Intranasal baclofen

Abstract

The present invention provides an intranasal baclofen formulation, an intranasal delivery device and a method for the treatment of muscular dystonia and myotonia.

Description

[0001] Related Applications

[0002] This application claims priority to U.S. Provisional Application Serial No. 63 / 337,585, filed on May 2, 2022, which is incorporated herein by reference in its entirety. Technical Field

[0003] In particular, the present application relates to formulations containing baclofen that are stable in, compatible with, and deliverable via intranasal administration devices. Background Art

[0004] Baclofen is a skeletal muscle relaxant and antispasmodic agent. Baclofen is a structural analog of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) and may work by stimulating GABA B receptor subtypes to exert their effects.

[0005] Intrathecal (baclofen injection) has been developed for chronic intrathecal infusion for the treatment of severe spasticity. Baclofen can be administered orally, but when injected directly into the patient's intrathecal space, therapeutically effective intrathecal concentrations are achieved, with the resulting plasma concentrations being 100-fold lower than those following oral administration. Therefore, baclofen injection ( Intrathecal, Medtronic, Inc.) is usually administered intrathecally to treat severe spasticity of spinal origin. Currently, baclofen is commercially available for intrathecal injection as a 0.05 mg / mL solution, a 0.5 mg / mL solution, or a 2 mg / mL solution with a pH of 5 to 7 in the following preservative-free formulation ( Intrathecal): baclofen (0.05 mg, 0.5 mg or 2 mg); sodium chloride (9 mg); water for injection qs 1 mL.

[0006] For many patients with severe spasticity, the 0.5 mg / mL and 2 mg / mL concentrations have been shown to be effective for administration via an implantable infusion device such as the SYNCHROMED However, such devices require surgery to implant the infusion set and catheter, which is associated with significant infection and complication rates and the need for regular re-implantation due to the limited battery life of the implanted device.

[0007] In fact, Haranhalli et al. note that approximately 20%-30% of patients with intrathecal baclofen pumps experience some type of complication. On average, a patient requires 3.5 procedures, has a total infection risk of 14.6%, and a total pump and catheter problem risk of 19.7%.

[0008] Complications can be divided into both mechanical and / or infection-related complications. Common mechanical complications include pump failure (battery failure or pump stall), catheter difficulties (kinking, breaking, rupture), CSF leaks at the catheter insertion site, and adhesion formation around the catheter site. Common types of infection include wound infection, pump or catheter infection, or, in rare cases, meningitis. Use of an intrathecal baclofen pump requires the patient to attend regular follow-up appointments where the healthcare provider will monitor dosing, refill the pump, and surgically replace the pump when the battery is about to expire.

[0009] Surgical risks and complications limit a large number of patients from receiving intrathecal baclofen therapy, despite its effectiveness over enteral agents. As only enteral and intrathecal drug delivery routes are available, there is a large unmet need for treatments that optimize hypertonia. Therefore, there is a clinical need to provide a non-invasive and cost-effective treatment for spasticity with minimal side effects. Summary of the invention

[0010] The present teachings provide a method of treating a patient with a condition treatable with baclofen, the method comprising: applying to one or more nasal mucosa of the patient a pharmaceutically acceptable solution for nasal administration consisting of a saline solution of baclofen. In various embodiments, the condition may be one or a combination of hypertonia, spasticity, and dystonia. In further embodiments, the saline solution further comprises an additive selected from the group consisting of citric acid, cyclodextrin, and hypromellose. In yet another embodiment, the drug solution is a pharmaceutically acceptable spray formulation having a volume of about 10 μL to about 200 μL. In another embodiment, the administration of the drug solution comprises spraying at least a portion of a therapeutically effective amount of baclofen into at least one nostril. In another embodiment, the administration of the drug solution comprises spraying at least a portion of a therapeutically effective amount of baclofen into each nostril. In another embodiment, the administration of the drug solution comprises spraying a first amount of the drug solution into a first nostril, spraying a second amount of the drug solution into a second nostril, and optionally after a preselected time delay, spraying a third amount of the drug solution into the first nostril. In various aspects, administering further comprises administering at least a fourth amount of the drug solution to a second nostril, optionally after a preselected time delay. In yet another embodiment, nasal administration of the drug solution is initiated at any time before or after the onset of symptoms of a condition treatable with the drug solution. In another embodiment, the bioavailability achieved by treatment is about 80%-125% of the bioavailability achieved by the same baclofen administered intrathecally.

[0011] Further teachings provide a pharmaceutical solution for nasal administration, the pharmaceutical solution consisting of: (a) baclofen or a pharmaceutically acceptable salt thereof; and (b) one or more of the following: citric acid, cyclodextrin, and hypromellose, or any combination thereof, in an amount of about 30% to about 95% (w / w); the pharmaceutical solution is a pharmaceutically acceptable formulation for administration to one or more nasal mucosa of a patient. In various embodiments, baclofen is present in the pharmaceutical solution at a concentration of about 2.0 mg / mL to about 10.0 mg / mL.

