# Patent

## Title
Biodegradable intravitreal tyrosine kinase implants

## Abstract

Biocompatible intraocular implants include a tyrosine kinase inhibitor and a biodegradable polymer that is effective to facilitate release of the tyrosine kinase inhibitor into the vitreous of an eye for an extended period of time. The therapeutic agents of the implants may be associated with a biodegradable polymer matrix, such as a matrix that is substantially free of a polyvinyl alcohol. The implants can be placed in an eye to treat or reduce the occurrence of one or more ocular conditions, such as posterior ocular conditions.

## Background
CROSS REFERENCE
This application is a continuation in part of application Ser. No. 10/837,361 filed Apr. 30, 2004, the entire content of which is incorporated herein by reference.


BACKGROUND
The present invention generally relates to devices and methods to treat an eye of a patient, and more specifically to intraocular implants that provide extended release of a therapeutic agent to an eye in which the implant is placed, and to methods of making and using such implants, for example, to treat or reduce one or more symptoms of an ocular condition.
Delivery of drugs to the retina, vitreous and uveal tract is typically achieved by high systemic dosing, intra-ocular injections or other heroic measures. Penetration of systemically administered drugs into the retina is severely restricted by the blood-retinal barriers (BRB) for most compounds. Although intraocular injection, such as intravitreal injections, resolves some constraints posed by the BRB and significantly reduces the risk of systemic toxicity, intraocular injection techniques may result in retinal detachment, physical damage to the lens, exogenous endophthalmitis, and also may result in high pulsed concentrations of drug at the lens and other intraocular tissues.
Compounds are eliminated from the vitreous by diffusion to the retro-zonular space with clearance via the aqueous humor or by trans-retinal elimination. Most compounds utilize the former pathway while lipophilic compounds and those with trans-retinal transport mechanisms will utilize the latter. Unfortunately, compounds that are eliminated across the retina have extremely short half-lives. Hence, for these compounds it is difficult to maintain therapeutic concentrations by direct intraocular injection, and therefore, frequent injection is often required.
Additionally, the rapid elimination of retinaly cleared compounds makes formulation of controlled delivery systems challenging. For example, tyrosine kinase inhibitors (TKIs) may possess extremely short intraocular half-lives, and thus, may pose a challenge to the formulation of controlled delivery systems. The inventors are unaware of any small molecule TKIs given by intraocular administration, let alone, intraocular implants containing TKIs.
U.S. Pat. No. 6,713,081 discloses ocular implant devices made from polyvinyl alcohol and used for the delivery of a therapeutic agent to an eye in a controlled and sustained manner. The implants may be placed subconjunctivally or intravitreally in an eye.
Biocompatible implants for placement in the eye have also been disclosed in a number of patents, such as U.S. Pat. Nos. 4,521,210; 4,853,224; 4,997,652; 5,164,188; 5,443,505; 5,501,856; 5,766,242; 5,824,072; 5,869,079; 6,074,661; 6,331,313; 6,369,116; and 6,699,493.
It would be advantageous to provide eye implantable drug delivery systems, such as intraocular implants, and methods of using such systems, that are capable of releasing a therapeutic agent at a sustained or controlled rate for extended periods of time and in amounts with few or no negative side effects.
SUMMARY
The present invention provides new drug delivery systems, and methods of making and using such systems, for extended or sustained drug release into an eye, for example, to achieve one or more desired therapeutic effects. The drug delivery systems are in the form of implants or implant elements that may be placed in an eye. The present systems and methods advantageously provide for extended release times of one or more therapeutic agents. Thus, the patient in whose eye the implant has been placed receives a therapeutic amount of an agent for a long or extended time period without requiring additional administrations of the agent. For example, the patient has a substantially consistent level of therapeutically active agent available for consistent treatment of the eye over a relatively long period of time, for example, on the order of at least about one week, such as between about one and about six months or even for more than one year after receiving an implant. Such extended release times facilitate obtaining successful treatment results. The implants allow for prolonged delivery of a therapeutic agent while reducing invasive procedures and reducing high transient concentrations associated with pulsed dosing.
Intraocular implants in accordance with the disclosure herein comprise a therapeutic component and a drug release sustaining component associated with the therapeutic component. The implants may be solid, semisolid, or viscoelastic. In accordance with the present invention, the therapeutic component comprises, consists essentially of, or consists of, a tyrosine kinase inhibitor (TKI), for example, an agent or compound that inhibits or reduces the activity of tyrosine kinase. The TKI may also be understood to be a small molecule TKI. The drug release sustaining component is associated with the therapeutic component to sustain release of an amount of the TKI into an eye in which the implant is placed. TKIs may be released from the implant by diffusion, erosion, dissolution or osmosis. The drug release sustaining component may comprise one or more biodegradable polymers or one or more non-biodegradable polymers. Examples of biodegradable polymers of the present implants may include poly-lactide-co-glycolide (PLGA and PLA), polyesters, poly(ortho ester), poly(phosphazine), poly(phosphate ester), polycaprolactone, natural polymers such as gelatin or collagen, or polymeric blends. The amount of the TKI is released into the eye for a period of time greater than about one week after the implant is placed in the eye and is effective in reducing or treating an ocular condition.
In one embodiment, the intraocular implants comprise a TKI and a biodegradable polymer matrix. The TKI is associated with a biodegradable polymer matrix that degrades at a rate effective to sustain release of an amount of the TKI from the implant effective to treat an ocular condition. The intraocular implant is biodegradable or bioerodible and provides a sustained release of the TKI in an eye for extended periods of time, such as for more than one week, for example for about one month or more and up to about six months or more. The implants may be configured to provide release of the therapeutic agent in substantially one direction, or the implants may provide release of the therapeutic agent from all surfaces of the implant.
The biodegradable polymer matrix of the foregoing implants may be a mixture of biodegradable polymers or the matrix may comprise a single type of biodegradable polymer. For example, the matrix may comprise a polymer selected from the group consisting of polylactides, poly(lactide-co-glycolides), polycaprolactones, and combinations thereof.
In another embodiment, intraocular implants comprise a therapeutic component that comprises a TKI, and a polymeric outer layer covering the therapeutic component. The polymeric outer layer includes one or more orifices or openings or holes that are effective to allow a liquid to pass into the implant, and to allow the TKI to pass out of the implant. The therapeutic component is provided in a core or interior portion of the implant, and the polymeric outer layer covers or coats the core. The polymeric outer layer may include one or more non-biodegradable portions. The implant can provide an extended release of the TKI for more than about two months, and for more than about one year, and even for more than about five or about ten years. One example of such a polymeric outer layer covering is disclosed in U.S. Pat. No. 6,331,313.
Advantageously, the present implants provide a sustained or controlled delivery of therapeutic agents at a maintained level despite the rapid elimination of the TKIs from the eye. For example, the present implants are capable of delivering therapeutic amounts of a TKI for a period of at least about 30 days to about a year despite the short intraocular half-lives associated with TKIs. Plasma TKI levels obtained after implantation are extremely low, thereby reducing issues or risks of systemic toxicity. The controlled delivery of the TKIs from the present implants permits the TKIs to be administered into an eye with reduced toxicity or deterioration of the blood-aqueous and blood-retinal barriers, which may be associated with intraocular injection of liquid formulations containing TKIs.
A method of making the present implants involves combining or mixing the TKI with a biodegradable polymer or polymers. The mixture may then be extruded or compressed to form a single composition. The single composition may then be processed to form individual implants suitable for placement in an eye of a patient.
Another method of making the present implants involves providing a polymeric coating around a core portion containing a TKI, wherein the polymeric coating has one or more holes.
The implants may be placed in an ocular region to treat a variety of ocular conditions, such as treating, preventing, or reducing at least one symptom associated with non-exudative age related macular degeneration, exudative age related macular degeneration, choroidal neovascularization, acute macular neuroretinopathy, cystoid macular edema, diabetic macular edema, Behcet's disease, diabetic retinopathy, retinal arterial occlusive disease, central retinal vein occlusion, uveitic retinal disease, retinal detachment, trauma, conditions caused by laser treatment, conditions caused by photodynamic therapy, photocoagulation, radiation retinopathy, epiretinal membranes, proliferative diabetic retinopathy, branch retinal vein occlusion, anterior ischemic optic neuropathy, non-retinopathy diabetic retinal dysfunction, retinitis pigmentosa, ocular tumors, ocular neoplasms, and the like.
Kits in accordance with the present invention may comprise one or more of the present implants, and instructions for using the implants. For example, the instructions may explain how to administer the implants to a patient, and types of conditions that may be treated with the implants.
Our invention also encompasses a biodegradable intravitreal implant comprising a tyrosine kinase inhibitor (TKI) and a biodegradable polymer. The implant can release the TKI at a rate effective to sustain release of the TKI from the implant for at least about one week after the implant is placed in the vitreous of an eye. The polymer can be a polylactide, poly(lactide-co-glycolide), polycaprolactone, or a derivative thereof, or a mixture thereof. The polymer can release the TKI at a rate effective to sustain release of an amount of the TKI from the implant for more than one month from the time the implant is placed in the vitreous of the eye. The TKI can be provided in an amount from about 30% by weight to about 70% by weight of the implant, and the biodegradable polymer matrix can comprise a poly(lactide-co-glycolide) in an amount from about 30% by weight to about 70% by weight of the implant. More preferably, the TKI can be provided in an amount from about 40% by weight to about 60% by weight of the implant, and the biodegradable polymer matrix can comprise a poly(lactide-co-glycolide) in an amount from about 40% by weight to about 60% by weight of the implant. The implant can be made by an extrusion process.
A detailed embodiment of our invention can be a method of making a biodegradable intravitreal implant, comprising the step of: extruding a mixture of a TKI and a biodegradable polymer to form a biodegradable implant that degrades at a rate effective to sustain release of an amount of the TKI from the implant for at least about one week after the implant is placed in the vitreous of an eye. The mixture can consist essentially of the TKI and the biodegradable polymer.
Our invention also encompasses a method of treating an ocular condition of an eye of a patient, comprising the step of placing a biodegradable intraocular implant into the vitreous of an eye of the patient, the implant comprising a TKI and a biodegradable polymer, wherein the implant degrades at a rate effective to sustain release of an amount of the TKI from the implant effective to treat the ocular condition. This method can be effective to treat, for example, a retinal ocular condition, glaucoma or a proliferative vitreoretinopathy.
The TKI used in the implant can have, for example, one of the following five possible formulas:




Each and every feature described herein, and each and every combination of two or more of such features, is included within the scope of the present invention provided that the features included in such a combination are not mutually inconsistent. In addition, any feature or combination of features may be specifically excluded from any embodiment of the present invention.
Additional aspects and advantages of the present invention are set forth in the following description and claims, particularly when considered in conjunction with the accompanying drawings.



DRAWINGS
FIG. 1 is a graph showing the vitreous humor concentration of two TKIs as a function of time.
FIG. 2 is a graph similar to FIG. 1 for two different TKIs.
FIG. 3 is a graph of the cumulative release profile for AGN 200954 as a function of time.
FIG. 4 is a graph of the cumulative release profile for AGN 202314 as a function of time.
FIG. 5 is a graph similar to FIG. 4 for different formulations of AGN 202314.
FIG. 6 is a graph of the TTL release for AGN 201634 as a function of time.
FIG. 7 is a graph similar to FIG. 6 with implants containing 30% AGN 201634.
FIG. 8 is a graph similar to FIG. 6 for AGN 201634 in different solutions.
FIG. 9 is a graph of the percent of TKI released as a function of time in different a Tween 80/saline solution.
FIG. 10 is a graph similar to FIG. 9 except in a phosphate buffer solution.
FIG. 11 is a graph of the cumulative release profile for TKI AGN 201634 of Formulation 1 in saline and PBS.
FIG. 12 is a graph of the cumulative release profile for TKI AGN 201634 release of Formulation 3 in media of a pH of 6.0 (with 0.1% CTAB), 7.4 (PBS) or 8.5 (with 0.5% SDS).
FIG. 13 is a graph of the cumulative release profile for TKI AGN 201634 release of Formulation 4 in media of a pH of 6.0 (with 0.1% CTAB), 7.4 (PBS) or 8.5 (with 0.5% SDS).
FIG. 14 is an illustration of a biodegradable implant comprising a drug-releasing active layer and a barrier layer.
FIG. 15 is a graph of the cumulative release profile for a TKI-containing implant and Dexamethasone-containing implants, in which the biodegradable polymer is polycaprolactone.
FIG. 16 is a graph of the cumulative release profile for three different formulations of TKI (AGN206639) containing implants in phosphate buffered saline release medium, pH 7.4.
FIG. 17 is a graph of the cumulative release profile for five further and different formulations of TKI (AGN206639) containing implants in phosphate buffered saline release medium, pH 7.4.
FIG. 18 is a graph of the cumulative release profile for three different formulations of TKI (AGN205558) containing implants in phosphate buffered saline release medium, pH 7.4.
FIG. 19 is a graph of the cumulative release profile for eight different formulations of TKI (AGN206320) containing implants in phosphate buffered saline release medium, pH 7.4.
FIG. 20 is a graph of the cumulative release profile for eight different formulations of TKI (AGN206784) containing implants in phosphate buffered saline release medium, pH 7.4.
FIG. 21 is a graph of the cumulative release profile for seven different formulations of TKI (AGN206316) containing implants in phosphate buffered saline release medium, pH 7.4.
FIG. 22 is a bar graph showing on the X axis time (14 days and 28 days) after intravitreal implantation into rabbit eyes (N=7) of either a PLGA placebo implant or a TKI (AGN206639) PLGA implant, and on the Y axis vitreoretinal fluorescence (as determined by a scanning ocular fluorophotometry area under the curve [AUC] method after intravenous injection of sodium fluorescein).



