CN107693486A - 包含阿朴吗啡和有机酸的组合物及其用途 - Google Patents
包含阿朴吗啡和有机酸的组合物及其用途 Download PDFInfo
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- CN107693486A CN107693486A CN201710922800.2A CN201710922800A CN107693486A CN 107693486 A CN107693486 A CN 107693486A CN 201710922800 A CN201710922800 A CN 201710922800A CN 107693486 A CN107693486 A CN 107693486A
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- Prior art keywords
- apomorphine
- acid
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Abstract
本发明涉及包含阿朴吗啡和有机酸的组合物及其用途,更具体地,所述组合物包含阿朴吗啡和有机酸,所述组合物可用于神经学的或运动疾病或障碍,例如帕金森病,或与其相关的病症的治疗。
Description
本申请是中国专利申请201380029952.X的分案申请,原申请201380029952.X的申请日为2013年6月5日,其名称为“包含阿朴吗啡和有机酸的组合物及其用途”。
相关申请的交叉参考
本申请要求2013年6月5日提交的美国临时申请No.61/655,633的优先权,其全部内容通过参考引入本文。
技术领域
本发明主要涉及稳定的液体或半固体的阿朴吗啡的药物组合物,及其用于治疗神经学的疾病或障碍包括帕金森病,或与其相关的病症。
背景技术
帕金森病是中枢神经系统的渐进退行性疾病。尽管帕金森病的主因还未知,但其特征在于黑质的多巴胺能神经元的退化。所述黑质位于中脑并与控制自主运动有关。所述神经元的退化引起大脑中多巴胺的缺乏,认为其引起所述疾病的可观察到的症状。这些症状包括运动的缺乏和僵直、静止性震颤、运动迟缓、和平衡性差。
存在各种可用于帕金森病的治疗。最著名的是作为多巴胺前体的左旋多巴;但是用左旋多巴治疗会引起严重的副作用,尤其是长期使用。这种用左旋多巴长期治疗的并发症之一为出现临床状态下急剧波动,该情况下患者在几分钟至几小时的时间内在能动与不能动之间突然转换。该现象称作“开关效应”,“开”状态的特征在于提前正常运动行为的左旋多巴效应,而“关”状态的特征在于运动不能—能动性的突然丧失,例如,该情况下患者在步行时可能突然停止。大约半数的左旋多巴治疗患者将在治疗几年之后出现这种开关效应。
虽然已证实阿朴吗啡盐酸盐对治疗帕金森病患者的“关”发作是有效的,但通过皮下注射阿朴吗啡盐酸盐给药的常见且严重的副作用是在注射位点出现皮下结节,其会感染,需要治疗或外科手术介入。输注阿朴吗啡的大多数人出现结节,且每当输注针重新定位时会形成新的结节,其可能每天发生。这种结节会疼痛,限制了可用的输注位点并影响吸收。此外,不稳定组合物,例如,具有阿朴吗啡或其它制剂的沉淀的组合物,可能引起或加剧这种结节副作用。因此,需要新的稳定的阿朴吗啡制剂(formulations),其可安全有效地给药于患者。
发明内容
该公开至少部分涉及如下发现:特定的有机酸,例如酸性氨基酸,形成稳定的阿朴吗啡盐,其适用于允许皮下给药而不产生不需要的副作用的组合物。
在一个方面中,本发明涉及一种稳定的液体或半固体药物组合物,特别是水性药物组合物,其包含阿朴吗啡、有机酸例如酸性氨基酸、和药学上可接受的载体,其中阿朴吗啡与有机酸的摩尔比为约1比约0.5-2.5,或约1比约0.5-1.5,例如1:1.2。
在另一个方面中,本发明涉及一种液体或半固体药物组合物,其包含(i)阿朴吗啡或其盐;和(ii)乳化剂或表面活性剂,或乳化剂和表面活性剂两者,其中所述组合物在25℃下在约3至约7.5范围内的pH下,或在大于4的pH下,实质上无固体沉淀达至少48小时。
在另一个方面中,本发明提供一种通过给药本文所公开的药物组合物来治疗患者的神经学的或运动疾病或障碍、或与其相关的病症的方法。在一个实施方案中,本发明的方法旨在治疗神经学的疾病或障碍(例如帕金森病),其特征在于通过给药所公开的组合物来降低患者大脑中多巴胺的水平。
在一个具体的该方面中,本发明提供一种通过给药本文所公开的组合物来治疗患者的帕金森病的方法。
在另一个具体的该方面中,本发明提供一种治疗患者的运动不能的方法,包括给药本文所公开的组合物于患者,其中所述患者已用左旋多巴治疗。
在另一个方面中,本发明涉及如上定义的液体或半固体药物组合物,用于治疗神经学的或运动疾病或障碍、或与其相关的病症。
在另一个方面中,本发明涉及如上定义的液体或半固体药物组合物,用于神经学的或运动疾病或障碍、或与其相关的病症的治疗。
附图说明
图1示出用于评价阿朴吗啡制剂组合物对猪皮着色的影响的体系。输注泵设定为0.05ml/h(A);使用22G蝴蝶型来输送制剂(B);全厚猪皮(表皮和皮下组织)放置在含PBS的瓶子上部。所述猪皮直接与PBS接触。用石蜡膜覆盖猪皮和瓶子以尽可能地使体系避免接触空气(C);用热PBS填充100ml瓶子至上部(D);以0.05ml/h经由22G针皮下给药0.4ml的制剂(共8h)(E);并将保温箱设定在37℃。温育样品达时长17h(F)。
