COMPOSITION COMPRISING BISPHOSPHONATES FOR PREVENTION AND/OR TREATMENT OF METABOLIC DISEASES OF BONES, PROCESS FOR PREPARING SUCH COMPOSITION AND USE THEREOF

Abstract: The present invention relates to a composition for prevention and/or treatment of metabolic diseases of bones comprising at least one bisphosphonate; viscosity agents comprising carboxymethylcellulose and xanthan gum; at least one flavouring agent; and purified water; a process for preparing a composition according to the present invention; and use of such a composition for prevention, treatment and/or diagnosis of metabolic diseases of bones, especially for children.

Description: COMPOSITION COMPRISING BISPHOSPHONATES FOR PREVENTION AND/OR TREATMENT OF METABOLIC DISEASES OF BONES, PROCESS FOR PREPARING SUCH COMPOSITION AND USE THEREOF Technical Field The present invention relates to a composition for prevention and/or treatment of metabolic diseases of bones, a process for preparing such composition and use thereof. Prior Art Bisphosphonates are well known chemical compounds used in medicine for the prevention or treatment of several metabolic diseases of the bone, e.g. metabolic osteopathies, such as osteoporosis, cancer metastasis and the osteopathies associated with rheumatoid arthritis. Bisphosphonates can be prepared using various methods already described in the literature through which different crystalline species can be obtained. A selection of known bisphosphonates is presented in the following scheme. Scheme Chemical structure of some bisphosphonates and amino-bisphosphonic acids A) B) Monosodic alendronate Disodic pamidronate C) D) Monosodic olpadronate Amino-alendronic acid E) F) Dimethyl-amiπo-alendronic acid Amino-pamidronic acid G) H) Amino-olpadronic acid Amino-etidronic acid Bisphosphonates may exist in the form of their acids, salts, hydrates and amino-derivatives. Monosodium alendronate, for example, may be prepared according to the Argentinean Patent AR 000.052. Pamidronate and olpadronate are other bisphosphonic derivatives which contain one nitrogen in the lateral chain. Olpadronate is the naturally most soluble compound in the group of bisphosphonates and may be synthesised according to the Argentinean Patent AR 246.743 and EP 0 891 979 Al, whereas the synthesis of pamidronate is disclosed in the Argentinean Patent AR 218.558. The amino-derivatives of bisphosphonates may be synthesised according to the methods stated in WO 97/02827 and AR 004.625. Further synthetic routes to obtain pamidronate are disclosed in US 3,962,432, further describing tablets, capsules, tooth-pastes and mouthwash containing pamidronate. US 4,407,761 and US 4,639,338 claim certain crystalline forms of pamidronate suitable for injectable solutions or pills, tablets, capsules and suppositories. US 4,446,052 discloses aqueous gels of tricalcic pamidronate to be administered in capsules or tooth-pastes, aimed at dissolving calcareous deposits. Alendronate is a derivative of bisphosphonates known since the 1970s and a method for its synthesis is for example disclosed in US 4,621,077, further disclosing general formulations of capsules, effervescent granules and injectable solutions. EP 402152 refers to trihydrate alendronate. US 5,462,932 discloses specific liquid oral formulations containing alendronate for facilitating deglutition in people who have difficulties in swallowing. The formulations of US 5,462,932 are based on the presence of EDTA as stabilising agent and/or the presence of citric acid as buffer agent. Special stabilizers were deemed to be essential in the formulations of bisphosphonates. EP 336851 discloses tablets of several types of bisphosphonates that contain sodium lauryl- sulphate as excipient which is well known for persons skilled in the art. Other bisphosphonates, such as ibandronate, are described in US 4,927,814 and 4,942,157. Among the several medical indications presented by the bisphosphonates, the use in the prevention and treatment of established osteoporosis, see Papapoulos S.E. et al., The use of bisphosphonates in the treatment of osteoporosis, Bone 1992, 13: A41-A49; the treatment of bone metastases of cancer, see van Holten-Nerzantvoort A. et. al., Oral pamidronate in the prevention and treatment of skeletal metastases in patients with breast cancer, Medicina (Buenos Aires), 1997, 57 (suppl.): 109-113; and the osteopathies associated with rheumatoid arthritis, see Maccagno A. et al., Double blind radiological assessment of continuous oral pamidronic acid in patients with rheumatoid arthritis, Scan J. Rheumatol, 1994, 23:211-214, are highlighted. All these medicinal uses imply the continuous/pulse administration of the bisphosphonate for long periods - 5 or more years. Thus, the use of preparations suitable for oral administration