DESCRIPTION
As described herein, controlled and sustained administration of a therapeutic agent through the use of one or more intraocular implants may improve treatment of undesirable ocular conditions. The implants comprise a pharmaceutically acceptable polymeric composition and are formulated to release one or more pharmaceutically active agents, such as tyrosine kinase inhibitors (TKIs), over an extended period of time. The implants are effective to provide a therapeutically effective dosage of the agent or agents directly to a region of the eye to treat, prevent, and/or reduce one or more symptoms of one or more undesirable ocular conditions. Thus, with a single administration, therapeutic agents will be made available at the site where they are needed and will be maintained for an extended period of time, rather than subjecting the patient to repeated injections or, in the case of self-administered drops, ineffective treatment with only limited bursts of exposure to the active agent or agents.
An intraocular implant in accordance with the disclosure herein comprises a therapeutic component and a drug release sustaining component associated with the therapeutic component. In accordance with the present invention, the therapeutic component comprises, consists essentially of, or consists of, a TKI. The drug release sustaining component is associated with the therapeutic component to sustain release of an effective amount of the therapeutic component into an eye in which the implant is placed. The amount of the therapeutic component is released into the eye for a period of time greater than about one week after the implant is placed in the eye, and is effective in treating and/or reducing at least one symptom of one or more ocular conditions, such as conditions wherein migration or proliferation of retinal pigment epithelium or glial cells causes or contributes to the cause of the condition. Some examples of ocular conditions that may be treated with the implants of the present invention include, without limitation, non-exudative age related macular degeneration, exudative age related macular degeneration, choroidal neovascularization, acute macular neuroretinopathy, cystoid macular edema, diabetic macular edema, Behcet's disease, diabetic retinopathy, retinopathy of prematurity, retinal arterial occlusive disease, central retinal vein occlusion, uveitic retinal disease, retinal detachment, trauma, conditions caused by laser treatment, conditions caused by photodynamic therapy, photocoagulation, radiation retinopathy, epiretinal membranes, proliferative diabetic retinopathy, branch retinal vein occlusion, anterior ischemic optic neuropathy, non-retinopathy diabetic retinal dysfunction, retinitis pigmentosa, ocular tumors, ocular neoplasms, and the like.
DEFINITIONS
The following terms as defined as follows, unless the context of the word indicates a different meaning.
As used herein, an “intraocular implant” refers to a device or element that is structured, sized, or otherwise configured to be placed in an eye. Intraocular implants are generally biocompatible with physiological conditions of an eye and do not cause adverse side effects. Intraocular implants may be placed in an eye without disrupting vision of the eye.
As used herein, a “therapeutic component” refers to a portion of an intraocular implant comprising one or more therapeutic agents or substances used to treat a medical condition of the eye. The therapeutic component may be a discrete region of an intraocular implant, or it may be homogenously distributed throughout the implant. The therapeutic agents of the therapeutic component are typically ophthalmically acceptable, and are provided in a form that does not cause adverse reactions when the implant is placed in an eye.
As used herein, a “drug release sustaining component” refers to a portion of the intraocular implant that is effective to provide a sustained release of the therapeutic agents of the implant. A drug release sustaining component may be a biodegradable polymer matrix, or it may be a coating covering a core region of the implant that comprises a therapeutic component.
As used herein, “associated with” means mixed with, dispersed within, coupled to, covering, or surrounding.
As used herein, an “ocular region” or “ocular site” refers generally to any area of the eyeball, including the anterior and posterior segment of the eye, and which generally includes, but is not limited to, any functional (e.g., for vision) or structural tissues found in the eyeball, or tissues or cellular layers that partly or completely line the interior or exterior of the eyeball. Specific examples of areas of the eyeball in an ocular region include the anterior chamber, the posterior chamber, the vitreous cavity, the choroid, the suprachoroidal space, the conjunctiva, the subconjunctival space, the episcleral space, the intracorneal space, the epicorneal space, the sclera, the pars plana, surgically-induced avascular regions, the macula, and the retina.
As used herein, an “ocular condition” is a disease, ailment or condition which affects or involves the eye or one of the parts or regions of the eye. Broadly speaking the eye includes the eyeball and the tissues and fluids which constitute the eyeball, the periocular muscles (such as the oblique and rectus muscles) and the portion of the optic nerve which is within or adjacent to the eyeball.
An “anterior ocular condition” is a disease, ailment or condition which affects or which involves an anterior (i.e. front of the eye) ocular region or site, such as a periocular muscle, an eye lid or an eye ball tissue or fluid which is located anterior to the posterior wall of the lens capsule or ciliary muscles. Thus, an anterior ocular condition primarily affects or involves the conjunctiva, the cornea, the anterior chamber, the iris, the posterior chamber (behind the retina but in front of the posterior wall of the lens capsule), the lens or the lens capsule and blood vessels and nerve which vascularize or innervate an anterior ocular region or site.
Thus, an anterior ocular condition can include a disease, ailment or condition, such as for example, aphakia; pseudophakia; astigmatism; blepharospasm; cataract; conjunctival diseases; conjunctivitis; corneal diseases corneal ulcer; dry eye syndromes; eyelid diseases; lacrimal apparatus diseases; lacrimal duct obstruction; myopia; presbyopia; pupil disorders; refractive disorders and strabismus. Glaucoma can also be considered to be an anterior ocular condition because a clinical goal of glaucoma treatment can be to reduce a hypertension of aqueous fluid in the anterior chamber of the eye (i.e. reduce intraocular pressure).
A “posterior ocular condition” is a disease, ailment or condition which primarily affects or involves a posterior ocular region or site such as choroid or sclera (in a position posterior to a plane through the posterior wall of the lens capsule), vitreous, vitreous chamber, retina, optic nerve (i.e. the optic disc), and blood vessels and nerves which vascularize or innervate a posterior ocular region or site.
Thus, a posterior ocular condition can include a disease, ailment or condition, such as for example, acute macular neuroretinopathy; Behcet's disease; choroidal neovascularization; diabetic uveitis; histoplasmosis; infections, such as fungal or viral-caused infections; macular degeneration, such as acute macular degeneration, non-exudative age related macular degeneration and exudative age related macular degeneration; edema, such as macular edema, cystoid macular edema and diabetic macular edema; multifocal choroiditis; ocular trauma which affects a posterior ocular site or location; ocular tumors; retinal disorders, such as central retinal vein occlusion, diabetic retinopathy (including proliferative diabetic retinopathy), proliferative vitreoretinopathy (PVR), retinal arterial occlusive disease, retinal detachment, uveitic retinal disease; sympathetic ophthalmia; Vogt Koyanagi-Harada (VKH) syndrome; uveal diffusion; a posterior ocular condition caused by or influenced by an ocular laser treatment; posterior ocular conditions caused by or influenced by a photodynamic therapy, photocoagulation, radiation retinopathy, epiretinal membrane disorders, branch retinal vein occlusion, anterior ischemic optic neuropathy, non-retinopathy diabetic retinal dysfunction, retinitis pigmentosa, and glaucoma. Glaucoma can be considered a posterior ocular condition because the therapeutic goal is to prevent the loss of or reduce the occurrence of loss of vision due to damage to or loss of retinal cells or optic nerve cells (i.e. neuroprotection).
The term “biodegradable polymer” refers to a polymer or polymers which degrade in vivo, and wherein erosion of the polymer or polymers over time occurs concurrent with or subsequent to release of the therapeutic agent. Specifically, hydrogels such as methylcellulose which act to release drug through polymer swelling are specifically excluded from the term “biodegradable polymer”. The terms “biodegradable” and “bioerodible” are equivalent and are used interchangeably herein. A biodegradable polymer may be a homopolymer, a copolymer, or a polymer comprising more than two different polymeric units.
The term “treat”, “treating”, or “treatment” as used herein, refers to reduction or resolution or prevention of an ocular condition, ocular injury or damage, or to promote healing of injured or damaged ocular tissue.
The term “therapeutically effective amount” as used herein, refers to the level or amount of agent needed to treat an ocular condition, or reduce or prevent ocular injury or damage without causing significant negative or adverse side effects to the eye or a region of the eye.
Intraocular implants have been developed which can release drug loads over various' time periods. These implants, which when inserted into an eye, such as the vitreous of an eye, provide therapeutic levels of a TKI, for extended periods of time (e.g., for about 1 week or more). The disclosed implants are effective in treating ocular conditions, such as non-exudative age related macular degeneration, exudative age related macular degeneration, choroidal neovascularization, acute macular neuroretinopathy, cystoid macular edema, diabetic macular edema, Behcet's disease, diabetic retinopathy, retinal arterial occlusive disease, central retinal vein occlusion, uveitic retinal disease, retinal detachment, trauma, conditions caused by laser treatment, conditions caused by photodynamic therapy, photocoagulation, radiation retinopathy, epiretinal membranes, proliferative diabetic retinopathy, branch retinal vein occlusion, anterior ischemic optic neuropathy, non-retinopathy diabetic retinal dysfunction, retinitis pigmentosa, ocular tumors, ocular neoplasms, and the like.
In one embodiment of the present invention, an intraocular implant comprises a biodegradable polymer matrix. The biodegradable polymer matrix is one type of a drug release sustaining component. The biodegradable polymer matrix is effective in forming a biodegradable intraocular implant. The biodegradable intraocular implant comprises a TKI associated with the biodegradable polymer matrix. The matrix degrades at a rate effective to sustain release of an amount of the TKI for a time greater than about one week from the time in which the implant is placed in ocular region or ocular site, such as the vitreous of an eye.
The TKI of the implant is typically an agent that inhibits or reduces the activity of a tyrosine kinase. The TKI may inhibit tyrosine kinase activity by directly acting on a tyrosine kinase molecule, or it may cooperate with one or more other factors or agents to achieve the desired inhibition. Examples of TKIs useful in the present implants are described in U.S. patent application Ser. No. 10/256,879 (U.S. Pub. No. 20030199478) and Ser. No. 10/259,703 (U.S. Pub. No. 20030225152).
In short, a TKI of the present implants include organic molecules capable of modulating, regulating and/or inhibiting tyrosine kinase signal transduction. Some compounds useful in the present implants are represented by the following formula




wherein R1 is selected from the group consisting of halogen, NO2, CN, C1 to C4 alkyl and aryl, e.g. phenyl; R2 is selected from the group consisting of hydrogen, C1 to C8 alkyl, COCH3, CH2CH2OH, CH2CH2CH2OH and phenyl; R is selected from the group consisting of D, halogen, C1 to C8 alkyl, CF3, OCF3, OCF2H, CH2CN, CN, SR2, (CR7R8)cC(O)OR2, C(O)N(R2)2, (CR7R8)cOR2, HNC(O)R2, HN—C(O)OR2, (CR7R8)cN(R2)2, SO2(CR7R8)cN(R2)2, OP(O)(OR2)2, OC(O)OR2, OCH2O, HN—CH═CH, —N(COR2)CH2CH2, HC═N—NH, N═CH—S, O(CR7R8)d—R6 and (CR7R8)c—R6, —NR2(CR7R8)dR6 wherein R6 is selected from the group consisting of halogen, 3-fluoropyrrolidinyl, 3-fluoropiperidinyl, 2-pyridinyl, 3-pyridinyl, 4-pyridinyl, 3-pyrrolinyl, pyrrolidinyl, methyl isonipecotate, N-(2-methoxyethyl)-N-methylamyl, 1,2,3,6-tetrahydropyridinyl, morpholinyl, hexamethyleneiminyl, piperazinyl-2-one, piperazinyl, N-(2-methoxyethyl)ethylaminyl, thiomorpholinyl, heptamethyleneiminyl, 1-piperazinylcarboxaldehyde, 2,3,6,7-tetrahydro-(1H)-1,4-diazepinyl-5(4H)-one, N-methylhomopiperazinyl, (3-dimethylamino)pyrrolidinyl, N-(2-methoxyethyl)-N-propylaminyl, isoindolinyl, nipecotamidinyl, isonipecotamidinyl, 1-acetylpiperazinyl, 3-acetamidopyrrolidinyl, trans-decahydroisoquinolinyl, cis-decahydroisoquinolinyl, N-acetylhomopiperazinyl, 3-(diethylamino)pyrrolidinyl, 1,4-dioxa-8-azaspiro[4.5]decaninyl, 1-(2-methoxyethyl)-piperazinyl, 2-pyrrolidin-3-ylpyridinyl, 4-pyrrolidin-3-ylpyridinyl, 3-(methylsulfonyl)pyrrolidinyl, 3-picolylmethylaminyl, 2-(2-methylaminoethyl)pyridinyl, 1-(2-pyrimidyl)-piperazinyl, 1-(2-pyrazinyl)-piperazinyl, 2-methylaminomethyl-1,3-dioxolane, 2-(N-methyl-2-aminoethyl)-1,3-dioxolane, 3-(N-acetyl-N-methylamino)pyrrolidinyl, 2-methoxyethylaminyl, tetrahydrofurfurylaminyl, 4-aminotetrahydropyran, 2-amino-1-methoxybutane, 2-methoxyisopropylaminyl, 1-(3-aminopropyl)imidazole, histamyl, N,N-diisopropylethylenediaminyl, 1-benzyl-3-aminopyrrolidyl 2-(aminomethyl)-5-methylpyrazinyl, 2,2-dimethyl-1,3-dioxolane-4-methanaminyl, (R)-3-amino-1-N-BOC-pyrrolidinyl, 4-amino-1,2,2,6,6-pentamethylpiperidinyl, 4-aminomethyltetrahydropyran, ethanolamine and alkyl-substituted derivatives thereof and wherein when c is 1 said CH2 may be





    
    
        and CH2CH2CH2; provided said alkyl or phenyl radicals may be substituted with one or two halo, hydroxy or lower alkyl amino radicals wherein R7 and R8 may be selected from the group consisting of H, F and C1-C4 alkyl or CR7R8 may represent a carbocyclic ring of from 3 to 6 carbons, preferably R7 and R8 are H or CH3;
        b is 0 or an integer of from 1 to 3;
        a is 0 or an integer of from 1 to 5, preferably 1 to 3;
        c is 0 or an integer of from 1 to 4,
        d is an integer of from 2 to 5;
        the wavy line represents a E or Z bond and pharmaceutically acceptable salts thereof.
    
    


In certain implants, the TKI is a compound having the foregoing formula, wherein R1 is selected from the group consisting of H, i.e. b is 0; CH3, F, Cl and phenyl.
Preferably, R is selected from the group consisting of CH3, CH2CH3, OCH3, OH, t-butyl, F, CN, C(O)NH2, HNC(O)CH3, CH2C(O)OH, SO2NH2, C(O)OH, OCF2H, isopropyl, C2H5OH, C(O)OCH3, CH2OH, NH—CH═CH, HC═N—N—H, N═CH—S, O(CR7R8)dR6, (CR7R8)cR6 and —NR2(CR7R8)dR6, wherein R6 is selected from the group consisting of 3-fluoropyrrolidinyl, 3-fluoropiperidinyl, 2-pyridinyl, 3-pyridinyl, 4-pyridinyl, 3-pyrrolinyl, pyrrolidinyl, methyl isonipecotate, N-(2-methoxyethyl)-N-methylamyl, 1,2,3,6-tetrahydropyridinyl, morpholinyl, hexamethyleneiminyl, piperazinyl-2-one, piperazinyl, N-(2-methoxyethyl)ethylaminyl, thiomorpholinyl, heptamethyleneiminyl, 1-piperazinylcarboxaldehyde, 2,3,6,7-tetrahydro-(1H)-1,4-diazepinyl-5(4H)-one, N-methylhomopiperazinyl, (3-dimethylamino)pyrrolidinyl, N-(2-methoxyethyl)-N-propylaminyl, isoindolinyl, nipecotamidinyl, isonipecotamidinyl, 1-acetylpiperazinyl, 3-acetamidopyrrolidinyl, trans-decahydroisoquinolinyl, cis-decahydroisoquinolinyl, N-acetylhomopiperazinyl, 3-(diethylamino)pyrrolidinyl, 1,4-dioxa-8-azaspiro[4.5]decaninyl, 1-(2-methoxyethyl)-piperazinyl, 2-pyrrolidin-3-ylpyridinyl, 4-pyrrolidin-3-ylpyridinyl, 3-(methylsulfonyl)pyrrolidinyl, 3-picolylmethylaminyl, 2-(2-methylaminoethyl)pyridinyl, 1-(2-pyrimidyl)-piperazinyl, 1-(2-pyrazinyl)-piperazinyl, 2-methylaminomethyl-1,3-dioxolane, 2-(N-methyl-2-aminoethyl)-1,3-dioxolane, 3-(N-acetyl-N-methylamino)pyrrolidinyl, 2-methoxyethylaminyl, tetrahydrofurfurylaminyl, 4-aminotetrahydropyran, 2-amino-1-methoxybutane, 2-methoxyisopropylaminyl, 1-(3-aminopropyl)imidazole, histamyl, N,N-diisopropylethylenediaminyl, 1-benzyl-3-aminopyrrolidyl 2-(aminomethyl)-5-methylpyrazinyl, 2,2-dimethyl-1,3-dioxolane-4-methanaminyl, (R)-3-amino-1-N-BOC-pyrrolidinyl, 4-amino-1,2,2,6,6-pentamethylpiperidinyl, 4-aminomethyltetrahydropyranyl, ethanolamine and alkyl-substituted derivatives thereof, e.g. R6 is morpholinyl or CH2N(CH3)2.
More preferably, R is selected from the group consisting of m-ethyl, p-methoxy, p-hydroxy, m-hydroxy, p-cyano, m-C(O)NH2, p-HNC(O)CH3, p-CH2C(O)OH, p-SO2NH2, p-CH2OH, m-methoxy, p-CH2CH2OH, HNCH═CH, HC═N—NH, p-morpholinyl, N═CH—S, p-OCHF2, p-COOH, p-CH3, p-OCH3, m-F, m-CH2N(C2H3)2, (CR7R8)cR6, O(CR7R8)dR6 and NR2(CR7R8)dR6.
It is noted that R may represent a condensed ring that is attached to the above phenyl ring at two positions. For example, CH2CH2CH2 may be attached at the 3 and 4 (or m and p) positions of the phenyl ring.
Still more preferably, R is selected from the group consisting of fluoro, methyl, (CR7R8)cR6, O(CR7R8)dR6 and NR2(CR7R8)dR6 wherein R6 is selected from dimethylamino, diethylamino, 3-fluoropyrrolidinyl, 3-fluoropiperidinyl, 3-pyridinyl, 4-pyridinyl, pyrrolidinyl, morpholinyl, piperazinyl, heptamethyleneiminyl, tetrahydrofurfurylaminyl, 4-aminotetrahydropyranyl, N,N-diisopropylethylenediaminyl and 4-aminomethyltetrahydropyran.
In particular, the compounds of the present implants may be selected from the compounds of the tables below.







