OA17450A - Combination formulation of two antiviral compounds. - Google Patents

Combination formulation of two antiviral compounds. Download PDF

Info

Publication number
OA17450A
OA17450A OA1201500300 OA17450A OA 17450 A OA17450 A OA 17450A OA 1201500300 OA1201500300 OA 1201500300 OA 17450 A OA17450 A OA 17450A
Authority
OA
OAPI
Prior art keywords
ledipasvir
sofosbuvir
weeks
pharmaceutical composition
génotype
Prior art date
Application number
OA1201500300
Inventor
Ben Chal
Erik Mogalian
Rowchanak Pakdaman
Reza Oliyai
Dimitrios Stefanidis
Vahid Zia
Original Assignee
Gilead Pharmasset Llc.
Filing date
Publication date
Application filed by Gilead Pharmasset Llc. filed Critical Gilead Pharmasset Llc.
Publication of OA17450A publication Critical patent/OA17450A/en

Links

Abstract

Disclosed are pharmaceutical compositions having an effective amount of substantially amorphous ledipasvir and an effective amount of substantially crystalline sofosbuvir.

Description

COMBINATION FORMULATION OF TWO ANTIVIRAL COMPOUNDS
CROSS-REFERENCE TO RELATE!) APPLICATION [0001] This application claims the benefit under 35 U.S.C. § 119(e) to U.S. Provisional Application Number 61/759,320, filed on January 31, 2013, U.S. Provisional Application Number 61/772,292, filed on March 4, 2013, U.S. Provisional Application Number 61/828,899, filed on May 30, 2013, U.S. Provisional Application Number 61/870,729, filed on August 27, 2013, U.S. Provisional Application Number 61/897,793, filed on October 30, 2013, and U.S. Provisional Application Number 61/907,332, filed on November 21, 2013, the entirety of which are ail incorporated herein by reference.
BACKGROUND [0002] Hepatitis C is recognized as a chronic viral disease of the liver which is characterized by liver disease. Although drugs targeting the liver are in wide use and hâve shown effectiveness, toxicity and other side effects hâve limited their usefulness. Inhibitors of hepatitis C virus (HCV) are useful to limit the establishment and progression of infection by HCV as well as in diagnostic assays for HCV.
[0003] Ledipasvir is a sélective inhibitor of non-structural protein 5A (NS5A), which has been described prevîously (see, for example, WO 2010/132601). The chemical name of ledipasvir i s ( 1 - {3 -[6-(9,9-difluoro-7- [ 2-[5-(2-methoxycarbonylamino-3-methyl-butyryl)-5aza-spiro[2.4]hept-6-yl]-3H-imidazol-4-yl}-9H-fluoren-2-yl)-lH-benzoimidazol-2-yl]-2-azabicyclo[2.2.1]heptane-2-carbonyl}-2-methyl-propyl)-carbamic acid methyl ester.
[0004] Sofosbuvir (SOF) is a sélective inhibitor of non-structural protein 5B (NS5B) (see, for example, WO 2010/132601 and U.S. Patent 7,964,580). The chemical name of sofosbuvir is (S)-isopropyl 2-(((S)-(((2R,3R,4R,5R)-5-(2,4-dioxo-3,4-dihydropyrimidinl(2H)-yl)-4-fluoro-3-hydroxy-4-methyltetrahydrofuran-2yl)methoxy)(phenoxy)phosphoryl)amino) propanoate.
SUMMARY [0005] The présent disclosure provides, in some embodiments, a pharmaceutical composition comprising ledipasvir in a substantially amorphous form and sofosbuvir in a substantially crystalline form.
[0006] Ledipasvir has the chemical name of (l-[3-[6-(9,9-difluoro-7-{2-[5-(2methoxycarbonylamino-3-methyl-butyryl)-5-aza-spiro[2.4]hept-6-yl]-3H-iinidazol-4-yl}-9Hfluoren-2-yl)-1 H-benzoimidazol-2-yl]-2-aza-bicyclo[2.2. l]heptane-2-carbonyl}-2-methylpropyl)-carbamic acid methyl ester, and has the following chemical formula:
[0007] Sofosbuvir (SOF) has the chemical name of (S)-isopropyl 2-(((S)-(((2RJR,4R,5R)5-(2,4-dioxo-3,4-dihydropyrimidin-l(2H)-yl)-4-fluoro-3-hydroxy-4-methyltetrahydrofuran-2“ yl)methoxy)(phenoxy)phosphoryl)amino)propanoate and has the following chemical formula:
[0008] In some embodiments, provided is a pharmaceutical composition comprising: a) an effective amount of ledipasvir, wherein ledipasvir is substantially amorphous; and b) an effective amount of sofosbuvir wherein sofosbuvir is substantially crystalline.
[0009] Further embodiments of the disclosure relate to pharmaceutical dosage forms and tablets. The disclosure also provides methods for using the combination in the treatment of hepatitis C.
BRIEF DESCRIPTION OF THE DRAWINGS [0010] FIG. 1 is a XRPD pattern of the solid dispersion formulation of ledipasvir comprising copovidone in a drug:polymer ratio of 1:1. As shown by the XRPD, the solid dispersion is in the amorphous state.
[0011] FIG. 2 is a modulated differential scanning calorimetry (DSC) curve of the solid dispersion of ledipasvir comprising copovidone in a drug:polymer ratio of 1:1. The glass transition température of the solid dispersion is about 140 °C.
[0012] FIG. 3 shows a solid state characterizatîon of the solid dispersion formulation of ledipasvir comprising copovidone in a drug:polymer ratio of 1:1 by solid state nuclear magnetic résonance (SS-NMR).
[0013] FIG. 4 is a Fourier-transformed Raman spectra of the solid dispersion of ledipasvir comprising copovidone in a drugtpolymer ratio of 1:1.
[0014] FIG. 5 shows the dissolution of sofosbuvir in the sofosbuvir ¢400 mg)/ledipasvir (90 mg) combination described în Example 7.
[0015] FIG. 6 shows the dissolution of ledipasvir in the sofosbuvir (400 mg)/ledipasvir (90 mg) combination formulation described in Example 3.
[0016] FIG. 7A-D shows the HCV RNA levels during 12 weeks of treatment and 24 weeks post-treatment for treatment naïve (FIG. 7A) or null responder (FIG. 7B) patients treated with sofosbuvir (SOF) and ribavirin (RBV) and for treatment naïve (FIG. 7C) or null responder (FIG. 7D) patients treated with sofosbuvir (SOF), ledipasvir and ribavirin (RBV). This data and experimental method are further described in Example 5.
[0017] FIG. 8A-B présent charts to show that ail three formulations had comparable dissolution performance, similar to that of the single-agent controls. This is more thoroughly described in Example 7.
[0018] FIG. 9 présents the pH-solubîlity profile of ledipasvir at room température (RT). The line is the nonlinear least-square régression fit using équation
St= So [(n-ioiPKe,'PH)+lO<pKaUpKa2’2,pH))] with an intrinsic solubility (So) of 0.04 pg/mL and a weakly basic pKal and pKa2 values of 5.0 and 4.0, respectively. This is more thoroughly described in Example 8.
