Abstract:
A drug delivery device for selecting and dispensing a number of user variable doses of a medicament includes a housing having an opening, a dose selector operable to set a dose by rotation relative to the housing, a release member controlling movement of a piston in a dispensing direction, and a display comprising a units number wheel and a tens number wheel which are coupled to each other such that a continuous rotation of the units number wheel is translated into an intermittent rotary motion of the tens number wheel. The release member rotates, during dose dispensing, an angle corresponding to the dose set by the dose selector, thereby allowing a piston to move in a dispensing direction.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
       [0001]    This application is a U.S. national stage application under 35 USC §371 of International Application No. PCT/EP2015/078927, filed on Dec. 8, 2015, which claims priority to European Patent Application No. 14306958.1, filed on Dec. 8, 2014, the entire contents of which are incorporated herein by reference. 
     
    
     TECHNICAL FIELD 
       [0002]    The present disclosure is generally directed to a drug delivery device suitable for selecting and dispensing a number of user variable doses of a medicament. 
         [0003]    Pen type drug delivery devices have application where regular injection by persons without formal medical training occurs. This may be increasingly common among patients having diabetes where self-treatment enables such patients to conduct effective management of their disease. In practice, such a drug delivery device allows a user to individually select and dispense a number of user variable doses of a medicament. The present disclosure is not directed to so called fixed dose devices which only allow dispensing of a predefined dose without the possibility to increase or decrease the set dose. 
         [0004]    There are basically two types of drug delivery devices: resettable devices (i.e., reusable) and non-resettable (i.e., disposable). For example, disposable pen delivery devices are supplied as self-contained devices. Such self-contained devices do not have removable pre-filled cartridges. Rather, the pre-filled cartridges may not be removed and replaced from these devices without destroying the device itself. Consequently, such disposable devices need not have a resettable dose setting mechanism. The present disclosure is applicable for both types of devices, i.e. for disposable devices as well as for reusable devices. 
         [0005]    These types of pen delivery devices (so named because they often resemble an enlarged fountain pen) generally comprise three primary elements: a cartridge section that includes a cartridge often contained within a housing or holder; a needle assembly connected to one end of the cartridge section; and a dosing section connected to the other end of the cartridge section. A cartridge (often referred to as an ampoule) typically includes a reservoir that is filled with a medication (e.g., insulin), a movable rubber type bung or stopper located at one end of the cartridge reservoir, and a top having a pierceable rubber seal located at the other, often necked-down, end. A crimped annular metal band is typically used to hold the rubber seal in place. While the cartridge housing may be typically made of plastic, cartridge reservoirs have historically been made of glass. 
         [0006]    The needle assembly is typically a replaceable double-ended needle assembly. Before an injection, a replaceable double-ended needle assembly is attached to one end of the cartridge assembly, a dose is set, and then the set dose is administered. Such removable needle assemblies may be threaded onto, or pushed (i.e., snapped) onto the pierceable seal end of the cartridge assembly. 
         [0007]    The dosing section or dose setting mechanism is typically the portion of the pen device that is used to set (select) a dose. During an injection, a spindle or piston rod contained within the dose setting mechanism presses against the bung or stopper of the cartridge. This force causes the medication contained within the cartridge to be injected through an attached needle assembly. After an injection, as generally recommended by most drug delivery device and/or needle assembly manufacturers and suppliers, the needle assembly is removed and discarded. 
         [0008]    A further differentiation of drug delivery device types refers to the drive mechanism: There are devices which are manually driven, e.g. by a user applying a force to an injection button, devices which are driven by a spring or the like and devices which combine these two concepts, i.e. spring assisted devices which still require a user to exert an injection force. The spring-type devices involve springs which are preloaded and springs which are loaded by the user during dose selecting. Some stored-energy devices use a combination of spring preload and additional energy provided by the user, for example during dose setting. 
         [0009]    WO 2014/166900 A1 discloses a spring driven drug delivery device with a dose setting member which is in splined and direct engagement with a dose indicating wheel. The dose indicating wheel is permanently coupled to a gear wheel which acts on a drive member interacting with the spring. A drive sleeve is operably releasable from a piston rod for switching the device between a dose setting mode and a dose dispensing mode. 
         [0010]    WO 2014/166916 A1 discloses an injection device comprising an epicyclic gear box permanently coupling a dial grip to a units gear carrying number markings. 
         [0011]    For dose accuracy reasons it is essential that the user may easily identify the actually set dose. Some devices comprise a number sleeve with a series of figures provided on a helical path on the outside of the number sleeve. The number sleeve is rotated during dose setting and dose dispensing, such that the actually set dose is visible through a window in the device. A possible drawback of such number sleeve displays is caused by the aim to minimize drug delivery devices, which results in smaller number sleeves and, thus, a smaller figure size which may be difficult to read for visually impaired users. 
         [0012]    WO 98/56436 A1 discloses a drug delivery device with a dose setting element comprising a scale on the dose setting element for indicating the set dose. 
         [0013]    WO 01/87386 A1 discloses a dose display comprising two flexible discs which each carry in a band along its perimeter numbers. A sprocket drum which is permanently coupled to a dose setting member has ten sprockets engaging sprocket holes in the units counting disc and one sprocket engaging sprocket holes in the tens counting disc. The flexible discs are cambered to fit into the cylindrical or rounded housing of the device. In an alternative embodiment one single flexible disc is provided which is permanently coupled to dose setting grip. The dose display of WO 01/87386 A1 requires that the dose setting member or grip rotates back during dose dispensing, which may be considered as disturbing or confusing for some users. In addition, in the embodiment with two discs the tens counting disc is not secured against unintended rotational movement when the sprocket is not engaging the sprocket hole. Thus, a misreading could occur if the tens counter disc moves unintended which results in poor dose accuracy. 