图2示出连续皮下输注下文中实施例3所示的一些组合物至全厚猪皮之后,制剂组合物对阿朴吗啡依赖性皮肤着色的影响,其中面(a)示出1%的阿朴吗啡-HClpH 3.5;面(b)示出1%的阿朴吗啡-谷氨酸盐,pH 3.5;面(c)示出1%的阿朴吗啡-谷氨酸盐及抗坏血酸,pH 3.3;面(d)示出1%的阿朴吗啡-谷氨酸盐及抗坏血酸和葡甲胺,pH 4.2;面(e)示出1%的阿朴吗啡-谷氨酸盐及葡甲胺,pH 4.3;面(f)示出1%的阿朴吗啡-天冬氨酸盐,pH 3.6;面(g)示出1%的阿朴吗啡-天冬氨酸盐及葡甲胺,pH 4.2;面(h)示出1%的阿朴吗啡-酒石酸盐,pH 2.9;面(i)示出1%的阿朴吗啡-半酒石酸盐,pH 3.2;和面(j)示出1%的阿朴吗啡-酒石酸盐及葡甲胺,pH 3.6。
图3示出含0.5%或2.0%Tween-80的阿朴吗啡溶液皮下给药1、2或3周之后,皮肤样品的组织学评分(皮下组织(SC)变化的评分)。
具体实施方式
组合物
一方面,本发明涉及一种稳定的液体或半固体药物组合物,特别是水性药物组合物,其包含阿朴吗啡和有机酸。示例性有机酸包括但不限制于氨基酸、羧酸和二羧酸。例如,涵盖的用于所要求保护的组合物的羧酸和/或二羧酸可包含至少两个、三个或四个碳原子,例如,酒石酸。涵盖的用于所要求保护的组合物的二羧酸可用亲水性或由亲水基团例如羟基取代。
在某些实施方案中,涵盖的组合物可包含阿朴吗啡和氨基酸,例如天然或非天然氨基酸。涵盖的用于所要求保护的组合物的氨基酸可为但不限制于酸性天然氨基酸如天冬氨酸或谷氨酸,或酸性非天然氨基酸如半胱氨酸。
本文涵盖的是例如包含阿朴吗啡和有机酸的稳定的药物组合物,其中阿朴吗啡与有机酸的摩尔比为约1比约0.5,或约1.0比约2.5,或约1比约0.5至1.5(例如,约1:0.5至约1.0比约1.5)。例如,在某些实施方案中,阿朴吗啡与有机酸的摩尔比为约1:0.5,或约1:0.6,或约1:0.7,或约1:0.8,或约1:0.9,或约1:1,或约1:1.1,或约1:1.2,或约1:1.3,或约1:1.4,或约1:1.5,或约1:1.6,或约1:1.7,或约1:1.8,或约1:1.9,或约1:2.0,或约1:2.1,或约1:2.2,或约1:2.3,或约1:2.4,或约1:2.5。
在一个具体实施方案中,本文涵盖的是包含阿朴吗啡和氨基酸的稳定的药物组合物,其中阿朴吗啡与氨基酸的摩尔比为约1比约0.5-2.5。例如,在某些实施方案中,阿朴吗啡与氨基酸的摩尔比为约1:0.5,或约1:0.6,或约1:0.7,或约1:0.8,或约1:0.9,或约1:1.1,或约1:1.2,或约1:1.3,或约1:1.4,或约1:1.5,或约1:1.6,或约1:1.7,或约1:1.8,或约1:1.9,或约1:2.0,或约1:2.1,或约1:2.2,或约1:2.3,或约1:2.4,或约1:2.5。在另一些具体实施方案中,氨基酸为酸性氨基酸,例如但不限制于天冬氨酸、谷氨酸或它们的组合。
在某些实施方案中,所述药物组合物具有25℃下约为3或大于3的pH。在某些具体的实施方案中,所述药物组合物具有25℃下在约3.0和约5.5之间,更具体地在约3.0和约5.0之间的pH。在另一些具体实施方案中,所述药物组合物具有25℃下在约3.1和约4.9、约3.2和约4.8、约3.3和约4.7、约3.4和约4.6、约3.5和约4.5、约3.6和约4.4、约3.7和约4.3、约3.8和约4.2、或约3.9和约4.1之间的pH。在另一些具体实施方案中,所述组合物的pH在25℃下为约4。在另一些具体实施方案中,所述药物组合物具有25℃下在约4.0和约5.0之间、或在约4.0和约7.5之间的pH。
在某些实施方案中,所述药物组合物包含至少约1重量%的阿朴吗啡。在某些实施方案中,所述组合物包含约1重量%至约4重量%的阿朴吗啡,例如,约1.25重量%、约1.5重量%、约1.75重量%、约2重量%、约2.25重量%、约2.5重量%、约2.75重量%、约3重量%、约3.25重量%、约3.5重量%、约3.75重量%、或约4重量%的阿朴吗啡。在其它实施方案中,涵盖的组合物包含约1重量%至约2.5重量%的阿朴吗啡,或约0.5重量%至约3重量%的阿朴吗啡,或约1.1重量%至约2.6重量%以上的阿朴吗啡。
在某些实施方案中,本发明的药物组合物在室温(例如在20℃至30℃)下,例如在25℃下稳定24小时,或至少24小时,或以上。例如,在某些实施方案中,所公开的组合物在25℃下稳定24小时,至少48小时,或7天以上。在一些具体实施方案中,公开的药物组合物在25℃下稳定至少48小时,或在室温下甚至稳定更长时间,例如3天、1周、1个月或更长。
在某些实施方案中,所述药物组合物在例如20℃至30℃下,例如25℃下实质上无固体沉淀达至少24小时、48小时、7天或2个月。在一个具体的实施方案中,所述药物组合物例如在20℃至30℃下,例如在25℃下实质上无固体沉淀达至少48小时。
在某些实施方案中,本发明的药物组合物进一步包含氨基糖、碱性氨基酸、一种或多种的抗氧化剂,或它们的组合。
在一些具体实施方案中,本发明的药物组合物进一步包含氨基糖,但不限制于如葡甲胺,且可还包含碱性氨基酸和一种或多种的抗氧化剂。具体地,该组合物包含阿朴吗啡、天冬氨酸和/或谷氨酸,和葡甲胺。
在一些具体实施方案中,本发明的药物组合物进一步包含碱性氨基酸,如但不限制于精氨酸,且还可包含氨基糖和一种或多种的抗氧化剂。具体地,该组合物包含阿朴吗啡、天冬氨酸和/或谷氨酸,和精氨酸。