[0019] FIG. 10 shows the study design for treatment naïve (non-cirrhotic) and for null responders (50% cîrrhotic) for patients treated with a fixed dose combination of sofosbuvir (SOF) and ledipasvir, with and without ribavirin (RBV) for 8 and 12 weeks. The data and experimental method are described in Example 9.
[0020] FIG. 11 shows the results for treatment naïve (non-cirrhotic) and for null responders (50% cirrhotic) for patients treated with a fixed dose combination of sofosbuvir (SOF) and ledipasvir, with and without ribavirin (RBV) for 8 and 12 weeks. This data and experimental method are further described in Example 9.
DETAILED DESCRIPTION
L Définitions (0021] As used in the présent spécification, the following words and phrases are generally intended to hâve the meanings as set forth below, except to the extent that the context in which they are used indicates otherwise.
[0022] As used herein, the term “about” used in the context of quantitative measurements means the indîcated amount ± 10%, or altematively ± 5%, or± 1%. For example, with a ± 10% range, “about 2:8” can mean 1.8-2.2:7.2-8.8.
[0023] The term “amorphous” refers to a state in which the material lacks long range order at the molecular level and, depending upon température, may exhibit the physical properties of a solid or a liquid. Typically such materials do not give distinctive X-ray diffraction patterns and, while exhîbiting the properties of a solid, are more formally described as a liquid. Upon heating, a change from solid to liquid properties occurs which is characterized by a change of state, typically second order (glass transition).
[0024] The term “crystalline” refers to a solid phase in which the material has a regular ordered internai structure at the molecular level and gives a distinctive X-ray diffraction pattern with defined peaks. Such materials when heated sufficiently will also exhibit the properties of a liquid, but the change from solid to liquid is characterized by a phase change, typically first order (melting point).
[0025] The term “substantially amorphous” as used herein is intended to mean that greater than 70%; or greater than 75%; or greater than 80%; or greater than 85%; or greater than 90%; or greater than 95%, or greater than 99% of the compound présent in a composition is in amorphous form. “Substantially amorphous” can also refer to material which has no more than about 20% crystallinity, or no more than about 10% crystallinity, or no more than about 5% crystallinity, or no more than about 2% crystallinity.
[0026] The term “substantially crystalline” as used herein is intended to mean that greater than 70%; or greater than 75%; or greater than 80%; or greater than 85%; or greater than
90%; or greater than 95%, or greater than 99% of the compound présent in a composition is in crystalline form. “Substantially crystalline” can also refer to material which has no more than about 20%, or no more than about 10%, or no more than about 5%, or no more than about 2% in the amorphous form.
[0027] The term “polymer” refers to a chemical compound or mixture of compounds consisting of repeating structural units created through a process of polymerization. Suitable polymers useful in this invention are described throughout.
[0028] The term “polymer matrix” as used herein is defined to mean compositions comprising one or more polymers in which the active agent is dispersed or included within the matrix.
[0029] The term “solid dispersion” refers to the dispersion of one or more active agents in a polymer matrix at solid state prepared by a variety of methods, including spray drying, the melting (fusion), solvent, or the melting-solvent method.
[0030] The term “amorphous solid dispersion” as used herein, refers to stable solid dispersions comprising an amorphous active agent and a polymer. By “amorphous active agent,” it is meant that the amorphous solid dispersion contains active agent in a substantially amorphous solid state form. In some aspects, as shown by the XRPD in FIG. 1, the solid dispersion is in the amorphous state, and the glass transition température of the solid dispersion is about 140 °C (see FIG. 2).
[0031] The term “pharmaceutically acceptable” indicates that the material does not hâve properties that would cause a reasonably prudent medical practitioner to avoîd administration of the material to a patient, taking into considération the disease or conditions to be treated and the respective route of administration. For example, it is commonly required that such a material be essentially stérile, e.g., for injectibles.
[0032] The term “pharmaceutically acceptable polymer” refers to a polymer that does not hâve properties that would cause a reasonably prudent medical practitioner to avoid administration of the material to a patient, taking into considération the disease or conditions to be treated and the respective route of administration.
[0033] The term “carrier” refers to a glidant, diluent, adjuvant, excipient, or vehicle etc with which the compound is administered, without limitation. Examples of carriers are described herein and also in “Remington's Pharmaceutical Sciences” by E.W. Martin.
[0034] The term “diluent” refers to chemical compounds that are used to dilute the compound of interest prior to delivery. Diluents can also serve to stabilize compounds. Nonlimiting examples of diluents include starch, saccharides, disaccharides, sucrose, lactose, polysaccharides, cellulose, cellulose ethers, hydroxypropyl cellulose, sugar alcohols, xylitol, sorbitol, maltitol, microcrystalline cellulose, calcium or sodium carbonate, lactose, lactose monohydrate, dicalcium phosphate, cellulose, compressible sugars, dibasic calcium phosphate dehydrate, mannitol, microcrystalline cellulose, and tribasic calcium phosphate.
[0035] The term “bindef” when used herein relates to any pharmaceutically acceptable film which can be used to bind together the active and inert components of the carrier together to maîntain cohesive and discrète portions. Non-limiting examples of binders include hydroxypropylcellulose, hydroxypropylmethyl cellulose, povidone, copovidone, and ethyl cellulose.
[0036] The term “disintegrant” refers to a substance which, upon addition to a solid préparation, facilitâtes its break-up or désintégration after administration and permits the release of an active ingrédient as efficiently as possible to allow for its rapid dissolution. Non-limiting examples of désintégrants include maize starch, sodium starch glycolate, croscarmellose sodium, crospovidone, microcrystalline cellulose, modified com starch, sodium carboxymethyl starch, povidone, pregelatinized starch, and alginic acid.
[0037] The term “lubricant” refers to an excipient which is added to a powder blend to prevent the compacted powder mass from sticking to the equipment during the tabletting or encapsulation process. It aids the éjection of the tablet form the dies, and can improve powder flow. Non-limiting examples of lubricants include magnésium stéarate, stearic acid, silica, fats, calcium stéarate, polyethylene glycol, sodium stearyl fumarate, or talc; and solubilizers such as fatty acids including lauric acid, oleic acid, and Cg/Cio fatty acid.
[0038] The term “film coating” refers to athin, uniform, film on the surface of a substrate (e.g. tablet). Film coatings are particularly useful for protectlng the active ingrédient from photolytic dégradation. Non-limiting examples of film coatings include polyvinylalcohol based, hydroxyethyl cellulose, hydroxypropylmethylcefiulose, sodium carboxymethylcellulose, polyethylene glycol 4000 and cellulose acetate phthalate film coatings.
[0039] The term “glidant” as used herein is intended to mean agents used in tablet and capsule formulations to improve flow-properties during tablet compression and to produce an anti-caking effect. Non-limiting examples of glidants include colloïdal silicon dioxide, talc, fumed silica, starch, starch dérivatives, and bentonite.
[0040] The term “effective amount” refers to an amount that îs sufïïcient to effect treatment, as defined below, when administered to a mammal in need of such treatment. The therapeutically effective amount will vary depending upon the patient being treated, the weight and âge of the patient, the severity of the disease condition, the manner of administration and the like, which can readily be determined by one of ordinary skill in the art.
