# Patent

## Title
Therapeutic treatment for cytomegalovirus infection

## Abstract

A metered unit dose comprising 40 .mu.g or less of budesonide is disclosed, as well as formulations thereof, and the use thereof for the treatment of nasal conditions.

## Background
The present invention relates to a new unit dose of budesonide, a formulation thereof, and its use for the treatment of conditions of the nose.

Glucocorticosteroids are widely used for the treatment of seasonal allergic as well as perennial rhinitis. Intranasal glucocorticosteroids reduce inflammation of the nasal mucosa including edema. In addition, they are known to suppress the recruitment of polymorpho-nuclear and mononuclear cells, cytokine production, and, during maintenance treatment, both early and late-phase nasal reactions.

One of the glucocorticosteroids known for intranasal use is budesonide, 16.alpha., 17.alpha.-butylidenedioxy-11.beta.,21-dihydroxypregna-1,4-diene-3,20-dione .

Initially solid budesonide was used in pressurized metered dose inhaler (pMDI) preparations for intranasal administration, suitably dispensed from a specially adapted nasal inhaler. A recommended maximum daily metered dose of budesonide has been 400 .mu.g. Later on a nasal spray preparation for delivery from a spray device was prepared, containing budesonide in the form of an aqueous suspension. The same maximum daily metered dose as for the pMDI preparation was recommended. A third formulation is a dry powder formulation.

Both the nasal pMDI inhaler device and the aqueous nasal spray device are constructed to dispense a defined unit dose at each actuation. For example, a metered unit dose of 50 .mu.g has a recommended administration regime of one dose per nostril, four times daily, yielding a total of eight 50 .mu.g metered doses per day. Alternatively, a metered unit dose of 100 .mu.g would provide the same total metered daily dose (400 .mu.g) if administered to each nostril twice daily, for a total of four 100 .mu.g metered doses per day.

We have now surprisingly found that a lower metered unit dose of budesonide than that previously used can be administered safely and effectively to the nose.

According to the invention we provide a metered unit dose of a therapeutic composition comprising budesonide in therapeutically effective amount that is less than about 40.mu.g, said composition being suitable for nasal administration to a mammal in a single dose.

Preferably, the metered unit dose comprises from about 16 to about 40 .mu.g of budesonide. In a preferred embodiment of the invention, the metered unit dose comprises about 32 .mu.g of budesonide.

With this new lower metered unit dose, it is possible for the patient to take a lower metered daily dose, while still maintaining efficacy. The new lower unit dose is also convenient for the patient. Surprisingly, metered daily doses of 256 .mu.g and 400 .mu.g, delivered by nasal spray, were found to be equally efficacious. A metered daily dose of 256 .mu.g can be obtained with a metered unit dose of 32 .mu.g budesonide, dispensed 8 times daily (two doses in each nostril, twice a day).

A suitable pharmaceutical formulation of budesonide is a suspension of micronised budesonide in an aqueous vehicle.

Thus, the invention also comprises a unit dose, and preferably a metered unit dose, of a therapeutic composition comprising a therapeutically effective amount of budesonide that is less than about 40 .mu.g, wherein the budesonide is in the form of finely divided particles and is suspended in an aqueous medium, said composition being suitable for administration to a mammal in a single dose.

Preferably, the unit dose formulation comprises from about 16 to about 40 .mu.g of budesonide. In a most preferred embodiment of the formulation, the amount of budesonide is about 32 .mu.g.

In a further aspect the invention comprises a suspension, preferably an aqueous suspension, comprising from about 0.6 to about 0.7 mg/ml (i.e. from about 0.06 to about 0.07% w/w) of budesonide.

In yet a further aspect the invention comprises a method of treating conditions of the nose of mammals by administering thereto a metered unit dose of 40 .mu.g or less of budesonide.

Conditions that can be treated according to the invention include birch, grass, ceder or other plants pteronyssinus and D. farinae), cockroaches and mammals such as cats, dogs and horses

In order to form a stable suspension with a minimal tendency to agglomerate or form a sediment, a thickening agent may be included in the formulation. Examples of suitable thickening agents are microcrystalline cellulose, sodium carboxymethylcellulose, xanthan gum, carbomer, guar gum and hydroxypropyl cellulose. The thickening agent may be present at about 0.1 to 3.0% w/w of the formulation. Preferably microcrystalline cellulose and sodium carboxymethyl cellulose are present at about 0.5 to 2.5%, xanthan gum at about 0.3 to 3%, carbomer at about 0.1 to 2%, guar gum at about 0.3 to 2% and hydroxypropyl methyl cellulose at about 0.5 to 3.0%, w/w of the formulation.

Agents which make the suspension isotonic may be added. Examples are dextrose, glycerin, mannitol, sodium chloride and potassium chloride.