在一些具体实施方案中,本发明的药物组合物进一步包含至少一种即一种、两种、三种以上的抗氧化剂,即抑制氧化产物的形成的制剂。这种制剂可为例如,酪氨酸酶抑制剂和/或邻醌清除剂和/或Cu++螯合剂和/或抗氧化剂,和/或四氢喹啉类。例如,涵盖的制剂可包含邻醌清除剂,如但不限制于N-乙酰半胱氨酸、谷胱甘肽、抗坏血酸、抗坏血酸钠、和/或L-半胱氨酸。例如,涵盖的制剂可包含抗坏血酸和半胱氨酸,例如L-半胱氨酸或N-乙酰半胱氨酸。在涵盖的制剂中,抗坏血酸与另一抗氧化剂例如L-半胱氨酸或N-乙酰半胱氨酸的比可以具体的重量与重量的比存在,如约1:1、约2:1、约3:1、约4:1、约5:1、约6:1、约7:1、约8:1、约9:1、或约10:1。在某些实施方案中,制剂可包含选自一种或多种的酪氨酸酶抑制剂的制剂,如卡托普利、甲硫咪唑、槲皮黄素、熊果苷、芦荟苦素、N-乙酰基葡萄糖胺、视黄酸、α-生育酚阿魏酸盐(α-tocopheryl ferulate)、MAP(抗坏血酸基磷酸镁)、基质类似物(例如,苯甲酸钠、L-苯丙氨酸)、Cu++螯合剂(例如,Na2-EDTA、Na2-EDTA-Ca),DMSA(琥疏酸)、DPA(D-青霉胺)、曲恩汀-HCl、二巯丙醇、氯磺羟喹、硫代硫酸钠、TETA、TEPA、姜黄、新亚铜树碱、丹宁酸、和/或环己铜二腙(cuprizone)。其它涵盖的可形成部分公开的制剂的抗氧化剂包括亚硫酸盐类、例如亚硫酸氢钠或偏亚硫酸氢钠,二-叔丁基甲基苯酚,叔丁基-甲氧基苯酚,多酚,生育酚和/或泛醌,包括但不限制于咖啡酸。
涵盖的可包含于公开的组合物的抗氧化剂可选自例如,硫醇类如硫代葡糖金、二氢硫辛酸、丙基硫氧嘧啶、硫氧还蛋白、谷胱甘肽、半胱氨酸、胱氨酸、胱胺、和硫代二丙酸;磺酰亚胺类如丁硫氨酸亚砜胺类、高半胱氨酸-磺酰亚胺、丁硫氨酸-砜类,和五硫堇、六硫堇、七硫堇-磺酰亚胺;金属螯合剂如α-羟基-脂肪酸、棕榈酸、植酸、乳铁蛋白、柠檬酸、乳酸、苹果酸、腐殖酸、胆汁酸、胆汁提取物、胆红素、胆绿素、EDTA、EGTA,和DTPA;偏亚硫酸氢钠;维生素类如维生素E、维生素C、抗坏血酸基棕榈酸酯、抗坏血酸基磷酸镁、和抗坏血酸基乙酸盐;酚类如丁基羟基甲苯、丁基羟基苯甲醚、泛醌、去甲二氢愈创木酸、和三羟基苯丁酮;苯甲酸盐类如松柏基苯甲酸盐;尿酸;甘露糖;没食子酸丙酯;硒如硒-蛋氨酸;茋类如茋氧化物和反式茋氧化物;及它们的组合。
在一个具体实施方案中,涵盖的药物组合物进一步包含一种或多种的抗氧化剂,所述抗氧化剂各自独立地选自抗坏血酸、抗坏血酸钠、L-半胱氨酸、N-乙酰半胱氨酸(NAC)、谷胱甘肽(GSH)、Na2-EDTA、Na2-EDTA-Ca、或亚硫酸氢钠。在这些具体实施方案中,涵盖的药物组合物进一步包含抗坏血酸和/或亚硫酸氢钠。
在某些实施方案中,本发明的药物组合物进一步包含表面活性剂,即降低液体表面张力的化合物。适合的表面活性剂的非限制实例包括聚山梨醇酯表面活性剂如Tween-80、Tween-60、Tween-40、Tween-20、Tween-65和Tween-85,和脱水山梨糖醇表面活性剂如Span 20、Span 40、Span 60、Span 80和Span 85。在一个具体实施方案中,本发明的药物组合物进一步包含Tween-80。
在某些实施方案中,本发明的药物组合物进一步包含局部麻醉剂,即在保持意识的同时对身体的有限区域引起感觉的可逆丧失的药物,和/或抗炎剂。局部麻醉剂的实例包括但不限制于酰胺类局部麻醉剂如利多卡因、丙胺卡因、丁哌卡因、左布比卡因、罗哌卡因、甲哌卡因、狄布卡因、和依替卡因;和酯类局部麻醉剂如普鲁卡因、阿美索卡因、可卡因、苯佐卡因、和丁卡因。抗炎剂的实例包括但不限制于非甾类抗炎剂如双氯芬酸、酮咯酸、水杨酸盐类布洛芬、吡罗昔康、和苄达明,和甾类抗炎剂如强的松、地塞米松、倍他米松、强的松氢化可的松或它们的盐类。
本发明的药物组合物可为液体溶液,即,在室温例如在25℃下实质上为均相液体混合物,或制剂配制的半固体溶液例如作为凝胶、树胶(gum)或糖胶。这种液体或半固体混合物可包括水和/或其它药学上可接受的或赋形剂。在一个具体实施方案中,公开的组合物实质上为水性的。
在某些实施方案中,公开的液体或半固体制剂在室温下将稳定达1天、2天、3天、1周、1个月或更长时间。在某些实施方案中,本文定义的药物组合物进一步包含药物上可接受的赋形剂,例如但不限制于Tween-80、Tween-60、Tween-40、Tween-20、N-甲基吡咯烷酮(NMP)、或聚乙烯吡咯烷酮(PVP)、EDTA(或其盐类)、半胱氨酸、N-乙酰半胱氨酸、和/或亚硫酸氢钠。
在某些实施方案中,所述组合物为稳定的冻干粉末。所述冻干粉末可通过单独添加水、或水和药学上可接受的载体再造成为液体制剂,且可或可不包含抗氧化剂。
在另一个方面中,本发明涉及稳定的液体或半固体药物组合物,特别是水性药物组合物,其包含(i)阿朴吗啡或其盐;和(ii)乳化剂或表面活性剂,或乳化剂和表面活性剂两者。在一个具体的该方面中,所述组合物包含阿朴吗啡,和乳化剂、表面活性剂、或两者。在另一具体的该方面中,所述组合物包含阿朴吗啡的盐、和乳化剂、表面活性剂、或两者。所述阿朴吗啡盐可为由阿朴吗啡与有机酸反应形成的任何盐。具体的有机酸包括但不限制于氨基酸,更具体地酸性氨基酸如天冬氨酸、谷氨酸、和半胱氨酸;以及包含至少两个、三个或四个碳原子的羧酸和二羧酸,例如酒石酸。特别地,该组合物在25℃下在约3至约7.5范围内的pH下,或在大于4的pH下,实质上无固体沉淀达至少48小时。这些组合物可为液体溶液,即在室温例如在25℃下实质上为均相液体混合物,或配制的半固体溶液,例如作为凝胶、树胶或糖胶,且可包含水和/或其它药学上可接受的载体或赋形剂。在一个具体实施方案中,公开的组合物实质上为水性的。
在某些实施方案中,所述药物组合物包含至少1重量%的阿朴吗啡,或约1重量%至约4重量%,例如约1.25重量%、约1.5重量%、约1.75重量%、约2重量%、约2.25重量%、约2.5重量%、约2.75重量%、约3重量%、约3.25重量%、约3.5重量%、约3.75重量%、或约4重量%的阿朴吗啡。