is preferred. "Continuous or pulse use" is understood as the use that fosters an inhibition of bone metabolism in a smooth and constant way, as proved by the steady levels curve of the markers of bone metabolism. On the other hand, there is the non-continuous or cyclical use of bisphosphonates, stimulating a stronger depression of bone metabolism, followed by a tendency to recover basal level. With this modality, the biochemical markers curve thus fluctuates with troughs and peaks, demarcated by each cycle of administration. In the continuous mode, each administration of bisphosphonates can be referred to as a pulse, see Roldan EJA et al, Clinical evaluation of bisphosphonates pharmacokinetics principles, Medicine (Buenos Aires), 1997, 57 (suppl.):76-82. While daily, weekly of half-weekly pulses foster a continuous metabolic change in the bone, monthly, bimonthly or three-monthly pulses foster a metabolic discontinuous or cyclical change. While no exact definition of the limit between cyclical and continuous modalities is known, the present invention is aimed at improving the pulse administration of bisphosphonates. The "pulse" concept for bisphosphonate administration has also been common clinical practice in patient with small body mass, in children, and in those who does not tolerate daily administrations, see Roldan EJA et al, JPediat Endocrinol Metab 1999, 12:555-559. Up to now, however, the requirement of high doses of bisphosphonates has hindered a successful oral administration, especially due to potential problems of digestive tolerance. Moreover, most bisphosphonates have a very low solubility, 3% v/v or less. This favours a very low absorption of the compound, that means a bioavailability of at best 1%. Therefore, 99% of the remaining active substance may easily form lumps and precipitate in the digestive lumen which can result in digestive irritability. Symptoms resulting from such irritability may range from unspecified discomfort to pain, vomit and as well as esophagitis and gastritis. Lesions in the digestive system can be related to the intrinsic potential of the bisphosphonate to irritate the digestive mucosa, to the solubility of the process or dissolution of the pharmaceutical form and to the quantity of molecules administered each time, see Spivacow R.S. et al, Tolerability of oral bisphosponates in patients with osteoporosis and other osteopathies, Medicina (Buenos Aires), 1997, 57(suppl.):114-118. Attempts have been made in the prior art to improve tolerability by prescribing doses low in bisphosphonates under very strict conditions, taking the bisphosphonate at least 30 - 60 minutes before breakfast with abundant water. Moreover, the patient must keep a strict fast and must remain standing or sitting during all the pre-breakfast period. Of course, these rigid instructions are bothersome and, together with side effects, may lead to the non-observance of the prescriptions. The patient finds little incentive to go on with an uncomfortable administration plan that disturbs the habitual rhythm of life and that, in most cases aims at preventing an uncertain fact, such as the probability of fractures due to osteoporosis in old age. Often, a short time after beginning treatment, the patient gives up the observation of the instructions and failures and side effects associated to poor fulfilment of the prescription appear. Therefore, it is an object of the present invention to overcome the drawbacks of the prior art, especially to provide a composition for prevention, treatment and/or diagnosis of metabolic diseases of bones which would enable a more comfortable administration of bisphosphonates, in order to make possible a strict fulfilment of the prescriptions and long-term clinical effects. Moreover, it is a further object of the invention to lessen a risk factor of toxicity that is represented by the lumps resulting from the break-up of oral forms. Moreover, it is a further object of the present invention to provide a process for preparing a composition according to the invention and to allow the use of such a composition for the prevention, treatment and/or diagnosis of metabolic diseases of bones. Disclosure of the invention The first objects are solved by a composition for prevention and/or treatment of metabolic diseases of bones comprising at least one bisphosphonate; viscosity agents comprising carboxymethylcellulose and xanthan gum; at least one flavouring agent; and purified water. Preferably, the viscosity agents further comprise microcristalline cellulose. Moreover, a composition is proposed wherein the bisphosphonate is present in an amount of between about 5 mg to about 600 mg, viscosity agents are present in an amount of between about 30 mg to about 1000 mg, the flavouring agent is present in