HK40000005A - Compositions and methods of using nintedanib for improving glaucoma surgery success - Google Patents

Description

Compositions and methods for improving the success of glaucoma surgery using nintedanib

Claim of priority

The benefit of U.S. provisional patent application serial No. 62/344,878, filed 2016, 06, 02, 2016, and U.S. provisional patent application serial No. 62/344,870, filed 2016, 06, 02, each of which is incorporated herein by reference in its entirety.

Technical Field

The present disclosure relates to ophthalmic compositions comprising nintedanib and methods of using the same to improve the success of glaucoma surgery.

Background

Glaucoma refers to a series of ocular conditions that damage the optic nerve, usually caused by abnormally elevated intraocular pressure. One method of reducing glaucoma intraocular pressure is to surgically create a drainage opening in the eye. This type of surgery is known as glaucoma filtration surgery (e.g., trabeculectomy). In glaucoma surgery, a piece of tissue in the drainage angle of the eye is cut to form an opening. This new opening forms a drain for liquid to drain from the eye. The intraocular pressure is reduced as fluid can now drain relatively easily through the new opening into the reservoir (bulb) under the conjunctiva. Fluid is then absorbed by the body.

As a result of glaucoma filtration surgery, scarring and fibrosis may occur at the surgical site. Scarring and fibrosis often result in a gradual decrease in filtration and loss of control of intraocular pressure. Excessive fibrosis is a key factor in the development of scarring and glaucoma filtration surgery failure. Current treatments for reducing failure are still inadequate and in need of improvement.

Disclosure of Invention

In certain aspects, the present disclosure provides a method for improving the success of glaucoma surgery (e.g., glaucoma filtration surgery) by administering nintedanib to the eye of a subject in need of such treatment. One aspect features a method of adjunctive treatment associated with glaucoma filtration surgery performed in a subject, comprising administering to a subject in need thereof a therapeutically effective amount of a composition comprising nintedanib or a pharmaceutically acceptable salt thereof. The method improves the success rate of glaucoma surgery. Glaucoma surgery includes, for example, classical trabeculectomy procedures or procedures selected from the group consisting of: trabecular ablation, gonioscopy assisted transluminal trabeculotomy, excimer laser trabeculostomy and endoscopic ciliary photocoagulation. The glaucoma surgery performed may also be implantation of an ocular filter device, wherein the ocular filter device is an ocular stent. For example, the ocular filtration device may be selected from the group consisting of: iStent, Hydras and CyPass microsupports.

In some aspects of the methods disclosed herein, the amount of nintedanib administered to the subject is effective to increase the duration of lower IOP, increase the absolute success rate or the success rate eligibility at least 10 days, at least 90 days, at least 365 days, at least 750 days, or at least 3650 days post-surgery; or the amount of nintedanib administered is effective to prolong vesicle survival.

In some aspects, the nintedanib composition is administered in a topical ophthalmic formulation (e.g., topical eye drops) or implant. In some examples, the nintedanib is a topical ophthalmic formulation for topical administration to the affected eye. In certain aspects, the concentration of nintedanib in the formulation is from 0.001% to 10% by weight or by volume of the total composition. In certain aspects, the topical ophthalmic formulation is a solution, suspension, or emulsion. In another aspect, the nintedanib is an implant or a semi-solid sustained release formulation injected into the affected eye. In certain aspects, the amount of nintedanib in the implant is from 1 μ g to 100 mg.

In certain aspects, the disclosed methods are practiced by combining nintedanib with an antimetabolite. The antimetabolite may be, but is not limited to, mitomycin C, 5-fluorouracil, floxuridine, cytarabine, 6-azauracil, azathioprine, methotrexate, mycophenolate mofetil, and thiothiophene.

In another aspect, the disclosed methods reduce scarring in glaucoma surgery by reducing abnormal vascularity and fibrosis at the surgical site. In certain aspects, the disclosed methods are performed prior to, in conjunction with, or after surgery to reduce failure of glaucoma surgery. Thus, in some aspects, the amount of nintedanib administered is effective to reduce scarring at the surgical site; in some aspects, the amount of nintedanib administered is effective to prolong the duration of lower IOP for at least 10 days, at least 90 days, at least 365 days, at least 750 days, or at least 3650 days post-surgery. In some aspects, the amount of nintedanib administered is effective to prolong vesicle survival.