       SUMMARY 
       [0014]    The present disclosure is directed to providing a drug delivery device allowing a reliable representation of the selected dose with improved ease of use. 
         [0015]    Certain implementations of the disclosure can be implemented as a drug delivery device for selecting and dispensing a number of user variable doses of a medicament according to claim  1 . The device may be a disposable device, i.e. a device which does not provide for an exchange of an empty cartridge. The device comprises a housing, e.g. with an aperture or window, a dose selector operable to set a dose by rotation relative to the housing, a release member controlling movement of a piston in a dispensing direction and a display with at least one number wheel or number sleeve, preferably comprising a units number wheel and a tens number wheel which are coupled to each other such that a continuous rotation of the units number wheel is translated into an intermittent rotary motion of the tens number wheel. 
         [0016]    According to a first independent aspect of the disclosure the units number wheel is coupled to the tens number wheel by a gear mechanism, which preferably not only transfers a continuous rotation of the units number wheel into an intermittent rotary motion of the tens number wheel but may also prevent unintended movement of the tens number wheel. Such an unintended movement of the tens number wheel may be avoided, if, for example, the units number wheel comprises a raised circular blocking disc that locks the tens number wheel in position between the steps of intermittent rotary motion of the tens number wheel. The tens number wheel may have several concave contact faces which abut the raised circular blocking disc. The circular blocking disc may have a recess to allow movement of the tens number wheel as a units number wheel driving dog engages a corresponding driven dog of the tens number wheel. 
         [0017]    According to a further independent aspect of the disclosure, the release member may rotate during dose dispensing an angle corresponding to the dose set by the dose selector thereby allowing a piston to move in a dispensing direction, wherein the device further comprises a clutch mechanism which rotationally couples the number wheel or number sleeve, preferably the units number wheel, to the dose selector and de-couples the number wheel or number sleeve, preferably the units number wheel, from the release member during dose setting and which rotationally de-couples the number wheel or number sleeve, preferably the units number wheel, from the dose selector and couples the number wheel or number sleeve, preferably the units number wheel, to the release member during dose dispensing. In other words, the number wheel or number sleeve, preferably the units number wheel, follows the rotation of the dose selector during dose setting, i.e. dialing up or down, while it follows the rotation of the release member during dose dispensing. Thus, the dose selector may be kept stationary during dose dispensing, while the display still shows the actually selected dose decreasing as the release member rotates. In this respect, the clutch mechanism is operable to be switched, preferably by an axial movement, between a dose setting position and a dose dispensing position, wherein, when the clutch mechanism is in its dose setting position, the number wheel or number sleeve is rotationally coupled via the clutch mechanism to the dose selector and the number wheel or number sleeve is rotationally de-coupled from the release member and wherein, when the the clutch mechanism is in its dose dispensing position, the number wheel or number sleeve is rotationally de-coupled from the dose selector and the number wheel or number sleeve is rotationally coupled via the clutch mechanism to the release member. 
         [0018]    The idea of constraining a display member to the dose selector during dose setting and to constrain the display member to the release member during dose dispensing is applicable in a variety of different drug delivery devices irrespective of the drive mechanism of the device. For example, this disclosure may be used in spring driven devices as well as manually driven devices. Further, it is applicable in devices where a piston is axially pushed forward during dispensing by a spring or by a piston rod which may be axially and/or rotationally driven. 
         [0019]    According to the disclosure, the device comprises at least a units number wheel and a tens number wheel. This allows displaying figures in a relatively large scale which are readable even for visually impaired persons. In addition, every single number of the selected dose may be displayed, which increases readability of the dose size compared with displays which only show every other number. The number wheels may be rigid discs each extending in a flat plane. 
         [0020]    The housing may be a single unitary component or a multi-component part encasing and/or guiding other component parts. Preferably, the housing comprises an outer housing shell and a chassis or the like inner housing parts. A window or opening may be provided in the housing through which the number wheels can be seen for reading the displayed dose. A closed transparent window may include a lens to enlarge the displayed dose. It further prevents intrusion of dust or the like dirt into the device. 
         [0021]    The dose selector (dial grip) and/or the release member may be disc-shaped or cup-shaped component parts rotatable with respect to the housing. Preferably, they are rotatable about a common axis. The piston may be guided in a cartridge and/or in the housing or a cartridge holder. Preferably, the piston is axially movable in a direction perpendicular to the axis of rotation of the dose selector and/or the release member. 
         [0022]    A preferred embodiment of the disclosure comprises a Geneva drive (Maltese cross) mechanism. For example, the gear mechanism comprises a driving dog provided on the units number wheel and several corresponding driven dogs provided on the tens number wheel. Every time a (the) driving dog of the units number wheel engages a corresponding driven dog of the tens number wheel, the tens number wheel is rotated for a given increment which results in a stepwise rotational movement of the tens number wheel upon a continuous rotational movement of the units number wheel. Preferably, the units number wheel comprises one single driving dog and is provided with the  FIGS. 0 to 9 . As an alternative, the units number wheel comprises two driving dogs and is provided with the  FIGS. 0 to 9  twice. 
