingredients and average in vitro dissolution times for solution versus gel formulations. FIG. 6 is an exemplary comparison of in vitro release of zoledronate from a formulation comprising zoledronate versus a formulation comprising zoledronate-calcium complex. FIG. 7 shows the mean dissolution time (MDT) for a particular formulation. FIG. 8 shows MRT for dexamethasone (Dex), dexamethasone sodium phosphate (DSP), and dexamethasone acetate (DA) from certain formulations following intramiddle injection in guinea pigs. FIG. 9 shows MRT for methylprednisolone soluble form (MPS) and methylprednisolone insoluble form (MPS) from certain formulations following intramiddle injection in guinea pigs. FIG. 10 shows the MRT for 0.6% L-701324 in a 17% poloxamer 407 formulation following intramiddle injection in guinea pigs. FIG. 11 shows the MRT for 0.5% SP-600125 in a 17% poloxamer 407 formulation following intramiddle injection in guinea pigs. FIG. 12 shows the MRT for 2% meclizine in a 17% poloxamer 407 formulation following intramiddle injection in guinea pigs. FIG. 13 shows the nearly uniform distribution of dexamethasone in the vortex tube (chochlea) from the formulation containing the heat-sensitive polymer following the injection in the middle ear and the absence of dexamethasone in the vortex tube from the dexamethasone solution without the heat-sensitive polymer. An even distribution is shown. FIG. 14 shows the effect of poloxamer 407 formulations containing various concentrations of dexamethasone on the ABR auditory threshold in guinea pigs following administration in the middle ear. Hearing ability was examined by recording brainstem activity in response to known auditory stimuli under general anesthesia in a sound insulation booth. Earphones (EC1, Tucker Davis Technologies) were placed in the ear just above the ear canal opening. Three hypodermic needle electrodes were used to measure brainstem activity and were placed in the region of the back of the ear (reference), on the top of the skull (active), and on the hind limb (ground). Voice stimuli were generated using the SigGen system (Tucker Davis Technologies) and consisted of 10 ms auditory clicks (frequency range 100 Hz-30 kHz). Responses were averaged from 512 presentations with acoustic levels up to 90 dB SPL with an increase in 5 dB SPL. The reaction was obtained using BioSig (Tucker Davis Technologies) and the threshold was determined as the average between the unobservable intensity and the smallest observable intensity. FIG. 15 shows in vitro release characteristics of otic drugs from 15-18% poloxamer formulation with water as solvent and 50% poloxamer formulation with water + ethanol as solvent upon administration to the middle ear in guinea pigs. A comparison of is shown. FIG. 16 shows in vitro release characteristics of otic drugs from 15-18% poloxamer formulation with water as solvent and 50% poloxamer formulation with water + ethanol as solvent upon administration to the middle ear in guinea pigs. A comparison of is shown. FIG. 17 shows the symptom of a 15-18% poloxamer formulation containing water as a solvent and a 50% poloxamer formulation containing water + ethanol as a solvent upon administration to the middle ear in a dry guinea pig. The drug concentration in the middle ear of profloxacin and dexamethasone is shown. FIG. 18 shows the results of 15-18% poloxamer formulation with water as solvent and 50% poloxamer formulation with water + ethanol as solvent upon administration to the middle ear in wet eared guinea pigs. The drug concentration in the middle ear of profloxacin and dexamethasone is shown. FIG. 19 shows the symptom of a 15-18% poloxamer formulation containing water as a solvent and a 50% poloxamer formulation containing water + ethanol as a solvent when administered to the middle ear in a dry guinea pig. The fluid levels in the middle ear of profloxacin and dexamethasone are shown. FIG. 20 is a comparison of release characteristics for the formulations described herein and Ciprodex® Otic solution. FIG. 21 shows the effects of the formulations described herein and Ciprodex® Otic solution on auditory function following intramiddle administration in guinea pigs. Administration of Ciprodex® Otic causes a temporary hearing change of 20-25 dB and improves by day 7. Administration of a formulation containing dexamethasone, ciprofloxacin, 15-18% P407 and water causes a minimal hearing shift (5-10 dB) and resolves by day 7. Administration of a formulation containing dexamethasone, ciprofloxacin, 50% P407 and water + ethanol causes a temporary hearing change of 40-50 dB and disappears by day 3. FIG. 22 shows the middle ear pharmacokinetics following administration in the middle ear of various concentrations of poloxamer containing all 0.5% Cipro and 0.1% DEX. Guinea pigs (n = 4) received one injection (50 μl) in the middle ear. Free drug levels in the middle ear were measured at the times indicated. Data are presented as mean ± SEM. The poloxamer concentrations are: 16% poloxamer (diamond), 17% poloxamer (square), 19% poloxamer (triangle) and 21% poloxamer (circle). FIG. 23 shows the pharmacokinetics of the middle ear following administration in the middle ear of various doses of the P407 formulation. Guinea pigs (n = 4) were injected in the middle ear with either 0.5% Cipro 0.1% DSP (circles) or 1% Cipro 0.1% DSP (squares) ( 50 μl). Free drug levels in the middle ear were measured at the times indicated. Data are presented as mean ± SEM. FIG. 24 shows the pharmacokinetics of the middle ear following administration in the middle ear of various doses of the P407 formulation. Guinea pigs (n = 4) are 0.3% Cipro 0.1% DEX (diamonds), 0.6% Cipro 0.2% DEX (circles), 2% Cipro 0.7% DEX (Triangles) or 6% Cipro 2% DEX (squares) received a single intramiddle injection (50 μl). Free drug levels in the middle ear were measured at the times indicated. Data are presented as mean ± SEM. FIG. 25 shows tissue-bound middle ear drug levels bound to tissue following administration in the middle ear of the P407 formulation. Guinea pigs (n = 4) received a single intramiddle injection (50 μl) of 0.3% Cipro 0.1% DEX. The amount of drug level bound to tissue in the middle ear epithelium was measured at the indicated times. Data are presented as mean ± SEM. Black bars: ciprofloxacin, white bars: dexamethasone. FIG. 26 shows middle ear pharmacokinetics following intra-middle administration of various volume formulations. Guinea pigs (n = 4) received one injection in the middle ear of either 25 μl (circle), 50 μl (square) or 75 μl (triangle) of 0.3% Cipro 0.1% DEX. Drug levels in the middle ear were measured at the indicated times. Data are presented as mean ± SEM. FIG. 27 shows the auditory evaluation of the P407 formulation administered intramitically. Guinea pigs (n = 4) received a single intramiddle dose (50 μl) of 0.2% CiproHCl, 0.2% DEX. Hearing assessment was performed using the auditory brainstem response over frequency. Data are presented as mean + ABR threshold SEM (n = 4). FIGS. 28A-G show hemolysis in guinea pig erythrocytes when exposed to a serially diluted poloxamer solution.

  Local administration of the active agent reduces the toxicity and / or side effects associated with systemic administration. The ability to provide sustained release of an active agent at a local site in the body is such that multiple sustained daily treatment regimens reduce the number of doses, thereby improving patient compliance. Desirable for current treatment modalities that require dosing and / or extended dosing. Provided herein are pharmaceutical formulations of sustained release active agents that gel upon contact with the body. Such formulations are topical at various target sites in the body including, but not limited to, the ear, eye, sinus, digestive tract, oral cavity, intrathecal and / or intracranial cavity, synovial cavity, and the like. Suitable for administration.

  Provided herein are formulations that are made with low biofouling or sterilized by stringent sterility requirements and that are suitable for in vivo administration. In some embodiments, the biocompatible compositions described herein are substantially free of pyrogens and / or microorganisms.

  Current standard therapies, including a schedule to accept multiple injections per day, allow multiple administrations of drops or infusions (eg, injection into the middle ear) over several days (eg, up to 2 weeks). Where necessary, the formulations described herein are administered at reduced dosing times compared to current standard treatments. In certain instances, a reduced number of doses may alleviate the inconvenience caused by multiple infusions in an individual undergoing treatment for a disease, disorder or condition and / or take a patient's medication during long-term therapy Improve compliance. In some embodiments, the formulations described herein are administered locally at the target site to extend the residence time of the active agent at the site of administration.

  Localized administration allows the active agent to reach the target organ (eg, inner ear), reducing or eliminating systemic accumulation of the active agent. In some instances, local administration provides a higher active agent therapeutic index that may otherwise have dose-limiting systemic toxicity. In addition, localized treatment also allows for the use of previously undesired therapeutic agents, including agents with poor pK properties, poor uptake, low systemic release, and / or toxicity issues.

  In some instances, a drawback of liquid formulations is their property of being washed away in physiological media and resulting in rapid clearance of the formulation from the site of administration. Provided herein are formulations comprising a polymer that, in certain embodiments, gels at approximately body temperature and remains in contact with a target surface (eg, round window epithelium) for an extended period of time. The formulations described herein avoid a weakening of the therapeutic effect due to drainage or washing away of the active agent.

  Accordingly, provided herein are pharmaceutical formulations that meet stringent criteria, including pH, ionic balance, and / or sterility. Such formulations are designed to be isotonic with body fluids. In some embodiments, the biocompatible compositions described herein are formulated with minimal excipients, thereby reducing or eliminating irritation or toxicity at the site of administration. Further, the formulation comprises a biocompatible and / or otherwise non-toxic heat sensitive polymer. In some embodiments, the thermosensitive gel is biodegradable and / or bioeliminated (eg, the copolymer is a biodegradable process or bioexhaust process (eg, urine, feces, etc.) Is excreted from the body).

Administration in the ear In some embodiments, the sustained release formulations described herein include, but are not limited to, Meniere's disease, sudden hearing loss, noise hearing loss, age-related hearing loss, dizziness, tinnitus, otosclerosis, self Suitable for administration to the ear for the treatment of ear disorders including immune ear disease (AIED), otitis media, otitis externa, ear infections and the like.

  The inner ear environment is an isolated environment. Endolymph and perilymph are static fluids that are not always in contact with the circulatory system. In certain instances, even trace amounts of pyrogens and / or microorganisms can cause infection and cause physical changes associated with the isolated microenvironment of the inner ear. When the eardrum is complete, the middle ear air is not in direct contact with air outside the body. In certain instances, even trace amounts of pyrogens and / or microorganisms can cause infection and associated physical changes in the isolated microenvironment of the inner ear and / or middle ear. The compositions described herein are sterile compositions suitable for administration to the isolated environment of the middle ear and / or inner ear and provide sustained release of the active agent at the target site.

  In some embodiments, for application to the inner ear, the formulations described herein can be behind the tympanic membrane at or near the round window membrane and / or the ossicular chain, and / or It is administered through the tympanic membrane (eg, as an ear fluid in the ear canal by injection in the middle ear, as a direct perfusion during ear surgery). In some embodiments, the sustained release formulation described herein is injected as a liquid into the tympanic cavity near the round window membrane and gelled and concentrated liquid when in contact with the ear surface. Form.

  In some embodiments, for application to the middle ear, the formulations described herein can be placed behind the ear drum and / or the ear drum so that they do not touch the round window membrane and / or the ossicular chain. (E.g., by infusion in the middle ear, as ear fluid in the ear canal, as direct perfusion during ear surgery). In some embodiments, the sustained release formulations described herein are administered away from the round window membrane in the tympanic cavity. In some embodiments, the formulation is deposited on the wall of the middle ear by injection and gels and forms a concentrated liquid upon contact with the ear surface.

  In other embodiments, the formulation is administered as a paint (eg, the formulation is smeared onto the wall of the tympanic cavity using a cotton swab). In some embodiments, the formulation is sprayed into the middle ear cavity (eg, as the tympanic membrane ruptures) (eg, as a fluid, foam, etc.). In some embodiments, the formulation is administered on the ear wall rather than on the otic bone (eg, small bone). In some embodiments, the compositions described herein are administered within the outer ear (eg, within the ear canal).

  In some embodiments, the formulations described herein are low viscosity liquid compositions suitable for administration as eardrops. After administration, the formulation forms a concentrated liquid and / or gel that is not washed away from the middle ear and / or round window membrane and the presence of body fluids such as middle ear fluid present in individuals suffering from exudative otitis media Even under, provides sustained release of the active agent. As an example, when a formulation comprising a polyoxyethylene and polyoxypropylene copolymer is administered to an individual suffering from exudative otitis media, the formulation is not washed away, but remains in contact with the wall of the middle ear and is free from infection and / or mucus. Prevent further accumulation. In certain other embodiments, the formulation accumulates in the otic bone (eg, as a treatment for otosclerosis).

Administration in Sinus Structures In some embodiments, sustained release formulations described herein include, but are not limited to, sinus polyposis, allergic fungal sinusitis, nasal polyps, sinus cancer, nasopharynx Surgery related to cancer, nasal bleeding, olfactory sensation, respiratory papilloma, papilloma virus-induced tumor (eg, varus papilloma), recurrent respiratory papilloma, sinus surgery (lower turbinate removal) For the treatment of sinusoidal, nasal and / or nasopharyngeal disorders, including later exacerbation of complications, chronic sinusitis, chronic rhinosinusitis, etc. Suitable for intranasal, intranasal and / or intranasal laryngeal administration There.

  In some embodiments, the sustained release formulations described herein can be provided in a sinus cavity and / or a sinus cavity comprising the ethmoid sinus, maxillary sinus, frontal sinus and / or sphenoid sinus, And administered in the vicinity of other anatomical or physiological structures within sinus cavities, such as nasal polyps, turbinates, surgical wound sites, and the like. There are considerable anatomical variations in the cavities in the individual. Current treatment regimens for sinus disease include spray nasal drops and / or nasal lavage for topical drug administration to the sinuses. However, spray nasal drops and / or nasal washes are not effective in delivering solutions to the sinuses and / or sinusoidal cavities. In addition, the solution flows out of the nasal passage. In some other embodiments, the sustained release formulations described herein are administered intranasally and provide sustained release without draining the formulation through the nasal passages to reduce the therapeutic effect. . In yet other embodiments, the sustained release formulations described herein are administered to a region within the nasopharynx.

  In some embodiments, the sustained release formulations described herein are administered in combination with a surgical procedure (eg, in combination with tympanic perforation, sinus polypectomy, balloon rhinoplasty, etc.). In some embodiments, the sustained release formulation described herein is a specific device such as AdvaCoat ™ Rinus Dressing and AdvaCoat ™ Rx for chronic sinusitis (available from Carbylan BioSurgery Inc), Catheter-based devices such as Balloon Sinplasty ™ devices available from Acclarent, or Intersec ENT, Inc. Suitable for use with bioabsorbable drug eluting stents such as stents available from.

  In some embodiments, the formulations described herein are at least about 5.0% and at most about about 5.0% of a heat sensitive polymer (eg, polyoxyethylene-polyoxypropylene triblock copolymer) by weight of the composition. Includes 50%. In some embodiments, the formulations described herein are at least about 5.0% and at most about about 5.0% of a heat sensitive polymer (eg, polyoxyethylene-polyoxypropylene triblock copolymer) by weight of the composition. Includes 40%. In some embodiments, a formulation described herein comprises at least about 10.0% and at most about about 0.0% of a heat sensitive polymer (eg, polyoxyethylene-polyoxypropylene triblock copolymer) by weight of the composition. Includes 35%. In some embodiments, a formulation described herein comprises at least about 10.0% and at most about about 0.0% of a heat sensitive polymer (eg, polyoxyethylene-polyoxypropylene triblock copolymer) by weight of the composition. Includes 30%. In some embodiments, a formulation described herein comprises at least about 10.0% and at most about about 0.0% of a heat sensitive polymer (eg, polyoxyethylene-polyoxypropylene triblock copolymer) by weight of the composition. Includes 25%. In some embodiments, a formulation described herein is at least about 12.0% and at most about about 22.0% of a heat sensitive polymer (eg, polyoxyethylene-polyoxypropylene triblock copolymer) by weight of the composition. Includes 25%. In some embodiments, the formulations described herein are at least about 10% and at most about 20% of a heat sensitive polymer (eg, polyoxyethylene-polyoxypropylene triblock copolymer) by weight of the composition. including. In some embodiments, a formulation described herein is at least about 12% and at most about 20% of a heat sensitive polymer (eg, polyoxyethylene-polyoxypropylene triblock copolymer) by weight of the composition. including. In some of such embodiments, the heat sensitive polymer is a purified polymer. In other embodiments, the heat sensitive polymer is unpurified. In any of the foregoing embodiments, the formulation further comprises a gelling temperature modifier.

  In some embodiments, a formulation described herein is at least about 5% and at most about 20% of a heat sensitive polymer (eg, polyoxyethylene-polyoxypropylene triblock copolymer) by weight of the composition. including. In some embodiments, the formulations described herein are at least about 10% and at most about 20% of a heat sensitive polymer (eg, polyoxyethylene-polyoxypropylene triblock copolymer) by weight of the composition. including. In some embodiments, the formulations described herein are at least about 10% and at most about 18% of a heat sensitive polymer (eg, polyoxyethylene-polyoxypropylene triblock copolymer) by weight of the composition. including. In some embodiments, a formulation described herein is at least about 10% and at most about 16% of a heat sensitive polymer (eg, polyoxyethylene-polyoxypropylene triblock copolymer) by weight of the composition. including. In some embodiments, a formulation described herein is at least about 10% and at most about 15% of a heat sensitive polymer (eg, polyoxyethylene-polyoxypropylene triblock copolymer) by weight of the composition. including. In some embodiments, a formulation described herein is at least about 12% and at most about 14% of a heat sensitive polymer (eg, polyoxyethylene-polyoxypropylene triblock copolymer) by weight of the composition. including. In some embodiments, a formulation described herein is at least about 10% and at most about 13% of a heat sensitive polymer (eg, polyoxyethylene-polyoxypropylene triblock copolymer) by weight of the composition. including. In some embodiments, a formulation described herein is at least about 5% and at most about 15% of a heat sensitive polymer (eg, polyoxyethylene-polyoxypropylene triblock copolymer) by weight of the composition. 16%, 17%, 18%, 19% or 20%. In some of such embodiments, the heat sensitive polymer is a purified polymer. In other embodiments, the heat sensitive polymer is unpurified. In any of the previous embodiments, the formulation further comprises a gelling temperature modifier.

  In some embodiments, the formulations described herein are at least about 5.0%, 10.0%, 10.5%, 11.0%, 11.5% by weight of the composition, 12.0%, 12.5%, 13.0%, 13.5%, 14.0%, 14.5%, 15.0%, 15.5%, 16.0%, 16.5%, 17.0%, 17.5% or 18.0% P407, and at most about 14.5%, 15.0%, 15.5%, 16.0%, 16.5%, 17.0% 17.5%, 18.0%, 18.5%, 19.0%, 20.0%, 21.0%, 25.0%, 30%, 40% or 50% P407.

  In some embodiments, the formulation has a gelling temperature between about 5 ° C. and about 42 ° C., and comprises between about 5% and up to about 50% heat sensitive polymer by weight of the composition. . In some embodiments, the formulation has a gelling temperature between about 14 ° C. and about 42 ° C., and comprises between about 5% and up to about 40% heat sensitive polymer by weight of the composition. . In some embodiments, from about 5% to about 40% heat sensitive polymer by weight of the composition comprises a polyoxyethylene-polyoxypropylene triblock copolymer. In some embodiments, the heat sensitive polymer (eg, polyoxyethylene-polyoxypropylene triblock copolymer) is purified. In some embodiments, the heat sensitive polymer (eg, polyoxyethylene-polyoxypropylene triblock copolymer) is unpurified (eg, P407NF commercially available from BASF). In some embodiments, about 5% to about 40% of the thermosensitive polymer comprises a polyoxyethylene-polyoxypropylene triblock copolymer and the formulation further comprises a gelling temperature modifier. As an example, in certain embodiments, the gelling temperature modifier is selected from, for example, cyclodextrin, PEG, P188, P338, carboxymethylcellulose, hyaluronic acid, Carbopol®, chitosan, and the like.

  In some embodiments of the above formulations, the formulation comprises purified poloxamer. In some embodiments, a formulation comprising a purified poloxamer retains the ability to gel at a temperature between about 14 ° C. and about 42 ° C. while being lower compared to a formulation comprising an unpurified poloxamer Includes poloxamer concentration. By way of example, a micronized dexamethasone formulation comprising between about 10% and about 12% fractionated poloxamer 407 gels at a temperature between about 14 ° C. and about 42 ° C., and about 14 Micronized dexamethasone formulations containing between 5% and about 25% crude poloxamer 407 also gel at temperatures between about 14 ° C and about 42 ° C. Thus, the use of purified poloxamers allows the use of lower amounts of heat sensitive polymers while retaining the gelation temperature and sustained release characteristics of the formulation.

  Thus, within the scope of the embodiments described herein, mainly comprises a heat sensitive polymer comprising polyoxyethylene and a polyoxyethylene copolymer as the main component polymer and a gelling temperature regulator as the minor component, resulting in a formulation Active compositions are contemplated that retain the ability to gel at temperatures between about 14 ° C and about 42 ° C. As an example, a composition comprising about 30% unpurified P407 by weight of the composition and about 3% P188 by weight of the composition gels at about body temperature.

  In some embodiments, the formulations described herein are free or substantially free of additional preservatives that cause irritation and / or toxicity. Additional preservatives do not include trace amounts of antioxidants (eg, butylhydroxytoluene (BHT)) that stabilize the heat sensitive polymers, which are typically provided commercially with heat sensitive polymers. Examples of further preservatives include benzethonium chloride, benzalkonium chloride and thiomersal. In some embodiments, the formulations disclosed herein comprise less than about 50 ppm of each benzethonium chloride, benzalkonium chloride and thiomersal. In some embodiments, the formulations disclosed herein comprise less than about 25 ppm of each benzethonium chloride, benzalkonium chloride, and thiomersal. In some embodiments, the formulations disclosed herein comprise less than about 20 ppm of each benzethonium chloride, benzalkonium chloride, and thiomersal. In some embodiments, the formulations disclosed herein comprise less than about 10 ppm of each benzethonium chloride, benzalkonium chloride, and thiomersal. In some embodiments, the formulations disclosed herein comprise less than about 5 ppm of each benzethonium chloride, benzalkonium chloride, and thiomersal. In some embodiments, the formulations disclosed herein comprise less than about 1 ppm of each benzethonium chloride, benzalkonium chloride, and thiomersal.

  In some embodiments, the formulations described herein are free or substantially free of additional isotonic agents that cause irritation and / or toxicity. Examples of further tonicity agents include propylene glycol. Accordingly, in some embodiments, the formulations described herein are free or substantially free of propylene glycol. In some embodiments, the formulations disclosed herein comprise less than about 50 ppm propylene glycol. In some embodiments, the formulations disclosed herein comprise less than about 25 ppm propylene glycol. In some embodiments, the formulations disclosed herein comprise less than about 20 ppm propylene glycol. In some embodiments, the formulations disclosed herein comprise less than about 10 ppm propylene glycol. In some embodiments, the formulations disclosed herein comprise less than about 5 ppm propylene glycol. In some embodiments, the formulations disclosed herein comprise less than about 1 ppm propylene glycol.

  In some embodiments, the formulations described herein are free or substantially free of additional humectants. An example of a humectant includes glycerin. Accordingly, in some embodiments, the formulations described herein are free or substantially free of glycerin. In some embodiments, the formulations disclosed herein comprise less than about 50 ppm glycerin. In some embodiments, the formulations disclosed herein comprise less than about 25 ppm glycerin. In some embodiments, the formulations disclosed herein comprise less than about 20 ppm glycerin. In some embodiments, the formulations disclosed herein comprise less than about 10 ppm glycerin. In some embodiments, the formulations disclosed herein comprise less than about 5 ppm glycerin. In some embodiments, the formulations disclosed herein comprise less than about 1 ppm glycerin.

  The formulations described herein are substantially free of degradation products of the active agent and / or polymer component. As used herein, “substantially free of degradation products” means that less than 5% by weight of active agent and / or polymer component is degradation product of active agent and / or polymer component. It means that there is. In a further embodiment, the term means that less than 3% by weight of the active agent and / or polymer component is a degradation product of the active agent and / or polymer component. In yet a further embodiment, the term means that less than 2% by weight of the active agent and / or polymer component is a degradation product of the active agent and / or polymer component. In a further embodiment, the term means that less than 1% by weight of the active agent and / or polymer component is a degradation product of the active agent and / or polymer component.

  In some embodiments, the formulations described herein are free or substantially free of additional thickeners. Examples of further thickeners include chitosan or polyethylene glycol (PEG). In some embodiments, the formulations disclosed herein comprise less than about 5% by weight of chitosan. In some embodiments, a formulation disclosed herein comprises less than about 4% by weight of chitosan. In some embodiments, the formulations disclosed herein comprise less than about 3% by weight of chitosan. In some embodiments, a formulation disclosed herein comprises less than about 2% by weight of chitosan. In some embodiments, the formulations disclosed herein comprise less than about 1% by weight of chitosan. In some embodiments, the formulations disclosed herein comprise less than about 0.5% by weight of chitosan.

  In some embodiments, the formulations described herein are free or substantially free of additional mucoadhesives. Examples of further mucoadhesive agents include hyaluronic acid. In some embodiments, the formulations described herein comprise less than about 5% by weight of hyaluronic acid. In some embodiments, the formulations described herein comprise less than about 4% by weight of hyaluronic acid. In some embodiments, the formulations described herein comprise less than about 3% by weight of hyaluronic acid. In some embodiments, the formulations described herein comprise less than about 2% by weight of hyaluronic acid. In some embodiments, the formulations described herein comprise less than about 1% by weight of hyaluronic acid. In some embodiments, the formulations described herein comprise less than about 0.5% by weight of hyaluronic acid.

  In some embodiments, the formulations described herein are free or substantially free of additional common solvents that cause irritation and / or toxicity. Examples of further solvents include ethanol, propylene glycol, DMSO, N-methyl-2-pyrrolidone and cyclohexane. Accordingly, in some embodiments, the formulations described herein are free or substantially free of ethanol, propylene glycol, DMSO, N-methyl-2-pyrrolidone and cyclohexane. In some embodiments, the formulations disclosed herein comprise less than about 50 ppm of each ethanol, propylene glycol, DMSO, N-methyl-2-pyrrolidone and cyclohexane. In some embodiments, the formulations disclosed herein comprise less than about 25 ppm of each ethanol, propylene glycol, DMSO, N-methyl-2-pyrrolidone and cyclohexane. In some embodiments, the formulations disclosed herein comprise less than about 20 ppm of each ethanol, propylene glycol, DMSO, N-methyl-2-pyrrolidone and cyclohexane. In some embodiments, the formulations disclosed herein comprise less than about 10 ppm of each ethanol, propylene glycol, DMSO, N-methyl-2-pyrrolidone and cyclohexane. In some embodiments, the formulations disclosed herein comprise less than about 5 ppm of each ethanol, propylene glycol, DMSO, N-methyl-2-pyrrolidone and cyclohexane. In some embodiments, the formulations disclosed herein comprise less than about 1 ppm of each ethanol, propylene glycol, DMSO, N-methyl-2-pyrrolidone and cyclohexane.

In some embodiments, the formulations described herein are commonly used to sterilize any component of the active formulation and are free or substantially free of additional toxic preservatives. Not included. Examples of further preservatives known to be toxic include acetic acid, iodine and merbromine. In addition, chlorhexidene, a commonly used preservative (which is used to sterilize active formulation ingredients, including devices used to administer the formulation), is in trace concentrations (eg 0.05% ) Is very toxic. Accordingly, in some embodiments, the formulations disclosed herein are free or substantially free of acetic acid, iodine, merbromine and chlorhexidene. In some embodiments, the formulations disclosed herein comprise less than about 50 ppm of each acetic acid, iodine, merbromine and chlorhexidene. In some embodiments, the formulations disclosed herein comprise less than about 25 ppm of each acetic acid, iodine, merbromine, and chlorhexidene. In some embodiments, the formulations disclosed herein comprise less than about 20 ppm of each acetic acid, iodine, merbromine and chlorhexidene. In some embodiments, the formulations disclosed herein comprise less than about 10 ppm of each acetic acid, iodine, merbromine, and chlorhexidene.
In some embodiments, the formulations disclosed herein comprise less than about 5 ppm of each acetic acid, iodine, merbromine and chlorhexidene. In some embodiments, the formulations disclosed herein comprise less than about 1 ppm of each acetic acid, iodine, merbromine and chlorhexidene.