As used in this application, the term "one or more" includes at least one, and more suitably 1, 2,3, 4, 5, 10, 20, 50, 100, 500, etc., of the item referred to as "one or more".

The term "subject" refers to an animal or human, or one or more cells derived from an animal or human. Preferably, the subject is a human. Subjects may also include non-human primates. The human subject may be referred to as a patient.

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. The present application describes methods and materials for use in the present invention; other suitable methods and materials known in the art may also be used. The materials, methods, and examples are illustrative only and not intended to be limiting. All publications, patent applications, patents, sequences, database entries, and other references mentioned in this application are incorporated by reference in their entirety. In case of conflict, the present specification, including definitions, will control.

Other features and advantages of the invention will be apparent from the following detailed description and drawings, and from the claims.

Drawings

Figure 1 is a flow chart showing exemplary mechanisms for reducing excessive scarring and improving the success of glaucoma surgery.

Figure 2 is a graph showing bleb survival after glaucoma filtration surgery in a domestic rabbit model.

Fig. 3 is a graph showing intraocular pressure (IOP) after glaucoma filtration surgery in a rabbit model.

Figure 4 is a graph showing the absolute success rate of glaucoma filtration surgery in a clinical study according to the methods disclosed herein.

Detailed Description

Glaucoma is a series of diseases characterized by the death of retinal ganglion cells ("RGCs"), loss of specific visual fields, and optic nerve atrophy. Glaucoma is a worldwide cause of blindness. Various treatment options effective in lowering intraocular pressure ("IOP") are useful in controlling and possibly delaying disease progression. Treatment options include, for example, drug therapy (i.e., IOP lowering drugs), laser eye surgery, and/or conventional surgical approaches such as glaucoma filtration surgery (otherwise known as filtration surgery or trabeculectomy).

Despite the widespread use of local IOP lowering drugs in developed countries, glaucoma surgery is still widely used in other areas of the world (particularly for angle-closure glaucoma). Glaucoma surgery has the advantage of lower cost over time and is free of compliance issues associated with the need for multiple daily applications of topical eye drops. Conventional glaucoma filtration surgery and trabeculectomy procedures have higher failure rates (Schlunck et al, Exp Eye Res.2016; 142:76-82) and methods of implanting ocular filtration devices (e.g., glaucoma filtration devices) also suffer from long-term failure (Amoozgar et al, Curr Opinhhalmol.2016; 27(2): 164-9). The reason for failure is excessive healing of the wound after surgery, followed by scarring with fibrosis that impedes drainage. Surgical damage to tissue often induces pro-inflammatory nuclear pro-fibrotic factors, which lead to abnormal extracellular matrix changes and fibrosis. The myofibroblast hyperproliferation induced by these factors subsequently causes excessive fibrosis and scarring.

The antimetabolite mitomycin c (mmc) has been administered during or after glaucoma surgery as an anti-scarring agent. Another antimetabolite, 5-fluorouracil (5-FU), was also used during follow-up, primarily by local injection (Schlunck et al, Exp Eye Res.2016; 142: 76-82). These antimetabolites act by blocking the rapid proliferation of fibroblasts. Its activity is not selective and is known to cause side effects. For example, anti-cell division activity sometimes results in post-operative vesicle leakage. Better post-glaucoma management remains an unmet medical need.

Due to the many factors that contribute to scar formation after glaucoma surgery, targeting any single pathway alone may not be sufficient to improve the success of the surgery. The present disclosure improves the success of glaucoma surgery by administering to the eye a composition having the following key attributes: 1) the composition will inhibit simultaneously several important pathological pathways disclosed below; 2) the compositions utilize small molecule drugs rather than antibody drugs to achieve more efficient drug delivery to the target tissue; 3) the composition is a topical formulation in the form of eye drops or implants for convenient and consistent drug delivery to the surgical site; and 4) the compositions contain nintedanib, which can be combined with an antimetabolite to achieve additive or synergistic effects in improving the success of glaucoma filtration surgery.

