Stable corticosteroid compositions
阅读说明：本技术 稳定的皮质类固醇组合物 (Stable corticosteroid compositions ) 是由 拉马林格斯瓦尔·卡西纳 于 2019-01-10 设计创作，主要内容包括：本发明涉及包含皮质类固醇和抗氧化剂的药物组合物。本发明还涉及治疗、预防或缓解胃肠道的炎性疾病和状况的症状以及与胃肠道的炎性疾病和状况相关的炎症的方法,所述方法包括施用包含皮质类固醇和抗氧化剂的药物组合物。(The present invention relates to pharmaceutical compositions comprising a corticosteroid and an antioxidant. The invention also relates to methods of treating, preventing or ameliorating symptoms of and inflammation associated with inflammatory diseases and conditions of the gastrointestinal tract comprising administering a pharmaceutical composition comprising a corticosteroid and an antioxidant.)
1. A pharmaceutical composition comprising a corticosteroid and an antioxidant, wherein the antioxidant comprises a combination of ascorbic acid and a pharmaceutically acceptable salt of an ascorbate salt, and wherein the pharmaceutical composition does not substantially degrade in the presence of oxygen.
2. The pharmaceutical composition of claim 1, wherein the composition is substantially free of impurities formed by oxidative degradation after one month of storage.
3. The pharmaceutical composition of claim 2, wherein the composition is substantially non-discoloring after one month of storage.
4. The pharmaceutical composition of any one of claims 1-3, wherein the composition is substantially free of impurities formed by oxidative degradation and substantially free of discoloration after storage for two months.
5. The pharmaceutical composition of any one of claims 1-4, wherein the composition is substantially free of impurities formed by oxidative degradation and substantially free of discoloration after three months of storage.
6. The pharmaceutical composition of any one of claims 1-5, wherein the composition comprises less than 0.2% impurities formed by oxidative degradation after two months of storage.
7. The pharmaceutical composition of any one of claims 1-6, wherein the corticosteroid is budesonide.
8. The pharmaceutical composition of any one of claims 1-7, wherein the corticosteroid is budesonide and the antioxidant is a combination of ascorbic acid and sodium ascorbate.
9. The pharmaceutical composition of any one of claims 2-8, wherein the corticosteroid is budesonide, the antioxidant is a combination of ascorbic acid and sodium ascorbate, and the impurity formed by oxidative degradation comprises 21-dehydrobudesonide.
10. The pharmaceutical composition of any one of claims 1-9, having a pH between about 4 and about 5.2.
11. The pharmaceutical composition of any one of claims 1-10, further comprising a preservative.
12. The pharmaceutical composition of claim 11, wherein the preservative is selected from the group consisting of sodium benzoate and potassium sorbate.
13. The pharmaceutical composition of any one of claims 1-12, wherein the combination of the ascorbic acid and the salt of ascorbate is present in an amount from about 0.01% w/w to about 0.5% w/w of the composition.
14. A method of treating, preventing, or ameliorating symptoms of and inflammation associated with inflammatory diseases and conditions of the gastrointestinal tract in a subject in need thereof, comprising administering to the subject a pharmaceutical composition comprising a corticosteroid and an antioxidant, wherein the antioxidant comprises a combination of ascorbic acid and a pharmaceutically acceptable salt of an ascorbate salt.
15. The method of claim 14, wherein the corticosteroid is budesonide.
16. The method of claim 14 or 15, wherein the corticosteroid is budesonide and the antioxidant is a combination of ascorbic acid and sodium ascorbate.
17. The method of any one of claims 14-16, wherein the subject is less than 16 years of age.
18. The method of any one of claims 14-17, wherein the subject is less than 12 years of age.
19. The method of any one of claims 14-18, wherein the method of treating, preventing, or ameliorating the symptoms of and inflammation associated with inflammatory diseases and conditions of the gastrointestinal tract is a method of treating the symptoms of and inflammation associated with inflammatory diseases and conditions of the esophagus.
20. The method of any one of claims 14-19, wherein the inflammatory disease of the esophagus is eosinophilic esophagitis.
