Specification
TREATMENT OF GLAUCOMA USING LAQUINIMOD
This application claims priority of U.S. Provisional Application
No. 61/904,962, filed November 15, 2013, the entire content of
which is hereby incorporated by reference herein.
Throughout this application, various publications are referred to
by first author and year of publication. Full citations for these
publications are presented in a References section immediately
before the claims. Disclosures of the documents and publications
referred to herein are hereby incorporated in their entireties by
reference into this application.
Background
Glaucoma is a group of ocular diseases characterized by
progressive damage to the eye at least partly due to elevated
intraocular pressure (IOP) (Merck Manual of Diagnosis and Therapy
(1999)) . Additionally, glaucoma is characterized by retinal
ganglion cell (RGC) death, axon loss and an excavated appearance
of the optic nerve head (Alward 1998) . Glaucoma can be diagnosed
before vision loss occurs by visual field testing and by
ophthalmoscopic examination of the optic nerve to detect
"cupping." The mean IOP in normal adults is 15 to 16 mm Hg; the
normal range is 10 to 2 1 mm Hg . One form of management of
glaucoma is based on lowering the IOP using topically applied
medications (Coleman 1999) .
Currently there are five major classes of medications that are
used to lower the IOP: b-adrenergic antagonists, adrenergic
agonists, parasympathomimetics, prostaglandin-like analogues and
carbonic anhydrase inhibitors (Medeiros et al . 2002) . Although
most medications are applied topically to the eye, they can cause
severe systemic side effects and adversely affect the quality of
the patient's life. If additional lowering of IOP is indicated or
if medication fails to sufficiently lower the IOP, laser
trabeculoplasty is usually the next step. If IOP is still not
adequately controlled, incisional glaucoma surgery is indicated
(Id) . The lowering of IOP, despite significantly reducing the
extent of neuronal loss, does not ensure cessation of the disease
process, because the loss of RGCs may continue. Recent studies of
the association between IOP regulation and visual field loss
after medical or surgical intervention showed that ongoing
neuronal loss reflected in visual field tests can be diminished
if the IOP is low. However, neuronal loss may continue to occur
after reduction of IOP (Bakalash et al . 2002) .
Glaucomatous optic neuropathy appears to result from specific
pathophysiological changes and subsequent death of RGCs and their
axons. The process of RGC death is thought to be biphasic: a
primary injury responsible for initiation of damage followed by a
slower, secondary degeneration attributable to the hostile
environment surrounding the degenerating cells (Kipnis et al .
2000) .
The molecular mechanism triggering RGC death has not been
identified. Deprivation of neurotrophic factors, ischemia,
chronic elevation of glutamate and disorganized nitric oxide
metabolism are suspected to be possible mechanisms (Farkas et al .
2001) . In addition, it is possible that the mechanisms leading
to RGC death share common features with other types of neuronal
injury, such as signaling by reactive oxygen species,
depolarization of mitochondria, or induction of transcriptionally
regulated cell death (Weinreb et al . 1999) .
Laquinimod
Laquinimod (LAQ) is a novel synthetic compound with high oral
bioavailability which has been suggested as an oral formulation
for the treatment of Multiple Sclerosis (MS) (Polman, 2005;
Sandberg-Wollheim, 2005) . Laquinimod and its sodium salt form are
described, for example, in U.S. Patent No. 6,077,851. The
mechanism of action of laquinimod is not fully understood. Animal
studies show it causes a Thl (T helper 1 cell, which produces
pro-inflammatory cytokines) to Th2 (T helper 2 cell, which
produces anti-inflammatory cytokines) shift with an anti
inflammatory profile (Yang, 2004; Bruck, 2011) . Another study
demonstrated (mainly via the NFkB pathway) that laquinimod
induced suppression of genes related to antigen presentation and
corresponding inflammatory pathways (Gurevich, 2010) . Other
suggested potential mechanisms of action include inhibition of
leukocyte migration into the CNS, increase of axonal integrity,
modulation of cytokine production, and increase in levels of
brain-derived neurotrophic factor (BDNF) (Runstrom, 2006; Bruck,
2011) .
The effects of laquinimod on glaucoma have not previously been
studied .
Summary of the Invention
The subject invention provides a method of treating a subject
afflicted with glaucoma comprising administering to the subject
an amount of laquinimod effective to treat the subject.
The subject invention also provides a method of treating a subject
suffering from retinal ganglion cell loss or retinal ganglion
cell damage, or of reducing retinal ganglion cell loss or damage
in a subject, comprising administering to the subject an amount
of laquinimod effective to reduce retinal ganglion cell loss or
retinal ganglion cell damage in the subject.
The subject invention also provides a method of treating a subject
suffering from elevated intraocular pressure, or of reducing
intraocular pressure in a subject, comprising administering to
the subject an amount of laquinimod effective to reduce
intraocular pressure in the subject.
The subject invention also provides a package comprising a ) a
pharmaceutical composition comprising an amount of laquinimod;
and b ) instruction for use of the pharmaceutical composition to
treat a subject afflicted with glaucoma.
The subject invention also provides a therapeutic package for
dispensing to, or for use in dispensing to, a subject afflicted
with glaucoma, which comprises a ) one or more unit doses, each
such unit dose comprising an amount of laquinimod thereof,
wherein the amount of said laquinimod in said unit dose is
effective, upon administration to said subject, to treat the
subject, and b ) a finished pharmaceutical container therefor,
said container containing said unit dose or unit doses, said
container further containing or comprising labeling directing the
use of said package in the treatment of said subject.
The subject invention also provides a pharmaceutical composition
and a package as described herein for use in treating a subject
afflicted with glaucoma.
The subject invention also provides a pharmaceutical composition
in unit dosage form, useful in treating a subject afflicted with
glaucoma, which comprises an amount of laquinimod; which amount
of said laquinimod in said composition is effective, upon
administration to said subject of one or more of said unit dosage
forms of said composition, to treat the subject.
The subject invention also provides a package comprising a ) a
pharmaceutical composition as described herein; and b )
instruction for use of the pharmaceutical composition to treat a
subject afflicted with glaucoma.
The subject invention also provides laquinimod for the manufacture
of a medicament for use in treating a subject afflicted glaucoma.
Brief Description of the Figures
Figure 1 : Example 1 : Mean DIOR (OHT minus Non-OHT) (mmHg) .
Figure 2 : Example 1 : % Fluoro-gold Labeled RGC Loss.
Figure 3 : Example 1 : Mean Fluoro-gold Labeled RGC count per mm2 .
Figure : Optic Nerve Injury Grade (1-5) .
Figure 5A : Example 1 : Representative images of the retinas with
FG-labeled RGC - Animal Number 48, Group 1 , Left Eye.
Figure 5B : Example 1 : Representative images of the retinas with
FG-labeled RGC - Animal Number 48, Group 1 , Right Eye.
Figure 5C : Example 1 : Representative images of the retinas with
FG-labeled RGC - Animal Number 59, Group 2 , Left Eye.
Figure 5D : Example 1 : Representative images of the retinas with
FG-labeled RGC - Animal Number 59, Group 2 , Right Eye.
Figure 5E : Example 1 : Representative images of the retinas with
FG-labeled RGC - Animal Number 22, Group 3 , Left Eye.
Figure 5F : Example 1 : Representative images of the retinas with
FG-labeled RGC - Animal Number 22, Group 3 , Right Eye.
Figure 5G : Example 1 : Representative images of the retinas with
FG-labeled RGC - Animal Number 31, Group 4 , Left Eye.
Figure 5H : Example 1 : Representative images of the retinas with
FG-labeled RGC - Animal Number 31, Group 4 , Right Eye.
Figure 5 : Example 1 : Representative images of the retinas with
FG-labeled RGC - Animal Number 35, Group 5 , Left Eye.
Figure 5 : Example 1 : Representative images of the retinas with
FG-labeled RGC - Animal Number 35, Group 5 , Right Eye.
Detailed Description of the Invention
The subject invention provides a method of treating a subject
afflicted with glaucoma comprising administering to the subject
an amount of laquinimod effective to treat the subject.
In one embodiment, the administration of laquinimod is effective
to reduce or inhibit a symptom of the glaucoma in the subject. In
another embodiment, the symptom is retinal ganglion cell damage,
retinal ganglion cell loss, or elevated intraocular pressure. In
another embodiment, laquinimod is laquinimod sodium.
In one embodiment, the route of administration of laquinimod is
intraocular, periocular, systemic or topical. In another
embodiment, laquinimod is administered via oral administration. In
another embodiment, laquinimod is administered via ocular
administration. In another embodiment, laquinimod is administered
in the form of an aerosol, an inhalable powder, an injectable, a
liquid, a gel, a solid, a capsule or a tablet.
In an embodiment, the concentration of laquinimod in the liquid
or gel is 5-100 mg/ml solution, 20-100 mg/ml solution, 10-15
mg/ml solution, or 20-50 mg/ml solution. In another embodiment,
laquinimod is administered periodically. In another embodiment,
laquinimod is administered daily. In another embodiment,
laquinimod is administered more often than once daily. In yet
another embodiment, laquinimod is administered less often than
once daily.