The present disclosure provides a method of using topical formulations (e.g., topical eye drops, implants) containing nintedanib prior to, during, or after surgery that satisfies the need to inhibit vascular endothelial growth factor ("VEGF") receptors ("VEGFR") 1-3, Platelet Derived Growth Factor Receptors (PDGFR) - α and- β, and fibroblast growth factor receptor 2 ("FGFR 2") to achieve a desired therapeutic effect.

Without being bound by theory, it is understood that inhibition of all members of VEGFR is important because blocking placental growth factor ("PIGF") is required in addition to VEGF. PIGF acts only on pathological angiogenesis and inflammation and is more associated with problems associated with glaucoma surgery (Van Bergen et al, J Cell Mol Med.2013; 17(12): 1632-43). For glaucoma filtration surgery, the disclosed methods also inhibit FGFR2 because it has a role in scarring. The topical formulations disclosed herein can facilitate treatment before, during, and after surgery. The mechanism disclosed in this application to improve the success rate of glaucoma surgery is shown in figure 1, which shows that nintedanib in a suitable ophthalmic formulation will simultaneously block the signaling pathways of key pathological factors involved in wound healing (including PIGF, VEGF, PDGF, FGF) and will increase the success of glaucoma surgery by reducing scar formation.

As used herein, the term "improving the success of glaucoma surgery" refers to prolonging the duration of decreased (i.e., lower) IOP for a period of at least 10 days, at least 90 days, at least 365 days, at least 750 days, or at least 3650 days post-surgery, increasing the percentage of IOP decrease compared to pre-operative baseline for a given period of time post-surgery (e.g., at least 10 days, at least 90 days, at least 365 days, at least 750 days, or at least 3650 days), increasing the absolute (also referred to as full) success rate (defined as the percentage of patients who remain within the range of normal IOP and have decreased IOP compared to baseline without any glaucoma drug administration) for a given period of time, increasing the success rate (defined as the percentage of patients who remain within the range of normal IOP and have decreased IOP compared to baseline with glaucoma drug administration) for a given period of time (e.g., at least 10 days, at least 90 days, at least 365 days, at least 750 days, or at least 3650 days) The grading and survival of the vesicles improves over a period of time (e.g., at least 10 days, at least 90 days, at least 365 days, at least 750 days, or at least 3650 days).

As used herein, "normal IOP" or "normal IOP range" refers to an intraocular pressure in the human eye of between about 5mmHg to about 22mmHg, or between about 10mm Hg to about 21 mmHg.

The terms "treating", "treatment" and the like as used herein generally refer to obtaining a desired pharmacological and/or physiological effect. The effect may be prophylactic in terms of completely or partially preventing the disease or symptoms thereof and/or may be therapeutic in terms of partially or completely stabilizing or curing the disease and/or adverse effects due to the disease. The term "treatment" encompasses any treatment of a disease in a mammal (particularly a human) and includes: (a) preventing the occurrence of a disease and/or condition in a subject who may be predisposed to the disease or condition but has not yet been diagnosed as having the disease or condition; (b) inhibiting the disease and/or symptoms, i.e., arresting their development; or (c) alleviating the symptoms of the disease, i.e., causing regression of the disease and/or symptoms. Those in need of treatment include those already afflicted (e.g., those with high IOP, those with infection, etc.) as well as those in which prevention is desired (e.g., those with increased susceptibility to glaucoma, those suspected of having high IOP, etc.).

Nintedanib { (3Z) -3- { [ (4- { methyl [ (4-methylhexahydropyrazin-1-yl) acetyl ] amino } phenyl) amino ] (phenyl) methylene } -2-oxo-2, 3-dihydro-1H-indole-6-carboxylic acid methyl ester } is a kinase inhibitor as described herein nintedanib primarily inhibits receptor tyrosine kinases including, for example, vascular endothelial growth factor receptor (VEGFR1-3), platelet derived growth factor receptors (PDGFR α and β), fibroblast growth factor receptor (FGFR 1-4).

Formulations and dosing regimens

The methods described herein include the manufacture and use of pharmaceutical compositions comprising identifying compounds as active ingredients by the methods described herein. Also included are the pharmaceutical compositions themselves.