[0041] The term “treatment” or “treating,” to the extent it relates to a disease or condition includes preventing the disease or condition from occurring, inhibiting the disease or condition, eliminating the disease or condition, and/or relieving one or more symptoms of the disease or condition.
[0042] The term “sustained virologie response” refers to the absence of détectable RNA (or wherein the RNA is below the limit of détection) of a virus (i.e. HCV) în a patient sample (i.e. blood sample) for a specifc period of time after discontinuation of a treatment. For example, a SVR at 4 weeks indicates that RNA was not detected or was below the limit of dectection in the patient at 4 weeks after discontînuîng HCV therapy.
[0043] The term “% w/w” as used herein refers to the weight of a component based on the total weight of a composition comprising the component. For example, if component A is présent in an amount of 50% w/w in a 100 mg composition, component A is présent in an amount of 50 mg.
2. Pharmaceutical Compositions [0044] The pharmaceutical compositions comprise a combination of an effective amount of ledipasvir, wherein ledipasvir is substantially amorphous, and an effective amount of sofosbuvir, wherein sofosbuvir is substantially crystalline.
[0045] Such a combination composition, as the experimental examples demonstrate, exhibit unexpected properties. Both sofosbuvir and ledipasvir hâve previously been demonstrated to act as effective anti-HCV agents. Ledipasvir, when administered alone in a conventional formulation, however, exhibited a négative food effect as evidenced by a roughly 2-fold decrease in exposure when given with a high-fat meal relative to dosing in the fasted state (see, e.g,, Tables 10 and 11, Example 3). When ledipasvir is administered in a solid dispersion formulation and in the combination with sofosbuvir, no such négative food effect occurs (Table 12, Example 3).
[0046] In the combination composition, ledipasvir is présent in a substantially amorphous form. Compared to crystalline agents, amorphous agents are expected to be unstable and hâve nonlînear solubîlity and exposure profiles. The data presented herein, however, show that ledipasvir in the combination composition is stable under various conditions, both short-term and long-term, and maintains high and consistent solubîlity and exposure profiles (Example
6).
[0047] Further, according the conventional wisdom, it is not advisable to co-formulate an amorphous agent with a crystalline agent, because the crystals can serve as seeds to induce crystallization of the amorphous agent, leading to instability of the amorphous agent. The current data show that, however, whether co-granulated or co-blended with sofosbuvir in the same layer or integrated as separate layers, ledipasvir stays stable and does not form crystals in the composition (Example 6).
[0048] It is also been discovered that, in tablet formations of the combination composition where sofosbuvir and ledipasvir are either co-granulated or co-blended, drug-drug interaction does not occur (Example 7).
A. Ledipasvir [0049] Ledipasvir has previously been described (see, for example, WO 2010/132601) and can be prepared by methods described therein. In one embodiment, the pharmaceutical composition comprises ledipasvir formulated as a solid dispersion dispersed within a polymer matrix formed by a pharmaceutically acceptable polymer. The starting material of the solid dispersion can be a variety of forms of ledipasvir including crystalline forms, amorphous form, salts thereof, solvatés thereof and the free base. For example, the acetone solvaté, Dtartrate sait, anhydrous crystalline free base, amorphous free base, solvatés or desolvates of ledipasvir can be used. Solvatés of ledipasvir include, for example, those described in U.S. Publication No. 2013/0324740 (incorporated herein by reference) such as, for example, the monoacetone solvaté, diacetone solvaté, ethyl acetone solvaté, isopropyl acetate solvaté, methyl acetate solvaté, ethyl formate solvaté, acetonitrile solvaté, tetrahydrofuran solvaté, methyl ethyl ketone solvaté, tetrahydrofuran solvaté, methyl ethyl ketone solvaté, and methyl /erZ-butyl ether solvaté. Particuiar starting materials contemplated to be useful are the monoacetone solvaté, diacetone solvaté, anhydrous crystalline free base, D-tartrate sait, anhydrous crystalline free base, and amorphous free base. These forms are characterized and described in U.S. Publication No. 2013/0324496.
[0050] After dispersion with the polymer, the solid dispersion is in the amorphous form. FIGs. 1-4 characterize the amorphous solid dispersion comprising ledipasvir. As shown by the XRPD in FIG. 1, the solid dispersion is in the amorphous state, and the glass transition température of the solid dispersion is about 140 °C.
[0051] Various techniques are well known in the art for preparing solid dispersions including, but not limited to melt-extrusion, spray-drying, lyophilization, and solutionévaporation.
[0052) Melt-extrusion is the process of embedding a compound in a thermoplastic carrier. The mixture is processed at elevated températures and pressures, which disperses the compound în the matrix at a molecular level to form a solid solution. Extruded material can be further processed into a variety of dosage forms, including capsules, tablets and transmucosal Systems.
[0053] For the solution-évaporation method, the solid dispersion can be prepared by dissolving the compound în a suitable liquid solvent and then incorporating the solution directly into the melt of a polymer, which is then evaporated until a clear, solvent free film is left. The film is further dried to constant weight.
[0054] For the lyophilization technique, the compound and carrier can be co-dissolved in a common solvent, ffozen and sublîmed to obtain a lyophilized molecular dispersion.
[0055] For spray dried solid dispersions, the solid dispersion can be made by a) mixing the compound and polymer in a solvent to provide a feed solution; and b) spray drying the feed solution to provide the solid dispersion.
[0056] Spray dried solid dispersions of ledipasvir provide improved in vivo and in vitro performance and manufacturability/scal ability relative to the other formulation approaches, such as wet and dry granulation formulations. Ledipasvir can be provided either as the free base, D-tartrate sait, crystalline acetone solvaté, or other solvaté as described herein.
[0057] The sélection of the polymer for the solid dispersion is based on the stability and physical characteristics of the ledipasvir in the solution. Hypromellose and copovidone solid dispersions both showed adéquate stability and physical characteristics. Accordingly, in one embodiment, the polymer used in the solid dispersion is selected from hypromellose and copovidone. Furthermore, the copovidone-based dispersion increased in bioavailability more than the équivalent hypromellose-based formulation (F = 30% and 22%, respectively) when prepared at 2:1 APLpolymer ratio. Bioavailability of the copovidone-based formulation was further enhanced by increasing the fraction of polymer to a 1:1 ratio, resulting in a bioavailability of 35% in famotidine pretreated dogs.
[0058] In one embodiment, the polymer used in the solid dispersion of ledipasvir is hydrophilîc. Non-limiting examples of hydrophilic polymers include polysaccharides, polypeptides, cellulose dérivatives such as methyl cellulose, sodium carboxymethylcelluiose, hydroxyethylcellulose, ethylcellulose, hydroxypropyl methylcellulose acetate-succinate, hydroxypropyl methylcellulose phthalate, cellulose acetate phthalate, hydroxypropylcellulose, povidone, copovidone, hypromellose, pyroxylin, polyethylene oxide, polyvinyl alcohol, and methacrylic acid copolymers.
[0059] In a further embodiment, the polymer is non-ionic. Non-ionic polymers showed benefits in screening solubility experiments. Non-limiting examples of non-ionic polymers include hypromellose, copovidone, povidone, methyl cellulose, hydroxyethyl cellulose, hydroxypropyl cellulose, ethylcellulose, pyroxylin, polyethylene oxide, polyvinyl alcohol, polyethylene glycol, and polyvinyl caprolactam-polyvinyl acetate-polyethylene glycol.