在某些实施方案中,所公开的药物组合物包含0.01%至4%,例如0.01%、0.1%、0.2%、0.3%、0.4%、0.5%、0.6%、0.7%、0.8%、0.9%、1.0%、1.1%、1.2%、1.3%、1.4%、1.5%、1.6%、1.7%、1.8%、1.9%、2.0%、2.2%、2.4%、2.6%、2.8%、3.0%、3.2%、3.4%、3.6%、3.8%、或4.0%的乳化剂或表面活性剂。
在某些实施方案中,如上所述的药物组合物可进一步包含一种或多种,即一种、两种、三种以上的如上所述的抗氧化剂。在一个具体实施方案中,涵盖的药物组合物进一步包含一种或多种的抗氧化剂,其各自独立地选自抗坏血酸、抗坏血酸钠、L-半胱氨酸、NAC、GSH、Na2-EDTA、Na2-EDTA-Ca、或亚硫酸氢钠。
在某些实施方案中,本发明的稳定的药物组合物可适合于皮下、静脉内、鼻内、经皮、舌下、肌内、口腔、眼部或气管内给药。在有些实施方案中,连续注入所述组合物,例如,经由小泵皮下给药。在某些实施方案中,吸入所述组合物。在某些实施方案中,所述组合物为肠道外给药。
所公开的组合物可为皮下和/或例如实质上连续给药。当皮下或真皮(dermally)给药时,这种具有阿朴吗啡或其药学上可接受的盐、和有机酸例如酸性氨基酸的组合物可导致最小的局部组织损伤,例如,与包含阿朴吗啡-HCl的组合物的皮下或真皮给药相比。进一步地,这种阿朴吗啡/有机酸组合物,当进一步包含碱性氨基酸如精氨酸、和/或碱性氨基糖如葡甲胺、和/或表面活性剂如Tween-80时,可能稳定性更好,例如,与具有阿朴吗啡-HCl的组合物相比,一段时间后可不会沉淀和/或形成不需要的氧化产物。此外,这种阿朴吗啡/有机酸组合物,当进一步包含表面活性剂如Tween-80时,稳定性更好,例如,与具有阿朴吗啡而无表面活性剂的组合物相比,一段时间后可不会沉淀和/或形成不需要的氧化产物。如本文涵盖的,皮下给药可包含使用一种或多种输注泵和/或经皮和/或皮肤贴片。可选地,所公开的组合物可为十二指肠内、鼻内、舌下、肌内、眼部、口腔、气管内、静脉内给药。
本说明书中如此处所用的,术语“有机酸”指具有酸的性质的有机化合物如羧酸类、二羧酸类、磺酸类、醇类、羟基酸类、硫醇类、和硫代酸类。例如,用于所保护的组合物的有机酸可包含至少两个、三个或四个碳原子,例如酒石酸。有机酸的实例包括但不限制于氨基酸如天冬氨酸、谷氨酸、和精氨酸;和二羧酸类如富马酸、草酸、丙二酸、琥珀酸、戊二酸、和马来酸等。有机酸的进一步实例包括乳酸、苹果酸、乌头酸、柠檬酸、乙醇酸、抗坏血酸、甲酸、乙酸、酒石酸、和葡糖醛酸。
术语“天然氨基酸”指蛋白质中发现的任何氨基酸。天然氨基酸的实例包括但不限制于丙氨酸、精氨酸、天冬氨酸、谷氨酸、组氨酸、和赖氨酸等。
术语“非天然氨基酸”指自然产生或化学合成的非蛋白原氨基酸。非天然氨基酸的实例包括但不限制于鸟氨酸、β-丙氨酸、2-氨基己二酸、3-氨基己二酸、γ-羟基谷氨酸、羟赖氨酸、4-胍基丁酸、3-胍基丙酸、4-叠氮基丁酸、和5-叠氮基戊酸等。本文涵盖了D-氨基酸和L-氨基酸两者。
术语“氨基糖”指单糖,其中无糖苷的羟基被氨基或取代的氨基置换,如葡甲胺、D-葡萄糖胺、唾液酸、N-乙酰氨基葡糖、和半乳糖胺等。
术语“抗氧化剂”指抑制氧化产物的生成的制剂。
术语“乳化剂”,也称作“利泄药”,指通过增加其动力稳定性来稳定乳液的物质,例如“表面活性物质”或表面活性剂。术语“表面活性剂”指表面活性物质,即降低液体的表面张力、两个液体之间或液体和固体之间的界面张力的化合物。
本文所用的术语“药物组合物”指包含至少一种本文公开的与一种或多种药学上可接受的载体一起配制的活性剂的组合物。
本文所用的术语“药学上可接受的载体”或“药学上可接受的赋形剂”指与药物给药相容的任何和所有的溶剂、分散介质、防腐剂、抗氧化剂、涂料、等张和吸收延迟剂、和表面活性剂等。将这种介质和制剂用于药物活性物质是本领域公知的。所述组合物可包含提供附加的、额外的或提高的治疗功能的其它活性化合物。
术语“药学上可接受的”和“药理上可接受的”包括当对动物或人类适当给药时,不产生不利的、过敏的、或其它不希望的反应的分子实体和组合物。对于人类给药,制备需要满足政府药物管理部门例如,美国食品和药物管理局(FDA)的生物制剂标准要求的无菌、产热原性(pyrogenicity)、常规安全和纯度的标准。
术语“生理上可接受的pH”理解为指促进将化合物给药于患者而无显著的不利影响的组合物的pH,例如25℃下约3至约9.8的pH,例如约3.5±0.5至约9.5±0.3,或约3.5至约9.5的pH。
方法
在另一个方面中,本发明提供治疗患者的神经学的或运动疾病或障碍、或与其相关的病症的方法,包括将本文所公开的药物组合物给药于所述患者。
由本发明的方法治疗的神经学的或运动疾病或障碍的特征在于大脑中多巴胺的水平降低,并包括不宁腿综合症、帕金森病、续发性帕金森症、阿尔茨海默病、亨廷顿氏舞蹈病、起立性低血压综合征(Shy-Drager syndrome)、肌张力障碍、运动不能、酒精和吗啡成瘾、勃起功能障碍、及由大脑受损包括一氧化碳或锰中毒导致的病症。
在一个具体实施方案中,本发明提供治疗患者的帕金森病的方法,其包括将本文所公开的药物组合物给药于所述患者。
在另一个具体实施方案中,本发明提供治疗患者的运动不能的方法,其包括将本文所公开的药物组合物给药于所述患者,其中所述患者已用左旋多巴治疗。