Pharmaceutical compositions typically comprise a pharmaceutically acceptable excipient. As used herein, the term "pharmaceutically acceptable excipient" or "pharmaceutically acceptable carrier" includes saline, solvents, dispersion media, coatings, antibacterial and antifungal agents, isotonic and absorption delaying agents, and the like, compatible with pharmaceutical administration.

The phrase "pharmaceutically acceptable salt" as used herein refers to salts of the subject compounds that are safe and effective for mammalian administration and that possess the desired biological activity. Pharmaceutically acceptable acid salts include, but are not limited to, the hydrochloride, hydrobromide, hydroiodide, nitrate, sulfate, bisulfate, phosphate, acid phosphate, isonicotinate, carbonate, bicarbonate, acetate, lactate, salicylate, citrate, tartrate, propionate, butyrate, pyruvate, oxalate, malonate, pantothenate, bitartrate, ascorbate, succinate, maleate, gentisate, fumarate, gluconate, glucuronate, gluconate, formate, benzoate, glutamate, methanesulfonate, ethanesulfonate, benzenesulfonate, p-toluenesulfonate, and pamoate (i.e., I' methylene-bis- (2-hydroxy-3-naphthoic acid)) salts. Suitable basic salts include, but are not limited to, aluminum, calcium, lithium, magnesium, potassium, sodium, zinc, bismuth, and diethanolamine salts.

Methods for formulating suitable pharmaceutical compositions are well known in the art, see, e.g., Remington, the science and Practice of Pharmacy, 21 st edition, 2005; and Drugs and the pharmaceutical sciences a Series of texts of Textbooks and monggrams (Dekker, NY). For example, a solution, suspension or emulsion for ophthalmic applications may comprise the following components: sterile diluents such as water for injection, saline solution, fixed oils, polyethylene glycols, glycerin, propylene glycol or other synthetic solvents; an antibacterial agent; an antioxidant; a chelating agent; buffers such as acetates, citrates or phosphates and tonicity adjusting agents such as sodium chloride or dextrose. The pH can be adjusted using an acid or base (e.g., hydrochloric acid or sodium hydroxide).

Pharmaceutical compositions suitable for injectable use may include sterile aqueous solutions (if soluble in water) or dispersions and sterile powders for the extemporaneous preparation of sterile injectable solutions or dispersions. It should be stable under the conditions of manufacture and storage and must be protected from the contaminating action of microorganisms such as bacteria and fungi. The carrier can be a solvent or dispersion medium containing, for example, water, ethanol, polyol (for example, glycerol, propylene glycol, and liquid polyethylene glycol, and the like), and suitable mixtures thereof. Proper fluidity can be maintained, for example, by the use of a coating such as lecithin, by the maintenance of the required particle size in the case of dispersions and by the use of surfactants. The action of microorganisms can be prevented by using various antibacterial and antifungal agents, for example, parabens, chlorobutanol, phenol, ascorbic acid, thimerosal, and the like. In many cases, it will be preferable to include isotonic agents, for example, sugars, polyalcohols such as mannitol, sorbitol, and sodium chloride in the composition. Prolonged absorption of the injectable compositions can be brought about by including in the composition an agent which delays absorption, for example, aluminum monostearate and gelatin.

Sterile injectable solutions can be prepared by the following steps: the required amount of active compound is incorporated in an appropriate solvent with one of the ingredients listed above or a combination of these, as required, followed by filter sterilization. In general, dispersions are prepared by incorporating the active compound into a sterile vehicle which contains a basic dispersion medium and the required other ingredients from those listed above. In the case of sterile powders for the preparation of sterile injectable solutions, the preferred methods of preparation are vacuum drying and freeze-drying which yields a powder of the active ingredient plus any additional desired ingredient from a previously sterile-filtered solution thereof.

In one embodiment, the therapeutic compound is prepared using a carrier that will protect the therapeutic compound against rapid elimination in vivo, such as a controlled release formulation, including implants and microencapsulated delivery systems. Biodegradable biocompatible polymers such as vinyl acetate, polyanhydrides, polyglycolic acid, collagen, polyorthoesters, and polylactic acid may be used. Such formulations can be prepared using standard techniques or obtained commercially.

The pharmaceutical composition may be placed in a container, package, or dispenser along with instructions for administration.