In one embodiment, the amount laquinimod administered is at least
0.2 mg/day and/or less than 0.6 mg/day. In another embodiment, the
amount laquinimod administered is 0.03-600 mg/day, 0.1-40.0
mg/day, 0.1-2.5 mg/day, 0.25-2.0 mg/day or 0.5-1.2 mg/day. In
another embodiment, the amount laquinimod administered is 0.25
mg/day, 0.3 mg/day, 0.5 mg/day, 0.6 mg/day, 1.0 mg/day, 1.2
mg/day, 1.5 mg/day or 2.0 mg/day. In yet another embodiment, the
amount of laquinimod administered is 0.05-4.0 mg per
administration, 0.05-2.0 mg per administration, 0.2-4.0 mg per
administration, 0.2-2.0 g per administration, about 0.1 mg per
administration, or about 0.5 mg per administration.
In one embodiment of the present invention, the method further
comprises administration of a second agent for the treatment of
glaucoma. In another embodiment, the second agent is a b-
adrenergic antagonist, adrenergic agonist, parasympathomimetic,
prostaglandin-like analog, or carbonic anhydrase inhibitor.
In one embodiment, the periodic administration of laquinimod
continues for at least 3 days, more than 30 days, more than 42
days, 8 weeks or more, at least 12 weeks, at least 24 weeks, more
than 24 weeks, or 6 months or more. In another embodiment, the
subject is a human patient.
The subject invention also provides a method of treating a subject
suffering from retinal ganglion cell loss or retinal ganglion
cell damage, or of reducing retinal ganglion cell loss or damage
in a subject, comprising administering to the subject an amount
of laquinimod effective to reduce retinal ganglion cell loss or
retinal ganglion cell damage in the subject.
The subject invention also provides a method of treating a subject
suffering from elevated intraocular pressure, or of reducing
intraocular pressure in a subject, comprising administering to
the subject an amount of laquinimod effective to reduce
intraocular pressure in the subject.
The subject invention also provides a package comprising a ) a
pharmaceutical composition comprising an amount of laquinimod;
and b ) instruction for use of the pharmaceutical composition to
treat a subject afflicted with glaucoma.
In one embodiment of the present invention, the package comprises
a second pharmaceutical composition comprising an amount of a
second agent for the treatment of glaucoma. In another
embodiment, the second agent is a b-adrenergic antagonist,
adrenergic agonist, parasympathomimetic, prostaglandin-like
analog, or carbonic anhydrase inhibitor.
n one embodiment, the pharmaceutical composition is the form of
an aerosol, an inhalable powder, an injectable, a liquid, a gel,
a solid, a capsule or a tablet. In another embodiment, the
pharmaceutical composition is in a liquid or a gel form.
In one embodiment, the concentration of laquinimod in the liquid
or gel is 5-100 mg/ml solution, 20-100 mg/ml solution, 10-15
mg/ml solution or 20-50 mg/ml solution.
In another embodiment, the pharmaceutical composition is in
capsule form or in tablet form. In another embodiment, the
tablets are coated with a coating which inhibits oxygen from
contacting the core. In another embodiment, the coating comprises
a cellulosic polymer, a detackif ier, a gloss enhancer, or
pigment .
In one embodiment, the pharmaceutical composition further
comprises mannitol . In another embodiment, the pharmaceutical
composition further comprises an alkalinizing agent. In another
embodiment, the alkalinizing agent is meglumine. In another
embodiment, the pharmaceutical composition further comprises an
oxidation reducing agent.
In one embodiment, the pharmaceutical composition is stable and
free of an alkalinizing agent or an oxidation reducing agent. In
another embodiment, the pharmaceutical composition is free of an
alkalinizing agent and free of an oxidation reducing agent.
In one embodiment, the pharmaceutical composition is stable and
free of disintegrant . In another embodiment, the pharmaceutical
composition further comprises a lubricant. In another embodiment,
the lubricant is present in the pharmaceutical composition as
solid particles. In another embodiment, the lubricant is sodium
stearyl fumarate or magnesium stearate.
In one embodiment, the pharmaceutical composition further
comprises a filler. In another embodiment, the filler is present
in the pharmaceutical composition as solid particles. In another
embodiment, the filler is lactose, lactose monohydrate, starch,
isomalt, mannitol, sodium starch glycolate, sorbitol, lactose
spray dried, lactose anhydrouse, or a combination thereof. In
another embodiment, the filler is mannitol or lactose
monohydrate .
In one embodiment, the package further comprises a desiccant. In
another embodiment, the desiccant is silica gel.
In one embodiment, the pharmaceutical composition is stable and
has a moisture content of no more than 4%. In another embodiment,
laquinimod is present in the pharmaceutical composition as solid
particles. In another embodiment, the package is a sealed
packaging having a moisture permeability of not more than 15
mg/day per liter. In another embodiment, the sealed package is a
blister pack in which the maximum moisture permeability is no
more than 0.005 mg/day. In another embodiment, the sealed package
is a bottle. In another embodiment, the bottle is closed with a
heat induction liner. In another embodiment, the sealed package
comprises an HDPE bottle. In another embodiment, the sealed
package comprises an oxygen absorbing agent. In another
embodiment, the oxygen absorbing agent is iron.
In one embodiment, the amount of laquinimod in the pharmaceutical
composition is at least 0.2 mg or less than 0.6 mg . In another
embodiment, the amount of laquinimod in the pharmaceutical
composition is 0.1-40.0 mg, 0.03-600 mg, 0.1-2.5 mg, 0.25-2.0 mg,
0.5-1.2 mg, 0.25 mg, 0.3 mg, 0.5 mg, 0.6 mg, 1.0 mg, 1.2 mg, 1.5
mg, or 2.0 mg . In another embodiment, the pharmaceutical
composition comprises unit doses of laquinimod of 0.05-4.0 mg,
0.05-2.0 mg, 0.2-4.0 mg, 0.2-2.0 mg, about 0.1 mg, or about 0.5
mg .
In one embodiment, the pharmaceutical composition is formulated
for intraocular, periocular, systemic or topical administration.
In another embodiment, the pharmaceutical composition is
formulated for oral or ocular administration.
The subject invention also provides packages as described herein
for use in treating a subject afflicted with glaucoma.
The subject invention also provides a therapeutic package for
dispensing to, or for use in dispensing to, a subject afflicted
with glaucoma, which comprises a ) one or more unit doses, each
such unit dose comprising an amount of laquinimod thereof,
wherein the amount of said laquinimod in said unit dose is
effective, upon administration to said subject, to treat the
subject, and b ) a finished pharmaceutical container therefor,
said container containing said unit dose or unit doses, said
container further containing or comprising labeling directing the
use of said package in the treatment of said subject.
In one embodiment, the therapeutic package comprises a second
pharmaceutical composition comprising an amount of a second agent
for the treatment of glaucoma. In another embodiment, the second
agent is a b-adrenergic antagonist, adrenergic agonist,
parasympathomimetic, prostaglandin-like analog, or carbonic
anhydrase inhibitor.
The subject invention also provides a pharmaceutical composition
comprising an amount of laquinimod for use in treating a subject
afflicted glaucoma.
In one embodiment, the pharmaceutical composition comprises an
amount of a second agent for the treatment of glaucoma. In
another embodiment, the second agent is a b-adrenergic
antagonist, adrenergic agonist, parasympathomimetic,
prostaglandin-like analog, or carbonic anhydrase inhibitor.
In an embodiment, the pharmaceutical composition is in the form
of an aerosol, an inhalable powder, an injectable, a liquid, a
gel, a solid, a capsule or a tablet. In another embodiment, the
pharmaceutical composition is in a liquid or a gel form.
In an embodiment, the concentration of laquinimod in the liquid
or gel is 5-100 mg/ml solution, 20-100 mg/ml solution, 10-15
mg/ml solution or 20-50 mg/ml solution. In another embodiment,
the pharmaceutical composition comprises a unit dose of 10 of
an aqueous pharmaceutical solution which contains in solution at
least 0.2 g laquinimod. In another embodiment, laquinimod is
laquinimod sodium.
In one embodiment, the pharmaceutical composition is in capsule
form or in tablet form. In another embodiment, the tablets are
coated with a coating which inhibits oxygen from contacting the
core. In another embodiment, the coating comprises a cellulosic
polymer, a detackif ier , a gloss enhancer, or pigment. In another
embodiment, the pharmaceutical composition further comprises
mannitol .
In one embodiment, the pharmaceutical composition further
comprises an alkalinizing agent. In another embodiment, the
alkalinizing agent is meglumine. In another embodiment, the
pharmaceutical composition further comprises an oxidation
reducing agent.
In one embodiment, the pharmaceutical composition is free of an
alkalinizing agent or an oxidation reducing agent. In another
embodiment, the pharmaceutical composition is free of an
alkalinizing agent and free of an oxidation reducing agent.
In one embodiment, the pharmaceutical composition is stable and
free of disintegrant . In another embodiment, the pharmaceutical
composition further comprises a lubricant. In another embodiment,
the lubricant is present in the pharmaceutical composition as
solid particles. In another embodiment, the lubricant is sodium
stearyl fumarate or magnesium stearate.