[0012] Still further teachings provide a device for delivering a drug solution, the device comprising a drug solution of baclofen or a pharmaceutically acceptable salt thereof; and one or more of: citric acid, cyclodextrin, and hypromellose, or any combination thereof, in an amount of about 30% to about 95% (w / w); the drug solution is a pharmaceutically acceptable formulation, wherein the drug solution is stored in a cartridge; a nebulizer, wherein the nebulizer receives the baclofen formulation from the cartridge and delivers the baclofen formulation to a patient's nasal cavity; an optional dose adjustment control, wherein the dose adjustment control determines the amount of baclofen formulation to be delivered; and a spray control, wherein the spray control triggers delivery of the baclofen formulation to the patient's nasal cavity.

[0013] In one aspect of the invention, a method of treating a patient with a condition treatable with baclofen comprises administering to one or more nasal mucosa of the patient a pharmaceutically acceptable solution for nasal administration consisting of a saline solution of baclofen. The condition may be selected from the group consisting of hypertonia, spasticity, and dystonia. In some embodiments, the saline solution further comprises an additive selected from the group consisting of citric acid, cyclodextrin, and hypromellose. The drug solution may be a pharmaceutically acceptable spray formulation having a volume of about 10 μL to about 200 μL. Administration of the drug solution may include spraying at least a portion of a therapeutically effective amount of baclofen into at least one nostril or spraying at least a portion of a therapeutically effective amount of baclofen into each nostril. Administration of the drug solution may include spraying a first amount of the drug solution into a first nostril, spraying a second amount of the drug solution into a second nostril, and optionally after a preselected time delay, spraying a third amount of the drug solution into the first nostril. Optionally, after a preselected time delay, at least a fourth amount of the drug solution may be administered to the second nostril. Nasal administration of the drug solution may be initiated at any time before or after the onset of symptoms of a condition treatable with the drug solution. The bioavailability achieved with this treatment is approximately 80%-125% of the bioavailability achieved with the same baclofen administered intrathecally.

[0014] In another aspect of the invention, a pharmaceutical solution for nasal administration comprises (a) baclofen or a pharmaceutically acceptable salt thereof; and one or more of the following: (b) citric acid, cyclodextrin and hypromellose, or any combination thereof, in an amount of about 30% to about 95% (w / w); the pharmaceutical solution is a pharmaceutically acceptable formulation for administration to one or more nasal mucosa of a patient. Baclofen may be present in the pharmaceutical solution at a concentration of about 2.0 mg / mL to about 10.0 mg / mL.

[0015]

[0011] These and other features, aspects, and advantages of the present teachings will become better understood with reference to the following description, examples, and appended claims.

[0016] BRIEF DESCRIPTION OF THE DRAWINGS

[0017] Those skilled in the art will appreciate that the drawings described below are for illustration purposes only and are not intended to limit the scope of the present teachings in any way.

[0018] Figure 1 Represents summary results of a study of approximately 40 patients. Grey bars represent patients treated with nasal baclofen, and white bars represent placebo. The left bar (negative) represents reduced tension, and the right bar (positive) represents worse tension. The middle line is unchanged. Statistically significant results are provided in the figure with error bars.

[0019] This graph shows the increment (change) in torque response measured at each patient visit relative to baseline. The first bar from left to right is the baseline compared to Visit 2 low dose (250mcg). The second bar from left to right is the baseline compared to Visit 3 medium dose (1000mcg). The third bar from left to right is the baseline compared to Visit 4 high dose (2000mcg). The fourth bar from left to right is the baseline compared to Visit 5 withdrawal back to baseline (providing some residual effect). The p-values ​​for the third group representing the high dose are: treatment p-value 0.004959 and control p-value 0.232.

[0020] Figure 2 is a depiction of an intranasal baclofen delivery device 101. The delivery device includes a baclofen cartridge 102 (in Figure 2 1 (shown in an upper position when not attached), which may be mounted to the airbrush housing 103. The nebulizer 104 may be mounted to the baclofen cartridge 102 at the nebulizer attachment point 106. Optionally, the dose of baclofen administered to the patient may be controlled by turning the dose adjustment dial 110. The baclofen dose is administered into the patient's nostrils using the spray button 111. Optionally, a cap 120 may be provided to enclose the baclofen cartridge and nebulizer when attached to the airbrush housing. DETAILED DESCRIPTION

[0021] Hypertonia is a common symptom in individuals with central nervous system (CNS) pathology. Excessive muscle tone may be of cerebral or spinal origin and may present as spasticity, dystonia, or rigidity, and often a combination is present. Many conditions can cause hypertonia, including cerebral palsy, acquired brain injury, metabolic disorders, leukodystrophy, stroke, multiple sclerosis, hydrocephalus, or spinal cord injury. Patients with hypertonia are unable to produce smooth and fluid limb movements due to an imbalance in signals from the brain and spinal cord, and may or may not experience spasticity. Severe spasticity is associated with pain, sleep disturbances, feeding problems, and difficulty with activities of daily living such as positioning, transferring, dressing, and hygiene.