在另一个实施方案中,本发明提供治疗患者的与神经学的疾病或障碍相关的病症的方法,其包括将本文所公开的药物组合物给药于所述患者。本文涵盖的神经学的疾病或障碍为帕金森病、阿尔茨海默病、或运动不能,及与神经学的疾病或障碍相关的病症,包括但不限制于酒精中毒、鸦片成瘾和勃起功能障碍。
在另一个方面中,本发明涉及用于治疗如上所述的神经学的或运动疾病或障碍、或与其相关的病症的如上所述的液体药物组合物。
在另一个方面中,本发明涉及用于治疗如上所述的神经学的或运动疾病或障碍、或与其相关的病症的如上所述的液体药物组合物。
本说明书中此处所用的术语“神经学的疾病或障碍”指人体神经系统的疾病或障碍。
术语“运动障碍”指引起不正常自主运动或非自主运动、或缓慢减少运动的神经系统病症。
术语“用左旋多巴治疗”包括过去或现在用左旋多巴治疗患者。
试剂盒
涵盖的试剂盒可包含阿朴吗啡盐或具有阿朴吗啡和有机酸(任选地和额外的治疗剂,例如左旋多巴、卡比多巴或恩他卡朋)的液体组合物。这种组合物可为液体或可再造成液体制剂的冻干粉末,或例如,可形成部分经皮贴片,并可设计为通过任何适合途径但不限制于如经皮、静脉内、皮下、皮内、肌内、或十二指肠内给药。
在有些实施方案中,所公开的例如包含阿朴吗啡和有机酸的液体组合物,可提供于适合于患者或医师使用的例如一个、两个以上的预填充盒中。例如,本文所提供的是包括预填充盒的试剂盒和任选的使用说明,其中所公开的液体制剂放置于预填充盒中(例如,具有将阿朴吗啡和有机酸制剂(任选地和额外的治疗剂,例如左旋多巴或卡比多巴)单剂或适合于单独给药于患者的剂量的预填充盒)。
对本发明进行了概括性描述,但通过参考以下实施例将更易于理解本发明,所包含的实施例仅出于说明本发明的某些方面及实施方案的目的,且在任何情况下不会限制本发明。
实施例
实施例1.用于皮下给药的阿朴吗啡盐溶液/制剂的制备
添加0.1N碳酸氢钠溶液至1%的阿朴吗啡-HCl溶液中。所述阿朴吗啡-HCl溶液来源于包含10mg/ml阿朴吗啡-HCl溶液的商购产品用水洗涤为阿朴吗啡基质(apomorphine base)的沉淀物两次。用0.59%谷氨酸溶液、0.53%天冬氨酸溶液、或0.6%酒石酸溶液溶解沉淀的阿朴吗啡基质以形成与谷氨酸、天冬氨酸或酒石酸的摩尔比为1:1、或与酒石酸的摩尔比为1:0.5的最终1%的阿朴吗啡溶液。在有些情况下,添加抗坏血酸和/或葡甲胺溶液至阿朴吗啡盐溶液中以得到分别为0.5%或0.6%的最终浓度。表1示出如上所述制备的阿朴吗啡制剂的组合物。
表1:阿朴吗啡制剂的组合物
prec.=沉淀;trans.=透明
实施例2.用于皮下给药的阿朴吗啡盐溶液/制剂的制备
将阿朴吗啡-HCl半水合物溶解在0.1%亚硫酸氢钠溶液中以形成1%的阿朴吗啡溶液。通过添加适合量的0.1N碳酸氢钠溶液以沉淀阿朴吗啡。用水洗涤沉淀物两次。用1.47%谷氨酸溶液溶解沉淀的阿朴吗啡基质以形成与谷氨酸的摩尔比为1:1的最终2.5%的阿朴吗啡溶液。在某些情况下,添加抗坏血酸和/或葡甲胺和/或精氨酸溶液至阿朴吗啡-谷氨酸盐溶液以得到分别为0.5%、0.6%或0.56%的最终浓度。表2示出如上所述制备的阿朴吗啡制剂的组合物。
表2:阿朴吗啡制剂的组合物
制剂编号 | 1 | 2 |
APO.HCl(10mg/ml)μl | 1250 | 1250 |
NaHCO3 0.1N | 412 | 412 |
沉淀 | 沉淀 | |
谷氨酸(14.7mg/ml)μl | 400 | 400 |
葡甲胺(60mg/ml)μl | 50 | |
L-精氨酸(56mg/ml) | ||
抗坏血酸5%μl | 50 | |
水μl | 100 | |
阿朴吗啡/酸的比 | 1:1 | 1:1 |
阿朴吗啡浓度(mg/ml) | 25 | 25 |
溶液外观 | 透明 | 透明 |
pH | 3.60 | 4.13 |
总计μl | 500 | 500 |
实施例3.阿朴吗啡盐溶液的体外物理稳定性
在室温下放置一段时间之后测试各种阿朴吗啡盐溶液的稳定性。研究结果示出于表3中。明显可以看出,包含天冬氨酸盐、谷氨酸盐、酒石酸盐、马来酸盐和任选地葡甲胺的阿朴吗啡盐溶液在测试时间范围内是稳定的。
表3:用于稳定性试验的阿朴吗啡盐溶液的组合物
*在室温下48小时后测试
实施例4.用于皮下给药的阿朴吗啡盐溶液/制剂的制备
将阿朴吗啡-HCl半水合物溶解在0.1%亚硫酸氢钠溶液中以形成1%的阿朴吗啡溶液。通过添加适合量的0.1N碳酸氢钠溶液以沉淀阿朴吗啡。用水洗涤沉淀物两次。用0.94%谷氨酸溶液溶解沉淀的阿朴吗啡基质以形成与谷氨酸的摩尔比为1:1的最终浓度为1%或1.5%的阿朴吗啡溶液。在有些情况下,添加抗坏血酸和/或葡甲胺和/或精氨酸溶液至阿朴吗啡-谷氨酸盐溶液以得到分别为0.5%、0.6%或0.56%的最终浓度。表4示出如上所述制备的阿朴吗啡制剂的组合物。
表4:阿朴吗啡制剂的组合物
制剂编号(%) | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 |
APO.HCl(10mg/ml)μl | 1000 | 1500 | 1000 | 1500 | 1000 | 1500 | 1000 | 1500 |
NaHCO3 0.1N | 330 | 495 | 330 | 495 | 330 | 495 | 330 | 495 |
prec. | prec. | prec. | prec. | prec. | prec. | prec. | prec. | |
谷氨酸(9.4mg/ml)μl | 500 | 750 | 500 | 750 | 500 | 750 | 550 | 826 |
葡甲胺(60mg/ml)μl | 100 | 100 | 100 | 87 | ||||