  In addition, certain formulations (eg, formulations for inner ear administration, intraspinal administration) require particularly low concentrations of some potentially common contaminants that are known to be toxic. Other dosage forms attempt to limit the contamination that can be attributed to these compounds, but do not require the strict precautions required by such formulations. For example, in some embodiments, the formulations described herein are free or substantially free of contaminants such as arsenic, lead, mercury and tin. Accordingly, in some embodiments, the formulations disclosed herein are free or substantially free of arsenic, lead, mercury and tin. In some embodiments, the formulations disclosed herein comprise less than about 50 ppm of each arsenic, lead, mercury and tin. In some embodiments, the formulations disclosed herein comprise less than about 25 ppm of each arsenic, lead, mercury and tin. In some embodiments, the formulations disclosed herein comprise less than about 20 ppm of each arsenic, lead, mercury and tin. In some embodiments, the formulations disclosed herein comprise less than about 10 ppm of each arsenic, lead, mercury and tin. In some embodiments, the formulations disclosed herein comprise less than about 5 ppm of each arsenic, lead, mercury and tin. In some embodiments, the formulations disclosed herein comprise less than about 1 ppm of each arsenic, lead, mercury and tin.

Specific Definitions A “thermosensitive polymer” or “thermosetting polymer” is a polymer that undergoes a reversible temperature-dependent phase transition (eg, liquid gel transition, gel liquid transition, etc.). Examples of heat sensitive polymers that form a heat sensitive gel include, but are not limited to, poloxamers (eg, Pluronic F68®, F88®, F108®, F127®, etc.) or Other thermosetting polymers described in 1.

  As used herein, a “purified” heat sensitive polymer is a commercially purchased heat sensitive polymer that is subjected to further steps prior to the preparation of the formulations described herein. Purified heat sensitive polymers have lower polydispersity (ie, narrower molecular weight distribution in individual polymer chains therein) and / or lower ethylene content and compared to commercial samples of the same polymer It has / or less unsaturation and / or weight% oxyethylene values. Purification includes, but is not limited to, fractionation, chromatography, washing, and / or decantation, purification using supercritical fluids (see, eg, US Patent Application Publication No. 2008/0269449, described therein). Disclosure of polymer purification by use of a supercritical fluid is incorporated herein by reference), reverse precipitation (see, eg, US Pat. No. 7,148,320, reverse precipitation described therein) The disclosure of which is incorporated herein by reference), salt extraction and liquid phase separation (see, eg, US Pat. No. 5,800,711, the disclosure of poloxamer purification described therein is incorporated herein by reference). Etc., which are incorporated into the specification, etc. Other processes for polymer purification and / or fractionation are described, for example, in US 6,977,045 and US 6,761,824, the processes described therein being incorporated herein by reference. It is.

  As an example, in some embodiments, the purified poloxamer 407 is a fractionated P407 that has a lower polydispersity index compared to a batch of P407 grade NF commercially purchased from BASF. . As an example, commercially purchased P407 has a polydispersity index of about 1.2. In some embodiments, the polydispersity index of fractionated P407 as described herein is between about 1 and about 1.15. In other embodiments, the polydispersity index of the fractionated P407 described herein is between about 1 and about 1.1. In yet other embodiments, the polydispersity index of the fractionated P407 described herein is between about 1 and about 1.05. As used herein, the calculated polydispersity index (PDI) is the weight average molecular weight (Mw / Mn) divided by the number average molecular weight of the polymer chain. It shows the distribution of individual molecular weights in a batch of polymers.

  “Viscosity that can be infused” refers to a narrow gauge needle with a normal finger pressure (eg, the normal finger pressure that a physician uses on a syringe plunger) as described herein. Viscosity low enough to be a liquid that can be administered (eg, infused) via a cannula or catheter, so that the syringe needle can be placed on the target site (eg, the round window membrane of the inner ear, The pharmaceutical formulation can be delivered accurately and stably in a sinus cavity). Accordingly, in some embodiments, the formulations described herein are dosed via an 18-31 gauge needle or cannula or catheter. In some embodiments, the formulations described herein are dosed via a 20-26 gauge needle or cannula or catheter. In some embodiments, the formulations described herein are administered via a 25-31 gauge needle or cannula or catheter. In some embodiments, the formulations described herein can be infused via a 27-31 gauge needle or cannula or catheter. In some embodiments, the formulations described herein can be infused via a 27 gauge needle or cannula or catheter. In some embodiments, the formulations described herein can be infused via a 29 gauge needle or cannula or catheter. In some embodiments, the formulations described herein are infused via a 31 gauge needle or cannula or catheter.

  “Gelation temperature modifying agents or gel temperature modifying agents” are additives added to any of the formulations described herein, and in some embodiments, the gelation temperature of the formulation. The gelation temperature of the formulation is changed so that is maintained between about 5 ° C and about 42 ° C. In some other embodiments, the gelling temperature modifier is the gelation of the formulation such that in some embodiments the gelation temperature of the formulation is maintained between about 14 ° C. and about 42 ° C. Change the temperature. In some embodiments, the gelling temperature modifier increases the gelling temperature of the formulation as compared to the gelling temperature in the absence of the gelling temperature modifier. In some embodiments, the gelling temperature modifier lowers the gelling temperature of the formulation compared to the gelling temperature in the absence of the gelling temperature modifier.

  The term “effective amount” or “therapeutically effective amount” as used herein is administered as expected to alleviate to some extent one or more symptoms of the disease or condition to be treated. Refers to a sufficient amount of active agent or active agent (eg, active agent, anti-inflammatory agent). For example, the result of administering an active agent disclosed herein is to reduce and / or alleviate signs, symptoms, or causes of tinnitus or balance disorder. For example, an “effective amount” for therapeutic use is an active agent comprising an active agent disclosed herein that is necessary to reduce or ameliorate disease symptoms without causing undue adverse side effects. Amount. The term “therapeutically effective amount” includes, for example, a prophylactically effective amount. An “effective amount” of an active agent disclosed herein is an amount effective to achieve the desired pharmacological effect or therapeutic improvement without causing undue adverse side effects. An “effective amount” or “therapeutically effective amount” is, in some embodiments, the metabolism of a compound administered, the age, weight, general condition of the subject, the disease being treated, the disease being treated. It can be understood that the severity of the disease and the judgment of the attending physician vary depending on the subject. It is also understood that an “effective amount” in a sustained release dosage form may differ from an “effective amount” in an immediate release dosage form based on pharmacokinetics and pharmacology.

  As used herein, the term “active agent” refers to an active agent that treats, reduces or ameliorates the severity of any active disorder described herein. Suitable “active agents” include antimicrobial agents (eg, antibacterial agents (effective against bacteria), antiviral agents (effective against viruses), (effective against fungi) An antifungal agent, an antiprotozoal agent (which has an effect on protozoa), and / or an anthelmintic against any class of microbial parasites), corticosteroids, or any other described herein It can be an active agent. "Active agent". Non-limiting examples that may work by any suitable mechanism include those by anti-inflammatory, anti-microbial agents, toxic agents, cytostatics, immunomodulators, ion channel modulators, anti-angiogenic agents and the like.

  Mean residence time (MRT) is the average time an active agent molecule is in an active structure after administration of a single dose.

  “Prodrug” refers to an active agent that is converted into the parent drug in vivo. In certain embodiments, a prodrug is enzymatically metabolized to a biologically, pharmaceutically or therapeutically active form of the compound by one or more steps or processes. To produce a prodrug, the pharmaceutically active compound is modified so that the active compound is regenerated when administered in vivo. In one embodiment, prodrugs are designed to alter the metabolic stability or migration properties of a drug, eliminate side effects or toxicity, or alter other properties or properties of the drug. The compounds provided herein are derivatized into suitable prodrugs in some embodiments.

  Other objects, features, and advantages of the methods and compositions described herein will become apparent from the detailed description that follows. However, the detailed description of the invention and the specific examples, while indicating specific embodiments, are given for illustration only.

Active Agents Provided herein are active agent compositions and formulations that are suitable for topical administration and provide sustained release of an active agent at a target site.

Antimicrobial Agents In some embodiments, active agents suitable for use in the formulations and methods disclosed herein include antibacterial agents, antifungal agents, antiviral agents, antiprotozoal agents, and / or anthelmintic agents. It is an antimicrobial agent. In some embodiments, the antimicrobial agent is a protein, peptide, antibody, DNA, siRNA, carbohydrate, inorganic molecule or organic molecule. In certain embodiments, the active agent is an antimicrobial small molecule.

Antibacterial agent In some embodiments, the active agent is an antibacterial agent. In some embodiments, the antibacterial agent treats infection by gram positive bacteria. In some embodiments, the antibacterial agent treats infection by gram negative bacteria. In some embodiments, the antimicrobial agent treats infection by mycobacteria. In some embodiments, the antimicrobial agent treats an infection with Giardia.

  In some embodiments, the antimicrobial agent treats the infection by inhibiting bacterial protein synthesis. In some embodiments, the antimicrobial agent treats the infection by disrupting bacterial cell wall synthesis. In some embodiments, the antimicrobial agent treats the infection by altering the permeability of the bacterial cell membrane. In some embodiments, the antimicrobial agent treats the infection by interrupting DNA replication in the bacterium.

  In some embodiments, the antimicrobial agent is an antibiotic. In some embodiments, the antibiotic is an aminoglycoside. Examples of aminoglycoside antibiotics include, but are not limited to amikacin, gentamicin, kanamycin, neomycin, netilmycin, streptomycin, tobramycin, paromycin and the like. In some embodiments, the antibiotic is ansamycin. Examples of ansamycin include, but are not limited to, geldanamycin, herbimycin and the like. In some embodiments, the antibiotic is carbacephem. Examples of carbacephem include, but are not limited to, loracarbeve and the like. In some embodiments, the antibiotic is carbapenem. Examples of carbapenems include, but are not limited to ertapenem, doripenem, imipenem (cilostatin), meropenem, and the like. In some embodiments, the antibiotic is a cephalosporin (eg, a first generation, second generation, third generation, fourth generation, or fifth generation cephalosporin). Examples of cephalosporin include cefaclor, cefamandol, cefotoxin, cefprozil, cefuroxime, cefixime, cefdinir, cefditoren, cefpodoxime, ceftazidime, ceftibutene, ceftizoxime, ceftrixone, cefepime, cefopir Including, but not limited to. In some embodiments, the antibiotic is a glycopeptide. Examples of glycopeptides include, but are not limited to vancomycin and the like. In some embodiments, the antibiotic is a macrolide antibiotic. Examples of macrolides include, but are not limited to, azithromycin, clarithromycin, dirithromycin, erythromycin, roxithromycin, troleandomycin, tethromycin, spectinomycin and the like. In some embodiments, the antibiotic is monobactam. Examples of monobactam include, but are not limited to, aztreonam and the like. In some embodiments, the antibiotic is a β-lactamase inhibitor and / or penicillin. Examples of β-lactamase inhibitors include clavulanic acid and / or penicillin and / or beta-lactam. Examples of penicillin are amoxicillin, ampicillin, azocillin, carbenicillin, cloxacillin, dicloxacillin, flucloxacillin, mezulocillin, methicillin, nafcillin, oxacillin, piperacillin (trademark ent), tikacillin ent )) And the like, but is not limited thereto. In some embodiments, the antibiotic is quinolone. Examples of quinolones are ciprofloxacin, enoxacin, gatifloxacin, levofloxacin, lomefloxacin, moxifloxacin, nonfloxacin, ofloxacin, trovafloxacin, grepafloxacin, sparfloxacin, AL-15469A , AL-38905 and the like. In some embodiments, the antibiotic is a sulfonamide. Examples of sulfonamides include mafenide (afenide), prontodyl, sulfacetamide, sulfamethizole, sulfanilamide, sulfasalazine, sulfisoxazole, trimethoprim, cotrimoxazole, and the like. It is not limited. In some embodiments, the antibiotic is a tetracycline antibiotic. Examples of tetracycline include, but are not limited to, demeclocycline, doxycycline, minocycline, oxytetracycline, tetracycline and the like. In some embodiments, the antibiotic is an oxazolidinone antibiotic. Examples of oxazolidinone antibiotics include but are not limited to linezolid and the like. In some embodiments, the antibiotic is an arsogebanube chloramphenicol, clindamycin, lincomycin, ethambutol, fosfomycin, fusidic acid, furazolidone, isoniazid, linezolid, metronidazole, mupirocin, nitrofurantoin , Platensymycin, pyrazinamide, quinupristin, dalfopristin, rifampicin, thiamphenicol, tinidazole and the like.

  In some embodiments, the antibiotic compatible with the compositions described herein is a broad spectrum antibacterial spectrum antibiotic. In some embodiments, antibiotics compatible with the compositions described herein are effective in treating infections resistant to other classes of antibiotics. For example, in some cases, vancomycin is effective in treating infections caused by methicillin-resistant Staphylococcus aureus.

  In some embodiments, the active antibacterial agent is, as a non-limiting example, by way of non-limiting example: maximin H5, dermicidin, cecropin, andropine, moricin, seratotoxin, melittin, magainin, dermaseptin, bombinin, brevinin-1, Esculentins and buforin II, CAP18, LL37, abaecin, apidaesin, profenin, indolicidin, brevinin, protegrin, tachypressin, defensin, droxomycin, alamethicin, pexiganan or MSI-84, or MSI-84 And other MSI peptides such as MSI-594, polyphemusin, class I, II And bacterocins of III and III such as: colicin, piocin, clevicin, subtilin, epidermin, herbicolin, brevicin, halocin, agrosin, albecicin, carnosine, cerbellocycin (Enterolysin), erwiniocin, glycinecin, lactococin, lacticin, leucoccin, mesentericin, sediocine, sulphocin, acsulfin, plantacin Folobicin), Vibrio thin, Wanerinando (warnerinand), nisin is a peptide or lantibiotics including. In some embodiments, the antibiotic is a polypeptide or peptide. Examples of polypeptide antibiotics include, but are not limited to bacitracin, colistin, polymyxin B, and the like. Examples of peptide antimicrobial agents include, but are not limited to OP-145 (Octoplus).

  In a specific embodiment, the antibiotic used in the formulations described herein is ciprofloxacin (Cipro®). In certain embodiments, the antibiotic used in the formulations described herein is amoxiline. In a specific embodiment, the antibiotic used in the formulations described herein is amoxicillin + clavulanic acid (Augmentin®). In a specific embodiment, the antibiotic used in the formulations described herein is moxifloxacin.

  Local administration of the antimicrobial composition reduces the risk of developing resistance to antibiotics compared to the risk of developing resistance to antibiotics when the antibiotic is administered systemically. The compositions described herein do not require changing the treatment regimen (e.g., in response to progression of antibiotic resistance), e.g., recurrent active diseases, including recurrent ear infections in children or Effective for diseases.

Antiviral agent In some embodiments, the active agent is an antiviral agent. Antiviral agents include, but are not limited to, acyclovir, famciclovir, and valacyclovir. Other antiviral agents are abacavir, acyclovir, adefovir, amantadine, amprenavir, arbidol, atazanavir, atlipla, brivudine, cidofovir, combivir, edoxine, efavirenz, emtricitabine, enfuvirtide, entecvirfod fomvirsen), phosamprenavir, foscarnet, phosphonet, ganciclovir, gardacil, ivacitabine, immunoville, idoxuridine, imiquimod, indinavir, inosine, integrase inhibitor, type III interferon, type II interferon, type I Interferon including interferon, lamivudine, lopinavir, lobilide, MK-0518, ma Biroc, moloxidine, nelfinavir, nevirapine, nexavir, nucleoside analog, oseltamivir, pencyclovir, peramivir, pleconaril, podophyllotoxin, protease inhibitor, reverse transcriptase inhibitor, ribavirin, rimantadine, ritonavir, saquinatevir, stavudine Including tenofovir disoproxil, tipranavir, trifluridine, tridivir, tromantadine, turvada, valganciclovir, bicrivirok, vidarabine, viramidine, zalcitabine, zanamivir, zidovudine, and combinations thereof.

Antifungal Agent In some embodiments, the active agent is an antifungal agent. Antifungal agents include amorolfine, butenafine, naphthifine, terbinafine, flucytosine, fluconazole, itraconazole, ketoconazole, posaconazole, rubconazole, voriconazole, clotrimazole, econazole, miconazole, oxiconazole, cononasol , Nikkomycin Z, Caspofungin, Micafungin, Anidurafungin, Amphotericin B, Liposomal nystatin, Pimaricin, Griseofulvin, Ciclopirox olamine, Haloprozin, Tolnaftate, Undecylenate, Clioquinol, and combinations thereof Including, but not limited to.

  Anthelmintic drugs include amitraz, amoscanate, avermectin, carbadox, diethylcarbamazine, dimethridazole, diminazene, ivermectin, macrophyllariside, malathion, mitaban, oxamuniquine, permethrin, praziquantel, pamocantel plantamate pamoate), selamectin, sodium stibogluconate, thiabendazole, and combinations thereof.

  Antimicrobial agents are also described in U.S. Application Nos. 12 / 427,663, 12 / 466,310, 12 / 472,034, 12 / 486,697, 12 / 493,611, 12th. / 494,156, 12 / 500,486, 12 / 504,553, 12 / 506,091, 12 / 506,127, 12 / 506,573, 12/506 , 616 and 12 / 506,664, including antibacterial agents, antiviral agents, antifungal agents, antiprotozoal agents and / or anthelmintic agents, the disclosure of antimicrobial agents described therein is , Incorporated herein by reference. Although not disclosed herein, antimicrobial agents useful in the sustained release formulations described herein are expressly included within and within the scope of the illustrated embodiments. It is intended to be.

Anti-inflammatory agents Corticosteroids (including agents that act at the glucocorticoid receptor) or other anti-inflammatory steroids are compatible with the formulations disclosed herein. One advantage of using the formulations described herein is that systemic exposure with anti-inflammatory glucocorticoid steroids is significantly reduced.

  In one embodiment, the active pharmaceutical ingredient of the formulations described herein is prednisolone. In another embodiment, the active pharmaceutical ingredient of the formulations described herein is dexamethasone. In a further embodiment, the active pharmaceutical ingredient of the formulations described herein is beclomethasone. In further embodiments, the active pharmaceutical ingredient of the formulations described herein is triamcinolone. In further embodiments, the active pharmaceutical ingredients of the formulations described herein include 21-acetoxypregnenolone and alclomethasone, algestone, amsinonide, beclomethasone, betamethasone, budesonide, chloroprednisone, clobetasol, clobetasone, crocortron, clopredonol, corticostero , Cortisone, cortibazole, deflazacort, desonide, desoxymethazone, dexamethasone, diflorazone, diflucortron, difluprednate, enoxolone, fluazacort, fluchloronide, flumethasone, flunisolide, fluocinolone acetonide, fluocinonide, fluocortinyl, Fluocortron, fluorometholone, fluperolone acetate, fluprednidene acetate, flupredone Ron, fullland lenolide, fluticasone propionate, formocotal, halcinonide, halobetasol propionate, halomethasone, halopredone acetate, hydrocortamate, hydrocortisone, loteprednol etabonate, madipredon, medrizone, meprednisone, methylprednisolone, mometasone furoate, Parameterzone, prednisocarbate, prednisolone, prednisolone 25-diethylamino-acetate, sodium prednisolone phosphate, prednisone, predonivale, prednidene, rimexolone, thixocortol, triamcinolone, triamcinolone acetonide, triamcinolone venetonide, triamcinolone hexatridone Selected from combinations.

  Although not disclosed herein, anti-inflammatory agents useful in the sustained release formulations described herein are clearly included and intended to be within the scope of the illustrated embodiments. Has been.

Bisphosphonates In some embodiments, bisphosphonates are used in the formulations disclosed herein, including for the treatment of otosclerosis. Bisphosphonates are contemplated as modulators of bone remodeling in active capsules (eg in the treatment of otosclerosis). Examples of bisphosphonates are etidronate (DIDRONEL®); clodronate (BONEFOS®), tiludronate (SKELID®), pamidronate (APD, AREDIA®); neridronate; olpadronate; alendronate (FOSFAMAX (registered trademark)), ibandronate (BONIVA (registered trademark)), risedronate (ACTONEL (registered trademark)), zoledronate (ZOMETA (registered trademark)) and the like. In certain embodiments, the bisphosphonate is zoledronate or risedronate.

  The relative potential of bisphosphonates is shown in Table A below:

  Bisphosphonates and / or other bone remodeling agents not described herein but useful in the sustained release formulations described herein are clearly included within the scope of the indicated embodiments. Is intended to be within.

Immunosuppressant <TNF-α modulator>
Contemplated for use with the formulations disclosed herein are active agents that reduce or ameliorate symptoms or effects as a result of autoimmune diseases and / or inflammatory disorders. Accordingly, some embodiments of the methods and compositions described herein comprise an anti-TNF agent for treating sinus and / or otic diseases associated with autoimmune diseases and / or inflammation. Incorporate the use of drugs that block the effects of TNF-α. By way of example only, anti-TNF agents are protein-based therapies such as etanercept (ENBREL®), infliximab (REMICADE®), adalimumab (HUMIRA®) and golimumab (CNTO 148), and Including small molecule therapies, such as TACE inhibitors, IKK inhibitors or calcineurin inhibitors, or combinations thereof. Calcineurin inhibitors are a group of structurally diverse small molecule immunomodulators that function by inhibiting the action of calcineurin. Examples of calcineurin modulators include tacrolimus, pimecrolimus, cyclosporine and the like. IKK inhibitors are yet another structurally diverse group of small molecule immunomodulators, examples of which include, but are not limited to, PC-839, PS-1145, BMS-345541, SC-514, and the like.

  Other immunomodulatory agents suitable for use in the methods and compositions described herein include, but are not limited to:

<TACE inhibitor>
Examples of TACE inhibitors are nitroarginine analog A, GW3333, TMI-1, BMS-561392, DPC-3333, TMI-2, BMS-563394, TMI-005, aprastatat, GW4459, W-3646, IK-682, GI -5402, GI-245402, BB-2983, DPC-A38088, DPH-0667517, R-618, CH-138, and the like, but are not limited thereto.

<Interleukin inhibitor>
Examples of interleukin inhibitors are WS-4 (antibody against IL-8), SB265610 (N- (2-bromophenyl) -N ′-(7-cyano-1H-benzotriazol-4-yl) urea); SB 225002 (N- (2-bromophenyl) -N ′-(2-hydroxy-4-nitrophenyl) urea); SB203580 (4- (4-fluorophenyl) -2- (4-methylsulfinylphenyl) -5- (4-Pyridyl) 1H-imidazole); SB272844 (GlaxoSmithKline); SB517785 (GlaxoSmithKline), SB656933 (GlaxoSmithKline), Sch527123 (2-hydroxy-N, N-dimethyl-3- {2-[[(R) -1- (5-methyl-furan-2 Yl) -propyl] amino] -3,4-dioxo-cyclobut-1-enylamino} -benzamide); PD98059 (2- (2-amino-3-methoxyphenyl) -4H-1-benzopyran-4- ON); reparixin; N- [4-chloro-2-hydroxy-3- (piperazine-l-sulfonyl) phenyl] -N '-(2-chloro-3-fluorophenyl) urea p-toluenesulfonic acid , Basiliximab; cyclosporin A; SDZ RAD (40-O- (2-hydroxyethyl) -rapamycin); FR235222 (Asterlas Pharma); daclizumab; anakinra; AF12198 (Ac-Phe-Glu-Trp-Thr-Pro-Gly-Trp) -Tyr-Gln- - azetidine-2-carbonyl -Tyr-Ala-Leu-Pro-Leu-NH2) including such as, but not limited to.

<Platelet activating factor antagonist>
Platelet activating factor antagonists include caslenone, fomactin G, ginsenoside, apaphant (4- (2-chlorophenyl) -9-methyl-2 [3 (4-morpholinyl) -3-propanol-1-yl [6H- Thieno [3.2-f [[1.2.4] triazolo] 4,3-1]] 1.4] diazepine), A-85783, BN-52063, BN-52021, BN-50730 (tetrahedra). ) -4,7,8,10 methyl-1 (chloro-1phenyl) -6 (methoxy-4phenyl-carbamoyl) -9pyrido [4 ', 3'-4,5] thieno [3,2-f] Triazolo-1,2,4 [4,3-a] diazepine-1,4), BN50739, SM-12502, RP-55778, Ro24- 736, SR27417A, CV-6209, WEB2086, WEB2170,14- deoxy andrographolide, CL184005, CV-3988, TCV-309, PMS-601, TCV-309 including such as but not limited to.

<Toll-like receptor inhibitor>
An example of a Toll-like receptor inhibitor is E5531 ((6-O- {2-deoxy-6-O-methyl-4-O-phosphono-3-O-[(R) -3-Z-dodec). -5-endoyloxydecyl] -2- [3-oxo-tetradecanoylamino] -β-O-phosphono-α-D-glucopyranose tetrasodium salt; E5564 (α-D-glucopyranose) , 3-O-decyl-2-deoxy-6-O- [2-deoxy-3-O-[(3R) -3-methoxydecyl] -6-O-methyl-2-[[(11Z) -1 -Oxo-11-octadecenyl] amino] -4-O-phosphono-β-D-glucopyranosyl] -2-[(1,3-dioxotetradecyl) amino] -1-dihydrogen phosphate), tetra Compound 4a (hydrocinnamoyl-L-valylpyrrolidine; PNAS, June 24, 2003, vol. 100, no. 13, 7971-7976, which is cited for disclosure relating to compound 4a). CPG 52364 (Coley Pharmaceutical Group); LY294002 (2- (4-morpholinyl) -8-phenyl-4H-1-benzopyran-4-one); PD98059 (2- (2-amino) -3-methoxyphenyl) -4H-1-benzopyran-4-one); chloroquine; and the like.

<Progesterone receptor modulator>
An example of a progesterone receptor modulator is RU-486 ((11b, 17b) -11- [4- (dimethylamino) phenyl] -17-hydroxy-17- (1-propynyl) -estradi-4,9-diene-3. CDB-2914 (17α-acetoxy-11β- [4-N, N-dimethylaminophenyl] -19-norpregna-4,9-diene-3,20-dione); CDB-4124 (17α-acetoxy -21-methoxy-11β- [4-N, N-dimethylaminophenyl] -19-norpregna-4,9-diene-3,20-dione); CDB-4453 (17α-acetoxy-21-methoxy-11β-) [4-N-methylaminophenyl] -19-norpregna-4,9-diene-3,20-dione); RTI 3021-02 2 (Research Triangle Institute); ZK 230211 (11- (4-acetylphenyl) -17-hydroxy-17- (1,1,2,2,2-pentafluoroethyl) estradi-4,9-diene-3- ON); ORG31710 (11- (4-dimethylaminophenyl) -6-methyl-4 ′, 5′-dihydro (estradi-4,9-diene-17,2 ′-(3H) -furan) -3-one ORG 33628 (Organon); onapristone (ZK 98299); azoprisnil; ulipristal; anti-progesterone antibody; anti-progesterone receptor antibody and the like.

<Prostaglandin>
Examples of prostaglandins and / or analogs thereof include natural prostaglandins, latanoprost, travoprost, unoprostone, minprostin, prostaglandin analogs such as F2alpha and bimatoprost, SQ29548, JB004 / A, etc. Including, but not limited to.

