WO2000054747A2 - Methode de traitement de keratoconjonctivite seche - Google Patents

Methode de traitement de keratoconjonctivite seche Download PDF

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Publication number
WO2000054747A2
WO2000054747A2 PCT/US2000/006794 US0006794W WO0054747A2 WO 2000054747 A2 WO2000054747 A2 WO 2000054747A2 US 0006794 W US0006794 W US 0006794W WO 0054747 A2 WO0054747 A2 WO 0054747A2
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WO
WIPO (PCT)
Prior art keywords
eye
dry eye
solution
percent
present
Prior art date
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Ceased
Application number
PCT/US2000/006794
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English (en)
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WO2000054747A3 (fr
Inventor
John Denick, Jr.
David J. Heiler
Zhenze Hu
Joseph C. Salamone
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Bausch and Lomb Inc
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Bausch and Lomb Inc
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Publication date
Application filed by Bausch and Lomb Inc filed Critical Bausch and Lomb Inc
Priority to AU37478/00A priority Critical patent/AU3747800A/en
Publication of WO2000054747A2 publication Critical patent/WO2000054747A2/fr
Publication of WO2000054747A3 publication Critical patent/WO2000054747A3/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/70—Carbohydrates; Sugars; Derivatives thereof
    • A61K31/715—Polysaccharides, i.e. having more than five saccharide radicals attached to each other by glycosidic linkages; Derivatives thereof, e.g. ethers, esters
    • A61K31/716—Glucans
    • A61K31/717—Celluloses
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00—Medicinal preparations characterised by special physical form
    • A61K9/0012—Galenical forms characterised by the site of application
    • A61K9/0048—Eye, e.g. artificial tears