To obtain an efficient dispersion of the budesonide particles in the suspension, a surfactant may be used. Examples of suitable surfactants are Polysorbate 80 (Tween 80) as well as other polyoxyethylene sorbitan fatty acid esters, poloxamers, polyoxyethylene alkyl ethers and polyoxyethylene castor oil derivatives. The surfactant may be present at about 0.005 to 2% w/w of the formulation. We prefer the polyoxyethylene sorbitan fatty acid esters to be present at about 0.005 to 0.5%, poloxamers at about 0.01 to 2%, and polyoxyethylene alkyl ethers or the polyoxyethylene castor oil derivatives at about 0.01 to 1.0%, w/w of the formulation.

We also prefer the formulation to contain a suitable chelating agent, e.g. disodium edetate (EDTA). The chelating agent may be present at about 0.005 to 0.1% w/w of the formulation.

A preservative agent may be added to protect the formulation from microbial contamination. Examples of suitable preservatives are benzalkonium chloride, methylparaben, propylparaben, potassium sorbate and sodium benzoate. The preservative may be present at about 0.002 to 0.5% w/w of the formulation. Preferably benzalkonium chloride is present at about 0.002 to 0.02%, methylparaben at about 0.05 to 0.25%, propylparaben at about 0.01 to 0.2%, potassium sorbate at about 0.05 to 0.2%, and sodium benzoate at about 0.1 to 0.5%, w/w of the formulation.

The pH of the suspension may be adjusted as required. Examples of suitable pH regulating agents are strong mineral acids, e.g. hydrochloric acid. Alternatively, the pH of the system can be adjusted by balancing the acid and salt forms of preservative and chelating agent. We prefer the formulation to have a pH in the range 3.5 to 5.0 and more preferably from about 4.2 to 4.6.

The suspension medium is made essentially of purified water (as describe in the European Pharmacopoeia and the United States Pharmacopoeia), e.g. water for injection.

In the suspension the active constituent budesonide is present as small particles, where at least 90% of the small particles have a mass equivalent sphere diameter of less than 20 .mu.m, preferably at least 80% less than 10 .mu.m and most preferably at least 80% less than 7 .mu.m.

The new unit dose can suitably be dispensed from the above mentioned specially adapted nasal inhaler or spray device. Other means for administration include a simple drop pipette or a rhinyl. Pre-compression metered-dose spray pumps with dose volumes from 25 .mu.l to 150 .mu.l can be used, whereby the concentration of budesonide in the suspension is adjusted to give the desired unit dose of budesonide. Monospray or a bispray pump can be used; for the latter, the recommended unit dose is sequentially delivered into each nostril, for a total metered dose per administration of less than 80 .mu.g budesonide.

According to a further feature of the invention we also provide a therapeutic method of treating or preventing conditions of the upper respiratory tract, the method comprising metering into a nostril of a mammal a unit dose of budesonide, wherein said metered unit dose comprises budesonide in a therapeutically effective amount that is less than about 40 .mu.g.

The metered amount of budesonide is preferably less than about 320 .mu.g per day, delivered as 8 or more unit doses each dose comprising budesonide in an amount that is less than about 40 .mu.g.

According to a yet further feature of the invention we provide a container containing budesonide and adapted to deliver a unit dose or a formulation according to the invention.

The invention will now be described more in detail in the following non-limiting examples.

A unit dose comprising a suspension of 32 .mu.g budesonide in water was prepared by mixing the following ingredients: Ingredient                     (mg) Budesonide, micronized         0.032 Microcrystalline cellulose and 0.625 carboxymethylcellulose Sodium (Avicel) Dextrose, anhydrous            2.375 Polysorbate 80                 0.008 Edetate disodium               0.005 Potassium sorbate              0.060 Hydrochloric acid              to pH 4.5 Purified water                 to 50 .mu.l (approx. 47.9 mg added)

A 200 litre bulk suspension, which corresponds to approximately 23,000 containers with 120 doses (32 .mu.g/dose) of budesonide each, was prepared by mixing the following ingredients: Ingredient                              Amount (kg) Budesonide, micronised                  0.128 Microcrystalline cellulose and          2.500 carboxymethylcellulose Sodium (Avicel) Dextrose, anhydrous                     9.500 Polysorbate 80                          0.032 Edetate disodium                        0.020 Potassium sorbate                       0.240 Hydrochloric acid                       to pH 4.5 Purified water                          to 204.2

## Claims

1. A unit dose of a therapeutic composition comprising about 32 .mu.g budesonide, wherein the budesonide is in the form of finely divided particles and is suspended in an aqueous medium, said composition being suitable for administration to a mammal in a single dose, wherein the composition includes no more than about 32 .mu.g budesonide.

2. The unit dose of claim 1, further comprising one or more pharmaceutically acceptable additives selected from the group consisting of thickening agents, isotonicity agents, surfactants, chelating agents, and preservatives.