L-精氨酸(56mg/ml) | 100 | 100 | ||||||
抗坏血酸5%μl | 100 | 100 | 100 | 100 | 100 | 87 | ||
水μl | 500 | 250 | 300 | 50 | 300 | 50 | 250 | |
阿朴吗啡/酸的比 | 1:1 | 1:1 | 1:1 | 1:1 | 1:1 | 1:1 | 1:1.1 | 1:1.1 |
阿朴吗啡浓度(mg/ml) | 10 | 15 | 10 | 15 | 10 | 15 | 10 | 15 |
溶液外观 | trans. | trans. | trans. | trans. | trans. | trans. | trans. | trans. |
pH | 3.83 | 3.76 | 4.40 | 4.27 | 4.46 | 4.32 | 4.41 | 4.20 |
总计μl | 1000 | 1000 | 1000 | 1000 | 1000 | 1000 | 1000 | 1000 |
prec.=沉淀;trans.=透明
实施例5.连续皮下输注至全厚猪皮之后制剂组合物对阿朴吗啡依赖性皮下组织着色的影响
制备各种阿朴吗啡-盐制剂并通过以0.05ml/h的速度连续输注至全厚猪皮(表皮和皮下组织)来皮下给药。图1示出该方法所用的体系。输注期间,在37℃下温育阿朴吗啡制剂达17小时。
图2示出将下列于表3中的一些组合物连续皮下输注至全厚猪皮之后,制剂组合物对阿朴吗啡依赖性皮着色的影响,其中面(a)示出1%的阿朴吗啡-HClpH3.5;面(b)示出1%的阿朴吗啡-谷氨酸盐,pH 3.5;面(c)示出1%的阿朴吗啡-谷氨酸盐及抗坏血酸,pH 3.3;面(d)示出1%的阿朴吗啡-谷氨酸盐及抗坏血酸和葡甲胺,pH 4.2;面(e)示出1%的阿朴吗啡-谷氨酸盐及葡甲胺,pH 4.3;面(f)示出1%的阿朴吗啡-天冬氨酸盐,pH 3.6;面(g)示出1%的阿朴吗啡-天冬氨酸盐及葡甲胺,pH 4.2;面(h)示出1%的阿朴吗啡-酒石酸盐,pH 2.9;面(i)示出1%的阿朴吗啡-半酒石酸盐,pH 3.2;和面(j)示出1%的阿朴吗啡-酒石酸盐及葡甲胺,pH 3.6。如图2所示,含1%的阿朴吗啡-HCl的制剂引起体外猪皮的最重着色。明显可以看出,含酸性氨基酸(天冬氨酸盐和谷氨酸盐)和任选地葡甲胺的阿朴吗啡盐制剂引起比阿朴吗啡-酒石酸盐和HCl盐显著少的猪皮着色。
实施例6.阿朴吗啡的谷氨酸盐、天冬氨酸盐、酒石酸盐的制备
按以下方式进行阿朴吗啡基质的制备。将阿朴吗啡盐酸盐(Johnson Maltey,Macfarlan Smith)溶解在0.1%偏亚硫酸氢钠溶液(10mg/ml)中。将0.4M的碳酸氢钠溶液慢慢搅拌添加至溶液中。然后在室温下搅拌混合物30分钟。在氮气下过滤所形成的白色沉淀,用无菌水洗涤两次,并在真空烘箱内在干燥的氮气气流中干燥4小时。阿朴吗啡干基质的产量为75.5%。
通过以1:0.5和1:1.5之间的摩尔比溶解所述阿朴吗啡干基质于适当的酸溶液中来制备阿朴吗啡盐。
通过在0.1M谷氨酸溶液中溶解阿朴吗啡基质来制备阿朴吗啡谷氨酸盐溶液。添加水至所得的阿朴吗啡:谷氨酸的摩尔比为1:1或1:1.2的溶液中,使阿朴吗啡的最终浓度为2%。各溶液的pH分别为4.7和4.4。
通过在0.1M天冬氨酸溶液中溶解阿朴吗啡基质来制备阿朴吗啡天冬氨酸盐溶液。添加水至所得的阿朴吗啡:天冬氨酸的摩尔比为1:1的溶液中,使阿朴吗啡的最终浓度为2%。溶液的pH为4.9。
通过在0.1M酒石酸溶液中溶解阿朴吗啡基质来制备阿朴吗啡酒石酸盐溶液。添加水至所得的阿朴吗啡:酒石酸的摩尔比为1:1或1:0.5的溶液中,使阿朴吗啡的浓度为2%。各溶液的pH分别为3.45和4.0。
通过在0.1M苹果酸溶液中溶解阿朴吗啡基质来制备阿朴吗啡苹果酸盐溶液。添加水至所得的阿朴吗啡:苹果酸的摩尔比为1:1的溶液中,使阿朴吗啡的浓度为2%。各溶液的pH为4.0。表5示出各阿朴吗啡有机盐溶液的组合物。
实施例7.阿朴吗啡-谷氨酸盐制剂和Tween-80的制备
按以下方式制备阿朴吗啡谷氨酸盐溶液。将抗氧化剂溶解在水中以得到1%抗氧化剂溶液。将Tween-80溶解在抗氧化剂溶液中以得到最终浓度为4%的Tween-80。用抗氧化剂溶液进一步稀释4%Tween/抗氧化剂溶液以得到所需最终浓度的Tween-80。然后称重阿朴吗啡基质和谷氨酸以得到所需的摩尔比(例如,1:1至1:1.5)。添加所制备的Tween-80/抗氧化剂溶液并搅拌溶液直至发生溶解。
表5:阿朴吗啡的有机酸盐的组合物
实施例8.阿朴吗啡-谷氨酸盐溶液和商购的阿朴吗啡-HCl溶液的稳定性比较
比较含1%的阿朴吗啡的阿朴吗啡-谷氨酸盐制剂和商购可得的10mg/ml(1%)阿朴吗啡-HCl溶液的稳定性。通过用pH7.5的磷酸盐缓冲盐溶液(PBS)以1:10来稀释溶液以在接近生理条件下进行比较。表6示出用于与商购可得的阿朴吗啡-盐酸盐溶液比较而合成的称作ND1和ND2的阿朴吗啡-谷氨酸盐溶液的组合物。表7示出阿朴吗啡-盐酸盐溶液和阿朴吗啡-谷氨酸盐溶液中阿朴吗啡的稳定性,以阿朴吗啡-谷氨酸盐溶液合成之后,在不同时间点下测量的每克溶液中阿朴吗啡的毫克数表示。表8示出在不同时间点下配制的溶液中阿朴吗啡的降解产物的生产。表9示出阿朴吗啡-盐酸盐溶液和阿朴吗啡-谷氨酸盐溶液中阿朴吗啡的稳定性,以暴露在生理条件下之后,在不同时间点下测量的每克溶液中阿朴吗啡的毫克数表示。表10示出暴露在生理条件下之后,在不同时间点下溶液中阿朴吗啡的降解产物的生产。表8和10中的降解产物以按高效液相色谱法(HPLC)测量的阿朴吗啡峰面积的百分数示出。