<Adenosine receptor modulator>
An example of an adenosine receptor modulator is ATL313 (4- (3- (6-amino-9- (5-cyclopropylcarbamoyl-3,4-dihydroxytetrahydrofuran-2-yl) -9H-purin-2-yl) prop -2-Inyl) piperidine-1-carboxylic acid methyl ester); GW328267X ((2R, 3R, 4S, 5R) -2- {6-amino-2-[(1-benzyl-2-hydroxyethyl) amino]- 9H-purin-9-yl-5- (2-ethyl-2H-tetrazol-5-yl) tetrahydrofuran-3,4-diol); CGS 21680 hydrochloride (4- [2-[[6-amino-9- (N-ethyl-bD-ribofuranuronamidosyl) -9H-purin-2-yl] amino] ethyl] benzenepropanoic acid hydrochloride); CV 1808 (2-phenylaminoadenosine); p-DITC-APEC (2- [4- [2- [2-[(4-isothiocyanatophenyl) thiocarbonylamino] ethylaminoarbonyl] ethyl] phenethylamino ( phenethylamino)]-5′-N-ethylcarboxamide adenosine); SDZ WAG994 (N-cyclohexyl-2′-O-methyladenosine); CVT-3146 (ligadenoson; 1- (9- (3,4-dihydroxy-5- (Hydroxymethyl) oxolan-2-yl) -6-aminopurin-2-yl) pyrazol-4-yl) -N-methylcarboxamide); ATL-146e (4- {3- [6-amino-9- ( 5-ethylcarbamoyl-3,4-dihydroxy-tetrahydro-furan-2-yl) 9H-purin-2-yl] -prop-2-ynyl} -cyclohexanecarboxylic acid methyl ester); 5′-n-ethyl-carboxamide adenosine; tecadenosone; CVT-510 (N- (3 (R) -tetrahydrofuranyl) CCPA (2-chloro-N6-cyclopentyladenosine); CPA (N6-cyclopentyladenosine); GR 79236 (N-[((1S, 2S))-2-hydroxycyclopentyl] adenosine) 2′-MeCCPA; PD81723 ((2-amino-4,5-dimethyl-3-thienyl)-[3- (trifluoromethyl) phenyl] methanone); PSB 36 (1-butyl-8- (hexahydro-2) , 5-Methanopentalen-3a (1H) -yl) -3,7-dihydro-3- ( -Hydroxypropyl) -1H-purine-2,6-dione); ribavirin; CHA (N6-cyclohexyladenosine); GW493838 (GSK); (-)-N6- (2-phenylisopropyl) adenosine; GW 664067 (((2R , 3R, 4S, 5R) -5-ethynyl-2- [6-tetrahydro-2H-pyran-4-ylamino) -9H-purin-9-yl] tetrahydrofuran-3,4-diol); CVT-3619 (2 -(6-((2-hydroxycyclopentyl) amino) purin-9-yl) -5-((2-fluorophenylthio) methyl) oxolane-3,4-diol); 2-Cl-IB-MECA (CF102 ; 2-chloro ^-N 6 - (3- iodobenzyl)-5'-N-methyl-carbonitrile moil adenosine); HE ^{ADO; IB-MECA (CF101;} N 6 - (3- iodobenzyl)-5'-N-methyl-carbonitrile moil ^{adenosine); CP-532903 (N 6} (2,5- dichlorobenzyl) -3'-amino-adenosine - CF502 (Can-Fite BioPharmacia); LJ-529 (2-chloro-N (6)-(3-iodobenzyl) -5'-N-methylcarbamoyl-4'-thioadenosine BAA (8-butylaminoadenosine); 6-amino-2-chloropurine riboside; 2-chloroadenosine; NECA (5'-N-ethylcarboxamide adenosine); APNEA (N6-2- (4-aminophenyl) ) Ethyl adenosine, and the like.

  Other immunosuppressive agents are described, for example, in U.S. Application Nos. 12 / 472,034 and 12 / 427,663, which are incorporated herein by reference and are incorporated herein by reference. Contemplated as being within the scope of the embodiments shown.

Cytotoxic and / or chemotherapeutic agents Contemplated for use with the formulations disclosed herein are active agents that reduce or ameliorate symptoms or effects as a result of cell proliferation disorders. Thus, some embodiments of the methods and compositions described herein incorporate the use of cytotoxic agents to treat sinus and / or otic diseases, including but not limited to cancer.

  Examples of cytotoxic agents include methotrexate (RHEUMATTREX®, amethopterin) cyclophosphamide (CYTOXAN®), thalidomide (THALIDOMID®), acridine carboxamide, actimid®, actinomycin, 17-N-allylamino-17-demethoxygeldanamycin, aminopterin, amsacrine, anthracycline, antineoplastic agent, antineoplaston, 5-azacytidine, azathioprine, BL22, bendamustine, vilicodal, bleomycin, bortezomib, bryostatin, Busulfan, caliculin, camptothecin, capecitabine, carboplatin, chlorambucil, cisplatin, cladribine, clofarabine, cytarabine, Carbazine, dasatinib, daunorubicin, decitabine, dichloroacetic acid, discodermolide, docetaxel, doxorubicin, epirubicin, epothilone, eribulin, estramustine, etoposide, exatecan, exislind, feruginol, floxuridine, fludarabine, fluorouracil, fluorouracil Hotemustine, gemcitabine, hydroxyurea, IT-101, idarubicin, ifosfamide, imiquimod, irinotecan, ilofulvene, ixabepilone, ranikidal, lapatinib, lenalidomide, lomustine, raltotecan, mafosfamide, masloprotamine, purine, micloretamine Santron, Neralabine, Nilotinib, Oblime Sen, oxaliplatin, PAC-1, paclitaxel, pemetrexed, pentostatin, pipbroman, pixantrone, pricamycin, procarbazine, proteasome inhibitor (eg bortezomib), raltitrexed, rebeccamycin, revlimid®, rubitecan, SN-38, salinospora A, satraplatin, streptozotocin, swainsonine, tarikidal, taxane, tegafur uracil, temozolomide, test lactone, thio TEPA, thioguanine, topotecan, trabectedin, tretinoin, triplatin tetranitrate, tris (2-chloroethyl) amine, troxacitabine, uracimaster dobin Valrubicin, vinblastine, vincristine, vinorelbine, vorinos Including, but not limited to, tatt, zoskidal and the like.

  Other cytotoxic agents are described, for example, in US application Ser. No. 12 / 493,611, which agents are incorporated herein by reference.

Estrogen Receptor Modulators Contemplated for use with the formulations disclosed herein are active agents that modulate estrogen receptors. Thus, some embodiments of the methods and compositions described herein include, but are not limited to, sinus and / or otic diseases including polyps and / or cancer in the sinus and / or otic structures. Incorporates the use of estrogen receptor modulators to treat. Examples of estrogen receptor modulators are PPT (4,4 ′, 4 ″-(4-propyl- [1H] -pyrazole-1,3,5-triyl) trisphenol); SKF-82958 (6-chloro- 7,8-dihydroxy-3-allyl-1-phenyl-2,3,4,5-tetrahydro-1H-3-benzazepine); estrogen; estradiol; but not limited to, 17-β estradiol, estrone, estriol, synthesis Estradiol derivatives including, but not limited to, estrogenic compositions or combinations thereof. In some embodiments, the ERβ agonist is ERβ-131, phytoestrogens, MK 101 (bioNovo); VG-1010 (bioNovo); DPN (diarylpropiotritrile); ERB-041; WAY-202196 WAY-214156; genistein; estrogen; estradiol.

Growth Factors Contemplated for use with the formulations disclosed herein are agents that modulate epithelial cell growth. Accordingly, some embodiments of the methods and compositions described herein may treat sinus and / or otic diseases associated with abnormal growth in the nasal, sinus and / or nasopharyngeal areas. Incorporates the use of growth factors and / or modulators of growth factors to treat. Examples of growth factors contemplated for incorporation into the compositions described herein include, for example, fibroblast growth factor (FGF), insulin-like growth factor (IGF), epidermal growth factor (EGF), platelet derived growth Factor (PGF), epidermal growth factor (EGF) receptor agonist, hepatocyte growth factor (HGF), transforming growth factor alpha (TGF-α), transforming growth factor beta (TGF-β), vascular endothelial cell proliferation Factor (VEGF) modulator, neurotrophic factor and the like.

Apoptosis Modulators Contemplated for use with the formulations disclosed herein are agents that reduce or ameliorate a disease or effect as a result of apoptosis. Accordingly, some embodiments of the methods and compositions described herein incorporate the use of apoptosis modulators for the treatment of sinus and / or otic diseases associated with abnormal apoptosis. Inhibitors of apoptosis include inhibitors such as MAPK / JNK signaling cascade AKT inhibitors, IKK inhibitors, JAK inhibitors, PI3 kinase inhibitors, NF-κB inhibitors, p38 inhibitors, ERK inhibitors, Src inhibitors related to the apoptotic pathway. Other modulators of the apoptotic pathway include caspase or sirtuin modulators.

<JNK modulator>
In some embodiments, the anti-apoptotic agent is an agent that inhibits (partially or completely) the activity of the MAPK / JNK signaling cascade. In some embodiments, the anti-apoptotic agent is minocycline; SB-203580 (4- (4-fluorophenyl) -2- (4-methylsulfinylphenyl) -5- (4-pyridyl) 1H-imidazole); PD 169316 (4- (4-fluorophenyl) -2- (4-nitrophenyl) -5- (4-pyridyl) -1H-imidazole); SB 202190 (4- (4-fluorophenyl) -2- (4- Hydroxyphenyl) -5- (4-pyridyl) 1H-imidazole); RWJ67657 (4- [4- (4-fluorophenyl) -1- (3-phenylpropyl) -5- (4-pyridinyl) -1H-imidazole) -2-yl)]-3-butyn-1-ol); SB 220025 (5- (2-amino-4-pyri) Jiniru) -4- (4-fluorophenyl) -1- (4-piperidinyl) imidazole); or combinations thereof. In some embodiments, an agent that antagonizes the MAPK / JNK signaling cascade, D-JNKI-1 ((D) hJIP _175-157 -DPro-DPro- (D) _-HIV -TAT _57-48 ), AM- 111 (Auris), SP600125 (anthra [1,9-cd] pyrazol-6 (2H) -one), JNK inhibitor I ((L) (HIV-TAT _48-57- PP-JBD ₂₀ ), JNK inhibitor III ( L) (HIV-TAT _47-57 -Gaba-c-Junδ3357), AS601245 (1,3-benzothiazol-2-yl (2-[[2- (3-pyridinyl) ethyl] amino] -4-pyrimidinyl) acetonitrile, JNK inhibitor _{VI (H 2 N-RPKRPTTLNLF-} NH 2), JN K inhibitor VIII (N- (4-amino-5-cyano-6-ethoxypyridin-2-yl) -2- (2,5-dimethoxyphenyl) acetamide), JNK inhibitor IX (N- (3-cyano-4 , 5,6,7-tetrahydro-1-benzothien-2-yl) -1-naphthamide), dicoumarol (3,3'-methylenebis (4-hydroxycoumarin)), SC-236 (4- [5- (4 -Chlorophenyl) -3- (trifluoromethyl) -1H-pyrazol-1-yl] benzene-sulfonamide), CEP-1347 (Cephalon), CEP-11004 (Cephalon); or combinations thereof. In an embodiment, the anti-apoptotic agent is AM-111 (Auris).

<JAK (Janus Kinase) Modulator>
Contemplated for use with the formulations disclosed herein are active agents that completely or partially inhibit JAK kinase. In some embodiments, the anti-apoptotic agent is VX-680, TG101348, TG101209, INCB018424, XL019, CEP-701, AT9283 or combinations thereof.

<Akt modulator>
In some embodiments, the anti-apoptotic agent is an agent that inhibits (partially or completely) the activity of Akt1. In some embodiments, the anti-apoptotic agent is a growth factor. In some embodiments, the growth factor is EGF.

<PI3 kinase modulator>
In some embodiments, the anti-apoptotic agent is an agent that inhibits (partially or completely) the activity of PI3 kinase. In some embodiments, the anti-apoptotic agent is 740Y-P; SC 3036 (KKHTDDGYMPMSPGVA); PI 3-kinase activator (Santa Cruz Biotechnology, Inc.), wortmannin, wortmannin analog (eg, PX-866). ); Or a combination thereof.

<NF-kB modulator>
Some embodiments incorporate the use of active agents that modulate the NF-kB transcription factor. In particular examples, the agent that modulates the NF-kB transcription factor is an antagonist, half agonist, inverse agonist, neutral or competitive antagonist, allosteric antagonist, and / or orthosteric antagonist of NF-kB. In some embodiments, the NF-kB transcription factor agonist, half agonist, and / or positive allosteric modulator is Pam ₃ Cys ((S)-(2,3-bis (palmitoyloxy)-(2RS) -propyl) -N-palmitoyl- (R) -Cys-S) -Ser (S) -Lys4-OH, trihydrochloride); Act1 (NF-kB activator 1); acetyl-11-keto-b-boswellic acid; andrograph Caffeic acid phenethyl ester (CAPE); gliotoxin; isohelenine; NEMO-binding domain binding peptide (DRQKIKIWFQNRRMKWKKTALDWSWLQTE); NF-kB activation inhibitor (6-amino-4- (4-phenoxyphenylethylamino) quinazoline); F-kB activation inhibitor II (4-methyl-N1- (3-phenylpropyl) benzene-1,2-diamine); NF-kB activation inhibitor III (3-chloro-4-nitro-N- (5- Nitro-2-thiazolyl) -benzamide); NF-kB activation inhibitor IV ((E) -2-fluoro-4'-methoxystilbene); NF-kB activation inhibitor V (5-hydroxy- (2,6-) Diisopropylphenyl) -1H-isoindole-1,3-dione); NF-kB SN50 (AAVALLPAVLLALLAPVQRKRQKLMP); oridonin; parthenolide; PPM-18 (2-benzoylamino-1,4-naphthoquinone); Ro106-9920; sulfasalazine; TIRAP inhibitor peptide (RQIK WFNRRMKWKKLQLRDAAPGGAIVS); Witherin A; Ogonin; BAY11-7082 ((E) 3-[(4-t-butylphenyl) sulfonyl] -2-propenenitrile); Methylphenyl) sulfonyl] -2-propenenitrile); (E) capsaitine; or a combination thereof.

<P38 modulator>
Some embodiments incorporate the use of active agents that modulate p38. In some embodiments, the agent that modulates p38 is a p38 antagonist, half-agonist, inverse agonist, neutral or competitive antagonist, allosteric antagonist, and / or orthosteric antagonist. In some embodiments, the p38 antagonist, semi-agonist, inverse agonist, neutral or competitive antagonist, allosteric antagonist, and / or orthosteric antagonist is ARRY-797 (Array BioPharmacia); SB-220025 (5- (2-amino-4-pyrimidinyl) -4- (4-fluorophenyl) -1- (4-piperidinyl) imidazole); SB-239063 (trans-4- [4- (4-fluorophenyl) -5- ( 2-methoxy-4-pyrimidinyl) -1H-imidazol-1-yl] cyclohexanol); SB-202190 (4- (4-fluorophenyl) -2- (4-hydroxyphenyl) -5- (4-pyridyl) 1H-imidazole); JX- 401 (-[2-methoxy-4- (methylthio) benzoyl] -4- (phenylmethyl) piperidine); PD-169316 (4- (4-fluorophenyl) -2- (4-nitrophenyl) -5- ( 4-pyridyl) -1H-imidazole); SKF-86002 (6- (4-fluorophenyl) -2,3-dihydro-5- (4-pyridinyl) imidazo [2,1-b] thiazole dihydrochloride]; SB -200636 (N- (1-methyl-1H-indol-5-yl) -N'-3-pyridinylurea); CMPD-1 (2'-fluoro-N- (4-hydroxyphenyl)-[1,1 ' -Biphenyl] -4-butanamide); EO-1428 ((2-methylphenyl)-[4-[(2-amino-4-bromophenyl) amino] -2-chloroph SB-253080 (4- [5- (4-fluorophenyl) -2- [4- (methylsulfonyl) phenyl] -1H-imidazol-4-yl] pyridine); SD-169 (1H- Indole-5-carboxamide); SB-203580 (4- (4-fluorophenyl) -2- (4-methylsulfinylphenyl) -5- (4-pyridyl) 1H-imidazole); or a combination thereof.

<Src modulator>
Contemplated for use in the methods and compositions described herein are Src modulators. In some embodiments, an antagonist, semi-agonist, inverse agonist, neutral or competitive antagonist, allosteric antagonist and / or orthosteric antagonist of Src is 1-naphthyl PP1 (1- (1,1-dimethylethyl). ) -3- (1-Naphthalenyl) -1H-pyrazolo [3,4-d] pyrimidin-4-amine); ravendastine A (5-[[(2,5-dihydroxyphenyl) methyl] [(2-hydroxy Phenyl) methyl] amino] 2-hydroxybenzoic acid); MNS (3,4-methylenedioxy-b-nitrostyrene); PP1 (1- (1,1-dimethylethyl) -1- (4-methylphenyl) -1H-pyrazolo [3,4-d] pyrimidin-4-amine); PP2 (3- (4 1- (1,1-dimethylethyl) -1H-pyrazolo [3,4-d] pyrimidin-4-amine); KX1-004 (Kinex); KX1-005 (Kinex); KX1-136 (Kinex) KX1-174 (Kinex); KX1-141 (Kinex); KX2-328 (Kinex); KX1-306 (Kinex); KX1-329 (Kinex); KX2-391 (Kinex); KX2-377 (Kinex) ZD4190 (Astra Zeneca; N- (4-Bromo-2-fluorophenyl) -6-methoxy-7- (2- (1H-1,2,3-triazol-1-yl) ethoxy) quinazolin-4-amine ); AP22408 (Ariad Pharmaceuticals); AP23236 (A iad Pharmaceuticals); AP23451 (Ariad Pharmaceuticals); AP23464 (Ariad Pharmaceuticals); AZD0530 (Astra Zeneca); (4- (2-hydroxy-ethyl) -piperazin-1-yl) -2-methylpyrimidin-4-ylamino) thiazole-5-carboxamide); GN963 (trans-4- (6,7-dimethoxyquinoxalin-2-ylamino) ) Cyclohexanol sulfate); bosutinib (4-((2,4-dichloro-5-methoxyphenyl) amino) -6-methoxy-7- (3- ( 4-methyl-1-piperazinyl) propoxy) -3-quinolinecarbonitrile); or a combination thereof.

<Caspase modulator>
In some embodiments, caspase target antagonists, including but not limited to caspase-8 and / or caspase-9, semi-agonists, inverse agonists, neutral or competitive antagonists, allosteric antagonists, and / or orthosteric antagonists Are suitable for use in the methods and compositions described herein. In some embodiments, the caspase inhibitor is z-VAD-FMK (benzyloxycarbonyl-Val-Ala-Asp (OMe) -fluoromethylketone); z-LEHD-FMK (benzyloxycarbonyl-Leu-Glu (OMe). ) -His-Asp (OMe) -fluoromethylketone); BD-FMK (boc-aspartyl (Ome) -fluoromethylketone); Ac-LEHD-CHO (N-acetyl-Leu-Glu-His-Asp- Ac-IETD-CHO (N-acetyl-Ile-Glu-Thr-Asp-CHO); z-IETD-FMK (benzyloxycarbonyl-Ile-Glu (OMe) -Thr-Asp (OMe) -fluoromethyl) Ketone)); FAM-LEHD-FMK ( Nyloxycarbonyl Leu-Glu-His-Asp-fluoromethylketone); FAM-LETD-FMK (benzyloxycarbonyl Leu-Glu-Thr-Asp-fluoromethylketone); Q-VD-OPH (quinoline-Val-Asp) -CH ₂ -O-Ph); or a combination thereof.

<Sirtuin Modulator Modulator>
Some embodiments incorporate the use of one or more sirtuin antagonists, semi-agonists, inverse agonists, neutral or competitive antagonists, allosteric antagonists, and / or orthosteric antagonists as active agents. In some embodiments, the agonist, semi-agonist, and / or positive allosteric modulator of sirtuin activity is a stilbene, flavone, isoflavone, flavanone, catechin, free radical protecting compound, isonicotinamide, dipyridamole, ZM336372 (3- (dimethyl Amino) -N- [3-[(4-hydroxybenzoyl) -amino] -4-methylphenyl] benzamide), camptothecin, cumestrol, nordihydroguaiaretic acid, esculetin, SRT-1720 (Sirtris), SRT- 1460 (Sirtris), SRT-2183 (Sirtris), resveratrol, picetanol, rapaponin, deoxyrappontin, butein chalcone (eg, chalcone; isorichiriti) Butine; 4,2 ′, 4′-trihydroxychalcone; 3,4,2 ′, 4 ′, 6′-pentahydroxychalcone); morin, fizetin; luteolin; quercetin; kaempferol; apigenin; : Myricetin; 6-hydroxyapigenin; 5-hydroxyflavone; 5,7,3 ′, 4 ′, 5′-pentahydroxyflavone; 3,7,3 ′, 4 ′, 5′-pentahydroxyflavone; 3,3 ', 4'-tetrahydroxyflavone;7,3', 4 ', 5'-tetrahydroxyflavone;3,6,2',4'-tetrahydroxyflavone;7,4'-dihydroxyflavone; 8,3 ′, 4′-tetrahydroxyflavone; 3,6,2 ′, 3′-tetrahydroxyflavone; 4′-hydroxyflavone; Bon; or combinations thereof; 5,4'- dihydroxy flavone; 5,7-dihydroxy flavone.

  Other pro-apoptotic and anti-apoptotic agents are described in US application Ser. No. 12 / 500,486, which agents are hereby incorporated by reference and shown herein. Contemplated as being within the scope of the embodiments.

Antihistamines Contemplated for use with the formulations disclosed herein are agents that reduce or ameliorate symptoms or effects as a result of wheal and redness in the sinus passageways. Thus, some embodiments of the methods and compositions described herein incorporate the use of antihistamines for the treatment of sinus diseases. Examples of antihistamines suitable for the methods and compositions described herein include, but are not limited to, meclizine, diphenhydramine, loratadine, levocetirizine, fexofenadine, quetiapine, mepyramine, piperoxane, antazoline, carbinoxamine, doxylamine, clemastine, Dimenhydrinate, pheniramine, chlorphenamine, chlorpheniramine, dexchlorphenylamine, brompheniramine, triprolidine, cyclidine, chlorcyclidine, hydroxyzine, promethazine, alimemazine, trimeprazine, cyproheptadine, azatazine, ketotifen, oxatomide, meclizine hydrochloride , Bromethazine hydrochloride, hydroxyzine pamoate, chlorperazine and the like.

  Other antihistamines are described in U.S. Application Nos. 12 / 472,034 and 12 / 427,663, which are incorporated herein by reference and practiced herein. Contemplated as being within the scope of the form.

Ion Channel Modulator NMDA Receptor Modulators Contemplated for use with the formulations disclosed herein are abnormal ion channel activity in epithelial cells lining the sinus cavity and / or in ear hair cells. An agent that reduces or ameliorates the resulting symptoms or effects. In some examples, aberrant NMDA receptor activity is associated with an influx of Ca ²⁺ and / or Na ⁺ ions in epithelial cells. Accordingly, some embodiments of the methods and compositions described herein may be used to treat NMDA receptor antagonists or NMDA receptors for the treatment of sinus and / or otic diseases associated with abnormal ion channel activity. Incorporate the use of body agonists. Examples of NMDA receptor antagonists include aminoadamantane, dextromethorphan, dextrorphan, ibogaine, ketamine (including R or S ketamine), nitrous oxide, phencyclidine, riluzole, tiretamine, memantine, neramexane, dizocilpine, Aptiganel, remacemide, 7-chlorocainurenate, DCKA (5,7-dichloroquinurenic acid), kynurenic acid, 1-aminocyclopropanecarboxylic acid (ACPC), AP7, (2-amino) -7-phosphonoheptanoic acid), APV (R-2-amino-5-phosphonopentanoate), CPPene (3-[(R) -2-carboxypiperazin-4-yl] -prop-2-enyl -1-phosphonic acid); (+)- 1S, 2S) -1- (4-hydroxy-phenyl) -2- (4-hydroxy-4-phenylpiperidino) -1-propanol); (1S, 2S) -1- (4-hydroxy-3- (Methoxyphenyl) -2- (4-hydroxy-4-phenylpiperidino) -1-propanol); (3R, 4S) -3- (4- (4-fluorophenyl) -4-hydroxypiperidin-1-yl -)-Chroman-4,7-diol; (1R ^* , 2R ^* )-1- (4-hydroxy-3-methylphenyl) -2- (4- (4-fluorophenyl) -4-hydroxypiperidine-1 -Yl) -propano-1-ol-mesylate); AM-101, L-701324, dextromethorphan, eliprodil, and / or them Including combinations, without limitation.

ENaC Receptor Modulators In some embodiments, the active agent modulates ion channel activity (eg, in the epithelium of the sinuses in ear hair cells) and is a modulator of ENaC channels. Epithelial sodium channels (ENaC, non-neuronal sodium-neuronal 1 (SCNN1) or amiloride-sensitive sodium channel (ASSC)) are permeable to Li ⁺ ions, protons and Na ⁺ ions This is a membrane-bound ion channel. ENaC is located in the apical membrane of polarized epithelial cells and is involved in transepithelial Na ⁺ ion transport. Na ⁺ / K ⁺ -ATPase is also involved in Na ⁺ transport and ion homeostasis. Examples of modulators of ENaC activity include, by way of example, the mineralocorticoid aldosterone, triamterene and amiloride.

Calcium Channel Modulators In some embodiments, the active agent modulates ion channel activity (eg, in nasal epithelium, in ear hair cells) and is an agonist or antagonist of a calcium channel. In some embodiments, the calcium channel antagonist is cinnarizine, flunarizine or nimodipine. Other calcium channel blockers include but are not limited to verapamil, diltiazem, omega-conotoxin, GVIA, amrodin, felodipine, lacidipine, mibefradil, NPPB (5-nitro-2- (3-phenylpropylamino) benzoic acid), flunarizine And / or combinations thereof.

Potassium Channel Modulators In some embodiments, the active agent modulates ion channel activity (eg, in nasal epithelium, in ear hair cells) and is an agonist or antagonist of a potassium channel. In some embodiments, the potassium channel agonist is nicorandil; minoxidil, lebucromacarim; remacalim; cromakalim; L-735,334 (14-hydroxy CAF-603 oleate); retigabine; flupirtine; +)-(5-chloro-2-methoxyphenyl) -1,3-dihydro-3-fluoro-6- (trifluoromethyl) -2H-indol-2-one); DMP-543 (10,10-bis) ((2-fluoro-4-pyridinyl) methyl) -9 (10H) -anthracenone); or a combination thereof.

In some embodiments, the active agent modulates potassium channel activity (eg, in nasal epithelium, in ear hair cells) and is an antagonist of potassium channel (eg, potassium channel blocker). In some embodiments, the potassium channel antagonist is linopyridine; XE991 (10,10-bis (4-pyridinylmethyl) -9 (10H) -anthraceneone); 4-AP (4-aminopyridine);
3,4-DAP (3,4-diaminopyridine); E-4031 (4 ′-[[1- [2- (6-methyl-2-pyridyl) ethyl] -4-piperidinyl] carbonyl] -methanesulfonanilide ); DIDS (4,4′-diisothiocyanostilbene-2,2′-disulfonic acid); Way 123,398 (N-methyl-N- (2- (methyl (1-methyl-1H-benzimidazole ( benzimidazol) -2-yl) amino) ethyl) -4-((methylsulfonyl) amino (benzenesulfonamide HCl); CGS-12066A (7-trifluoromethyl-4- (4-methyl-1-piperazinyl) pyrrolo- [1,2-a] quinoxaline); dofetilide; sotalol; apamin; amiodarone hydrochloride; azimilide; bretylium; Tejisamil; ibutilide; sematilide; nifekalant; or combinations thereof.