In one embodiment, the pharmaceutical composition further
comprises a filler. In another embodiment, the filler is present
in the pharmaceutical composition as solid particles. In another
embodiment, the filler is lactose, lactose monohydrate, starch,
isomalt, mannitol, sodium starch glycolate, sorbitol, lactose
spray dried, lactose anhydrouse, or a combination thereof. In
another embodiment, the filler is mannitol or lactose
monohydrate .
n one embodiment, the amount of laquinimod in the pharmaceutical
composition is at least 0.2 mg or less than 0.6 mg . In another
embodiment, the amount of laquinimod in is 0.1-40.0 mg, 0.03-600
mg, 0.1-2.5 mg, 0.25-2.0 mg, 0.5-1.2 mg, 0.25 mg, 0.3 mg, 0.5 mg,
0.6 mg, 1.0 mg, 1.2 mg, 1.5 mg, or 2.0 mg . In another embodiment,
the pharmaceutical composition comprises unit doses of laquinimod
of 0.05-4.0 mg, 0.05-2.0 mg, 0.2-4.0 mg, 0.2-2.0 mg, about 0.1
mg, or about 0.5 mg .
In one embodiment, the pharmaceutical composition is formulated
for intraocular, periocular, systemic or topical administration.
In another embodiment, the pharmaceutical composition is
formulated for oral or ocular administration.
The subject invention also provides a pharmaceutical composition
as described herein for use in treating a subject afflicted with
glaucoma.
The subject invention also provides a pharmaceutical composition
in unit dosage form, useful in treating a subject afflicted with
glaucoma, which comprises an amount of laquinimod; which amount
of said laquinimod in said composition is effective, upon
administration to said subject of one or more of said unit dosage
forms of said composition, to treat the subject.
The subject invention also provides a package comprising a ) a
pharmaceutical composition as described herein; and b )
instruction for use of the pharmaceutical composition to treat a
subject afflicted with glaucoma.
The subject invention also provides laquinimod for the manufacture
of a medicament for use in treating a subject afflicted glaucoma.
For the foregoing embodiments, each embodiment disclosed herein
is contemplated as being applicable to each of the other
disclosed embodiments. For instance, the elements recited in the
method embodiments can be used in the pharmaceutical composition,
package, and use embodiments described herein and vice versa.
Terms
As used herein, and unless stated otherwise, each of the
following terms shall have the definition set forth below.
As used herein, "laquinimod" means laquinimod acid or a
pharmaceutically acceptable salt thereof.
A "salt thereof" is a salt of the instant compounds which have
been modified by making acid or base salts of the compounds. The
term "pharmaceutically acceptable salt" in this respect, refers
to the relatively non-toxic, inorganic and organic acid or base
addition salts of compounds of the present invention. For example,
one means of preparing such a salt is by treating a compound of
the present invention with an inorganic base.
As used herein, an "amount" or "dose" of laquinimod as measured
in milligrams refers to the milligrams of laquinimod acid present
in a preparation, regardless of the form of the preparation. A
"dose of 0.6 mg laquinimod" means the amount of laquinimod acid
in a preparation is 0.6 mg, regardless of the form of the
preparation. Thus, when in the form of a salt, e.g. a laquinimod
sodium salt, the weight of the salt form necessary to provide a
dose of 0.6 mg laquinimod would be greater than 0.6 mg (e.g.,
0.64 mg) due to the presence of the additional salt ion.
As used herein, a "unit dose", "unit doses" and "unit dosage
forra (s )" mean a single drug administration entity/entities .
As used herein, "about" in the context of a numerical value or
range means ±10% of the numerical value or range recited or
claimed .
As used herein, a composition that is "free" of a chemical entity
means that the composition contains, if at all, an amount of the
chemical entity which cannot be avoided although the chemical
entity is not part of the formulation and was not affirmatively
added during any part of the manufacturing process. For example,
a composition which is "free" of an alkalizing agent means that
the alkalizing agent, if present at all, is a minority component
of the composition by weight. Preferably, when a composition is
"free" of a component, the composition comprises less than 0.1
wt%, 0.05 wt%, 0.02 wt%, or 0.01 wt% of the component.
A s used herein, "alkalizing agent" is used interchangeably with
the term "alkaline-reacting component" or "alkaline agent" and
refers to any pharmaceutically acceptable excipient which
neutralizes protons in, and raises the pH of, the pharmaceutical
composition in which it is used.
A s used herein, "oxidation reducing agent" refers to a group of
chemicals which includes an "antioxidant", a "reduction agent"
and a "chelating agent" .
A s used herein, "antioxidant" refers to a compound selected from
the group consisting of tocopherol, methionine, glutathione,
tocotrienol, dimethyl glycine, betaine, butylated hydroxyanisole,
butylated hydroxytoluene, turmerin, vitamin E , ascorbyl palmitate,
tocopherol, deteroxime mesylate, methyl paraben, ethyl paraben,
butylated hydroxyanisole, butylated hydroxytoluene, propyl gallate,
sodium or potassium metabisulf ite, sodium or potassium sulfite,
alpha tocopherol or derivatives thereof, sodium ascorbate, disodium
edentate, BHA (butylated hydroxyanisole), a pharmaceutically
acceptable salt or ester of the mentioned compounds, and mixtures
thereof .
The term "antioxidant" as used herein also refers to Flavonoids
such as those selected from the group of quercetin, morin,
naringenin and hesperetin, taxifolin, afzelin, quercitrin,
myricitrin, genistein, apigenin and biochanin A , flavone,
flavopiridol , isof lavonoids such as the soy isof lavonoid,
genistein, catechins such as the tea catechin epigallocatechin
gallate, flavonol, epicatechin, hesperetin, chrysin, diosmin,
hesperidin, luteolin, and rutin.
A s used herein, "reduction agent" refers to a compound selected
from the group consisting of thiol-containing compound,
thioglycerol , mercaptoethanol , thioglycol, thiodiglycol , cysteine,
thioglucose, dithiothreitol (DTT) , dithio-bis-maleimidoethane
(DTME) , 2 ,6-di-tert-butyl-4-methylphenol (BHT) , sodium dithionite,
sodium bisulphite, formamidine sodium metabisulphite, and ammonium
bisulphite ."
A s used herein, "chelating agent" refers to a compound selected
from the group consisting of penicillamine, trientine, N,N '-
diethyldithiocarbamate (DDC) , 2,3,2 '-tetraamine (2, 3 ,2 '-tet) ,
neocuproine, N , , ', '-tetrakis (2-pyridylmethyl) ethylenediamine
(TPEN) , 1,1O-phenanthroline (PHE), tetraethylenepentamine ,
triethylenetetraamine and tris (2-carboxyethyl) phosphine (TCEP) ,
ferrioxamine, CP94, EDTA, def eroxainine B (DFO) as the
methanesulf onate salt (also known as desf errioxanilne B mesylate
(DFOM) ), desferal from Novartis (previously Ciba-Giegy) , and
apof erritin .
A s used herein, a pharmaceutical composition is "stable" when the
composition preserves the physical stability/integrity and/or
chemical stability/integrity of the active pharmaceutical
ingredient during storage. Furthermore, "stable pharmaceutical
composition" is characterized by its level of degradation products
not exceeding 5% at 40°C/75%RH after 6 months or 3% at 55°C/75% RH
after two weeks, compared to their level in time zero.
A s used herein, "effective" when referring to an amount of
laquinimod refers to the quantity of laquinimod that is
sufficient to yield a desired therapeutic response. Efficacy can
be measured by e.g., a reduced intraocular pressure (IOP) .
Administering to the subject" or "administering to the (human)
patient" means the giving of, dispensing of, or application of
medicines, drugs, or remedies to a subject/patient to relieve,
cure, or reduce the symptoms associated with a condition, e.g., a
pathological condition. The administration can be periodic
administration. A s used herein, "periodic administration" means
repeated/recurrent administration separated by a period of time.
The period of time between administrations is preferably
consistent from time to time. Periodic administration can include
administration, e.g., once daily, twice daily, three times daily,
four times daily, weekly, twice weekly, three times weekly, four
times weekly and so on, etc.
The route of administration can be, e.g., topical. Routes of
administration can also be classified by whether the effect is
local (e.g., in topical administration) or systemic (e.g., in
enteral or parenteral administration) . "Local administration" as
used herein shall mean administration of a compound or
composition directly to where its action is desired, and
specifically excludes systemic administration. "Topical
administration" of a compound or composition as used herein shall
mean application of the compound or composition to body surfaces
such as the skin or mucous membranes such as eyes. "Ocular
administration" as used herein shall mean application of a
compound or composition to the eye of a subject or to the skin
around the eye (periocular skin) of a subject, i.e., local
administration. Examples of ocular administration include topical
administration directly to the eye, topical application to the
eye lid or injection into a portion of the eye or eye socket. In
addition, an "ocular pharmaceutical composition" as used herein
means a pharmaceutical composition formulated for ocular
administration .
"Treating" as used herein encompasses, e.g., inducing inhibition,
regression, or stasis of a disease or disorder, e.g., glaucoma,
or alleviating, lessening, suppressing, inhibiting, reducing the
severity of, eliminating or substantially eliminating, or
ameliorating a symptom of the disease or disorder.
"Inhibition" of disease progression or disease complication in a
subject means preventing or reducing the disease progression
and/or disease complication in the subject.
A "symptom" associated with glaucoma includes any clinical or
laboratory manifestation associated with glaucoma and is not
limited to what the subject can feel or observe.
As used herein, a subject "afflicted" with glaucoma means the
subject has been diagnosed with glaucoma.
A s used herein, a subject at "baseline" is as subject prior to
administration of laquinimod in a therapy as described herein.