[0022] Treatment of hypertonia involves a comprehensive evaluation by a large multidisciplinary team of professionals to develop a unique treatment plan that addresses the overall goals of the child and family. Available treatments for hypertonia include physical therapy (eg, forced induction therapy), enteral medications, botulinum toxin injections, intrathecal baclofen (ITB), and dorsal rhizotomy.

[0023] Baclofen is a GABA receptor B ) agonist, first reported by Hudgson et al. for the treatment of spasticity. As a drug that has been widely used on the market since it was approved by the FDA in 1977, baclofen is recommended for the treatment of severe spasticity or hypertonia.

[0024] Baclofen is initially administered enterally and is readily and rapidly absorbed from the gastrointestinal tract, however, only a small fraction of the dose crosses the blood-brain barrier (BBB) ​​and ultimately reaches its site of action in the central nervous system. Enteral baclofen doses in the range of 30 to 90 mg are associated with plasma levels of 0.05-0.65 mcg / mL and CSF levels of <0.012-0.096 mcg / mL.

[0025] The effects of systemic baclofen on the CNS are limited by the inability of baclofen to easily cross the blood-brain barrier. Baclofen relies on amino acid transporters to enter the cerebrospinal fluid.

[0026] Penn et al. introduced intrathecal baclofen (ITB), which directly bypasses the blood-brain barrier as a treatment for spasticity. When injected directly into the intrathecal space of a patient, therapeutically effective intrathecal concentrations of baclofen can be achieved, with the resulting plasma concentrations being 100-fold lower than those following enteral administration. Intrathecal administration of baclofen increases the concentration of baclofen present in the CSF of adults: an intrathecal dose of 400 μg is associated with concentrations approaching 400 μg / mL in the CSF and lower concentrations in the serum.

[0027] In 1996, ITB administered via an implanted pump was approved by the U.S. Food and Drug Administration for the treatment of spasticity. ITB has been clinically shown to be more effective than enteral baclofen in relieving spasticity. It can be used in patients who have not seen adequate reduction in their hypertonia or who experience unsustainable adverse side effects from enteral baclofen. Use of ITB allows the dose of baclofen to be maximized and its peripheral side effects to be minimized.

[0028] ITB therapy involves a surgical procedure to implant a subcutaneous pump into the patient's abdomen, and an additional catheter system is implanted into the spinal canal, with the tip of the catheter positioned within the cerebrospinal fluid (CSF). Direct access to the CSF results in higher concentrations of baclofen in the CNS, which also results in smaller dosing regimens than would be required for systemic administration.

[0029] However, ITB therapy requires surgical implantation of an infusion set and catheter, which is associated with significant infection and complication rates as well as the need for regular re-implantation due to limited battery life of the implanted device, thus creating a need for a more easily administered form of baclofen that achieves similar efficacy to intrathecal baclofen but with the ease of administration of enteral baclofen.

[0030] ITB therapy is the most effective treatment for severe spasticity and dystonia; however, it is associated with a relatively high complication rate and requires regular re-implantation due to the limited battery life of the implanted device.

[0031] It is necessary for the patient to have access to specialized medical care, and the patient and caregiver must be able to comply with the maintenance required by the pump. Caregiver reluctance is a barrier to caring for the patient. Pump size may be an issue for very small or thin patients. For extremely overweight hospitalized patients, it may not be possible to refill the pump, a situation further complicated by the fact that weight may be gained after the pump is implanted. Despite these limitations, studies have shown that most patients who use ITB pumps and their caregivers are satisfied with the results produced by this treatment.

[0032] Blood-brain barrier crossing

[0033] The blood-brain barrier (BBB) ​​is the primary regulator of drug transport into the CNS via specific transport pathways through a tightly controlled and dynamic process. From a clinical perspective, the problem is twofold: neuroleptics may not penetrate the BBB as effectively as enteral baclofen, and neuroleptics undergo first-pass metabolism in the systemic circulation, which may generate active metabolites with side effects, as is the case with enteral baclofen.

[0034] Non-invasive delivery, especially transnasal administration, has several advantages over traditional enteral medications because it targets a delivered dose with higher absorption than the enteral route, which means a smaller dose and less susceptibility to overdose complications. In addition, transnasal delivery avoids the complications of the invasive procedure required for intrathecal administration of baclofen.

[0035] Nasal administration bypasses the first-pass metabolism observed in enteral delivery, and the lungs and nasal cavity have low drug metabolism environments.The nasal route for delivering drugs to the brain via the olfactory region is an alternative solution to improve penetration across the BBB.

[0036] Compared to invasive strategies for bypassing the BBB, such as implanted pumps, the transnasal route can be used to deliver drugs noninvasively to the CNS. The surface area of ​​the nasal epithelium is small, approximately 150 cm 2 , and consists of respiratory and olfactory regions. Although the olfactory system possesses a complex epithelial, endothelial, and glial barrier, it provides direct access to the brain due to its unique anatomical positioning. Intranasal delivery offers the efficacy of intrathecal delivery, but with the convenience of enteral administration without the need for surgical procedures or implanted pumps.