21. A kit for treating, preventing, or ameliorating symptoms of and inflammation associated with inflammatory diseases and conditions of the gastrointestinal tract in a subject in need thereof, the kit comprising a pharmaceutical composition comprising a corticosteroid and an antioxidant, wherein the antioxidant comprises a combination of ascorbic acid and a pharmaceutically acceptable salt of an ascorbate salt, and wherein the pharmaceutical composition does not substantially degrade in the presence of oxygen.
22. The kit of claim 21, wherein the corticosteroid is budesonide and the antioxidant is a combination of ascorbic acid and sodium ascorbate.
Technical Field
The present invention relates to an antioxidant pharmaceutical composition comprising a corticosteroid and an antioxidant.
Background
Esophageal inflammatory disorders are gaining increasing attention in both adults and children (recoginations). One example is eosinophilic esophagitis (EE or EoE), a emerging and rapidly growing disorder characterized by high levels of eosinophils and basal zone hyperplasia in the esophagus. Ee (eoe) is considered to be caused by food allergy or airborne allergen exposure in at least a subset of patients (1-5, 44). Ee (eoe) diagnosis is often associated with other hypersensitivity disorders including asthma, rhinitis, and other food and aerogenic allergen inhalation (39-40) sensitivities. Diagnosis is often performed, for example, in young children and depends on the finding of 15 to 20 or more to 24 or more eosinophils/high power field (eos/hpf) (6-12) in esophageal mucosa biopsy.
In parallel with other atopic disorders (atopic disorders), the incidence of ee (eoe) appears to be higher and higher (15, 35). The disorder may present with reflux-like symptoms, pain and dysphagia, clinical symptoms similar to those of gastroesophageal reflux disease ("GERD") (42). Symptoms of ee (eoe) include, for example, abdominal pain, chest pain, asphyxia, dysphagia, growth to stasis (failure to thrive), nausea, reflux which cannot be alleviated by standard anti-flow therapy (anti-flux therapy), rash or urticaria, vomiting, and weight loss. In one series, 15% of ee (eoe) patients had a concurrent developmental delay (45).
Although ee (eoe) becomes more frequently diagnosed throughout developing countries (7, 8, 13-16), many aspects of the disease remain unclear, including its etiology, natural history, and optimal therapy. The symptoms of ee (eoe) are often similar to those of GERD and include vomiting, dysphagia, pain and food impaction (8, 14, 17-20). However, the treatment of ee (eoe) and GERD is different and it is important to distinguish them, especially since untreated ee (eoe) may be associated with esophageal stenosis in 10% -30% of cases (14, 18, 20, 21). Overlap of GERD symptoms and ee (eoe) symptoms is common; failure to respond to high PPIGERD treatment may be a diagnostic guideline for ee (eoe). The common incidence of misdiagnosis of EE (eoe) as GERD often leads to delayed treatment of patients with EE (42).
Long-term systemic steroid therapy can produce significant secondary side effects on growth and skeletal development. Although treatment with anti-IL-5 monoclonal antibodies has been reported to be successful in EE, this therapy is currently not approved for use in children (36).
Current treatments include the exclusion of diets (22, 23) and elemental formulas (2, 24). Identifying truly irritating food allergens can be difficult and the elemental formulas are often unpalatable, complicating dietary intervention (1, 22). Spontaneous imbibition and swallowing skills (Improvised puff and swallowtechniques) may be difficult to perform effectively for patients, particularly smaller children and particularly children with developmental delay. This may result in less than an effective dose of the topical steroid being delivered to the esophagus.
Corticosteroid compositions have recently been developed for the treatment of EE, see U.S. patent nos. 8,679,545 and 9,050,368. These compositions are designed for oral administration to the esophagus and comprise a therapeutically active amount of a corticosteroid and several excipients.
Oxidative degradation of drugs is a well known problem to those of ordinary skill in the art. Corticosteroids, such as budesonide, degrade in the presence of oxygen. In particular, budesonide is known to undergo oxidative degradation upon storage, with the formation of undesirable 21-dehydrobudesonide (21-DHB) species. It would therefore be highly desirable to provide a pharmaceutical formulation that: wherein one or more oxidatively susceptible corticosteroid active pharmaceutical ingredients are protected from oxidative degradation inherent to long term storage. One way to combat oxidative degradation is through the use of antioxidants. Some antioxidants employed in various pharmaceutical formulations may include, inter alia, vitamin E, ascorbic acid, BHT (butylated hydroxytoluene), BHA (butylated hydroxyanisole), and the like.