表6:用于稳定性分析的阿朴吗啡-谷氨酸盐制剂的组合物
成分(%) | ND1 | ND2 |
阿朴吗啡基质(FW 267.32) | 1.0 | 1.0 |
谷氨酸(FW 147.13) | 0.8 | 0.8 |
Tween-80 | 0.5 | 2.0 |
抗氧化剂 | 0.6 | 0.6 |
表7:在不同时间点阿朴吗啡-谷氨酸盐和阿朴吗啡-盐酸盐溶液中
阿朴吗啡的稳定性(mg阿朴吗啡/g溶液)
ND=未测出
表8:以峰面积的百分比表示的制剂中产生的阿朴吗啡的降解产物
(阿朴吗啡峰面积%)
ND=未测出
表9:暴露于生理条件(以1:10在PBS中稀释)之后阿朴吗啡稳定性(mg阿朴吗啡/g溶液)
ND=不适用;暴露于生理条件之后6天阿朴吗啡在溶液中的浓度如灰色所示。
表10:以峰面积的百分比表示的生理条件(以1:10在PBS中稀释)下产生的阿朴吗啡的降解产物(阿朴吗啡峰面积%)
NA=不适用;暴露于生理条件之后1天和6天阿朴吗啡在溶液中的浓度如灰色所示。
结果清晰地说明在生理条件下,在室温下阿朴吗啡的谷氨酸盐稳定至少6天,然而商购产品普遍劣化。0.5%浓度的Tween-80足够维持阿朴吗啡-谷氨酸盐溶液的化学稳定性,然而甚至2%的Tween-80不足以维持阿朴吗啡-HCl溶液的化学稳定性。
实施例9.制剂组分对阿朴吗啡-谷氨酸盐溶液稳定性的分析
通过用PSB以1:10或1:20稀释制剂来检测Tween-80、抗氧化剂、和谷氨酸对阿朴吗啡的摩尔比对阿朴吗啡-谷氨酸盐制剂的物理稳定性的影响。各待测
制剂(F1-5)的组成示出于表11中。各组分以总溶液的百分比示出。
表11:阿朴吗啡谷氨酸盐制剂
用新鲜制备的PSB稀释各制剂的样品,如表12和13所示。用PBS以1:20稀释制剂F1-F3的样品(表11)。用PBS以1:10和1:20稀释制剂F4和F5的样品。稀释20分钟和5小时后观察各溶液的外观,并测量pH和Tween浓度。
表12:1:20稀释之后制剂F1、F2和F3的观察结果
表13:1:10或1:20稀释之后制剂F4和F5的观察结果
用PBS稀释制剂后,仅在如果它们包含Tween-80、抗氧化剂,且以阿朴吗啡:谷氨酸的摩尔比大于1:1.2含有谷氨酸时,制剂物理稳定至少5小时。无Tween-80且在阿朴吗啡:谷氨酸的摩尔比为1:1.18时,制剂在7至7.5的pH下无法物理稳定(参见表11和12,制剂F3)。无抗氧化剂时,溶液变蓝(参见表11和12,制剂F1)。
实施例10.阿朴吗啡制剂皮下给药之后皮肤炎症的分析
将含1%的阿朴吗啡和以摩尔比为1:1.5的谷氨酸的制剂经由微型泵以4ml/24h的速度连续皮下给药于猪。单独将商购的1%的阿朴吗啡-HCl给药,以对各制剂的给药产生的影响进行对比。给药的各溶液的制剂示出于表14中。收集输注后1、2、或3周的皮肤样品并进行组织病理学评价。结果示出于表15中。阿朴吗啡-谷氨酸盐制剂的输注位点的特征是微小至轻微的慢性皮下炎症,而商购的阿朴吗啡-HCL制剂显示出具有坏死的严重的皮下炎症(参见表15的灰框)。在图3所示的含0.5%或2%Tween-80的制剂的给药位点之间所观察到的病变严重程度没有差异。
表14:用于皮下给药的制剂
表15:暴露于阿朴吗啡制剂中的皮肤的组织学评价
组织变化的评分:0=无变化,1=微小变化,2=轻微变化,3=中度变化,4=显著变化
如表16、17和18所示,HPLC分析说明制备之后4和6天之间,待测试的含0.5%或2%Tween-80的制剂(标识为ND1和ND2)的稳定性相似。平均阿朴吗啡浓度(AVG mg/g)以灰色示出于表16和17中。
表16:制剂制备4天后阿朴吗啡溶液的分析
表17:制剂制备5天后阿朴吗啡溶液的分析
表18:制剂制备0和6天后阿朴吗啡溶液的HPLC分析
ND-未测出
实施例11.Tween-80对阿朴吗啡溶液稳定性的影响
分析Tween-80对阿朴吗啡-HCl制剂和阿朴吗啡-谷氨酸盐制剂的物理稳定性的影响。所有待试验的制剂包含抗氧化剂的所有组合。在25℃下4天或1周之后记录关于未稀释溶液颜色的观察和这些溶液中沉淀的迹象。另外,在25℃下4天之后记录关于稀释溶液中沉淀迹象的观察。通过在小瓶中放置pH7.5的2.85ml的50mM PBS,并逐滴添加各未稀释溶液150μl来实现各溶液的1:20稀释。Tween-80对未稀释的阿朴吗啡-HCl制剂的稳定性的影响如表19所示。Tween-80对用PBS以1:20稀释的阿朴吗啡-HCl制剂的稳定性的影响如表20所示。Tween-80对阿朴吗啡-谷氨酸盐制剂的稳定性的影响如表21所示。Tween-80对用PBS以1:20稀释的阿朴吗啡-谷氨酸盐制剂的稳定性的影响如表22所示。
表19:Tween-80对未稀释的阿朴吗啡-HCl制剂的稳定性的影响
表20:Tween-80对稀释的阿朴吗啡-HCl制剂的稳定性的影响
表21:Tween-80对未稀释的阿朴吗啡-谷氨酸盐制剂的稳定性的影响
表22:Tween-80对稀释的阿朴吗啡-谷氨酸盐制剂的稳定性的影响
所有测试的阿朴吗啡-HCl制剂在室温下1周内发生沉淀,但测试的所有阿朴吗啡-谷氨酸盐制剂未发生沉淀。然而,用PBS以1:20稀释之后,无Tween的两种阿朴吗啡盐(例如,参见表20和22中的制剂F-1、F-7和F-10)均沉淀。没有Tween无法制备2.5%的阿朴吗啡-HCl溶液,因为其不溶解。
实施例12.阿朴吗啡-谷氨酸盐和阿朴吗啡-HCl制剂的稳定性的比较
使用UV-HPLC分析并比较阿朴吗啡-谷氨酸盐和阿朴吗啡-HCl制剂的化学稳定性。表23总结了25℃下1个月后包含不同量Tween-80的阿朴吗啡盐制剂中的阿朴吗啡的回收率。表23记录的结果示出与本发明的阿朴吗啡-谷氨酸盐制剂相比,阿朴吗啡-HCl制剂较不稳定。