Compositions and formulations of nintedanib may be administered topically (e.g., in a topical ophthalmic formulation) or as an injection in a semi-solid formulation or solid implant, or by any other suitable method known in the art. Although the agents disclosed herein may be used as such, it is preferred to administer the agents in the form of pharmaceutical formulations, for example in admixture with suitable pharmaceutical excipients, diluents or carriers selected with respect to the intended route of administration and standard pharmaceutical practice. Pharmaceutical formulations comprise at least one active compound in association with a pharmaceutically acceptable excipient, diluent and/or carrier.

The pharmaceutical compositions disclosed herein may comprise a "therapeutically effective amount" of an agent described herein. Such effective amounts may be determined by the action of the agent being administered, or by the combined action of agents if more than one agent is used. The therapeutically effective amount of the agent can also vary according to factors such as the disease state, age, sex, and weight of the individual, and the ability of the compound to elicit a response in the individual (e.g., amelioration of at least one disorder parameter or amelioration of at least one symptom of the disorder). A therapeutically effective amount is also one in which the therapeutically beneficial effect outweighs any toxic or detrimental effects of the composition.

The effective dosage of the compositions of the present disclosure for treating a condition can vary depending on a variety of factors, including the method of administration, the location of the target, the physiological state of the subject, whether the subject is a human or an animal, other drugs being administered, and whether the treatment is prophylactic or therapeutic. Therapeutic doses can be titrated to optimize safety and efficacy using routine methods well known to those skilled in the art.

In some examples, the topical ophthalmic formulation is a solution, suspension, cream, ointment, gel-forming liquid, liposome or micelle containing suspension, spray formulation, or emulsion. In some examples, the topical ophthalmic formulation further comprises one or more pharmaceutically acceptable excipients selected from the group consisting of: stabilizers, surfactants, polymer-based carriers, gelling agents, organic co-solvents, pH active ingredients, osmotic active ingredients, and with or without preservatives. In some examples, the sustained release semi-solid formulation, sustained release solid formulation, or ocular implant is injected into the affected eye. In some embodiments, the sustained release semi-solid formulation, sustained release solid formulation, or ophthalmic implant further comprises a pharmaceutically acceptable excipient. In some examples, the sustained release semi-solid formulation, sustained release solid formulation, or ophthalmic implant comprises a multikinase inhibitor, an antimetabolite, or a combination thereof; and a biodegradable polymer selected from the group consisting of: polylactic acid (PLA), polyglycolic acid (PLGA), and polylactic-polyglycolic acid copolymers.

The administration of the composition or formulation may be once daily, twice daily, three times daily, four times daily, or more frequently. The frequency may be reduced during the treatment maintenance period of treatment, for example, once every two or three days instead of once or twice daily. Dosages and frequency of administration may be adjusted at the discretion of the treating physician, for example taking into account the clinical indications, pathological indications and clinical and subclinical symptoms of the disease condition being treated using the methods of the invention, as well as the clinical history of the patient.

It will be appreciated that the amount of the agents disclosed herein required for use in treatment will vary with the route of administration, the nature of the condition to be treated and the age, weight and condition of the patient and will ultimately be at the discretion of the attendant physician. The composition will generally contain an effective amount of nintedanib. Initial dosages can be determined from animal experiments, and scaling of dosages for human administration can be performed according to art-recognized practices.

The length of treatment (i.e., number of days) will be readily determined by the subject's physician; however, the number of treatment days may range from about 1 day to about 365 days. As provided by the methods of the invention, the efficacy of the treatment can be monitored during the course of treatment to determine whether the treatment was successful or whether additional (or modified) treatment is required.

The dosage, toxicity, and therapeutic efficacy of a therapeutic compound can be determined in cell cultures or experimental animals by standard pharmaceutical procedures, e.g., procedures for determining LD50 (the dose lethal to 50% of the population) and ED50 (the dose therapeutically effective in 50% of the population). The dosage form of nintedanib can be readily determined by one of ordinary skill in the art and can be obtained, for example, in animal models for determining dosage, safety and efficacy according to standard methods well known in the art and in clinical studies reported in the literature. The exact formulation, route of administration and dosage may be selected by the individual physician according to the condition of the patient

The composition used in the method of the present invention may comprise nintedanib in a concentration of 0.001% to 10% by weight or volume of the total composition. For example, the aqueous composition comprises 0.001%, 0.01%, 0.1%, 0.5%, 1.0%, 1.5%, 2.0%, 5.0% or up to 10% of nintedanib.