         [0023]    Preferably, the maximum settable dose is limited to a given value by a maximum dose stop feature. In addition, a zero unit dose stop feature may be provided which may also determine the end position of dose dispensing movements. For example, the drug delivery device may comprise a dose ring gear which is rotationally coupled to the dose selector during dose setting and which is rotationally coupled to the release member during dose dispensing. The dose ring gear may have a maximum dose stop feature and/or a minimum dose stop feature with corresponding counter stop(s) provided on a housing part or a component part which is rotationally constrained to the housing. In other words, the dose ring gear is allowed to rotate a predetermined degree with respect to the housing between end stop positions. 
         [0024]    If the dose ring gear is permanently rotationally coupled to the units number wheel, the position of the dose ring gear relative to the zero unit stop and/or the maximum dose stop may be displayed by units number wheel and the tens number wheel. 
         [0025]    The clutch may further rotationally couple the dose ring gear to the units number wheel, rotationally couple the dose ring gear to the dose selector and de-couple the dose ring gear from the release member during dose setting and rotationally couple the dose ring gear to the release member and de-couple the dose ring gear from the dose selector during dose dispensing. Thus, the clutch is a multi-function element coupling and de-coupling several different component parts. Preferably, the clutch and the release member each comprise at least one gear wheel. 
         [0026]    According to a preferred embodiment of the disclosure the clutch comprises a clutch gear having a first gear wheel and a second gear wheel which is rotationally constrained to the first gear wheel, e.g. via a shaft portion. 
         [0027]    It is preferred if the clutch gear is axially movable between a dose setting position, in which the first gear wheel is rotationally coupled to the dose selector and the units number wheel and in which the second gear wheel is rotationally coupled to the dose ring gear, and a dose dispensing position, in which the first gear wheel is rotationally coupled to the units number wheel and in which the second gear wheel is rotationally coupled to the dose ring gear and the release member. In the dose setting position, the second gear wheel is de-coupled from the release member and in the dose dispensing position the first gear wheel is de-coupled from the dose selector. 
         [0028]    The clutch gear may be rotatable about a first axis wherein the dose selector, the dose ring gear and the release member are rotatable about a second common axis which is parallel to and offset from the first axis. 
         [0029]    The drug delivery device may further comprise a trigger for actuating the clutch. The trigger may comprise a clutch lever pivot-mounted within the housing. Preferably, the clutch lever comprises a guiding sleeve at least partially surrounding a part of the clutch for axially displacing the clutch upon actuation of the trigger. The lever may be supported in the housing or a chassis of the housing such that actuation of the trigger causes an axial displacement of the guiding sleeve. 
         [0030]    In a preferred embodiment the device is a spring driven device. The spring may be a compression spring which is charged (strained) during or prior to assembly of the device. As an alternative, the spring may be charged during dose setting. Preferably, the device is a disposable device with the spring being charged for life, i.e. allowing dispensing several variable user selectable doses until the device or its cartridge is empty. Thus, the forces required for dose setting and dose dispensing are relatively low. 
         [0031]    The spring may act directly or indirectly on the piston. Preferably, a cable, belt or wire is attached with one of its ends to the piston and with its other end to a cable spool of the release member, such that upon rotation of the release member the piston is allowed to be pushed in the dispensing direction by the spring. As an alternative to a cable wound on a spool with a relatively small diameter, a toothed belt and a toothed belt drum may be used, wherein the belt is wrapped around approximately 75% of the belt drum. This may have advantages in terms of assembly and robustness in use. 
         [0032]    To avoid uncontrolled release of the spring, the device may further comprise a stop element preventing rotation of the release member during dose setting and allowing rotation of the release member during dose dispensing. 
         [0033]    Additional features like a clicker mechanism generating a tactile and/or audible feedback upon dose setting and/or dose dispensing or a last dose stop mechanism preventing setting of a dose which exceeds the amount of medicament remaining in the cartridge may be provided. For example, a dial clicker may be provided by a ring of teeth on the dose selector engaging a flexible finger e.g. on the chassis or outer housing shell. The dispense clicker may include the release member. As an alternative, a clicker may be provided by the dosing ring gear and a rotationally fixed component. A last dose stop feature may comprise a threaded shaft and a nut with one of the shaft or the nut being rotationally coupled to the dose selector while the other of the shaft and the nut is rotationally fixed. The threaded shaft and the nut may have corresponding stops preventing further relative rotation if a dose is set which exceeds the amount of medicament remaining in the cartridge. Thus, further rotation of the dose selector (in the dialing up direction) is prevented. 
         [0034]    To avoid that the spring energy is not released in an unsafe manner, the order in which the clutch disengages and engages with the other release mechanism components is important. 
         [0035]    According to a preferred embodiment, as the clutch lever moves from the dose setting position, it first locks the rotation of the dose selector by moving the dial clicker into a position whereby it requires a very high torque to dial either up or down. As the clutch lever continues to move it causes the clutch gear to axially engage the release member (release gear). The clutch and release gears may have chamfered teeth for ease of engagement to accommodate moulding and positional tolerances. As the clutch lever continues to move further, it causes the clutch gear to disengage from the dose selector so that the last dose mechanism is not rewound and the dose selector does not spin during dispense (preventing the user from jamming the device by touching it). Finally, the clutch lever causes the dose stop to disengage from the release member, allowing the release gear with the cable spool to rotate, releasing some cable and permitting the piston spring to move the piston. 
         [0036]    The drug delivery device may comprise a cartridge containing a medicament. The term “medicament”, as used herein, means a pharmaceutical formulation containing at least one pharmaceutically active compound, 
         [0000]    wherein in one embodiment the pharmaceutically active compound has a molecular weight up to 1500 Da and/or is a peptide, a proteine, a polysaccharide, a vaccine, a DNA, a RNA, an enzyme, an antibody or a fragment thereof, a hormone or an oligonucleotide, or a mixture of the above-mentioned pharmaceutically active compound,
 