A common problem observed in the appearance of pharmaceutical products is discoloration of the pharmaceutical composition. There are many potential reasons for this problem. For example, the source and manufacture of the raw materials, the composition manufacturing process, and the storage process/storage conditions. Discoloration of the composition during storage may involve interactions between the active, excipients, and packaging materials.
Accordingly, there is a need in the art to provide corticosteroid compositions that do not substantially degrade and/or discolor upon storage. There is also a need in the art to provide corticosteroid compositions that are palatable and do not have a bitter taste, and do not cause allergic reactions in most patients.
Summary of The Invention
Various non-limiting aspects and embodiments of the invention are described below.
In one aspect, a pharmaceutical composition comprising a corticosteroid and an antioxidant is provided, wherein the pharmaceutical composition does not substantially degrade in the presence of oxygen. In one embodiment, the pharmaceutical composition shows substantially no signs of oxidative degradation after one month of storage, or after two months of storage, or after three months of storage, or after four months of storage. In another embodiment, the pharmaceutical composition shows substantially no signs of oxidative degradation at 40 ℃ and 75% humidity after one month of storage, or after two months of storage, or after three months of storage or after four months of storage. In another embodiment, the corticosteroid is budesonide. In yet another embodiment, the pharmaceutical composition comprises an antioxidant comprising a combination of ascorbic acid and a pharmaceutically acceptable ascorbate salt. In yet another embodiment, the combination of ascorbic acid and a pharmaceutically acceptable salt of an ascorbate salt is present in an amount from about 0.01% w/w to about 0.5% w/w of the composition, or from about 0.05% w/w to about 0.25% w/w of the composition.
In yet another embodiment, the pharmaceutical composition may further comprise a viscosity modifier, a preservative, a flavoring agent, a sweetener, at least one additional excipient, and a pharmaceutically acceptable vehicle. In some embodiments, the pharmaceutical composition may change color after storage, for example after one month of storage, or after two months of storage, or after three months of storage, or after four months of storage. In other embodiments, the pharmaceutical composition is substantially non-discoloring after storage, for example after one month of storage, or after two months of storage, or after three months of storage or after four months of storage. In one embodiment, the pharmaceutical composition has a pH between about 4 and about 5.2. In another embodiment, the pharmaceutical composition comprises antimicrobial preservatives, such as sodium benzoate and potassium sorbate.
In another aspect, there is provided a method for treating, preventing or alleviating symptoms of and inflammation associated with inflammatory diseases and conditions of the gastrointestinal tract, e.g., the esophagus, comprising administering a pharmaceutical composition comprising a therapeutically effective amount of a corticosteroid and an antioxidant. In one embodiment, the administered pharmaceutical composition does not substantially degrade in the presence of oxygen. In one embodiment, the pharmaceutical composition is administered orally. In another embodiment, the inflammation of the gastrointestinal tract is inflammation of the esophagus.
In some embodiments, administration of the pharmaceutical compositions described herein is to an individual who has been diagnosed with: eosinophilic esophagitis, inflammatory bowel disease involving the esophagus, crohn's disease, celiac disease, proximal gastrointestinal pathology (e.g., in individuals with hypocholecystosis), eosinophilic gastrointestinal inflammation, eosinophilic duodenitis, hypereosinophilia duodenalis, functional dyspepsia, intermediate esophagitis (interstitial eosinophilias), esophageal inflammation secondary to corrosive/irritant uptake, persistent/recurrent esophageal stenosis of any cause and including corrosive/irritant uptake, pill-induced esophagitis, systemic disease, congenital disease, post-operative inflammation, intermediate esophagitis, epithelial hyperplasia, basal cell hyperplasia, papillary elongation (elongastepapile), papillary vasodilation, fungal esophagitis (e.g., candida, torulopsis, histoplasma, and the like, Aspergillus, etc.), viral esophagitis (e.g., HSV, CMV, V2V), bacterial esophagitis (e.g., tuberculosis, actinomycosis, syphilis), erosive esophagitis, radiation esophagitis, chemotherapy esophagitis, graft-versus-host disease, skin diseases involving the esophagus (e.g., bullous pemphigoid, pemphigus vulgaris, epidermolysis bullosa, Stevens-Johnson syndrome), Behcet's disease, sarcoidosis, idiopathic esophagitis, eosinophilic gastritis, Meniere's disease, parasitic gastritis (parasitic gastritis), lymphocytic esophagitis, inflammatory bowel disease-related esophagitis, parasitic gastritis, or gastroenteritis. In a particular embodiment, the subject has eosinophilic esophagitis. In some particular embodiments, the individual has been diagnosed with gastroesophageal reflux disease (GERD), non-erosive reflux disease (NERD), or erosive esophagitis. In some embodiments, the inflammation of the gastrointestinal tract is an inflammation of the stomach and/or small intestine, such as gastroenteritis. In one embodiment, the inflammation of the gastrointestinal tract is eosinophilic esophagitis (EE or EoE).