an amount between about 150 mg to about 550 mg. Preferably, the flavouring agent is a flavouring orange liquid. The composition may comprise the bisphosphonate in the form of its acid, salt, hydrate or amino-derivative . Preferably, the bisphosphonate is selected from the group comprising monosodium alendronate, disodium pamidronate, monosodium olpadronate, amino-alendronate, amino-dimethyl- alendronate, amino-pamidronate, amino-olpadronate amino-etidronate, neridronate, etidronate, clodronate, ibandronate, incadronate, risedronate, zolendronate, tiludronate and the like, and mixtures thereof. The bisphosphonate may be soluble in the composition according to the present invention. Preferably, sodium alendronate is present in the composition in an amount of between 5 mg to 140 mg. Alternatively, sodium olpedronate is present in an amount of between about 5mg to about 500mg, or disodium pamidronate is present in an amount of between about 50 mg to about 600 mg. According to the present invention, the composition may comprise further ingredients, such as sorbitol, glycerine, sodium saccharine, sodium cyclamate, methyl p-hydroxy benzoate, propyl p- hydroxybenzoate, sorbic acid, sucrose, and/or dyes. Further, the present invention provides a process comprising the following steps (i) suspending carboxymethylcellulose in an appropriate solvent, such as sorbitol or glycerine; (ii) dissolving bisphosphonate in demineralized water; (iii) heating further demineralized water to a temperature of about 60°C and dissolving the potassium sorbate in water; (iv) suspending xanthan gum in the solution of step (iii); (v) dissolving sodium saccharine and sodium cyclamate in the mixture of step (iii); (vi) incorporating homogeneously the carboxymethylcellulose suspension of step (i) into the mixture of step (iii); (vii) adding to the mixture of step (vi) the bisphosphonate of step (ii); (viii) incorporating flavouring agent to the mixture of step (vii) once the temperature of the mixture is below 40°C; (ix) reaching a desired volume with demineralized water; and (x) optionally fractionating the mixture of step (ix). According to the present invention the composition may be used for prevention and/or treatment of metabolic diseases of bones, especially for metabolic osteopathies, cancer metastasis, osteopathies associated with rheumatoid arthritis, and osteoporosis. Most preferably, the composition according to the invention may be used for a pulse administration. Preferably, the composition according to the present invention may be used for children. The composition of the present invention may further be used as pre-breakfast, pre-lunch and/or pre-dinner drink. Surprisingly a composition was found for prevention and/or treatment of metabolic diseases of bones having natural-fruit-juice appearance, flavour and consistency. The excipients comprised in the composition do not cause any adverse interaction, keep the quantities given in soluble form, that is, minimise the risk of lumps or irritant particle formation, and of the subsequent contact with sensitive mucosa in patients that, incidentally, cannot remain upright. Because of their "nutritional" aspect, the composition is suitable and tasty enough to be administered as pre- breakfast juice, thus improving treatment completion, helping to keep in mind that it must be administered before breakfast or other meal, lessening side effects and consequently increasing the possibility of obtaining long-term therapeutic benefits. These two latter concepts are based on the fact that in the composition according to the present invention all the given bisphosphonate is dissolved. The composition according to the present invention may potentially be used in children. Due to the fruit-juice appearance of the composition of the present invention, it is simpler to remember when the composition according to the present invention should be taken, since it can be associated with a drink to be taken before meals, overcoming the therapeutic failure which often occurs when people forget to take the bisphosphonates or take them in the wrong moment. However, it is also possible for example for olpadronate, to administer the bisphosphonate together with food ad-libitum. Moreover, it has to be mentioned that the composition of the present invention does not require any stabilising agent, such as EDTA or citric acid. The composition of the present invention is stable in a glass or polymer container. The fruit flavour of the composition of the present invention may be obtained by an orange essence, such as Meroar 73781, and a combination of carboxymehthylcellulose, such as Avicel RC591 which is commercially available by F.M.C., and may comprise microcristalline cellulose, and xanthan gum. These synthetic excipients where