TABLE 1







Unsubstituted 4-Methyl & 5-Chloro 3-[(Substituted Phenylamino)-


methylene]-1,3-dihydro-indol-2-ones.








 









R Substitution













Example #
R1
2
3
4
5
6





1
H
H
H
H
H
H


2
H
H
Br
H
H
H


3
H
H
H
Br
H
H


4
H
Br
H
H
H
H


5
H
H
H
Et
H
H


6
H
H
Et
H
H
H


7
H
H
H
OMe
H
H


8
H
H
H
CO2Et
H
H


9
H
Et
H
H
H
H


10
H
H
F
Me
H
H


11
H
Me
F
H
H
H


12
H
H
H
OH
H
H


13
H
H
Cl
OH
H
H


14
H
Me
H
F
H
H


15
H
H
OH
H
H
H


16
H
H
OMe
H
OMe
H


17
H
H
H
tBu
H
H


18
H
H
H
Me
H
H


19
H
H
Me
H
Me
H


20
H
H
Me
Me
H
H


21
H
H
F
OMe
H
H


22
H
H
CF3
H
H
H












23
H
H
—CH2CH2CH2—
H
H













24
H
F
H
Cl
H
H


25
H
H
H
CF3
H
H


26
H
F
H
Me
OCO2Et
H


27
H
F
H
Me
OCO2CH2C(CH3)3
H


28
H
F
H
Cl
OH
H


29
H
H
H
CN
H
H


30
H
H
H
CH2CN
H
H












31
H
H
—CH═CH—NH—
H
H


32
H
H
—NH—N═CH—
H
H













33
H
H
H
CONH2
H
H


34
H
H
H
NHCOCH3
H
H


35
H
H
CH2CO2H
H
H
H


36
H
H
H
Cl
H
H


37
H
H
CO2H
Cl
H
H


38
H
H
H
SO2NH2
H
H


39
H
H
H
SO2NHCOCH3
H
H


40
H
H
H
N-morpholino
H
H


41
H
H
H
OPh
H



42
H
H
OMe
OMe
H
H












43
H
H
—S—CH═N—
H
H













44
H
H
OH
CO2H
H
H


45
H
H
CF3
Cl
H
H


46
H
H
CF3
H
CF3
H


47
H
H
CF3
F
H
H


48
H
H
OH
Me
H
H


49
H
H
OH
OMe
H
H


50
H
H
H
OCHF2
H
H


51
H
H
H
OCF3
H
H


52
H
H
H
iPr
H
H


53
H
F
H
Me
H
H


54
H
H
Me
Cl
H
H


55
H
H
CF3
OMe
H
H


56
H
H
CF3
Me
H
H


57
5′-Cl
H
OMe
H
H
H


58
4′-Me
H
H
H
H
H


59
4′-Me
H
H
OMe
H
H


60
4′-Me
H
OH
H
H
H


61
4′-Me
H
OMe
H
OMe
H


62
4′-Me
H
H
Me
H
H


63
4′-Me
H
Me
H
Me
H


64
5′-Cl
H
H
OCHF2
H
H


65
5′-Cl
H
OH
OMe
H
H


66
5′-Cl
H
H
OCF3
H
H


67
5′-Cl
H
Me
OH
H
H












68
5′-Cl
H
—OCH2O—
H
H













69
5′-Cl
H
Me
Me
H
H


70
5′-Cl
H
H
iPr
H
H


71
5′-Cl
H
OH
Me
H
H


72
5′-Cl
H
H
(CH2)2OH
H
H


73
5′-Cl
H
H
OMe
H
H


74
5′-Cl
H
H
H
H
H


75
5′-Cl
H
OMe
H
OMe
H


76
5′-Cl
H
OH
H
H
H


77
5′-Cl
H
H
OH
H
H


78
5′-Cl
H
Me
H
Me
H


79
5′-Cl
H
H
Me
H
H












80
H
H
—OCH2O—
H
H













81
H
H
CO2H
OH
H
H


82
H
H
H
OEt
H
H












83
H
H
—N(COMe)—CH2—CH2—
H
H













84
H
H
H
OPO(OH)2
H
H


85
H
H
CO2H
CO2H
H
H


86
H
H
H
CO2H
H
H


87
H
H
H
(CH2)2OH
H
H


88
H
H
H
CH2OH
H
H


89
H
H
OMe
CO2CH3
H
H












90
4′-Me
H
—NH—N═CH—
H
H













91
4′-Me
H
F
OMe
H
H












92
4′-Me
H
—S—CH═N—
H
H













93
4′-Me
H
OMe
CO2CH3
H
H


94
H
H
OMe
H
H
H


95
4′-Me
H
Me
Me
H
H


96
4′-Me
H
H
OH
H
H












97
4′-Me
H
—CH═CH—NH—
H
H













98
4′-Me
H
H
t-Bu
H
H


99
4′-Me
H
H
CH2OH
H
H


100
5′-Cl
H
H
t-Bu
H
H












101
5′-Cl
H
—S—CH═N—
H
H













102
5′-Cl
H
OMe
OMe
H
H












103
5′-Cl
H
—NH—N═CH—
H
H













104
5′-Cl
OMe
H
Cl
OMe
H


105
5′-Cl
H
F
OMe
H
H


106
5′-Cl
H
H
N-morpholino
H
H


107
5′-Cl
H
H
OEt
H
H


108
5′-Cl
H
CO2H
OH
H
H


109
5′-Cl
H
CH2NEt2
OH
H
H












110
5′-Cl
H
—CH═CH—NH—
H
H













111
5′-Cl
H
H
CH2OH
H
H


112
5′-Cl
H
Me
iPr
H
H


113
4′-Me
H
H
CH2CH2OH
H
H


114
5′-Cl
H
H
NHCOMe
H
H


115
5′-Cl
H
H
CH2CO2H
H
H


116
5′-Cl
H
H
SO2NH2
H
H


117
4′-Me
H
OH
OMe
H
H


118
4′-Me
H
CO2H
OH
H
H


119
4′-Me
H
H
OCHF2
H
H


120
4′-Me
H
H
OCF3
H
H


121
4′-Me
H
CF3
OMe
H
H


122
4′-Me
H
H
OEt
H
H


123
4′-Me
H
H
iPr
H
H












124
4′-Me
H
—O—CH2—O—
H
H













125
4′-Me
H
OH
Me
H
H


126
4′-Me
H
OMe
OMe
H
H


127
4′-Me
Et
H
H
H
H


128
4′-Me
H
H
CN
H
H


129
4′-Me
H
H
CONH2
H
H


130
4′-Me
H
H
NHCOCH3
H
H


131
4′-Me
H
H
CH2CO2H
H
H


132
4′-Me
H
Me
OH
H
H


133
H
H
Me
OH
H
H


134
H
H
OH
NHCO2Et
H
H


135
4′-Me
F
H
OMe
H
H


136
H
H
H
SMe
H
H


137
4′-Me
H
H
SMe
H
H


138
5′-Cl
H
H
SMe
H
H


139
H
H
H
—CH2CH2CH2CO2H
H
H


140
4′-Me
H
H
—CH2CH2CH2CO2H
H
H


141
H
H
—CH2CH2CO2H
H
H
H


142
4′-Me
H
—CH2CH2CO2H
H
H
H


143
5′-Cl
H
—CH2CH2CO2H
H
H
H


144
H
H
H
—CH2CH2CO2H
H
H


145
4′-Me
H
H
—CH2CH2CO2H
H
H


146
5′-Cl
H
H
—CH2CH2CO2H
H
H










Unsubstituted, 4-methyl, 5-Chloro & 5-Fluoro 3-[(Substituted Phenylamino)-


methylene]-1,3-dihydro-indol-2-ones.








 









R Substitution













Example #
R1
2
3
4
5
6





147
4′-Me
H
Et
H
H
H


148
5′-Cl
H
Et
H
H
H


149
5′-Cl
H
H
Et
H
H


150
5′-Cl
H
H
—CH2CH2CH2CO2H
H
H


151
4′-Me
H
H
Et
H
H


152
5′-Cl
H
H
—CN
H
H


155
4′-Me
H
OH
CO2H
H
H


156
H
H
H
N(Me)2
H
H


 


157
H
H
H




H
H


 


158
H
H
H




H
H


 


159
H
H
H




H
H


 


160
H
H
CH2N(Et)2
OH
H
H


161
4′-Me
H
CH2N(Et)2
OH
H
H












162
5′-F
H
—CH—CH—NH—
H
H


163
5′-F
H
—NH—N═CH—
H
H













164
5′-F
H
OH
OMe
H
H


165
5′-F
H
H
CH2CH2CO2H
H
H


166
5′-F
H
H
SO2NH2
H
H


 


167
5′-F
H
H




H
H


 


168
5′-F
H
H




H
H


 


169
5′-F
H
H
H
H
H


170
5′-F
H
H
CONH2
H
H


171
5′-F
H
H
SMe
H
H


172
5′-F
H
F
OMe
H
H












173
5′-F
H
—S—CH═N—
H
H













174
5′-F
H
H
CH2CO2H
H
H


175
5′-F
H
CH2CH2CO2H
H
H
H


176
5′-F
H
Et
H
H
H


177
5′-F
H
OH
H
H
H


178
5′-F
H
H
CH2OH
H
H


 


179
H
H
H




H
H


 


180
H
H
H
NH2
H
H


181
4′-Me
H
H
NH2
H
H


182
H
H
CH(OH)CH3
H
H
H


183
4′-Me
H
CH(OH)CH3
H
H
H


184
H
H
CH2OH
H
H
H


185
4′-Me
H
CH2OH
H
H
H


186
H
H
NHCO2t-Bu
H
H
H


187
4′-Me
H
NHCO2t-Bu
H
H
H


188
H
H
H
N(Et)2
H
H


189
4′-Me
H
H
N(Et)2
H
H


190
H
H
SO2N(CH2CH2OH)2
H
H
H


191
4′-Me
H
SO2N(CH2CH2OH)2
H
H
H


192
H
H
H
SO2NCH2CH2OH
H
H


193
H
H
SO2NCH2CH2CH2OH
H
H
H


194
4′-Me
H
SO2NCH2CH2CH2OH
H
H
H


 


195
H
H
CO2H




H
H


 


196
4′-Me
H
H




H
H


 


197
4′-Me
H
H
SO2NCH2CH2OH
H
H


198
H
H
H
OCH2CH2CH2Cl
H
H


199
H
H
H
OCH2CH2CH2CH2Cl
H
H


200
H
H
H
OCH2CH2CH2I
H
H


201
H
H
H
OCH2CH2CH2CH2I
H
H


202
4′-Me
D
D
D
D
D


203
H
D
D
CO2H
D
D


204
H
D
D
NH2
D
D


205
4′-Me
D
D
NH2
D
D


206
H
H
H




H
H


207
H
H
H
OCH2CH2CH2CH2N(Et)2
H
H


 


208
H
H
H




H
H


 


209
H
H
H




H
H


 


210
4′-Me
H
NH2
H
H
H


211
H
H
NH2
H
H
H


212
H
H
NH2
Me
H
H


213
4′-Me
H
NH2
Me
H
H


214
H
H
H
OCH2CH2CH2N(Et)2
H
H


 


215
H
H
H




H
H


 


216
H
H
H




H
H


 


217
H
H
H




H
H


 


218
H
H
H




H
H


 


219
5′-F
H
H




H
H


 


220
4′-Me
H
H




H
H










Unsubstituted, 4-Fluoro, 4-methyl, 5-Chloro, 5-Cyano, 5-Fluoro, 5-Nitro, 6-


Fluoro & 6-Aryl 3-[(Substituted Phenylamino)-methylene]-1,3-dihydro-indol-2-


ones.








 









R Substitution













Example #
R1
2
3
4
5
6





221
5′-F
H
H




H
H


 


222
5′-F
H
H
OMe
H
H


223
H
D
D
D
D
D


224
H
H
H
CH2CO2H
H
H


 


225
H
H
H




H
H


 


226
H
H
H




H
H


 


227
4′-Me
H
H




H
H


 


228
6′-F
H
H




H
H


 


229
6′-F
H
H




H
H


 


230
6′-F
H
H




H
H


 


231
4′-Me
H
H




H
H


 


232
5′-Cl
H
H




H
H


 


233
5′-F
H
H




H
H


 


234
6′-F
H
H




H
H


 


235
H
H
H




H
H


 


236
5′-NO2
H
H




H
H


 


237
5′-CN
H
H




H
H


 


238
4′-Me
H
H




H
H


 


239
6′-F
H
H




H
H


 


240
5′-F
H
H




H
H


 


241
5′-Cl
H
H




H
H


 


242
4′-Me
H
H




H
H


 


243
6′-F
H
H




H
H


 


244
5′-F
H
H




H
H


 


245
5′-Cl
H
H




H
H


 


246
4′-Me
H
H




H
H


 


247
6′-F
H
H




H
H


 


248
H
H
F




H
H


 


249
4′-Me
H
F




H
H


 


250
6′-F
H
F




H
H


 


251
H
H
H




H
H


 


252
4′-Me
H
H




H
H


 


253
6′-F
H
H




H
H


 


254
H
H
H




H
H


 


255
4′-F
H
H




H
H


 


256
4′-Me
H
H




H
H


 


257
4′-F
H
H




H
H


 


258
5′-F
H
H




H
H


 


259
6′-F
H
H




H
H


 


260
5′-Cl
H
H




H
H


 


261
4′-F
H
H




H
H


 


262
5′-Cl
H
H




H
H


 


263
5′-F
H
H




H
H


 


264
4′-Me
H
H




H
H


 


265
H
H
H




H
H


 


266
6′-F
H
H




H
H


 


267
4′-F
H
H




H
H


 


268
6′-(3- Methoxyphenyl)
H
H




H
H


 


269
6′-(3- Methoxyphenyl)
H
H




H
H


 


270
4′-Me
H
H




H
H


 


271
6′-F
H
H




H
H


 


272
H
H
H




H
H


 


273
4′-F
H
H




H
H


 


274
5′-F
H
H




H
H


 


275
5′-Cl
H
H




H
H


 


276
6′-(3- Methoxyphenyl)
H
H




H
H


 


277
6′-(3- Methoxyphenyl)
H
H




H
H


 


278
4′-Me
H
H




H
H


 


279
6′-F
H
H




H
H


 


280
H
H
H




H
H


 


281
4′-F
H
H




H
H


 


282
5′-F
H
H




H
H


 