In certain embodiments, the individual to whom the pharmaceutical composition for treating, preventing, or ameliorating inflammation of the gastrointestinal tract or a symptom associated with inflammation of the gastrointestinal tract is administered is a child or an infant. In various embodiments, the child or infant is less than 16 years old, less than 12 years old, less than 8 years old, less than 6 years old, less than 4 years old, or less than 2 years old.
In some embodiments, a pharmaceutical dosage form is provided that includes a pharmaceutical composition (e.g., any of the pharmaceutical compositions described herein) comprising a corticosteroid and an antioxidant. In some embodiments, the pharmaceutical compositions of the present invention are in liquid form. By way of non-limiting example, liquid forms include emulsions, solutions, suspensions, syrups, slurries, dispersions, colloids, and the like. In some embodiments, the pharmaceutical composition is in a unit dose formulation for oral administration to a subject. In some embodiments, the pharmaceutical composition is in a unit dose package such as a stick-pack (e.g.,
In some embodiments, provided herein are kits comprising a multiple unit container and more than one unit dose of a pharmaceutical composition comprising a corticosteroid and an antioxidant (e.g., any of the pharmaceutical compositions described herein).
These and other aspects of the invention will become apparent to those skilled in the art upon reading the following detailed description of the invention, including the appended claims.
Brief Description of Drawings
Figure 1 is a graph depicting the effect of combinations of different concentrations of ascorbic acid and sodium ascorbate on the formation of 21-dehydrobudesonide (21-DHB) upon storage for several months under simulated storage conditions of 40 ℃ and 75% relative humidity.
Detailed Description
Detailed embodiments of the present invention are disclosed herein; however, it is to be understood that the disclosed embodiments are merely illustrative of the invention that may be embodied in various forms. Furthermore, each of the examples given in connection with the various embodiments of the invention are intended to be illustrative, and not restrictive. Therefore, specific structural and functional details disclosed herein are not to be interpreted as limiting, but merely as a representative basis for teaching one skilled in the art to variously employ the present invention.
Unless defined otherwise, all technical and scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this invention belongs.
As used in this specification and the appended claims, the singular forms "a," "an," and "the" include plural referents unless the context clearly dictates otherwise. Thus, for example, reference to "a method" includes one or more methods and/or steps of the type described herein, and/or of the type that will become apparent to those skilled in the art upon reading this disclosure.
The term "treatment" or "treatment" of a state, disorder or condition includes: (1) preventing, delaying or reducing the likelihood of occurrence and/or emergence of at least one clinical or subclinical symptom of a state, disorder or condition developing in a subject who may be suffering from or susceptible to a state, disorder or condition but who has not experienced or exhibited clinical or subclinical symptoms of a state, disorder or condition; or (2) inhibiting the state, disorder or condition, i.e., arresting, reducing or delaying the development of the disease or its recurrence or at least one clinical or subclinical symptom thereof; or (3) ameliorating the disease, i.e., causing regression of at least one of the states, disorders or conditions or clinical or subclinical symptoms thereof. The benefit to the subject to be treated is statistically significant or at least perceptible to the patient or to a physician.
As used herein, "subject" or "patient" or "individual" or "animal" refers to humans, veterinary animals (e.g., cats, dogs, cows, horses, sheep, pigs, etc.), and experimental animal models of disease (e.g., mice, rats). In a preferred embodiment, the subject is a human.