Sodium Channel Modulators In some embodiments, the active agent modulates ion channel activity (eg, in nasal epithelium, in ear hair cells) and is an agonist or antagonist of a sodium channel. In some embodiments, the Na ⁺ channel blocker is vinpocetine ((3a, 16a) -ebrunamenin-14-carboxylic acid ethyl ester); cipatrigine (2- (4-methylpiperazin-1-yl) -5- ( 2,3,5-trichlorophenyl) -pyrimidin-4-amine); amiloride (3,5-diamino-N- (aminoiminomethyl) -6-chloropiperazinecarboxamide hydrochloride); carbamazepine (5H-dibenzo [b, f] azepine-5-carboxamide); TTX (octahydro-12- (hydroxymethyl) -2-imino-5,9: 7,10a-dimethano (o-10aH- [1,3] dioxosino [6,5-d ] Pyrimidine-4,7,10,11,12-pentol); RS100632 (1- (2,6 Dimethyl-phenoxy) -2-ethylaminopropane hydrochloride)); mexiletine ((1- (2,6-dimethylphenoxy) -2-aminopropane hydrochloride; QX-314 (N- (2,6-dimethylphenylcarbamoyl)) Methyl) triethylammonium bromide); phenytoin (5,5-diphenylimidazolidine-2,4-dione); lamotrigine (6- (2,3-dichlorophenyl) -1,2,4-triazine-3,5-diamine) 4030W92 (2,4-diamino-5- (2,3-dichlorophenyl) -6-fluoromethylpyrimidine); BW1003C87 (5- (2,3,5-trichlorophenyl) pyrimidine-2,4-1.1 ethane; Sulfonate); QX-222 (2-[(2,6-dimethylpheny ) Amino] -N, N, N-trimethyl-2-oxoethaninium chloride); ambroxol (trans-4-[[(2-amino-3,5-dibromophenyl) methyl] amino] cyclo) Hexanol hydrochloride); R56865 (N- [1- (4- (4-fluorophenoxy) butyl] -4-piperidinyl-N-methyl-2-benzo-thiazolamine); ruberzole; ajumarin ((17R, 21alpha)) -Ajumaran-17,21-diol); procainamide (4-amino (N-no- (2-diethylaminoethyl) benzamide hydrochloride); flecainide; riluzoleor; or combinations thereof.

AMPA Receptor Modulators In some embodiments, the active agent modulates ion channel activity (eg, in the epithelium of the sinuses in ear hair cells) and is an AMPA receptor antagonist. In some embodiments, the agent that antagonizes the AMPA receptor is CNQX (6-cyano-7-nitroquinoxaline-2,3-dione); NBQX (2,3-dihydroxy-6-nitro-7-sulfamoyl- Benzo [f] quinoxaline-2,3-dione); DNQX (6,7-dinitroquinoxaline-2,3-dione); kynurenic acid; 2,3-dihydroxy-6-nitro-7-sulfamoylbenzo- [ f] quinoxaline); or a combination thereof.

Metabotropic glutamate receptor modulators In some embodiments, the active agent modulates ion channel activity (eg, in the epithelium of the sinuses in an ear hair cell) and activates the ion channel by activating a biochemical cascade. Control the opening indirectly. In some of such embodiments, the agent is a modulator of mGlu receptor.

  Examples of agents that are Group II mGlu receptor agonists are LY3899795 ((−)-2-thia-4-aminobicyclo-hexane-4,6-dicarboxylate; LY379268 ((−)-2-oxa-4) -Aminobicyclo-hexane-4,6-dicarboxylate); LY354740 ((+)-2-aminobicyclo-hexane-2,6 dicarboxylate); DCG-IV ((2S, 2'R, 3'R)- 2- (2 ′, 3′-dicarboxycyclopropyl) glycine); 2R, 4R-APDC (2R, 4R-4-aminopyrrolidine-2,4-dicarboxylate), (S) -3C4HPG ((S) -3-carboxy-4-hydroxyphenylglycine); (S) -4C3HPG ((S) -4-carboxy-3-hydroxyphenylglycine) L-CCG-I ((2S, 1 ′S, 2 ′S) -2- (carboxycyclopropyl) glycine); and the like, which are group III type mGlu receptor agonists. Examples of drugs are ACPT-I ((1S, 3R, 4S) -1-aminocyclopentane-1,3,4-tricarboxylic acid); L-AP4 (L-(+) 2-amino-4-phosphonobutyric acid ); (S) -3,4-DCPG ((S) -3,4-dicarboxyphenylglycine); (RS) -3,4-DCPG ((RS) -3,4-dicarboxyphenylglycine); (RS) -4-phosphonophenylglycine ((RS) PPG); AMN082 (, N′-bis (diphenylmethyl) -1,2-ethanediaminedihydrochloride); DCG-IV ((2S, 2′R, 3 R) -2- (2 ′, 3′-dicarboxycyclopropyl) glycine) ;, etc. Other mGlu receptor modulators include 3,5-dimethylpyrrole-2,4-dicarboxylic acid. Acid 2-propyl ester 4- (1,2,2-trimethyl-propyl) ester (3,5-dimethyl PPP); 3,3′-difluorobenzaldazine (DFB), 3,3′-dimletoxybenzaza Rudazine (DMeOB), 3,3'-difluorobenzaldazine (DCB) and other mGluR5 allosteric modulators disclosed in Mol. Pharmacol. 2003, 64, 731-740; (E) -6-methyl-2- (Phenyldiazenyl) pyridin-3-ol (SIB 1757): (E) -2-methyl-6-styrylpyridy (SIB 1893); 2-methyl-6- (phenylethynyl) pyridine (MPEP), (2-methyl-4-((6-methylpyridin-2-yl) ethynyl) thiazole (MTEP); 7- (hydroxyimino ) Cyclopropa [b] chromen-1α-carboxylic acid ethyl ester (CPCCOEt), N-cyclohexyl-3-methylbenzo [d] thiazolo [3,2-a] imidazole-2-carboxamide (YM-298198), tricyclo [3.3.3.1] Nonanylquinoxaline-2-carboxamide (NPS 2390); 6-methoxy-N- (4-methoxyphenyl) quinazolin-4-amine (LY 456239), piracetam, oxiracetam, aniracetam, Pramiracetam, phenylpiracetam (calf) Included in Carphedon), Etiracetam, Levetiracetam, Nefiracetam, Nicoracetam, Loracetam, Nebrasetam, Fasolacetam, Colracetam, Dimiracetam, Brivaracetam, Not included in Seretracetam, Rolipram

TRPV1 Modulators In some embodiments, the active agent modulates ion channel activity (eg, in nasal epithelium, in ear hair cells) and is a TRPV1 agonist or antagonist. In some embodiments, the one or more agonists of the TRPV receptor is capsaicin, resiniferatoxin, or a combination thereof.

  Other ion channel modulators include purine receptor modulators, GABA receptor modulators, and the like. The ion channel modulators described in U.S. Application Nos. 12 / 506,664, 12 / 427,663, and 12 / 494,156 are incorporated herein by reference and are the implementations shown herein. Considered as being within the scope of the form.

Anti-angiogenic drugs,
Contemplated for use with the formulations disclosed herein are agents that are anti-angiogenic agents. In some embodiments, the formulations provided herein allow for sustained release of anti-angiogenesis in the intranasal and / or nasal and / or nasopharyngeal areas. In some embodiments, the anti-angiogenic agent is a modulator of VEGF1 and / or VEGF2 receptor (s). Examples of anti-angiogenic agents suitable for use in the methods described herein include, but are not limited to, bevacizumab, thalidomide, linamide, TNP-470, matrix metalloprotease inhibitors, VEGFR antagonists, and the like.

Immunosuppressive agents Contemplated for use with the formulations disclosed herein are agents that are immunosuppressive agents. In some embodiments, the formulations provided herein allow sustained release of immunosuppressive agents in affected areas for long-term treatment of diseases such as, for example, Wegner granulomatosis .
Further, the intranasal and / or nasal and / or nasopharyngeal formulations described herein are administered at reduced dosage frequency, thereby ensuring patient compliance and long term treatment is indicated. Improve peace of mind. Examples of immunosuppressive agents include, but are not limited to, cyclosporine, 6-MP and methotrexate. In some embodiments, the immunosuppressive agent comprises a glucocorticoid receptor (e.g., without limitation, hydrocortisone, cortisone, prednisone, prednisolone, methylprednisolone, dexamethasone, betamethasone, triamcinolone, beclomethasone, fludrocortisone acetate, aldosterone, etc. Including any glucocorticoid described herein).

RNAi
In some embodiments, RNA interference is utilized when target inhibition or down-regulation is desired (eg, a gene encoding one or more calcineurins, IKK, TACE, TLR or cytokines). In some embodiments, the agent that inhibits or down-regulates the target is a siRNA molecule. In certain instances, siRNA molecules inhibit transcription of a target by RNA interference (RNAi). In some embodiments, double stranded RNA (dsRNA) molecules with sequences complementary to the target are generated (eg, by PCR). In some embodiments, 20-25 bp siRNA molecules with sequences complementary to the target are generated. In some embodiments, a 20-25 bp siRNA molecule has a 2-5 bp overhang on the 3 ′ hydroxyl end of each strand, and a 3 ′ end and a 5 ′ phosphate end.
In some embodiments, the 20-25 bp siRNA molecule has a blunt end. For techniques for generating RNA, see Molecular Cloning:
A Laboratory Manual, second edition (Sambrook et al., 1989) and Molecular Cloning:
A Laboratory Manual, third edition (Sambrook and Russel, 2001) (cited herein jointly as “Sambrook”); Current Protocols in Molecular Biology (F. M. Ausubel, et al. Current Protocols in Nucleic Acid Chemistry John Wiley & Sons, Inc.). , New York, 2000), which are incorporated herein by reference for such disclosure.

  In some embodiments, a dsRNA or siRNA molecule is incorporated into a sustained release formulation described herein and injected into or near the sinus and / or near the ear cavity or structure.

  In certain instances, following administration of a dsRNA or siRNA molecule, cells at the administration location (eg, cells in the sinus pathway, ear hair cells) are transformed with the dsRNA or siRNA molecule. In a specific example following transformation, the dsRNA molecule is cleaved into multiple fragments of about 20-25 bp to give siRNA molecules. In certain instances, the fragment has an approximately 2 bp overhang on the 3 'end of each strand.

  In a particular example, siRNA molecules are split into two strands (guide strand and non-guide strand) by an RNA-induced silencing complex (RISC). In a particular example, the guide strand is incorporated into the catalytic component (ie Argonaute) of RISC. In certain instances, the guide strand binds to a complementary target mRNA sequence. In certain instances, RISC cleaves the target mRNA. In certain instances, target gene expression is down-regulated.

  In some embodiments, a sequence complementary to the target is bound to the vector. In some embodiments, the sequence is placed between two promoters. In some embodiments, the promoter is positioned in the opposite direction. In some embodiments, the vector communicates with the cell. In some examples, the cells are transformed with the vector. In some examples following transformation, the sense and non-sense strands of the sequence are generated. In certain instances, the sense and non-sense strands are hybridized to form a dsRNA molecule that is cleaved into siRNA molecules. In certain instances, the strands are hybridized to form siRNA molecules. In some embodiments, the vector is a plasmid (eg, pSUPER; pSUPER.neo; pSUPER.neo + gfp).

  In some embodiments, the vector is incorporated into a sustained release microsphere or microparticle, hydrogel, liposome, or thermoreversible gel.

Other Agents In some embodiments, agents suitable for use in the formulations described herein are epithelial cells lining the sinuses and / or nasal passages and / or the interior of ear hair cells. Containing agents that modulate the activity of Examples of agents that modulate epithelial cell activity include, but are not limited to, modulators of the PTEN pathway; modulators of PPARs; modulators of EGFR; growth factors including but not limited to TGFbeta, and fibroblast growth factors; and / or Contains modulators of epithelial cell adhesion.

In some embodiments, agents suitable for use in the formulations described herein include agents that modulate the synthesis and / or activity of keratin (eg, actinomycin D, vitamin A, etc.). In some embodiments, agents suitable for use in the intranasal formulations described herein include agents that modulate eosinophils and / or inflammatory cytokines. Examples of agents that modulate the activity of eosinophils and / or inflammatory cytokines include, but are not limited to, leukotriene blockers (eg, montelukast, Singulair®), prostaglandin D ₂ receptor (PGD2 ) Modulators, lysophosphatidic acid receptor (LPA) modulators, 5-lipoxygenase activating protein (FLAP) modulators, CRTH2 (DP2) modulators and the like. In some embodiments, agents suitable for use in the intranasal formulations described herein are cadherins (eg, trichostatin A, ADH1 (Molecular and Cellular Neuroscience, 28, 2005, 253-263). ), An antibody sc-59778, etc.).

  In some embodiments, the active agent compatible with the formulations described herein comprises a neurotoxin for the treatment of active neurological disorders. Such neurotoxins include, but are not limited to, botulinum toxin type A (Botox®), erabutoxin, tetrodotoxin, batracotoxin, morotoxin, aditoxin, caribodotoxin, margatoxin, slototoxin, slatatoxin, heftoxin, calciceptin Venom, channel drugs and / or neurologic drugs, including tycatoxin, calcycludin, PhTx3, etc.). In some embodiments, active agents compatible with the formulations described herein include vascular and / or vestibular response inhibitors. Examples of vestibular response inhibitors include, but are not limited to, meclizine, amytriptyline; dropperidol and other vascular and / or vestibular response inhibitors described in US application Ser. No. 12 / 486,697. The vascular and / or vestibular response inhibitors described in 1 are incorporated herein by reference. In some embodiments, an active agent compatible with the formulations described herein comprises an agent that modulates regrowth of damaged ear sensory hair cells. In some instances, modulation of the WNT pathway promotes morphogenesis and / or regrowth of damaged ear sensory hair cells. WNT signaling protein is encoded by WNT1, WNT2, WNT2B, WNT3, WNT3A, WNT4, WNT5A, WNT5B, WNT6, WNT7A, WNT7B, WNT8A, WNT8B, WNT9A, WNT9B, WNT10A, WNT10B, WNT11 or WNT16 Contains protein products. Modulators of the WNT pathway include, but are not limited to, 2-amino-4- [3,4- (methylenedioxy) benzyl-amino] -6- (3-methoxyphenyl) pyrimidine, the signaling molecule Kerberos.

  Other active agents compatible with the formulations described herein include, but are not limited to, U.S. Application Nos. 12 / 427,663, 12 / 466,310, 12 / 472,034, 12 / 486,697, 12 / 493,611, 12 / 494,156, 12 / 500,486, 12 / 504,553, 12 / 506,091, 12/506 , 127, 12 / 506,573, 12 / 506,616 and 12 / 506,664, the disclosure of the active agents described therein is incorporated herein by reference. Incorporated in the description.

Combination Therapy Antimicrobial Agents and Anti-inflammatory Agents Compositions comprising antimicrobial agents in combination with anti-inflammatory agents are contemplated within the scope of the embodiments set forth herein. In specific embodiments, the formulations described herein comprise an antimicrobial agent (eg, any antimicrobial agent described herein) in combination with an anti-inflammatory agent (eg, any anti-inflammatory agent described herein). )including. In certain embodiments, the formulations described herein comprise an antibiotic (eg, any antibiotic described herein) in combination with a corticosteroid.

  In some embodiments, the composition comprising an antibiotic and a corticosteroid has different release characteristics for each of the active agents. In other embodiments, a composition comprising an antibiotic and a corticosteroid drug has approximately similar release characteristics for each of the active drugs.

  In certain embodiments, the formulations described herein comprise an antibiotic in combination with dexamethasone. In certain embodiments, the formulations described herein comprise methylprednisolone or an antibiotic in combination with prednisolone. In certain embodiments, the formulations described herein comprise ciprofloxacin in combination with dexamethasone. In certain embodiments, the formulations described herein comprise ciprofloxacin in combination with methylprednisolone or prednisolone or triamcinolone.

  In some embodiments, a composition comprising an antibiotic and a corticosteroid comprises one or both agents as multiparticulates (eg, micronized active agent). As an example, in some embodiments, a composition comprising water-soluble dexamethasone and low water-soluble multiparticulate form of ciprofloxacin provides a sustained release of dexamethasone for at least 3 days and at least 10 days Provides sustained release of ciprofloxacin. As an example, in some embodiments, a composition comprising a low water-soluble dexamethasone multiparticulate form (eg, micronized particles) and a water-soluble form of ciprofloxacin for at least 3 days. Providing sustained release of profloxacin and providing sustained release of dexamethasone for at least 10 days. As an example, in some embodiments, low water-soluble forms of dexamethasone multiparticulates (eg, micron-sized particles, nanoparticles, non-sized particles), and low water solubility Compositions comprising multiparticulates in the form of ciprofloxacin (eg, micron-sized particles, nanoparticles, non-constant particles) provide sustained release of each active agent for at least 7 days.

  Other active agents suitable for combination therapy include, but are not limited to, U.S. Application Nos. 12 / 427,663, 12 / 466,310, 12 / 472,034, 12 / 486,697, 12 / 493,611, 12 / 494,156, 12 / 500,486, 12 / 504,553, 12 / 506,091, 12 / 506,127, 12 / 506,573, 12 / 506,616 and 12 / 506,664, which are incorporated herein by reference.

Imaging Device In some embodiments, any of the formulations described herein are used in combination with a mechanical device or imaging device that monitors or examines the disease being treated. For example, a magnetic resonance imaging (MRI) apparatus is envisioned to be within the scope of embodiments described herein, where an MRI device (eg, a 3 Tesla MRI device) is used to assess disease progression. And subsequent treatment with the pharmaceutical formulations disclosed herein can be evaluated. In some embodiments, the formulations described herein include gadolinium-based dyes, iodine-based dyes, barium-based dyes, etc., and are used in the treatment of any active disorder described herein. And / or with any mechanical or imaging device or method described herein (eg, a CAT scan). Such formulations allow visualization of disease progression and / or formulation penetration (eg, penetration of the formulation across the round window membrane and / or effectiveness of treatment). In certain embodiments, three-dimensional real inversion recovery (3D-real IR) and / or three-dimensional flare (3D-FLAIR) magnetic resonance imaging (MRI), and / or disease A contrast agent (eg, gadolinium water) in combination with any of the formulations described herein for assessing the severity of (eg, nasal polyp size), formulation penetration at the site of administration, and / or the therapeutic effect of the formulation Japanese injection) is used. In some instances, the formulation herein facilitates delivery of a sufficient amount of contrast agent to the site of treatment, allowing for disease progression and / or formulation penetration and / or visualization of the therapeutic effect of the formulation. To.

  In some embodiments, the compositions described herein include a dye to help enhance visualization of the penetration of the formulation into the target site of administration and / or treatment. In some such embodiments, dyes that are compatible with the compositions described herein include, but are not limited to, Evans Blue, Methylene Blue, Isosulfan Blue, Trypan Blue, Indocyanine Green, and the like.

Surgery and transplantation In some embodiments, a pharmaceutical formulation described herein is combined with a transplant (eg, a cochlear implant) (eg, its transplant, its short-term use, its long-term use, or its removal) Used. As used herein, an implant includes a medical device, examples of which include a cochlear implant, hearing-imparting device, hearing-improving device, short electrode, tympanic tube, microprosthesis or piston-like prosthesis; needle; stem cell Implantation; drug delivery devices; any cell-based therapy; drug delivery stents; catheters, Baron nasal surgery;

  In some embodiments, administration of a pharmaceutical formulation described herein in combination with surgery is accompanied by incidental damage (eg, irritation, inflammation) caused by external active intervention (eg, placement of an external device or surgery). And / or delaying or preventing infection). In some embodiments, administration of a pharmaceutical formulation described herein in combination with active intervention may result in post-surgical and / or post-transplant complications (eg, inflammation, cell damage, infection, osteogenesis). ) Etc.) is reduced or eliminated. In some examples, perfusion of the surgical area with the formulations described herein shortens recovery time after surgery or post-transplant. In one embodiment, the formulations described herein, and the mode of administration thereof, are administered directly at the site of surgery, during surgery, before surgery, or after surgery, or a combination thereof. Applicable to the flow method. In a specific embodiment, a formulation described herein comprising an antimicrobial agent (eg, an antibiotic such as ciprofloxacin) or an anti-inflammatory agent (eg, a corticosteroid such as dexamethasone, triamcinolone), or a combination thereof Is administered in combination with surgery (eg ear surgery for cholesteatoma or otitis media).

Sterilization Embodiments disclosed herein include means and processes for sterilizing the pharmaceutical formulations disclosed herein for use in humans. The goal is to obtain safe pharmaceuticals that are relatively free of microorganisms that cause infection. The US Food and Drug Administration is available at http: // www. fda. gov / cder / guidance / 5882fnl. Regulatory guidance is provided in the publication available at http: // guidanceforindustry: SterileDrugProductsProductedbyAbstractProcessing, which is incorporated herein by reference in its entirety.

  As used herein, sterilization means a process used to destroy or remove microorganisms and / or pyrogens present in a product or package. Methods that can be used to inactivate microorganisms include, but are not limited to, applying intense heat, applying lethal chemicals, or gamma radiation.

  Dry heat sterilization methods include the use of a saturated steam autoclave at a temperature of at least 121 ° C, or dry heat sterilization (eg, about 3-11 hours at an internal powder temperature of 130-140 ° C, or an internal temperature of 150-180 ° C. And heating the dried powder for 1-2 hours). Filter sterilization is a method used to remove microorganisms from a solution.

  In some embodiments, the formulation is subjected to final sterilization. In other words, the autoclaved formulation includes the active agent and all excipients. In other embodiments, all excipients are subjected to dry heat sterilization and the active agent is sterilized separately; thereafter, the active agent and excipient are aseptically mixed. In still other embodiments, the active agent is sterilized separately (eg, dry heat sterilization, irradiation sterilization, steam sterilization) and other excipients are sterile filtered; then sterile active agent and sterile filtration The resulting solution is mixed aseptically. In a further embodiment, a sterile suspension of the active agent in a solution comprising a thermosetting polymer is aseptically mixed with a second solution comprising a thermosetting polymer and optionally a second active agent.

  In some examples, conventional sterilization methods (e.g., heat treatment (e.g., in an autoclave), gamma radiation, filtration) may result in polymer components (e.g., thermosetting polymer components) in the formulation, and / or Or the active agent degrades irreversibly. In some instances, sterilization of a pharmaceutical formulation by filtration through a membrane (eg, a 0.2 μm membrane) is not possible if the formulation has a thixotropic polymer.

  Accordingly, provided herein are methods for sterilizing pharmaceutical formulations that prevent degradation of the polymer components and / or active agent during the sterilization process. In some embodiments, the use of a suitable thermosetting polymer in combination with a specific buffer and / or pH region for the formulation results in little degradation of the therapeutic agent and / or polymer excipient. High temperature final sterilization of the formulation described in the document becomes possible.

Any suitable buffer is used, depending on the active agent used in the formulation. In some examples, the TRIS pK _a decreases by about −0.03 / ° C. as the temperature increases, and the PBS pK _a increases by about 0.003 / ° C. as the temperature increases. Autoclaving at 121 degrees Celsius) causes a significant downward pH shift (ie, becomes more acidic) in TRIS buffer, while the pH shift is relatively insignificant in PBS buffer. Thus, hydrolysis and / or degradation of the active agent is much greater in TRIS than in PBS. The degradation of the active agent and / or polymer component is reduced by using an appropriate combination of buffer and thermosensitive polymer concentrations.

  In certain embodiments, any sustained release formulation described herein is less than about 100 colony forming units, less than about 60 colony forming units, less than about 50 colony forming units, less than about 40 colony forming units per gram of formulation. Or having a microbial factor of less than about 30 colony forming units. The sterile formulation described herein is substantially free of microorganisms.

  A further aspect of the sterilization process is to remove by-products that result from killing the microorganisms. Such pyrogens are removed from the sample by a pyrogen removal process. Because of the wide variety of endotoxin molecular sizes, the presence of endotoxin is expressed in “endotoxin units” (EU). 1 EU Equivalent to 100 picograms of E. coli LPS. Humans may produce a response of only 5 EU / kg body weight. In certain embodiments, an active composition described herein has a lower endotoxin level (eg, test subject) compared to a conventional acceptable endotoxin level (eg, 5 EU / kg subject body weight). For body weight, <5 EU / subject body weight 1 kg, <4 EU / subject body weight 1 kg). In certain embodiments, the compositions described herein are substantially free of pyrogens.

pH and Actual Osmotic Concentration In some embodiments, the pharmaceutical formulations disclosed herein are compatible with bodily fluids (eg, endolymph and / or perilymph in the inner ear environment, intrathecal cerebrospinal fluid, etc.) Formulated to provide a sexual ion balance.

  As used herein, “actual osmolarity (volume osmolarity / molar osmolarity)” or “deliverable osmolarity (volume osmolarity / molar osmolarity) "Pressure concentration)" refers to the osmolarity (volume osmolarity / weight of active agent) and all excipients excluding gelling agents and / or polymeric agents (eg, polyoxyethylene-polyoxypropylene copolymers, etc.) It means the osmolality of the formulation (volume osmolality / wt osmolality) as determined by measuring osmolarity. The actual osmolarity of the formulations disclosed herein can be determined by any suitable method, such as Viegas et. al. , Int. J. et al. Pharm. , 1998, 160, 157-162. In some examples, the actual osmolarity of the formulations disclosed herein can be determined by vapor pressure osmometry (eg, vapor pressure drop method), which can determine the osmolarity of the formulation at higher temperatures. ). In some examples, the vapor pressure drop method allows measurement of the osmolarity of a formulation comprising a heat sensitive polymer at higher temperatures, such as the gelation temperature of the heat sensitive polymer.

  In some embodiments, the osmotic pressure of the target site of action (eg, perilymph of the inner ear, spinal fluid, sinus fluid, etc.) is the actual osmotic pressure of the formulations described herein (ie, positive in the ear). This is almost the same as the osmotic pressure of the substance that crosses or penetrates the round window membrane.

  The actual osmotic pressure of the otic formulations disclosed herein is about 100 mOsm / kg to about 1000 mOsm / kg, about 200 mOsm / kg to about 800 mOsm / kg, about 250 mOsm / kg to about 500 mOsm / kg, or about 250 mOsm / kg. kg to about 320 mOsm / kg, or about 250 mOsm / kg to about 350 mOsm / kg, or about 280 mOsm / kg to about 320 mOsm / kg. In some embodiments, the formulations described herein have about 100 mOsm / L to about 1000 mOsm / L, about 200 mOsm / L to about 800 mOsm / L, about 250 mOsm / L to about 500 mOsm / L, about 250 mOsm / L. It has an actual osmolarity of about 350 mOsm / L, about 250 mOsm / L to about 320 mOsm / L, or about 280 mOsm / L to about 320 mOsm / L. In some embodiments, the actual osmolarity is inferred as an additive combination of the osmolarity of the buffer and the osmolarity of the gelled poloxamer supernatant in water.

  In a specific embodiment, the actual osmolarity of the formulations described herein is measured in a cell-based assay. The osmolality seen by red blood cells isolated from guinea pigs was measured as a function of the hemolytic index. RBCs were placed in poloxamer solutions with varying concentrations. 0.5 mL of 10% guinea pig erythrocytes in saline was added to 2.5 mL of poloxamer 407 solution in buffer. The resulting suspension was serially diluted and the hemolytic index of RBC was recorded for each solution. The hemolytic index is defined as the ratio of the absorbance of the sample at 540 nm to the absorbance of 0.9% saline at 540 nm. A hemolytic index of 1 indicates that the “actual osmolarity” seen by RBC is suitable for inner ear administration. RBCs are intact in the medium at the appropriate actual osmolality (FIG. 28). The osmolality of the poloxamer solution was also measured by the freezing point depression method or the vapor pressure method. The actual osmolarity of the formulation is measured using a commercially available osmometer and the value is confirmed by hemolysis assay.

  Table 10 shows a comparison of osmolality as measured by serial dilution cell-based assay and direct measurement using freezing point depression or vapor pressure methods. The serial dilution method predicts the actual osmolarity that is compatible with the inner ear environment.