[0060] In another embodiment, the polymer is ionic. Examples of ionic polymers include hydroxypropyl methylcellulose acetate-succinate, hydroxypropyl methylcellulose phthalate, cellulose acetate phthalate, and methacrylic acid copolymers.
|0061] In a further embodiment, the polymer is selected from the group consisting of hypromellose, copovidone, and povidone. Hypromellose and copovidone solid dispersions both showed adéquate stability and physical characteristics. A copovidone-based dispersion increased bioavailability more than the équivalent hypromellose-based formulation (F = 30% and 22%, respectively) when spray dried at 2:1 ledipasviripolymer ratio (data not shown).
Accordingly, in a spécifie embodiment, the polymer is copovidone.
(0062] In certain embodiments, the weight ratio of ledipasvir to polymer is from about 5:1 to about 1:5. In further embodiments, the weight ratio of ledipasvir to polymer is about 5:1 to about 1:4, or from about 5:1 to about 1:3, or from about 5:1 to about 1:2, or from about 2:1 to about 1:2, or from about 2:1 to about 1:1. In a spécifie embodiment, the weight ratio of ledipasvir to polymer is about 1:1. In another embodiment, the weight ratio of ledipasvir to polymer is about 2:1. In further embodiments, the weight ratio of ledipasvir to polymer is about 5:1, 1:4, 1:3, or 1:2. Increasing the fraction of polymer to a 1:1 ratio may, in some instances, resuit in an increased bioavailability. For example, a 1:1 ratio of ledipasvir:copovidone resulted in increased bioavailability (F = 35%) in famotidine pretreated dogs.
[0063] The solid dispersion comprising ledipasvir may be présent in the pharmaceutical composition in a therapeutically effective amount. In some embodiments, the pharmaceutical compositions comprises from about 1% to about 50% w/w of the solid dispersion of ledipasvir. In further embodiments, the composition comprises from about 5% to about 40% w/w, or from about 5% to about 35% w/w, or from about 5% to about 30% w/w, or from about 10% to about 30% w/w, or from about 10% to about 25% w/w, or from about 15% to about 20% w/w of the solid dispersion of ledipasvir. In further embodiments, the pharmaceutical composition comprises about 1% w/w, about 5% w/w, about 10% w/w, about 20% w/w, about 25% w/w, about 30% w/w, about 35% w/w, or about 40% w/w of the solid dispersion of ledipasvir In a spécifie embodiment, the pharmaceutical composition comprises about 18% w/w of the solid dispersion of ledipasvir.
[0064] Ledipasvir may be présent in the pharmaceutical composition in a therapeutically effective amount. In some embodiments, the pharmaceutical compositions comprises from about 1% to about 50% w/w of ledipasvir. In further embodiments, the composition comprises from about 1% to about 40% w/w, or from about 1% to about 30% w/w, or from about 1% to about 20% w/w, or from about 5% to about 15% w/w, or from about 7% to about 12% w/w of ledipasvir. In further embodiments, the pharmaceutical composition comprises about 1% w/w, about 3% w/w, about 5% w/w, about 7% w/w, about 11% w/w, about 13% w/w, about 15% w/w, about 17% w/w, about 20% w/w, about 23% w/w, about 25% w/w, or about 28% w/w, or about 30% w/w of ledipasvir. In a spécifie embodiment, the pharmaceutical composition comprises about 9% w/w of ledipasvir.
[0065] As noted above, after the ledipasvir is mixed with the polymer, the mixture can then be solubilized in a solvent. It is within the skill of those in the art to select an appropriate solvent based on the drug and/or polymer properties such as solubility, glass transition température, viscosity, and molecular weight. Acceptable solvents include but are not limited to, water, acetone, methyl acetate, ethyl acetate, chlorinated solvents, éthanol, dichloromethane, and methanol. In one embodiment, the solvent is selected from the group consisting of éthanol, dichloromethane, and methanol. In a iùrther embodiment, the solvent is éthanol or methanol. In a spécifie embodiment, the solvent is éthanol.
[0066] Upon solubilization of the compound and polymer mixture with the solvent, the mixture may then be spray dried. Spray drying is a well known process wherein a liquid feedstock is dispersed into droplets into a drying chamber along with a heated process gas stream to aid in solvent removal and to produce a powder product. Suitable spray drying parameters are known in the art, and it is within the knowledge of a skilled artisan în the field to select appropriate parameters for spray drying. The target feed concentration is generally about 10 to about 50% wîth a target of about 20% and a viscosity of about 15 to about 300 cP. The inlet température of the spray dry apparatus is typically about 50-190° C, while the outlet température is about 30-90° C. The two fluid nozzle and hydrolic pressure nozzle can be used to spray dry ledipasvir. The two fluid nozzle gas flow can be about 1-10 kg/hr, the hydrolic pressure nozzle flow can be about 15-300 kg/hr, and the chamber gas flow may be about 25-2500 kg/hr The spray-dried material typically has particle size (D<xi) under 80 pm. In some instances, a milling step may be used, if desired to further reduce the particle size. Further descriptions of spray drying methods and other techniques for forming amorphous dispersions are provided in U.S. Pat. No. 6,763,607 and U.S. Pat. Pub. No. 2006-0189633, the entirety of each of which is incorporated herein by reference.
[0067] Spray drying out of éthanol resulted in high yields (88, 90, 92, 95, 97, 98, 99%) across a wide range of spray-drying outlet températures (30-90 °C) with no material accumulation on the spray dry chamber, and the yields obtained from spray drying out of
DCM were 60%, 78%, and 44%. Furthermore, ledipasvir demonstrated good chemical stability in the ethanolic feed solution.
B. Sofosbuvir [0068] Sofosbuvir has previously been described in U.S. Patent 7,964,580 and U.S.
Publication Nos: 2010/0016251, 2010/0298257, 2011/0251152 and 2012/0107278.
Sofosbuvir is provided as substantially crystalline in the pharmaceutical compositions described herein. Examples of preparing crystalline forms of sofosbuvir are disclosed in U.S. Publication Nos: 2010/0298257 and 2011/0251152, both of which are incorporated by reference. Crystalline forms, Forms 1-6, of sofosbuvir are described in U.S. Publication Nos.: 2010/0298257 and 2011/0251152, both of which are incorporated by reference. Forms 1 -6 of sofosbuvir hâve the following characteristic X-ray powder diffraction (XRPD) pattern 20-values measured according to the XRPD methods disclosed therein:
(1) 20-reflections (° ± 0.2Θ) at about: 7.5, 9.6, and 18.3 (Form 1);
(2) 26-reflections (° ± 0.20) at about: 5.0, 7.3, and 18.1 (Form 1);
(3) 29-reflections (° ± 0.20) at about: 6.9, 24.7, and 25.1 (Form 2);
(4) 20-reflections (Q ± 0.2Θ) at about: 19.7, 20.6, and 24.6 (Form 3), (5) 20-reflections (° ± 0.2Θ) at about: 5.0, 6.8, and 24.9 (Form 4);
(6) 20-reflections (° ± 0.20) at about: 5.2, 6.6, and 19.1 (Form 5); and (7) 20-reflections (° ± 0.20) at about: 6.1, 20.1, and 20.8 (Form 6).
