TOPICAL COMPOSITION
20230022570 · 2023-01-26
Inventors
Cpc classification
A61K45/06
HUMAN NECESSITIES
A61K31/5575
HUMAN NECESSITIES
A61K47/10
HUMAN NECESSITIES
A61K31/045
HUMAN NECESSITIES
A61K31/045
HUMAN NECESSITIES
A61K47/26
HUMAN NECESSITIES
A61K9/0034
HUMAN NECESSITIES
A61K47/32
HUMAN NECESSITIES
G01N25/58
PHYSICS
A61K2300/00
HUMAN NECESSITIES
A61L31/14
HUMAN NECESSITIES
A61K2300/00
HUMAN NECESSITIES
A61K9/0014
HUMAN NECESSITIES
International classification
A61K47/10
HUMAN NECESSITIES
A61K31/417
HUMAN NECESSITIES
A61K31/5575
HUMAN NECESSITIES
A61K45/06
HUMAN NECESSITIES
A61K9/00
HUMAN NECESSITIES
A61L31/14
HUMAN NECESSITIES
Abstract
There is provided a composition for topical application to the penis for the treatment of erectile dysfunction, the composition being free of glyceryl trinitrate (GTN), sildenafil and an acetylcholinesterase inhibitor, and comprising volatile and non-volatile solvents, the volatile solvents comprising a lower alcohol and water and the non-volatile solvents comprising a polyhydric alcohol and a glycol. Preferably, the composition does not contain any pharmaceutically active ingredients for the treatment of erectile dysfunction. Also provided is a method of determining the cooling ability of a test composition, such as the composition described above.
Claims
1. A composition for topical application to the penis for the treatment of erectile dysfunction, the composition being free of glyceryl trinitrate (GTN), sildenafil and an acetylcholinesterase inhibitor, and comprising volatile and non-volatile solvents, the volatile solvents comprising a lower alcohol and water and the non-volatile solvents comprising a polyhydric alcohol and a glycol.
2. A composition according to claim 1, wherein the composition is free of GTN, sildenafil and an acetylcholinesterase inhibitor, or derivatives or prodrugs thereof.
3, A composition according to claim 1 or 2, wherein the composition does not contain any pharmaceutically active ingredients for the treatment of erectile dysfunction.
4. A composition according to any preceding claim, wherein the composition does not contain any pharmaceutically active ingredients.
5. A composition according to any preceding claim, wherein the composition has a pH above 5.0 and lower than 7.0.
6. A composition according to any preceding claim, having the form of a gel.
7. A composition according to claim 6, wherein the composition has the form of a gel having a viscosity in the range 125,000 to 600,000 mPas.
8. A composition according to any preceding claim, wherein the lower alcohol is ethanol or isopropanol.
9. A composition according to any preceding claim, wherein the polyhydric alcohol is selected from glycerol, sorbitol, erythritol, arabitol and xylitol.
10. A composition according to any preceding claim, wherein the glycol is selected from propylene glycol, butylene glycol, pentylene glycol and hexylene glycol.
11. A composition according to any preceding claim, wherein the polyhydric alcohol to glycol weight ratio is from 1.5:1 to 6.0:1.
12. A composition according to and preceding claim, wherein the polyhydric alcohol to glycol weight ratio is from 3:1 to 5:1.
13. A composition according to any preceding claim, further comprising a thickening or gelling agent.
14. A composition according to any preceding claim, comprising the following ingredients, the ranges being expressed in percentages by weight of the overall composition: lower alcohol: 30-45% water: 20-40% polyhydric alcohol: 22-26% glycol: 4-12%
15. A composition according to any preceding claim, wherein the water is in the range 30-40% by weight.
16. A composition according to any preceding claim, wherein the lower alcohol is in the range 30-35% by weight.
17. A composition according to any preceding claim, wherein the combined amount of the polyhydric alcohol and the glycol is not more than 35% by weight.
18. A composition according to any preceding claim, comprising the following ingredients, the ranges being expressed in percentages by weight of the overall composition: lower alcohol: 30-35% water: 33-37% polyhydric alcohol: 22-26% glycol: 4-8%
19. A composition according to any preceding claim, wherein the composition is in the form of a gel and comprises the following ingredients, the ranges being expressed in percentages by weight of the overall composition: lower alcohol: 30-35% water: 33-37% polyhydric alcohol: 22-26% glycol: 4-8% a thickening or gelling agent: 0.5-1.5%, wherein the composition has a pH as manufactured in the range 5.25 to 5.75.