表23:25℃下1个月后溶液中的阿朴吗啡回收率
阿朴吗啡盐 | Tween-80(%) | 阿朴吗啡回收率(%) |
1%的阿朴吗啡+谷氨酸 | 0 | 99.0 |
1%的阿朴吗啡+谷氨酸 | 0.50 | 101.7 |
2.5%的阿朴吗啡+谷氨酸 | 0 | 94.6 |
2.5%的阿朴吗啡+谷氨酸 | 2.00 | 98.0 |
2.5%的阿朴吗啡+谷氨酸 | 3.00 | 98.3 |
2.5%的阿朴吗啡+谷氨酸 | 4.00 | 95.0 |
1%的阿朴吗啡-HCl | 0 | 89.3 |
1%的阿朴吗啡-HCl | 0 | 89.5 |
等同物
虽然已讨论本发明的具体实施方案,但上述说明书为示例性的而非限制性的。在阅读本说明书时,本发明的许多变型对本领域技术人员是显而易见的。本发明的全部保护范围通过参考权利要求及其等同物的全部范围、以及本说明书及这些变型而确定。
除非特别说明,本说明书和权利要求中所用的表达成分的量、和反应条件等的全部数字可理解为在所有情况下由术语“约”修改而来的。因此,除非有相反说明,本发明书及其所附权利要求中所用的数值参数为取决于本发明希望得到的所需性质而变化的近似值。
通过参考引入
本文引用的所有专利出版物、网站和其它参考文献的全部内容通过参考的方式整体明确引入本文。
Claims (11)
1.一种液体或半固体药物组合物,其包含阿朴吗啡的盐和表面活性剂,其中所述组合物在25℃下在3至7.5范围内的pH下,或在大于4的pH下,实质上无固体沉淀达至少48小时,和其中所述阿朴吗啡的盐为阿朴吗啡和酸性氨基酸反应形成的盐。
2.根据权利要求1所述的药物组合物,其包含至少1重量%的阿朴吗啡。
3.根据权利要求2所述的药物组合物,其包含1重量%-4重量%的阿朴吗啡。
4.根据权利要求2所述的药物组合物,其包含至少0.01%-4%的表面活性剂。
5.根据权利要求1所述的药物组合物,其中所述组合物是水性的。
6.根据权利要求1所述的药物组合物,其还包含一种或多种抗氧化剂。
7.根据权利要求6所述的药物组合物,所述一种或多种抗氧化剂各自独立地选自抗坏血酸、抗坏血酸钠、L-半胱氨酸、N-乙酰半胱氨酸(NAC)、谷胱甘肽(GSH)、Na2-EDTA、Na2-EDTA-Ca或亚硫酸氢钠。
8.根据权利要求1-7任一项所述的药物组合物,其调配为供皮下、静脉内、鼻内、经皮、舌下、肌内、口腔、眼部或气管内给药。
9.权利要求1-8任一项所述的液体或半固体药物组合物的用途,其用于制备治疗神经学的或运动疾病或障碍、或与其相关的病症的药物。
10.根据权利要求9所述的用途,其中所述神经学的或运动疾病或障碍为帕金森病、阿尔茨海默病、或运动不能;与所述神经学的疾病或障碍相关的所述病症为酒精中毒、鸦片成瘾、或勃起功能障碍。
11.根据权利要求10所述的用途,其中所述神经学的或运动疾病或障碍为帕金森病。
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CN101848713A (zh) * | 2007-05-21 | 2010-09-29 | 东丽株式会社 | 含有特定的有机酸的口服制剂以及口服制剂的溶出性和化学稳定性的改善方法 |
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EP2854764B1 (en) | 2018-12-12 |
RU2688672C2 (ru) | 2019-05-22 |
CN104349768B (zh) | 2017-11-07 |
JP2015518880A (ja) | 2015-07-06 |
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US20160067339A1 (en) | 2016-03-10 |
HUE042425T2 (hu) | 2019-06-28 |
US9999674B2 (en) | 2018-06-19 |
PT2854764T (pt) | 2019-03-21 |
JP2018070633A (ja) | 2018-05-10 |
ES2715028T3 (es) | 2019-05-31 |
WO2013183055A1 (en) | 2013-12-12 |
EP3456315A1 (en) | 2019-03-20 |
JP6458124B2 (ja) | 2019-01-23 |
MX2014014902A (es) | 2015-03-04 |
US10525134B2 (en) | 2020-01-07 |
DK2854764T3 (en) | 2019-04-08 |
TR201903492T4 (tr) | 2019-04-22 |
BR112014030265A2 (pt) | 2017-06-27 |
CA2875446A1 (en) | 2013-12-12 |
PL2854764T3 (pl) | 2019-07-31 |
JP6257604B2 (ja) | 2018-01-10 |
ZA201409516B (en) | 2016-03-30 |
AU2013273138B2 (en) | 2017-06-15 |
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CN104349768A (zh) | 2015-02-11 |
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