[0069] Form 6, as described in the patent publications above, may be referred to as Form 2, such for example, by the Food and Drug Administration. Forms 1 and 6 are altematively characterized by the following characteristic XRPD pattern 20-values as measured according to the methods disclosed in U.S. Pat. Pub. Nos.: 2010/0298257 and 2011/0251152:
(1) 20-reflections (°) at about: 5.0 and 7.3 (Form 1); and (2) 20-reflectîons (°) at about: 6.1 and 12.7 (Form 6).
[0070] In one embodiment, the crystalline sofosbuvir has XRPD 20-reflections (° ± 0.2Θ) at about:
(1) 7.5, 9.6, and 18.3; (Form IA) (2) 5.0,7 3, and 18.1; (Form IB) (3) 6.9, 24.7, and 25.1; (Form 2) i
(4) 19.7, 20.6, and 24.6; (Form 3) (5) 5.0, 6.8, and 24.9; (Form 4) (6) 5.2, 6.6, and 19.1, (Form 5) or (7) 6,1,20.1, and 20.8; (Form 6).
[0071] In certain embodiments, the crystalline sofosbuvir has XRPD 20-reflections (° ±
0.2Θ) at about:
(1) 5.2, 7.5, 9.6, 16.7, 18.3, and 22.2 (Form 1);
(2) 5.0, 7.3, 9.4, and 18.1 (Form 1);
(3) 4.9, 6.9, 9.8, 19.8, 20.6, 24.7, 25.1, and 26.1 (Form 2);
(4) 6.9, 9.8, 19.7, 20.6, and 24.6 (Form 3);
(5) 5.0, 6.8, 19.9, 20.6, 20.9, and 24.9 (Form 4);
¢6)5.2,6.6, 7.1, 15.7, 19.1, and 25.0 (Form 5); or (7)6.1,8.2, 10.4, 12.7, 17.2, 17.7, 18.0, 18.8, 19.4, 19.8,20.1,20.8,21.8, and
23.3 (Form 6).
[0072] In a further embodiment, crystalline sofosbuvir has XRPD 29-reflections (° ± 0.29) at about: 6.1, 8.2, 10.4, 12.7, 17.2, 17.7, 18.0, 18.8, 19.4, 19.8, 20.1, 20.8,21.8, and 23.3. In yet a further embodiment, crystalline sofosbuvir has XRPD 29-reflections (° ± 0.29) at about: 6.1 and 12.7.
[0073] Sofosbuvir may be présent in the pharmaceutical composition in a therapeutically effective amount. In some embodiments, the pharmaceutical compositions comprises from about 10% to about 70% w/w of sofosbuvir. In further embodiments, the composition comprises from about 15% to about 65% w/w, or from about 20% to about 60% w/w, or from about 25% to about 55% w/w, or from about 30% to about 50% w/w, or from about 35% to about 45% w/w of sofosbuvir. In further embodiments, the pharmaceutical composition comprises about 10% w/w, about 15% w/w, about 20% w/w, about 25% w/w, about 30% w/w, about 35% w/w, about 45% w/w, about 50% w/w, about 55% w/w, about 60% w/w, about 65% w/w, or about 70% w/w, or about 75% w/w. In a spécifie embodiment, the pharmaceutical composition comprises about 40% w/w of sofosbuvir.
C. Excipients [0074] The pharmaceutical compositions provided in accordance with the présent disclosure are usually administered orally. This disclosure therefore provides pharmaceutical compositions that comprise a solid dispersion comprising ledipasvir as described herein and one or more pharmaceutically acceptable excipients or carriers including but not limited to, inert solid diluents and fillers, diluents, including stérile aqueous solution and various organic solvents, perméation enhancers, solubilizers, disintegrants, lubricants, binders, glidants, adjuvants, and combinations thereof. Such compositions are prepared in a manner well known in the pharmaceutical art (see, e.g., Remington’s Pharmaceutical Sciences, Mace Pubiishing Co., Philadelphia, PA 17th Ed. (1985); and Modem Pharmaceutics, Marcel Dekker, Inc. 3rd Ed. (G.S. Banker& C.T. Rhodes, Eds).
[0075] The pharmaceutical compositions may be administered in either single or multiple doses by oral administration. Administration may be via capsule, tablet, or the like. In one embodiment, the ledipasvir is in the form of a tablet. In a further embodiment, the tablet is a compressed tablet. In making the pharmaceutical compositions that include the solid described herein, the active ingrédient is usually diluted by an excipient and/or enclosed within such a carrier that can be in the form of a capsule, tablet, sachet, paper or other container. When the excipient serves as a diluent, it can be in the form of a solid, semi-solid or liquid material (as above), which acts as a vehicle, carrier or medium for the active ingrédient.
]0076] The pharmaceutical composition may be formulated for immédiate release or sustained release. A “sustained release formulation” is a formulation which is designed to slowly release a therapeutic agent in the body over an extended period of time, whereas an “immédiate release formulation” is an formulation which îs designed to quickly release a therapeutic agent in the body over a shortened period of time. In some cases the immédiate release formulation may be coated such that the therapeutic agent is only released once it reached the desired target in the body (e.g. the stomach). In a spécifie embodiment, the pharmaceutical composition îs formulated for immédiate release.
[0077] The pharmaceutical composition may further comprise pharmaceutical excipients such as diluents, binders, fillers, glidants, disintegrants, lubricants, solubilizers, and combinations thereof. Some examples of suitable excipients are described herein. When the pharmaceutical composition is formulated into a tablet, the tablet may be uncoated or may be coated by known techniques including microencapsulation to delay disintegration and adsorption in the gastrointestinal tract and thereby provide a sustained action over a longer period. For example, a time delay material such as glyceryl monostearate or glyceryl dîstearate alone or with a wax may be employed.
[0078] In one embodiment, the pharmaceutical composition comprises a diluent selected from the group consisting of dicalcium phosphate, cellulose, compressible sugars, dibasic calcium phosphate dehydrate, lactose, lactose monohydrate, mannitol, microcrystalline cellulose, starch, tribasic calcium phosphate, and combinations thereof.
[0079] In further embodiments, the pharmaceutical composition comprises lactose monohydrate in an amount from about 1 to about 50% w/w, or from about 1 to about 45% w/w, or from about 5 to about 40% w/w, or from about 5 to about 35% w/w, or from about 5 to about 25% w/w, or from about 10 to about 20% w/w. In spécifie embodiments, the lactose monohydrate is présent at about 5% w/w, at about 10% w/w, at about 15% w/w, at about 20% w/w, at about 25% w/w, at about 30% w/w, at about 35% w/w, at about 40% w/w, at about 45% w/w, or at about 50% w/w. In a further spécifie embodiment, the lactose monohydrate is in an amount of about 16.5% w/w.
[0080] In yet further embodiments, the pharmaceutical composition comprises microcrystalline cellulose in an amount from about 1 to about 40% w/w, or from about 1 to about 35% w/w, or from about 1% to about 25% w/w, or from about 5 to about 25% w/w, or from about 10 to about 25% w/w, or from about 15 to about 20% w/w. In spécifie embodiments, the microcrystalline cellulose is présent in an amount of about 5%, or about 10%, or about 15%, or about 20%, or about 25%, or about 30%, or about 35%, or about 40%w/w. In a further spécifie embodiment, the microcrystalline cellulose is in an amount of about 18% w/w.