  In some embodiments, useful formulations also include one or more pH adjusters or buffers. Suitable pH adjusting or buffering agents include, but are not limited to, acetate, bicarbonate, ammonium chloride, citrate, phosphate, pharmaceutically acceptable salts thereof, and combinations or mixtures thereof. It is not limited. In certain embodiments of the present disclosure, the amount of buffer included in the gel formulation is such that the pH of the gel formulation does not affect the natural buffer system in the body and / or the osmotic pressure of body fluids. In some embodiments, the pH of the formulations described herein is about 3.0, 3.5, 4.0, 4.5, 5.0, 5.5, 6.0, 6.5. Or 7.0 and about 7.0, 7.5, 8.0, 8.5, 9.0, 9.5, 10.0, 10.5, 11.0, 11.5 or 12.0 Between. In some embodiments, the pH of the formulations described herein is between about 3.0 and about 12.0. In some embodiments, the pH of the formulations described herein is between about 4.5 and about 10.0. In some embodiments, the pH of the formulations described herein is between about 3.5 and about 8.5. In some embodiments, the pH of the formulations described herein is between about 5.5 and about 8.0. In some embodiments, the pH of the formulations described herein is between about 6.5 and about 8.0. In some embodiments, the pH of the formulations described herein is between about 7.0 and about 7.8. In some embodiments, the pH of the formulations described herein is between about 7.0 and about 7.6. In some embodiments, the pH of the formulations described herein is between about 7.0 and about 7.4. In some embodiments, the pH of the formulations described herein is between about 7.4 and about 7.8.

  In some embodiments, the formulations described herein have a pH and / or actual osmolarity as described herein, between about 1 μM and about 10 μM, between about 1 mM and about 1 mM. Having an active pharmaceutical ingredient at a concentration between 100 mM, between about 0.1 mM and about 100 mM, between about 0.1 mM and about 100 nM. In some embodiments, a formulation described herein has a pH and / or actual osmotic pressure as described herein, and is about 0.01% by weight of the active ingredient in the formulation. -About 40%, about 0.01%-about 20%, about 0.01%-about 10%, about 0.01-about 7.5%, about 0.01%- Between about 6%, between about 0.01% and about 5%, between about 0.1% and about 40%, between about 0.1% and about 30%, between about 0.1% and about 20 %, About 0.1% to about 10%, or about 0.1% to about 6% of the active pharmaceutical ingredient. In some embodiments, a formulation described herein has a pH and / or actual osmolarity as described herein, and is about 1% by weight of the active ingredient in the formulation. Between about 40%, between about 5% and about 40%, between about 10% and about 40%, between about 15 and about 40%, between about 10% and about 30%, about 10%; Having an active pharmaceutical agent at a concentration between about 20%, between about 15% and about 25%, or between about 20% and about 30%. In some embodiments, a formulation described herein has a pH and / or actual osmolarity as described herein, and is about 1 μg / in volume of active agent in the formulation. between about mL and about 500 μg / mL, between about 1 μg / mL and about 250 μg / mL, between about 1 μg / mL and about 100 μg / mL, between about 1 μg / mL and about 50 μg / mL, or about 1 μg / mL Active pharmaceutical ingredient at a concentration between ˜about 20 μg / mL.

Adjustable release characteristics Particle size For any formulation described herein, to increase surface area and / or to adjust the dissolution characteristics of the formulation, and / or consistent mean particle size distribution (PSD) In order to maintain (eg, micrometer sized particles, nanometer sized particles, etc.), size reduction is used. In some embodiments, any formulation described herein comprises multiparticulate, i.e., multiple particle sizes (e.g., micronized particles, nano-sized particles, non-constant particles, That is, the formulation is a multiparticulate formulation. In some embodiments, any formulation described herein comprises one or more multiparticulate (eg, micronized) therapeutic agent. In some embodiments, any formulation described herein comprises a micronized therapeutic agent. Micronization is a process of reducing the average diameter of solid material particles. In some embodiments, the average diameter of the particles in the micronized solid is from about 0.5 μm to about 500 μm. In some embodiments, the average diameter of the particles in the micronized solid is from about 1 μm to about 200 μm. In some embodiments, the average diameter of the particles in the micronized solid is from about 2 μm to about 100 μm. In some embodiments, the average diameter of the particles in the micronized solid is from about 3 μm to about 50 μm. In some embodiments, the use of multiparticulates of the active agent allows sustained release of the active agent from any formulation described herein and compared to formulations comprising non-multiparticulate or water soluble active agents and / Or sustained release is possible.

  In a specific embodiment, when a sustained release pharmaceutical formulation comprising a micronized active agent is administered to an individual in need thereof, the micronized active agent particles are present after the gel is eroded. Even serve as a depot for further sustained release of the active agent. In some of such embodiments, the micronized particles remain attached to the active surface. Accordingly, in some embodiments, sustained release pharmaceutical formulations suitable for the methods described herein comprise a substantially high concentration of micronized active agent. In some of such embodiments, the sustained release pharmaceutical formulation is a suspension containing the micronized active agent.

  In some examples, any particles in any formulation described herein are coated or uncoated particles (eg, coated micronized particles, nanoparticles) and / or Microspheres and / or liposome particles. Examples of techniques for reducing the particle size include grinding, milling (for example, milling by air friction (milling by jet mill), milling by ball mill), coacervation, complex coacervation, high-pressure homogenization method, spray drying And / or crystallization with a supercritical fluid. In some examples, the particles are sized by mechanical impact (eg, by hammer mill, ball mill and / or pin mill). In some examples, the particles are sized by fluid energy (eg, by a spiral jet mill, loop jet mill, and / or fluid bed jet mill).

  In some embodiments, the formulations described herein include crystalline particles and / or isotropic particles. In some embodiments, the formulations described herein include amorphous particles and / or anisotropic particles. In some embodiments, the formulations described herein comprise therapeutic agent particles wherein the therapeutic agent is a free base or salt of a therapeutic agent, or a prodrug, or any combination thereof.

  As shown in FIG. 2, a composition comprising a multiparticulate (eg, micronized) active agent has a longer duration compared to a composition comprising a nonparticulate and / or water soluble active agent. Provides sustained release over. In some instances, the multiparticulate and / or less water-soluble active agent provides a stable supply (eg, +/− 20%) of the active agent by slow degradation and as a depot for the active agent Useful; such storage effects increase the residence time of the active agent in the ear. In certain embodiments, selection of the appropriate particle size and solubility (which is water) of an active agent (eg, micronized active agent) in combination with the amount of heat sensitive polymer component in the composition can be hours, days Providing an adjustable sustained release profile that allows for release of the active agent over a period of weeks or months.

Solubility The release characteristics of the active agent from the formulations described herein are adjusted by altering the solubility of the active agent in biological and / or aqueous media. One approach to extending the release of the active agent is to make the soluble active agent insoluble. The solubility of the drug in biological and / or body fluids is altered by the selection of a pharmacologically acceptable salt that is insoluble or has a lower solubility than the drug alone or a different salt of the drug. In certain instances, the solubility of the drug in biological fluids and / or body fluids is by selection of crystalline salt forms (polymorphs) that are insoluble or have lower solubility than other salt forms or drugs alone. Be changed.

  As an example, in the case of an anionic drug (eg, an active agent having an acidic moiety such as carboxylic acid, phosphoric acid, sulfuric acid, etc.), the soluble drug is a metal ion from group 1 of the periodic table (eg, sodium or potassium). ) From the second group of the periodic table (eg calcium or magnesium) or other multivalent cations (eg iron, zinc, barium, cesium, etc.) It is insoluble or hardly soluble in biological fluids and / or fluids. As an example, oligonucleotide anionic drugs (eg, alicaforsen) are insoluble or poorly soluble in biological and / or body fluids by the formation of their calcium salts. As an example, a protein (eg, insulin) is made insoluble or poorly soluble in biological and / or body fluids by formation of its zinc salt.

  As an example, for a cationic drug (eg, an active agent comprising a primary, secondary, or tertiary aliphatic or aromatic amine), the soluble drug is at least one pKa of the amine moiety, or By formulating above its pKa, it is insoluble or poorly soluble in biological and / or body fluids. As an example, formulating at pH> 5 for pKa-5 for the amine moiety in the drug reduces the solubility of the drug in biological and / or body fluids. As an example, meclizine is not soluble in water by two amine groups (pKa-5 and 9), but it easily becomes soluble in poloxamer formulations when the pH of the solution is maintained below pH 5.5, which Insoluble in poloxamer formulations above pH 6. As an example (when the active agent is a cationic agent (eg, an agent having at least one amine moiety of pKa-5), a poloxamer gel formulation at pH 4.5 is compared to a poloxamer formulation at pH 7.4, Has a lower mean dissolution time (MDT).

  Furthermore, changing the solubility of the active agent can also affect the properties of the heat sensitive gel. As an example, amitriptyline is water soluble (> 100 mg / mL) and raises the gelation temperature of poloxamer formulations. By reducing the solubility of amitriptyline (eg, by forming a prodrug), the gelation temperature of the poloxamer formulation can be adjusted.

  In addition, cationic drugs (eg, drugs having one or more amine moieties) can convert salts of such drugs from mineral salts (eg, hydrochloric acid or sulfate) from small to intermediate sizes. By exchanging with a salt of an organic acid (for example, citrate, maleate, nicotinate, or besylate besylate salt), it is insoluble or poorly soluble in biological and / or body fluids. As an example, dexamethasone acetate is not as soluble as dexamethasone hydrochloride in biological and / or body fluids. As an example, the water-soluble active agent has a solubility of 10 mg / mL or more. Active agents that are rendered sparingly soluble or insoluble in body fluids and / or biological fluids have a water solubility of less than 10 mg / mL, less than 1 mg / mL, or less than 0.1 mg / mL. The release profile of the active agent and / or any salt thereof is compared using the in vitro and in vivo procedures described herein.

  A second approach to controlling the dissolution and / or release characteristics of the active agent is to form a complex of the complexing agent and the active agent that delays the dissolution of the active agent in biological and / or body fluids. Examples of such complexing agents are cryptands (eg [2.2.2] cryptand, diaza-18-crown-6), cyclodextrins, crown ethers etc. (eg 12-crown-4, 15-crown-5). , 18-crown-6, dibenzo-18-crown-6, etc.). In further examples, as an example, anionic active agents, cationic (eg, amine-based) active agents and zwitterionic active agents are polymers (eg, hyaluronic acid), insoluble organic compounds (eg, phospholipids, etc.) Surfactants) or polyvalent metal ions (for example, multiple bond complexes with cesium, calcium, magnesium, iron, zinc, etc.) or insoluble or difficult in biological and / or body fluids It is considered soluble. As an example, complex coacervation of a protein with bovine serum albumin (BSA) or a gelatin moiety (eg, insulin) alters the dissolution and / or release characteristics of the protein from the formulations described herein .

  By way of example, the amount of systemically administered (eg, administered orally or intravenously) bisphosphonate reaching the perilymph in the inner ear and / or ear skeleton is about 0. 0 for risedronate. 6 ng / day, and about 0.1 ng / day for zoledronic acid, alters cochlear function. The formulations described herein deliver a therapeutically effective amount of bisphosphonates via the perilymph and / or active capsule compared to bisphosphonates administered via a systemic route; Therefore, the toxicity of bisphosphonate is reduced. As an example, a sustained release formulation of zoledronate (eg, a formulation comprising a complex of calcium ions and zoledronate) is caused by a higher amount of zoledronic acid that can alter the function of the cochlea (eg, by calcium deficiency at the delivery site). Releases a therapeutically effective amount of zoledronic acid that reduces any toxicity that may occur. FIG. 6 shows a comparison of the in vitro mean dissolution time (MDT) of a 16% P407 formulation containing zoledronate versus a 16% P407 formulation containing calcium and zoledronate complex. Complexation with calcium increases the average dissolution time of zoledronate from 2 hours to 8 hours.

  Yet another approach to adjusting the release characteristics of an active agent from the formulations described herein is to use a salt or free base of the active agent and a polyelectrolyte (eg, poly (sodium styrene sulfonate), polyacrylic acid, polyamine. Etc.) to form a complex. Ionic interactions between the polyelectrolyte and the salt or free base of the active agent alter the solubility characteristics of the active agent in biological and / or body fluids. As an example, the solubility of genetic material in biological and / or aqueous media is altered by the addition of cationic polymers and / or the formation of cationic micelles. The release characteristics of the active agent and its complexes are compared using the in vitro and in vivo procedures described herein.

  A further approach to sustaining the release profile of the active agent from the formulations described herein is to use a prodrug of the active agent. Active agents (anions, cations, zwitterions, or neutrals) can be produced in vivo and / or by forming prodrugs that are insoluble or poorly soluble in biological and / or aqueous media from the agent alone. It is insoluble or hardly soluble in an aqueous medium. Such prodrugs share a moiety (eg, an ester or a bulky or water-insoluble amide such as benzoic acid, amine, fatty acid, cyclic or aromatic acid or alcohol, polymer chain, etc.) with the parent drug. Formed by bonding. The release characteristics of the active agent and its prodrugs are compared using the in vitro and in vivo procedures described herein.

  A further method for adjusting the dissolution and / or release characteristics of the active agent is to coat the particles of the active agent with certain sustained release excipients (eg, hydroxypropylmethylcellulose, carboxymethylcellulose, etc.). By way of example, the active agent is micronized and the micronized particles are coated with a sustained release excipient; the coated active agent particles are then incorporated into any of the compositions described herein. Formulated.

Active Agent Concentration The active agent release profile is adjusted by varying the concentration of the active agent in the formulation. As an example, at increased concentrations of active agent, a) the initial drug concentration reaching the inner ear (as measured by perilymph) is high and b) increases during the exposure period. FIG. 3 shows the dose proportionality effect of the drug when formulated into a poloxamer gel. FIG. 4 shows the in vitro dose proportional effect in the release kinetic assay, increasing the drug concentration is related to increasing the average dissolution time. Increasing the concentration of active agent in the formulation prolongs the residence time and / or MDT of the active agent in the ear. In some embodiments, the MDT for an active agent from a formulation described herein is from about 30 hours to about 48 hours. In some embodiments, the MDT for an active agent from a formulation described herein is from about 30 hours to about 96 hours. The linear correlation between the mean dissolution time (MDT) of the formulation and the concentration of P407 (also known as PF-127, Pol-407, Pluronic-127) indicates that the active agent is released by erosion of the polymer gel (poloxamer) It shows that it does not go through diffusion. Non-linear correlation indicates active agent release by a combination of diffusion and / or polymer gel alteration.

  MDT is inversely proportional to the release rate of the active agent from the compositions described herein. Experimentally, the released active agent is optionally fit to the following Korsmeyer-Peppas equation.

  Where Q is the amount of active agent released at time t, Qα is the total amount of active agent released, k is the nth order release constant, n is a dimensionless number with respect to the dissolution mechanism, b is the axial intercept and n = l characterizes the initial burst release mechanism that characterizes the erosion suppression mechanism. The mean dissolution time (MDT) is the sum of the different time intervals during which drug molecules remain in the matrix before release divided by the total number of molecules, and is optionally calculated by the following formula:

  In some embodiments, the MDT for an active agent from a formulation described herein is from about 30 hours to about 1 week. In some embodiments, the MDT for a formulation described herein is from about 1 week to about 6 weeks. In some embodiments, the mean residence time (MRT) for an active agent from a formulation described herein is from about 20 hours to about 48 hours. In some embodiments, the MRT for an active agent from a formulation described herein is from about 20 hours to about 96 hours. In some embodiments, the MRT for an active agent from a formulation described herein is from about 20 hours to about 1 week. In some embodiments, the MRT for an active agent from a formulation described herein is from about 1 week to about 6 weeks.

  In some embodiments, the intermediate or final otic formulations described herein allow maintaining therapeutic levels of the active agent in dry or moist otic conditions. By way of example, a formulation described herein comprising ciprofloxacin, about 40-60% thermoreversible polymer, buffer, and additional solvent such as ethanol, is ciprofloxacin for at least 7 days. And the drug level detected in the middle ear fluid is equal to or higher than the minimum inhibitory concentration (MIC), i.e., such a formulation has a middle ear fluid for at least 7 days. Provide ciprofloxacin concentrations in MEF above 1 μg / mL. In other examples, a formulation described herein comprising dexamethasone, about 40-60% thermoreversible polymer, buffer, and additional solvent such as ethanol, provides a sustained release of dexamethasone for at least 7 days. The drug level detected in the middle ear fluid exceeds 1-40 mcg / mL for at least 7 days. FIGS. 15-19 show the sustained release characteristics of otic agents from the formulations described herein when the formulation is administered to the middle ear. FIG. 20 shows the sustained release characteristics of the formulations described herein as compared to the release characteristics of Ciprodex®. FIG. 21 shows a comparison of therapeutic efficacy for otic solutions (Ciprodex®) and the formulations described herein, and shows the minimal hearing shift that occurs upon administration of the gel formulations described herein. Show.

Gel Strength The gel strength and concentration of the active agent affects the release kinetics (eg, average dissolution time) of the active agent from the composition. For example, at low poloxamer concentrations, the drainage rate is accelerated (lower average dissolution time (MDT)). FIG. 5 shows the in vitro average dissolution time of high versus low solubility and solution versus gel formulations.

  In some embodiments, the MDT for poloxamers from the formulations described herein is at least 6 hours. In some embodiments, the MDT for poloxamers from the formulations described herein is at least 10 hours. In some embodiments, the MDT for a poloxamer from the formulations described herein is at least 24, 48, 60, 100, 150, or 250 hours. MDT is measured using the techniques described herein (eg, in Example 6). FIG. 7 shows the MDT for a particular formulation.

  In some embodiments, the mean residence time (MRT) of the active agent in the perilymph for any formulation described herein is about 5, 7, 10, 15, 20, 24, 36, 48, 60 or Between 80 hours and about 100, 200, 300, 400, 500 or 600 hours. FIG. 8 shows the MRT for dexamethasone (Dex), dexamethasone sodium phosphate (DSP), and dexamethasone acetate (DA) from certain formulations after intramiddle injection in guinea pigs. FIG. 9 shows MRT for soluble methylprednisolone (MPS) and insoluble methylprednisolone (MP) from certain formulations after intramiddle injection in guinea pigs. FIG. 10 shows the MRT for 0.6% L-701324 in a 17% poloxamer 407 formulation after intramiddle injection in guinea pigs. FIG. 11 shows the MRT for 0.5% SP-600125 in a 17% poloxamer 407 formulation after intramiddle injection in guinea pigs. FIG. 12 shows the MRT for 2% meclizine in a 17% poloxamer 407 formulation after intramiddle injection in guinea pigs.

  In some embodiments, the compositions described herein are microparticulates or a solution of micronized active agent and are substantially free of heat sensitive polymer components. In some such embodiments, the composition provides essentially immediate release of the active agent. In other embodiments, a suspension of micronized or micronized active agent substantially free of heat sensitive polymer components provides an intermediate sustained release of the active agent. In certain other embodiments, a formulation comprising microparticulate or micronized active agent and a heat sensitive polymer provides sustained sustained release of the active agent. As used herein, immediate release of the active agent is said to substantially complete the release of the active agent from the formulation in less than about 5 hours. As used herein, sustained release is, for example, at least 2, 3, 5, 7, 14, 21, 28 days, or at least 1, 2, 3, 4, 5 or 6 months, or 1 Refers to sustained release of the active agent from the formulation, such as sustained release of the active agent over the years.

  In some embodiments, the pharmaceutical formulations provided herein provide sustained release of an active agent (eg, corticosteroid, antibiotic) for at least one day. In some embodiments, the pharmaceutical formulations provided herein provide sustained release of an active agent (eg, corticosteroid, antibiotic) for at least 2 days. In some embodiments, the pharmaceutical formulations provided herein provide sustained release of an active agent (eg, corticosteroid, antibiotic) for at least 2 days. In some embodiments, the pharmaceutical formulations provided herein provide sustained release of an active agent (eg, corticosteroid, antibiotic) for at least 3 days. In some embodiments, the pharmaceutical formulation, provided herein, provided, an active agent (eg, a corticosteroid (antibiotic)) for a period of at least 4 days, in some embodiments, The pharmaceutical formulations provided herein provide sustained release of the active agent (eg, corticosteroid, antibiotic) for at least 5 days. In some embodiments, the pharmaceutical formulations provided herein provide sustained release of an active agent (eg, corticosteroid, antibiotic) for at least 6 days. In some embodiments, the pharmaceutical formulations provided herein provide sustained release of the active agent (eg, corticosteroid, antibiotic) for at least 7 days. In some embodiments, the pharmaceutical formulations provided herein provide sustained release of the active agent (eg, corticosteroid, antibiotic) for at least 8 days. In some embodiments, the pharmaceutical formulations provided herein provide sustained release of the active agent (eg, corticosteroid, antibiotic) for at least 9 days. In some embodiments, the pharmaceutical formulations provided herein provide sustained release of an active agent (eg, corticosteroid, antibiotic) for at least 10 days. In some embodiments, the pharmaceutical formulations provided herein provide sustained release of an active agent (eg, corticosteroid, antibiotic) for at least 2 weeks. In some embodiments, the pharmaceutical formulations provided herein provide sustained release of an active agent (eg, corticosteroid, antibiotic) for at least 3 weeks. In some embodiments, the pharmaceutical formulations provided herein provide sustained release of an active agent (eg, corticosteroid, antibiotic) for at least 4 weeks. In some embodiments, the pharmaceutical formulations provided herein provide sustained release of an active agent (eg, corticosteroid, antibiotic) for at least 5 weeks. In some embodiments, the pharmaceutical formulations provided herein provide sustained release of the active agent (eg, corticosteroid, antibiotic) for at least 7 days. In some embodiments, the pharmaceutical formulations provided herein provide sustained release of an active agent (eg, corticosteroid, antibiotic) for at least 6 weeks. In some embodiments, the pharmaceutical formulations provided herein provide sustained release of an active agent (eg, corticosteroid, antibiotic) for at least 7 weeks. In some embodiments, the pharmaceutical formulations provided herein provide sustained release of an active agent (eg, corticosteroid, antibiotic) for at least 8 weeks. In some embodiments, the pharmaceutical formulations provided herein provide sustained release of an active agent (eg, corticosteroid, antibiotic) for at least 3 months. In some embodiments, the pharmaceutical formulations provided herein provide sustained release of an active agent (eg, corticosteroid, antibiotic) for at least 4 months. In some embodiments, the pharmaceutical formulations provided herein provide sustained release of an active agent (eg, corticosteroid, antibiotic) for at least 5 months. In some embodiments, the pharmaceutical formulations provided herein provide sustained release of an active agent (eg, corticosteroid, antibiotic) for at least 6 months. In some embodiments, the pharmaceutical formulations provided herein provide sustained release of an active agent (eg, corticosteroid, antibiotic) for at least 7 months. In some embodiments, the pharmaceutical formulations provided herein provide sustained release of an active agent (eg, corticosteroid, antibiotic) for at least 8 months. In some embodiments, the pharmaceutical formulations provided herein provide sustained release of an active agent (eg, corticosteroid, antibiotic) for at least 10 months. In some embodiments, the pharmaceutical formulations provided herein provide sustained release of an active agent (eg, corticosteroid, antibiotic) for at least 12 months.

  Release characteristics can also be altered by co-crystal formation (norfloxacin is known to form co-crystals, Crystal Growth & Design, Vol. 6, No. 12, 2006 Basavoju et al.). As an example, the free base of ciprofloxacin forms a co-crystal with dexamethasone, which changes the release of the co-crystal. MDT of a suspension of ciprofloxacin (Cipro) / dexamethasone (Dex) or dexamethasone phosphate (DSP) in 16% P407 shows the formation of co- or inclusion crystals as seen in the table below Operated by.

  As described above, the release characteristics of the active agent from a solution or suspension or gel formulation can be adjusted. Thus, in certain embodiments, a suspension of micronized or micronized active agent provides an intermediate or sustained sustained release. In certain embodiments, a composition comprising a heat sensitive polymer and a microparticulate or micronized active agent provides an intermediate sustained or sustained sustained release. In certain embodiments, the solution of active agent provides immediate release or intermediate sustained release.

Biodistribution In some embodiments, the in vivo distribution of an agent from a formulation described herein is governed by passive diffusion. In some embodiments, formulations comprising the heat sensitive gels described herein advantageously allow for a substantially uniform distribution of the active agent and reduce variability in drug exposure in vivo. For example, a solution of dexamethasone that does not contain a thermosensitive polymer provides an uneven distribution (large slope) of the active agent within the cochlea. FIG. 13 shows an approximately uniform distribution of dexamethasone in the cochlea upon administration of a formulation containing a thermosensitive polymer, and dexamethasone in the cochlea upon administration of a dexamethasone solution that does not contain a thermosensitive polymer after injection into the middle ear. The non-uniform distribution of is shown.

Pharmacokinetics The pharmacokinetic properties of the active agent released from the formulations described herein depend on the nature of the vehicle (eg, an aqueous solution containing a thermosensitive polymer relative to an aqueous solution that does not contain a thermosensitive polymer). Furthermore, the pharmacokinetic properties of the active agent depend on the physicochemical properties of the active agent as described above. Thus, a combination of a suitable heat sensitive polymer vehicle and drug physicochemical properties provides optimized release characteristics. As an example, for a 17% poloxamer 407 formulation, if either dexamethasone or methylprednisolone is present as a water soluble salt (ie, DSP and MPS, respectively), the MDT value is about 3 hours. However, the MDT values of water-insoluble forms of dexamethasone and methylprednisolone (eg, DEX, DA and MP) range from 40 to 71 hours. As an example, an aqueous DSP solution has an MDT of 0.3 hours, while a micronized DEX suspension in water has an MDT value of 44 hours.

  In some embodiments, the solubility of the drug modulates pharmacokinetics regardless of the vehicle used in the formulation. As an example, administration in the middle ear of a DSP in either a water-soluble vehicle or a hydrogel vehicle in guinea pigs has limited inner ear exposure (AUC ranges from 28 to 57 μg.h / ml) and inner ear compartments. Caused rapid drainage (4-7 hours MRT) from (inner ear compartment). However, administration of poorly soluble drugs (ie, DEX or DA) in either water-soluble or hydrogel vehicles, higher dexamethasone exposure in the perilymph (84-359 μg.h / ml AUC) and prolonged Residence time (MRT 17-82 hours) was derived.

  As an example, the inner ear properties of methylprednisolone can be adjusted by using a soluble form (MPS) and a water-insoluble form (MP). Methylprednisolone levels in perilymph peaked rapidly at 6.5 μg / ml after intra-middle administration of MPS hydrogels in guinea pigs and were within a fraction of the peak level (0.8-1. 0%) (decreased to a fraction of the peak levels). In contrast, administration of the formulation containing poorly soluble MP resulted in higher peak levels (19.2 μg / ml) that decreased slowly over 10 days.

  Thus, in certain embodiments, the nature and composition of the vehicle and the degree of water solubility of the drug present in the formulation affects pharmacokinetic parameters such as the average residence time and / or exposure of the target area. .

  In certain instances, once the drug exposure of a drug (eg, concentration in perilymph, sinus fluid, cerebrospinal fluid, etc.) reaches steady state, the drug concentration is increased for an extended period (eg, 1 2 days, 3 days, 4 days, 5 days, 6 days, or 1 week, 3 weeks, 6 weeks, 2 months) at or around the therapeutic amount. In some embodiments, the steady state concentration of active agent released from a sustained release formulation described herein is from about 5 times the steady state concentration of active agent released from a non-sustained release formulation. About 20 times. In some embodiments, the steady state concentration of active agent released from a sustained release formulation described herein is from about 20 times to about the steady state concentration of active agent released from a formulation that is not a sustained release formulation. 50 times.

  In specific embodiments, any formulation described herein is at least 7 days, at least 10 days, at least 2 weeks, at least 4 weeks, at least 6 weeks, at least 8 weeks, at least 12 weeks or at least 16 weeks. In the meantime, it provides a sustained release of the active agent.

Pharmaceutical formulations Provided herein are pharmaceutical formulations comprising at least one active agent and a pharmaceutically acceptable diluent (s), excipient (s) or carrier (s). .