20. The composition according to any preceding claim, comprising the following ingredients being expressed in percentages by weight of the overall composition: ethanol: 33% water: 35% glycerol: 24% propylene glycol: 6% a thickening or gelling agent: 1% optionally, a pH control agent, an agent for enhancing skin feel, and/or an antimicrobial preservative, wherein the composition has a pH as manufactured in the range 5.25 to 5.75.
21. The composition according to any preceding claim, comprising the following ingredients being expressed in percentages by weight of the overall composition: ethanol: 33% water: 35% glycerol: 24% propylene glycol: 6% Carbopol® Ultrez 10: 1% optionally, a pH control agent, an agent for enhancing skin feel, and/or an antimicrobial preservative, wherein the composition has a pH as manufactured in the range 5.25 to 5.75.
22. The composition according to any preceding claim, consisting of the following ingredients being expressed in percentages by weight of the overall composition: ethanol: 33% water: 35% glycerol: 24% propylene glycol: 6% a thickening or gelling agent: 1% optionally, a pH control agent, an agent for enhancing skin feel, and/or an antimicrobial preservative, wherein the composition has a pH as manufactured in the range 5.25 to 5.75.
23. The composition according to any of claims 1 to 22 for use in therapy.
24. The composition according to any of claims 1 to 22 for use in treating or ameliorating erectile dysfunction in a male subject.
25. Use of the composition according to any of claims 1 to 22 in the manufacture of a medicament for treating or ameliorating erectile dysfunction in a male subject.
26. A method for treating or ameliorating erectile dysfunction, the method comprising topically applying a biologically effective amount of the composition of any of claims 1 to 22 to the penis of a male subject.
27. The use of claim 24 or 25, or the method of claim 26, wherein the subject has an existing medical condition, wherein the existence of the condition precludes the taking of an active ingredient for treating erectile dysfunction, optionally wherein the existing medical condition is selected from angina, low blood pressure, high blood pressure, benign prostatic hyperplasia, and retinitis pigmentosa.
28. The use of claim 24 or 25, or the method of claim 26, wherein the subject has an existing medical condition, wherein the treatment of the condition precludes the taking of an active ingredient for treating erectile dysfunction, optionally wherein the existing medical condition is selected from angina, low blood pressure, high blood pressure, benign prostatic hyperplasia, and retinitis pigmentosa.
29. The use or method according to claim 28, wherein treatment of the existing medical condition involves administration of an active ingredient selected from PDE-5 inhibitors, nitrates and alpha blockers.
30. The use or method according to claim 29, wherein the active ingredient for treating the existing medical condition is selected from GTN, isosorbide mononitrate, isosorbide dinitrate, alfuzosin, doxazosin, indoramin, prazosin, tamsulosin, and terazosin.
31. The use or method according to any one of claims 24 to 30, further comprising administering at least one active agent for treating or ameliorating erectile dysfunction, wherein the method excludes the topical application of GTN, sildenafil or an acetylcholinesterase inhibitor to the penis of the subject.
32. The use or method according to claim 31, wherein the at least one active agent for treating or ameliorating erectile dysfunction is selected from PDE-5 inhibitors, alprostadil and phentolamine mesilate.
33. The use or method according to any one of claims 24 to 32, wherein the male subject has severe erectile dysfunction.
34. A condom comprising the composition according to any one of claims 1 to 22.
35. A kit comprising the composition according to any of claims 1 to 22 and an active agent for treating or ameliorating erectile dysfunction, wherein the kit does not comprise GTN, sildenafil or an acetylcholinesterase inhibitor for inclusion in the composition.
36. The kit of claim 35, wherein the active agent is selected from PDE-5 inhibitors, alprostadil and phentolamine mesilate.
37. A method of determining the cooling ability of a test composition, the method comprising: applying a layer of the test composition to a temperature probe, wherein the test composition and the temperature probe are at a pre-determined temperature which is between about 25° C. and about 50° C.; placing the temperature probe in an environment which has a relatively constant temperature which is the same as the pre-determined temperature; monitoring the temperature change of the temperature probe over time; and optionally monitoring the weight change of the temperature probe over time.