wherein in a further embodiment the pharmaceutically active compound is useful for the treatment and/or prophylaxis of diabetes mellitus or complications associated with diabetes mellitus such as diabetic retinopathy, thromboembolism disorders such as deep vein or pulmonary thromboembolism, acute coronary syndrome (ACS), angina, myocardial infarction, cancer, macular degeneration, inflammation, hay fever, atherosclerosis and/or rheumatoid arthritis,
 
wherein in a further embodiment the pharmaceutically active compound comprises at least one peptide for the treatment and/or prophylaxis of diabetes mellitus or complications associated with diabetes mellitus such as diabetic retinopathy,
 
wherein in a further embodiment the pharmaceutically active compound comprises at least one human insulin or a human insulin analogue or derivative, glucagon-like peptide (GLP-1) or an analogue or derivative thereof, or exendin-3 or exendin-4 or an analogue or derivative of exendin-3 or exendin-4.
 
         [0037]    Insulin analogues are for example Gly(A21), Arg(B31), Arg(B32) human insulin; Lys(B3), Glu(B29) human insulin; Lys(B28), Pro(B29) human insulin; Asp(B28) human insulin; human insulin, wherein proline in position B28 is replaced by Asp, Lys, Leu, Val or Ala and wherein in position B29 Lys may be replaced by Pro; Ala(B26) human insulin; Des(B28-B30) human insulin; Des(B27) human insulin and Des(B30) human insulin. 
         [0038]    Insulin derivatives are for example B29-N-myristoyl-des(B30) human insulin; B29-N-palmitoyl-des(B30) human insulin; B29-N-myristoyl human insulin; B29-N-palmitoyl human insulin; B28-N-myristoyl LysB28ProB29 human insulin; B28-N-palmitoyl-LysB28ProB29 human insulin; B30-N-myristoyl-ThrB29LysB30 human insulin; B30-N-palmitoyl-ThrB29LysB30 human insulin; B29-N—(N-palmitoyl-Y-glutamyl)-des(B30) human insulin; B29-N—(N-lithocholyl-Y-glutamyl)-des(B30) human insulin; B29-N-(ω-carboxyheptadecanoyl)-des(B30) human insulin and B29-N-(ω-carboxyheptadecanoyl) human insulin. 
         [0039]    Exendin-4 for example means Exendin-4(1-39), a peptide of the sequence H-His-Gly-Glu-Gly-Thr-Phe-Thr-Ser-Asp-Leu-Ser-Lys-Gln-Met-Glu-Glu-Glu-Ala-Val-Arg-Leu-Phe-Ile-Glu-Trp-Leu-Lys-Asn-Gly-Gly-Pro-Ser-Ser-Gly-Ala-Pro-Pro-Pro-Ser-NH2. 
         [0040]    Exendin-4 derivatives are for example selected from the following list of compounds: 
       H-(Lys)4-des Pro36, des Pro37 Exendin-4(1-39)-NH2, 
     H-(Lys)5-des Pro36, des Pro37 Exendin-4(1-39)-NH2, 
     des Pro36 Exendin-4(1-39), 
     des Pro36 [Asp28] Exendin-4(1-39), 
     des Pro36 [IsoAsp28] Exendin-4(1-39), 
     des Pro36 [Met(O)14, Asp28] Exendin-4(1-39), 
     des Pro36 [Met(O)14, IsoAsp28] Exendin-4(1-39), 
     des Pro36 [Trp(O2)25, Asp28] Exendin-4(1-39), 
     des Pro36 [Trp(O2)25, IsoAsp28] Exendin-4(1-39), 
     des Pro36 [Met(O)14 Trp(O2)25, Asp28] Exendin-4(1-39), 
     des Pro36 [Met(O)14 Trp(O2)25, IsoAsp28] Exendin-4(1-39); or 
     des Pro36 [Asp28] Exendin-4(1-39), 
     des Pro36 [IsoAsp28] Exendin-4(1-39), 
     des Pro36 [Met(O)14, Asp28] Exendin-4(1-39), 
     des Pro36 [Met(O)14, IsoAsp28] Exendin-4(1-39), 
     des Pro36 [Trp(O2)25, Asp28] Exendin-4(1-39), 
     des Pro36 [Trp(O2)25, IsoAsp28] Exendin-4(1-39), 
     des Pro36 [Met(O)14 Trp(O2)25, Asp28] Exendin-4(1-39), 
     des Pro36 [Met(O)14 Trp(O2)25, IsoAsp28] Exendin-4(1-39), 
       [0041]    wherein the group -Lys6-NH2 may be bound to the C-terminus of the Exendin-4 derivative;
 