neither used nor suggested before for a composition comprising bisphosphonates. Embodiments of the invention The present invention will be now further illustrated by the following examples which are not intended to limit the scope of the invention in any way. Example 1: Process for preparing an oral solution of bisphosphonate as medicinal fruit juice A process for preparing a composition according to the present invention may comprise the following steps: (i) suspending carboxymethylcellulose in glycerine or sorbitol; (ii) dissolving bisphosphonate in an appropriate amount of demineralized water; (iii) heating further demineralized water to a temperature of about 60°C and dissolving the potassium sorbate in water; (iv) suspending xanthan gum in the mixture of step (iii); (v) dissolving sodium saccharine and sodium cyclamate in the mixture of step (iii); (vi) incorporating homogeneously the carboxymethylcellulose suspension of step (i) into the mixture of step (iii); (vii) adding to the mixture of step (vi) the bisphosphonate of step (ii); (viii) incorporating Meroar 73781 as flavouring agent to the mixture of step (vii) once the temperature of the mixture is below 40°C; (ix) reaching a desired volume with demineralized water; and (x) optionally fractionating the mixture of step (ix). Example 2: Composition according to the present invention comprising monosodium alendronate A composition according to the present invention may comprise the following ingredients with respective amounts: Sodium alendronate 5,0mg-140,0mg Avicel RC591 150mg-500mg Xanthan gum 30mg-100mg Sorbitol 70% 3,0g-15,0g Sodium saccharine lOmg-lOOmg Sodium cyclamate lOOmg-lOOOmg Methyl p-hydroxy benzoate 50mg - 120mg Propyl p-hydroxy benzoate 10mg-30mg Potassium sorbate 70mg - 120 mg Orange essence Meroar 73781 150mg-550mg Sunset yellow (dye) lmg-3mg Purified water q.s.100ml Avicel RC 591 is commercially available by F.M.C. and is comprised of carboxymethylcellulose and microcristalline cellulose. The composition according to example 1 may be administered daily wherein the content of monosodium alendronate per unit may vary within a range of 5mg to 20mg, half- weekly wherein the content of monosodium alendronate per unit may vary within a range of 15mg to 60mg, weekly wherein the content may vary in a range of 35mg to 140mg, and fortnightly wherein the content may vary in a range of 70mg to 140mg. Example 3: Composition according to the present invention comprising monosodium alendronate Sodium alendronate 5,0mg - 140,0mg Avicel RC591 150mg - 500mg Xanthan gum 30mg- 100mg Sucrose 10g- 50g Sorbitol 70% 3,0g - 15,0g Methyl p-hydroxy benzoate 50mg - 120mg Propyl p-hydroxy benzoate 10mg - 30mg Potassium sorbate 70mg - 120mg Meroar 73781 150mg - 550mg Sunset yellow (dye) lmg - 3mg Purified water q.s. 100ml Example 4:Composition according to the present invention comprising sodium olpadronate Sodium olpadronate 50mg - 600mg Avicel RC591 150mg - 500mg Xanthan gum 30mg- 100mg Sorbitol 70% 3,0g - 15,0g Sodium saccharine lOmg-lOOmg Sodium cyclamate lOOmg-lOOOmg Methyl p-hydroxy benzoate 50mg- 120mg Propyl p-hydroxy benzoate 10mg-30mg Potassium sorbate 70mg - 120mg Orange essence Meroar 73781 150mg-550mg Sunset yellow (dye) lmg-3mg Purified water q.s.100ml The composition according to example 4 may be administered, for example, weekly wherein the content of sodium olpadronate per unit may vary within a range of 50mg to 500mg, or fortnightly wherein the content may vary in a range of lOOmg to 500mg. Example 5: Composition according to the present invention comprising sodium olpadronate Sodium olpadronate 50mg-600mg Avicel RC591 150mg-500mg Xanthan gum 30mg-100mg Sucrose 10g-50g Sorbitol 70% 3,0g-15,0g Methyl p-hydroxy benzoate 50mg- 120mg Propyl p-hydroxy benzoate 10mg-30mg Potassium sorbate 70mg - 120mg Orange essence Meroar 73781 150mg-550mg Sunset yellow (dye) lmg-3mg Purified water q.s.100ml Using pamidronate in a composition according to the present invention the amount of pamidronate may be in the range of between 50mg to 600mg, wherein the remaining ingredients, as already disclosed in the examples, do not change. As is apparent for persons skilled in the art, other bisphosphonates, as already disclosed in the description, may be used within the present invention. Moreover, it is possible to use another type of food/soft drink-like beverage, such as another flavouring liquid. The composition prepared as outlined above may be filled in a one-unit or multi-unit container or commercial kit remarking the modality of medicinal use, with the aim of preventing incorrect use. The features disclosed in the description, in the examples and in the claims may, both separately and in any combination thereof, the material for realising the invention in diverse forms thereof.