A "pharmaceutically acceptable carrier" refers to a carrier or
excipient that is suitable for use with humans and/or animals
without undue adverse side effects (such as toxicity, irritation,
and allergic response) commensurate with a reasonable
benefit/risk ratio. It can be a pharmaceutically acceptable
solvent, suspending agent or vehicle, for delivering the instant
compounds to the subject.
It is understood that where a parameter range is provided, all
integers within that range, and tenths thereof, are also provided
by the invention. For example, "0 .1-2 .5mg/day" includes 0.1
mg/day, 0.2 mg/day, 0.3 mg/day, etc. up to 2.5 mg/day.
This invention will be better understood by reference to the
Experimental Details which follow, but those skilled in the art
will readily appreciate that the specific experiments detailed
are only illustrative of the invention as described more fully in
the claims which follow thereafter.
Experimental Details
Example 1 : Assessment Of The Neuroprotective Efficacy of
Laquinimod For The Retinal Ganglion Cell (RGC) Survival In A Rat
Glaucoma Model
The purpose of this study was to assess the efficacy of
laquinimod in protecting against chronic ocular hypertension (OHT)
and RGC degeneration in a rat model of glaucoma, created by
injecting hypertonic saline into the episcleral veins in one eye
of the Brown Norway rat. In this model, RGC degeneration occurs
in response to increased IOP and OHT similar to that in human
patients with glaucoma.
SUMMARY
The study included 5 groups (n=8 each) : Group 1 (1% Laquinimod
for topical administration) , Group 2 (Vehicle for topical
administration) , Group 3 (4% Laquinimod for topical
administration), Group 4 (0.25% Laquinimod for topical
administration) and Group 5 (0.1% Laquinimod for oral
administration) .
Prior to any experimental procedure, clinical observations were
performed daily, body weights were obtained, intraocular pressure
(IOP) was measured and detailed ocular examinations were
performed on both eyes. Animals that were found to be clinically
normal with no baseline ocular abnormalities were selected for
use in the study.
The rat model of chronic ocular hypertension (OHT) /glaucoma was
created in the left eye of each animal via two hypertonic saline
injections (HSI) each one week apart. The un-injected right eye
served as the control. Throughout the study, the vehicle control
and the test articles were prepared weekly.
Rats were dosed once daily for oral administration (Group 5 ) and
twice daily for topical administration groups (Groups 1-4) ,
starting on the day of the first HSI until euthanasia. Detailed
ocular examinations were performed one week after the 2nd HSI and
on the day of euthanasia. Approximately one week prior to
euthanasia, RGCs were retrogradely-labeled by bilateral
injections of Fluoro-Gold (FG) into the superior colliculus in
the brain. Post-dose IOP was measured weekly for 5 weeks starting
one week after the 2nd HSI until euthanasia.
For each IOP measurement time-point following the 2nd HSI, the
IOP elevation was calculated as the difference between the IOP in
the left eye with OHT and that in the non-OHT right eye (DIOR ) .
The DIOR for the 5 weekly post-HSI IOP measurements were averaged
and constituted the Mean DIOR for each animal. Rats which did not
have individual IOP measurements of ³ 50 mmHg in the OHT eyes
were selected from a larger pool and groups (n=8 each) were
matched for the Mean DIOR . Other animals were removed from the
study .
Animals were euthanized 5 weeks after the 2nd HSI. The retinas
were flat-mounted, slide IDs were masked and 8 regions per retina
were imaged using a confocal microscope. RGC at these regions
were counted using the Image J software. After the optic nerves
were extracted, they were plastic-embedded, sectioned and stained
with Toluidine Blue at Schepens Eye Research Institute, Boston,
MA. The injury in the optic nerves was evaluated and graded by
microscopic examination in a masked fashion.
There were no abnormal clinical signs or ocular abnormalities
noted in any of the 40 animals in the beginning of the study.
There were no treatment-related findings in the clinical
observations or ocular examinations during the study in any of the
animals .
A One-Way ANOVA indicated that the group body weights were not
statistically different on the day of dosing among groups (P =
0.957) . Groups also did not differ in the amount of weight gained
between the day of dosing and the day of euthanasia (One-Way
ANOVA; P = 0.559) . For five weeks post-dose, the mean DIOR values
(OHT - Non-OHT) (Mean ± SD) were 9.1 ± 2.2 mmHg, 9.1 ± 2.6 mmHg,
9.3 ± 2.7 mmHg, 9.2 ± 1.5 mmHg, and 9.1 ± 2.9 mmHg for Groups 1 ,
2 , 3 , 4 and 5 , respectively. A One-Way ANOVA analysis indicated
that the groups were well-matched for Mean DIOR (P > 0.9) .
Compared to the non-OHT retinas, % Fluoro-gold labeled-RGC Loss
(Mean ± SD) in the OHT retinas was 17.6 ± 33.8, 34.8 ± 42.7, 26.8
± 36.4, 21.6 ± 21.7, and 22.9 ± 33.1 for Groups 1 , 2 , 3 , 4 and 5 ,
respectively. FG-Labeled RGC counts per mm2 were compared between
the Non-OHT and the OHT retinas for each group using two-tailed
paired-t tests. Group 2 (vehicle topical; P = 0.047) and Group 4
(0.25% Laquinimod topical; P = 0.033) had fewer RGCs in the OHT
eye compared to the Non-OHT eyes. The number of RGCs in Group 3
(4% Laquinimod topical; P = 0.071) and Group 5 (0.1% Laquinimod
oral; P = 0.075) were statistically different between the OHT and
Non-OHT eyes. However, in Group 1 (1% Laquinimod topical), there
was no statistically significant difference in the RGC counts
between the OHT and Non-OHT eyes (P = 0.189) . This suggests that
the daily topical application of 1% Laquinimod may be
neuroprotective for the RGC . For the optic nerves in the Non-OHT
(control) eyes, the Mean Injury Grades (Mean ± SD) were 1.1 ±
0.1, 1.2 ± 0.2, 1.2 ± 0.2, 1.2 ± 0.3 and 1.2 ± 0.2 for Groups 1 ,
2 , 3 , 4 and 5 , respectively. For the optic nerves in the OHT
eyes, the Mean Injury Grades (Mean ± SD) for the OHT optic nerves
were 2.5 ± 1.3, 3.0 ± 1.6, 3.0 ± 1.5, 2.8 ± 1.3 and 2.7 ± 1.5 for
Groups 1 , 2 , 3 , 4 , and 5 respectively. As a secondary analysis,
Mean ON Injury Grades were compared between the Non-OHT and the
OHT optic nerves for each group using two-tailed paired-t tests.
The Mean ON injury grades were significantly greater in the OHT
eyes compared to the Non-OHT control eyes in all groups (P <
0.05) .
MATERIALS
Test Article: laquinimod sodium stored at room temperature
protected from light.
Control Article: 0% laquinimod sodium stored under refrigeration.
ANIMALS
Number and Species: The study quote and outline-specified data
were collected on 40 Brown Norway rats (Rattus norvegicus) . Rats
have been used historically as OHT models and there are no other
approved alternative (non-animal methods) . The study started with
90 animals to ensure that sufficient data were available at the
end of the study.
Sex: male
Weight/Age Range: approximately 271.2-366.4 grams/at least 12
weeks old (adult) weighed to nearest 0.1 g .
PROCEDURE
Ocular and oral exposure corresponds to the route of human
exposure. For the four topical administration groups, the test
and control articles were applied topically to the surface of one
eye of the test system. The test article was administered orally
for the fifth group of animals.
Preparation of Test and Control Articles
All test and control articles were prepared as described below.
The final volume for the formulations described below is 200 mL
but the formulations were proportionally changed to the required
volume for each preparation. Three different concentrations
(0.25%, 1%, and 4%) of the test article for topical application
and the test article for oral gavage (0.1%) were prepared weekly.
The control article for topical application was also prepared
weekly. The identification of the test and control articles for
the topical administration was masked after preparation of the
topical formulations.
Table 1 : LAQ 4.0% Topical Formulation (40 mg/mL of LAQ)
Table 1 Process:
The entire process is performed under yellow light or at
dark conditions .
Weigh 175 g (175 mL) of water for injection in a glass
container containing a stirrer.
Weigh and add the Sodium Phosphate Monobasic Monohydrate
and Sodium Phosphate Dibasic 7 Hydrate and stir for
approximately 5 minutes. Verify complete dissolution by
visual inspection of a clear transparent solution.
Measure the pH (Approximately 7.7-8.3)
5 . Weigh and add Laquinimod Sodium to the solution. Rinse the
weighing boat from the Laquinimod Sodium remaining with ~5
mL of water and to the solution. Stir for approximately 5
minutes and verify complete dissolution by visual
inspection of a clear transparent solution.
Weigh and add the Hydroxy Ethyl Cellulose H .
Stir for approximately 2 hours.
Remove the stirrer and add the solution to a 200 mL
volumetric flask.
Add water for injection up to 200 mL .
Shake manually for approximately two minutes.
Transfer into an appropriate container. Wrap with aluminum
foil and keep the solution refrigerated.
Table 2 : LAQ 1.0% Topical Formulation (10 mg/mL of LAQ)
Table 2 Process :
1 . The entire process is performed under yellow light or at
dark conditions .
2 . Weigh 175 g (175 mL) of water for injection in a glass
container containing a stirrer.
3 . Weigh and add the Sodium Phosphate Monobasic Monohydrate
and Sodium Phosphate Dibasic 7 Hydrate and stir for
approximately 5 minutes. Verify complete dissolution by
visual inspection of a clear transparent solution.