Thermosensitive gel A polymer composed of polyoxypropylene and polyoxyethylene forms a thermosensitive gel when incorporated into an aqueous solution. These polymers have the ability to change from a liquid state to a gel state at temperatures close to body temperature, thus enabling the application of useful formulations to the targeted structure (s). The phase transition between the liquid state and the gel state (gelation temperature) depends on the polymer concentration, the buffer concentration, and the components in the solution. In some embodiments, a heat sensitive gel suitable for the compositions described herein is an aqueous gel comprising a polymer of polyoxypropylene and polyoxyethylene.

  Poloxamers are synthetic block polymers of ethylene oxide and propylene oxide. Poloxamer 407 (PF-127, P407) is a thermoreversible polymer composed of a polyoxyethylene-polyoxypropylene copolymer. Other poloxamers include 124, 188 (F-68 grade), 237 (F-87 grade), and 338 (F-108 grade). An aqueous solution of poloxamer is stable in the presence of acid, alkali and metal ions. PF-127 (or P407) is a commercially available polyoxyethylene-polyoxypropylene triblock copolymer having an average molecular weight of 13,000. The polymer can be further purified by a suitable method that enhances the gelability of the polymer. The polymer contains about 70% ethylene oxide, and this portion provides its hydrophilicity. This polymer is a kind of poloxamer ABA block copolymer, and its members share the chemical formula shown below.

Poloxamers are available in several types and have different molecular weights ranging from about 2000 to about 15000. The α-hydro-ω-hydroxy poly (oxyethylene) _a (poly (oxypropylene) _b poly (oxyethylene) _a block copolymer comprises different proportions of a and b as shown below:

  In certain embodiments, the heat sensitive gel formulation described herein comprises a poloxamer. In a specific embodiment, the heat sensitive gel formulation described herein comprises P407. When placed in contact with the body, such gel preparations form a semi-solid structure and form a sustained release depot. Furthermore, poloxamers (eg, P407) have good solubilizing ability, low toxicity, and are biocompatible.

  In an alternative embodiment, the heat sensitive gel comprises a PEG-PLGA-PEG triblock copolymer (Jeong et al, Nature (1997), 388: 860-2; Jeong et al, J. Control. Release (2000). 63: 155-63; Jeong et al, Adv. Drug Delivery Rev. (2002), 54: 37-51). The polymer exhibits a sol-gel behavior over concentrations from about 5% w / w to about 40% w / w. Depending on the desired properties, the lactide / glycolide molar ratio in the PLGA copolymer is in the range of about 1: 1 to about 20: 1. The resulting copolymer is soluble in water and forms a free flowing liquid at room temperature, but forms a gel at body temperature.

  ReGel® is reversible as described in US Pat. Nos. 6,004,573, 6,117,949, 6,201,072, and 6,287,588. Is a trade name of MacroMed Incorporated for a class of low molecular weight biodegradable block copolymers with excellent thermal gelation properties. It also includes biodegradable polymeric pharmaceutical carriers disclosed in pending US patent applications 09 / 906,041, 09 / 559,799 and 10 / 919,603. The biodegradable drug carrier comprises an ABA or BAB type triblock copolymer or mixtures thereof, the A block is relatively hydrophobic, comprises a biodegradable polyester or poly (orthoester), and a B block Is relatively hydrophilic and comprises polyethylene glycol (PEG), the copolymer having a hydrophobic content of 50.1 to 83% by weight and a hydrophilic content of 17 to 49.9% by weight; The final block copolymer molecular weight is 2000-8000 daltons.

  In some embodiments, other heat sensitive polymers are useful depending on the particular active agent, other pharmaceutical agent or excipient / additive used, and as such are considered to be within the scope of this disclosure. For example, other commercially available glycerin-based gels, glycerin-derived compounds, conjugated or cross-linked gels, matrices, hydrogels, polymers, and gelatin and gelatin derivatives, alginate, alginate-based gels, and various Natural and synthetic hydrogels and compounds derived from hydrogels are all expected to be useful in the pharmaceutical formulations described herein. In some embodiments, the bioacceptable gel includes, but is not limited to, alginate hydrogel, SAF®-Gel (ConvaTec, Princeton, NJ), Duderm® Hydroactive. Gel (ConvaTec), Nu-gel (registered trademark) (Johnson & Johnson Medical, Arlington, Tex.); Agent Elta® Hydrogel (Swiss-American Products, Inc., Dallas, Tex.), K- Including (R) Sterile (Johnson & Johnson), gelatin hydrogel, chitosan, silicone-based gel (e.g. Medgel (registered trademark)) and the like. Other heat-sensitive and / or bio-acceptable gels suitable for the compositions described herein include acrylic acid based polymers (eg, Carbopol®), cellulosic polymers (eg, hydroxypropyl methylcellulose, Carboxymethylcellulose, etc.), alkylaryl polyether alcohol-based polymers (eg, Tyloxapol (registered trademark)), and the like.

Purification of poly (oxyethylene) / poly (oxypropylene) triblock polymer In some embodiments, any active composition described herein comprises a purified heat sensitive polymer. In some embodiments, any active composition described herein comprises a fractionated purified heat sensitive polymer consisting of a polyoxyethylene-polyoxypropylene copolymer. In some such embodiments, the heat sensitive polymer is a poloxamer.

  Purification of poloxamers can be accomplished by using low molecular weight components (eg, oligomers, unreacted materials and / or other unwanted impurities generated during production or storage), and / or high molecular weight components (unnecessary multimers-multimers. Based on removal of components) from body reactions. The resulting purified product has a narrower PDI with approximately the same molecular weight as the original material. In some embodiments, the purified poloxamer has better gelling properties (eg, provides a higher viscosity in the gel state while having a lower Tgel for the same% poloxamer concentration).

  As used herein, a purified thermosensitive polymer has low polydispersity (ie, a narrow molecular weight distribution within individual polymer chains therein). For example, commercially available poloxamers contain certain impurities such as poly (oxyethylene) homopolymers and poly (oxyethylene) / poly (oxypropylene) diblock polymers due to the nature of the method by which they are produced. . As the molecular weight of the component block increases, the relative amounts of these by-products increase. In some examples, in the commercially available poloxamer 407, by-products may comprise from about 15 to about 50% by weight of the polymer, depending on the manufacturer, thus resulting in high polydispersity. Example 15 shows a procedure for fractionation of P407 that reduces polydispersity in commercially available P407.

In some embodiments, supercritical fluid extraction techniques are used to fractionate polyoxyalkylene block copolymers. See US Pat. No. 5,567,859, the disclosure for fractionation of the polymers described therein is incorporated herein by reference. In this technique, lower molecular weight fractions in commercially purchased polymers are removed in a stream of CO ₂ maintained at a pressure of 2200 pounds per square inch (psi) and a temperature of 40 ° C. Thereby providing a purified polymer having low polydispersity.

  In some embodiments, gel permeation chromatography allows separation of polymer fractions. See European patent application WO 92/16484; the use of gel permeation chromatography to separate fractions of poloxamers having low polydispersity and saturation described therein is incorporated herein by reference.

  In some embodiments, one or more blocks are purified prior to production of the copolymer. As an example, purifying either the polyoxypropylene center block during copolymer synthesis or the copolymer product itself (see US Pat. Nos. 5,523,492 and 5,696,298, which are , Incorporated herein by reference for such disclosure) allows the production of purified poloxamers.

  In some embodiments, fractionation of the polyoxyalkylene block copolymer may be performed using salt extraction and liquid phase separation techniques (see US Pat. No. 5,800,711, wherein the multimer purification steps described therein are , Which is incorporated herein by reference) through the removal of batch low molecular weight species. Such fractions have increased gel strength, reduced polydispersity, higher average molecular weight, reduced gelation concentration and / or extended compared to commercially available poloxamers (eg BASF to P407 NF grade). Polyoxyalkylene block copolymers (eg, poloxamer 407, poloxamer 188, etc.) having improved physical properties including gel dissolution properties are created. Other steps of polymer purification and / or fractionation are described, for example, in US 6,977,045 and US 6,761,824, which are incorporated herein by reference.

  In some instances, low molecular weight contaminants of polymers (eg, poloxamers) cause adverse side effects in vivo; the use of purified poloxamers in the pharmaceutical formulations described herein may cause such in vivo side effects. Reduce.

  Thus, within the embodiments presented herein, a purified, substantially free of poly (oxyethylene) homopolymer and / or poly (oxypropylene) / poly (oxyethylene) diblock byproducts. Formulations comprising poly (oxyethylene) / poly (oxypropylene) triblock polymers are contemplated, thereby narrowing the molecular weight distribution of the block copolymer (ie, providing low polydispersity). In some embodiments, such purified poly (oxyethylene) / poly (oxypropylene) triblock polymers (eg, fractionated poloxamers) are unfractionated poly (oxyethylene) / poly ( Compared to an active composition comprising an oxypropylene) triblock polymer, it allows formulation of an active composition comprising a lower concentration of poly (oxyethylene) / poly (oxypropylene) triblock polymer.

  Conveniently, such a composition comprising a lower concentration of fractionated poly (oxyethylene) / poly (oxypropylene) triblock polymer (eg, poloxamer) will result in a lower concentration of poly (oxyethylene) / Despite having a poly (oxypropylene) triblock polymer (eg, poloxamer), gelling properties (eg, gelling between about 15 ° C. and about 42 ° C.) and sustained release properties (eg, at least 3 days, 5 Sustained release of dexamethasone over a day or 7 days).

  Thus, by way of example, a formulation comprising micronized dexamethasone and a lower concentration of fractionated P407 (eg, between about 5% to about 14% P407) is micronized dexamethasone and fractionated. Gelling properties and / or slow release properties that are approximately the same as or better than the gelling properties and / or sustained release properties of formulations containing no P407 (eg, P407 NF from about 14.5% to about 25% BASF) Has release characteristics.

Gelling Temperature Modifier In some embodiments, the pharmaceutical formulations described herein comprise a gelling temperature modifier.
A “gelation temperature modifying agent / gel temperature modifying agent” is an additive added to any of the formulations described herein, and the gelation temperature of the formulation is about 14 ° C. and about 42 ° C. The gelation temperature of the formulation is changed so that it is maintained during Gelling temperature modifiers increase or decrease the gelling temperature of any formulation described herein such that the formulation is maintained at a gelling temperature between about 14 ° C and about 42 ° C.

  In some embodiments, the gelling temperature modifier is an agent that increases the gelling temperature. For example, if a formulation comprising a thermosensitive polymer has a gelling temperature of less than 14 ° C., a gelling temperature raising agent (eg, P188, P388, cyclodextrin, carboxymethylcellulose, hyaluronic acid, Carbopol®, Tween 20, Tween 40 , Tween 60, Tween 80, Tween 81, Tween 85, n-methylpyrrolidone and short chain fatty acid salts (for example, sodium oleate, sodium caprate, sodium caprylate, etc.) And increase to between about 42 ° C.

  In some embodiments, the gelling temperature modifier is an agent that lowers the gelling temperature. For example, if a formulation comprising a thermosensitive polymer has a gelling temperature higher than 42 ° C., a gelling temperature lowering agent (eg, P188, P388, cyclodextrin, carboxymethylcellulose, hyaluronic acid, Carbopol®, Tween 20, Tween 40 , Tween 60, Tween 80, Tween 81, Tween 85, n-methylpyrrolidone, fatty acid salts (eg, sodium oleate, sodium caprate, sodium caprylate, etc.) have a gelation temperature of the formulation of less than 42 ° C. and about 14 ° C. Decrease between 42 ° C.

  In some embodiments, the gelling temperature modifier is a pH sensitive polymer (eg, chitosan). In some embodiments, the gelling temperature modifier is a heat sensitive polymer. In some embodiments, the gelling temperature modifier is an ion sensitive polymer (eg, an alginate gel in the presence of calcium ions). In some embodiments, the gelling temperature modifier is an acrylic acid-based polymer (eg, Carbopol®). In some embodiments, the gelling temperature modifier is a cellulose-based polymer (eg, hydroxypropylmethylcellulose, carboxymethylcellulose, etc.). In some embodiments, the gelling temperature modifier is an alkylaryl polyether alcohol-based polymer (eg, Tyloxapol®).

  In some embodiments, the gelling temperature modifier is a poloxamer. As an example, adding about 5% or less of poloxamer 188 to a formulation containing about 16% P407 increases the gelation temperature of the 16% P407 formulation by about 5 ° C.

Gelation temperature In one embodiment, the pharmaceutical formulations described herein are liquid at about room temperature. In certain embodiments, the pharmaceutical formulation is characterized by a phase transition between room temperature and body temperature, including individuals with severe fever, eg, up to about 42 ° C. In some embodiments, the phase transition is between a temperature and body temperature at least about 1 ° C. below body temperature, between a temperature and body temperature at least about 2 ° C. below body temperature, and at a temperature and body temperature at least about 3 ° C. below body temperature. Between body temperature and at least about 4 ° C. below body temperature, between body temperature and at least about 6 ° C. below body temperature, and at least about 10 ° C. between body temperature and at least about 8 ° C. below body temperature. Occurs between a temperature below body temperature and between body temperature and at least about 15 ° C. below body temperature or between body temperature and at least about 20 ° C. below body temperature.

  In some embodiments, the formulations described herein are about 5 ° C., 10 ° C., 14 ° C., 15 ° C., 16 ° C., 17 ° C., 18 ° C., 19 ° C. or 20 ° C. and about 25 ° C., 28 ° C. It has a gel temperature between 30 ° C, 30 ° C, 33 ° C, 35 ° C, 37 ° C, 40 ° C or 42 ° C. In some embodiments, the formulations described herein have a gelling temperature between about 5 ° C and about 42 ° C. In some embodiments, the formulations described herein have a gelling temperature between about 10 ° C and about 42 ° C. In some embodiments, the formulations described herein have a gelling temperature between about 14 ° C and about 42 ° C. In some embodiments, the formulations described herein have a gelling temperature between about 14 ° C and about 40 ° C. In some embodiments, the formulations described herein have a gelling temperature between about 14 ° C. and about 37 ° C. In some embodiments, the formulations described herein have a gelling temperature between about 14 ° C and about 35 ° C. In some embodiments, the formulations described herein have a gelling temperature between about 16 ° C and about 35 ° C. In some embodiments, the formulations described herein have a gelling temperature between about 18 ° C and about 35 ° C. In some embodiments, the formulations described herein have a gelling temperature between about 20 ° C and about 42 ° C. In some embodiments, the formulations described herein have a gelling temperature between about 20 ° C and about 37 ° C. In some embodiments, the formulations described herein have a gelling temperature between about 20 ° C and about 35 ° C. In some embodiments, the formulations described herein have a gelling temperature between about 20 ° C and about 30 ° C. In some embodiments, the formulations described herein have a gelling temperature between about 20 ° C and about 28 ° C. In some embodiments, the formulations described herein have a gelling temperature between about 20 ° C and about 25 ° C.

  Since the polymer system of heat sensitive gels dissolves more completely at reduced temperatures, the method of dissolution involves adding the required amount of polymer to the amount of water used at low temperatures. Generally, after wetting the polymer by shaking, the mixture is capped and placed in a cold chamber at about 0-10 ° C. or in a constant temperature vessel to dissolve the polymer. In some embodiments, the dissolution is performed at a temperature between about 10 ° C and about 20 ° C. To dissolve the heat sensitive gel polymer more rapidly, the mixture is stirred or shaken. In some instances, the active agent and / or other pharmaceutically active agent is suspended if it is insoluble in water. The pH / molar osmolarity of the formulation is adjusted by adding an appropriate buffer.

Viscosity In some embodiments, the formulations described herein include sufficient heat sensitive polymer to provide a viscosity between about 10,000 and 1,000,000 centipoise. In some embodiments, the formulations described herein comprise sufficient heat sensitive polymer to provide a viscosity between about 50,000 and 1,000,000 centipoise. In some embodiments, the formulations described herein comprise sufficient heat sensitive polymer to provide a viscosity between about 150,000 and 1,000,000 centipoise. In some embodiments, the formulations described herein comprise sufficient heat sensitivity to provide a viscosity between about 50,000 and 600,000 centipoise. In some embodiments, the formulations described herein comprise sufficient heat sensitive polymer to provide a viscosity between about 100,000 and 500,000 centipoise. In some embodiments, the formulations described herein comprise sufficient heat sensitive polymer to provide a viscosity between about 150,000 and 400,000 centipoise. As an example, a concentration of about 15.5% heat sensitive polymer in the compositions described herein provides an apparent viscosity of about 270,000 cP. As an example, a concentration of about 16% heat sensitive polymer in the compositions described herein provides an apparent viscosity of about 360,000 cP. As an example, a concentration of about 17% heat sensitive polymer in the compositions described herein provides an apparent viscosity of about 480,000 cP.

  In some embodiments, the formulations described herein are low viscosity formulations at body temperature. In some embodiments, the low viscosity formulations described herein provide an apparent viscosity from about 100 cP to about 10,000 cP.

  In some embodiments, the formulations described herein comprise a viscosity enhancing polymer sufficient to provide a viscosity between about 1,000 and 1,000,000 centipoise at body temperature. In some embodiments, the formulations described herein comprise a viscosity enhancing polymer sufficient to provide a viscosity between about 1,000 and 500,000 centipoise at body temperature. In some embodiments, the formulations described herein comprise a viscosity enhancing polymer sufficient to provide a viscosity between about 1,000 and 250,000 centipoise at body temperature. In some embodiments, the formulations described herein comprise a viscosity enhancing polymer sufficient to provide a viscosity between about 1,000 and 100,000 centipoise at body temperature.

  In one embodiment, administration of any formulation described herein at about room temperature (eg, between about 18 ° C. and about 28 ° C.) is for cold (eg, temperatures below about 18 ° C.) ears. Reduce or prevent dizziness associated with administration in the middle ear of the formulation.

  In some embodiments, the use of a higher concentration of active agent results in a formulation having a higher viscosity compared to a formulation having a lower concentration of active agent. As shown in Example 15, increasing the concentration of drug in the formulation and the use of purified poloxamer allows the use of lower concentrations of heat sensitive polymers by weight of the formulation.

Viscosity is measured using a conical plate viscometer (for reference, a Brookfield DVII + Pro viscometer with a CP8 spindle of 0.08 rpm) at a shear rate of 0.31 s ⁻¹ .

  In some embodiments, the formulations described herein are about 0.1%, 0.5%, 1%, 2%, 3%, 4%, 5%, 6%, 7%, 8% 9%, 10%, 15%, 20%, 25%, 30%, 35%, 40%, 45%, 50% or 55% and about 0.5%, 1%, 5%, 10%, Contains between 15%, 20% 25%, 30%, 35%, 40%, 45%, 50%, 55%, 60%, 65%, 70%, 75% 80% or 89% viscosity enhancing polymer . In some embodiments, the formulations described herein comprise between about 0.1% and about 50% viscosity enhancing polymer by weight of the composition. In some embodiments, the formulations described herein comprise between about 0.5% and about 30% viscosity enhancing polymer by weight of the composition. In some embodiments, the formulations described herein comprise between about 0.1% and about 20% viscosity enhancing polymer by weight of the composition. In some embodiments, the formulations described herein comprise between about 0.1% and about 10% viscosity enhancing polymer by weight of the composition. In some embodiments, the formulations described herein comprise between about 0.1% and about 1% viscosity enhancing polymer by weight of the composition. In some embodiments, the formulations described herein comprise between about 0.1% and about 0.5% viscosity enhancing polymer by weight of the composition. In some embodiments, the formulations described herein comprise between about 1% and about 30% viscosity enhancing polymer by weight of the composition. In some embodiments, the formulations described herein comprise between about 1% and about 10% viscosity enhancing polymer by weight of the composition. In some embodiments, the formulations described herein comprise between about 10% and about 80% viscosity enhancing polymer by weight of the composition. In some embodiments, the formulations described herein comprise between about 10% and about 50% viscosity enhancing polymer by weight of the composition. In some embodiments, the formulations described herein comprise between about 10% and about 30% viscosity enhancing polymer by weight of the composition. In some embodiments, the formulations described herein comprise between about 20% and about 75% viscosity enhancing polymer by weight of the composition. In some embodiments, the formulations described herein comprise between about 20% and about 65% viscosity enhancing polymer by weight of the composition. In some embodiments, the formulations described herein comprise between about 20% and about 50% viscosity enhancing polymer by weight of the composition. In some embodiments, the formulations described herein comprise between about 25% and about 75% viscosity enhancing polymer by weight of the composition. In some embodiments, the formulations described herein comprise between about 15% and about 75% viscosity enhancing polymer by weight of the composition. In some embodiments, the formulations described herein comprise between about 30% and about 75% viscosity enhancing polymer by weight of the composition. In some embodiments, the formulations described herein comprise between about 35% and about 75% viscosity enhancing polymer by weight of the composition. In some embodiments, the formulations described herein comprise between about 40% and about 75% viscosity enhancing polymer by weight of the composition. In some embodiments, the formulations described herein comprise between about 45% and about 75% viscosity enhancing polymer by weight of the composition. In some embodiments, the formulations described herein comprise between about 45% and about 65% viscosity enhancing polymer by weight of the composition. In some embodiments, the formulations described herein comprise between about 40% and about 60% viscosity enhancing polymer by weight of the composition. In some of such embodiments, the viscosity enhancing polymer is a hydrogel, thermoreversible polymer, acrylic acid-based polymer, pH sensitive polymer, polymer sensitive to the concentration of Io (eg, in the presence of calcium ions). Alginate gel).

  In some embodiments, the formulations described herein are about 10%, 15%, 20%, 25%, 30%, 35%, 40%, 45%, 50% or 55%, and about 25%. %, 20%, 25%, 30%, 35%, 40%, 45%, 50%, 55%, 60%, 65%, 70%, 75% or 89% of a thermoreversible polymer. In some of such embodiments, the thermoreversible polymer is a poloxamer. In some embodiments, the resulting formulation is a thermoreversible gel, but it need not be thermoreversible; that is, the resulting depends on the amount of thermoreversible polymer in the composition. The gel may be thermoreversible or not thermoreversible. The classification “thermoreversible polymer” refers to a polymer capable of forming a thermoreversible gel in the range of 15 to 42 degrees Celsius. In some of such embodiments, the poloxamer is Pluronic-127 (PF-127, Pol-407). As an example, a buffered poloxamer 407 solution containing between about 15-25% poloxamer has thermoreversible gelling properties and degrades in an aqueous environment. As an example, a buffered poloxamer 407 solution containing between about 35% and about 80% poloxamer by weight of the composition and an additional solvent such as ethanol has substantially reduced thermoreversible gelling properties. It is almost stable in an aqueous solution environment. In some of such embodiments, the formulation comprising between about 35% and about 80% poloxamer, alcohol (eg, ethanol), and water by weight of the composition is about room temperature (eg, about 25 ° C.). Or high viscosity (eg, 5000-8000 cP) at approximately body temperature (eg, about 37 ° C.-42 ° C., including individuals with heat).

  In some embodiments, the formulations described herein comprise between about 10% and about 80% PF-127 by weight of the composition. In some embodiments, the formulations described herein comprise between about 10% and about 75% PF-127 by weight of the composition. In some embodiments, the formulations described herein comprise between about 15% and about 75% PF-127 by weight of the composition. In some embodiments, the formulations described herein comprise between about 20% and about 75% PF-127 by weight of the composition. In some embodiments, the formulations described herein comprise between about 25% and about 75% heat sensitive polymer of PF-127 by weight of the composition. In some embodiments, the formulations described herein comprise between about 30% and about 75% of a heat sensitive polymer of PF-127 by weight of the composition. In some embodiments, the formulations described herein comprise between about 35% and about 75% PF-127 by weight of the composition. In some embodiments, the formulations described herein comprise between about 40% and about 75% PF-127 by weight of the composition. In some embodiments, the formulations described herein comprise between about 45% and about 75% PF-127 by weight of the composition. In some embodiments, the formulations described herein comprise between about 45% and about 65% PF-127 by weight of the composition. In some embodiments, the formulations described herein comprise between about 40% and about 60% PF-127 by weight of the composition.

Buffer In some embodiments, the formulations described herein comprise a buffer. In one embodiment, the buffer is an acetate or citrate buffer at slightly acidic pH. In one embodiment, the buffer is a sodium acetate buffer having a pH of about 4.5 to about 6.5. In one embodiment, the buffer is a sodium citrate buffer having a pH of about 5.0 to about 8.0, or about 5.5 to about 7.0.

  In an alternative embodiment, the buffer used is tris (hydroxymethyl) aminomethane, bicarbonate, carbonate or phosphate at a slightly basic pH. In one embodiment, the buffer is a sodium bicarbonate buffer having a pH of about 6.5 to about 8.5, or about 7.0 to about 8.0. In another embodiment, the buffer is a dibasic sodium phosphate buffer having a pH of about 6.0 to about 9.0.

  In some embodiments, the concentration of the buffer component is adjusted to bring the actual osmolarity of any formulation described herein within the biocompatible range.

Solvents In some embodiments, the release characteristics of the concentrated formulation are altered by the selection of an appropriate solvent or solvent combination. In some embodiments in the formulations described herein, the solvent is water. In some embodiments, the formulations described herein comprise a mixture of solvents (eg, a mixture of water and an additional solvent such as an alcohol). In some embodiments, the formulations described herein include additional solvents including, but not limited to, ethanol, propylene glycol, PEG 400, DMSO, N-methylpyrrolidone or any other suitable solvent for the ear. . In some embodiments, the additional solvent is a water miscible solvent. In some embodiments, following administration of a formulation comprising a mixture of solvents, diffusion into the body fluid and / or biological fluid thereby concentrating the composition. In some embodiments, the additional solvent is between about 5% and about 50%, between about 10% and about 40%, between about 10% and about 30%, or between about 10% and about 20%. Including the solvent present in the formulations described herein between. As an example, the formulations described herein comprise water (including water in a buffer) as a solvent and ethanol as an additional solvent. FIG. 15 shows a comparison of the in vitro release characteristics of an otic agent in middle ear fluid from a composition comprising water as a solvent and a composition comprising a mixture of water and ethanol. FIG. 16 shows a comparison of in vivo release characteristics of an otic agent in middle ear fluid from a composition comprising water as a solvent and a composition comprising a mixture of water and ethanol.

  In some embodiments, in the formulations described herein, the solvent is water. In some embodiments, the formulations described herein comprise a mixture of solvents (eg, a mixture of water and a further such as an alcohol). In some embodiments, in the formulations described herein, the solvent is a mixture of ethanol and water.

Additional excipients In some embodiments, the formulations described herein further comprise additional biocompatible excipients. Examples of additional excipients include agents for imaging and / or visualization, penetration enhancers (including but not limited to alkyl sugars such as dodecyl maltose glycosides), hyaluronic acid (including but not limited to Hyalastine®) Trademark), Hyallectin®, Hyalofil®, and / or partial esters and / or salts thereof (eg, barium salts of hyaluronic acid, or hyaluronic acid as described in WO / 1998/017285) Release characteristics of other salts, including salts described therein, including hyaluronidase (eg, PH-20 (Halzoyme)), or any formulation described herein And / or stability and / or permeability and / or drug uptake and / or bioavailability And / or toxic and / or any other excipients that modulate immune and / or gelling properties. Additional excipients are described in U.S. Application Nos. 12 / 427,663, 12 / 466,310, 12 / 472,034, 12 / 486,697, 12 / 493,611, 12 / 494,156, 12 / 500,486, 12 / 504,553, 12 / 506,091, 12 / 506,127, 12 / 506,573, 12/506 616 and 12 / 506,664, the disclosure of excipients described therein is incorporated herein by reference.

Methods of Dosing In some embodiments, the formulations described herein are perfused with otic and / or sinus structures. In some embodiments, the formulations described herein are placed in an intrathecal space, in the intrathecal cavity, or around a sinus structure (eg, nasal polyp, swollen turbinate). , Administered to the synovial cavity, to the ear (eg, by injection in the middle ear, at or near the round window membrane of the ear) by a needle or cannula or catheter. In some embodiments, the formulations described herein are administered as drops, paints, foams, in situ sponges, and the like.