[0037] The nasal absorption mechanism of baclofen tested in animals suggests that the absorption rate in the nasal mucosa is relatively large and occurs via passive diffusion and via carrier-mediated mechanisms responsible for transport of baclofen across the BBB.

[0038] The nasal mucosa nonspecifically and efficiently absorbs both enantiomers of baclofen. The observed concentration-independent transport and the absence of polarized flux in excised nasal tissue suggest that baclofen is absorbed primarily via simple passive diffusion through bovine nasal tissue.

[0039] Because the nasal membranes and the brain are in close proximity, nasal administration of baclofen may result in faster presentation of the drug to the brain. Thus, for example, patients with spasticity may see relief more quickly than with oral and / or intrathecal administration.

[0040] Intranasal baclofen and drug solutions for nasal administration

[0041] As used herein, baclofen refers to 4-amino-3-(p-chlorophenyl)butyric acid, its enantiomers, racemic mixtures, polymorphs, salts, solvates, esters or hydrates. Baclofen is described by the following structural formula:

[0042]

[0043] Baclofen includes R-baclofen (D-baclofen), S-baclofen (L-baclofen) or a mixture thereof (including a racemate). A racemate refers to a mixture of R and S-baclofen (DL-baclofen) in equal proportions.

[0044] As used herein, the phrase "pharmaceutically acceptable salt" means those salts of baclofen that are safe and effective for use in mammals and possess the desired biological activity. Salts of baclofen include salts of acidic or basic groups present in the compounds of the present application. Pharmaceutically acceptable acid addition salts include, but are not limited to, hydrochloride, hydrobromide, hydroiodide, nitrate, sulfate, bisulfate, phosphate, acid phosphate, isonicotinate, acetate, lactate, salicylate, citrate, tartrate, pantothenate, bitartrate, ascorbate, succinate, maleate, gentisate, fumarate, gluconate, glucuronate, sucrose salt, formate, benzoate, glutamate or pamoate. Certain compounds of the present invention may form pharmaceutically acceptable salts with various amino acids. Suitable base salts include, but are not limited to, aluminum, calcium, lithium, magnesium, potassium, sodium, zinc or diethanolamine salts. Potassium salts include potassium chloride, potassium bicarbonate, potassium phosphate, potassium gluconate, potassium citrate, and the like.

[0045] Those skilled in the art will recognize that baclofen and its pharmaceutically effective salts have low solubility and can be modified in solution to be delivered intranasally via the nasal route at higher concentrations, to achieve therapeutic levels of baclofen in the CNS more quickly, to avoid the hepatic portal vein, and to simultaneously avoid the first-pass effect and / or to present the baclofen drug to the brain more quickly. Pires et al. describe several modifications, including providing a carrier system that can be used to enhance the solubility of baclofen and thereby provide a more concentrated baclofen formulation. See Pires, PC et al., Strategies to Improve Drug Strength in Nasal Preparations for Brain Delivery of Low Aqueous Solubility Drugs. Pharmaceutics 2022, 14, 588 (available from DOI handle "10.3390 / pharmaceutics14030588"), which is incorporated herein by reference in its entirety.

[0046] For example, some baclofen salts are sparingly soluble in water, such that a therapeutically effective amount cannot be dissolved in a volume of aqueous solvent suitable for application to a mucosa. By using a carrier system, the present invention allows for administration of baclofen to one or more mucosa, including to the nasal mucosa. This can allow one to administer the drug without hospitalization or unnecessary discomfort. Additionally, in some embodiments of the present invention, such as nasal administration, the digestive system can be largely bypassed. The latter improvement can result in improved bioavailability, more rapid achievement of therapeutic levels of baclofen in the CNS and / or plasma, avoidance of the hepatic portal vein, and / or simultaneous avoidance of the first pass effect.

[0047] As provided in U.S. Pat. No. 9,180,108, it has been found that baclofen has increased solubility in solutions containing sulfate or phosphate. It has been described that baclofen at concentrations greater than 2 mg / mL, such as greater than 4 mg / mL, greater than 5 mg / mL, greater than 6 mg / mL, or greater than 7 mg / mL, can be dissolved in solutions containing phosphate, sulfate, potassium, or magnesium.

[0048] The drug solution may have any suitable ionic strength. The drug solution may include a salt, such as NaCl or KCl, to maintain the ionic strength. In various embodiments, the combined ionic strength of the drug solution contributed by the various components of the formulation, such as baclofen and one or more salts, is equivalent to an ionic strength of between about 0.1 M and 0.2 M NaCl or KCl, or about 0.15 M NaCl or KCl.