As will be familiar to those skilled in the art, the aqueous solution administered to the eye may be in the form of "drops" or drops (e.g., a nintedanib solution) of a particle dropper or pipette or other specialized sterile device. Such drops will typically be up to 50 microliters, but may be less, e.g., less than 10 microliters, by volume.

Examples

The invention is further described in the following examples, which do not limit the scope of the invention described in the claims.

Example 1: rabbit glaucoma operation model

A rabbit glaucoma surgery model was used to demonstrate the success of glaucoma filtration surgery using the methods disclosed herein. In particular, the established rabbit glaucoma filtration surgery model was used to study the effect of 0.2% nintedanib solution on post-operative wound healing events. The surgical procedure is described in Wong et al (Wong et al, Invest Ophthalmol VisSci.2003; 44(3): 1097-. Briefly, a partially torn 8-0 silk corneal traction suture was placed over and the eye was pulled down. The culprit-based conjunctival flap is lifted, followed by blunt dissection of the subconjunctival space about 5mm along the limbus and 8mm posteriorly. A partially torn scleral incision was made 3 to 4mm posterior to the limbus using a micro retinal (MVR) knife and a scleral tunnel was made to the corneal stroma. A22 gauge, 25-mm intravenous cannula (Venflon 2; Beckton Dickinson, Oxford, UK) was advanced through the scleral tunnel until the trocar was visible in the clear cornea. The trocar is advanced into the anterior chamber and then withdrawn as the cannula is advanced into the mid-pupillary segment. The cannula was trimmed and tilted at the scleral end so that it protruded 1mm from the insertion point, and 10-0 nylon sutures were placed to secure the tube to the scleral surface. The conjunctival incision was closed using two interrupted sutures attached to a needle (B/V100-4; Ethicon) to form a water tight closure, and a central mattress 10-0 nylon suture. At the end of the surgery, a drop of chloramphenicol and Betnesol-N (Glaxo Wellcome, Uxbridge, UK) ointment, respectively, was applied dropwise to the eye.

20 female New Zealand white rabbits (2-2.4kg, 12-14 weeks old; Charles River) were acclimated for 5 days before the experiment began. Glaucoma surgery as described above is performed on the left eye. After surgery, rabbits were divided into two groups, one group treated with vehicle and the other group treated with 0.2% nintedanib solution. Treatment was started immediately after surgery and 3 times daily for 2 weeks. Survival of postoperative formed blebs and intraocular pressure (IOP) follow-up was followed for 28 days. Histological analysis of scar tissue will be performed at the end of the study.

Results

The nintedanib group will significantly prolong the outcome of surgery success compared to the vehicle group. Figure 2 provides a graph showing the vesicle survival curve after surgery. As shown in fig. 2, the nintedanib group showed significantly prolonged vesicle survival compared to the vehicle group. At the end of the study on day 28, no vesicles survived in the vehicle group, whereas most vesicles survived in the nintedanib group. Figure 3a is a graph showing IOP curves during a post-operative follow-up. IOP in the nintedanib group was still low (i.e., below 20mm Hg), while IOP in the vehicle group was gradually elevated. The difference was statistically significant. In addition to vesicle survival and IOP changes, histological analysis of scar tissue at the surgical site showed that the nintedanib group had less scar tissue than the vehicle group.

The results of this experiment demonstrate that the 0.2% nintedanib solution increases the success of glaucoma surgery (i.e., extends the survival of the bleb after surgery, extends the duration of lower IOP, and/or reduces fibrosis/scarring).

Example 2: topical ophthalmic formulations of nintedanib as adjunctive therapy for glaucoma filtration surgery

In one clinical study, 0.2% nintedanib was administered topically as an adjuvant therapy to increase the success of trabeculectomy. The effect of topical administration of 0.2% nintedanib on trabeculectomy success was examined in a randomized, double-blind, placebo-controlled, 12-month trial. The study design was as described by Vandewale et al (Vandewale et al, Br JOphthalmol.2014, Jan; 98(1): 73-8).