or an Exendin-4 derivative of the sequence
 
       des Pro36 Exendin-4(1-39)-Lys6-NH2 (AVE0010), 
     H-(Lys)6-des Pro36 [Asp28] Exendin-4(1-39)-Lys6-NH2, 
     des Asp28 Pro36, Pro37, Pro38Exendin-4(1-39)-NH2, 
     H-(Lys)6-des Pro36, Pro38 [Asp28] Exendin-4(1-39)-NH2, 
     H-Asn-(Glu)5des Pro36, Pro37, Pro38 [Asp28] Exendin-4(1-39)-NH2, 
     des Pro36, Pro37, Pro38 [Asp28] Exendin-4(1-39)-(Lys)6-NH2, 
     H-(Lys)6-des Pro36, Pro37, Pro38 [Asp28] Exendin-4(1-39)-(Lys)6-NH2, 
     H-Asn-(Glu)5-des Pro36, Pro37, Pro38 [Asp28] Exendin-4(1-39)-(Lys)6-NH2, 
     H-(Lys)6-des Pro36 [Trp(O2)25, Asp28] Exendin-4(1-39)-Lys6-NH2, 
     H-des Asp28 Pro36, Pro37, Pro38 [Trp(O2)25] Exendin-4(1-39)-NH2, 
     H-(Lys)6-des Pro36, Pro37, Pro38 [Trp(O2)25, Asp28] Exendin-4(1-39)-NH2, 
     H-Asn-(Glu)5-des Pro36, Pro37, Pro38 [Trp(O2)25, Asp28] Exendin-4(1-39)-NH2, 
     des Pro36, Pro37, Pro38 [Trp(O2)25, Asp28] Exendin-4(1-39)-(Lys)6-NH2, 
     H-(Lys)6-des Pro36, Pro37, Pro38 [Trp(O2)25, Asp28] Exendin-4(1-39)-(Lys)6-NH2, 
     H-Asn-(Glu)5-des Pro36, Pro37, Pro38 [Trp(O2)25, Asp28] Exendin-4(1-39)-(Lys)6-NH2, 
     H-(Lys)6-des Pro36 [Met(O)14, Asp28] Exendin-4(1-39)-Lys6-NH2, 
     des Met(O)14 Asp28 Pro36, Pro37, Pro38 Exendin-4(1-39)-NH2, 
     H-(Lys)6-desPro36, Pro37, Pro38 [Met(O)14, Asp28] Exendin-4(1-39)-NH2, 
     H-Asn-(Glu)5-des Pro36, Pro37, Pro38 [Met(O)14, Asp28] Exendin-4(1-39)-NH2, 
     des Pro36, Pro37, Pro38 [Met(O)14, Asp28] Exendin-4(1-39)-(Lys)6-NH2, 
     H-(Lys)6-des Pro36, Pro37, Pro38 [Met(O)14, Asp28] Exendin-4(1-39)-(Lys)6-NH2, 
     H-Asn-(Glu)5 des Pro36, Pro37, Pro38 [Met(O)14, Asp28] Exendin-4(1-39)-(Lys)6-NH2, 
     H-Lys6-des Pro36 [Met(O)14, Trp(O2)25, Asp28] Exendin-4(1-39)-Lys6-NH2, 
     H-des Asp28 Pro36, Pro37, Pro38 [Met(O)14, Trp(O2)25] Exendin-4(1-39)-NH2, 
     H-(Lys)6-des Pro36, Pro37, Pro38 [Met(O)14, Asp28] Exendin-4(1-39)-NH2, 
     H-Asn-(Glu)5-des Pro36, Pro37, Pro38 [Met(O)14, Trp(O2)25, Asp28] Exendin-4(1-39)-NH2, 
     des Pro36, Pro37, Pro38 [Met(O)14, Trp(O2)25, Asp28] Exendin-4(1-39)-(Lys)6-NH2, 
     H-(Lys)6-des Pro36, Pro37, Pro38 [Met(O)14, Trp(O2)25, Asp28] Exendin-4(S1-39)-(Lys)6-NH2, 
     H-Asn-(Glu)5-des Pro36, Pro37, Pro38 [Met(O)14, Trp(O2)25, Asp28] Exendin-4(1-39)-(Lys)6-NH2; 
       [0042]    or a pharmaceutically acceptable salt or solvate of any one of the afore-mentioned Exendin-4 derivative. 
         [0043]    Hormones are for example hypophysis hormones or hypothalamus hormones or regulatory active peptides and their antagonists as listed in Rote Liste, ed. 2008, Chapter 50, such as Gonadotropine (Follitropin, Lutropin, Choriongonadotropin, Menotropin), Somatropine (Somatropin), Desmopressin, Terlipressin, Gonadorelin, Triptorelin, Leuprorelin, Buserelin, Nafarelin, Goserelin. 
         [0044]    A polysaccharide is for example a glucosaminoglycane, a hyaluronic acid, a heparin, a low molecular weight heparin or an ultra low molecular weight heparin or a derivative thereof, or a sulphated, e.g. a poly-sulphated form of the above-mentioned polysaccharides, and/or a pharmaceutically acceptable salt thereof. An example of a pharmaceutically acceptable salt of a poly-sulphated low molecular weight heparin is enoxaparin sodium. 
         [0045]    Antibodies are globular plasma proteins (˜150 kDa) that are also known as immunoglobulins which share a basic structure. As they have sugar chains added to amino acid residues, they are glycoproteins. The basic functional unit of each antihousing is an immunoglobulin (Ig) monomer (containing only one Ig unit); secreted antibodies can also be dimeric with two Ig units as with IgA, tetrameric with four Ig units like teleost fish IgM, or pentameric with five Ig units, like mammalian IgM. 
         [0046]    The Ig monomer is a “Y”-shaped molecule that consists of four polypeptide chains; two identical heavy chains and two identical light chains connected by disulfide bonds between cysteine residues. Each heavy chain is about 440 amino acids long; each light chain is about 220 amino acids long. Heavy and light chains each contain intrachain disulfide bonds which stabilize their folding. Each chain is composed of structural domains called Ig domains. These domains contain about 70-110 amino acids and are classified into different categories (for example, variable or V, and constant or C) according to their size and function. They have a characteristic immunoglobulin fold in which two β sheets create a “sandwich” shape, held together by interactions between conserved cysteines and other charged amino acids. 
         [0047]    There are five types of mammalian Ig heavy chain denoted by α, δ, ε, γ, and μ. The type of heavy chain present defines the isotype of antibody; these chains are found in IgA, IgD, IgE, IgG, and IgM antibodies, respectively. 
         [0048]    Distinct heavy chains differ in size and composition; α and γ contain approximately 450 amino acids and δ approximately 500 amino acids, while μ and ε have approximately 550 amino acids. Each heavy chain has two regions, the constant region (CH) and the variable region (VH). In one species, the constant region is essentially identical in all antibodies of the same isotype, but differs in antibodies of different isotypes. Heavy chains γ, α and δ have a constant region composed of three tandem Ig domains, and a hinge region for added flexibility; heavy chains μ and ε have a constant region composed of four immunoglobulin domains. The variable region of the heavy chain differs in antibodies produced by different B cells, but is the same for all antibodies produced by a single B cell or B cell clone. The variable region of each heavy chain is approximately 110 amino acids long and is composed of a single Ig domain. 
         [0049]    In mammals, there are two types of immunoglobulin light chain denoted by λ and κ. A light chain has two successive domains: one constant domain (CL) and one variable domain (VL). The approximate length of a light chain is 211 to 217 amino acids. Each antibody contains two light chains that are always identical; only one type of light chain, κ or λ, is present per antibody in mammals. 
         [0050]    Although the general structure of all antibodies is very similar, the unique property of a given antibody is determined by the variable (V) regions, as detailed above. More specifically, variable loops, three each the light (VL) and three on the heavy (VH) chain, are responsible for binding to the antigen, i.e. for its antigen specificity. These loops are referred to as the Complementarity Determining Regions (CDRs). Because CDRs from both VH and VL domains contribute to the antigen-binding site, it is the combination of the heavy and the light chains, and not either alone, that determines the final antigen specificity. 
         [0051]    An “antibody fragment” contains at least one antigen binding fragment as defined above, and exhibits essentially the same function and specificity as the complete antibody of which the fragment is derived from. Limited proteolytic digestion with papain cleaves the Ig prototype into three fragments. Two identical amino terminal fragments, each containing one entire L chain and about half an H chain, are the antigen binding fragments (Fab). The third fragment, similar in size but containing the carboxyl terminal half of both heavy chains with their interchain disulfide bond, is the crystalizable fragment (Fc). The Fc contains carbohydrates, complement-binding, and FcR-binding sites. Limited pepsin digestion yields a single F(ab′)2 fragment containing both Fab pieces and the hinge region, including the H—H interchain disulfide bond. F(ab′)2 is divalent for antigen binding. The disulfide bond of F(ab′)2 may be cleaved in order to obtain Fab′. Moreover, the variable regions of the heavy and light chains can be fused together to form a single chain variable fragment (scFv). 
         [0052]    Pharmaceutically acceptable salts are for example acid addition salts and basic salts. Acid addition salts are e.g. HCl or HBr salts. Basic salts are e.g. salts having a cation selected from alkali or alkaline, e.g. Na+, or K+, or Ca2+, or an ammonium ion N+(R1)(R2)(R3)(R4), wherein R1 to R4 independently of each other mean: hydrogen, an optionally substituted C1-C6-alkyl group, an optionally substituted C2-C6-alkenyl group, an optionally substituted C6-C10-aryl group, or an optionally substituted C6-C10-heteroaryl group. Further examples of pharmaceutically acceptable salts are described in “Remington&#39;s Pharmaceutical Sciences” 17. ed. Alfonso R. Gennaro (Ed.), Mark Publishing Company, Easton, Pa., U.S.A., 1985 and in Encyclopedia of Pharmaceutical Technology. 
         [0053]    Pharmaceutically acceptable solvates are for example hydrates. 
         [0054]    The disclosure relates to a mechanism for use in a medical device that can be operated to deliver variable, user-selectable doses of medicament from a cartridge, via a needle. The mechanism provides simple, push button trigger operation. A dose is set by rotating a dial grip located on the housing of the device and is injected by pushing the separate trigger button. The mechanism contains a factory pre-charged compression spring, the extension of which dispenses medicament and is controlled by the user via a spur gear-based release mechanism. The device provides audible, visual and tactile feedback both on setting and delivery of each dose. 
         [0055]    This device is a disposable, user-selectable, variable dose pen injector that can be used with cartridges containing liquid medicament. It has a novel layout, and is particularly attractive for ergonomic reasons (comfortable to hold, a dose display with every dose number, compact, low setting torque, short button travel, and low dispense force). 
     