As used herein, the term "effective" as applied to a dose or amount refers to an amount of a compound or pharmaceutical composition sufficient to produce a desired activity upon administration to a subject in need thereof. It should be noted that when a combination of active ingredients is administered, the effective amount of the combination may or may not include the amount of each ingredient that would be effective if administered separately. The precise amount required will vary from subject to subject, depending on the species, age and general condition of the subject, the severity of the condition being treated, the particular drug or drugs employed, the mode of administration, and the like.
The phrase "pharmaceutically acceptable" as used in connection with the compositions of the present invention refers to molecular entities and other ingredients of the compositions that are physiologically tolerable and do not typically produce adverse reactions when administered to a mammal (e.g., a human). Preferably, as used herein, the term "pharmaceutically acceptable" means approved by a regulatory agency of the federal or a state government or listed in the U.S. pharmacopeia or other generally recognized pharmacopeia for use in mammals and, more particularly, in humans.
Pharmaceutical compositions and dosage forms
The present invention provides pharmaceutical compositions comprising a corticosteroid and an antioxidant. In some embodiments, the pharmaceutical composition further comprises a pharmaceutically acceptable carrier. These compositions may be prepared in a manner well known in the pharmaceutical art and may be administered by a variety of routes. The pharmaceutical compositions of the present invention may be administered locally or systemically. The term "systemic" as used herein includes parenteral, topical, transdermal, oral, by inhalation/pulmonary, rectal, nasal, buccal and sublingual administration. In a particular aspect, pharmaceutical compositions for oral administration are described.
The pharmaceutical compositions of the present invention comprising a corticosteroid and an antioxidant may be prepared in combination with one or more pharmaceutically acceptable carriers. In preparing the compositions of the present invention, the active ingredient is typically mixed with an excipient, diluted by an excipient, or enclosed within such a carrier in the form of, for example, a capsule, sachet, paper, or other container. When the excipient serves as a diluent, it may be a solid, semi-solid, or liquid material that serves as a vehicle, carrier, or medium for the active ingredient. Thus, the compositions may be in the form of tablets, pills, powders, lozenges, sachets, cachets, elixirs, suspensions, emulsions, solutions, syrups, aerosols (as a solid or in a liquid medium), ointments, soft and hard gelatin capsules, suppositories, injectable solutions including sterile injectable solutions, and sterile packaged powders.
In some embodiments, the pharmaceutical compositions of the present invention are in liquid form. By way of non-limiting example, liquid forms include emulsions, solutions, suspensions, syrups, slurries, dispersions, colloids, and the like. In some embodiments, the pharmaceutical compositions described herein are in liquid, semi-solid, or solid (e.g., powder) form. In particular embodiments, the pharmaceutical compositions described herein are in a semi-solid form, such as a gel, a gel matrix, a cream, a paste, and the like. In some embodiments, the semi-solid form comprises a liquid vehicle.
In some embodiments, the pharmaceutical compositions of the present invention may comprise one or more pharmaceutically acceptable carriers. As used herein, the language "pharmaceutically acceptable carrier" is intended to include any and all solvents, excipients, dispersion media, coatings (coatings), antibacterial and antifungal agents, isotonic and absorption delaying agents, and the like, compatible with pharmaceutical administration. Pharmaceutical preparations are a well established technology and are described, for example, in Gennaro (eds.), Remington: the science and Practice of pharmacy, 20 th edition, Lippincott, Williams & Wilkins (2000) (ISBN: 0683306472); ansel et al, Pharmaceutical document Forms and Drug delivery systems, 7 th edition, Lippincott Williams & Wilkins Publishers (1999) (ISBN: 0683305727); and Kibbe (ed.), Handbook of Pharmaceutical Excipients American Pharmaceutical Association, 3 rd edition (2000) (ISBN: 091733096X). Except insofar as any conventional media or agent is incompatible with the active compound, such media can be used in the compositions of the invention. Supplementary active compounds may also be incorporated into the compositions.