283
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284
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285
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286
4′-Me
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287
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288
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289
6′-F
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290
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291
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292
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293
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294
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295
6′-F
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296
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297
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298
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299
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300
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301
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302
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303
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304
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Unsubstituted, 4-Fluoro, 4-methyl, 5-Chloro, 5-Fluoro & 6-Fluoro 3-


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Example #
R1
2
3
4
5
6





305
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306
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307
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308
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309
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310
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311
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312
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313
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314
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315
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316
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317
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318
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319
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320
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321
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322
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323
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The present implants may also comprise a TKI or a combination of TKIs represented by the following formulas




Additional TKIs that may be used in the present implants include those compounds disclosed in Goel et al., “Tyrosine Kinase Inhibitors: A Clinical Perspective”, Current Oncology Reports, 4:9-19 (2002); Haluska et al., “Receptor tyrosine kinase inhibitors”, Current Opinion in Investigational Drugs, 2(2):280-286 (2001); Hubbard et al., “Protein tyrosine kinase structure and function”, Annu. Rev. Biochem., 69:373-98 (2000); Busse et al., “Tyrosine kinase inhibitors: rationale, mechanisms of action, and implications for drug resistance”, Semin Oncol 28(suppl 16) 47-55 (2001); and Fabbro et al., “Protein tyrosine kinase inhibitors: new treatment modalities?”, Current Opinion in Pharmacology, 2:374-381 (2002).
The foregoing compounds may be synthesized using routine chemical technologies and methods including those disclosed in U.S. patent application Ser. No. 10/256,879 (U.S. Pub. No. 20030199478) and Ser. No. 10/259,703 (U.S. Pub. No. 20030225152) and the other above-identified references.
The present implants may also include salts of the TKIs. Pharmaceutically acceptable acid addition salts of the compounds of the invention are those formed from acids which form non-toxic addition salts containing pharmaceutically acceptable anions, such as the hydrochloride, hydrobromide, hydroiodide, sulfate; or bisulfate, phosphate or acid phosphate, acetate, maleate, fumarate, oxalate, lactate, tartrate, citrate, gluconate, saccharate and p-toluene sulphonate salts.
Thus, the implant may comprise a therapeutic component which comprises, consists essentially of, or consists of a TKI, salts thereof, and mixtures thereof. The biodegradable polymer matrix of such implants may be substantially free of polyvinyl alcohol, or in other words, includes no polyvinyl alcohol.
Additional TKIs may be obtained or synthesized using conventional methods, such as by routine chemical synthesis methods known to persons of ordinary skill in the art. Therapeutically effective TKIs may be screened and identified using conventional screening technologies used for the TKIs described herein.
The TKIs may be in a particulate or powder form and entrapped by the biodegradable polymer matrix. Usually, TKI particles in intraocular implants will have an effective average size less than about 3000 nanometers. In certain implants, the particles may have an effective average particle size about an order of magnitude smaller than 3000 nanometers. For example, the particles may have an effective average particle size of less than about 500 nanometers. In additional implants, the particles may have an effective average particle size of less than about 400 nanometers, and in still further embodiments, a size less than about 200 nanometers.
The TKI of the implant is preferably from about 10% to 90% by weight of the implant. More preferably, the TKI is from about 20% to about 80% by weight of the implant. In a preferred embodiment, the TKI comprises about 40% by weight of the implant (e.g., 30%-50%). In another embodiment, the TKI comprises about 60% by weight of the implant.
Suitable polymeric materials or compositions for use in the implant include those materials which are compatible, that is biocompatible, with the eye so as to cause no substantial interference with the functioning or physiology of the eye. Such materials preferably are at least partially and more preferably substantially completely biodegradable or bioerodible.
Examples of useful polymeric materials include, without limitation, such materials derived from and/or including organic esters and organic ethers, which when degraded result in physiologically acceptable degradation products, including the monomers. Also, polymeric materials derived from and/or including, anhydrides, amides, orthoesters and the like, by themselves or in combination with other monomers, may also find use. The polymeric materials may be addition or condensation polymers, advantageously condensation polymers. The polymeric materials may be cross-linked or non-cross-linked, for example not more than lightly cross-linked, such as less than about 5%, or less than about 1% of the polymeric material being cross-linked. For the most part, besides carbon and hydrogen, the polymers will include at least one of oxygen and nitrogen, advantageously oxygen. The oxygen may be present as oxy, e.g. hydroxy or ether, carbonyl, e.g. non-oxo-carbonyl, such as carboxylic acid ester, and the like. The nitrogen may be present as amide, cyano and amino. The polymers set forth in Heller, Biodegradable Polymers in Controlled Drug Delivery, In: CRC Critical Reviews in Therapeutic Drug Carrier Systems, Vol. 1, CRC Press, Boca Raton, Fla. 1987, pp 39-90, which describes encapsulation for controlled drug delivery, may find use in the present implants.
Of additional interest are polymers of hydroxyaliphatic carboxylic acids, either homopolymers or copolymers, and polysaccharides. Polyesters of interest include polymers of D-lactic acid, L-lactic acid, racemic lactic acid, glycolic acid, polycaprolactone, and combinations thereof. Generally, by employing the L-lactate or D-lactate, a slowly eroding polymer or polymeric material is achieved, while erosion is substantially enhanced with the lactate racemate.
Among the useful polysaccharides are, without limitation, calcium alginate, and functionalized celluloses, particularly carboxymethylcellulose esters characterized by being water insoluble, a molecular weight of about 5 kD to 500 kD, for example.
Other polymers of interest include, without limitation, polyesters, polyethers and combinations thereof which are biocompatible and may be biodegradable and/or bioerodible.
Some preferred characteristics of the polymers or polymeric materials for use in the present invention may include biocompatibility, compatibility with the therapeutic component, ease of use of the polymer in making the drug delivery systems of the present invention, a half-life in the physiological environment of at least about 6 hours, preferably greater than about one day, not significantly increasing the viscosity of the vitreous, and water insolubility.
The biodegradable polymeric materials which are included to form the matrix are desirably subject to enzymatic or hydrolytic instability. Water soluble polymers may be cross-linked with hydrolytic or biodegradable unstable cross-links to provide useful water insoluble polymers. The degree of stability can be varied widely, depending upon the choice of monomer, whether a homopolymer or copolymer is employed, employing mixtures of polymers, and whether the polymer includes terminal acid groups.
Equally important to controlling the biodegradation of the polymer and hence the extended release profile of the implant is the relative average molecular weight of the polymeric composition employed in the implant. Different molecular weights of the same or different polymeric compositions may be included in the implant to modulate the release profile. In certain implants, the relative average molecular weight of the polymer will range from about 9 to about 64 kD, usually from about 10 to about 54 kD, and more usually from about 12 to about 45 kD.
In some implants, copolymers of glycolic acid and lactic acid are used, where the rate of biodegradation is controlled by the ratio of glycolic acid to lactic acid. The most rapidly degraded copolymer has roughly equal amounts of glycolic acid and lactic acid. Homopolymers, or copolymers having ratios other than equal, are more resistant to degradation. The ratio of glycolic acid to lactic acid will also affect the brittleness of the implant, where a more flexible implant is desirable for larger geometries. The % of polylactic acid in the polylactic acid polyglycolic acid (PLGA) copolymer can be 0-100%, preferably about 15-85%, more preferably about 35-65%. In some implants, a 50/50 PLGA copolymer is used.
The biodegradable polymer matrix of the intraocular implant may comprise a mixture of two or more biodegradable polymers. For example, the implant may comprise a mixture of a first biodegradable polymer and a different second biodegradable polymer. One or more of the biodegradable polymers may have terminal acid groups.
Release of a drug from an erodible polymer is the consequence of several mechanisms or combinations of mechanisms. Some of these mechanisms include desorption from the implants surface, dissolution, diffusion through porous channels of the hydrated polymer and erosion. Erosion can be bulk or surface or a combination of both. As discussed herein, the matrix of the intraocular implant may release drug at a rate effective to sustain release of an amount of the TKI for more than one week after implantation into an eye. In certain implants, therapeutic amounts of the TKI are released for more than about one month, and even for about six months or more.
One example of the biodegradable intraocular implant comprises a TKI with a biodegradable polymer matrix that comprises a poly(lactide-co-glycolide) or a poly(D,L-lactide-co-glycolide). The implant may have an amount of the TKI from about 20% to about 60% by weight of the implant. Such a mixture is effective in sustaining release of a therapeutically effective amount of the TKI for a time period from about one month to about six months from the time the implant is placed in an eye.
Another example of the biodegradable intraocular implant comprises a TKI with a biodegradable polymer matrix that comprises a single type of polymer. For example, the biodegradable polymer matrix may consist essentially of a polycaprolactone. The polycaprolactone may have a molecular weight between about 10 and about 20 kilodaltons, such as about 15 kilodaltons. These implants are capable of providing a nearly linear release rate for at least about 70 days.
The release of the TKI(s) from the intraocular implant comprising a biodegradable polymer matrix may include an initial burst of release followed by a gradual increase in the amount of the TKI released, or the release may include an initial delay in release of the TKI followed by an increase in release. When the implant is substantially completely degraded, the percent of the TKI(s) that has been released is about one hundred. Compared to existing implants, the implants disclosed herein do not completely release, or release about 100% of the TKI(s), until after about one week of being placed in an eye.
It may be desirable to provide a relatively constant rate of release of the TKI(s) from the implant over the life of the implant. For example, it may be desirable for the TKI(s) to be released in amounts from about 0.01 μg to about 2 μg per day for the life of the implant. However, the release rate may change to either increase or decrease depending on the formulation of the biodegradable polymer matrix. In addition, the release profile of the TKI(s) may include one or more linear portions and/or one or more non-linear portions. Preferably, the release rate is greater than zero once the implant has begun to degrade or erode.
The implants may be monolithic, i.e. having the active agent or agents homogenously distributed through the polymeric matrix, or encapsulated, where a reservoir of active agent is encapsulated by the polymeric matrix. Due to ease of manufacture, monolithic implants are usually preferred over encapsulated forms. However, the greater control afforded by the encapsulated, reservoir-type implant may be of benefit in some circumstances, where the therapeutic level of the drug falls within a narrow window. In addition, the therapeutic component, including the TKI(s), may be distributed in a non-homogenous pattern in the matrix. For example, the implant may include a portion that has a greater concentration of the TKI(s) relative to a second portion of the implant.
One such implant 100 is illustrated in FIG. 14. The implant 100 may be understood to be a unidirectional drug delivery device. The implant 100 is characterized by comprising a first portion 110 and a second portion 120. First portion 110 comprises a mixture of a therapeutic agent, such as TKI, and a biodegradable polymer matrix, such as a matrix of PLGA, PLA, or a combination thereof. Second portion 120 comprises a polymer, such as a biodegradable polymer, and is substantially free of the therapeutic agent. The polymeric component of the first portion 110 and the second portion 120 may comprise the same polymer material, e.g., both components may be made from a PLGA polymer. Although the therapeutic agent is a TKI, other implants may include other therapeutic agents, including those described herein. First portion 110 may be understood to be an active layer, and second portion 120 may be understood to be a barrier layer, which is effective to prevent or reduce diffusion of the therapeutic agent from one side of the implant. The layers may be separately formed as films and pressed together using a Carver press, for example. Or the layers may be co-extruded using conventional extrusion techniques or injection molded using injection molding techniques. The implant 110 is effective to control the flow or release of a therapeutic agent in a specific direction, such as one direction. The implant can be applied to a diseased location, such as in an eye, that needs the release of the therapeutic agent in a specific and controlled manner, such as for subconjunctival applications.
The present implants may also comprise a combination of a TKI and polycaprolactone, as described herein. Such implants may provide a single order release rate for about 70 days or more after placement in an eye. The polycaprolactone may have a molecular weight of about 15 kilodaltons. Thus, one embodiment of the present implants, comprises a poorly soluble drug or therapeutic agent and a single polymeric component that releases the drug at a substantially linear release rate (e.g., a zero order rate).
The present implants may also include a non-biodegradable polymer component, as described herein. The release of a therapeutic agent, such as TKI, may be achieved by movement of the therapeutic agent through one or more openings, orifices, or holes. An example of such an implant is disclosed in U.S. Pat. No. 6,331,313.
The intraocular implants disclosed herein may have a size of between about 5 μm and about 2 mm, or between about 10 μm and about 1 mm for administration with a needle, greater than 1 mm, or greater than 2 mm, such as 3 mm or up to 10 mm, for administration by surgical implantation. The vitreous chamber in humans is able to accommodate relatively large implants of varying geometries, having lengths of, for example, 1 to 10 mm. The implant may be a cylindrical pellet (e.g., rod) with dimensions of about 2 mm×0.75 mm diameter. Or the implant may be a cylindrical pellet with a length of about 7 mm to about 10 mm, and a diameter of about 0.75 mm to about 1.5 mm.
The implants may also be at least somewhat flexible so as to facilitate both insertion of the implant in the eye, such as in the vitreous, and accommodation of the implant. The total weight of the implant is usually about 250-5000 μg, more preferably about 500-1000 μg. For example, an implant may be about 500 μg, or about 1000 μg. For non-human individuals, the dimensions and total weight of the implant(s) may be larger or smaller, depending on the type of individual. For example, humans have a vitreous volume of approximately 3.8 ml, compared with approximately 30 ml for horses, and approximately 60-100 ml for elephants. An implant sized for use in a human may be scaled up or down accordingly for other animals, for example, about 8 times larger for an implant for a horse, or about, for example, 26 times larger for an implant for an elephant.
Thus, implants can be prepared where the center may be of one material and the surface may have one or more layers of the same or a different composition, where the layers may be cross-linked, or of a different molecular weight, different density or porosity, or the like. For example, where it is desirable to quickly release an initial bolus of drug, the center may be a polylactate coated with a polylactate-polyglycolate copolymer, so as to enhance the rate of initial degradation. Alternatively, the center may be polyvinyl alcohol coated with polylactate, so that upon degradation of the polylactate exterior the center would dissolve and be rapidly washed out of the eye.