    
     
       BRIEF DESCRIPTION OF THE FIGURES 
         [0056]    Non-limiting, exemplary embodiments of the disclosure will now be described with reference to the accompanying drawings, in which: 
           [0057]      FIG. 1  shows a cut away view of the drug delivery device of the present disclosure; 
           [0058]      FIG. 2  shows a cut away view of the cable and spring of the device of  FIG. 1 ; 
           [0059]      FIG. 3  shows a detail view of the clicker mechanism of the device of  FIG. 1 ; 
           [0060]      FIG. 4 a    shows a partial section view of the release mechanism of the device of  FIG. 1  before dialing; 
           [0061]      FIG. 4 b    shows a partial section view of the release mechanism of the device of  FIG. 1  during dialing; 
           [0062]      FIG. 5  shows a cut away view of the release mechanism during dose setting of the device of  FIG. 1 ; 
           [0063]      FIG. 6  shows a cut away view of the release mechanism during dose dispensing of the device of  FIG. 1 ; 
           [0064]      FIGS. 7 a    &amp;  b  show partial section view of the dose stop of the device of  FIG. 1  during dose setting and dose dispensing; 
           [0065]      FIG. 8  shows a cut away view of the last dose lock-out mechanism of the device of  FIG. 1 ; 
           [0066]      FIG. 9  shows a view of the last dose nut engaged with the last dose spool; and 
           [0067]      FIGS. 10 a, b    show top and bottom views of the dose counter mechanism. 
       