38. The method of claim 37, wherein, in the applying step, the temperature probe and the test composition are at substantially the same temperature when the layer of the test composition is applied to the temperature probe.
39. The method of claim 37 or 38, wherein between about 40 mg and about 100 mg of test composition are applied to the temperature probe.
40. The method of any one of claims 37 to 39, wherein the temperature change of the temperature probe, and optionally the weight change of the temperature probe, is monitored for at least about 5 minutes.
41. The method of any one of claims 37 to 40, wherein the temperature change of the temperature probe, and optionally the weight change of the temperature probe, is monitored for between about 20 minutes and about 30 minutes.
42. The method of any one of claims 37 to 41, wherein, prior to the applying step, the test composition and the temperature probe are incubated in an environment which has a relatively constant temperature and which is at the pre-determined temperature so that the test composition and the temperature probe are at the pre-determined temperature for the applying step.
43. The method of any one of claims 37 to 42, wherein the pre-determined temperature is 27° C.±1° C., 32° C.±1° C. or 37° C.±1° C.
44. The method of any one of claims 37 to 43, wherein the weight of the temperature probe is measured before the application of the test composition.
45. The method of any one of claims 37 to 44, wherein the method comprises: incubating the test composition and a temperature probe in an environment which has a relatively constant temperature and which is at a pre-determined temperature between about 25° C. and about 40° C.; applying a layer of between about 40 mg and about 100 mg of the test composition to the temperature probe, wherein the test composition and the temperature probe are at the pre-determined temperature; placing the temperature probe in an environment which has a relatively constant temperature and which is at the pre-determined temperature; and monitoring the temperature change and the weight change of the temperature probe for between about 20 minutes and about 30 minutes.
46. A method of determining the cooling ability of a test composition, the method comprising the following steps: 1. Drill a hole about 5 mm in diameter into a 15 mL centrifuge tube lid. Weigh the empty centrifuge tube on an analytical balance. 2. Place about 14 mL of sample gel into the 15 mL centrifuge tube. Seal with a normal lid and centrifuge at about 1500 rpm for about 30 seconds to collect the gel. 3. Place the tube containing sample gel, a calibrated temperature probe and an analytical balance into a bench top oven set at 32° C.±1° C. 4. Weigh the tube containing the sample gel. (Weight Check 1). 5. Leave all apparatus including the tube containing sample gel overnight to incubate. 6. After incubation, weigh the tube containing the sample gel. (Weight Check 2). 7. Place the lid with the 5 mm hole cut out onto the centrifuge tube containing sample gel. Stopper the hole to prevent any evaporation until it is ready to be sampled. Place back into the benchtop oven. 8. Tare the balance with the temperature probe. Ensure the temperature of the probe is within 32° C.±1° C. 9. Remove the temperature probe from the balance and insert it into centrifuge tube containing sample gel until the base of the probe makes contact with the tube lid. Approximately 70 mg is applied (±20 mg). 10. In one smooth motion, withdraw the probe from the gel taking care not to make contact with the sides of the centrifuge cap. Place the probe back onto the balance, close the oven door and start the stopwatch. 11. Record the weight and temperature of the probe for 25 minutes.
47. The method of claim 46, wherein the method is carried out at a temperature of 27° C.±1° C. or 37° C.±1° C. instead of 32° C.±1° C.
48. A composition which provides a maximum temperature reduction of at least 5° C. when tested using the method of any one of claims 37 to 47.
49. The composition of any one of claims 1 to 22, wherein the composition provides a maximum temperature reduction of at least 5° C. when tested using the method of any one of claims 37 to 47.
50. The composition of claim 48 or 49, wherein the composition provides a maximum temperature reduction of at least 8° C.
51. The composition of any one of claims 48 to 50, wherein the composition provides a maximum temperature reduction of between about 8° C. and about 14° C.
52. The composition of any one of claims 48 to 51, wherein the composition provides a temperature reduction after 1 minute of monitoring of at least 5° C.
53. The composition of any one of claims 48 to 52, wherein the composition provides a temperature reduction after 1 minute of monitoring of between about 8° C. and about 14° C.
54. The composition of any one of claims 48 to 53, wherein the composition provides a temperature recovery after 25 minutes of monitoring of at least 4° C.