Patients with open angle glaucoma, uncontrolled by drugs scheduled for primary trabeculectomy, were enrolled and randomized to receive treatment with one drop of either nintedanib or placebo solution three times daily. Treatment is started immediately after surgery and will last for 1 month. Approximately 150 patients were enrolled in the study.

The surgery will be performed under general or retrobulbar anesthesia by a skilled surgeon using a modified Moorfields technique. IOP was measured using a Goldmann applanation tonometer. Two measurements were made by blind observers and if the difference between the two results was within 2mm Hg, they were averaged to determine the average IOP. A third measurement is made if the difference before the first two results is >2mm Hg.

Day 1 after trabeculectomy; weeks 1, 2 and 4; and patients were examined at months 3, 6 and 12. A comprehensive ophthalmic examination will be performed on all patients, including measuring best corrected vision, slit lamp examination including Seidel test, measuring IOP, and fundus biomicroscopy using 90 diopter lenses. The number of postoperative hypotensive drugs, book-neutralizing postoperative complications, and surgical interventions will also be recorded.

Absolute success was taken as the primary endpoint, defined as intraocular pressure (IOP). ltoreq.21 mm Hg and >5mm Hg, which is reduced by at least 20% compared to baseline with no sensory loss.

Results

Both the nintedanib and placebo groups had effectively reduced IOP at the 12 month visit compared to baseline. As shown in fig. 4, the absolute success rate of glaucoma surgery (i.e., maintaining IOP below about 20mm Hg for more than 12 months after surgery) was higher for the nintedanib group than for the placebo group. At the 6 month time point, the difference was statistically significant.

Example 3: preparation

Nintedanib ophthalmic solution

The drug product is an isotonic ophthalmic solution prepared in 2-hydroxypropyl β cyclodextrin or other similar cyclodextrins and buffered solutions (pH ranging from 5.5 to 8.0.) other viscosity enhancers, lubricants, preservatives may be added to enhance the functionality of the formulation.

TABLE 1 Nintedanib ophthalmic solutions

Nintedanib ophthalmic suspension

The drug product is an isotonic ophthalmic suspension prepared in sodium carboxymethylcellulose and in a buffer solution (pH ranging from 5.5 to 8.0). The drug particle size is reduced to less than 40 microns. Other viscosity increasing agents, lubricants, solubilizers, and preservatives may be added to enhance the functionality of the formulation suspension. The compositions are shown in table 2.

TABLE 2 Nintedanib ophthalmic suspensions

Nintedanib emulsion for eyes

The medicament is an isotonic ophthalmic emulsion. The drug is dissolved in a mixture of an oil phase and an emulsifier vehicle, which is then emulsified and mixed with an aqueous phase (pH ranging from 5.5 to 8.0). Other viscosity builders, lubricants, solubilizers, and preservatives may be added to enhance the functionality of the emulsion formulation. The compositions are shown in table 3.

TABLE 3 Nintedanib ophthalmic emulsions

Nintedanib sustained-release semisolid preparation

The drug product is an isotonic sustained release semisolid formulation. The drug substance is dissolved and/or suspended in a semi-solid medium (pH ranging from 5.5 to 8.0). Other viscosity increasing agents, lubricants, solubilizing agents and preservatives may be added to enhance the function of the sustained release semisolid formulation. The compositions are shown in table 4.

TABLE 4 sustained Release semisolid formulations

Nintedanib sustained release implant

The medicament is a solid implant. The drug is mixed and blended with one or more polymers. The mixture of drug and polymer is melted at a predetermined temperature and extruded into a filament having a predetermined diameter size. The preparation wire is cut into segments of a predetermined size that can be implanted into ocular tissue. The compositions are shown in table 5.

TABLE 5 sustained Release implants

Without limitation, exemplary compositions for use in the methods according to the present invention may be modified from existing ophthalmically acceptable compositions.

Other embodiments

It is to be understood that while the invention has been described in conjunction with the detailed description thereof, the foregoing description is intended to illustrate and not limit the scope of the invention, which is defined by the scope of the appended claims. Other aspects, advantages, and modifications are within the scope of the following claims.