Measure the pH (Approximately 7.7 to 8.3) .
Weigh and add Laquinimod Sodium to the solution. Rinse
weighing boat from the Laquinimod Sodium remaining with
mL of water and to the solution. Stir for approximately 5
minutes and verify complete dissolution by visual
inspection of a clear transparent solution.
6 . Weigh and add the Sodium Chloride to the solution. Stir for
approximately 2 minutes. Verify complete dissolution by
visual inspection of a clear transparent solution.
7 . Weigh and add the Hydroxy Ethyl Cellulose H .
8 . Stir for approximately 2 hours.
9 . Remove the stirrer and add the solution to a 200mL
volumetric flask.
10. Add water for injection up to 200 mL .
11. Shake manually for approximately two minutes.
Transfer into an appropriate container. Wrap with aluminum
foil and keep the solution refrigerated.
Table 3 : LAQ 0.25% Topical Formulation (2.5 mg/mL of LAQ)
Table 3 Process :
1 . The entire process is performed under yellow light
dark conditions .
Weigh 175 g (175 mL) of water for injection in a glass
container containing a stirrer.
Weigh and add the Sodium Phosphate Monobasic Monohydrate
and Sodium Phosphate Dibasic 7 Hydrate and stir for
approximately 5 minutes. Verify complete dissolution by
visual inspection of a clear transparent solution.
Measure the pH (Approximately 7.7-8.3) .
Weigh and add Laquinimod Sodium to the solution. Rinse the
weighing boat from the Laquinimod Sodium remaining with ~5
mL of water and to the solution. Stir for approximately 5
minutes and verify complete dissolution by visual
inspection of a clear transparent solution.
Weigh and add the Sodium Chloride to the solution. Stir for
approximately 2 minutes. Verify complete dissolution by
visual inspection of a clear transparent solution.
Weigh and add the Hydroxy Ethyl Cellulose H .
Stir for approximately 2 hours.
Remove the stirrer and add the solution to a 200 mL
volumetric flask.
Add water for injection up to 200 mL .
Shake manually for approximately two minutes.
Transfer into an appropriate container. Wrap with aluminum
foil and keep the solution refrigerated.
Table 4 : LAQ 0% Topical Formulation (Control Article)
Table 4 Process :
1 . The entire process is performed under yellow light or at
dark conditions .
2 . Weigh 175 g (175 mL) of water for injection in a glass
container containing a stirrer.
Weigh and add the Sodium Phosphate Monobasic Monohydrate
and Sodium Phosphate Dibasic 7 Hydrate and stir for
approximately 5 minutes. Verify complete dissolution by
visual inspection of a clear transparent solution.
Measure the pH (Approximately 7.7 to 8.3) .
Weigh and add the Sodium Chloride to the solution. Stir for
approximately 2 minutes. Verify complete dissolution by
visual inspection of a clear transparent solution.
Weigh and add the Hydroxy Ethyl Cellulose H .
Stir for approximately 2 hours.
Remove the stirrer and add the solution to a 200 mL
volumetric flask.
Add water for injection up to 200 mL .
Shake manually for approximately two minutes.
Transfer into an appropriate container.
Table 5 : LAQ 0.1% Oral Formulation (1.0 mg/mL of LAQ)
Table 5 Process :
1 . The entire process is performed under yellow light or at
dark conditions .
2 . Weigh 150 g (150 mL) of autoclaved tap water in a glass
container containing a stirrer.
3 . Weigh and add Laquinimod Sodium to the solution. Rinse the
remaining Laquinimod Sodium in the weighing boat with ~5 mL
of water and add to the solution. Stir for approximately 5
minutes and verify complete dissolution by visual
inspection of a clear transparent solution.
4. Add autoclaved tap water up t o 200 mL .
5. Sti r for 5 minutes .
6. Trans fer into an appropriate amber
Pre-Dose Administration and Selection of Animals:
Cl inical observat ions were performed dai l y according t o Table 6
bel ow:
Table 6: Cl inical Signs and Obs ervations
Animal s were we ighed wee kly prior t o initiation of dos ing . The
f i rst day the rats are weighed was des ignated as Study Day 1, and
the beginning of Study Week 1.
Ophthalmi c Examinations :
Animal s selected for the study were examined prior t o the initial
admini stration of the test or the control arti cles t o ensure that
both eyes we r e free of abnormal ity, damage , and di sease . Both
eyes were examined, scored and recorded prior t o the initial dose
admini stration u s ing a hand held s l it- lamp and a d i rect
ophthalmo scope o r the surgical microscope according t o the
Cl a s s i fication System for Grading Ocular Les ions a s described i n
Table 7 , and the Ocular Poste rior Segment Scoring Scale o f Tabl e
8 . Po sterio r segment examinati on was perfo rmed after topical
appl icati on o f Tropicamide i n the conscious s tate , o r after the
rats are anestheti zed with i s o florane inhalation . Onl y rat s
showing n o s igns o f eye i rritat ion , ocular d e fects , o r
preexi sting corneal inj ury were used i n the study .
CONJUNCTIVA
A. REDNESS / CONGESTION
0 Vessels normal.
May appear blanched to reddish pink without perilimbal injection (except at 12:00 and 6:00
o'clock positions) with vessels of the palpebral and bulbar conjunctivae easily observed.
1 Vessels definitely injected above normal.
A flushed, reddish color predominately confined to the palpebral conjunctivae with some
perilimbal injection but primarily confined to the lower and upper parts of the eye from, the 4:00
and 7:00 and 11:00 to 1:00 o'clock positions.
2*† More diffuse, deeper crimson red, individual vessels not easily discernible.
Bright red color of the palpebral conjunctiva with accompanying perilimbar injection covering
at least 75% of the circumference of the perilimbal region.
3*† Diffuse beefy red.
Dark beefy red color with congestion of both the bulbar and palpebral conjunctiva along with
pronounced perilimbal injection and the presence of petechia on the conjunctiva. The
B. CHEMOSIS:
0 Normal. No swelling of the conjunctival tissue.
1 Any swelling above normal (includes nictitating membrane).
Swelling above normal without eversion of the lids (can be easily ascertained by noting that the
upper and lower eyelids are positioned as in the normal eye); swelling generally starts in the
lower cul-de-sac near the inner canthus which needs slit-lamp examination.
2*† Obvious swelling with partial eversion of lids.
Swelling with misalignment of the normal approximation of the lower and upper eyelids;
primarily confined to the upper eyelid so that in the initial stages the misapproximation of the
eyelids begins by partial eversion of the upper eyelid. In this stage, swelling is confined
generally to the upper eyelid, although it exists in the lower cul-de-sac.
Swelling with lids about half closed.
3*† Swelling definite with partial eversion of the upper and lower eyelids essentially equivalent.
This can be easily ascertained by looking at the animal straight head on and noticing the
positioning of the eyelids; if the eye margins do not meet, eversion has occurred.
*† Swelling with lids about half closed to completely closed.
Eversion of the upper eyelid is pronounced with less pronounced eversion of the lower eyelid. It
is difficult to retract the lids and observe the perilimbal region.
C. DISCHARGE:
0 Normal or no discharge.
1 Any amount different from normal (does not include small amounts observed in inner canthus of
normal animals).
Discharge above normal and present on the inner portion of the eye but not on the lids or hairs
of the eyelids. One can ignore the small amount that is in the inner and outer canthus if it has not
been removed prior to starting the study.
2 Discharge with moistening of lids and hairs just adjacent to lids. Discharge is abundant, easily
observed, and has collected on the lids around the hairs of the eyelids.
3 Discharge with moistening of the lids and hairs, and considerable area around the eye.
CORNEA
D. OPACITY-degree of density (areas most dense taken for reading):
0 No ulceration or opacity.
Normal cornea. Appears with the slit lamp as having a bright gray line on the endothelial surface
and a bright gray line on the endothelial surface with a marble-like gray appearance of the
stroma.
1* Scattered or diffuse areas of opacity (other than slight dulling of normal luster), details of iris
clearly visible. Some loss of transparency. Only the anterior one-half of the stroma is involved
as observed with an optical section of the slit lamp. The underlying structures are clearly visible
with diffuse illumination, although some cloudiness can be readily apparent with diffuse
illumination.
2*† Easily discernible translucent areas, details of iris slightly obscured. Moderate loss of
transparency. In addition to involving the anterior stroma, the cloudiness extends all the way to
the endothelium. The stroma has lost its marble-like appearance and is homogeneously white.
With diffuse illumination, underlying structures are clearly visible.
3*† Opalescent/nacreous areas, no details of iris visible, size of pupil barely discernible.
Involvement of the entire thickness of the stroma. With optical section, the endothelial surface is
still visible. However, with diffuse illumination the underlying structures are just barely visible
(to the extent that the observer is still able to grade flare, iritis, observe for pupillary response,
and note lenticular changes.
*† Opaque cornea, iris not discernible through opacity.
Involvement of the entire thickness of the stroma. With the optical section, cannot clearly
visualize the endothelium. With diffuse illumination, the underlying structures cannot be seen.
Cloudiness removes the capability of judging and grading aqueous flare, iritis, lenticular
changes, and pupillary response.
E. AREAS OF CORNEA INVOLVED:
0 Normal cornea with no area of cloudiness.
1 One-quarter (or less), but not zero.
2 Greater than one-quarter, but less than one-half.
* Greater than one-half, but less than three-quarters.