The implants may be of any geometry including fibers, sheets, films, microspheres, spheres, circular discs, plaques and the like. The upper limit for the implant size will be determined by factors such as toleration for the implant, size limitations on insertion, ease of handling, etc. Where sheets or films are employed, the sheets or films will be in the range of at least about 0.5 mm×0.5 mm, usually about 3-10 mm×5-10 mm with a thickness of about 0.1-1.0 mm for ease of handling. Where fibers are employed, the fiber diameter will generally be in the range of about 0.05 to 3 mm and the fiber length will generally be in the range of about 0.5-10 mm. Spheres may be in the range of about 0.5 μm to 4 mm in diameter, with comparable volumes for other shaped particles.
The size and form of the implant can also be used to control the rate of release, period of treatment, and drug concentration at the site of implantation. Larger implants will deliver a proportionately larger dose, but depending on the surface to mass ratio, may have a slower release rate. The particular size and geometry of the implant are chosen to suit the site of implantation.
The proportions of TKI(s), polymer, and any other modifiers may be empirically determined by formulating several implants with varying proportions. A USP approved method for dissolution or release test can be used to measure the rate of release (USP 23; NF 18 (1995) pp. 1790-1798). For example, using the infinite sink method, a weighed sample of the implant is added to a measured volume of a solution containing 0.9% NaCl in water, where the solution volume will be such that the drug concentration is after release is less than 5% of saturation. The mixture is maintained at 37° C. and stirred slowly to maintain the implants in suspension. The appearance of the dissolved drug as a function of time may be followed by various methods known in the art, such as spectrophotometrically, HPLC, mass spectroscopy, etc. until the absorbance becomes constant or until greater than 90% of the drug has been released.
In addition to the TKI(s) included in the intraocular implants disclosed herein, the intraocular implants may also include one or more additional ophthalmically acceptable therapeutic agents. For example, the implant may include one or more antihistamines, one or more antibiotics, one or more beta blockers, one or more steroids, one or more antineoplastic agents, one or more immunosuppressive agents, one or more antiviral agents, one or more antioxidant agents, and mixtures thereof.
Pharmacologic or therapeutic agents which may find use in the present systems, include, without limitation, those disclosed in U.S. Pat. No. 4,474,451, columns 4-6 and U.S. Pat. No. 4,327,725, columns 7-8.
Examples of antihistamines include, and are not limited to, loratadine, hydroxyzine, diphenhydramine, chlorpheniramine, brompheniramine, cyproheptadine, terfenadine, clemastine, triprolidine, carbinoxamine, diphenylpyraline, phenindamine, azatadine, tripelennamine, dexchlorpheniramine, dexbrompheniramine, methdilazine, and trimeorazine doxylamine, pheniramine, pyrilamine, chlorcyclizine, thonzylamine, and derivatives thereof.
Examples of antibiotics include without limitation, cefazolin, cephradine, cefaclor, cephapirin, ceftizoxime, cefoperazone, cefotetan, cefuroxime, cefotaxime, cefadroxil, ceftazidime, cephalexin, cephalothin, cefamandole, cefoxitin, cefonicid, ceforanide, ceftriaxone, cefadroxil, cephradine, cefuroxime, cyclosporine, ampicillin, amoxicillin, cyclacillin, ampicillin, penicillin G, penicillin V potassium, piperacillin, oxacillin, bacampicillin, cloxacillin, ticarcillin, azlocillin, carbenicillin, methicillin, nafcillin, erythromycin, tetracycline, doxycycline, minocycline, aztreonam, chloramphenicol, ciprofloxacin hydrochloride, clindamycin, metronidazole, gentamicin, lincomycin, tobramycin, vancomycin, polymyxin B sulfate, colistimethate, colistin, azithromycin, augmentin, sulfamethoxazole, trimethoprim, gatifloxacin, ofloxacin, and derivatives thereof.
Examples of beta blockers include acebutolol, atenolol, labetalol, metoprolol, propranolol, timolol, and derivatives thereof.
Examples of steroids include corticosteroids, such as cortisone, prednisolone, fluorometholone, dexamethasone, medrysone, loteprednol, fluazacort, hydrocortisone, prednisone, betamethasone, prednisone, methylprednisolone, triamcinolone hexacetonide, paramethasone acetate, diflorasone, fluocinonide, fluocinolone, triamcinolone, derivatives thereof, and mixtures thereof.
Examples of antineoplastic agents include adriamycin, cyclophosphamide, actinomycin, bleomycin, daunorubicin, doxorubicin, epirubicin, mitomycin, methotrexate, fluorouracil, carboplatin, carmustine (BCNU), methyl-CCNU, cisplatin, etoposide, interferons, camptothecin and derivatives thereof, phenesterine, taxol and derivatives thereof, taxotere and derivatives thereof, vinblastine, vincristine, tamoxifen, etoposide, piposulfan, cyclophosphamide, and flutamide, and derivatives thereof.
Examples of immunosuppressive agents include cyclosporine, azathioprine, tacrolimus, and derivatives thereof.
Examples of antiviral agents include interferon gamma, zidovudine, amantadine hydrochloride, ribavirin, acyclovir, valacyclovir, dideoxycytidine, phosphonoformic acid, ganciclovir and derivatives thereof.
Examples of antioxidant agents include ascorbate, alpha-tocopherol, mannitol, reduced glutathione, various carotenoids, cysteine, uric acid, taurine, tyrosine, superoxide dismutase, lutein, zeaxanthin, cryptoxanthin, astaxanthin, lycopene, N-acetyl-cysteine, carnosine, gamma-glutamylcysteine, quercetin, lactoferrin, dihydrolipoic acid, citrate, Ginkgo Biloba extract, tea catechins, bilberry extract, vitamins E or esters of vitamin E, retinyl palmitate, and derivatives thereof.
Other therapeutic agents include squalamine, carbonic anhydrase inhibitors, alpha agonists, prostamides, prostaglandins, antiparasitics, antifungals, and derivatives thereof.
The amount of active agent or agents employed in the implant, individually or in combination, will vary widely depending on the effective dosage required and the desired rate of release from the implant. As indicated herein, the agent will be at least about 1, more usually at least about 10 weight percent of the implant, and usually not more than about 80, more usually not more than about 40 weight percent of the implant.
In addition to the therapeutic component, the intraocular implants disclosed herein may include effective amounts of buffering agents, preservatives and the like. Suitable water soluble buffering agents include, without limitation, alkali and alkaline earth carbonates, phosphates, bicarbonates, citrates, borates, acetates, succinates and the like, such as sodium phosphate, citrate, borate, acetate, bicarbonate, carbonate and the like. These agents advantageously present in amounts sufficient to maintain a pH of the system of between about 2 to about 9 and more preferably about 4 to about 8. As such the buffering agent may be as much as about 5% by weight of the total implant. Suitable water soluble preservatives include sodium bisulfite, sodium bisulfate, sodium thiosulfate, ascorbate, benzalkonium chloride, chlorobutanol, thimerosal, phenylmercuric acetate, phenylmercuric borate, phenylmercuric nitrate, parabens, methylparaben, polyvinyl alcohol, benzyl alcohol, phenylethanol and the like and mixtures thereof. These agents may be present in amounts of from 0.001 to about 5% by weight and preferably 0.01 to about 2% by weight.
In addition, the implants may include a solubility enhancing component provided in an amount effective to enhance the solubility of the TKI(s) relative to substantially identical implants without the solubility enhancing component. For example, an implant may include a β-cyclodextrin, which is effective in enhancing the solubility of the TKI. The β-cyclodextrin may be provided in an amount from about 0.5% (w/w) to about 25% (w/w) of the implant. In certain implants, the β-cyclodextrin is provided in an amount from about 5% (w/w) to about 15% (w/w) of the implant.
In some situations mixtures of implants may be utilized employing the same or different pharmacological agents. In this way, a cocktail of release profiles, giving a biphasic or triphasic release with a single administration is achieved, where the pattern of release may be greatly varied. The implants may also have a sigmoidal release profile.
Additionally, release modulators such as those described in U.S. Pat. No. 5,869,079 may be included in the implants. The amount of release modulator employed will be dependent on the desired release profile, the activity of the modulator, and on the release profile of the TKI in the absence of modulator. Electrolytes such as sodium chloride and potassium chloride may also be included in the implant. Where the buffering agent or enhancer is hydrophilic, it may also act as a release accelerator. Hydrophilic additives act to increase the release rates through faster dissolution of the material surrounding the drug particles, which increases the surface area of the drug exposed, thereby increasing the rate of drug bioerosion. Similarly, a hydrophobic buffering agent or enhancer dissolve more slowly, slowing the exposure of drug particles, and thereby slowing the rate of drug bioerosion.
Various techniques may be employed to produce the implants described herein. Useful techniques include, but are not necessarily limited to, solvent evaporation methods, phase separation methods, interfacial methods, molding methods, injection molding methods, extrusion methods, co-extrusion methods, carver press method, die cutting methods, heat compression, combinations thereof and the like.
Specific methods are discussed in U.S. Pat. No. 4,997,652. Extrusion methods may be used to avoid the need for solvents in manufacturing. When using extrusion methods, the polymer and drug are chosen so as to be stable at the temperatures required for manufacturing, usually at least about 85 degrees Celsius. Extrusion methods use temperatures of about 25 degrees C. to about 150 degrees C., more preferably about 65 degrees C. to about 130 degrees C. An implant may be produced by bringing the temperature to about 60 degrees C. to about 150 degrees C. for drug/polymer mixing, such as about 130 degrees C., for a time period of about 0 to 1 hour, 0 to 30 minutes, or 5-15 minutes. For example, a time period may be about 10 minutes, preferably about 0 to 5 min. The implants are then extruded at a temperature of about 60 degrees C. to about 130 degrees C., such as about 75 degrees C.
In addition, the implant may be coextruded so that a coating is formed over a core region during the manufacture of the implant.
Compression methods may be used to make the implants, and typically yield implants with faster release rates than extrusion methods. Compression methods may use pressures of about 50-150 psi, more preferably about 70-80 psi, even more preferably about 76 psi, and use temperatures of about 0 degrees C. to about 115 degrees C., more preferably about 25 degrees C.
The implants of the present invention may be inserted into the eye, for example the vitreous chamber of the eye, by a variety of methods, including placement by forceps or by trocar following making a 2-3 mm incision in the sclera. One example of a device that may be used to insert the implants into an eye is disclosed in U.S. Patent Publication No. 2004/0054374. The method of placement may influence the therapeutic component or drug release kinetics. For example, delivering the implant with a trocar may result in placement of the implant deeper within the vitreous than placement by forceps, which may result in the implant being closer to the edge of the vitreous. The location of the implant may influence the concentration gradients of therapeutic component or drug surrounding the element, and thus influence the release rates (e.g., an element placed closer to the edge of the vitreous may result in a slower release rate).
The present implants are configured to release an amount of the TKI(s) effective to treat or reduce a symptom of an ocular condition, such as a posterior ocular condition.
The implants disclosed herein may also be configured to release the TKI or additional therapeutic agents, as described above, which to prevent diseases or conditions, such as the following:
MACULOPATHIES/RETINAL DEGENERATION: Non-Exudative Age Related Macular Degeneration (ARMD), Exudative Age Related Macular Degeneration (ARMD), Choroidal Neovascularization, Diabetic Retinopathy, Acute Macular Neuroretinopathy, Central Serous Chorioretinopathy, Cystoid Macular Edema, Diabetic Macular Edema.
UVEITIS/RETINITIS/CHOROIDITIS: Acute Multifocal Placoid Pigment Epitheliopathy, Behcet's Disease, Birdshot Retinochoroidopathy, Infectious (Syphilis, Lyme, Tuberculosis, Toxoplasmosis), Intermediate Uveitis (Pars Planitis), Multifocal Choroiditis, Multiple Evanescent White Dot Syndrome (MEWDS), Ocular Sarcoidosis, Posterior Scleritis, Serpiginous Choroiditis, Subretinal Fibrosis and Uveitis Syndrome, Vogt-Koyanagi-Harada Syndrome.
VASCULAR DISEASES/EXUDATIVE DISEASES: Coat's Disease, Parafoveal Telangiectasis, Papillophlebitis, Frosted Branch Angitis, Sickle Cell Retinopathy and other Hemoglobinopathies, Angioid Streaks, Familial Exudative Vitreoretinopathy.
TRAUMATIC/SURGICAL: Sympathetic Ophthalmia, Uveitic Retinal Disease, Retinal Detachment, Trauma, Laser, PDT, Photocoagulation, Hypoperfusion During Surgery, Radiation Retinopathy, Bone. Marrow Transplant Retinopathy. PROLIFERATIVE DISORDERS: Proliferative Vitreal Retinopathy and Epiretinal Membranes, Proliferative Diabetic Retinopathy, Retinopathy of Prematurity (retrolental fibroblastic).
INFECTIOUS DISORDERS: Ocular Histoplasmosis, Ocular Toxocariasis, Presumed Ocular Histoplasmosis Syndrome (POHS), Endophthalmitis, Toxoplasmosis, Retinal Diseases Associated with HIV Infection, Choroidal Disease Associated with HIV Infection, Uveitic Disease Associated with HIV Infection, Viral Retinitis, Acute Retinal Necrosis, Progressive Outer Retinal Necrosis, Fungal Retinal Diseases, Ocular Syphilis, Ocular Tuberculosis, Diffuse Unilateral Subacute Neuroretinitis, Myiasis.
GENETIC DISORDERS: Systemic Disorders with Associated Retinal Dystrophies, Congenital Stationary Night Blindness, Cone Dystrophies, Fundus Flavimaculatus, Best's Disease, Pattern Dystrophy of the Retinal Pigmented Epithelium, X-Linked Retinoschisis, Sorsby's Fundus Dystrophy, Benign Concentric Maculopathy, Bietti's Crystalline Dystrophy, pseudoxanthoma elasticum, Osler Weber syndrome.
RETINAL TEARS/HOLES: Retinal Detachment, Macular Hole, Giant Retinal Tear.
TUMORS: Retinal Disease Associated with Tumors, Solid Tumors, Tumor Metastasis, Benign Tumors, for example, hemangiomas, neurofibromas, trachomas, and pyogenic granulomas, Congenital Hypertrophy of the RPE, Posterior Uveal Melanoma, Choroidal Hemangioma, Choroidal Osteoma, Choroidal Metastasis, Combined Hamartoma of the Retina and Retinal Pigmented Epithelium, Retinoblastoma, Vasoproliferative Tumors of the Ocular Fundus, Retinal Astrocytoma, Intraocular Lymphoid Tumors.
MISCELLANEOUS: Punctate Inner Choroidopathy, Acute Posterior Multifocal Placoid Pigment Epitheliopathy, Myopic Retinal Degeneration, Acute Retinal Pigment Epithelitis, Ocular inflammatory and immune disorders, ocular vascular malfunctions, Corneal Graft Rejection, Neovascular Glaucoma and the like.
In one embodiment, an implant, such as the implants disclosed herein, is administered to a posterior segment of an eye of a human or animal patient, and preferably, a living human or animal. In at least one embodiment, an implant is administered without accessing the subretinal space of the eye. For example, a method of treating a patient may include placing the implant directly into the posterior chamber of the eye. In other embodiments, a method of treating a patient may comprise administering an implant to the patient by at least one of intravitreal injection, subconjunctival injection, sub-tenon injections, retrobulbar injection, and suprachoroidal injection.
In at least one embodiment, a method of improving vision or maintaining vision in a patient comprises administering one or more implants containing one or more TKIs, as disclosed herein to a patient by at least one of intravitreal injection, subconjunctival injection, sub-tenon injection, retrobulbar injection, and suprachoroidal injection. A syringe apparatus including an appropriately sized needle, for example, a 22 gauge needle, a 27 gauge needle or a 30 gauge needle, can be effectively used to inject the composition with the posterior segment of an eye of a human or animal. Repeat injections are often not necessary due to the extended release of the TKI from the implants.
In another aspect of the invention, kits for treating an ocular condition of the eye are provided, comprising: a) a container comprising an extended release implant comprising a therapeutic component including a TKI, and a drug release sustaining component; and b) instructions for use. Instructions may include steps of how to handle the implants, how to insert the implants into an ocular region, and what to expect from using the implants.
EXAMPLE 1
Intravitreal Pharmacokinetics of TKIs in Fluid Compositions
The ocular pharmacokinetics of AGN 199659, AGN 200954, AGN 201088 and AGN 201666 following single intravitreal injections into female albino rabbit eyes was determined. The animals were dosed with a 50 μL intravitreal injection of 242 ng AGN 201088, 128 ng AGN 201666, 114 ng AGN 199659 or 222 ng of AGN 200954 per eye. Vitreous humor samples (n=4 eyes per timepoint) were collected at 0.5, 1, 2, 4, 8, and 12 hr postdose. The TKI concentration in the vitreous humor was determined using a liquid chromatography tandem mass spectrometry method (LC-MS/MS).
All compounds were eliminated fairly rapidly from the rabbit eye. This indicates a transretinal route of elimination. There was no bias to compound nucleus. However, even though elimination was extremely rapid it was determined that local sustained delivery was feasible. Based on the vitreal clearance determined in this study for 3-[(4-Morpholin-4-yl-phenylamino)-methylene]-1,3-dihydro-indol-2-one, 3-(6-Amino-3H-isobenzofuran-1-ylidene)-5-chloro-1,3-dihydro-indol-2-one, AGN 201088 and AGN 201666, and assuming steady state efficacious concentration at twice the EC50 values (determined by in vitro receptor binding and intracellular Ca2+ assay) all the tyrosine kinase inhibitors tested could be formulated into 1 mg implants that would maintain the desired steady state drug vitreal concentrations for a duration of about six months. This data is summarized in Table 1 and FIGS. 1 and 2.