In some embodiments, the composition is in a unit dose formulation for oral administration or other administration to a patient. The term "unit dosage form" refers to physically discrete units suitable as unitary dosages for human subjects and other mammals, each unit containing a predetermined quantity of active material calculated to produce the desired therapeutic effect, in association with a suitable pharmaceutical excipient. In some embodiments, the pharmaceutical composition is packaged in a unit dose package such as a stick pack (e.g.,
In some embodiments, the compositions or unit dosage forms described herein are administered as an emulsion, solution, suspension, syrup, slurry, dispersion, colloid, capsule, gelcapsule, semisolid, solid gel, gel matrix, cream, paste, tablet, granule, sachet, powder, and the like. In certain aspects, from about 0.000001mg to about 2000mg, from about 0.00001mg to about 1000mg, or from about 0.0001mg to about 500mg, from about 0.001mg to about 100mg, from about 0.005mg to about 20mg, from about 0.01mg to about 10mg, from about 0.05mg to about 5mg, or from about 0.1mg to about 1mg of corticosteroid per dose per day is administered to the subject.
In some embodiments, the pharmaceutical compositions or unit dosage forms described herein comprise from about 0.001% w/w to about 5% w/w antioxidant, or from about 0.005% w/w to about 1% w/w antioxidant, or from about 0.01% w/w to about 0.5% w/w antioxidant, or from about 0.05% w/w to about 0.25% w/w antioxidant, or about 0.1% w/w antioxidant.
In some embodiments, there is provided a pharmaceutical composition, wherein the pharmaceutical composition does not substantially degrade and/or change color in the presence of oxygen after storage, the pharmaceutical composition comprising:
a. a therapeutically effective amount of a corticosteroid is provided,
b. a combination of ascorbic acid and a pharmaceutically acceptable salt of ascorbic acid,
c. the salt of Ethylene Diamine Tetraacetic Acid (EDTA),
d. a salt of a citric acid, which is,
e. the content of the polysorbate 80 is as follows,
f. a preservative agent, a preservative agent and a preservative agent,
g. optionally a flavoring agent, and optionally a flavoring agent,
h. optionally a sweetener, and
i. a liquid vehicle.
In some embodiments, there is provided a pharmaceutical composition, wherein the pharmaceutical composition does not substantially degrade and/or change color in the presence of oxygen after storage, the pharmaceutical composition comprising:
a. budesonide in an amount from about 0.02mg/mL to about 0.75mg/mL,
b. a combination of ascorbic acid and a pharmaceutically acceptable ascorbate in an amount from about 0.01mg/mL to about 2.5mg/mL,
c. ethylenediaminetetraacetate in an amount of about 0.05mg/mL to about 25mg/mL,
d. citrate in an amount of from about 0.1mg/mL to about 30mg/mL,
e. polysorbate 80 in an amount of 0.05mg/mL to about 1mg/mL,
f. a preservative agent, a preservative agent and a preservative agent,
g. a flavoring agent, a sweetening agent or a combination thereof, and
h. an aqueous liquid vehicle.
In some embodiments, there is provided a pharmaceutical composition, wherein the pharmaceutical composition does not substantially degrade and/or change color in the presence of oxygen after storage, the pharmaceutical composition comprising:
a. budesonide in an amount from about 0.001% w/w to about 0.1% w/w,
b. a combination of ascorbic acid and a pharmaceutically acceptable ascorbate salt in an amount of from about 0.005% w/w to about 0.25% w/w,
c. ethylenediaminetetraacetate in an amount of about 0.005% w/w to about 1% w/w.
d. Citrate in an amount of about 0.01% w/w to about 1% w/w,
e. polysorbate 80 in an amount of 0.001% w/w to about 0.01% w/w,
f. a preservative agent, a preservative agent and a preservative agent,
g. a flavoring agent, a sweetening agent or a combination thereof, and
h. an aqueous liquid vehicle.
In some embodiments, a particular pH is sought to achieve the desirable properties of the compositions of the present invention. In one non-limiting example, where the preservative sodium benzoate is used as an antimicrobial preservative in the composition, it has been observed that a lower pH of the composition results in a higher effectiveness of the preservative. In some embodiments, the compositions of the present invention have an acidic pH, i.e., a pH of less than about 7. In some embodiments, the composition has a pH between about 3 and about 6, or between about 4 and about 5.2.
The choice of antioxidants suitable for use in the compositions of the present invention is deliberate and depends on many factors specific to the formulation of the invention, the method of administration and the patient population. For example, many subjects suffering from inflammatory diseases and conditions of the gastrointestinal tract, such as the esophagus, are susceptible to allergic reactions. Care must be taken to avoid antioxidants that may cause allergic reactions in the patient. In addition, care must be taken to mask the unpleasant taste and produce a palatable preparation, particularly because corticosteroids such as budesonide have a bitter taste. Thus, antioxidants which themselves have an unpleasant taste should be avoided. It has been found that the combination of ascorbic acid and ascorbate is non-allergenic, has a pleasant taste and provides the desired effect of protecting the formulation from oxidative degradation.