    
    
     DETAILED DESCRIPTION 
       [0068]    The mechanism comprises the following key components as depicted in  FIG. 1 : a housing  10 , a chassis  20 , a dose button  30 , a dose selector in the form of a dial grip  40 , a dose counter mechanism  50  with a units number wheel  51  and a tens number wheel  52 , a clutch  60 , a last dose spool  70 , a last dose nut  80 , a dose ring gear  90 , a release gear  100 , a cable  110  with a piston  111  or bearing disc, a piston spring  120 , a clutch lever  130  with and a cartridge  140 . 
         [0069]    The medicament cartridge  140  is housed within a cartridge holder component  11  of housing  10 . The cartridge holder  11  is rigidly connected to the housing  10  of the pen injector during assembly. The piston  111  is a bearing component located on the main axis I of the pen injector, and is rigidly connected to the cable  110  and the piston spring  120  on its proximal face, and on its distal face abuts the bung  141  of the medicament cartridge  140 . The proximal end of the piston spring  120  reacts on the chassis  20 . 
         [0070]    The proximal end of the cable  110  is terminated on and wrapped around a cable spool  101  of the release gear  100 . As the cable spool  101  rotates, a controlled length of the cable  110  is released, forced by the action of the piston spring  120  via the piston  111 , causing the piston  111  to advance into the medicament cartridge  140  and dispel some of the medicament. The cable spool  101  is attached and locked in rotation to the release gear  100 . The release gear  100  is able to rotate relative to the chassis  20  and the dose counter mechanism  50  about a fixed axis II, perpendicular to the main medicament cartridge axis I. The amount that the release gear  100  rotates during dispense of a dose is defined by the user, and controlled by the release mechanism. This consists of the dose ring gear  90 , a clutch gear  61  with a first gear wheel  62  and a second gear wheel  63  connected via a shaft portion, a clutch lever  130 , the dial grip  40  and dose stop element  150 . As can be seen in  FIGS. 5 and 6 , the clutch gear  61  has a rotational axis III which is parallel to and off-set from the rotational axis II of the release gear  100 . 
         [0071]    The clutch lever  130  is pivotably supported in the chassis  20  such that actuation of the button  30  swivels the clutch lever  30 , thus raising or lowering the clutch gear  61  as shown in  FIGS. 5 and 6  via a sleeve-like end of the clutch lever  130  supporting the clutch gear  61 . The opposite end of clutch lever  130  actuates stop element  150  by raising it from the blocking position in which release member  100  is prevented from rotation for dose dispensing or lowering it into the locking position after dispensing. 
         [0072]    When the device is in its “dose setting mode” as shown in  FIG. 5 , i.e. the button  30  is not pressed by the user, the teeth of clutch gear  61  are engaged with the dial grip  40  and the dose ring gear  90 . This engagement causes the dose stop face on the dose ring gear  90  to be rotated away from the dose stop element  150  as the dose is dialed. The position of the dial grip  40  mid-dose is controlled by a dial clicker element which is biased to single-unit detent positions on the dial grip  40  (see  FIG. 3 ). Each of these detent positions corresponds to a single-unit during dialing. The set dose can be dialed both up and down (increasing and decreasing the dose number). An audible click will be produced by the dial clicker, once per unit increment. 
         [0073]    The rotational position of release gear  100  is locked via the dose stop element  150  to the housing  10  and chassis  20  throughout dose setting mode and in storage. A maximum, fixed dose limit stop feature between dose ring gear  90  and dose stop element  150  ensures the dose ring gear  90  is not dialed above the maximum permissible dose. 
         [0074]    To dispense the user-selected dose, the dose button  30  is pressed in, acting on the clutch lever  130 , causing it to rotate about its central pivot and move the clutch gear  61  axially into the dispense position (see  FIG. 6 ). In the dispense position, the clutch gear  61  is engaged with the release gear  100  and the dose ring gear  90 , and disengaged from the dial grip  40 . The axial movement of the clutch gear  61  is limited by features which act on the release gear  100  and the dial grip  40 . 
         [0075]    The order in which the clutch gear  61  disengages and engages with the other release mechanism components is important to ensure that the spring energy is not released in an unsafe manner. As the clutch lever  130  moves from the set position, it first locks the rotation of the dial grip  40  by moving the dial clicker into a position whereby it requires a very high torque to dial either up or down. As the clutch lever  130  continues to move it causes the clutch gear  61  to axially engage the release gear  100 . The clutch gear  61  and the release gear  100  have chamfered teeth for ease of engagement to accommodate moulding and positional tolerances. As the clutch lever  130  continues to move further, it causes the clutch gear  61  to disengage from the dial grip  40  so that the last dose mechanism is not rewound and the dial grip  40  does not spin during dispense (preventing the user from jamming the device by touching it). Finally, the clutch lever  130  causes the dose stop element  150  to disengage from the release gear  100  (see  FIG. 7 ), allowing the cable spool  101  and the release gear  100  to rotate, releasing some cable  110  and permitting the piston spring  120  to move the bung  141  by piston  111 . The cable spool  101  of the release gear  100  rotates (keyed to the dose ring gear  90 ) until the stop face on the dose ring gear  90  contacts the dose stop element  150 , preventing any further rotation and ending dispense. 
         [0076]    When the dose button  30  is released after the dose has been expelled, the action of the release mechanism is reversed. The dose stop element  150  re-engages with the release gear  100 , then the clutch gear  61  engages with the dial grip  40 , then the clutch gear  61  disengages with the release gear  100 , and finally the dial clicker is released, allowing the dial grip  40  to be dialed again. 
         [0077]    Preferably, there is a return spring integrated into the clutch lever  130  that provides the return force to move the components during this operation. A separate integrated spring on the dose button  30  returns it to its default position. Both springs act on the mechanism chassis  20 . 
         [0078]    When the medicament cartridge  140  has been emptied, the mechanism locks to prevent the user from setting another dose. As shown in  FIGS. 8 and 9 , the last dose spool  70  is restrained in the chassis  20  so that it is only able to rotate. It is geared to the dial grip  40  assembly. The last dose nut  80  is engaged with the thread on the last dose spool  70  and prevented from rotating by a spline engagement with the chassis  20 . When a dose is dialed, the dial grip  40  rotation causes the last dose spool  70  to rotate via their geared engagement. This rotation causes the last dose nut  80  to move axially up the thread of the last dose spool  70 . When a dose is dispensed, as the dial grip  40  is stationary, the last dose mechanism is also held stationary. Eventually, as the total number of doses dialed reaches the capacity of the medicament cartridge, the last dose nut  80  is so far up the thread on the last dose spool  70  that corresponding stop faces on the two components contact each other. This prevents the last dose spool  70  rotating and, therefore, prevents the dial grip  40  rotating, locking out the device. 
         [0079]    The size of the dialed dose is displayed to the user via a dose counter mechanism  50 . This consists of the following components: a counter drive gear  53  with a smaller pinion and a larger pinion, the units number wheel  51 , and the tens number wheel  52  (see  FIGS. 10 a, b   ). The mechanism is clutched to and is actuated by the dial grip  40  during dose setting, and is de-clutched from the dial grip  40  and actuated by the release gear  100  during dispense mode, both via the clutch gear  61 . This ensures the remaining dose is displayed throughout the whole dispense operation. 
         [0080]    The counter mechanism is situated in a recess within the dial grip  40 . The units number wheel  51  has gear teeth that are permanently engaged with the counter drive gear  53 , and a protrusion  54  (driving dog) that acts on the gear tooth-like features  55  (corresponding driven dogs) on the tens number wheel  52 . The counter chassis  21  allows the number wheel axes to remain fixed relative to the device housing  10  while the dial grip  40  rotates around them. 
         [0081]    Between indexed movement, the tens number wheel  52  is locked from rotating by scalloped recesses on the tens number wheel  52  which are restrained against the circular outer diameter of the units number wheel  51 . The tens number wheel  52  is indexed to display the next number by the rotating action of the protrusion on the units number wheel  51  which engage on every rotation of the units number wheel  51 . The counter drive gear  53  is in permanent toothed engagement with the clutch gear  61  so that it is rotated during dose setting and dispensing. 
         [0082]    As an alternative embodiment the aforementioned device with the cable  110  can also be embodied as a timing belt (not shown). This alternative concept differs predominantly as described below. In this embodiment, the cable  110  and cable spool  101  are replaced with a toothed timing belt, and a toothed belt drum. This has advantages in terms of assembly and robustness in use. The belt drum increases the radius of curvature of the timing belt, thus reducing the stress that it is subjected to. The piston may be of a different design to allow integration with the timing belt. The timing belt has toothed regions at both ends of a plain cross section region, which makes up the majority of the length of the belt. The toothed regions allow permanent attachment to the piston at the distal end and the belt drum at the proximal end of the device. The plain region is wrapped around approximately 75% of the belt drum, and then runs down the inside of the piston spring  120  to the piston. The inner surface of the belt drum is in toothed engagement with the smaller pinion region of the release gear  100 . 
         [0083]    This alternative embodiment shares the other major functionality with the embodiment comprising the cable  110 . This includes, but is not limited to: the dialing and dose setting mechanism, action of the clutch gear  61 , zero and maximum unit dose stops, last dose lockout and dose display. 
         [0000]    
       