[0081] In other embodiments, the pharmaceutical composition comprises a disintegrant selected from the group consisting of croscarmellose sodium, crospovidone, microcrystalline cellulose, modîfied corn starch, povidone, pregelatinized starch, sodium starch glycolate, and combinations thereof.
(0082] In certain embodiments, the pharmaceutical composition comprises croscarmellose sodium in an amount from about 1 to about 20% w/w, or from about 1 to about 15% w/w, or from about 1 to about 10% w/w, or from about 1 to about 8% w/w, or from about 2 to about
8% w/w. In spécifie embodîments, the croscarmellose sodium is présent in an amount of about 1%, or about 3%, or about 6%, or about 8%, or about 10%, or about 13%, or about
15% w/w. In a further spécifie embodiment, the croscarmellose sodium is in an amount of about 5% w/w.
]0083] In other embodîments, the pharmaceutical composition comprises a glidant selected from the group consîsting of colloïdal silicon dioxide, talc, starch, starch dérivatives, and combinations thereof.
[0084] In further embodîments, the pharmaceutical composition comprises colloïdal silicon dioxide in an amount from about 0.1 to about 5% w/w, or from about 0.1 to about 4.5% w/w, or from about 0.1 to about 4% w/w, or from about 0.5 to about 5.0% w/w, or from about 0.5 to about 3% w/w, or from about 0,5 to about 2% w/w, or from about 0.5 to about 1,5% w/w. In spécifie embodîments, the colloïdal silicon dioxide is présent in an amount of about 0.1% w/w, 0.5% w/w, 0.75% w/w, 1.25% w/w, 1.5% w/w, or 2% w/w. In a further spécifie embodiment, the colloïdal silicon dioxide is présent in an amount of about 1% w/w.
[0085] In other embodîments, the pharmaceutical composition comprises a lubricant selected from the group consîsting of calcium stéarate, magnésium stéarate, polyethylene glycol, sodium stearyl fumarate, stearic acid, talc, and combinations thereof.
(0086] In further embodîments, the pharmaceutical composition comprises magnésium stéarate in an amount from about 0.1 to about 3% w/w, or from about 0.1 to about 2.5% w/w, or from about 0.5 to about 3% w/w, or from about 0.5 to about 2.5% w/w, or from about 0.5 to about 2% w/w, or from about 1 to about 3% w/w, or from about 1 to about 2% w/w. In spécifie embodîments, the magnésium stéarate is présent in an amount of about 0.1%, or about 0.5, or about 1%, or about 2%, or about 2.5%, or about 3% w/w. In a fùrther spécifie embodiment, the magnésium stéarate is in an amount of about 1.5% w/w.
[0087] In one embodiment, the pharmaceutical composition comprises a) about 30 to about
50% w/w of sofosbuvir and b) about 5 to about 35 %w/w of the solid dispersion comprising ledipasvir. In a related embodiment, the composition comprises a) about 40% w/w of sofosbuvir and b) about 18% w/w of the solid dispersion comprising ledipasvir. In yet a further related embodiment, the composition further comprises a) about 5 to about 25% w/w lactose monohydrate, b) about 5 to about 25% w/w microcrystalline cellulose, c) about 1 to about 10% w/w croscarmellose sodium, d) about 0.5 to about 3% w/w colloïdal silicon dioxide, and e) about 0.1 to about 3% w/w magnésium stéarate. In a further embodiment, the pharmaceutical composition comprises a) about 40% w/w of sofosbuvir, b) about 18 %w/w of the solid dispersion comprising ledipasvir, c) about 16.5% w/w lactose monohydrate, d) about 18% w/w microcrystalline cellulose, e) about 5% w/w croscarmellose sodium, f) about
1% w/w colloïdal silicon dioxide, and g) about 1.5% w/w magnésium stéarate.
3. Pharmaceutical Dosage Forms [0088] The disclosure provides for tablets, pills, and the like, comprising the pharmaceutical compositions or dosage forms described herein. The tablets or pills of the présent disclosure may be coated to provide a dosage form affording the advantage of prolonged action or to protect from the acid conditions of the stomach. The tablets may also be formulated for immédiate release as previously described. In certain embodiments, the tablet comprises a film coating. A film coating is useful for limiting photolytic dégradation. Suitable film coatings are selected by routine screening of commercially available préparations. In one embodiment, the film coating is a polyvinylalcohol-based coating.
[0089] The tablets may be formulated into a monolayer or bilayer tablet. Typically, monolayer tablet comprise the active ingrédients (i.e., ledipasvir and sofosbuvir) co-mixed in a single uniform layer. For making monolayer tablets, exemplary methods include, but are not limited to coblend (or bi-granulation) and codry granulation. Coblend granulation is a multi-step process consisting of separate dry granulations for each active ingrédient with excipients followed by the blending of the two granulations together. Codry granulation consisted of dry granulating both active ingrédients and excipients together.
[0090] Bilayer tablets comprise the active ingrédients (i.e., ledipasvir and sofosbuvir) in separate layers and can be made by making a blend comprising excipients and one active ingrédient (i.e., ledipasvir), and making a separate blend comprising the second active ingrédient (i.e., sofosbuvir) and excipients. One blend may then be precompressed, and the second blend may then be added on top of the first precompressed blends. The resulting tablet comprises two separate layers, each layer comprising a different active ingrédient.
[0091] In one embodiment, the tablet comprises a) about 30 to about 50% w/w of sofosbuvir and b) about 10 to about 40 %w/w of the solid dispersion comprising ledipasvir.
In a related embodiment, the tablet comprises a) about 40% w/w of sofosbuvir and b) about
18% w/w of the solid dispersion comprising ledipasvir. In a further embodiment, the tablet comprises a) about 300 to about 500 mg of sofosbuvir and b) about 50 to about 130 mg of ledipasvir. In a yet further embodiment, the tablet comprises a) about 400 mg of sofosbuvir and b) about 90 mg of ledipasvir. In related embodiment, the tablet further comprises a) about 5 to about 25% w/w lactose monohydrate, b) about 5 to about 25% w/w microcrystalline cellulose, c) about 1 to about 10% w/w croscarmellose sodium, d) about 0.5 to about 3% w/w colloïdal silicon dioxide, and e) about 0.1 to about 3% w/w magnésium stéarate.
[0092] In some embodiments, the pharmaceutical compositions as described herein are formulated in a unit dosage or pharmaceutical dosage form. The term “unît dosage forms” or “pharmaceutical dosage forms” refers to physically discrète units suitable as unitary dosages for human patients and other mammals, each unit containing a predetermined quantity of active material calculated to produce the desired therapeutic effect, in association with a suitable pharmaceutical excipient (e.g., a tablet or capsule). The compounds are generally administered in a pharmaceutically effective amount. In some embodiments, each dosage unit contains from 3 mg to 2 g of ledipasvir. In other embodiments, the pharmaceutical dosage form comprises from about 3 to about 360 mg, or about 10 to about 200 mg, or about 10 to about 50 mg, or about 20 to about 40 mg, or about 25 to about 35 mg, or about 40 to about 140 mg, or about 50 to about 130 mg, or about 60 to about 120 mg, or about 70 to about 110 mg, or about 80 to about 100 mg. In spécifie embodiments, the pharmaceutical dosage form comprises about 40, or about 45, or about 50, or about 55, or about 60, or about 70, or about 80, or about 100, or about 120, or about 140, or about 160, or about 180, or about 200, or about 220 mg of ledipasvir. In a further spécifie embodiment, the pharmaceutical dosage form comprises about 90 mg of ledipasvir. In yet a further spécifie embodiment, the pharmaceutical dosage form comprises about 30 mg of ledipasvir.