[0049] Preferably, the pharmaceutical solution has a pH between 5.0 and 7.5, such as between 5.5 and 6.5 or about 6.0. For example, the pH may be about 5.1, 5.2, 5.3, 5.4, 5.5, 5.6, 5.7, 5.8, 5.9, 6.0, 6.1, 6.2, 6.3, 6.4, 6.5, 6.6, 6.7, 6.8, 6.9, 7.0, 7.1, 7.2, 7.3, 7.4, or 7.5.

[0050] In some embodiments, the present invention describes the use of a stable aqueous solution of baclofen at a concentration greater than 2.0 mg / mL. Specifically, in some embodiments, the present invention provides a stable aqueous solution of baclofen at a concentration greater than about 2.0, 2.1, 2.2, 2.3, 2.4, 2.5, 2.6, 2.7, 2.8, 2.9, 3.0, 3.1, 3.2, 3.3, 3.4, 3.5, 3.6, 3.7, 3.8, 3.9, 4.0, 4.1, 4.2, 4.3, 4.4, 4.5, 4.6, 4.7, 4.8, 4.9, 5.0, 5.1, 5.2, 5.3, 5.4, 5.5, 5.6, 5.7, 5.8, 5.9, 6.0, 6.1, 6.2, 6.3, 6.4, 6.5, 6.6, 6.7, 6.8, 6.9, 7.0, 7.1, 7.2, 7.3, 7.4, 7.5, 7.6, 7.7, 7.8, 7.9, 8.0, 8.1, 8.2, 8.3, 8.4, 8.5, 8.6, 8.7, 8.8, 8.9, 9.0, 9.1, 9.2, 9.3, 9.4, 9.5, 9.6, 9.7, 9.8, 9.9, or 10.0 mg / mL of a stable aqueous solution of baclofen.

[0051] In various embodiments, the baclofen-containing pharmaceutical solution comprises (i) baclofen at a concentration greater than 2 mg / mL; and (ii) optionally sulfate or phosphate at a concentration between 5 mM and 25 mM. The solution has an ionic strength equivalent between 1.4 M NaCl and 1.6 M NaCl. In some embodiments, the solution consists essentially of baclofen, sulfate or phosphate, sodium ions, and water. In embodiments, the solution consists essentially of baclofen, sulfate or phosphate, sodium ions, chloride ions (e.g., from NaCl), and water.

[0052] In some embodiments, the aqueous solvent is preferably water, a saline solution (which, as used herein, means a solution consisting of or consisting essentially of water and dissolved sodium chloride), a sulfate or phosphate solution (which, as used herein, means a solution consisting of or consisting essentially of water and dissolved sulfate or phosphate or an acid), or a sulfate or phosphate saline solution (which, as used herein, means a solution consisting of or consisting essentially of water and dissolved sodium chloride and dissolved sulfate or phosphate or an acid).

[0053] The terminally sterilized intranasal baclofen formulation can have any suitable baclofen concentration, such as between 0.01 mg / mL and 10 mg / mL baclofen. In an embodiment, the terminally sterilized intranasal baclofen formulation has between 0.05 mg / mL and 2 mg / mL baclofen.

[0054] The pH can be adjusted with any suitable acid or base. In an embodiment, the pH is adjusted with HCl, H2SO4, H3PO4 or NaOH.

[0055] Preferably, a therapeutically effective amount of baclofen is administered to a patient in need of treatment. "Therapeutically effective amount" herein means a dose that produces the effect for which it is administered. The exact dose will depend on the purpose of the treatment and will be determined by one skilled in the art using known techniques. In some embodiments, a dose of about 0.5 micrograms / kg to about 5 micrograms / kg is used. As is known in the art, adjustments for systemic versus local delivery and the rate of new protease synthesis, as well as age, weight, general health, sex, diet, time of administration, drug interactions, and severity of the condition may be necessary and will be determined by one skilled in the art through routine experimentation.

[0056] In some embodiments, baclofen is delivered to the patient at a daily dose of between about 0.001 mg / kg / day and 100 mg / kg / day. For the purposes of this disclosure, "patients" include both humans and other animals, particularly mammals, including mice, rats, guinea pigs, rabbits, dogs, cats, pigs, cows, monkeys, baboons, chimpanzees and other organisms. Thus, the method is suitable for both human therapy and veterinary applications. In preferred embodiments, the patient is a mammal, such as a human. Those "in need of treatment" include mammals already suffering from a disease or disorder, as well as those prone to suffering from a disease or disorder, including those in need of prevention of the disease or disorder.

[0057] The baclofen formulations of the present invention allow for subsequent dilution by the addition of other components that are administered intranasally simultaneously with baclofen. These include analgesic drugs suitable for combination with baclofen, and include morphine, clonidine, hydromorphine, hydrocodone, merperidine, celeroxib, tramadol, oxycodone, acetaminophen, ketoprofen, ketorolac, ibuprofen, naproxen, etc. It will be appreciated in the art that other chemical compounds are equally suitable for co-administration or separate administration with baclofen in the present application.

