Compositions, methods and systems for respiratory delivery of two or more active agents

Abstract

Compositions, methods and systems are provided for pulmonary or nasal delivery of two or more active agents via a metered dose inhaler. In one embodiment, the compositions include a suspension medium, active agent particles, and suspending particles, in which the active agent particles and suspending particles form a co-suspension within the suspension medium.

1 . A method for treating a pulmonary disease or disorder in a patient, the method comprising:
 providing a metered dose inhaler comprising a canister containing a pharmaceutically acceptable co-suspension, the co-suspension comprising:
 a suspension medium comprising a pharmaceutically acceptable propellant substantially free of additional constituents; 
 a first species of respirable active agent particles comprising a first active agent, wherein the first active agent is substantially crystalline glycopyrrolate, including pharmaceutically acceptable salts, esters, isomers or solvates thereof; 
 one or more additional species of respirable active agent particles comprising one or more additional active agents selected from a short-acting beta agonist, a long-acting and ultra long-acting β 2  adrenergic receptor agonist (LABA), a corticosteroid, an anti-inflammatory, an anti-tussive, a bronchodilator, and a muscarinic antagonist; and 
 a plurality of respirable suspending particles, wherein the total mass of the respirable suspending particles exceeds the total mass of the respirable active agent particles and the active agent particles associate with the plurality of suspending particles to form a co-suspension; and 
   administering the co-suspension to the patient by actuating the metered dose inhaler, wherein said administering of the co-suspension comprises delivering a dose of 150 μg, or less, of glycopyrrolate per actuation of the metered dose inhaler and said delivery results in a clinically significant increase in FEV 1  in 0.5 hours, or less, and the increase in FEV 1  remains clinically significant for up to 12 hours or more.   
     
     
         2 . The method of  claim 1 , wherein the pulmonary disease or disorder is selected from at least one of asthma, COPD, allergic rhinitis, sinusitis, pulmonary vasoconstriction, inflammation, allergies, impeded respiration, respiratory distress syndrome, pulmonary hypertension, pulmonary vasoconstriction, pulmonary inflammation associated with cystic fibrosis, and pulmonary obstruction associated with cystic fibrosis. 
     
     
         3 . The method of  claim 2 , wherein administering the co-suspension to the patient further results in a clinically significant increase in inspiratory capacity (IC) in the patient 
     
     
         4 . The method of  claim 3 , wherein said administering of the co-suspension comprises administering a delivered dose of no more than 100 μg glycopyrrolate per actuation, and said administration results in an increase in FEV 1  of at least 150 mL within 0.5 hours, or less, and a clinically significant increase in FEV 1  is maintained for at least 10 hours. 
     
     
         5 . The method of  claim 4 , wherein said administering of the co-suspension comprises administering a delivered dose of no more than 80 μg glycopyrrolate per actuation, and said administration results in an increase in FEV 1  of at least 150 mL within 0.5 hours, or less, and a clinically significant increase in FEV 1  is maintained for at least 10 hours. 
     
     
         6 . The method of  claim 4 , wherein said administering of the co-suspension results in an increase in IC of at least 300 ml within 1 hour or less. 
     
     
         7 . The method of  claim 5 , wherein said administering of the co-suspension results in an increase in IC of at least 150 ml within 1 hour or less. 
     
     
         8 . The method of  claim 4 , wherein administering the co-suspension to the patient by actuating the metered dose inhaler comprises delivering glycopyrrolate to the patient at a DDU of ±25%, or better, throughout emptying of the canister. 
     
     
         9 . The method of  claim 8 , wherein and administering the co-suspension to the patient by actuating the metered dose inhaler comprises delivering glycopyrrolate to the patient at a DDU of ±20%, or better, throughout emptying of the canister. 
     
     
         10 . The method of  claim 1 , wherein providing a metered dose inhaler comprising a canister containing a pharmaceutically acceptable co-suspension comprises providing a co-suspension exhibiting a ratio of total mass of the suspending particles to total mass of the active agent particles of between about 3:1 and about 15:1. 
     