Definitions

  • This invention relates to a method for treating dry eye.
  • solutions comprising a cationic cellulosic polymer have been found useful for alleviating the symptoms of dry eye.
  • Dry eye also known generically as keratoco ⁇ junctivitis sicca and dyslacrima
  • a patient with dry eye may experience burning, a feeling of dryness and persistent irritation.
  • dry eye can seriously impair a person's vision and hence handicap the sufferer in activities such as driving.
  • Certain diseases such as Sjogren's disease manifest dry eye symptoms.
  • the lacrimal ducts in the eye may produce less moisture, resulting in eyes that become dry, inflamed, itchy and gritty.
  • One common approach has been to supplement the ocular tear film using artificial tears instilled throughout the day.
  • Examples of the tear substitute approach include the use of buffered, isotonic saline solutions and aqueous solutions containing water-soluble polymers that render the solutions more viscous and thus less easily shed by the eye by the washing action of the tear fluid. See, for example, U.S. Patent No. 5,209,927 to Gressel, et al.; U.S. Patent No. 5,294,607 to Glonek, et al; and U.S. Patent No. 4,409,205 to Shively.
  • U.S. Patent No. 5,645,827 to Marlin, et al. discloses the use of compositions comprising a cationic polysaccharide in combination with an anionic therapeutic agent, for example, hyaluronic acid or its salt, which is a known demulcent for the treatment of dry eye.
  • an anionic therapeutic agent for example, hyaluronic acid or its salt
  • Marlin, et al. believe that the anionic therapeutic agent is electrostatically bonded to the cationic polysaccharide which in turn is substantive to the mucosal surface.
  • Substantivity is characterized by an increase of the cationic polysaccharide on the mucosal surface and can be measured through the use of an ocular fluorometer.
  • European Application 088770 Al to Marlin et al. discloses cationic cellulose polymers to deliver cationic therapeutic agents, especially for the treatment of glaucoma.
  • U.S. Patent Nos. 4,436,730 and 5,401,327 to Ellis, et al. disclose the use of cationic cellulosic derivatives in contact-lens treating solutions, including the combination of a cationic cellulose polymer and an ethoxylated glucose such as glucam.
  • a cationic cellulose material with a PEO component such as glucam is particularly advantageous for the reason that the cationic component complexes with the PEO component and the complex more strongly absorbs on the lens surface.
  • the cationic cellulose polymer and entangled PEO is believed to reach into the aqueous phase to provide cushioning and protein resistance.
  • the present invention is directed to a method of treating dry eye employing a solution comprising an effective amount of a cationic cellulose for alleviating the symptoms of dry eye. Such solutions are effective in the absence of hyaluronic acid and other anionic therapeutic agents.
  • the invention is also directed to a method of using the foregoing composition to treat the symptoms of dry eye.
  • FIG. 1 shows the results from the tests of Example 2 below, involving the measurement of the concentration of FITC-Dextran in a solution according to the present invention versus the concentration of FITC-Dextran in a control solution over a period of six hours in rabbit eyes.
  • FIG. 2 shows the results from the tests of Example 2 below, involving measurement of the concentration of FITC-Dextran in a second solution according to the present invention versus the concentration of FITC-Dextran in a control solution over a period of six hours in rabbit eyes.
  • FIG. 3 shows the results for the tests of Example 3 below, involving measurement of the increase in non-invasive break up time (NIBUT) of tear film over a period of instillation of a solution according to present invention over thirty (30) minutes in rabbits eyes.
  • NBIUT non-invasive break up time
  • the present invention is directed to a method of treating the symptoms of dry eye employing an ophthalmic solution that can be applied in the form of drops and which comprises a cationic cellulosic polymer that exhibits prolonged duration in the eye.
  • a cationic cellulosic material may be used in the practice of this invention. Specific examples include cellulosic polymers containing N,N-dimethylaminoethyl groups (either protonated or quaternized) and cellulosic polymers containing N,N- dimethylamino-2-hydroxylpropyl groups (either protonated or quaternized).
  • Cationic cellulosic polymers are commercially available or can be prepared by methods known in the art.
  • quaternary nitrogen-containing ethoxylated glucosides can be prepared by reacting hydroxyethyl cellulose with a trimemylammonium-substituted epoxide.
  • Various preferred cationic cellulosic polymers are commercially available, for example water-soluble polymers available under the CTFA (Cosmetic, Toiletry, and Fragrance Association) designation Polyquaternium-10. Such polymers are commercially available under the tradename UCARE® Polymer from Amerchol Corp., Edison, NJ, USA. These polymers contain quaternized N,N-dimethylamino groups along the cellulosic polymer chain.
  • the cationic cellulosic component may be employed in the compositions at about 0.01 to about ten (10) weight percent of the composition, preferably at about 0.05 to about five (5) weight percent, with about 0.1 to about one (1) weight percent being especially preferred.
  • Suitable cationic cellulosic materials have the following formula:
  • R, R, and R 3 are selected from H, derivatives of C,-C 20 carboxylic acid, C,-C 20 alkyl groups, C, to C 3 monohydric and dihydric alkanols, hydroxyethyl groups, hydroxypropyl groups, ethylene oxide groups, propylene oxide groups, phenyl groups, "Z" groups and combinations thereof. At least one of R l5 R 2 ,and R 3 is a Z group. The nature of the "Z" groups is:
  • R', R" and R'" can be H, CH 3 , C 2 H 5 , CH 2 CH 2 OH and
  • one or more additional polymeric or non-polymeric demulcents may be combined with the above-named ingredients.
  • Demulcents are known to provide wetting, moisturizing and/or lubricating effects, resulting in increased comfort.
  • Polymeric demulcents can also act as a water-soluble viscosity builder. Included among the water-soluble viscosity builders are the non-ionic cellulosic polymers like methyl cellulose, hydroxyethyl cellulose, hydroxypropyl cellulose, and carboxymethyl cellulose, poly(N-vinylpyrrolidone), poly(vinylalcohol) and the like.
  • Such viscosity builders or demulcents may be employed in a total amount ranging from about 0.01 to about 5.0 weight percent or less.
  • the viscosity of the final formulation is 10 cps to 50 cps.
  • Comfort agents such as glycerin or propylene glycol can also be added.
  • the solutions of the present invention are effective in the absence of conventional anionic therapeutic agents for the treatment of dry eye.
  • Prior art anionic therapeutic agents include glycosaminoglycans such as hyaluronic acid, hylan, hylaluronan, heparin, heparan sulfate, chondroitin sulfate, keratin sulfate and dermatan sulfate.
  • glycosaminoglycans absent from the present composition are listed in U.S. Patent No. 5,358,706, hereby incorporated by reference.
  • Hyaluronic acid is an anionic biopolymer that has been identified as useful in the treatment of the symptoms of dry eye.
  • Synthetic anionic polymers for the treatment of dry eye also include carboxy- vinyl polymers known as Carbopol,® commercially available from B.F. Goodrich, as described in U.S. Patent No. 5,209,927 to Gressel, et al.
  • the cationic polysaccharides are, in themselves, effective for the treatment of dry eye.
  • the polymers after binding to the mucosal tissue of the eye, in turn promote the mucin in the eye, either by supplementing the mucin and/or by helping to bind and maintain mucin on the surface of the eye.
  • Mucins are proteins, which are heavily glycosylated with glucosamine-based moieties. Mucins have been shown to be secreted by vesicles and discharged on the surface of the conjunctival epithelium of the eye.
  • Mucins provide lubrication and additionally attract and hold moisture and sebaceous material for lubrication.
  • the present composition may also contain a disinfecting amount of a preservative or an antimicrobial agent.
  • a particularly preferred preservative is sorbic acid (0.15%).
  • Antimicrobial agents are defined as organic chemicals that derive their antimicrobial activity through a chemical or physiochemical interaction with the microbial organisms.
  • biguanides include the free bases or salts of alexidine, chlorhexidine, hexamethylene biguanides and their polymers, and combinations of the foregoing.
  • the salts of alexidine and chlorhexidine can be either organic or inorganic and are typically gluconates, nitrates, acetates, phosphates, sulfates, halides and the like.
  • the preferred biguanide is the hexamethylene biguanide commercially available from Zeneca, Wilmington, DE under the trademark CosmocilTM CQ.
  • the hexamethylene biguanide polymers also referred to as polyaminopropyl biguanide (PAPB) have molecular weights of up to about 100,000.
  • the aqueous solutions employed in this invention may contain, in addition to the active ingredients described above, one or more other components that are commonly present in ophthalmic solutions, for example, buffers, stabilizers, tonicity agents and the like, which aid in making ophthalmic compositions more comfortable to the user.
  • the aqueous solutions of the present invention are typically adjusted with tonicity agents to approximate the tonicity of normal lacrimal fluids which is equivalent to a 0.9% solution of sodium chloride or 2.8% of glycerol solution.
  • the solutions are made substantially isotonic with physiological saline used alone or in combination; otherwise, if simply blended with sterile water and made hypotonic or made hypertonic, the lenses will lose their desirable optical parameters.
  • excess salt or other tonicity agents may result in the formation of a hypertonic solution that will cause stinging and eye irritation.
  • An osmolality of about 225 to 400 mOsm/kg is preferred, more preferably 280 to 320 mOsm/kg.
  • the pH of the present solutions used to treat dry eye should be maintained within the range of 5.0 to 8.0, more preferably about 6.0 to 8.0, most preferably about 6.5 to 7.8; suitable buffers may be added, such as borate, citrate, bicarbonate, TRIS and various mixed phosphate buffers (including combinations of Na 2 HPO 4 , NaH 2 PO 4 and KH 2 PO 4 ) and mixtures thereof. Borate buffers are preferred, particularly for enhancing the efficacy of PAPB. Generally, buffers will be used in amounts ranging from about 0.05 to 2.5 percent by weight, and preferably, from 0.1 to 1.5 percent.
  • Ethylene- ⁇ aminetetraacetic acid (EDTA) and its salts (disodium) are preferred examples. They are usually added in amounts ranging from about 0.01 to about 0.2 weight percent.
  • the solutions employed in the present invention can be prepared by a variety of techniques.
  • One method employs two-phase compounding procedures.
  • first phase about 30 percent of the distilled water is used to dissolve the cationic cellulosic polymer by mixing for about 30 minutes at around 50° C.
  • the first-phase solution is then autoclaved at about 120° C for 30 minutes.
  • second phase alkali metal chlorides, sequestering agents, preservatives and buffering agents are then dissolved in about 60 percent of the distilled water under agitation, followed by the balance of distilled water.