[0093] In other embodiments, the pharmaceutical dosage form comprises from about 1 mg to about 3g of sofosbuvir. In other embodiments, the pharmaceutical dosage form comprises from about 1 to about 800 mg, or about 100 to about 700 mg, or about 200 to about 600 mg, or about 300 to about 500 mg, or about 350 to about 450 mg, of sofosbuvir. In spécifie embodiments, the pharmaceutical dosage form comprises about 50, or about 100, or about 150, or about 200, or about 250, or about 300, or about 350, or about 450, or about 500, or about 550, or about 600, or about 650, or about 700, or about 750, or about 800 mg of sofosbuvir. In a further spécifie embodiment, the pharmaceutical dosage form comprises about 400 mg of sofosbuvir. It will be understood, however, that the amount of ledipasvir and/or sofosbuvir actually admînistered usually will be determined by a physician, in the light of the relevant circumstances, including the condition to be treated, the chosen route of administration, the actual compound admînistered and its relative activity, the âge, weight and response of the indîvidual patient, the severity of the patient’s symptoms, and the like.
[0094] In a spécifie embodiment, the pharmaceutical dosage form comprises about 400 mg of sofosbuvir and about 90 mg of ledipasvir.
[0095] In one embodiment, the pharmaceutical composition, or altematively, the pharmaceutical dosage form or tablet comprises about 90 mg of amorphous ledipasvir formulated in a solid dispersion comprising a polymer:ledipasvir ratio of 1:1, about 400 mg crystalline sofosbuvir, lactose monohydrate in an amount from about 5 to about 25% w/w, microcrystalline cellulose in an amount from about 5 to about 25% w/w, croscarmellose sodium in an amount from about 1 to about 10% w/w, colloïdal silicon dioxoide ïn an amount from about 0.5 to about 3% w/w, and magnésium stéarate in an amount from about 0.1 to about 3% w/w. In one embodiment, the polymer is copovidone.
[0096] In further embodiments, the pharmaceutical composition, pharmaceutical dosage form, or tablet as described herein is free of négative drug-drug interactions. In a related embodiment, the pharmaceutical composition, pharmaceutical dosage form, or tablet is free of négative drug-drug interactions with acid suppressive thérapies. In a further embodiment, the pharmaceutical composition, pharmaceutical dosage form, or tablet as described herein is administrable without regard to food and with or without regard to the patient being on an aeîd-suppressive therapy.
4. Methods of Use |0097] The solid dispersions, pharmaceutical compositions, pharmaceutical dosage forms, and tablets of ledipasvir and sofosbuvir as described herein are admînistered to a patient suffering from hepatitis C virus (HCV) in a daily dose by oral administration. In one embodiment, the patient is human.
[0098] Previously, ledipasvir had been demonstrated to hâve a négative food effect when admînistered alone. Unexpectedly, the combination treatment of ledipasvir and sofosbuvir does not exhibit a négative food effect. Accordingly, the administration of the pharmaceutical composition comprising sofosbuvir and ledipasvir can be taken without regard to food.
[0099] In some embodiments, the combination composition achieved a reduced food effect. In some aspects, the composition achieves a first exposure, when administered to a patient following a meal, that is no more than 25%, or aitematively not more than 20%, 15% or 10%, lower than a second exposure when administered to the patient not following a meal. The exposures can be measured as Cmax, AUCiast or AUCinf. In some aspects, the administration is carried out within four, three, two or one hours following the meal.
[0100] In one embodiment, the solid dispersions, pharmaceutical compositions, pharmaceutical dosage forms, and tablets of ledipasvir and sofosbuvir as described herein are effective in treating one or more of génotype 1 HCV infected patients, génotype 2 HCV infected patients, génotype 3 HCV infected patients, génotype 4 HCV infected patients, génotype 5 HCV infected patients, and/or génotype 6 HCV infected patients. In one embodiment, the solid dispersions, pharmaceutical compositions, pharmaceutical dosage forms, and tablets of ledipasvir and sofosbuvir as described herein are effective in treating génotype 1 HCV infected patients, including génotype la and/or génotype lb. In another embodiment, the solid dispersions, pharmaceutical compositions, pharmaceutical dosage forms, and tablets of ledipasvir and sofosbuvir as described herein are effective in treating génotype 2 HCV infected patients, including génotype 2a, génotype 2b, génotype 2c and/or génotype 2d. In another embodiment, the solid dispersions, pharmaceutical compositions, pharmaceutical dosage forms, and tablets of ledipasvir and sofosbuvir as described herein are effective in treating génotype 3 HCV infected patients, including génotype 3a, génotype 3b, génotype 3c, génotype 3d, génotype 3e and/or génotype 3f In another embodiment, the solid dispersions, pharmaceutical compositions, pharmaceutical dosage forms, and tablets of ledipasvir and sofosbuvir as described herein are effective in treating génotype 4 HCV infected patients, including génotype 4a, génotype 4b, génotype 4c, génotype 4d, génotype 4e, génotype 4f, génotype 4g, génotype 4h, génotype 4i and/or génotype 4j. In another embodiment, the solid dispersions, pharmaceutical compositions, pharmaceutical dosage forms, and tablets of ledipasvir and sofosbuvir as described herein are effective in treating génotype 5 HCV infected patients, including génotype 5a. In another embodiment, the solid dispersions, pharmaceutical compositions, pharmaceutical dosage forms, and tablets of ledipasvir and sofosbuvir as described herein are effective in treating génotype 6 HCV infected patients, including génotype 6a. In one embodiment, the compositions are pangenotypic, meaning they are useful across ail génotypes and drug résistant mutants thereof.
[0101] In some embodiments, the pharmaceutical composition, pharmaceutical dosage form, or tablet of ledipasvir and sofosbuvir as described herein is administered, either alone or in combination with one or more therapeutic agent(s) for treating HCV (such as a HCV NS3 protease inhibitor or an inhibitor of HCV NS5B polymerase), for about 24 weeks, for about 16 weeks, or for about 12 weeks, or less. In further embodiments, the pharmaceutical composition, pharmaceutical dosage form, or tablet of ledipasvir and sofosbuvir is administered, either alone or in combination with one or more therapeutic agent(s) for treating HCV (such as a HCV NS3 protease inhibitor or an inhibitor of HCV NS5B polymerase), for about 24 weeks or less, about 22 weeks or less, about 20 weeks or less, about 18 weeks or less, about 16 weeks or less, about 12 weeks or less, about 10 weeks or less, about 8 weeks or less, or about 6 weeks or less or about 4 weeks or less. The pharmaceutical composition, pharmaceutical dosage form, or tablet may be administered once daily, twice daily, once every other day, two times a week, three times a week, four tîmes a week, or five times a week.