[0058] In some embodiments, the pharmaceutical solution comprises at least one additional ingredient selected from the group consisting of: an active pharmaceutical ingredient; an enhancer; an excipient; and agents for adjusting pH, buffering the composition, preventing degradation, and improving appearance, smell, or taste.

[0059] Vector system

[0060] In some embodiments, the carrier system comprises one or more alcohols or glycols, or any combination thereof, in an amount of about 10% to about 55%, about 10% to about 40%, about 10% to about 35%, about 12% to about 55%, about 12% to about 40%, about 12% to about 35%, about 15% to about 55%, about 15% to about 40%, about 15% to about 35%, about 10%, about 12.5%, about 15%, about 17.5%, about 20%, about 22.5%, about 25%, about 27.5%, about 30%, about 32.5%, about 35%, about 37.5%, about 40%, about 42.5%, about 45%, about 47.5%, about 50%, about 52.5%, or about 55% (w / w). In some embodiments, the carrier system comprises one or more alcohols or diols, or any combination thereof, in an amount of about 25% to about 40% (w / w). In some embodiments, the carrier system comprises one or more alcohols or diols, or any combination thereof, in an amount of about 30% (w / w). In some embodiments, the alcohol is ethanol or contains ethanol. In some preferred embodiments, the diol does not include a diol polymer. In some preferred embodiments, the diol does not include a diol polymer having an average molecular weight greater than 200. In some embodiments, the diol does not include a polyethylene glycol having an average molecular weight greater than about 200.

[0061] Lower alkyl alcohols are those having six or fewer carbon atoms. Thus, any one of ethanol, propanol, butanol, pentanol, benzyl alcohol, any isomer thereof, or any combination thereof may be used.

[0062] Lower alkyl glycols are those having six or fewer carbon atoms. Thus, any one of ethylene glycol, propylene glycol, butylene glycol, pentanediol, any isomer thereof, or any combination thereof may be used.

[0063] Additional excipients

[0064] In some embodiments, the drug solution comprises at least one penetration enhancer in addition to baclofen. In some embodiments, the penetration enhancer is at least one alkyl glycoside. In some embodiments, an alkyl glycoside refers to any sugar linked to any hydrophobic alkyl group, as described in U.S. Pat. No. 5,661,130, which is incorporated herein by reference in its entirety. The hydrophobic alkyl group can be of any suitable length, for example, from about 9 to about 24 carbons in length, particularly from about 10 to about 14 carbons in length. The hydrophobic alkyl group can be branched and / or partially or fully unsaturated. The alkyl group can be linked to the sugar core, for example, via a carbonyl group, whereby an ester group can be formed. Suitable alkyl glycosides will have non-toxic, non-ionic characteristics and can increase the absorption of baclofen when administered intranasally as described herein. Exemplary sugars that can be covalently linked to an alkyl group according to the present invention include glucose, maltose, maltotriose, maltotetraose, sucrose, and trehalose. Exemplary alkyl glycosides that can be used include octyl-, nonyl-, decyl-, undecyl-, dodecyl, tridecyl, tetradecyl, pentadecyl, octadecyl α- or β-D-maltoside, -glucoside or sucrose. In some embodiments, preferred glycosides include maltose, sucrose or glucose connected to an alkyl chain of 9, 10, 12, 14, 16, 18 or 20 carbon atoms by a glycosidic bond. Specific excipients that can be used in the nasal composition according to the present invention include alkyl sugars, i.e., dodecyl maltoside, tetradecyl maltoside, sucrose dodecanoate, sucrose monostearate, sucrose distearate and / or a combination of two or more thereof. When present, the amount of alkyl glycoside in the composition is sufficient to enhance the absorption of baclofen administered by the intranasal route. In some embodiments, the amount of alkyl glycoside in the composition is selected to enhance the absorption of baclofen while not significantly irritating the nasal mucosa. In some embodiments, the amount of alkyl glycoside in the composition is in the range of about 0.01% (w / v) to about 1% (w / v). In some embodiments, the amount of alkyl glycoside in the composition ranges from about 0.05% (w / v) to about 0.5% (w / v), or from about 0.125% (w / v) to about 0.5% (w / v).

[0065] The term "penetration enhancer" means any material that acts to increase absorption through the mucosa and / or increase bioavailability. In some embodiments, such materials include mucolytic agents, degradative enzyme inhibitors, and compounds that increase the permeability of mucosal cell membranes. Whether a given compound is an "enhancer" can be determined by comparing two preparations (with or without an enhancer) containing non-associated small polar molecules as drugs in vivo or in a good model test and determining whether the uptake of the drug is enhanced to a clinically significant degree. Enhancers should not cause any problems in terms of chronic toxicity because in vivo enhancers should be non-irritating and / or rapidly metabolized into normal cell components that do not have any significant irritation.