     
         11 . The method of  claim 1 , wherein providing a metered dose inhaler comprising a canister containing a pharmaceutically acceptable co-suspension comprises providing a co-suspension exhibiting a ratio of total mass of the suspending particles to total mass of the active agent particles of between about 2:1 and about 8:1. 
     
     
         12 . A method for respiratory delivery of a therapeutically effective amount of at least two active agents to a patient, the method comprising:
 providing a metered dose inhaler comprising a canister containing a pharmaceutically acceptable co-suspension, the co-suspension comprising:
 a suspension medium comprising a pharmaceutically acceptable propellant substantially free of additional constituents; 
 a plurality of respirable active agent particles comprising a first active agent, wherein the first active agent is substantially crystalline glycopyrrolate, including pharmaceutically acceptable salts, esters, isomers or solvates thereof; 
 one or more additional species of respirable active agent particles comprising one or more additional active agents selected from a short-acting beta agonist, a long-acting and ultra long-acting β 2  adrenergic receptor agonist (LABA), a corticosteroid, an anti-inflammatory, an anti-tussive, a bronchodilator, and a muscarinic antagonist; and 
 a plurality of respirable suspending particles, wherein the plurality of respirable suspending particles and the plurality of respirable active agent particles associate with the plurality of suspending particles to form a co-suspension; and 
   actuating the metered dose inhaler to deliver each of the active agents from the metered dose inhaler in respirable form at a DDU of ±30%, or better, throughout emptying of the canister.   
     
     
         13 . The method of  claim 12 , wherein actuating the metered dose inhaler to deliver each of the active agents from the metered dose inhaler in respirable form at a DDU of ±20%, or better, throughout emptying of the canister. 
     
     
         14 . The method of  claim 12 , wherein providing a metered dose inhaler comprising a canister containing a pharmaceutically acceptable co-suspension comprises providing a co-suspension comprising sufficient active agent particles to provide a delivered dose of glycopyrrolate per actuation of the metered dose inhaler of between about 2 μg and about 200 μg and actuating the metered dose inhaler to deliver glycopyrrolate from the metered dose inhaler in respirable form further comprises expelling glycopyrrolate from the metered dose inhaler in an aerosol composition having an initial fine particle fraction and, throughout emptying of the canister, the aerosol composition expelled from the metered dose inhaler exhibits a fine particle fraction that is maintained within 80% of the initial fine particle fraction. 
     
     
         15 . The method of  claim 14 , wherein providing a metered dose inhaler comprises providing a metered dose inhaler comprising a canister containing a co-suspension comprising sufficient active agent particles to provide a delivered dose of glycopyrrolate per actuation of the metered dose inhaler of between about 10 μg and about 150 μg, and wherein, throughout emptying of the canister the aerosol composition expelled from the metered dose inhaler exhibits a fine particle fraction that is maintained within 90% of the initial fine particle fraction. 
     
     
         16 . The method of  claim 15 , wherein, throughout emptying of the canister, the aerosol composition expelled from the metered dose inhaler exhibits a fine particle fraction that is maintained within 95% of the initial fine particle fraction. 
     
     
         17 . The method of  claim 12 , wherein providing a metered dose inhaler comprising a canister containing a pharmaceutically acceptable co-suspension comprises providing a canister containing a co-suspension exhibiting a ratio of total mass of the respirable suspending particles to total mass of the respirable active agent particles of between about 3:1 and about 15:1. 
     
     
         18 . The method of  claim 12 , wherein providing a metered dose inhaler comprising a canister containing a pharmaceutically acceptable co-suspension comprises providing a canister containing a co-suspension exhibiting a ratio of total mass of the respirable suspending particles to total mass of the respirable active agent particles of between about 2:1 and about 8:1. 
     
     
         19 . The method of  claim 15 , wherein providing a metered dose inhaler comprising a canister containing a co-suspension, comprises providing a canister containing a co-suspension comprising sufficient active agent particles to provide a delivered dose of glycopyrrolate per actuation of the metered dose inhaler of between about 15 μg and about 80 μg. 
     