Frequency of administration In some embodiments, the compositions disclosed herein are administered once to an individual in need thereof. In some embodiments, the compositions disclosed herein are administered more than once to an individual in need thereof.

  The number of times a composition is administered to an individual in need thereof depends on the judgment of the physician, the disorder, the severity of the disorder, and the individual response to the formulation. In some embodiments, the formulations described herein are administered prophylactically, therapeutically, or as a chronic treatment over an extended period of time.

  If the patient's condition improves, continue to administer the active agent compound at the discretion of the physician; or temporarily reduce or discontinue the dose of the drug being administered for a specified period of time Sometimes (drug holiday). The length of the drug holiday varies from 2 days to 1 year, and by way of example only 2, 3, 4, 5, 6, 7, 7, 10, 12, 15, Includes 20 days, 28 days, 35 days, 50 days, 70 days, 100 days, 120 days, 150 days, 180 days, 200 days, 250 days, 280 days, 300 days, 320 days, 350 days, and 365 days . The dose reduction during the drug holiday can be 10% to 100%, by way of example only 10%, 15%, 20%, 25%, 30%, 35%, 40%, 45%, 50% , 55%, 60%, 65%, 70%, 75%, 80%, 85%, 90%, 95%, and 100%.

  Once the patient's activity symptoms improve, a maintenance active drug dose is administered if necessary. Thereafter, depending on the symptoms, the dosage and / or frequency of administration is optionally reduced until the improved disease, disorder or condition is maintained. In certain embodiments, patients require intermittent treatment on a long-term basis upon any recurrence of symptoms.

<Kit / Product>
In some embodiments, the pharmaceutical formulations described herein are manufactured as ready to use a single component solution that is administered to an individual in need thereof. In other embodiments, the pharmaceutical formulations described herein comprise dry heat sterilized multiparticulate (eg, micronized, nanoparticles, non-constant particles) active drug powder, dried powder. Manufactured as a multi-component kit comprising a medium for reconstitution (eg, sterile water or buffer or saline) and / or a solution containing a heat sensitive polymer and a buffer. The dried powder is reconstituted with a sterile medium and / or solution containing a thermosensitive polymer and buffer just prior to administration of the pharmaceutical formulation to an individual in need thereof.

Example 1-Preparation of heat sensitive gel dexamethasone composition containing micronized dexamethasone powder

  A 10 g batch of gel formulation containing 2.0% dexamethasone is prepared. Powdered 13.8 mg sodium phosphate dibasic dihydrate USP (Fisher Scientific.) And 3.1 mg sodium phosphate monobasic monohydrate USP (Fisher Scientific.) + 74 mg sodium chloride USP (Fisher Scientific.) Is dissolved in 8.2 g of sterile filtered deionized water (DI water) and the pH is adjusted to 7.4 with 1 M NaOH. The buffer solution was cooled and the appropriate amount of poloxamer 407 (BASF Corp. containing about 100 ppm BHT) or the resulting poloxamer (see Example 15 below) was mixed with chilled PBS while mixing. Shake into solution and mix solution until all poloxamers are dissolved. The poloxamer is sterile filtered using a 33 mm PVDF 0.22 μm sterile syringe filter (Millipore Corp.) and delivered in a sterile environment to a 2 mL sterile glass vial (Wheaton) where the vial is a sterile butyl rubber stopper Tighten with (Kimble) and press-fit with a 13 mm Al seal (Kimble). 20 mg of micronized dexamethasone is placed in a separate clean pyrogen-free vial, the vial is tightened with a sterile butyl rubber stopper (Kimble), and crimp sealed with a 13 mm Al seal (Kimble). Are sterilized by dry heat at 140 ° C. for 7 hours (by Fisher Scientific Isotemp oven). Prior to administration for the experiments described herein, 1 mL of cold poloxamer solution was transferred to 20 mg of sterile fine powder using a 21 G needle (Becton Dickinson) attached to a 1 mL sterile syringe (Becton Dickinson). Deliver to a vial containing dexamethasone, and mix well by shaking the suspension to ensure that the suspension is homogeneous. The suspension is then collected using a 21G syringe and the needle is replaced with a 27G needle for administration.

<Example 2-5> Preparations each containing amoxicillin, moxifloxacin, triamcinolone and prednisolone are prepared using the above procedure.

<Example 6-Preparation of heat-sensitive gel zoledronate composition>
<16% poloxamer 407NF in 50 mM TRIS buffer>: 0.4518 g sodium chloride (Fisher scientific) + 0.6034 g tromethamine (Fisher scientific), dissolve in 82 g DI water, then 850 μL 5 N HCl To pH 7. The osmolarity of the solution is 277 mOsm / kg. Weigh out 67.3 g of the above buffer, cool the buffer, and then sprinkle 12.8 g of Poloxamer 407 NF (Spectrum chemicals) while mixing. Stir until a clear solution is obtained. The solution is filter sterilized using a 0.2 μm sterilizing filter.

  A 3.4 mM formulation of zoledronic acid in 16% P407 in 50 mM TRIS buffer was transferred to 17 g of 16% poloxamer 407 in 50 mM TRIS buffer to zoledronic acid monohydrate (Betapharma) 17. Prepared by dissolving 6 mg, pH was adjusted to 7.3 with 5N NaOH.

  The zoledronic acid 3.4 mM formulation complexed with 16% P407 calcium in 50 mM TRIS buffer, 17.6 mg zoledronic acid monohydrate (Betapharma), 50 mM TRIS The pH was adjusted to 7.3 with 5N NaOH, adjusted by dissolving in 17 g 16% poloxamer 407 in buffer. Thereafter, 2 mg of calcium chloride anhydride was added to 2 mL of the above solution and the mixture was stirred until homogeneous.

  Lysis was performed at 37 ° C. in snap wells (6.5 mm diameter polycarbonate membrane with 0.4 μm successor). 0.2 mL of the formulation was placed in a snap well and allowed to cure, then 0.5 mL of 0.9% saline was placed in the reservoir and shaken at 70 rpm using a Labline orbit shaker. Samples are taken every hour (0.1 mL is removed and replaced with warm buffer). Samples were analyzed for zoledronic acid concentration at 215 nm UV using an Evolution 160 UV / Vis spectrophotometer (Thermo Scientific). Quantification was performed against external calibration standards.

Example 7-Preparation of heat sensitive gel JNK inhibitor composition
Dispersing 5.3 mg SP600125 (LC Labs) in 994.7 mg 16% P407 in 50 mM Tris buffer with a formulation containing 0.5% w / w SP600125 in 16% poloxamer 407 It was produced by. When the solubility in the gel was measured, it was 190 μg / mL. The reported water solubility of SP600125 is 11 μg / mL with a LogD (7.4) of 3.2 and a melting point of 183 degrees.

  The solubility test was performed as described above. The MDT for 0.5% SP600125 in 16% poloxamer 407 gel was calculated to be 60 hours.

Example 8-Preparation of a thermosensitive gel vascular inhibitor composition comprising poloxamer 407, alone or in combination with poloxamer 188>
<2% amitriptyline HCl in 16% poloxamer 407> 102 mg of amitriptyline HCl (MP biomedicals) was quantified to 5 g with 16% poloxamer 407 in 50 mM TRIS buffer, pH 6.8- (QS to 5g). Until amitriptyline dissolved, the mixture was stirred. The Tgel measurement is 0.08 rpm (shear rate 0.31 s-1) equipped with a temperature control unit (temperature ramped from 15 to 37 ° C. at 1.6 degrees / min). ) Using a Brookfield viscometer RVDV-II + P equipped with a CP-51 spindle rotating. Tgel was measured at 30.7 ° C.

<2% meclizine di-HCl (final pH 4.7) in 16% poloxamer 407/2% poloxamer 188 in TRIS buffer>: 100.5 g of meclizine dihydrochloride (MP biomedicals) Quantified to 5.023 g with a solution of 16% poloxamer 407/2% poloxamer 188 in 50 mM TRIS buffer. 20 microliters of 5N NaOH was adjusted to pH 4.7, mixed until clear and filtered through a 0.22 μm PES syringe filter. The gelation temperature of this formulation was 26 ° C.

<2% meclizine dihydrochloride (final pH 6.8) in 16% poloxamer 407/1% poloxamer 188 in TRIS buffer> 102.5 g of meclizine hydrochloride (MP biomedicals) in 50 mM TRIS buffer Of 16% poloxamer 407/1% poloxamer 188 was quantified to 5.023 g. 1 mL of the above solution was taken, 7 μL of 5N NaOH was added, the pH was adjusted to 6.8, and the resulting suspension was mixed until it was homogeneous. The gelation temperature of this formulation was 24 ° C.

Example 9-Preparation of heat sensitive gel composition comprising micronized ciprofloxacin hydrate powder or ciprofloxacin powder and micronized dexamethasone powder>
Using the procedure in Example 1, the following formulations, formulations containing gelling temperature modifiers (Formulations A and C), and formulations containing P407 alone (Formulation B) are prepared.

  Compare the gelation temperatures of formulations A, B and C. Formulation A is expected to gel at approximately body temperature, Formulation B is expected to gel at temperatures above body temperature, and Formulation C is expected to gel at approximately body temperature. Therefore, P188 is expected to be a gelling temperature lowering agent in Formulation A.

  Carboxymethylcellulose is expected to be a gelling temperature raising agent in Formulation C.

Example 10 Effect of pH on degradation products for autoclaved 17% poloxamer 407NF / 2% active agent in PBS buffer>
A stock solution of 17% poloxamer 407/2% active agent was added to 351.4 g sodium chloride (Fisher Scientific.), 302.1 mg sodium phosphate dibasic anhydride (Fisher Scientific.), 122.1 mg Sodium phosphate monobasic anhydride (Fisher Scientific.) And the appropriate amount of active agent are prepared by dissolving with 79.3 g of sterile filtered DI water. The solution is cooled in an ice bath, after which 17.05 g of Poloxamer 407NF (SPECTRUM CHEMICALS) is sprinkled into the cooled solution while mixing.
The mixture is further mixed until the poloxamer is completely dissolved.
The pH of this solution is measured.

  17% poloxamer 407/2% active agent in PBS pH 5.3. Remove the aliquot (approximately 30 mL) of the stock solution and add 1 M HCl to adjust the pH to 5.3.

  17% poloxamer 407/2% active agent in PBS pH 8.0. Remove an aliquot (about 30 mL) of the stock solution and add 1 M NaOH to adjust the pH to 8.0.

  PBS buffer (pH 7.3) dissolves sodium chloride (Fisher Scientific.) 805.5 mg, sodium phosphate dibasic anhydride (Fisher Scientific.) 606 mg, sodium phosphate monobasic anhydride (Fisher Scientific.) 247 mg And then quantified (QS) to 200 g using sterile filtered DI water.

  A 2% solution of the active agent in PBS pH 7.3 is prepared by dissolving the appropriate amount of active agent in PBS buffer and then quantified to 10 g using PBS buffer.

  1 mL of sample is individually placed in a 3 mL screw cap glass vial (with rubber lining) and tightened. Place vials in Market Forge-sterilmatic autoclave (setting, slow liquid) and sterilize at 250 ° F. for 15 minutes. After autoclaving, the sample is left to cool to room temperature and then placed in the refrigerator. The sample is homogenized by mixing the vials while cooling.

  Observe and record appearance (eg, discoloration and / or precipitate). HPLC analysis using a 30-80 acetonitrile gradient (1-10 min) (water-acetonitrile mixture containing 0.05% TFA) for a total of 15 min, Luna C18 (2) (3 μm, 100 mm, 250 × 4.6 mm column). Dilute the sample by taking 30 μL of sample and dissolving in 1.5 mL of 1: 1 acetonitrile water mixture. Record the purity of the active agent in the autoclaved sample.

  Formulations containing gentamicin, ciprofloxacin, and micronized dexamethasone prepared by the procedure are tested using the procedure to determine the effect of pH on degradation during the autoclaving step.

Example 11 Effect of Buffer Type on Degradation Product for Formulation Containing Poloxamer 407NF After Heat Sterilization (Pressure Sterilization)>
TRIS buffer was made by dissolving 377.8 mg sodium chloride (Fisher Scinific) and 602.9 mg tromethamine (Sigma Chemical Co.), then quantified (QS) to 100 g with sterile filtered DI water, The pH was adjusted to 7.4 with 1M HCl.

  Stock solution containing 25% poloxamer 407 solution in TRIS buffer: Weigh 45 g of TRIS buffer, cool in ice-cold bath, and then mix 15 g of poloxamer 407NF (Spectrum Chemicals) into buffer. Put it in. The mixture is further mixed until all poloxamers are completely dissolved.

  A series of formulations is prepared with the stock solution. The appropriate amount of active agent (or salt or prodrug thereof) and / or active agent (or salt or prodrug thereof) as micronized / coated / liposomal particles is used in all experiments.

<Storage solution containing 25% poloxamer 407 solution in PBS buffer (pH 7.3)> The above PBS buffer solution is used. 704 mg of sodium chloride (Fisher Scientific), 601.2 mg of sodium phosphate dibasic anhydride (Fisher Scientific) and 242.7 mg of sodium phosphate monobasic anhydride (Fisher Scientific) were aseptically filtered to 140.4 g. Dissolve in DI water. The solution is cooled in an ice-cold water bath, after which 50 g of poloxamer 407NF (SPECTRUM CHEMICALS) is sprinkled into the cold solution while mixing. The mixture is further mixed until the poloxamer is completely dissolved.

  A series of formulations is prepared with the stock solution. The appropriate amount of active agent (or salt or prodrug thereof) and / or active agent (or salt or prodrug thereof) as micronized / coated / liposomal particles is used in all experiments. Tables 4 and 5 are a list of samples prepared using the procedure described above. An appropriate amount of active agent is added to each sample to provide the active agent in the sample at a final concentration of 2%.

  Place 1 mL samples separately into 3 mL screw cap glass vials (with rubber lining) and tighten tightly. Vials are placed in a Market Forge-sterilmatic autoclave (setting, slow liquid) and sterilized at 250 ° F. for 25 minutes. After autoclaving, leave the sample and cool to room temperature. Place vials in refrigerator and mix while homogenizing while cooling.

  HPLC analysis using a 30-80 acetonitrile gradient (1-10 min) (water-acetonitrile mixture containing 0.05% TFA) for a total of 15 min, Luna C18 (2) (3 μm, 100 mm, 250 × 4.6 mm column). Dilute the sample by taking 30 μL of sample and dissolving in 1.5 mL of 1: 1 acetonitrile water mixture. Record the purity of the active agent in the autoclaved sample. The stability of the formulations in TRIS buffer and PBS buffer is compared.

  Viscosity measurements were taken at 0.08 rpm (temperature ramped) equipped with a water jacketed temperature control unit (temperature ramped from 15 to 34 ° C. at 1.6 ° C./min). This is done using a Brookfield viscometer RVDV-II + P equipped with a CPE-51 spindle rotating at a shear rate of 0.31 s-1). Tgel is defined as the inflection point of the curve where the increase in viscosity occurs due to the sol-gel transition. Only formulations that show no change after pressure sterilization are analyzed.

  Formulations containing gentamicin, ciprofloxacin, dexamethasone were tested using the procedure described above, 2% degradation products after heat sterilization (autoclaved), and formulation containing active agent and 17% poloxamer 407NF The viscosity is measured. The stability of the formulation containing the micronized active agent is compared to the non-micronized formulation comparison.

<Example 12: Adjustment of gel temperature>
The effect of poloxamer 188 and sodium dexamethasone phosphate on the gelation temperature and viscosity of poloxamer 407 is evaluated for the purpose of manipulating the gelation temperature.

  A 25% poloxamer 407 stock solution in PBS buffer and the PBS stock solution from Example 11 were used. Poloxamer 188NF from BASF was used.

  The average dissolution time (MDT) for 20% poloxamer 407/10% poloxamer 188 was measured at 2.2 hours, indicating that 20% poloxamer 407/5% poloxamer 188 is 2.6 hours. It was. Table 7 shows that the change is the gelation temperature upon incorporation of the mixture of polymers in the composition.

The data obtained can be fitted to a formula and the formula can be used to approximate the gelation temperature of the F127 / F68 mixture (17-20% F127 and 0-10% F68).
T _gel = −1.8 (% F127) +1.3 (% F68) +53

The data obtained was fit to the formula and using the formula, the results obtained in Examples 6 and 8 were used to gel a F127 / F68 mixture (17-25% F127 and 0-10% F68). The average dissolution time (hours) can be estimated based on the crystallization temperature.
MDT = −0.2 (T _gel ) +8

<Effects on gelation temperature regulator and PK in guinea pigs after intramural administration>
Table 8 describes the following formulations that were prepared:

  Samples were prepared using the following general method.

  A Tris buffer in saline-deionized water was made, followed by the addition (or absence) of a modulator. The osmolarity of this mixture was adjusted to 250-300 mOsM / kg if necessary. The solution was then cooled and poloxamer 407 was sprinkled while mixing until a clear solution was obtained. This solution was sterile filtered and added to sterile dexamethasone containing enough dexamethasone to reach a concentration of 1.5% w / v dexamethasone. Tgel and maximum viscosity were measured as described herein.

  Guinea pigs were dosed 50 μl by delivery in the middle ear and PK in the perilymph was measured as described herein. Table 9 lists specific measurements.

<Example 13: Comparison of in vitro release characteristics>
Dissolution is performed in a snap well (0.4 mm diameter, 6.5 mm diameter polycarbonate membrane) at 37 ° C. and 0.2 mL of the gel formulation described herein is placed in the snap well and left to stand. Allow to cure, then place 0.5 mL of buffer in the reservoir and shake at 70 rpm using a Labline orbit shaker. Samples are taken every hour (remove 0.1 mL and replace with warm buffer). Samples are analyzed by UV at 245 nm against an external calibration standard curve for the concentration of active agent. Pluronic concentration is analyzed at 624 nm using the cobalt thiocyanate method. Determine the relative rank order of mean dissolution time (MDT) as a function of% P407. The linear relationship between the mean dissolution time (MDT) of the formulation and the P407 concentration indicates that the active agent is released by the erosion of the polymer gel (poloxamer) and not via diffusion. Yes. A non-linear relationship indicates the release of the active agent by a combination of diffusion and / or alteration of the polymer gel.

  MDT is inversely proportional to the release rate of the active agent from the compositions described herein. Experimentally, the released active agent is optionally fitted to the Korsmeyer-Peppas equation.

Where Q is the amount of active agent released at time t, Qα is the total amount of active agent released, k is the nth order release constant, n is a dimensionless number with respect to the dissolution mechanism, b is the axial intercept and n = l characterizes the initial burst release mechanism that characterizes the erosion suppression mechanism. The mean dissolution time (MDT) is the sum of the different time intervals where the drug molecules remain in the matrix before release divided by the total number of molecules and is calculated by the following formula:

  Alternatively, samples were analyzed using the method described in the Li Xin-Yu literature (Acta Pharmaceuticalsina Sica 2008, 43 (2): 208-203) and the mean dissolution time (MDT) as a function of% P407. Determine the rank order.

Example 14 Influence of Poloxamer Concentration and Active Agent Concentration on Release Kinetics
A series of compositions containing various changes in gelling agent and micronized dexamethasone concentrations were formulated using the procedure described above. The average dissolution time (MDT) of each composition in Table 3 was measured using the procedure described above.

  The effect of gel strength and active agent concentration on the release kinetics of active agent from the formulation was determined by measuring MDT for poloxamer and MDT for active agent. The active agent half-life and mean active agent residence time (MRT) were determined for each formulation by measuring the concentration of active agent in the perilymph using the Korsmeyer-Peppas described herein.

<Example 15 Purification of Poloxamer>
<Method A> Poloxamer 407 (BASF Corporation, Lot WPEB612B)) is dissolved in a 75/25 water / isopropanol v / v solution. The solution is equilibrated at 27 ° C. Sodium chloride is added by vigorous mixing and the solution is centrifuged to give two clear and colorless phases. Drain the lower phase and dilute the solution again to near its original weight / volume by adding a water / isopropanol 75/25 v / v solution, equilibrate at 27 ° C. and add sodium chloride. The solution is centrifuged to form two distinct and colorless phases. The lower phase is drained a second time and returned to its initial weight by adding a water / isopropanol solution, and sodium chloride is added as previously described. The resulting solution is centrifuged and the lower phase is drained and discarded. The upper phase from the third extraction is dried and then extracted with chloroform. The chloroform layer is then evaporated in a vacuum. The residue is dried under vacuum.

<Method B> Poloxamer 407 from BASF Corporation, Mount Olive, NJ is dissolved in deionized water. The solution is kept near freezing and then ammonium sulfate is added. The solution is equilibrated at 2 ° C. to form two separate phases, after which the lower phase is discarded and the upper phase is collected and weighed. Deionized water is added and the solution is equilibrated at 2 ° C., followed by the addition of ammonium sulfate with stirring. After dissolving the salt, the solution is kept at approximately 2 ° C. until two phases are formed. The upper phase is separated and diluted with deionized water. Cool the solution to about 2 ° C. and add ammonium sulfate. The phases are allowed to separate as described above. The upper phase is separated and extracted with dichloromethane. Two phases are allowed to form overnight. The organic phase (lower phase) is separated and dried over sodium sulfate. The dichloromethane phase is filtered through a PTFE filter (0.45 μm pore size) to remove undissolved salts. The dichloromethane is removed in vacuo and the residue is dried overnight in an oven.

Sample Preparation The following ciprofloxacin / dexamethasone samples were prepared as follows.

  Cold 16% P407 in 50 mM TRIS buffer saline (molar osmolarity of pH 7.4 and 280 mOsM) is placed in an empty container and then ciprofloxacin free base or ciprofloxacin free base water The Japanese product (3.5 mol) was sprinkled while mixing. The ciprofloxacin suspension was mixed for at least 10 minutes, after which micronized dexamethasone was added slowly while mixing. The homogeneous suspension was then transferred to 3 mL vials and filled with different volumes (v1 = 4 g, v2, 3 g and v3 2 g). The glass vial was sealed with a West stopper (fluorote coated) and an aluminum seal and then autoclaved at 250 ° F. for 30 minutes.

  The following dexamethasone suspension was prepared by dispersing micronized dexamethasone in either 2% P407 or 10% P407 at a concentration of 28% dexamethasone. Thereafter, 1 mL of the homogeneous suspension was transferred to a 20 mL vial. The glass vial was sealed with a Weststop (fluorote coated) and aluminum seal and then autoclaved to 250 ° F. for 30 minutes.

  When ciprofloxacin free base is used, a clear increase in particle size is seen after autoclaving, mainly as an increase in ciprofloxacin needle size. When ciprofloxacin free base hydrate is used above a concentration of 3%, minimal growth or recrystallization is observed after pressure sterilization.

  Higher viscosity of suspension made with 2% ciprofloxacin / 0.7% dexedrine compared to the viscosity observed with 6% ciprofloxacin hydrate / 2% dexamethasone Is seen. Minimal degradation or change is observed when dexamethasone is autoclaved at high concentrations with up to 10% P407.

<Example 16-Dry heat sterilization of dexamethasone>
Place 10 mg of micronized dexamethasone powder (Spectrum lot XD0385) into a 2 mL glass vial, seal with a 13 mm butyl strubber stopper (Kimble) and dry at different temperatures for 7-11 hours. Put in the vessel.

  HPLC analysis was performed using a 30-95 gradient (1 to 35) of solvent B (solvent A 35% methanol: 35% water: 30% acetate buffer, solvent B 70% methanol: 30% acetate buffer pH 4). 6 minutes) followed by an Agilent 1200 equipped with a Luna C18 (2), 3 μm, 100 Å, 250 × 4.6 mm column using a uniform concentration (95% solvent B) for 11 minutes and a total run of 22 minutes. Used. Samples were dissolved in ethanol and analyzed. Dry heat sterilization of micronized dexamethasone at temperatures up to 138 ° C. did not affect the particle size distribution of micronized dexamethasone. HPCL analysis showed 99% purity of micronized dexamethasone sterilized by dry heat.

  Dry heat sterilized dexamethasone is optionally aseptically mixed with a sterile filtered poloxamer solution prior to administration.

Example 17-Preparation of heat sensitive gel containing dexamethasone and moxifloxacin

  A formulation comprising micronized dexamethasone and moxifloxacin is prepared according to Example 1 above. Fractionated poloxamer is prepared according to Example 15 described herein.

Example 18-Preparation of a composition comprising micronized dexamethasone powder and ciprofloxacin powder

<2% dexamethasone and 2% ciprofloxacin HCl in 16% poloxamer 407>
115.5 mg of ciprofloxacin HCl (LKT laboratories) + 100.2 mg of micronized dexamethasone (Pfizer) are suspended in 5 g weight with 16% poloxamer 407 in TRIS buffer and the pH is adjusted to 7 with 60 μL of 5 N NaOH. .5.

<2% dexamethasone in 2% Poloxamer 407 50% / 25% ethanol / 25% water, 2% ciprofloxacin HCl>
Weigh pluronic F127 (Sigma Chemical Co) 2.5 g + ethanol (200 proof, Acros) 1.25 g. The mixture was dissolved by adding heat (40-60 ° C.), after which 1.25 g of water was added during mixing. Ciprofloxacin HCl (LKT laboratories) 115.6 mg + micronized dexamethasone (Pfizer) 111.7 mg were suspended in poloxamer / ethanol / water.

  Poloxamer 407 50% / ethanol 25% / water 25% is sterile filtered through a 0.22 μm PES syringe filter. The P407 / EtOH / water mixture has an initial viscosity of about 3000-8000 cP and is concentrated upon administration.

  In a snap well (a polycarbonate membrane having a pore size of 0.4 μm and a diameter of 6.5 mm), dissolution is carried out at 37 ° C., 0.2 mL of the preparation is placed in the snap well, left to cure, and then 0.9. 0.5 mL of normal saline was placed in the reservoir and shaken at 70 rpm using a Labline orbit shaker. Samples were taken every hour (remove 0.1 mL and replace with warm buffer). Samples are analyzed for dexamethasone and ciprofloxacin concentrations using an Evolution 160 UV / Vis spectrophotometer (Thermo Scientific) by UV at 245 and 270 nm, respectively. Quantification was performed against an external calibration standard.

Examples 19-21 A formulation containing the combination of amoxicillin + triamcinolone, moxifloxacin + prednisolone, and zoledronicate + dexamethasone is prepared using the procedure described above.

Example 22 Production and Properties of Ciprofloxacin Hydrogel Formulation
<3% ciprofloxacin hydrogel>
Weigh out 1.1399 g NaCl (fisher lot 080788) + 1.50222 g tromethamine (fisher lot 081507) + 205 g Millipore DI water. Dissolve and adjust to pH 7.75 with a final osmolarity of 273 mOsm / kg with ~ 1.8 mL of 5N HCl solution. Weigh 58.8 g of the above buffer and allow to cool, then shake poloxamer 407NF (BASF lot WPNF580C) 11.291 g while mixing and mix until completely dissolved. Weigh 64.8 g of 16% P407 (solution above) into a 100 mL glass bottle containing a 35 mm stir bar and then sprinkle 2.2915 g of ciprofloxacin hydrate (Neuland lot CHI071000). While cooling, mix for at least 2 hours on an 11 minute setting (IKA stir plate), then fill 31 2 mL vials with approximately 2 g of suspension and plug them into them with a 13 mm West stopper. They are sealed with Al seals and autoclaved at 250 ° C. for 30 minutes.

<Discharge characteristics>
In a snap well (0.4 μm pore diameter, 6.5 mm diameter polycarbonate membrane), dissolve at 37 ° C., place 0.2 mL of gel in the snap well, let stand and cure, 0.9% Saline 0.5 mL was placed in the reservoir and shaken at 70 rpm using a Labline orbit shaker. Samples were taken every hour (all saline was removed and replaced with warm 0.9% saline with an osmolarity of 290 mOsm). Samples were analyzed for ciprofloxacin by HPLC.