The present application also includes a pharmaceutical kit useful, for example, in treating, preventing, or ameliorating symptoms of and inflammation associated with inflammatory diseases and conditions of the gastrointestinal tract, e.g., the esophagus, including one or more containers containing a pharmaceutical composition comprising a therapeutically effective amount of a corticosteroid and an antioxidant. Such kits may also include, if desired, one or more of a variety of conventional pharmaceutical kit components, such as, for example, a container with one or more pharmaceutically acceptable carriers, additional containers, and the like, as will be readily apparent to those of skill in the art. Instructions indicating the amounts of the components to be administered, directions for administration, and/or directions for mixing the components may also be included in the kit, as an insert or as a label.
The delivery device is not only important for delivering the pharmaceutical composition of the present invention, but also for providing a suitable storage environment. This would include protection from microbial contamination and chemical degradation. The device and formulation should be compatible so as to avoid possible leaching (leaching) or adsorption. The delivery device (or its packaging) may optionally be provided with a label and/or with instructions for use to indicate that the composition should be used, for example orally.
Method of treatment
In another aspect, there is provided a method for treating, preventing or alleviating symptoms of and inflammation associated with inflammatory diseases and conditions of the gastrointestinal tract, e.g., the esophagus, comprising administering a pharmaceutical composition comprising a therapeutically effective amount of a corticosteroid and an antioxidant. In one embodiment, the administered pharmaceutical composition does not substantially degrade in the presence of oxygen. In one embodiment, the pharmaceutical composition is administered orally. In another embodiment, the inflammation of the gastrointestinal tract is inflammation of the esophagus.
In some embodiments, administration of the pharmaceutical compositions described herein is to an individual who has been diagnosed with: eosinophilic esophagitis, inflammatory bowel disease involving the esophagus, crohn's disease, celiac disease, proximal gastrointestinal pathology (e.g., in individuals with hypofunction of the gall bladder), eosinophilic gastrointestinal inflammation, eosinophilic duodenitis, duodenal eosinophilia, functional dyspepsia, intermediate esophagitis, esophagitis secondary to corrosive/irritant uptake, persistent/recurrent esophagostenosis of any cause and including corrosive/irritant uptake, pill-induced esophagitis, systemic disease, congenital disease, post-operative inflammation, intermediate esophagitis, epithelial hyperplasia, basal cell hyperplasia, papillary elongation, papillary vasodilation, fungal esophagitis (e.g., candida, torulopsis, histoplasma, aspergillus, etc.), viral esophagitis (e.g., HSV), CMV, V2V), bacterial esophagitis (e.g., tuberculosis, actinomycosis, syphilis), erosive esophagitis, radiation esophagitis, chemotherapy esophagitis, graft versus host disease, skin diseases involving the esophagus (e.g., bullous pemphigoid, pemphigus vulgaris, epidermolysis bullosa, stevens-johnson syndrome), behcet's disease, sarcoidosis, idiopathic esophagitis, eosinophilic gastritis, meniere's disease, parasitic gastritis, lymphocytic esophagitis, inflammatory bowel disease-related esophagitis, parasitic gastritis, or gastroenteritis. In a particular embodiment, the subject has eosinophilic esophagitis. In some particular embodiments, the individual has been diagnosed with gastroesophageal reflux disease (GERD), non-erosive reflux disease (NERD), or erosive esophagitis. In some embodiments, the inflammation of the gastrointestinal tract is an inflammation of the stomach and/or small intestine, such as gastroenteritis. In one embodiment, the inflammation of the gastrointestinal tract is eosinophilic esophagitis (EE or EoE).
In certain embodiments, the individual to whom the pharmaceutical composition for treating, preventing, or ameliorating inflammation of the gastrointestinal tract or a symptom associated with inflammation of the gastrointestinal tract is administered is a child or an infant. In various embodiments, the child or infant is less than 16 years old, less than 12 years old, less than 8 years old, less than 6 years old, less than 4 years old, or less than 2 years old.
Examples