     
         20 . The method of  claim 1 , wherein said clinically significant increase in FEV 1  resulting from said administration of the co-suspension includes an increase in FEV 1  of at least 150 mL achieved within 0.5 hours, or less. 
     
     
         21 . The method of  claim 2 , wherein the co-suspension contained within the canister comprises a first species of respirable active agent particles comprising substantially crystalline glycopyrrolate, including pharmaceutically acceptable salts, esters, isomers or solvates thereof, and a second species of respirable active agent particles comprising a substantially crystalline LABA active agent selected from bambuterol, clenbuterol, formoterol, salmeterol, carmoterol, milveterol, indacaterol, and saligenin- or indole-containing and adamantyl-derived β 2  agonists, including pharmaceutically acceptable salts, esters, isomers or solvates thereof. 
     
     
         22 . The method of  claim 21 , wherein the second species of respirable active agent particles comprises substantially crystalline formoterol, including pharmaceutically acceptable salts, esters, isomers or solvates thereof. 
     
     
         23 . The method of  claim 12 , wherein the co-suspension contained within the canister comprises a first species of respirable active agent particles comprising substantially crystalline glycopyrrolate, including pharmaceutically acceptable salts, esters, isomers or solvates thereof, and a second species of respirable active agent particles comprising a substantially crystalline LABA active agent selected from bambuterol, clenbuterol, formoterol, salmeterol, carmoterol, milveterol, indacaterol, and saligenin- or indole-containing and adamantyl-derived β 2  agonists, including pharmaceutically acceptable salts, esters, isomers or solvates thereof. 
     
     
         24 . The method of  claim 23 , wherein the second species of respirable active agent particles comprises substantially crystalline formoterol, including pharmaceutically acceptable salts, esters, isomers or solvates thereof. 
     
     
         25 . The method of  claim 24 , wherein administering the co-suspension to the patient results in the patient experiencing either an increase from baseline in FEV 1  of at least 200 ml or a 12%, or greater, increase from baseline in FEV 1  coupled with total increase in FEV 1  of at least 150 ml within a period of time selected from 1 hour, or less, 1.5 hours or less, 2 hours, or less, and 2.5 hours, or less. 
     
     
         26 . The method of  claim 25 , wherein administering the co-suspension to the patient results in the patient experiencing either an increase from baseline in FEV 1  of at least 200 ml or a 12%, or greater, increase from baseline in FEV 1  coupled with total increase in FEV 1  of at least 150 ml within 1 hour, or less. 
     
     
         27 . The method of  claim 25 , wherein administering the co-suspension to the patient additionally results in a clinically significant increase in inspiratory capacity (IC). 
     
     
         28 . The method of  claim 27 , wherein the clinically significant increase in IC is achieved in 1 hour, or less. 
     
     
         29 . The method of  claim 12 , wherein the co-suspension contained within the canister comprises a first species of respirable active agent particles comprising substantially crystalline glycopyrrolate, including pharmaceutically acceptable salts, esters, isomers or solvates thereof, a second species of respirable active agent particles comprising a substantially crystalline LABA active agent selected from bambuterol, clenbuterol, formoterol, salmeterol, carmoterol, milveterol, indacaterol, and saligenin- or indole-containing and adamantyl-derived β 2  agonists, including pharmaceutically acceptable salts, esters, isomers or solvates thereof, and a third species of respirable active agent particles comprising a substantially crystalline corticosteroid active agent selected from beclomethasone, budesonide, ciclesonide, flunisolide, fluticasone, methyl-prednisolone, mometasone, prednisone and trimacinolone, including any pharmaceutically acceptable salts, esters, isomers or solvates thereof. 
     
     
         30 . The method of  claim 29 , wherein the second species of respirable active agent particles comprises substantially crystalline formoterol, including pharmaceutically acceptable salts, esters, isomers or solvates thereof, and the third species of respirable active agent particles comprises substantially crystalline mometasone, including pharmaceutically acceptable salts, esters, isomers or solvates thereof.