TABLE 1







TKI Pharmacokinetic Parameters after


a Single Intravitreal Injection














AGN
AGN
AGN
AGN



Parameter
199659
200954
201088
201666
















Dose (ng)
114
222
242
128



C0 (ng/mL)
502
566
222
332



t1/2 (hr)
1.21
2.59
1.11
2.32



AUC0-tlast
488
778
272
466



(ng · hr/mL)







Cl (mL/hr)
0.232
0.260
0.885
0.270



Vss (mL)
0.255
0.705
1.23
0.577



Theoretical 6
200 ug
5 ug
150 ug
126 ug



mo dose









EXAMPLE 2
TKI Biodegradable Implants
Tyrosine kinase inhibitors were incorporated into PLGA or PLA implants by extrusion. The TKIs were milled with the polymers at certain ratios then extruded into filaments. These filaments were subsequently cut into implants weighing approximately 1 mg. Several TKIs were formulated in the PLGA and PLA implants based on their potencies and physicochemical properties as shown in Table 2.







TABLE 2







Tyrosine Kinase Inhibitors Formulated in PLGA Implants














Projected
Solubility




AGN

Css
(μg/mL)




Number
Structure
Efficacy
pH 7
log P
pKa















AGN 200954




 4 ng/mL
0.3
2.21
 4.24 10.03


 


AGN 202314




 96 ng/mL
202
3.80
 9.68


 


AGN 202560




105 ng/mL
41
3.66
 9.65


 


AGN 201634




 28 ng/mL
88
1.25
 4.06 10.25









TKI release from the implants was assessed in vitro. Implants were placed into vials containing release medium and shaken at 37° C. At the appropriate time points a sample was taken from the release medium for analysis and the medium totally replaced to maintain sink conditions. Drug in the sample was assayed by HPLC and the cumulative percent release of drug from the implant noted as a function of time. The in vitro release profiles of AGN 200954, AGN 202314, AGN 201635 and AGN 202564 are depicted in FIGS. 3 through 10, respectively.
From the formulation release data depicted in FIGS. 3 through 10 it is evident that TKIs over a wide range of physicochemical properties can be engineered to release drug in vitro over a period of weeks to a year.
EXAMPLE 3
In Vivo Pharmacokinetic Properties of TKI-Containing Implants
Implants containing AGN 202314 were placed intravitreally or subconjunctivally in an eye. The implants released AGN 202314 in-vitro over a 14 day period (FIG. 3.). The intent of this study was to achieve an intravitreal in-vivo/in-vitro correlation with the intravitreal implants and assess the feasibility of periocular delivery.
Intravitreal Implants, PLGA (400 μg AGN 202314 dose, 1 mg total implant weight), were implanted by surgical incision into the mid vitreous of albino rabbits. At days 8, 15, 31 and 61 rabbits were sacrificed and the vitreous humor, lens, aqueous humor and plasma assayed for AGN 202314.
Subconjunctival implants, PLGA (1200 μg AGN 202314 dose; three implants) and PLA microspheres (300 μg AGN 202314) were implanted subconjunctivally. At days 8, 15, 31 and 61 rabbits were sacrificed and the vitreous humor, lens, aqueous humor and plasma assayed for AGN 202314.
The data are summarized in Tables 3 through 5







TABLE 3







PK Results from 2 Month Intravitreal Implantation


AGN 202314 Implant (400 μg rod)









Day












8
15
31
61














Retina (ng/g)
1220
100
BLQ
BLQ


Vitreous
327
85
BLQ
BLQ


Humor (ng/g)






Lens (ng/g)
ALQ (6580)
ALQ (8980)
724
35.8


Aqueous Humor
2.10
6.50
BLQ
BLQ


(ng/mL)






Plasma (ng/mL)
0.255
BLQ
BLQ
BLQ





Below the limit of quantitation (BLQ): Retina and lens: <5 ng/g, VH: <30 ng/g, AH: <0.5 ng/mL, Plasma: <0.5 ng/mL


Above the limit of quantitation (ALQ): Retina and lens: >2000 ng/g, VH: >3000 ng/g, AH: >30 ng/mL, Plasma: >200 ng/mL













TABLE 4







PK Results from 2 Mo Subconjunctival Implantation


of AGN 202314 Microspheres










Day













8
15
31
61










Microsphere (300 μg AGN 202314) - 0.63 dL/g PLA













Retina (ng/g)
12.4
BLQ
19.2
BLQ



Vitreous
BLQ
BLQ
BLQ
BLQ



Humor (ng/g)







Lens (ng/g)
5.19
BLQ
BLQ
BLQ



Aqueous
BLQ
BLQ
BLQ
BLQ



Humor (ng/mL)







Plasma (ng/mL)
BLQ
BLQ
BLQ
BLQ







Microsphere (300 μg AGN 202314) - 1.2 dL/g PLA













Retina (ng/g)
3.7
5.1
BLQ
BLQ



Vitreous
BLQ
BLQ
BLQ
BLQ



Humor (ng/g)







Lens (ng/g)
BLQ
BLQ
2.72
BLQ



Aqueous
BLQ
BLQ
BLQ
BLQ



Humor (ng/mL)







Plasma (ng/mL)
BLQ
BLQ
BLQ
BLQ





BLQ = Retina (<5 ng/g), VH (<30 ng/g), lens (<5 ng/g), AH (<0.5 ng/mL), plasma (<0.5 ng/mL)













TABLE 5







Month Subconjunctival Implantation (3 rods


with a total of 1.2 mg AGN 202314)










Day













8
15
31
61
















Retina (ng/g)
63.8
BLQ
BLQ
BLQ



Vitreous
BLQ
BLQ
BLQ
BLQ



Humor (ng/g)







Lens (ng/g)
229
7.93
BLQ
BLQ



Aqueous Humor
6.38
BLQ
BLQ
BLQ



(ng/mL)







Plasma (ng/mL)
BLQ
BLQ
BLQ
BLQ





BLQ: Retina and lens: <5 ng/g, VH: <30 ng/g, AH: <0.5 ng/mL, Plasma: <0.5 ng/mL






The data from this study indicates that a good in vitro in vivo correlation was established for AGN 202314. The AGN 202314 implant released drug over a two week period both in vitro and in vivo. It is also important that plasma levels remain BLQ or extremely low for all time points. This shows that even in a worst case scenario of intravitreal delivery over two weeks systemic exposure is negligible. It was also noted that periocular delivery was unsuccessful at delivering AGN 202314 to the vitreous and retina.
A follow-on two-month ocular pharmacokinetic study of AGN 202314 following a single intravitreal implantation into albino rabbit eyes was initiated. The formulations delivered AGN 202314 over a period of four months in-vitro. The following 1 mg implants were evaluated: 30% AGN 202314/70% Purac PLA; Lot# JS493028 (FIG. 4), 50% AGN 201634/50% Purac PLA; Lot # JS493034 (FIG. 6.). Two rabbits (4 eyes and 2 plasma) were used per timepoint. Implants were administered by a bilateral surgical intravitreal placement by sclerotomy without vitrectomy. The vitreous humor and retina AGN 202314 concentrations were assayed at days 8, 15, 31 and 61. The data are displayed in Table 6.







TABLE 6







One Month Data from the AGN 202314 Intravitreal Study









Day











8
15
31










50% Purac PLA (AGN 202314 - 500 μg)












Retina (ng/g)
95.3 ± 18.7
87.7 ± 29.6
157 ± 120



VH (ng/g):
22.2 ± 25.6
BLQ
69.9 ± 87.5







70% Purac PLA (AGN 202314 - 300 μg)












Retina (ng/g)
78.1 ± 7.2 
 197 ± 88.7
189 ± 126



VH (ng/g)
BLQ
33.7 ± 25.8
BLQ





Analytical range: Retina BLQ < 5 ng/g; VH BLQ < 30 ng/g






The retinal levels achieved from this study approach therapeutic levels by the first week and are maintained over the first thirty days. This data shows that actual in vivo sustained delivery of a TKI locally is feasible.
A six month pharmacokinetic study was initiated with intravitreal and subconjunctival AGN 200954 implants. The implants released AGN 200954 in-vitro over a 180 day period (FIG. 3). Intravitreal Implants, PLGA (500 μg AGN 200954 dose, 1 mg total implant weight, Purac polymer) and PLGA (500 μg AGN 200954 dose, 1 mg total implant weight, RG503H polymer), were implanted by surgical incision into the mid vitreous of albino rabbits. At days 8, 15, 31 and 61 rabbits were sacrificed and the vitreous humor, lens, aqueous humor and plasma assayed for AGN 200954. Subconjunctival implants, PLGA implant (500 μg AGN 200954 dose, 1 mg total implant weight, Purac polymer) and PLGA microspheres (370 μg and 740 μg AGN 200954), were administered. At days 8, 15, 31 and 61 rabbits were sacrificed and the vitreous humor, lens, aqueous humor and plasma assayed for AGN 200954.
AGN 200954 Pharmacokinetics after Intravitreal Administration













Day













8
31
61
91
181











Intravitreal Implantation (500 μg rod) Formulation PU












Retina (ng/g)
BLQ
48.7
207
161
210


Vitreous
BLQ
18.2
109
657
76.3


Humor(ng/g)


Lens (ng/g)
70.2
243
586
768
1296


Aqueous Humor
BLQ
BLQ
BLQ
BLQ
288


(ng/mL)


Plasma (ng/mL)
BLQ
BLQ
BLQ
BLQ
BLQ







Intravitreal Implantation (500 μg rod) Formulation RG503H












Retina (ng/g)
15.7
17.7
416
58.4
24.9


Vitreous
560
126
189
65.2
227


Humor(ng/g)


Lens (ng/g)
160
386
464
239
248


Aqueous Humor
BLQ
BLQ
BLQ
BLQ
316


(ng/mL)


Plasma (ng/mL)
BLQ
BLQ
BLQ
BLQ
BLQ





BLQ = Retina (5 ng/g), VH (30 ng/g), lens (5 ng/g), AH (0.05 ng/mL), plasma (0.05 ng/mL)






It is evident from the data that a considerable in-vivo lag time exists for the first formulation not seen in vitro. Neither formulation exhibits measurable plasma concentrations.
EXAMPLE 4
In Vitro Release of a TKI (AGN 201634) from an Implant
TKI release was examined for implants made from poly(D,L-lactide-co-glycolide) (PDLG) or poly(D,L-lactide) (PDL) in different media with or without addition of detergent at 37° C. in a shaking water bath.
AGN 201634 was obtained from Allergan, and its chemical structure is shown below. It was used as received without further purification. PDLG/PDL polymer materials were obtained from Purac America Inc.




TKI release was examined in various medium, including saline, phosphate buffer saline of pH 7.4, 50 mM bicarbonate buffer of pH 6.0±0.1 with 0.1% cetyltrimethylammonium bromide (CTAB), and 50 mM borate buffer of pH 8.5±0.1 with 0.5% sodium dodecyl sulfate (SDS) in a shaking water bath (Precision) at 37° C. Sample was incubated in 10 mL of medium, and was totally replaced with fresh medium at each sampling time. Drug concentration was determined by HPLC using a Waters 2690 Separation Module equipped with a Waters XTerra RP8 column (3.9×150 mm, 5 μm, equilibrated at ambient) and a Waters 996 photodiode array detector (set at 238 nm) using 0.1% acetic acid in acetonitrile/water (40/60 by volume) as the mobile phase under a flow rate of 1.2 mL/min. The column was equilibrated with mobile phase for at least 30 min before initiating any sample injection.
The characteristics of formulations, including formulation identification, Lot number, drug loading, inherent viscosity of polymer, and extrusion temperature are summarized in the following table. The drug load is from 20 to 50%. The formulations were extruded from a 750 μm nozzle to form cylindrical DDS.







TABLE 8







Characteristics of TKI formulations.














Drug


Extrusion


Formulation

Loading


Temp


#
Lot #
(%)
Polymer
I.V.
(° C.)





F1
JS443159
40
PDLG
0.2
68


F2
JS443020
20
PDLG
0.2
70


F3
JS493023
50
PDL
0.5
85


F4
JS493034
30
PDL
0.5
78





Note:


I.V.: inherent viscosity of polymer material.






The stability of AGN 201634 standard solution in deionized water/acetonitrile (75%/25%) was examined at 4° C., and the results are summarized in the following table. The concentration of standard solution was from 0.0695 μg/mL to 8.693 μg/mL, and was analyzed on day 14, 21, and 35. The results show that the recovery was all greater than 95%, indicating a good stability of AGN 201634 in deionized water/acetonitrile (75%/25%) at 4° C. for up to 35 days even the concentration was up to 8.7 μg/mL.
Stability of AGN 201634 standard solution of various concentrations in DI water/acetonitrile (75%/25%) at 4° C. (Table 9).












Day
Conc. Of Standard (μg/mL)
Recovery (%)

















14
0.0695
95.2



0.348
98.3



0.695
98.4



2.173
98.6



8.693
98.6


21
0.0695
96.5



0.348
101.3



0.695
102.1



2.173
101.0









Stability of AGN 201634 standard solution of various concentrations in DI water/acetonitrile (75%/25%) at 4° C. (Table 9).












Day
Conc. Of Standard (μg/mL)
Recovery (%)


















8.693
101.6


35
0.0695
106.1



0.348
98.3



0.695
101.3



2.173
100.8



8.693
100.3









To examine the stability of TKI in formulation, Formulations 3 and 4 were prepared to various concentration in a medium of pH 6.0, 7.4 or 8.5, respectively, and subjected to an incubation condition of either 7 days under ambient condition or 14 days at 4° C., and the results are summarized in the following table. The results show that the recovery was all better than 98%, indicating that AGN 201634 was stable in media of pH 6.0, 7.4 and 8.5, and lasted for 7 days in ambient or 14 days at 4° C.







TABLE 10







Stability of TKI in Formulations 3 and 4 in


media under various incubation conditions.