3. The unit dose of claim 1, wherein the mass equivalent sphere diameter of the budesonide particles is 10 .mu.m or less.

4. A container containing budesonide and adapted to deliver a unit dose according to claim 1.

5. The unit dose of claim 1, wherein said composition is suitable for nasal administration to a mammal.

6. The unit dose of claim 1, wherein the composition contains about 0.6 to 0.7 mg/ml budesonide.

7. A therapeutic method of treating or preventing conditions of the upper respiratory tract, the method comprising administering into a nostril of a mammal a metered unit dose of finely divided budesonide particles suspended in an aqueous medium, wherein said metered unit dose consists of about 32 .mu.g budesonide and one or more ingredients other than budesonide.

8. A method according to claim 7, in which the condition to be treated is selected from the group consisting of seasonal allergic rhinitis, perennial allergic rhinitis, perennial non-allergic rhinitis, chronic sinusitis, recurrent sinusitis and nasal polyps.

9. A therapeutic method according to claim 7, wherein the condition to be treated is seasonal allergic rhinitis.

10. A therapeutic method according to claim 7, wherein the condition to be treated is perennial allergic rhinitis.

11. A therapeutic method according to claim 7, wherein the condition to be treated is perennial non-allergic rhinitis.

12. A therapeutic method according to claim 7, wherein the condition to be treated is chronic sinusitis.

13. A therapeutic method according to claim 7, wherein the condition to be treated is recurrent sinusitis.

14. A therapeutic method according to claim 7, wherein the condition to be treated is nasal polyps.

15. The method of claim 7, wherein the unit dose contains about 0.6 to 0.7 mg/ml budesonide.

16. A therapeutic method of treating conditions of the upper respiratory tract, the method comprising metering into the nose of a mammal a therapeutically effective amount of budesonide that is less than about 320 .mu.g per day, delivered as 8 or more unit doses, wherein each unit dose comprises finely divided budesonide particles suspended in an aqueous medium in a metered amount of about 32 .mu.g budesonide.

17. A therapeutic method according to claim 16, wherein the amount of budesonide is about 256 .mu.g per day.

18. The method of claim 16, wherein each unit dose contains about 0.6 to 0.7 mg/ml budesonide.

19. A unit dose of a therapeutic composition consisting of: carboxymethyl cellulose, the composition at about 0.5 to 2.5% by weight of the therapeutic composition; composition; composition; and composition, in an aqueous medium, said therapeutic composition being suitable for nasal administration to a mammal in a single dose.

20. A therapeutic method of treating conditions of the upper respiratory tract, the method comprising metering into the nose of a mammal a therapeutically effective amount of budesonide that is less than about 320 .mu.g per day, delivered as 8 or more unit doses, wherein each unit dose consists of about 32 .mu.g budesonide and other ingredients, the other ingredients comprising carboxymethyl cellulose, the composition at about 0.5 to 2.5% by weight of the therapeutic composition; composition; composition; and composition, in an aqueous medium.

21. The method of claim 20, wherein each unit dose contains about 0.6 to 0.7 mg/ml budesonide.

22. A unit dose of a therapeutic composition, the active ingredient of which consists of about 32 .mu.g budesonide formulated as finely divided particles suspended in an aqueous medium, said camposition being suitable for administration to a mammal in a single dose.

23. The unit dose of claim 22, wherein the composition contains about 0.6 to 0.7 mg/ml budesonide.

24. A therapeutic method of treating or preventing conditions of the upper respiratory tract, the method comprising administering into a nostril of a mammal a metered unit dose, the active ingredient of which consists of about 32 .mu.g of budesonide formulated as finely divided particle s suspended in an aqueous medium.

25. The method of claim 24, wherein the unit dose contains about 0.6 to 0.7 mg/ml budesonide.

26. A therapeutic method of treating conditions of the upper respiratory tract, the method comprising metering into the nose of a mammal a therapeutically effective amount of budesonide that is less than about 320 .mu.g per day, delivered as 8 or more unit doses, the active ingredient of each unit dose consisting of about 32 .mu.g budesonide formulated as finely divided particle suspended in an aqueous medium.

27. The method of claim 26, wherein each unit dose contains about 0.6 to 0.7 mg/ml budesonide.

28. A unit dose of a therapeutic composition, the active ingredient of which consists of about 32 .mu.g budesonide, wherein the therapeutic composition additionally comprises carboxymethyl cellulose, the composition at about 0.5 to 2.5% by weight of the therapeutic composition; composition; composition; and composition, and suspended in an aqueous medium, said therapeutic composition being suitable for nasal administration to a mammal in a single dose.

29. The method of claim 28, wherein each unit dose contains about 0.6 to 0.7 mg/ml budesonide.