[0066] In some embodiments, the preferred reinforcing material is a lysophospholipid, such as lysophosphatidylcholine, which can be obtained from egg or soy lecithin. Other lysophosphatidylcholines with different acyl groups can be used, as well as lyso compounds with similar membrane-modifying properties produced by phosphatidylethanolamine and phosphatidic acid. Acylcarnitines (e.g., palmitoyl-dl-carnitine chloride) are an alternative. In some embodiments, a suitable concentration is 0.02 to 20% (w / v).

[0067] In some embodiments, suitable enhancers include chelating agents (EGTA, EDTA, alginates), surfactants (especially non-ionic materials), acylglycerols, fatty acids and salts, tyloxapol, and biodetergents. Agents that alter membrane fluidity and permeability are also suitable, such as enamines (e.g., phenylalanine enamine of ethyl acetoacetate), malonates (e.g., divinyloxymethylene malonate), salicylates, bile salts and analogs, and fusidic acids. Suitable concentrations are up to 20% (w / v).

[0068] Mucosal preparations

[0069] Mucosal preparations are usually administered as a metered spray with a volume of less than 250 μL, preferably less than 150 μL, and ideally 25 to 100 μL. Although not prohibited in the present invention, administration of a volume greater than about 300 μL per dose usually exceeds the absorption capacity of the membrane. This results in the loss of most of the active pharmaceutical ingredient.

[0070] The dosage volume of the formulation, particularly the nasal formulation, is preferably in the range of 25 to 100 μL. Volumes exceeding this range may bypass the sinuses and flow down the back of the throat, where the excess volume may be swallowed.

[0071] Application

[0072] In some embodiments, administration of the composition comprises administering at least a portion of the therapeutically effective amount of baclofen to at least one mucosa. In some embodiments, administration of the composition comprises spraying at least a portion of the therapeutically effective amount of baclofen into at least one nostril. In some embodiments, administration of baclofen comprises spraying at least a portion of the therapeutically effective amount of baclofen into each nostril. In some embodiments, administration of baclofen comprises spraying a first amount of baclofen into a first nostril, spraying a second amount of baclofen into a second nostril, and optionally after a preselected time delay, spraying a third amount of baclofen into the first nostril. Some embodiments further comprise, optionally after a preselected time delay, administering at least a fourth amount of baclofen to a second nostril.

[0073] Examples

[0074] Aspects of the present teachings may be further understood in light of the following examples, which should not be construed as limiting the scope of the present teachings in any way.

[0075] Example 1 - Intranasal Baclofen Study

[0076] Forty (40) hospitalized patients with newly acquired brain injury receiving acute care in the PICU have been treated with intranasal baclofen. An intranasal aqueous solution containing 250mcg, 1000mcg, and / or 2000mcg of baclofen and 9 grams of sodium chloride per mL delivered baclofen to the CNS via the nasal route by bypassing the BBB.

[0077] The response to intranasal baclofen is much greater than that observed with enteral baclofen, even when the enteral baclofen dose has been maximized (>90 mg / day). Intranasal baclofen has been used in patients with newly acquired brain injury with hypertonia or paroxysmal sympathetic hyperactivity (PSH), where enteral baclofen has historically been the first-line agent. The efficacy of intranasal baclofen exceeds that observed with enteral baclofen, with much less sedation.

[0078] Example 2 - Subject treated with intranasal baclofen

[0079] A patient was admitted to the pediatric intensive care unit (PICU) with increased tone following surgical implantation of an intrathecal baclofen pump. The patient was on maximal doses of several enteral medications, including enteral baclofen. While in the PICU, he received a test dose of intranasal baclofen using commercially prepared intrathecal baclofen as the test dose (gablofen 2-50mcg vial delivered intranasally as a single administration). Despite withholding all enteral medications prior to the intranasal challenge, a significant improvement in tone was noted.

[0080] References cited

[0081] All publications, patents, patent applications, and other references cited in this application are incorporated herein by reference in their entirety for all purposes to the same extent as if each individual publication, patent, patent application, or other reference was specifically and individually indicated to be incorporated by reference in its entirety for all purposes. Citation of a reference herein should not be construed as an admission that this is prior art to the present invention.

[0082] Specifically intended to fall within the scope of the present invention and are incorporated herein by reference in their entirety are the following publications:

[0083] 1. Pandyan AD, Gregoric M, Barnes MP, et al. Spasticity: clinical perceptions, neurological realities and meaningful measurement. Disabil Rehabil 2005; 27: 2–6.

[0084] 2. Sanger TD, Delgado MR, Gaebler-Spira D, et al. Classification and definition of disorders causing hypertonia in childhood. Pediatrics. 2003; 111(1): e89-e97.

[0085] 3. Tilton AH. Therapeutic interventions for tone abnormalities in cerebral palsy. The American Society for Experimental NeuroTherapeutics 2006; 3: 217-24.

[0086] 4. Hudgson P, Weightman D. Baclofen in the treatment of spasticity. Br Med J. 1971; 4(5778): 15-27.

[0087] 5. Knutsson E, Lindblom UL, A. Plasma and cerebrospinal fluid levels of baclofen at optimal therapeutic responses in spastic paresis. Journal of the neurological sciences. 1974 Nov 1; 23(3): 473-84.