55. The composition of any one of claims 48 to 54, wherein the composition provides a temperature recovery after 25 minutes of monitoring of between about 4° C. and about 12° C.
56. The composition of any one of claims 48 to 55, wherein the composition is tested at a pre-determined temperature of 32° C.±1° C., and wherein 1) the composition provides a maximum temperature reduction of at least 9° C.; 2) the composition provides a maximum temperature reduction of between about 9° C. and about 13° C.; 3) the composition provides a temperature reduction after 1 minute of monitoring of at least 9° C.; 4) the composition provides a temperature reduction after 1 minute of monitoring of between about 9° C. and about 13° C.; 5) the composition provides a temperature recovery after 25 minute of monitoring of at least 6° C.; and/or 6) the composition provides a temperature recovery after 25 minute of monitoring of between about 6° C. and about 10° C.
57. The composition of any one of claims 48 to 55, wherein the composition is tested using the method of claim 46, and wherein 1) the composition provides a maximum temperature reduction of between about 9° C. and about 13° C.; 2) the composition provides a temperature reduction after 1 minute of monitoring of between about 9° C. and about 13° C.; and 3) the composition provides a temperature recovery after 25 minute of monitoring of between about 6° C. and about 10° C.
Description
BRIEF DESCRIPTION OF THE DRAWINGS
[0133] The invention will now be described in detail by way of example only with reference to the figures in which:
[0134]
[0135]
[0136]
DETAILED DESCRIPTION OF THE INVENTION
Efficacy of Composition
[0137] The results of a clinical trial of compositions according to the invention show that they are equivalent in performance to compositions containing GTN as active ingredient, as set out hereinbefore. The composition of the invention contained: ethanol: 33%; water: 35%; glycerol: 24%; propylene glycol: 6%; Carbopol® Ultrez 10: 1%. pH was adjusted to 5.25 with potassium hydroxide solution. The ethanol used in the manufacture of the composition was absolute ethanol (i.e. 100% ethanol free from water) such that the final composition contained 33% of pure ethanol. If a lower grade of ethanol was used which contained impurity amounts of water (e.g. 96% ethanol), then the amount used would have to be adjusted to ensure the final composition contained the correct amount of the components, i.e. 33% pure ethanol and 35% water.
[0138] The availability of an efficacious composition for treatment of erectile dysfunction, without the inclusion of GTN or any other active ingredient, means that the composition has reduced contraindications compared with other treatments, thus for example enabling the composition to be used by men taking nitrate medication. Furthermore, the high safety profile enables the compositions to be used in conjunction with other treatments such as sildenafil. In summary, compositions according to the invention, in providing fast onset time and sustained erection quality, together with a high safety profile, represent a significant improvement to known treatments and offer further treatment opportunities to patients who hitherto have been unable to or are contra-indicated to use currently-available treatments.
[0139] The appended Tables show clinical trial results for compositions according to the invention, compared with equivalent compositions containing GTN and with commercially-available Cialis and Vitaros. In the results, the IIEF figures are on the basis of questionnaire responses relating to the evaluation of male sexual function and SWEP2 and SEP3 respectively relate to the ability to insert the penis into the vagina and the ability of the erection to sustain long enough for completion of intercourse.