         
               
             
               
               
             
           
               
                   
               
               
                 Reference Numerals: 
               
               
                   
               
             
             
               
                   
               
             
          
           
               
                 10 
                 housing 
               
               
                 11 
                 cartridge holder 
               
               
                 20 
                 chassis 
               
               
                 21 
                 counter chassis 
               
               
                 30 
                 dose button (trigger) 
               
               
                 40 
                 dial grip (dose selector) 
               
               
                 50 
                 dose counter mechanism 
               
               
                 51 
                 units number wheel 
               
               
                 52 
                 tens number wheel 
               
               
                 53 
                 counter drive gear 
               
               
                 54 
                 protrusion (driving dog) 
               
               
                 55 
                 tooth-like feature (driven dog) 
               
               
                 60 
                 clutch 
               
               
                 61 
                 clutch gear 
               
               
                 62 
                 first gear wheel 
               
               
                 63 
                 second gear wheel 
               
               
                 70 
                 last dose spool 
               
               
                 80 
                 last dose nut 
               
               
                 90 
                 dose ring gear 
               
               
                 100 
                 release gear 
               
               
                 101 
                 cable spool 
               
               
                 110 
                 cable 
               
               
                 111 
                 piston 
               
               
                 120 
                 piston spring 
               
               
                 130 
                 clutch lever 
               
               
                 140 
                 cartridge 
               
               
                 141 
                 bung 
               
               
                 150 
                 dose stop element 
               
               
                 I 
                 main axis 
               
               
                 II 
                 axis of rotation 
               
               
                 III 
                 axis of clutch gear