Concen-
Incubation
Incubation



Formu-

tration
Time
Temperature
Recovery


lation
Medium
(μg/mL)
(day)
(o C.)
(%)















F3
pH 6.0
5.60
7
ambient
100.1




3.45
14
4
102.7



pH 7.4
2.53
7
ambient
101.1




2.29
14
4
103.7



pH 8.5
10.34
7
ambient
100.8




10.24
14
4
98.8


F4
pH 6.0
0.94
7
ambient
100.4




0.84
14
4
102.4



pH 7.4
0.18
7
ambient
104.3




0.48
14
4
101.3



pH 8.5
1.39
7
ambient
100.4




1.20
14
4
100.2









TKI releases of Formulation 1 in 20 mL of saline or 20-30 mL of PBS are demonstrated in FIG. 11. The DDS was incubated in a vial of either 40 or 20 mL, and 10 mL sample solution was replaced by same volume of fresh medium, respectively, at each sampling time. The release profiles in saline and PBS were obviously different. Less than 5% of TKI was released in saline during the first 70 days. In contrast, less than 5% of AGN 201634 was released at the first 3 weeks when DDS was incubated in PBS, the same as in saline, but more than 80% of AGN 201634 was released after 70 days. However, no significantly difference in release profile was found when DDS was incubated in 20 or 30 mL of PBS in a 20 or 40 mL vial. It seems that release medium plans an important role in the variation of release profile instead of incubation volume. Due to this slow and diverged release profile, the release profile of Formulation 2 was not performed since its formulation was based on the same polymer with a lower drug loading.
TKI releases of Formulations 3 and 4 in 10 mL media of a pH of 6.0 (with 0.1% CTAB), 7.4 (PBS) or 8.5 (with 0.5% SDS) at 37° C. are demonstrated in FIGS. 12 and 13, respectively. For F3, more than 50%, 45%, and 75% TKI was released at the first 3, 7, and 2 weeks, when DDS was incubated in a medium of pH 6.0 (with 0.1% CTAB), 7.4 (PBS) and 8.5 (with 0.5% SDS), respectively. On the other hand, approximately 47%, 6%, and 68% of TKI was released from F4 when DDS was incubated in media as described above. It seems that TKI release in different pH medium is pH 8.5>pH 6.0>pH 7.4, with or without the assistant from detergent in the medium. No large standard deviations are found in all media for both formulations.
To monitor the appearance of DDS during dissolution, the images of F3 and F4 formulations incubated in 10 mL media of a pH of 6.0 (with 0.1% CTAB), 7.4 (PBS) or 8.5 (with 0.5% SDS) at 37° C. were. All formulations experienced swelling followed by matrix degradation, resulting in drug release. No complete disintegration of formulation matrix was observed within 153 days at 37° C.
In summary, tyrosine kinase inhibitor (AGN 201634) DDS were formulated using various PLGA or PLA at various drug loading. The stability of AGN 201634 solution in DI water/acetonitrile (75%/25%) at 4° C. was more than 35 days, and DDS solution in various pH medium was more than 7 days under ambient condition or 14 days at 4° C. Different drug release profiles were found when DDS was tested in PBS or saline. Drug burst effect was found only in Formulation 3 when incubating in a medium of pH 6.0. Controlled AGN 201634 release in vitro was more than 4 weeks in a medium of pH 8.5, and more than 5 months in media of pH 7.4 and pH 6.0.
EXAMPLE 5
Biodegradable Implants with a Linear Release Profile
Biodegradable implants are made by combining a TKI with a biodegradable polymer composition in a stainless steel mortar. The biodegradable polymer composition comprises a single type of biodegradable polymer. The combination is mixed via a Turbula shaker set at 96 RPM for 15 minutes. The powder blend is scraped off the wall of the mortar and then remixed for an additional 15 minutes. The mixed powder blend is heated to a semi-molten state at specified temperature for a total of 30 minutes, forming a polymer/drug melt.
Rods are manufactured by pelletizing the polymer/drug melt using a 9 gauge polytetrafluoroethylene (PTFE) tubing, loading the pellet into the barrel and extruding the material at the specified core extrusion temperature into filaments. The filaments are then cut into about 1 mg size implants or drug delivery systems. The rods have dimensions of about 2 mm long×0.72 mm diameter. The rod implants weigh between about 900 μg and 1100 μg.
Wafers are formed by flattening the polymer melt with a Carver press at a specified temperature and cutting the flattened material into wafers, each weighing about 1 mg. The wafers have a diameter of about 2.5 mm and a thickness of about 0.13 mm. The wafer implants weigh between about 900 μg and 1100 μg.
In-vitro release testing can be performed on each lot of implant (rod or wafer). Each implant may be placed into a 24 mL screw cap vial with 10 mL of Phosphate Buffered Saline solution at 37° C. and 1 mL aliquots are removed and replaced with equal volume of fresh medium on day 1, 4, 7, 14, 28, and every two weeks thereafter.
Drug assays may be performed by HPLC, which consists of a Waters 2690 Separation Module (or 2696), and a Waters 2996 Photodiode Array Detector. An Ultrasphere, C-18 (2), 5 μm; 4.6×150 mm column heated at 30° C. can be used for separation and the detector can be set at 264 nm. The mobile phase can be (10:90) MeOH—buffered mobile phase with a flow rate of 1 mL/min and a total run time of 12 min per sample. The buffered mobile phase may comprise (68:0.75:0.25:31) 13 mM 1-Heptane Sulfonic Acid, sodium salt—glacial acetic acid—triethylamine—Methanol. The release rates can be determined by calculating the amount of drug being released in a given volume of medium over time in μg/day.
The single polymer chosen for the implant was poly(caprolactone). Rod and wafer implants were formulated at a ratio of 50:50 (poly(caprolactone):TKI). Thus, a 1 mg implant comprises about 500 μg poly(caprolactone) and 500 μg TKI. AGN 200954 was used as the TKI.
As shown in FIG. 15, implants formed from a poorly soluble drug (TKI) and a single type of a biodegradable polymer (poly(caprolactone)) released TKI at nearly zero-order rate for at least about 70 days. The particular poly(caprolactone) had a molecular weight of about 15 kilodaltons. The nearly linear release rate is extremely hard to achieve with other biodegradable implants based on a single polymeric component, as shown for the dexamethasone containing implants in FIG. 15.
EXAMPLE 6
Manufacture and Testing of Implants Containing an TKI and a Biodegradable Polymer Matrix
Additional biodegradable implants are made by combining a TKI with a biodegradable polymer composition as described in Example 5. The polymers chosen for the implants can be obtained from Boehringer Ingelheim or Purac America, for example. Examples of polymers include: RG502, RG752, R202H, R203 and R206, and Purac PDLG (50/50). RG502 is (50:50) poly(D,L-lactide-co-glycolide), RG752 is (75:25) poly(D,L-lactide-co-glycolide), R202H is 100% poly(D, L-lactide) with acid end group or terminal acid groups, R203 and R206 are both 100% poly(D, L-lactide). Purac PDLG (50/50) is (50:50) poly(D,L-lactide-co-glycolide). The inherent viscosity of RG502, RG752, R202H, R203, R206, and Purac PDLG are 0.2, 0.2, 0.2, 0.3, 1.0, and 0.2 dL/g, respectively. The average molecular weight of RG502, RG752, R202H, R203, R206, and Purac PDLG are, 11700, 11200, 6500, 14000, 63300, and 9700 daltons, respectively.
EXAMPLE 7
In Vitro Evaluation of Various TKI Implants
Summary
TKIs can inhibit the intrinsic tyrosine kinase activity necessary for activation of vascular endothelial growth factor receptors (VEGFR). VEGF and VEGF signaling pathways can induce angiogenesis and increase vascular permeability, activities required for neovascularization. Thus, TKIs can have utility to prevent or to treat choroidal neovascularization (CNV), such as CNV that can result from or be a symptom of, for example, age-related macular degeneration (AMD) and diabetic retinopathy (DRO).
In this experiment implants containing one of five different TKIs (receptor-mediated tyrosine kinase inhibitors) with antiangiogenic activity were made and evaluated. The implants were formulated as TKI, sustained release, biodegradable polymer implants with different poly(D,L-lactide-co-glycolide) and poly(D-L-lactide)polymers, made by a melt extrusion process. These implants are suitable for intraocular (such as intravitreal) use to treat one or more ocular disorders. Specifically, we made and evaluated controlled release intravitreal implants for the TKIs AGN206639, AGN205558, AGN206320, AGN206784, and AGN206316, showing that such implants can consistently release a TKI over a period of from about three to about six months. The implant formulations were evaluated in vitro in two different release media (phosphate buffered saline and citrate phosphate buffer with 0.1% cetyltrimethylammonium bromide). The effects of the elevated temperature storage and of gamma sterilization on potency were also examined.
Although the implants were made by melt extrusion with poly(lactide) or poly(lactide-co-glycolide)polymers various implant formulations were made with or under different drug (TKI) load, lactide-glycolide ratio, intrinsic viscosity, and extrusion temperature. The polymer implant drug delivery systems (DDSs) made were assayed by HPLC for potency initially, post-sterilization, and after exposure to accelerated conditions. The TKI release from the DDS was assayed by HPLC after incubation in two different release media at 37° C.: (1) phosphate buffered saline (pH 7.4), and; (2) citrate phosphate buffer with 0.1% cetyltrimethylammonium bromide (pH 5.4). Generally, release rates were higher for similar polymer systems with higher drug (TKI) loading.
Table 11 sets forth the five different TKIs formulated into drug delivery systems (i.e. implants).







TABLE 11





Chemical properties of the TKIs AGN206639, AGN205558,


AGN206320, AGN206784, and AGN206316.

















AGN
AGN206639
AGN205558


Number




 


Chemical Structure










 


Tm
Not detectable/ Amorphous
114.9, 133.2


(deg. C)




Solubility
N/A
N/A


(μg/ml)




in water,




2 hours




Solubility
N/A
N/A


(μg/ml)




in pH




7.4 buffer,




2 hours




Solubility
 3.09
 3.8


(μg/ml)




in water,




3 hours




Solubility
17.91
31.6


(μg/ml)




in pH




7.4 buffer,




3 hours




Solubility
N/A
N/A


(μg/ml)




in water,




24 hours




Solubility
N/A
N/A


(μg/ml)




in pH




7.4 buffer,




24 hours




Solubility
15.87
35.9


(μg/ml)




in water,




72 hours




Solubility
29.19
96.2


(μg/ml)




in pH




7.4 buffer,




72 hours




Release
Supelco, HS F5 5 um column;
Supelco, HS F5 5 um column;


method
75:24.5:0.5 ACN:Water:
75:24.5:0.5 ACN:Water:



Acetic acid w/5 Mm HAS;
Acetic acid w/5 Mm HAS;



1 ml/min. for 10 min.
1 ml/min. for 10 min.














AGN
AGN206320
AGN206784



Number




 



Chemical Structure










 



Tm
324.2
286.1



(deg. C)





Solubility
 0.2
N/A



(μg/ml)





in water,





2 hours





Solubility
 3.7
N/A



(μg/ml)





in pH





7.4 buffer,





2 hours





Solubility
N/A
10.71



(μg/ml)





in water,





3 hours





Solubility
N/A
 3.98



(μg/ml)





in pH





7.4 buffer,





3 hours





Solubility
 0.5
N/A



(μg/ml)





in water,





24 hours





Solubility
 5 
N/A



(μg/ml)





in pH





7.4 buffer,





24 hours





Solubility
N/A
11.86



(μg/ml)





in water,





72 hours





Solubility
N/A
 6.37



(μg/ml)





in pH





7.4 buffer,





72 hours





Release
Supelco, HS F5 5 um column;
Supelco, HS F5 5 um column;



method
75:24.5:0.5 ACN:Water:
60:40:1 ACN:Water:TFA:




Acetic acid w/5 Mm HAS;
1 ml/min. for 10 min.




1 ml/min. for 10 min.













AGN
AGN206316



Number



 



Chemical Structure






 



Tm
198.2, 261.6



(deg. C)




Solubility
 2.1



(μg/ml)




in water,




2 hours




Solubility
14.1



(μg/ml)




in pH




7.4 buffer,




2 hours




Solubility
N/A



(μg/ml)




in water,




3 hours




Solubility
N/A



(μg/ml)




in pH




7.4 buffer,




3 hours




Solubility
 6.6



(μg/ml)




in water,




24 hours




Solubility
20 



(μg/ml)




in pH




7.4 buffer,




24 hours




Solubility
N/A



(μg/ml)




in water,




72 hours




Solubility
N/A



(μg/ml)




in pH




7.4 buffer,




72 hours




Release
Supelco, HS F5 5 um column;



method
75:24.5:0.5 ACN:Water:




Acetic acid w/5 Mm HAS;




1 ml/min. for 10 min.









The polymers used to formulate the TKI-drug delivery systems were:
Purasorb PDL, Poly(D,L-lactide), Purac Corp. lot #DG676GA (inherent viscosity [iv] is up to 6 dl/g, molecular weight [mw in Daltons] is up to 700K).
Resomer RG502, 50:50 Poly(D,L-lactide-co-glycolide), Boehringer Ingelheim Corp. Lot #R02M002(iv is 0.16 to 0.24 dl/g).
Resomer RG502S, 50:50 Poly(D, L-lactide-co-glycolide), Boehringer Ingelheim Corp. Lot #Res-0354 (iv is 0.16 to 0.24 dl/g).
Resomer RG504, 50:50 Poly(D,L-lactide-co-glycolide), Boehringer Ingelheim Corp. Lot #1009731 (iv is 0.45 to 0.60 dl/g).
Resomer RG505, 50:50 Poly(D,L-lactide-co-glycolide), Boehringer Ingelheim Corp. Lot #223799 (iv is 0.61 to 0.74 dl/g).
Resomer RG506, 50:50 Poly(D,L-lactide-co-glycolide), Boehringer Ingelheim Corp. Lot #34034 (iv is 0.75 to 0.95 dl/g).
Resomer RG752, 75:25 Poly(D,L-lactide-co-glycolide), Boehringer Ingelheim Corp. Lot #R02A005 (iv is 0.16 to 0.24 dl/g).
Resomer RG755, 75:25 Poly(D,L-lactide-co-glycolide), Boehringer Ingelheim Corp. Lot #1009232 (iv is 0.50 to 0.70 dl/g).
Resomer R104, Poly(D,L-lactide), Boehringer Ingelheim Corp. Lot #290588 (mw is determined by the presence in the polymer of between about 1,500 and about 2,250 of the repeating monomer unit C3H402).
Resomer R207, Poly(D,L-lactide), Boehringer Ingelheim Corp. Lot #260911 (iv is 1.3 to 1.7 dl/g).
Citrate phosphate buffer (CTAB) solution used was prepared by adding 27.56 g sodium dibasic phosphate heptahydrate, 9.32 g citric acid, and 2 g (1%) cetyltrimethylammonium bromide (CTAB, JT Baker) to a 2-L volumetric flask and filling with deionized water.
Phosphate buffered saline (PBS) solution used was prepared by adding two packets of PBS (Sigma catalog #P-3813) granules to a 2-L volumetric flask and adding deionized water.
Release Profile Standards
For stock standard preparation for compounds other than AGN206784, 5 mg was added into a 50-mL volumetric flask and acetonitrile was added to the mark. Working standards were prepared by adding 5 mL of stock standard to a 50-mL volumetric flask and adding a blend of 60:40 acetonitrile:water. For AGN206784 stock standard preparation, 5 mg of compound was added into a 50-mL volumetric flask and a solution of 80% acetonitrile and 20% water was added until full. For working standard preparation, 5 mL of stock standard was added to a 50-mL volumetric flask and a solution of 40:60 acetonitrile:water was added until full.
Release Profile Mobile Phase
Acetonitrile (ACN) was manufactured by Burdick and Jackson. Trifluoroacetic acid (TFA) was manufactured by Burdick and Jackson. A blend of 75:24.5:0.5 ACN:water:acetic acid with 5 mM hexanesulfonic acid was used for all analyses except for AGN206748 formulations where a blend of 60:40:1 ACN:Water:TFA was used as the mobile phase.
Equipment:
Powder blending: a Glenn Mills Inc. Turbula shaker type T2F, ID number 990720 was used. In addition, an F. Kurt Retsch GmbH& Co model MM200 ball mill was used.
Powder compaction: A modified Janesville Tool and Manufacturing Inc. pneumatic drive powder compactor, model A-1024 was used.
Piston Extrusion: A custom built piston extruder produced by APS Engineering Inc. was used with a Watlow 93 temperature controller and thermocouple.
Weighing: A Mettler Toledo MT6 balance, S/N 1118481643 was used. Sample incubation: A Precision Inc. Reciprocal Shaking Bath with water was used.
HPLC: A Waters LC module 1 plus, S/N M98LCJ242M with a Supelco HSF5 μm, 4.6×150 mm column and Waters 2487 dual wavelength absorbance detector was used. Data was analyzed using Peak Pro software, version 9.1b.
Powder Blending
The drug (TKI) was stored at room temperature With minimal light exposure, and polymers were stored at 5° C. and allowed to equilibrate to room temperature prior to use. Both materials were used as received. Formulations, listed in Table 12, were blended in a stainless steel mixing capsule with two stainless steel balls and placed in a Retsch mill at 30 cps or Turbula blender at 96 rpm for 5 to 15 minutes. Depending on the starting materials, formulations underwent four to six blending cycles at five to fifteen minutes each. Between blending cycles, a stainless steel spatula was used to dislodge material from the inside surfaces of the mixing vessel. Formulation ratios and extrusion temperatures for all formulations are listed in Table 2.
Powder Compaction
A die with a 720 μm opening was attached to a stainless steel barrel. The powder compactor was set to 50 psi. The barrel was inserted into the powder compactor assembly. A stainless steel powder funnel was used to add a small amount of powder into the barrel and then the pneumatic compactor was actuated. This process was repeated until the barrel was full or no more powder remained.
Extrusion
A piston extruder was set to temperature and allowed to equilibrate. The extrusion temperature was chosen based on drug load and polymer. The extrusion temperature was adjusted for each formulation to produce smooth, uniform looking filaments. After the extruder temperature equilibrated, the piston extrusion barrel was inserted into the extruder, and a thermocouple was inserted to measure the temperature at the surface of the barrel. After the barrel temperature equilibrated, the piston was inserted into the barrel and the piston speed was set at 0.0025 in/min. The first 2-4 inches of extrudate was discarded.
Afterwards, 3-5-inch pieces were cut directly into a centrifuge tube. Samples were labeled and stored in a sealed foil pouch containing desiccant.
Formulations with higher drug load required higher extrusion temperatures.
Polymers with higher intrinsic viscosities required higher extrusion temperatures than polymers with lower intrinsic viscosities. Lactide-glycolide co-polymers with a higher lactide percentage (75:25) required a lower processing temperature than polymers with a lower lactide percentage (50:50). Formulation information and extrusion temperatures are listed in Table 12.
Content Uniformity Analysis
Ten samples of 1 mg (+/−10%) were cut from each formulation. Each was weighted and placed individually into 50-mL volumetric flasks. For AGN206784, a 40:60 ACN:Water or 100% acetonitrile was added and samples were sonicated. Samples were analyzed according to the HPLC method used for release profile analysis, below. For the other TKIs, a 60:40 ACN:Water was added to each 50-mL volumetric flask. Flasks were sonicated and samples were tested according to the same HPLC method that is used for in-vivo release (below).
Gamma Sterilization
Samples were weighed and packaged in vials, and each vial was sealed in a foil pouch with desiccant and labeled. All samples were sterilized with 25-40 kGy of gamma radiation.
Stability Testing:
Filaments were cut into 1 mg (+/−10%) samples and packaged together in screw-top vials. Formulations were then placed in an oven at 40° C. and ambient humidity. After 14 days, samples were tested for percent TKI content.
In Vitro Release Profile Analysis
Twelve samples of 1 mg (+/−10%) were cut from each formulation. Each sample was then weighed and placed individually into 60-mL sample vials. Fifty milliliters of citrate phosphate buffer solution was added to six vials and fifty milliliters of phosphate buffered saline release media was added to six vials. All vials were placed into a shaking water bath set at 37° C. and 50 RPM. At each time point 2 mL was taken from each vial for analysis, the remaining solution was disposed of, and 50 mL of new release media was added to the vial.