  • the second-phase solution can then be sterilely added into the first-phase solution by forcing it through an 0.22 micron filter by means of pressure, followed by packaging in sterilized plastic containers.
  • compositions for use in the present invention may be sold in a wide range of small-volume containers from 1 to 30 ml in size.
  • Such containers can be made from HDPE (high density polyethylene), LDPE (low density polyethylene), polypropylene, poly(ethylene terepthalate) and the like.
  • Flexible bottles having conventional eye-drop dispensing tops are especially suitable for use with the present invention.
  • the above-described solutions may be used by instilling, for example, about one (1) or three (3) drops in the affected eye(s) as needed, for the temporary relief of burning and irritation due to dryness in the eye and for use as a protectant against further irritation, or to relieve dryness to the eye.
  • EXAMPLE 1 An aqueous solution for use in treating the symptoms of dry eye according to the present invention, by means of eyedrops of the solution administered to the eye, is prepared with the following ingredients in water:
  • the formulation is prepared in bulk as follows. In a 316-grade stainless-steel- jacketed pressure kettle equipped with agitation, distilled water is added in the amount of about 800 g and heated to 60° to 70°C, preferably 65°C. Under agitation the following batch quantities of the following ingredients are added, wherein after one ingredient is dissolved or hydrated, the next is added: Polymer JR, Boric Acid, Sodium Borate, Benzalkonium Chloride, Glycerin. Agitation is maintained throughout the entire processing of the batch. Upon dissolution of these components, the batch is charged with purified water to 98 percent of the final weight. The solution is mixed for a minimum of thirty(30) minutes to ensure complete dissolution.
  • the pH is adjusted to 6.5 to 7.4 at 25°C with 2.5 N NaOH or IN HC1 and measured at 6.8.
  • the osmolality is measured at 300 mOsm/Kg.
  • the solution may be sterilized by autoclave at 121-124°C for thirty (30) to forty-five (45) minutes and then immediately cooled to 40°C, after which a sufficient quantity of cool purified water may be added to obtain the final weight.
  • the finished solution should be aseptically passed through a sterile 40-50 micrometer polishing filter.
  • suitable polishing filters include Pall RigimeshTM RR 40 micrometer and Filterite DynalloyTM 30 micrometer PSP 12-10SL-M7 filters.
  • This example illustrates the effective duration in the eye of solutions according to the present invention as measured using FITC-dextran (also referred to as "FD").
  • FITC-dextran also referred to as "FD”
  • This material having a molecular weight of 40,000, is commercially available from the Sigma Chemical Company (MO, USA).
  • the control solution was five (5) percent FD dissolved in distilled, de-ionized water.
  • Test solution 1 contained five (5) percent FITC-dextran with the combination of UCARE® Polymer JR 30M (0.5 percent) and Carbowax® Sentry® Polyethylene Glycol 20M (0.5 percent).
  • Test Solution 2 contained five (5) percent FITC-dextran with UCARE® Polymer JR 30M (0.5 percent) only. The two solutions were tested in triplicate in male New Zealand rabbits (weighing 1.5 to 2 kilograms). The test solution was administered into the right eye and the control solution was administered into the left eye of the rabbit. The solutions (25mg) were instilled in the lower cul-de-sac of each rabbit eye. All solutions were administered with a micropipettor. The eyes were held closed for thirty (30) seconds after instillation.
  • Tear fluid was collected at 0.5, 1, 2, 3, 4.5 and 6 hours using 2 ⁇ l disposable glass capillaries.
  • the upper eyelid of the rabbit eye was held up, and the capillary tube was placed in the upper cul-de-sac.
  • the tear was collected by gently drawing the end of the tube between the globe of the eye and the eyelid for about one minute. During sampling, contact between the capillary tip and any visible gel lumps was avoided.
  • the fluid in the capillaries was flushed into tubes containing one ml of water, and the resulting samples were stored at 4°C until analysis of the FD content. The concentration of FD in the samples was determined using a spectrofluorophotometer.
  • the excitation wavelength was 491 nm, and the emission wavelength was 513 nm.
  • a standard curve was obtained using solutions containing 0.05, 0.1, 0.2, 0.4, 0.6 and 1.0 ⁇ g/ml of FD. Because the volume of tears in each rabbit eye is different, the concentration of FD in one ml of tear was calculated. The FD concentrations versus time curves were plotted.
  • a non-parametric statistical test (Wilcoxon rank sum test) was used to compare the FD concentrations in tears, obtained following administration of the test solution and the control.
  • This example illustrates the effectiveness of the present invention to stabilize the tear film and decrease the symptoms of dry eye in an animal model.
  • New Zealand white rabbits had the nictitating membrane and the accessory and main lacrimal glands surgically removed from their right eye.
  • the non- invasive break up time was then measured in minutes for each eye. After baseline measurements were taken in the right eye, one (1) drop of the test solution was administered and the NIBUT was measured immediately and at 5, 15 and 30 minutes after instillation. Three (3) solutions were tested.
  • the first was a borate-buffered saline (BBS); the second was a composition containing 0.5% Polymer JR and 1% Glycerin in the BBS; and the third was a combination of 1% Propylene Glycol and 0.3% Glycerin in the BBS.
  • BBS borate-buffered saline