[0088] 6. Zhang H, Schmidt M, Murry DJ, Donovan MD. Permeation and systemic absorption of R- and S-baclofen across the nasal mucosa. J Pharm Sci. 2011;100(7):2717-2723. doi:10.1002 / jps.22499

[0089] 7. Penn RD, Kroin JS. Continuous intrathecal baclofen for severe spasticity. Lancet. 1985;2(8447):125-127。

[0090] 8. Ramstad K, Jahnsen R, Lofterod B, Skjeldal OH. Continuous intrathecal baclofen therapy in children with cerebral palsy–when does improvement emerge?Acta Paediatric. 2010;99:1661-65。

[0091] 9. Kraus T, Gegenleitner K, Svehlik M, Novak M, Steinwender G, Singer G. Long-term therapy with intrathecal baclofen improves quality of life in children with severe spastic cerebral palsy. Eur J Paediatr Neurol 2017;21:565-69。

[0092] 10. Dan B, Motta F, Vles JS et al. Consensus on the appropriate use of intrathecal baclofen(ITB)therapy in paediatric spasticity. Eur J Paediatr Neurol 2010;14(1):19-28。

[0093] 11. Imerci A, Rogers KJ, Pargas C, Sees JP, Miller F. Identification of Complications in Paediatric Cerebral Palsy Treated with Intrathecal Baclofen Pump: A Descriptive Analysis of 15 Years at One Institution. J Child Orthop 2019; 13(5):529 - 535。

[0094] 12. Haranhalli N, Anand D, Wisoff JH, Harter DH, Weiner HL, Blate M, Roth J. Intrathecal baclofen therapy: complication avoidance and management. Child's Nervous System. 2011 March; 27(3):421 - 7。

[0095] 13. Ghadiri M, Young PM, Traini D. Strategies to Enhance Drug Absorption via Nasal and Pulmonary Routes. Pharmaceutics. 2019 March 11; 11(3):113. DOI handle “10.3390 / pharmaceutics11030113”. PMID: 30861990; PMCID: PMC6470976

[0096] 14. Agu R.U., Ugwoke M.I., Armand M., Kinget R., Verbeke N. The lung as a route for systemic delivery of therapeutic proteins and peptides. Respir.Res. 2001; 2:198–209。

Claims

1. A method of treating a patient suffering from a condition treatable with baclofen, the method comprising: A pharmaceutically acceptable solution for nasal administration consisting of baclofen in saline is administered to one or more nasal mucosa of the patient.

2. The method of claim 1, wherein the disorder is selected from the group consisting of hypertonia, spasticity and dystonia.

3. The method of claim 1, wherein the saline solution further comprises an additive selected from the group consisting of citric acid, cyclodextrin, and hypromellose.

4. The method of claim 1, wherein the drug solution is a pharmaceutically acceptable spray formulation having a volume of about 10 μL to about 200 μL.

5. The method of claim 1, wherein administering the drug solution comprises spraying at least a portion of the therapeutically effective amount of the baclofen into at least one nostril.

6. The method of claim 1, wherein administering the drug solution comprises spraying at least a portion of the therapeutically effective amount of the baclofen into each nostril.

7. The method of claim 1, wherein administering the drug solution comprises spraying a first amount of the drug solution into a first nostril, spraying a second amount of the drug solution into a second nostril, and optionally after a preselected time delay, spraying a third amount of the drug solution into the first nostril.

8. The method of claim 7, further comprising administering at least a fourth amount of the drug solution to the second nostril, optionally after a preselected time delay.

9. The method of claim 1, wherein nasal administration of the drug solution is initiated at any time before or after the onset of symptoms of a condition treatable with the drug solution.

10. The method of claim 1, wherein the treatment achieves a bioavailability that is about 80%-125% of the bioavailability achieved by the same baclofen administered intrathecally.

11. A pharmaceutical solution for nasal administration, consisting of: (a) baclofen or a pharmaceutically acceptable salt thereof; and (b) one or more of the following: citric acid, cyclodextrin and hypromellose, or any combination thereof, in an amount of about 30% to about 95% (w / w); the pharmaceutical solution being a pharmaceutically acceptable formulation for administration to one or more nasal mucosa of a patient.

12. The pharmaceutical solution of claim 11, wherein the baclofen is present in the pharmaceutical solution at a concentration of about 2.0 mg / mL to about 10.0 mg / mL.

13. A device for delivering a drug solution, the device comprising: The drug solution according to claim 11, wherein the drug solution is stored in a cartridge; a nebulizer, wherein the nebulizer receives the baclofen formulation from the cartridge and delivers the baclofen formulation to a nasal cavity of a patient; optionally a dose adjustment control, wherein said dose adjustment control determines an amount of said baclofen formulation to be delivered; and and a spray control, wherein the spray control triggers delivery of the baclofen formulation to a nasal cavity of the patient.

Images