Claims: Claims 1. Composition for prevention and/or treatment of metabolic diseases of bones comprising: - at least one bisphosphonate; - viscosity agents comprising carboxymethylcellulose and xanthan gum; - at least one flavouring agent; and - purified water. 2. Composition according to claim 1 wherein the viscosity agents further comprise microcrystalline cellulose. 3. Composition according to claim 1 or 2 wherein the bisphosphonate is present in an amount of between about 5 mg to about 600 mg, viscosity agents are present in an amount of between about 30 mg to about 1000 mg, the flavouring agent is present in an amount between about 150 mg to about 550 mg. 4. Composition according to any of the preceding claims wherein the flavouring agent is a flavouring orange liquid. 5. Composition according to any of preceding claims wherein the bisphosphonate is in the form of its acid, salt, hydrate or amino-derivative. 6. Composition according to any of the preceding claims wherein the bisphosphonate is selected from the group comprising monosodium alendronate, disodium pamidronate, monosodium olpadronate, amino-alendronate, amino-dimethyl-alendronate, amino- pamidronate, amino-olpadronate, amino-etidronate, neridronate, etidronate, clodronate, ibandronate, incadronate, risedronate, zolendronate, tiludronate and the like, and mixtures thereof. 7. Composition according to any of the preceding claims wherein the bisphosphonate is soluble in the composition. 8. Composition according to any of the preceding claims wherein sodium alendronate is present in an amount of between about 5 mg to about 140 mg. 9. Composition according to any of the preceding claims 1 to 7 wherein sodium olpadronate is present in an amount of between about 5 mg to about 500 mg. 10. Composition according to any of the preceding claims 1 to 7 wherein disodium pamidronate is present in an amount of between about 50 mg to about 600 mg. 11. Composition according to any of the preceding claims wherein the composition comprises further ingredients, such as sorbitol, glycerine, sodium saccharine, sodium cyclamate, methyl p-hydroxy benzoate, propyl p-hydroxybenzoate, sorbic acid, sucrose, and/or dyes. 12. Process for preparing a composition according to any of the preceding claims 1 to 11, comprising the following steps: (i) suspending carboxymethylcellulose in an appropriate solvent, such as sorbitol or glycerine; (ii) dissolving bisphosphonate in demineralized water; (iii) heating further demineralized water to a temperature of about 60°C and dissolving the potassium sorbate in water; (iv) suspending xanthan gum in the solution of step (iii); (v) dissolving sodium saccharine and sodium cyclamate in the mixture of step (iii); (vi) incorporating homogeneously the carboxymethylcellulose suspension of step (i) into the mixture of step (iii); (vii) adding to the mixture of step (vi) the bisphosphonate of step (ii); (viii) incorporating flavouring agent to the mixture of step (vii) once the temperature of the mixture is below 40°C; (ix) reaching a desired volume with demineralized water; and (x) optionally fractionating the mixture of step (ix). 13. Use of the composition according to any of the claims 1 to 11 for prevention and/or treatment of metabolic diseases of bones. 14. Use according to claim 13 for a pulse administration. 15. Use according to claim 13 or 14 for metabolic osteopathies. 16. Use according to claim 13 or 14 for cancer metastasis. 17. Use according to claim 13 or 14 for osteopathies associated with rheumatoid artliritis. 18. Use according to claim 13 or 14 for osteoporosis. 19. Use according to any of the preceding claims 13 to 18 for children. 20. Use according to any of the preceding claims 13 to 19 as pre-breakfast, pre-lunch and/or pre- dinner drink.

Inventors: CAIRATTI DAMIAN, PAPAPOULOS SOCRATES, PICCINNI ENRIQUE, ROLDAN EMILIO J A, ZANETTI DANIEL, CAIRATTI, DAMIAN, PAPAPOULOS, SOCRATES, PICCINNI, ENRIQUE, ROLDAN, EMILIO, J., A., ZANETTI, DANIEL
Applicants: CAIRATTI DAMIAN, GADOR SA, PAPAPOULOS SOCRATES, PICCINNI ENRIQUE, ROLDAN EMILIO J A, UNIV LEIDEN, ZANETTI DANIEL, CAIRATTI, DAMIAN, GADOR S.A., PAPAPOULOS, SOCRATES, PICCINNI, ENRIQUE, ROLDAN, EMILIO, J., A., UNIVERSITY OF LEIDEN, ZANETTI, DANIEL
Application year: 2001
Main classification: A61K31
IPC codes: A23L2, A61K9, A61K31, A61K47, A61P19, A61P29, A61P35