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  • Health & Medical Sciences (AREA)
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  • Pharmacology & Pharmacy (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
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Abstract

La présente invention concerne une méthode de traitement de kératoconjonctivite sèche par instillation dans les yeux de gouttes d'une composition contenant un polymère cellulosique cationique. On a découvert que cette composition soulage les symptômes de kératoconjonctivite sèche sans nécessiter la présence d'agents thérapeutiques anioniques. On suppose que cette composition adhère aux endroits secs dans l'oeil et augmente ou favorise la présence de mucine, un lubrifiant connu produit naturellement par les muqueuses de l'oeil.
PCT/US2000/006794 1999-03-18 2000-03-15 Methode de traitement de keratoconjonctivite seche Ceased WO2000054747A2 (fr)

Priority Applications (1)

Application Number Priority Date Filing Date Title
AU37478/00A AU3747800A (en) 1999-03-18 2000-03-15 Method for treating dry eye

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US12495399P 1999-03-18 1999-03-18
US60/124,953 1999-03-18

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WO2000054747A2 true WO2000054747A2 (fr) 2000-09-21
WO2000054747A3 WO2000054747A3 (fr) 2000-12-21

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AR (1) AR022960A1 (fr)
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Cited By (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2001074330A3 (fr) * 2000-04-04 2002-06-27 Bausch & Lomb Procede de traitement de l'oeil sec
WO2001082984A3 (fr) * 2000-05-02 2002-07-04 Bausch & Lomb Compositions ophthalmiques a faible force ionique
EP1421974A1 (fr) * 2002-06-10 2004-05-26 D.M.G. Italia Srl Solution ophthalmique comprenant carboxy methyl beta-1, 3 glucan

Family Cites Families (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
DE3440352A1 (de) * 1984-11-05 1986-05-07 Dr. Thilo & Co GmbH, 8029 Sauerlach Dry-eye-packung
US5401327A (en) * 1993-06-18 1995-03-28 Wilmington Partners L.P. Method of treating contact lenses
US6274133B1 (en) * 1998-12-22 2001-08-14 Bausch & Lomb Incorporated Method for treating extended-wear contact lenses in the eyes

Cited By (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2001074330A3 (fr) * 2000-04-04 2002-06-27 Bausch & Lomb Procede de traitement de l'oeil sec
WO2001082984A3 (fr) * 2000-05-02 2002-07-04 Bausch & Lomb Compositions ophthalmiques a faible force ionique
EP1421974A1 (fr) * 2002-06-10 2004-05-26 D.M.G. Italia Srl Solution ophthalmique comprenant carboxy methyl beta-1, 3 glucan

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Publication number Publication date
AR022960A1 (es) 2002-09-04
WO2000054747A3 (fr) 2000-12-21
AU3747800A (en) 2000-10-04

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