[0140] Primary Endpoints at 12 Weeks Vs Baseline
TABLE-US-00001 0.6 mg 1.2 mg 1.8 mg Primary (0.2%) (0.4%) (0.6%) Endpoint Invention P-values GTN P-values GTN P-values GTN P-values IIEF-EF 3.60 <0.001 3.39% <0.001 3.42% <0.001 3.66% <0.001 Domain SEP2 13.8% <0.001 9% <0.001 13.27% <0.001 10.67% <0.001 SEP3 23.16% <0.001 20.76% <0.001 22.63% <0.001 23.27% <0.001
[0141] Clinically Important Differences at 12 Weeks (Rosen & Araujo)—Percentage of Patients Who Noticed a Meaningful Difference
TABLE-US-00002 Overall responders Responders in patients using with Mild/Moderate/ Rosen/Araujo Severe ED using Invention (%) Rosen/Araujo (%) IIEF 63 61/59/80 SEP2 75 83/57/77 SEP3 68 71/61/71
[0142] Primary Endpoints Vs Baseline for Composition of the Invention, Cialis & Vitaros
TABLE-US-00003 Primary Efficacy Vitaros 100, 200 & Parameters Invention Cialis 5 mg 300 ug IIEF 3.6 4.6 1.6/2.5/2.4 SEP2 13.8% 16.5% 2.9%/5.1%/7.2% SEP3 23.2% 21.5% 7.0%/13.8%/9.1%
[0143] Side Effect Profile—Invention vs. Cialis
TABLE-US-00004 Adverse events - Invention Adverse events - Cialis 5 mg Invention (N = 250) Cialis (N = 151) Headache 3% Headache 11% Flushing 0% Flushing 2% Nasal congestion 0% Nasal congestion 2% Back pain 0% Back pain 3% Dizziness 0% Myalgia 2% Penile burning 1% Pain in limb 1%
[0144] Cooling Effect of Composition
[0145] As indicated above, the compositions of the invention are believed to enhance production of endogenous NO by virtue of the latent heat of cooling as the volatile solvent component evaporates, stimulating the nerves locally and resulting in generation of endogenous NO. In the glans of the penis, there are sensors which are reactive to a range of physical sensations, such as and including touch, pressure and temperature, and topical application of compositions of the invention stimulate such sensors. It is thought that the rapid cooling brought about by the composition followed by the recovery in temperature acts as a stimulant so that the sensors react synergistically and result in tumescence and erection without the inclusion of an active ingredient.
[0146] The cooling effect of the composition used in the clinical trial above (ethanol: 33%; water: 35%; glycerol: 24%; propylene glycol: 6%; Carbopol® Ultrez 10: 1%. pH adjusted to 5.25 with potassium hydroxide solution) was tested and a protocol developed to enable the comparison of the cooling effect of different compositions.
[0147] 1. Principle
[0148] The cooling effect and rate of recovery of the gel composition is measured by applying the gel to a calibrated temperature probe that is weighed on an analytical balance. This allows the temperature change to be monitored simultaneously with weight loss over time. Different cooling/recovery ‘profiles’ can be generated when incubating the setup at different ambient temperatures (i.e. 27° C., 32° C. and 37° C.).
[0149] 2. Summary
[0150] A suitable method to assess the cooling profiles of the composition of the invention was developed at three different ambient temperatures: 27° C., 32° C. and 37° C. The method was issued to describe the process used to obtain the cooling profiles.
[0151] The results of the validation studies confirm that the method is fit for purpose regarding the repeatability (precision), reproducibility (intermediate precision) and accuracy.
[0152] 3. Instruments & Apparatus [0153] Temperature probe (e.g. Fisherbrand Traceable Flip-Stick Thermometer, P/N: 14-648-45). Total probe surface area: 11.64 cm.sup.2 [0154] 15 mL plastic centrifuge tubes or equivalent [0155] Power drill capable of drilling a 5 mm diameter hole or equivalent [0156] Analytical balance (e.g. Sartorius 4 decimal place Analytical Balance or equivalent) [0157] Stopwatch [0158] Bench top oven capable of maintaining 27° C., 32° C. and 37° C.±1° C. [0159] Bench top centrifuge [0160] Video recorder/Camera
[0161] 4. Sample
[0162] The following sample was used for the validation:
[0163] Gel comprising ethanol: 33%; water: 35%; glycerol: 24%; propylene glycol: 6%; Carbopol® Ultrez 10: 1%. pH adjusted to 5.25 with potassium hydroxide solution.
[0164] 5. Method Development
[0165] Development of the method utilised three different ambient temperatures: 27° C., 32° C. and 37° C., to assess the cooling profile of the sample gel. A description of the method can be found in section 6 (32° C. described only). The temperature and weight of the gel was recorded over a run time of 25 minutes. Six replicate preparations were performed and the average of the data calculated at each ambient temperature. The following cooling profiles were generated: Temperature vs Time (
[0166] During development, it was observed that the first replicate on each day at each ambient temperature was further from the mean result when compared to the other five replicates of data. This could be caused by fluctuations in oven temperature when opening the oven door for the first time after overnight incubation. For this reason, it was decided for the validation studies to disregard the first replicate on each day in order to allow the oven to stabilise before further replicates were performed.