TABLE 12







Formulation conditions for TKIs AGN206639, AGN205558,


AGN206320, AGN206784, and AGN206316 Implants.













API

Extrusion



Formulation
Loading

Temp


API
#
(%)
Polymer (s)
(Deg. C.)














AGN206639
7409-007
50
Purac PDL*
80



7409-023
60
Purac PDL
75



7409-024
50
Resomer RG752±
81



7409-025
50
Resomer RG755†
92



7409-026
60
Resomer RG755
94



7409-040
40
Resomer RG755
94



7409-041
30
Resomer RG755
94



7409-042
40
Resomer RG752
84



7409-045
40
Resomer RG502**
96



7409-046
40
Resomer RG505••
103


AGN205558
7409-009
50
Resomer RG755
96



7409-010
60
Resomer RG755
98



7409-012
50
Resomer R104††
67


AGN 206320
7409-014
50
Resomer RG755
110



7409-015
60
Resomer RG755
115



7409-017
50
Res. RG755,
94





Res. R104, 3:2




7409-021
50
Resomer RG506∘
117



7409-022
50
Resomer R104
71



7409-035
50
Resomer R207‡
139



7409-043
40
Resomer RG752
83



7409-044
40
Resomer RG502
94


AGN206784
7409-027
50
Resomer RG755
107



7409-028
60
Resomer RG755
118



7409-029
50
Purac PDL
109



7409-030
50
Resomer R104
80



7409-031
50
Resomer RG506
129



7409-032
60
Res. RG755,
100





Res. R104, 1:1




7409-033
50
Resomer R207‡
139



7409-034
60
RG502S
96


AGN206316
7409-070
60
Resomer RG755
114



7409-071
40
Resomer RG755
95



7409-072
60
Resomer RG752
91



7409-073
40
Resomer RG752
91



7409-074
60
Resomer RG502
102



7409-075
40
Resomer RG502
93



7409-076
60
Resomer RG504•
121





*Purac PDL = Purac 50:50 Poly(D,L-lactide-co-glycolide)


**Resomer RG502, RG502S = Boehringer Ingelheim 50:50 Poly(D,L-lactide-co-glycolide), IV = 0.16-0.24(dl/g)


•Resomer RG504 = Boehringer Ingelheim 50:50 Poly(D,L-lactide-co-glycolide), IV = 0.45-0.60(dl/g)


••Resomer RG505 = Boehringer Ingelheim 50:50 Poly(D,L-lactide-co-glycolide), IV = 0.7(dl/g)


∘Resomer RG506 = Boehringer Ingelheim 50:50 Poly(D,L-lactide-co-glycolide), IV = 0.8(dl/g)


±Resomer RG752 = Boehringer Ingelheim 75:25 Poly(D,L-lactide-co-glycplide), IV = 0.2(dl/g)


†Resomer RG755 = Boehringer Ingelheim 50:50 Poly(D,L-lactide-co-glycolide), IV = 0.6(dl/g)


††Resomer R104 = Poly(L-lactide), MW = 2000


‡Resomer R207 = Poly(L-lactide), IV = 1.6






In Table 12 the API (active pharmaceutical ingredient [i.e. the TKI] value is a weight percent value.
HPLC Assay
The HPLC was conditioned until stable at 1 mL per minute flow rate at 280 nm. Samples were transferred to auto sampler vials with added samples for system suitability and standardization. Total run time was 10 minutes, temperature was ambient and injection volume was 20 μL. Samples were taken on day 1, 4, 7, and at 7 day intervals after that until the studies were ended or 100% release was achieved. The total TKI present was calculated from the height of the peak at 280 nm compared to the height of the standard peak. Percent of drug released, total micrograms released, and standard deviations within formulations were calculated from the amount of drug detected.
Results
The content uniformity analysis carried showed that most formulations tested at 100% label strength plus or minus 20%.
FIGS. 16 to 21 are graphs which provide examples of in vitro release data (in either pH 5.4 citrate phosphate buffer release medium or in pH 7.4 phosphate buffer saline release medium) for the five TKI used in implants with varying polymer formulations. FIGS. 16 to 21 show that TKIs with higher solubilities had the tendency to release at a faster rate than TKIs with lower solubilities. Additionally, FIGS. 16 to 21 show that TKI implant formulations with lower drug (TKI) loading released at a slower rate than those with a higher drug loading. Thus, a number of different sustained release biodegradable polymeric formulations (implants) were made for five different tyrosine kinase inhibitor compounds. The results show that the release of TKIs from PLGA polymer implants can be modified by changing polymer matrices and extrusion conditions. Notably, sustained release was achieved for all five TKI compounds in phosphate buffered saline release medium (pH 7.4) and CTAB media and the results show that TKI release from the polymer matrix can last from about one to over six months, depending on the formulation. Significantly, linear, consistent drug release profiles were obtained achieved from for each of the five TKIs in phosphate buffered saline (see formulations 7409-024, 7409-009, 7409-022, 7409-032, and 7409-071).
EXAMPLE 8
In Vivo Evaluation of a TKI Implant
An experiment was carried out to evaluate effects of an intravitreal TKI implant upon mammalian vision. Thus, either a PLGA placebo implant or a TKI PLGA implant was inserted into the vitreous of rabbit eyes. It was determined that an intravitreal TKI PLGA implant can be used to effectively improve and maintain vision by effectively treating conditions such as, or common to, for example, retinal vasodilation, retinal vessel tortuosity (blood flow increase), blood-retinal barrier breakdown, retinal edema and macula edema.
We used as a model system for determination of vision improvement, rabbits with VEGF induced retinal damage. It is known that intravitreal injection of recombinant human VEGF165 in rabbits can cause robust vasodilation and vessel tortuosity (blood flow increase), blood-retinal barrier breakdown, and retinal edema. See e.g. Edelman, J. L. et al., Corticosteroids inhibit VEGF-induced vascular leakage in a rabbit model of blood-retinal and blood-aqueous barrier breakdown, Experimental Eye Research, 80:249-258 (2005). These VEGF induced ocular effects are believed to be mediated by activation of VEGF receptor-1 and VEGF receptor-2.
In this experiment we found that such VEGF induced retinal injuries can be treated (that is inhibited, alleviated, reversed and/or prevented) by use of a TKI intravitreal implant. Presumably, the tyrosine kinase inhibitor released (in therapeutic levels from the intravitreal implant) inhibits receptor phosphorylation at the target tissue, thereby blocking the VEGF-mediated responses. Thus, we determined that a 2 mg AGN-206639 (TKI) PLGA can for at least about one month after vitreal implantation provide significant inhibition of the







TABLE 1







Implant composition, size, and in vitro release rates









Implant
Active
Placebo





Active Ingredient (API)
AGN206639
None (Placebo)


Wt % Drug loading
30
0


Polymer
Resomer RG755
Resomer RG755


Wt % Polymer
70
100


Weight
2.0 mg (+/−10%)
1.0 mg (+/−10%)


Size (L × W)
4 mm × 1 mm
1 mm × 1 mm


Color
Gold
Transparent


% Potency
91.94
0


Sterilization method
25-40 kGy
25-40 kGy


Total % TKI Release Day 1
0.9
N/A


Total % TKI Release Day 7
4.5
N/A


Total TKI Release Day 14
8.5
N/A


Total TKI Release Day 21
15.1
N/A


Total TKI Release Day 28
24.0
N/A









The implants were intravitreally inserted as follows. At T0 (day zero) the rabbits (N=7) were anesthetized with ketamine/xylazine (subcutaneous), and the ocular surface was anesthetized with 2 drops of 1% proparacaine, irrigated with ophthalmic grade Betadine, and the conjunctiva was incised and retracted from the underlying sclera in the superotemporal quadrant of the eye. A 20G MVR knife was used to perforate the sclera at the pars plana (about 3 mm posterior to the limbus) adjacent to the temporal insertion of the superior rectus muscle. One implant (placebo or active) was inserted through the sclerotomy into the vitreous with sterile forceps. The scleral and conjunctival incisions were closed with 8-0 coated Vicryl suture. The implanted eyes was then instilled with topical ketarolac (Acular) and gentamicin t.i.d. immediately following surgery and continuing for at least 3 days.
At days 12 and 26, the implanted rabbits (N=7) were anesthetized with intravenous ketamine/xylazine and 1% proparacaine and Betadine were topically applied to the ocular surface. Immediately thereafter (on days 12 and 26) 500 ng VEGF165 was injected intravitreally in 100 uL of sterile PBS via a 28G needle inserted about 3 mm posterior to the limbus into each eye of each rabbit which had received an implant (placebo or active).
The implanted eyes were evaluated at several time points after implantation by: (1) fundus evaluation and angiography, and; (2) fluorophotometric measurement.
Fundus evaluation and angiography was carried out at 14 days and at 28 days post-implant insertion. Thus, using a Zeiss retinal camera, late phase angiograms were acquired 5 to 10 min. after intravenous injection of sodium fluorescein (10 mg/kg) via the margin ear vein. All images were masked and then graded by three examiners for severity of retinal fluorescein leakage (normal=1; severe=5). Statistical significance was determined using the Kruskal-Wallis non-parametric ANOVA test, the Dunn's multiple comparisons test, and the Mann-Whitney test (two-tailed). It was determined, for example, that at 14 days post implantation a placebo implant eye scored as high as a 4.6 grade, while a TKI implant eye scored as low as 1.0. Additionally, it was determined, for example, that at 28 days post implantation multiple placebo eyes scored as high as a 5.0 grade, while multiple TKI implant eyes scored as low as about 1.0. These results clearly demonstrate that compared to placebo, the 2 mg TKI (AGN206639) implant significantly inhibited VEGF-induced angiographic fluorescein leakage at both 14 days and 28 days after surgical insertion of the TKI implant in rabbit eyes.
Fluorophotometric measurement was also carried out at 14 days and at 28 days post-implant insertion. Thus, fifty minutes after intravenous injection of sodium fluorescein, blood-retinal barrier integrity was assessed using scanning ocular fluorophotometry. The area under the curve (AUC) for vitreoretinal fluorescence was calculated using Kaleidagraph software. Statistical significance was determined using the single factor parametric ANOVA test and the two-tailed unpaired t-test. As shown by FIG. 22, compared to placebo, the 2 mg AGN-206639 implant significantly inhibited VEGF-induced blood-retinal barrier breakdown, as measured by scanning ocular fluorophotometry at 14 days and at 28 days after surgical insertion of the implant in rabbits.
This experiment demonstrated that for at least about one month after vitreal implantation, a TKI PLGA intravitreal implant can be used to provide significant vision improvement, as determined by, for example, inhibition of experimental blood-retinal barrier breakdown in rabbits. These results therefore show that an intravitreal TKI implant can be used to treat a variety of ocular conditions, including ocular vasculopathies including diabetic macular edema, proliferative diabetic retinopathy, and choroidal neovascularization associated with age-related macular degeneration.
All references, articles, publications and patents and patent applications cited herein are incorporated by reference in their entireties.
While this invention has been described with respect to various specific examples and embodiments, it is to be understood that the invention is not limited thereto and that it can be variously practiced within the scope of the following claims.

## Claims

1. A biodegradable intravitreal implant comprising a tyrosine kinase inhibitor (TKI) and a biodegradable polymer matrix, the implant releasing the TKI at a rate effective to sustain release of the TKI from the implant for at least about one week after the implant is placed in the vitreous of an eye, wherein the tyrosine kinase inhibitor is provided in an amount from about 30% by weight to about 70% by weight of the implant, and the biodegradable polymer matrix comprises a poly(lactide-co-glycolide) in an amount from about 30% by weight to about 70% by weight of the implant.

2. The implant of claim 1, wherein the matrix releases the TKI at a rate effective to sustain release of an amount of the TKI from the implant for more than one month from the time the implant is placed in the vitreous of the eye.

3. The implant of claim 1, wherein the implant is made by an extrusion process.

4. An implant according to claim 1, wherein the poly(lactide-co-glycolide) is a 75:25 poly(D,L-lactide-co-glycolide) having an inherent viscosity of 0.50 to 0.70 dl/g.

5. An implant according to claim 4, wherein the implant comprises 30% by weight of the TKI and 70% by weight of the poly(D,L-lactide-co-glycolide).

6. A biodegradable intravitreal implant comprising a tyrosine kinase inhibitor (TKI) and a poly(D,L-lactide), wherein the poly(D,L-lactide) has a molecular weight of between about 1,500 and about 2,250, and wherein the implant is made by melt extrusion and comprises 50% by weight of the TKI and 50% by weight of the poly(D,L-lactide).