* Greater than three-quarters, up to whole area.
F. FLUORESCEIN STAINING:
0 Absence of fluorescein staining.
1 Slight fluorescein staining confined to a small focus. With diffuse illumination the underlying
structures are easily visible. The outline of the papillary margin is as if there were no fluorescein
staining.
2 Moderate fluorescein staining confined to a small focus. With diffuse illumination the
underlying structures are clearly visible, although there is some loss of detail.
3 Marked fluorescein staining. Staining may involve a larger portion of the cornea. With diffuse
illumination the underlying structures are barely visible but are not completely obliterated.
4 Extreme fluorescein staining. With diffuse illumination the underlying structures cannot be
observed.
G. CORNEA PANNUS:
0 No pannus
1 Vascularization is present but vessels have not invaded the entire corneal circumference. Where
localized vessel invasion has occurred, they have not penetrated beyond 2 mm.
2 Vessels have invaded 2 mm or more around the entire corneal circumference.
IRIS
0 Normal iris without any hyperemia of the iris vessels. Occasionally around the 12:00 to 1:00
position near the pupillary border and the 6:00 and 7:00 position near the pupillary border there
is a small area around 1-3 mm in diameter in which both the secondary and tertiary vessels are
slightly hyperemia
1*† Folds above normal, congestion, swelling, circumcorneal injection (any or all of these or
combination of any thereof), iris still reacting to light (sluggish reaction is positive). Minimal
injection of secondary vessels but not tertiary. Generally, it is uniform, but may be of greater
intensity at the 1:00 or 6:00 position, the tertiary vessels must be substantially hyperemia
2*† No reaction to light, hemorrhage, gross destruction (any or all of these). Minimal injection of
tertiary vessels and minimal to moderate injection of the secondary vessels.
3*† Moderate injection of the secondary and tertiary vessels with slight swelling of the iris stroma
(this gives the iris surface a slightly rupose appearance which is usually most prominent near the
3:00 and 9:00 positions).
*† Marked injection of the secondary and tertiary vessels with marked swelling of the iris stroma.
The iris appears rugose; may be accompanied by hemorrhage (hyperemia) in the anterior
chamber.
AQUEOUS FLARE
0 Absence of visible light beam in the anterior chamber (no Tyndall effect).
1 Tyndall effect is barely discernible. The intensity of the light beam in the anterior chamber is
less than the density of the slit beam as it passes through the lens.
2 The Tyndall effect in the anterior chamber is easily discernible and is of equal intensity as the
density of the slit beam as it passes through the lens.
3 The Tyndall effect in the anterior chamber is easily discernible; its intensity is greater than the
intensity of the slit beam as it passes through the lens.
PUPILLARY LIGHT REFLEX:
0 Normal pupillary light reflex
1 Sluggish pupillary light reflex
2 No pupillary light reflex
LENS
0 Normal
1 The presence of lenticular opacities should be described and the location noted as defined
below:
• Anterior capsule
• Anterior subcapsule
• Anterior cortical
• Nuclear
• Posterior cortical
• Posterior subcapsule
• Posterior capsule
Table 7 : Combined Draize and McDonald-Shadduck Scoring System
Positive Reaction (ISO)
Positive Reaction (OECD)
VITREOUS BODY
0 Normal, the vitreous body is clear or transparent.
1 Abnormal, the vitreous body is not clear or not transparent and homogenous gel that fills the
space between the posterior axial lens capsule, posterior chamber, and ocular fundus.
OPTIC DISC/OPTIC NERVE
0 Normal, the optic disc and optic nerve are with light red color, cupping size normal (cup-to-disc
ratio < 0.2), and normal sharpness of edge, without swelling, hemorrhages, notching in the optic
disc and any other unusual anomalies.
1 Abnormal, the optic disc and optic nerve are not with light red color or cupping size normal
(cup-to-disc ratio > 0.2), and no normal sharpness of edge or with swelling, hemorrhages,
notching in the optic disc and any other unusual anomalies.
RETINAL BLOOD VASCULATURE
0 Normal, the retinal arteries and veins fill in blood and normalize sharpness without hemorrhage
and exudation.
1 Abnormal, the retinal arteries and veins don't fill in blood and don't have normalize sharpness or
with hemorrhage and exudation.
RETINAL HEMORHAGE, EXUDATION, AND DETACHMENT
0 Normal retina with no area of hemorrhage or/and exudation or/and detachment
1 Retinal hemorrhage or/and exudation or/and detachment < 1 quadrant area
2 1 quadrant area < retinal hemorrhage or/and exudation or/and detachment < 2 quadrant areas
3 2 quadrant areas < hemorrhage or/and exudation or/and detachment < 3 quadrant areas
4 3quadrant areas 0.9) (Figure 1 ) . Representative images of
the retinas with FG-labeled RGC are shown in Figures 5A-5J. %
FG-Labeled RGC loss in the OHT retinas compared with the
corresponding non-OHT retinas is shown in Table 10. Compared
to the non-OHT retinas, % RGC Loss (Mean ± SD) in the OHT
retinas was 17.6 ± 33.8, 34.8 ± 42.7, 26.8 ± 36.4, 21.6 ±
21.7, and 22.9 ± 33.1 for Groups 1 , 2 , 3 , 4 and 5 ,
respectively (Figure 2 ) .
FG-labeled RGC counts: A Two-Way ANOVA on the RGC counts in
the OHT and Non-OHT (control) eyes versus groups did not show
a significant eye versus group interaction (P = 0.919),
indicating that groups did not differ for the RGC counts in
the OHT and Non-OHT eyes (Figure 3 ) . As a secondary analysis,
FG-Labeled RGC counts per mm2 were compared between the Non-
OHT and the OHT retinas for each group using a paired-t test
(two-tailed) . Group 2 (vehicle topical; P = 0.047) and Group 4
(0.25% Laquinimod topical; P =0.033) had fewer RGCs in the OHT
eye compared to the Non-OHT eyes. The number of RGCs in Group
3 (4% Laquinimod topical; P = 0.071) and Group 5 (0.1%
Laquinimod oral; P = 0.075) were statistically marginally
different between the OHT and Non-OHT eyes. However, in Group
1 (1% Laquinimod topical), there was no statistically
significant difference in the RGC counts between the OHT and
Non-OHT eyes (P = 0.189) . This suggests that the daily topical
application of 1% Laquinimod may be neuroprotective for the
RGC .
6 . Optic Nerve (ON) Injury Grades: Mean ON Injury Grades (Mean ±
SD) for the Non-OHT eyes were 1.1 ± 0.1, 1.2 ± 0.2, 1.2 ± 0.2,
1.2 ± 0.3 and 1.2 ± 0.2 for Groups 1 , 2 , 3 , 4 and 5 ,
respectively. Mean Injury Grades (Mean ± SD) for the OHT optic
nerves were 2.5 ± 1.3, 3.0 ± 1.6, 3.0 ± 1.5, 2.8 ± 1.3 and 2.7
± 1.5 for Groups 1 , 2 , 3 , 4 , and 5 , respectively. A Two-Way
ANOVA on the Mean ON injury grades in the OHT and Non-OHT
(control) eyes versus groups did not show a significant eye
versus group interaction (P = 0.98) , indicating that groups
did not differ for the injury in the OHT and Non-OHT optic
nerves (Figure 4 ) . As a secondary analysis, Mean ON Injury
Grades were compared between the Non-OHT and the OHT optic
nerves for each group using two-tailed paired-t tests. The
Mean ON injury grades were significantly greater in the OHT
eyes compared to the Non-OHT control eyes in all groups (P <
0.05) .
Ophthalmic Examinations (OEs) : At baseline ocular examinations
prior to initial dose, there were no ocular abnormalities
observed in either eye in any of the animals included in the
study. During the post-dose OEs, there were no ocular problems
observed in any of the animals in the Non-OHT eyes. However, ,
there were some ocular abnormalities observed in the OHT eyes
due to the glaucoma-model creation procedures (hypertonic
saline injection surgeries into the episcleral veins) in all
groups. These abnormalities included minor congestion and
chemosis (swelling) in the conjunctiva, minor corneal
opacities, lack of sufficient dilation of the pupil after
application of the pupil-dilating agent Tropicamide, slight
opacities in the lens and presence of free-floating iris
pigments in front of the lens in the OHT eyes. The post-HSI
ocular findings in the OHT eyes were observed in all groups
with a similar occurrence and were not test articlerelated .
CONCLUSION
The study involved daily dosing of five groups for approximately
six weeks: Group 1 (1% Laquinimod topical), Group 2 (Vehicle
topical), Group 3 (4% Laquinimod topical), Group 4 (0.25%
Laquinimod topical) and Group 5 (0.1% Laquinimod oral) . The
analyses for the RGC counts in Group 1 animals suggested a trend
towards neuroprotection following daily topical application of 1%
Laquinimod .
EXAMPLE 2 : Assessment of Efficacy of laquinimod for treating
patients afflicted with glaucoma
Periodic (e.g., daily or twice daily) administration of laquinimod
(oral or topical) is effective in treating glaucoma human patients
Periodic (e.g., daily or twice daily) administration of laquinimod
(oral or topical) is effective to reduce a glaucoma-associated
symptom in the subject.