Claims (27)

1. A method for improving the success rate of glaucoma filtration surgery comprising administering to the eye of a subject in need thereof a therapeutically effective amount of nintedanib or a pharmaceutically acceptable salt thereof.

2. The method of claim 1, wherein the nintedanib is administered as a topical eye drop or implant.

3. The method of claim 1, wherein the amount of nintedanib administered is effective to reduce scarring at the surgical site.

4. The method of claim 1, wherein the amount of nintedanib administered is effective to prolong the duration of lower IOP, increase the absolute or qualified success rate for at least 10 days, at least 90 days, at least 365 days, at least 750 days, or at least 3650 days post-operatively; or the amount of nintedanib administered is effective to prolong vesicle (bleb) survival.

5. The method of claim 1, wherein the nintedanib is administered in the form of a semi-solid or solid sustained release implant that is injected into the affected eye.

6. The method of claim 1, wherein the topical ophthalmic formulation is a solution, suspension, cream, ointment, gel-forming liquid, liposome or micelle containing suspension, spray formulation, or emulsion.

7. The method of claim 1, wherein the treatment is performed prior to surgery, during surgery, or after surgery.

8. The method of claim 1, wherein the glaucoma filtration surgery is performed using classical trabeculectomy or a method selected from the group consisting of: trabeculoplasty (trabeclome), Gonioscopy assisted transluminal trabeculotomy (goniosppy-assisted transluminal), excimer laser trabeculostomy (excimer laser trabeculostomy), and Endoscopic ciliary photocoagulation (Endoscopic cyclopoto).

9. The method of claim 1, wherein the glaucoma surgery is performed for implantation of an ocular filtration device (oculfiltration device).

10. The method of claim 9, wherein the ocular filtration device is an ocular stent.

11. The method of claim 9, wherein the ocular filtration device is selected from the group consisting of: iStent, Hydras and CyPass microsupports.

12. The method of claim 1, wherein nintedanib is administered in combination with an antimetabolite that inhibits cell proliferation.

13. The method of claim 12, wherein the antimetabolite is selected from the group consisting of: mitomycin C, 5-fluorouracil, floxuridine, cytarabine, 6-azauracil, azathioprine, methotrexate, mycophenolate mofetil, and thiothiophene.

14. A method of adjunctive treatment associated with glaucoma filtration surgery performed in a subject, comprising administering to a subject in need thereof a therapeutically effective amount of a composition comprising nintedanib or a pharmaceutically acceptable salt thereof.

15. The method of claim 14, wherein the composition is administered as a topical eye drop or implant.

16. The method of claim 14, wherein the composition contains an amount of nintedanib effective to reduce scarring at the surgical site.

17. The method according to claim 14, wherein the composition contains an amount of nintedanib effective to prolong the duration of lower IOP or to increase the absolute or qualified success rate defined above for at least 10 days, at least 90 days, at least 365 days, at least 750 days or at least 3650 days post-operatively.

18. The method of claim 15, wherein the amount of nintedanib administered is effective to prolong vesicle survival.

19. The method of claim 14, wherein the nintedanib is administered prior to, during or after glaucoma filtration surgery.

20. The method of claim 14, wherein the nintedanib is a semi-solid or solid sustained release implant that is injected into the affected eye.

21. The method of claim 14, wherein the topical ophthalmic formulation is a solution, suspension, or emulsion.

22. The method of claim 14, wherein the glaucoma filtration surgery is performed using classical trabeculectomy or a method selected from the group consisting of: trabecular ablation, gonioscopy assisted transluminal trabeculotomy, excimer laser trabeculostomy and endoscopic ciliary photocoagulation.

23. The method of claim 14, wherein the glaucoma surgery is performed for implantation of an ocular filter device.

24. The method of claim 23, wherein the ocular filtration device is an ocular stent.

25. The method of claim 23, wherein the ocular filtration device is selected from the group consisting of: iStent, Hydras and CyPass microsupports.

26. The method of claim 1, wherein nintedanib is administered in combination with an antimetabolite that inhibits cell proliferation.

27. The method of claim 26, wherein the antimetabolite is selected from the group consisting of: mitomycin C, 5-fluorouracil, floxuridine, cytarabine, 6-azauracil, azathioprine, methotrexate, mycophenolate mofetil, and thiothiophene.