<Flow characteristics>
The Tgel measurement is rotated at 0.08 rpm equipped with a temperature control unit (temperature is ramped to 15-37 ° C. at 1.6 ° C./min) (shear speed 0.31 s ⁻¹ ) This is done using a Brookfield viscometer RVDV-II + P equipped with a CP-51 spindle. Viscosity was measured at 20 ° C. using a Brookfield viscometer RVDV-II + P with a CP-40 spindle with shear rate from 7.5 to 375 s ⁻¹ . Data was fitted to the Casson model to calculate the plastic viscosity of the formulation and to obtain the yield stress of the drug product.

  The chromatographic purity of ciprofloxacin is shown in the table below.

<12% ciprofloxacin hydrogel>
Weigh 126.1 g of the above buffer (3% ciprofloxacin hydrogel), allow to cool, and add 24.0 g of Poloxamer 407 NF (BASF lot WPNF580C) to the solution while mixing to dissolve completely. Mix until. Weigh 34.68 g of 16% P407 (the above solution) into a 100 mL glass bottle containing a 35 mm stir bar, and then sprinkle 5.38 g of ciprofloxacin hydrate (Neuland lot CHI071000). While cooling, mix for at least 2 hours at 11 min setting (IKA stir plate), then 7 2 mL vials with approximately 2 g suspension and 1 3 mL with 3 g suspension Of vials, and one 10 mL vial with 8 g of suspension, then stopper them with a West stopper, seal them with Al seals and autoclaved at 250 ° C. for 30 minutes.

  To prepare 0.6, 2, and 6% ciprofloxacin hydrogels, the following procedure was used: 16% P407 was delivered into a glass vial, autoclaved and then added. A specific amount of autoclaved 12% ciprofloxacin hydrate was aseptically added and mixed thoroughly (see table below for details).

  The in vitro release characteristics of the ciprofloxacin hydrogel formulation are shown below.

The viscosity of the ciprofloxacin suspension in 16% poloxamer 407 is rotated at a ramp rate of 1-50 rpm (shear speed 3.8 to 192 s) equipped with a temperature control unit (temperature setting 20 ° C.). ^-1 ) Measured using a CP-40 spindle or a Brookfield viscometer RVDV-II + P equipped with a CP-51 spindle rotating at a ramp speed of 1-50 rpm (shear speed 3.8 to 192 s ^-1 ).

  The impact force is directly proportional to the viscosity of the suspension as represented by the Poiseille equation.

Example 23-Application of an enhanced viscosity pharmaceutical formulation on a round window membrane
The formulation is prepared according to Example 1 and filled into a 5 ml glass syringe treated with silicon attached to a 27 gauge luer lock disposable needle. Lidocaine is applied topically to the eardrum and a small incision is made to visualize the middle ear cavity. The needle tip is guided onto the round window membrane and the formulation is applied directly onto the round window membrane.

Example 24-In Vivo Test of Intratympanic Injection of Formulation in Guinea Pigs
Female guinea pigs (Charles River) weighing approximately 6-8 weeks and weighing 200-300 g are used (N = 4 per group). Prior to any procedure, anesthesia is given by intramuscular route for up to 1 hour with a combination of xylazine (10 mg / kg), ketamine (40 mg / kg) and acepromazine (0.75 mg / kg). If necessary, intraperitoneal boosters corresponding to one-tenth of the original dose are administered intraperitoneally. Injection in the middle ear—The animals are positioned so that the head is tilted at the preferred angle for injection into the round window gap. Briefly, animals are administered 50 μl of a formulation containing 0-50% active agent and different concentrations of P407 under visualization with a surgical microscope. The formulation is infused through the tympanic membrane using a 27G or 30G needle into the superior poster quadrant (with a round window gap behind it). The animals are placed on a heat-controlled (40 ° C.) heating pad during the procedure and until recovery, until consciousness is restored (the animals are then returned to the animal farm). Perilymph sampling procedure-The hair behind the anesthetized guinea pig ear is shaved and sterilized with povidone-iodine. Then make an incision behind the ear and carefully scrape the muscle from above the blister. A hole is drilled through the blister with a dental bar so that the middle ear is exposed and accessible. The cochlea and round window membrane are visualized under a stereoscopic microscope. A unique microhole was manually drilled through the bony shell of the cochlea (active capsule) adjacent to the round window. The perilymph (5 μl) is then collected using a microcapillary inserted in the cochlea trumpet floor. Plasma and CSF collection methods-Blood is collected into heparin-coated tubes by cardiac puncture. A small skin incision is made just behind the top of the skull to collect cerebrospinal fluid (CSF). The skin is then scraped and the trapezius muscle is scraped off the occipital bone. Then drill a small hole through the bone. Cut the dura with a sharp scalpel and insert a micropipette to collect blood free CSF (50 μl).

<Method of analysis>
The active agent concentration is measured using high pressure liquid chromatography (HPLC) combined with mass spectrometry detection (MS). The detection limit of the method is 1.0 ng / ml. Samples (perilymph, plasma and CSF) are extracted by liquid-liquid extraction using dichloromethane: hexane: MTBE (1: 1: 1 v / v / v). The organic portion is then dried and the extract is reconstituted with a water: methanol solution (1: 1, v / v). Samples are analyzed by reverse phase HPLC (1100 series, Agilent) using an Altantis dC18 column maintained at 40 ° C. The mobile phase is nebulized with heated nitrogen at the Z-spray source / interface and the ionized compound is detected using MS / MS (Tandem quadrupole mass spectrometer, Quattro Ultima, Waters). The peak height of the active agent is measured using MassLynx software (Waters). Using MassLynx, a calibration curve is obtained by fitting the analyte / internal standard peak height ratio and standard concentration to the appropriate equation. The sample active agent concentration is then interpolated using an equation derived from the calibration curve.

<Data analysis>
Pharmacokinetic parameters are calculated using conventional non-compartmental pharmacokinetic methods. Apparent clearance (CL app) is calculated as the ratio between dose in the middle ear administered and exposure (AUC). Thus, the injection volume and concentration of active agent in the formulation is tested to determine the optimal parameters for preclinical and clinical studies.

Example 25-In Vivo Study of Intratympanic Injection of Formulation in Sheep
Female sheep (Buckham Sheep Farm, Kalamazoo, MI), approximately 2-4 years old and weighing 50-65 kg are used (N = 1, 2 ears per group). Prior to any procedure, in addition to isoflurane by inhalation, a combination of xylazine (0.22 mg / kg), glycopyrrolate (0.01 mg / kg) and ketamine (15 mg / kg) administered IM is used. Anesthetize the animal. Injection-intubated animals in the middle ear are fixed and each is placed in a reverse Trendelenburg position with a slight tilt in forehead to ensure access to the round window. Following ear washing (using Otocalm and warm saline), animals are administered 600 μl of a formulation containing 0-50% active agent and P407 under otoscope visualization. The formulation is infused through the tympanic membrane using a 25G or 27G needle into the superior inferior quadrant toward the round window gap. After drug injection, the animal is placed with its head up and tilted for approximately 30 minutes so that the administered solution can settle into the tympanic cavity. The procedure is then repeated for the other ear. Perilymph sampling procedure-Intubate and lay down on animal. Make a skin incision in the back of the ear, locate the blood vessel in the back of the ear, and ligate. Cautery is performed to expose blisters and temporal bones. Access to the middle ear using a nitrogen powered drill and a round bar. Push the middle ear ossicles aside, taking care not to damage the round window membrane. A hole is manually drilled into the cochlear basal rotation using a 0.5-1 mm circular tip bar until the bone is thin enough to penetrate with the modified sewing needle. The perilymph (50 μl) is then collected using a Hamilton syringe connected to a 28-32G needle inserted in the cochlea tympanic floor. Plasma and CSF collection methods-Blood is collected from the jugular vein into heparin-coated tubes. To collect cerebrospinal fluid (CSF), a small skin incision is made across the cisterna and a 22G needle is inserted to sample CSF (500 μl) without blood.

  Samples are analyzed as described above. The time course of gel drainage for each formulation is measured. The time course of earlier gel ejection of the formulation indicates a smaller mean dissolution time (MDT). In order to determine the optimal parameters for preclinical and clinical studies, the dosage and concentration of active agent in the formulation is thus tested.

Example 26-In vivo sustained release kinetics in the ear
A cohort of 21 guinea pigs (Charles River, 200-300 g female) containing 1.5-35% active agent by weight of formulation, buffered at 280 mOsm / kg, 15-17% Inject 50 μL of Pluronic F-127 formulation into the middle ear. Animals are dosed on day 1. Release characteristics for the formulation are determined based on analysis of perilymph and / or middle ear fluid.

<Example 27-Evaluation of otic drug formulation in otitis media animal model>
<Induction of otitis media>
Healthy adult chinchillas weighing 400-600 g and having a normal middle ear confirmed by otoscopy and tympanometry are used in these studies. To prevent the inoculum from flowing out of the ear canal, the ear canal is occluded 24 hours prior to vaccination. 4-h-log phase type 3 S. cerevisiae One milliliter of Pneumoniae strain (including approximately 40 colony forming units (CFU) individuals) is placed directly into the blisters under both middle ear chambers of the chinchilla. Control mice are inoculated with 1 milliliter of sterile PBS.

<Treatment>
S. inoculated pneumoniae and control group mice are classified into two groups (n = 10 in each group). An otic drug formulation containing amoxiline is applied to the wall of the tympanic cavity of one group of animals. A control group formulation without amoxicillin is applied to the second group. Three days after the first application, the amoxicillin and control formulations are applied again. The animals are sacrificed after 7 days of treatment.

<Analysis of results>
Middle ear fluid (MEF) is sampled 1 hour, 2 hours, 6 hours, 12 hours, 24 hours, 48 hours, and 72 hours after pneumococcal inoculation. Quantitative MEF culture is performed on sheep blood agar at a metering threshold set at 50 CFU / ml. The amount of inflammatory cells was measured with a hemocytometer, and differential cell enumeration was performed by Wright's staining.

<Example 28-Evaluation of pharmaceutical preparations for ears in animal model of otitis externa>
To exacerbate the ear canal tissue, a plastic pipette is used to induce otitis externa in 20 Sprague-Dawley rats. All rats will progress OE within 1 day. Using the needle and syringe, the formulation of Example 2 is administered to half rat ears, while the remaining rats are given the same formulation without otic agents. The ear canal tissue is observed for redness and swelling characterizing the disease. Biopsy samples from rats are analyzed using an optical microscope.

Example 29-Clinical study of otic drug formulation combined with tympanic perforation for treatment of exudative otitis media>
The purpose of this study is to prevent and / or treat middle ear infections in patients with ear tubes where a composition comprising a combination of ciprofloxacin and dexamethasone administered in combination with tympanic perforation It is to judge whether it is safe and effective.

<Research Type>: Intervention

Study design: This is a non-inferiority open label study to compare the use of sustained release of compositions in the middle ear in combination with tympanic perforation versus current standard treatments. study). Current standard treatments require the use of otic drops for 5-7 days after surgery. The study is designed to test whether administration of a sustained release composition at the time of surgery eliminates the need for outpatient treatment. The test hypothesis is that administration of a single injection of sustained release composition at the time of surgery is not inferior to administration of otic drops after surgery.

<Inclusion criteria>:
Acute otitis media with exudation in one or both ears, 6 months to 12 years, patients who did not undergo ear surgery other than tube replacement last year negatively impact the conduct of the study Patients who do not have any disease or illness do not require other systemic antibacterial treatments during the study. Use of analgesics (other than acetaminophen) is not permitted. I don't have a trend

<Exclusion criteria>: Age

<Study Design>: Divide 20 patients into two groups. A first group of patients is injected with a sustained release composition comprising micronized ciprofloxacin and micronized dexamethasone during the surgical procedure. Each patient has a tympanic perforation for tube placement. During the surgical procedure, the surgeon flushes all ear exudates and the surgeon injects the test composition into the middle ear space while the myringotomy opening is open. Following injection of the sustained release composition into the middle ear space, the tube is inserted. The test composition is formulated in the operating room by suspending a dry micronized powder of ciprofloxacin and dexamethasone, along with other excipients, or the test composition can be injected Any of the prepared suspensions ready for.

  A second group of patients received eardrops containing ciprofloxacin in non-micronized aqueous form and dexamethasone in non-micronized aqueous form as an immediate release component administered 5-7 days after surgery give.

  Monitor patients at weekly follow-up visits for one month. Any difference in treatment outcome between the two groups is recorded.

<First evaluation item>: Stop time of otorrhea recorded by parent or guardian through patient

<Second endpoint>: clinical cure rate; microbiological outcome; treatment failure; disease recurrence.

  Administration of sustained release composition comprising ciprofloxacin and dexamethasone in combination with tympanic perforation includes ciprofloxacin and dexamethasone after surgery for reduction of ear leakage, infection or inflammation associated with perforation To determine if it is more effective than administering ear fluid, the treatment results of each group of patients are compared.

Example 30-Treatment of sinusitis in animal models and evaluation of sustained release in vivo
The animal model described by Chiu et al. In American Journal of Rhinology, 2007, 21, 5-9 is used in this study.

  The white rabbit's maxillary sinus ostium is closed with a surgical pledget through a mastoid opening made in the anterior surface of the maxilla. Inoculate the sinus with Pseudomonas aeruginosa. After 7 days, the mammary sinus opening is resumed, the stoma obstruction is removed, and a single lumen catheter is placed. In one group of rabbits, saline is washed through the catheter for 7 days (placebo group), while the control group is not washed. A third test group is given a single dose of the intranasal formulation of the test. On the seventh day of the study, the rabbits are euthanized and analyzed under a light microscope to determine the bacterial count in the nasal wash. The presence of sinusitis is confirmed by pus, mucosal and underlying bony inflammation in both controls and saline washes. Reduction of bacterial count, pus and inflammation in nasal lavage fluid in the treatment group indicates an effective therapeutic outcome.

  The sustained release of the active agent is measured in a nasal wash or nasal wash using appropriate techniques for detection of the active agent in the wash solution (eg, UV spectroscopy, HPLC, mass spectrometry). Epithelial abrasion from the sinus passage is used to measure tissue exposure of the active agent.

<Example 31: Clinical trial for evaluation of intranasal preparation combined with surgery>
This is a safe and effective combination of intranasal formulation and balloon nasal surgery in reducing sinusitis recurrence in pediatric patients with long history of sinusitis and drug treatment failure This is a study to measure sex.

<Eligibility>: 2-17 years old, both genders; planned surgical procedure recommended by PI agreed by the patient's legal guardian (ie endoscopic nasal surgery, pharyngeal tonsillectomy, culture) Nasal lavage to get things); long-standing sinusitis: more than 3 mo symptoms or 6 episodes per year, and failure of 2 courses of antibiotics followed by a positive CT scan.

<Exclusion Criteria>: Extensive previous sinus surgery in target ostia; cystic fibrosis; extensive sinus osteogenesis; sinus tumor or obstructive lesion; nasal tissue History of facial trauma that distorts and makes access to nasal pores impossible; cilia dysfunction

<Study Design>: Sinus balloon expansion is performed using commercially available devices including sinus guide catheters, sinus guidewires, sinus exchange and wash catheters, sinus balloon inflation devices and sinus balloon catheters. Balloon expansion is performed using endoscopic techniques with video documentation capabilities. A single dose of intranasal formulation from Example 9 is administered via a catheter to a cavity in the sinus. Monitor the patient for one year.

<First evaluation item>:
Adverse events related to nasal cavity during balloon dilatation through 12 months;
Improvement in nasal symptoms score.

<Second evaluation item>:
Efficacy of drug treatment throughout the year; efficacy of surgery and intranasal compositions as measured by postoperative intervention treatment; days out of school; relapse rate

Example 32: Effect of intranasal composition in the treatment of nasal polyposis
The purpose of this study is that administration of the intranasal formulation of Example 9 reduces the size of the nasal polyp, reduces the thickness of the nasal polyp, and affects the symptoms of people with chronic sinusitis (CRS). It is to decide whether to relieve or not.

Eligibility: Subjects must meet CRS criteria, i.e. they (1) have at least two consecutive criteria (facial pain / pressure or headache) for at least 3 consecutive months Nasal obstruction, anterior or posterior nasal drainage, reduced olfactory / anosmia); (2) abnormal nasal CT scans in at least two nasal areas documented within 3 months of entry Endoscopic evidence must be present; subject must have bilateral polyposis evidenced by CT or endoscopy with evidence of nasal polyps, or the following area: right maxillary sinus , Left maxillary sinus, right anterior ethmoid sinus, any of the polypoid mucosa on examination in at least two, plus the smallest polyp / poly in baseline nasal examination Jo score 4, must have. Nasal polyps are defined as inconspicuous polyps that are visible in the middle nasal passage area.

<Exclusion Criteria>: Subjects who received antibiotics within 3 weeks of the screening visit; uncontrolled moderate to severe asthma (defined as FEV1 <80% in the asthma control test <19 during the week prior to entry Subject) with recent exacerbations or use of systemic steroid bursts within 6 weeks of study entry. A subject receiving a maintenance dose of a corticosteroid.

Study Design: The patient is administered a single dose of the intranasal composition of Example 9 directly into or near the nasal polyp by a catheter. Patients are monitored for one year.

<First evaluation item>
Quantification of polypoid mucosal thickening within the anterior ethmoid and maxillary sinus on sinus CT scan. Symptoms and / or recurrence of polyps.

Example 32-Evaluation of Administration of Ion Channel Modulators in Meniere Patients

Purpose of research

  The primary objective of this study is to evaluate the safety and efficacy of dexamethasone in improving Meniere's disease in human subjects.

Research design

This is a prospective, randomized, double-blind, placebo-controlled, multicenter, 1B phase comparing dexamethasone administration in the treatment of Meniere's disease in patients with unilateral disease to placebo It is a study of. Approximately 100 subjects are enrolled in this study. Each group receives a single dose of sustained release, either an ion channel modulator formulation containing dexamethasone or a placebo treatment.

  Subjects who do not complete the study will not be replaced. Patients receiving study drug are administered the gel formulation of Example 1 directly onto the subject's round window membrane and monitored for 3 months. Each patient undergoes vestibular and hearing assessments before treatment and every 2 weeks after study drug administration.

First evaluation item

  The primary objective of this study is to evaluate the safety and tolerance of two increasing doses of dexamethasone versus placebo. A safety pre-assessment will be performed for 3 months after a single intramiddle injection of dexamethasone or placebo.

Second evaluation item

  A secondary objective of this study was to evaluate the clinical activity of two doses of dexamethasone against placebo. Evaluate baseline changes in the frequency of dizziness. Measure the impact of tinnitus on daily life movements. Hearing loss in the affected ear is measured by a hearing test. The quality of life is measured by the patient's reported questionnaire. The severity of the onset of dizziness is measured by the patient's reported dizziness score.

  While preferred embodiments of the invention have been shown and described herein, such embodiments are provided by way of example only. Various alternatives to the embodiments described herein are optionally employed in carrying out the present invention. The following claims are intended to define the scope of the invention, which is intended to encompass the methods and structures within the scope of these claims and their equivalents.

Claims (34)

A pharmaceutical formulation comprising an active agent and a thermosensitive polymer comprising a copolymer of polyoxyethylene and polyoxypropylene, wherein the pharmaceutical formulation comprises:
a) having a viscosity suitable for administration with a 25-31 gauge needle and capable of being injected at the time of administration;
b) having a gelling temperature between about 14 ° C and about 42 ° C;
c) providing sustained release of a therapeutically effective amount of the active agent for at least 3 days in vivo; and
(D) having a microbial factor of less than 50 cfu per gram of formulation;
here,
(I) the formulation comprises less than 14.5% heat sensitive polymer by weight of the formulation and further comprises one or more gelling temperature raising agents; or (ii) the formulation comprises 25% by weight of the formulation And (iii) the formulation comprises between about 5% and about 20% heat sensitive polymer by weight of the formulation, and comprises one or more gelation temperature lowering agents; The sensitive polymer has been purified and further comprises one or more gel temperature raising agents or gel temperature lowering agents; or (iv) the formulation comprises between about 14.5% and about 25% by weight of the formulation Comprising a thermosensitive polymer and further comprising one or more gelling temperature raising agents or gelling temperature lowering agents,
A pharmaceutical preparation characterized by the above.   2. The formulation of claim 1, wherein the formulation provides sustained release of a therapeutically effective amount of an active agent in vivo for at least 5 days.   2. The formulation of claim 1, wherein the formulation provides sustained release of a therapeutically effective amount of an active agent in vivo for at least 7 days.   2. The formulation of claim 1, wherein the formulation is administered at or near the round window membrane of the ear.   The formulation of claim 1, wherein the in vivo sustained release occurs in the inner ear.   2. The formulation of claim 1, wherein the formulation is administered to or near one or more sinuses.   The formulation of claim 1, wherein the in vivo sustained release occurs in or near the sinus cavity.   The preparation according to claim 1, wherein the heat-sensitive polymer is P407.   The formulation according to claim 1, characterized in that the formulation is substantially free of further preservatives.   The preparation according to claim 1, wherein the preparation is substantially free of pyrogens.   2. The formulation of claim 1, wherein the formulation comprises less than about 5 endotoxin units (EU) per kg body weight of the subject.   2. A formulation according to claim 1, characterized in that the formulation is substantially free of further toxic drugs.   2. The formulation of claim 1, wherein the formulation comprises a suspension of one or more multiparticulate active agents.   14. The formulation of claim 13, wherein the multiparticulate active agent is a micronized active agent sterilized by dry heat, radiation or steam sterilization.   The formulation of claim 1, wherein the formulation has impurities associated with any individual product of 1% or less by weight of the formulation.   The formulation of claim 1, wherein the formulation has impurities related to a total product of 2% or less by weight of the formulation.   The formulation according to claim 1, wherein the active agent is a corticosteroid, or a salt, prodrug or solvate thereof.   The corticosteroid is 21-acetoxypregnenolone, alclomethasone, algestone, amsinonide, beclomethasone, betamethasone, budesonide, chloroprednisone, clobetasol, clobetazone, crocortron, clopredonol, corticosterone, cortisone, cortibazole, deflazacord, desonide, desonide Methasone, dexamethasone, diflorazone, diflucortron, diflupredonate, enoxolone, fluazacort, fluchloronide, flumethasone, flunisolide, fluocinolone acetonide, fluocinonide, fluocortin butyl, fluocortron, fluorometholone, fluperolone acetate Denacetate, fluprednisolone, fullland lenolide, full propionate Kazone, formocotal, harsinonide, halobetasol propionate, halometasone, halopredone acetate, hydrocortamate, hydrocortisone, loteprednol etabonate, madipredon, medorizone, meprednisone, methylprednisolone, mometasone furoate, parameterzone, prednisolone, prednisolone, prednisolone 25-diethylamino-acetate, prednisolone phosphate sodium, prednisone, prednival, predonidene, rimexolone, thixocortol, triamcinolone, triamcinolone acetonide, triamcinolone venetonide, or triamcinolone hexacetonide, or a salt or prodrug thereof 18. A formulation according to claim 17 characterized in that   18. The formulation of claim 17, wherein the corticosteroid is dexamethasone, prednisolone, methylprednisolone, triamcinolone, or a salt or prodrug or solvate thereof, or a combination thereof.   18. The formulation according to claim 17, wherein the corticosteroid is dexamethasone, or a salt or prodrug or solvate thereof.   The preparation according to claim 20, wherein the dexamethasone is dexamethasone sodium phosphate or dexamethasone acetate.   21. The formulation of claim 20, wherein the dexamethasone, or salt or prodrug or solvate thereof, is present in an amount from about 0.05% to about 40% by weight of the formulation.   21. The formulation of claim 20, wherein the dexamethasone, or salt or prodrug or solvate thereof, is present in an amount from about 0.1% to about 30% by weight of the formulation.   21. The formulation of claim 20, wherein the dexamethasone, or salt or prodrug or solvate thereof, is present in an amount from about 0.5% to about 15% by weight of the formulation.   21. A formulation according to any one of claims 13 to 20, wherein the formulation provides sustained in vivo release of a therapeutically effective amount of dexamethasone for at least 7 days.   The preparation according to claim 1, wherein the active agent is an antimicrobial agent.   The preparation according to claim 26, wherein the antimicrobial agent is an antibiotic.   The antibiotic is amikacin, gentamicin, kanamycin, neomycin, netilmycin, streptomycin, tobramycin, paromycin, geldanamycin, herbimycin, loracarbef, ertapenem, doripenem, imipenem, meropenem, cefaclor, cefamandole, cefotoxin, cefprozil, cefuroxime, Cefixime, cefdinir, cefditoren, cefpodoxime, ceftazidime, ceftibbutene, ceftizoxime, ceftriaxone, cefepime, ceftbiprole, vancomycin, azithromycin, clarithromycin, dirithromycin, erythromycin, roxithromycin, troleandomycin, terrethromycin Spectinomycin, aztreonam, amoxicillin, ampi Phosphorus, azulocillin, carbenicillin, cloxacillin, dicloxacillin, flucloxacillin, mezlocillin, methicillin, nafcillin, oxacillin, piperacillin, ticarcillin, bacitracin, colistin, polymyxin B, ciprofloxacin, clavulanic acid, enoxacin, gatifloxacin Lomefloxacin, moxifloxacin, norfloxacin, ofloxacin, trovafloxacin, grepafloxacin, sparfloxacin, AL-15469A, AL-38905, OP-145, mafenide, prontodyl, sulfacetamide, sulfamethizole, Sulfanilamide, sulfasalazine, sulfisoxazole, trimethoprim, cotrimoxazole, demeclocycline, doki Cyclin, minocycline, oxytetracycline, tetracycline, linezolid, arsogebaneuben chloramphenicol, clindamycin, lincomycin, ethambutol, fosfomycin, fusidic acid, furazolidone, isoniazid, linezolid, metronidazole, mupirocin, nitrofurantoin, platenci Mycin, pyrazine amide, quinupristin, dalfopristin, rifampicin, thiamphenicol, tinidazole, amoxicillin + clavulanic acid, maximine H5, dermicidin, cecropin, andropine, moricin, seratotoxin, melittin, magainin, dermaseptin, bombinine, bredinin-1, esculetin And Buforin II, CAP18, LL37, Abaecin, Apidae , Prophenine, indolicidin, brevinin, protegrin, tachypressin, defensin, drosomycin, alamethicin, pexiganan or MSI-78, MSI-843, MSI-594, polyfemsin, colicin, pyocin, clevicin, subtilin, epidermin, herbicolacin, brevicin, halocin , Agrosin, arbesin, carnosine, curbacin, giversin, enterocin, enterolysin, erwiniocin, glycinecin, lactosin, lactisin, leucossin, mesentericin, pediocin, plantaricin, sasacin, sulforobicin, vibriocin, warnerinand, nisin, or nisin Crystals, or prodrugs or solvates, or combinations thereof The formulation according to claim 27, characterized in that.   28. The formulation of claim 27, wherein the antibiotic is ciprofloxacin, amoxicillin, amoxicillin + clavulanic acid, moxifloxacin or ofloxacin.   28. The formulation of claim 27, wherein the antibiotic is ciprofloxacin or ciprofloxacin hydrate.   32. The formulation of claim 30, wherein the ciprofloxacin or ciprofloxacin hydrate is present in an amount between about 0.1 and about 20% by weight of the formulation.   32. The formulation of claim 31, wherein the formulation provides sustained release of a therapeutically effective amount of ciprofloxacin in vivo for at least 7 days. The gel temperature raising agent or gel temperature lowering agent is selected from P188, P338, cyclodextrin, Tween 20, Tween 40, Tween 65, Tween 80, Tween 85, sodium oleate, sodium caprate, sodium caprylate and PEG. The formulation according to claim 1, characterized in that:
  A kit comprising: (a) a sterilized, multiparticulate active agent powder; and (b) a solution comprising a heat sensitive polymer, wherein (a) and (b) are combined in claim 1 A kit characterized in that it forms the formulation described.