[0167] The results obtained for the development work show that a different cooling profile is achieved when analysing at different ambient temperatures. This difference in the cooling profile is most apparent when plotting Temperature (° C.) against Time (minutes) (
[0168]
[0169] The cooling profiles obtained by plotting Temperature (° C.) against % Weight Change are shown in
[0170] 6. Analytical Guidance
[0171] The following steps were carried out to test the sample gel.
[0172] Note: the first run on each day of analysis is to be disregarded and treated as a mock run to allow the oven setup to stabilise after the first run. [0173] 1. Drill a hole ˜5 mm in diameter into a 15 mL centrifuge tube lid. Weigh the empty centrifuge tube on an analytical balance. Record the weight and tare the balance. [0174] 2. Place ˜14 mL of sample gel into the 15 mL centrifuge tube using a syringe. Seal with a normal lid and centrifuge at 1500 rpm for 30 seconds to collect the gel. [0175] 3. Place the tube containing sample gel, a calibrated temperature probe and an analytical balance into a bench top oven set at 32° C.±1° C. [0176] 4. Weigh the tube containing the sample gel. Record the weight of the gel (Weight Check 1). [0177] 5. Place another calibrated temperature probe inside the balance chamber (for ambient temperature monitoring only). Leave all apparatus including the tube containing sample gel overnight to incubate. [0178] 6. After incubation, weigh the tube containing the sample gel. (Weight Check 2). Calculate the weight change and check there is no significant weight loss (NMT 2%). [0179] 7. Place the lid with the 5 mm hole cut out onto the centrifuge tube containing sample gel. Stopper the hole to prevent any evaporation until it is ready to be sampled. Place back into the benchtop oven. [0180] 8. Tare the balance with the temperature probe. Ensure the temperature of the probe is within 32° C.±1° C. [0181] 9. Begin video recording ensuring the temperature and weight are visible. (NB: it is not required to video record beyond 5 minutes. Readings after this time may be manually recorded). [0182] 10. Remove the temperature probe from the balance and insert it into centrifuge tube containing sample gel until the base of the probe makes contact with the tube lid. Approximately 70 mg is applied (±20 mg). (NB: Time sensitive step). [0183] 11. In one smooth motion, withdraw the probe from the gel taking care not to make contact with the sides of the centrifuge cap. Place the probe back onto the balance, close the oven door and start the stopwatch. Stopper the centrifuge tube lid and centrifuge the tube for 15 seconds at 1500 rpm to collect the gel. Seal the tube with a regular lid and place back into the oven. (NB: Time sensitive step). [0184] 12. Record the weight and temperature of the probe for 25 minutes. See Table 2 for reading intervals. [0185] 13. If ambient temperature drift is observed, the oven may be maintained at 32° C.±1° C. by adjusting the oven control dial or by venting with a small gap in the oven door on the opposite side of the balance. [0186] 14. After 25 minutes, remove the temperature probe from the balance and clean with a dry lint-free tissue. Place the temperature probe back onto the balance maintained at 32° C.±1° C. Repeat steps 7-14 for the next replicate. [0187] 15. Repeat all steps for the remaining ambient temperatures of 27° C.±1° C. and 37° C.±1° C.
Reading Intervals
[0188]
TABLE-US-00005 Time (mins) Reading Interval 0-1.5 Every 5 seconds 1.5-4 Every 30 seconds 4-15 Every 1 minute 15-25 Every 5 minutes
[0189] 7. Results
[0190] Calculate % weight change at each reading interval using the following equation:
% weight change=−100+((Reading Interval Weight (g)/Initial Weight (g))*100)
Calculate the following:
Maximum Temperature Reduction=Ambient Temperature (° C.)−Lowest Temperature (° C.)
Temperature Recovery (T=25 mins)=Final Temperature (° C.)−Lowest Temperature (° C.)
[0191] In a validation study conducted at an ambient temperature of 32° C.±1° C. in accordance with the protocol given in section 6, the test sample gave the following results:
TABLE-US-00006 Target Precision Parameter (° C.) Mean SD % RSD (% RSD) Temperature Drop After 1 min 11.5 0.1 0.7 ≤7.5% RSD Maximum Temperature Drop 11.5 0.1 1.0 Temperature Recovery After 25 min 8.9 0.4 5.0