A laquinimod composition as described herein is administered
systematically or locally to the eye of a subject suffering from
glaucoma. The administration of the composition is effective to
treat the subject suffering from glaucoma. The administration of
the composition is also effective to reduce a glaucoma-associated
symptom of glaucoma in the subject. The administration of the
composition is also effective to reduce intraocular pressure in
the subject. The administration of the composition is effective
to reduce RGC damage and/or RGC loss, and improve RGC viability
in the subject.
"Glaucoma", Merck Manual of Diagnosis and Therapy (1999),
Merck Research Laboratories, (Whitehouse Station, NJ) , 733-
738 .
Alward, "Medical Management of Glaucoma", N Eng J Med, 1998;
339:1298-1307) .
Bakalash et al ., "Resistance of Retinal Ganglion Cells to
an Increase in Intraocular Pressure is Immune-dependent",
Invest Ophthalmol Vis Sci 2002; 43:2 64 8-2 653.
Brod et al . (2000) Annals of Neurology , 47:127-131.
Bruck et al ., (2011) "Insight into the mechanism of
laquinimod action", J . Neurol Sci . 306:173-179.
Cepurna et al . (2000) "Patterns of Intraocular Pressure
Elevation After Aqueous Humor Outflow Obstruction in Rats."
Invest Ophthalmol Vis Sci. 41(6) (May 2000) :1380-5 .
Coleman "Glaucoma", Lancet, 1999; 354:1803-1810.
Draize, J . H . (1965) "Appraisal of the Safety of Chemicals
in Foods, Drugs, and Cosmetics." Association of Food and
Drug Officials of the United States, Austin, Texas, 1965.
36-45 .
Farkas et al ., "Apoptosis, Neuroprotection and Retinal
Ganglion Cell Death: An Overview", Int Ophthalmol Clin 2001;
41:111-130 .
Freireich et al . (1966) "Quantitative comparison to
toxicity of anticancer agents in mouse, rat, hamster, dog,
monkey and man." Cancer Chemother Rep , 50:219-244.
Guidance for Industry. In vivo drug metabolism/drug
interaction studies - study design, data analysis, and
recommendations for dosing and labeling, U.S. Dept. Health
and Human Svcs ., FDA, Ctr. for Drug Eval . and Res., Ctr.
For Biologies Eval . and Res., Clin. / Pharm., Nov. 1999
.
Gurevich et al . (2010) "Laquinimod suppress antigen
presentation in relapsing-remitting multiple sclerosis :
invitro high- throughput gene expression study." J
Neuroimmunol .- 2010 Apr 15; 221 (1-2 ) :87-94 . Epub 2010 Mar 27.
Hla et al . (2001) "Lysophospholipids--receptor
revelations." Science , 294 (5548) :1875-8 .
Horga and Montalban 06/04/2008; Expert Rev Neurother. , 2008;
8 (5) :699-714 .
ISO/IEC 17025, 2005. General Requirements for the
Competence of Testing and Calibration Laboratories.
Kipnis et al ., "T Cell Immunity To Copolymer 1 Confers
Neuroprotection On The Damaged Optic Nerve: Possible
Therapy For Optic Neuropathies", Proc Natl Acad Sci 2000;
97 :7446-7451 .
Kleinschmidt-DeMasters et al . (2005) New England Journal of
Medicine , 353:369-379.
Langer-Gould et al . (2005) New England Journal of Medicine ,
353:369-379.
McDonald, and Shadduck (1983) . Eye Irritation in
Dermatotoxicology (2nd Ed.) . Edited by Marzulli F.N.
Hemishpere Publishing Corp., New York, NY.
Medeiros et al ., "Medical Backgrounders: Glaucoma", Drugs
of Today 2002; 38:563-570.
National MS Society Website, retrieved July 10, 2012 <
ht t.p ;/ w nationalms c et .org/ros-clinical-carene
or / ese cher /c n cal-study-measures/ nde .aspx>
OECD 405, Organization for Economic Co-Operation and
Development (OECD) , Guidelines for the Testing of
Chemicals, "Acute Eye Irritation/Corrosion", adopted 24
April 2002.
Ollivier F.J., et al . (2007) "Ophthalmic Examination and
Diagnostics Part 1 : The Eye Examination and Diagnostic
Procedure" in Veterinary Ophthalmology, 4th Ed. by Gelatt,
K.N. 2007, 438-483. Blackwell Publishing, Gainesville,
Florida .
PCT International Application Publication No. WO
2007/0047863, published April 26, 2007.
PCT International Application Publication No. WO
2007/0146248, published December 21, 2007.
Polman et al . (2005) "Treatment with laquinimod reduces
development of active MR lesions in relapsing MS."
Neurology . 64:987-991.
Polman et al . (2011) "Diagnostic Criteria for Multiple
Sclerosis: 2010 Revisions to the McDonald Criteria." Ann
Neural , 69:292-302.
Polman et al ., (2005) "Diagnostic criteria for multiple
sclerosis: 2005 revisions to the McDonald Criteria." Annals
of Neurology , 58 (6) :840-846 .
Rudick et al . (1999) "Use of the brain parenchymal fraction
to measure whole brain atrophy in relapsing-remitting MS:
Multiple Sclerosis Collaborative Research Group". Neurology
53 :1698-1704 .
Runstrom et al . (2002) "Laquinimod (ABR-215062) a
candidate drug for treatment of Multiple Sclerosis inhibits
the development of experimental autoimmune
encephalomyelitis in IFN- b knock-out mice," (Abstract),
Medicon Valley Academy, Malmoe, Sweden.
Sandberg-Wollheim et al . (2005) "48-week open safety study
with high-dose oral laquinimod in patients." Mult Scler .
11 :S154 (Abstract) .
U.S. Patent No. 6 , 077, 851, issued Jun 20, 2000 (Bjork et
al) .
U.S. Patent No. 7,589,208, issued September 15, 2009
(Jansson et al) .
Vollmer et al . (2008) "Glatiramer acetate after induction
therapy with mitoxantrone in relapsing multiple sclerosis."
Multiple Sclerosis , 00:1-8.
Weinreb et al ., "Is Neuroprotection a Viable Therapy for
Glaucoma?" Arch Ophthalmol 1999; 117:1540-1544.
Yang et al . (2004) "Laquinimod (ABR-215062) suppresses the
development of experimental autoimmune encephalomyelitis,
modulates the Thl/Th2 balance and induces the Th3 cytokine
TGF- b in Lewis rats." J . Neuroimmunol . 156:3-9.
What is claimed is :
1 . A method of treating a subject afflicted with glaucoma
comprising administering to the subject an amount of
laquinimod effective to treat the subject.
2 . The method of claim 1 , wherein the administration of
laquinimod is effective to reduce or inhibit a symptom of
the glaucoma in the subject.
3 . The method of claim 2 , wherein the symptom is retinal
ganglion cell damage, retinal ganglion cell loss, or
elevated intraocular pressure.
4 . The method of any one of claims 1-3, wherein laquinimod is
laquinimod sodium.
5 . The method of any one of claims 1-4, wherein the route of
administration of laquinimod is intraocular, periocular,
ocular, oral, systemic or topical.
6 . The method of any one of claims 1-5, wherein laquinimod is
administered in the form of an aerosol, an inhalable powder,
an injectable, a liquid, a gel, a solid, a capsule or a
tablet .
7 . The method of claim 6 , wherein the concentration of
laquinimod in the liquid or gel is 5-100 mg/ml solution, 20-
100 mg/ml solution, 10-15 mg/ml solution, or 20-50 mg/ml
solution .
8 . The method of any one of claims 1-7, wherein laquinimod is
administered periodically.
9 . The method of claim 8 , wherein laquinimod is administered
daily .
10. The method of claim 8 , wherein laquinimod is administered
more often than once daily or less often than once daily.
The method of any one of claims 1-10, wherein the amount
laquinimod administered is at least 0.2 mg/day and/or less
than 0.6 mg/day.
The method of any one of claims 1-10, wherein the amount
laquinimod administered is 0.03-600 mg/day, 0.1-40.0 mg/day,
0.1-2.5 mg/day, 0.25-2.0 mg/day, 0.5-1.2 mg/day, 0.25
mg/day, 0.3 mg/day, 0.5 mg/day, 0.6 mg/day, 1.0 mg/day, 1.2
mg/day, 1.5 mg/day or 2.0 mg/day.
The method of any one of claims 1-12, wherein the amount of
laquinimod administered is 0.05-4.0 mg per administration,
0.05-2.0 mg per administration, 0.2-4.0 mg per
administration, 0.2-2.0 mg per administration, about 0.1 mg
per administration, or about 0.5 mg per administration.
The method of any one of claims 1-13, further comprising
administration of a second agent for the treatment of
glaucoma .
The method of claim 14, wherein the second agent is a b-
adrenergic antagonist, adrenergic agonist,
parasympathomimetic, prostaglandin-like analog, or carbonic
anhydrase inhibitor.
The method of any one of claims 8-15, wherein the periodic
administration of laquinimod continues for at least 3 days,
more than 30 days, more than 42 days, 8 weeks or more, at
least 12 weeks, at least 24 weeks, more than 24 weeks, or 6
months or more.
The method of any one of claims 1-16, wherein the subject is
a human patient.
A method of treating a subject suffering from retinal
ganglion cell loss or retinal ganglion cell damage, or of
reducing retinal ganglion cell loss or damage in a subject,
comprising administering to the subject an amount of
laquinimod effective to reduce retinal ganglion cell loss
or retinal ganglion cell damage in the subject.
19. A method of treating a subject suffering from elevated
intraocular pressure, or of reducing intraocular pressure
in a subject, comprising administering to the subject an
amount of laquinimod effective to reduce intraocular
pressure in the subject.
20. A package comprising:
a ) a pharmaceutical composition comprising an amount of
laquinimod; and
b ) instruction for use of the pharmaceutical composition
to treat a subject afflicted with glaucoma.
21. The package of claim 20, wherein the package comprises a
second pharmaceutical composition comprising an amount of a
second agent for the treatment of glaucoma.
22. The package of claim 21, wherein the second agent is a b-
adrenergic antagonist, adrenergic agonist,
parasympathomimetic, prostaglandin-like analog, or carbonic
anhydrase inhibitor.
23. The package of any one of claims 20-22, wherein the
pharmaceutical composition is the form of an aerosol, an
inhalable powder, an injectable, a liquid, a gel, a solid,
a capsule or a tablet.
24. The package of claim 23, wherein the concentration of
laquinimod in the liquid or gel is 5-100 mg/ml solution, 20-
100 mg/ml solution, 10-15 mg/ml solution or 20-50 mg/ml
solution .
25. The package of claim 23, wherein the tablets are coated
with a coating which inhibits oxygen from contacting the
core .
26. The package of claim 25, wherein the coating comprises a
cellulosic polymer, a detackifier, a gloss enhancer, or
pigment .
27. The package of any one of claims 20-26, wherein the
pharmaceutical composition further comprises mannitol, an
alkalinizing agent, an oxidation reducing agent, a
lubricant, a filler, and/or a desiccant.
28. The package of claim 27, wherein the alkalinizing agent is
meglumine .
29. The package of any one of claims 20-27, wherein the
pharmaceutical composition is stable and free of an
alkalinizing agent or an oxidation reducing agent,
preferably the pharmaceutical composition is free of an
alkalinizing agent and free of an oxidation reducing agent.
30. The package of any one of claims 20-29, wherein the
pharmaceutical composition is stable and free of
disintegrant .
31. The package of claim 27, wherein the lubricant is present
in the pharmaceutical composition as solid particles.
32. The package of claims 27 or 31, wherein the lubricant is
sodium stearyl fumarate or magnesium stearate.
33. The package of claim 27, wherein the filler is present in
the pharmaceutical composition as solid particles .
34. The package of claims 27 or 33, wherein the filler is
lactose, lactose monohydrate, starch, isomalt, mannitol,
sodium starch glycolate, sorbitol, lactose spray dried,
lactose anhydrouse, or a combination thereof.
35. The package of claim 27, wherein the desiccant is silica
gel .
36. The package of any one of claims 20-35, wherein the
pharmaceutical composition is stable and has a moisture
content of no more than 4%.
37. The package of any one of claims 20-36, wherein laquinimod
is present in the pharmaceutical composition as solid
particles .
38. The package of any one of claims 20-37, wherein the package
is a sealed packaging having a moisture permeability of not
more than 15 mg/day per liter or a blister pack having a
maximum moisture permeability of not more than 0.005
mg/day .
39. The package of claim 38, wherein the sealed package is a
bottle or comprises an HDPE bottle, preferably the bottle
is closed with a heat induction liner.
40. The package of claims 38 or 39, wherein the sealed package
comprises an oxygen absorbing agent, which oxygen absorbing
agent is preferably iron.
41. The package of any one of claims 20-40, wherein the amount
of laquinimod in the pharmaceutical composition is at least
0.2 mg, less than 0.6 mg, 0.1-40.0 mg, 0.03-600 mg, 0.1-2.5
mg, 0.25-2.0 mg, 0.5-1.2 mg, 0.25 mg, 0.3 mg, 0.5 mg, 0.6
mg, 1.0 mg, 1.2 mg, 1.5 mg, or 2.0 mg .
42. The package of any one of claims 20-41, wherein the
pharmaceutical composition comprises unit doses of
laquinimod of 0.05-4.0 mg, 0.05-2.0 mg, 0.2-4.0 mg, 0.2-2.0
mg, about 0.1 mg, or about 0.5 mg .
43. The package of any one of claims 20-42, wherein the
pharmaceutical composition is formulated for intraocular,
periocular, ocular, oral, systemic or topical
administration .
44. The package of any one of claims 20-43, for use in treating
a subject afflicted with glaucoma.
45. A therapeutic package for dispensing to, or for use in
dispensing to, a subject afflicted with glaucoma, which
comprises :
a ) one or more unit doses, each such unit dose comprising
an amount of laquinimod thereof, wherein the amount of
said laquinimod in said unit dose is effective, upon
administration to said subject, to treat the subject,
and
b ) a finished pharmaceutical container therefor, said
container containing said unit dose or unit doses,
said container further containing or comprising
labeling directing the use of said package in the
treatment of said subject.
The therapeutic package of claim 45, wherein the package
comprises a second pharmaceutical composition comprising an
amount of a second agent for the treatment of glaucoma.
The therapeutic package of claim 46, wherein the second
agent is a b-adrenergic antagonist, adrenergic agonist,
parasympathomimetic, prostaglandin-like analog, or carbonic
anhydrase inhibitor.
A pharmaceutical composition comprising an amount of
laquinimod for use in treating a subject afflicted glaucoma
The pharmaceutical composition of claim 48, comprising an
amount of a second agent for the treatment of glaucoma.
The pharmaceutical composition of claim 49, wherein the
second agent is a b-adrenergic antagonist, adrenergic
agonist, parasympathomimetic, prostaglandin-like analog, or
carbonic anhydrase inhibitor.
The pharmaceutical composition of any one of claims 48-50,
in the form of an aerosol, an inhalable powder, an
injectable, a liquid, a gel, a solid, a capsule or a
tablet .
The pharmaceutical composition of claim 51, wherein the
concentration of laquinimod in the liquid or gel is 5-100
mg/ml solution, 20-100 mg/ml solution, 10-15 mg/ml solution
or 20-50 mg/ml solution.
53. The pharmaceutical composition of claim 51, comprising a
unit dose of 10 of an aqueous pharmaceutical solution
which contains in solution at least 0.2 mg laquinimod.
54. The pharmaceutical composition of any one of claims 48-53,
wherein laquinimod is laquinimod sodium.
55. The pharmaceutical composition of claim 51, wherein the
tablets are coated with a coating which inhibits oxygen
from contacting the core.
56. The pharmaceutical composition of claim 55, wherein the
coating comprises a cellulosic polymer, a detackif ier, a
gloss enhancer, or pigment.
57. The pharmaceutical composition of any one of claims 48-56,
further comprising mannitol, an alkalinizing agent, an
oxidation reducing agent, a lubricant and/or a filler.
58. The pharmaceutical composition of claim 57, wherein the
alkalinizing agent is meglumine.
59. The pharmaceutical composition of any one of claims 48-57,
which is free of an alkalinizing agent or an oxidation
reducing agent, preferably the pharmaceutical composition
is free of an alkalinizing agent and free of an oxidation
reducing agent .
60. The pharmaceutical composition of any one of claims 48-59,
which is stable and free of disintegrant .
61. The pharmaceutical composition of claim 57, wherein the
lubricant is present in the pharmaceutical composition as
solid particles.
62. The pharmaceutical composition of claims 57 or 61, wherein
the lubricant is sodium stearyl fumarate or magnesium
stearate .
63. The pharmaceutical composition of claim 57, wherein the
filler is present in the pharmaceutical composition as
solid particles.
64. The pharmaceutical composition of claims 57 or 63, wherein
the filler is lactose, lactose monohydrate, starch,
isomalt, mannitol, sodium starch glycolate, sorbitol,
lactose spray dried, lactose anhydrouse, or a combination
thereof .
65. The pharmaceutical composition of any one of claims 48-64,
wherein the amount of laquinimod is at least 0.2 mg, less
than 0.6 mg, 0.1-40.0 mg, 0.03-600 mg, 0.1-2.5 mg, 0.25-2.0
mg, 0.5-1.2 mg, 0.25 mg, 0.3 mg, 0.5 mg, 0.6 mg, 1.0 mg, 1.2
mg, 1.5 mg, or 2 .0 mg .
66. The pharmaceutical composition of any one of claims 48-65,
comprising unit doses of laquinimod of 0.05-4.0 mg, 0.05-2.0
mg, 0.2-4.0 mg, 0.2-2.0 mg, about 0.1 mg, or about 0.5 mg .
67. The pharmaceutical composition of any one of claims 48-66,
formulated for intraocular, periocular, ocular, oral,
systemic or topical administration.
68. The pharmaceutical composition of any one of claims 48-67,
for use in treating a subject afflicted with glaucoma.
69. A pharmaceutical composition in unit dosage form, useful in
treating a subject afflicted with glaucoma, which comprises
an amount of laquinimod; which amount of said laquinimod in
said composition is effective, upon administration to said
subject of one or more of said unit dosage forms of said
composition, to treat the subject.
70. A package comprising:
a ) a pharmaceutical composition of any one of claims 48-
9 and
b ) instruction for use of the pharmaceutical composition
to treat a subject afflicted with glaucoma.
71. Laquinimod for the manufacture of a medicament for use in
treating a subject afflicted glaucoma.