[0102] In further embodiments, a sustained virologie response is achieved at about 4 weeks, 6 weeks, 8 weeks, 12 weeks, or 16 weeks, or at about 20 weeks, or at about 24 weeks, or at about 4 months, or at about 5 months, or at about 6 months, or at about 1 year, or at about 2 years.
[0103] In one embodiment, the daily dose is 90 mg of ledipasvir and 400 mg of sofosbuvir administered in the form of a tablet. In a further embodiment, the daily dose is a tablet comprising a) about 30 to about 50% w/w of sofosbuvir, b) about 10 to about 40 %w/w of the solid dispersion comprising ledipasvir, c) about 5 to about 25% w/w lactose monohydrate, d) about 5 to about 25% w/w microcrystalline cellulose, e) about 1 to about 10% w/w croscarmellose sodium, f) about 0.5 to about 3% w/w colloïdal silicon dioxide, and g) about 0.1 to about 3% w/w magnésium stéarate.
[0104] In further embodiments, the patient is also suffering from cirrhosis. In yet a fùrther embodiment, the patient is not suffereing from cirrhosis.
5. Combination Therapy [0105] In the methods described herein, the method can further comprise the administration of another therapeutic agent for treating HCV and other conditions such as HIV infections. In one embodiment, non-limiting examples of suitable additional therapeutic agents include one or more interferons, ribavirin or its analogs, HCV NS3 protease inhibitors, alpha-glucosidase 1 inhibitors, hepatoprotectants, nucleoside or nucléotide inhibitors of HCV NS5B polymerase, non-nucleoside inhibitors of HCV NS5B polymerase, HCV NS5A inhibitors, TLR-7 agonîsts, cyclophillin inhibitors, HCV IRES inhibitors, pharmacokinetic enhancers, and other drugs or therapeutic agents for treating HCV, [0106] More specifically, the additional therapeutic agent may be selected from the group consisting of:
1) interferons, e.g., pegylated rIFN-alpha 2b (PEG-Intron), pegylated rIFN-alpha 2a (Pegasys), rIFN-alpha 2b (Intron A), rIFN-alpha 2a (Roferon-A), interferon alpha (MOR-22, OPC-18, Alfaferone, Alfanative, Multiferon, subalin), interferon alfacon-1 (Infergen), interferon alpha-nl (Wellferon), interferon alpha-n3 (Alferon), interferon-beta (Avonex, DL8234), interferon-omega (oméga DUROS, Biomed 510), albinterferon alpha-2b (Albuferon), IFN alpha-2b XL, BLX-883 (Locteron), DA-3021, glycosylated interferon alpha-2b (AVI005), PEG-Infergen, PEGylated interferon lambda-1 (PEGylated EL-29), and belerofon;
2) ribavirin and its analogs, e.g., ribavirin (Rebetol, Copegus), and taribavirin (Vîramidine);
3) HCV NS3 protease inhibitors, e.g., boceprevir (SCH-503034, SCH-7), telaprevir (VX-950), TMC435350, BI-1335, BI-1230, MK-7009, VBY-376, VX-500, GS-9256, GS9451, BMS-605339, PHX-1766, AS-101, YH-5258, YH5530, YH5531, ABT-450, ACH1625, ITMN-191, MK5172, MK6325, and MK2748;
4) alpha-glucosidase 1 inhibitors, e.g., celgosivir (MX-3253), Miglitol, and UT-231B;
5) hepatoprotectants, e.g., emerîcasan (IDN-6556), ME-3738, GS-9450 (LB-84451), silibilin, and MitoQ;
6) nucleoside or nucléotide inhibitors of HCVNS5B polymerase, e.g., R1626, R7128 (R4048), IDX184, IDX-102, BCX-4678, valopicitabine (NM-283), MK-0608, and ΓΝΧ-189 (now BMS986094);
7) non-nucleoside inhibitors of HCV NS5B polymerase, e.g., PF-868554, VCH-759, VCH-916, JTK-652, MK-3281, GS-9190, VBY-708, VCH-222, A848837, ANA-598, GL60667, GL59728, A-63890, A-48773, A-48547, BC-2329, VCH-796 (nesbuvir),
GSK625433, BILN-1941, XTL-2125, ABT-072, ABT-333, GS-9669, PSI-7792, and GS9190;
8) HCV NS5A inhibitors, e.g., AZD-2836 (A-831), BMS-790052, ACH-3102, ACH2928, MK8325, MK4882, MK8742, PSI-461, IDX719, ABT-267, and A-689;
9) TLR-7 agonists, e.g., imiquimod, 852A, GS-9524, ANA-773, ANA-975, AZD8848 (DSP-3025), and SM-360320,
10) cyclophillin inhibitors, e.g., DEBIO-025, SCY-635, and NIM811;
) HCV IRES inhibitors, e.g., MCI-067;
12) pharmacokinetic enhancers, e.g., BAS-100, SPI-452, PF-4194477, TMC-41629, GS-9350, GS-9585, and roxythromycin; and
13) other drugs for treating HCV, e.g., thymosin alpha 1 (Zadaxin), nitazoxanide (Alinea, NTZ), BIVN-401 (virostat), PYN-17 (altirex), KPE02003002, actilon (CPG-10101), GS-9525, KRN-7000, civacir, GI-5005, XTL-6865, BIT225, PTX-111, ITX2865, TT-0331, ANA971, NOV-205, tarvacin, EHC-18, VGX-410C, EMZ-702, AVI 4065, BMS-650032, BMS-791325, Bavituximab, MDX-1106 (ONO-4538), Oglufanide, and VX-497 (merimepodib).
|0107] More specifically, the additional therapeutic agent may be combined with one or more compounds selected from the group consisting of non-nucleoside inhibitors of HCV NS5B polymerase (ABT-072 and ABT-333), HCV NS5A inhibitors (ACH-3102 and ACH2928) and HCV NS3 protease inhibitors(ABT-450 and ACH-125).
[0108] In another embodiment, the therapeutic agent used in combination with the pharmaceutical compositions as described herein can be any agent having a therapeutic effect when used in combination with the pharmaceutical compositions as described herein. For example, the therapeutic agent used in combination with the pharmaceutical compositions as described herein can be interferons, ribavirin analogs, NS3 protease inhibitors, NS5B polymerase inhibitors, alpha-glucosidase 1 inhibitors, hepatoprotectants, non-nucleoside inhibitors of HCV, and other drugs for treating HCV.
|0109] In another embodiment, the additional therapeutic agent used in combination with the pharmaceutical compositions as described herein is a cyclophillin inhibitor, including for example, a cyclophilîn inhibitor dîsclosed in WO2013/185093. Non-limiting examples include one or more compounds selected from the group consisiting of:
[0110| In another embodiment, the additional therapeutic agent used in combination with the pharmaceutical compositions as described herein is a non-nucleoside inhibitor of HCV NS5B polymerase. A non-limiting example includes Compound E (as described below).
[0111] Examples of additional anti-HCV agents which can be combined with the compositions provided herein include, without limitation, the following:
A. interferons, for example, pegylated rIFN-alpha 2b (PEG-Intron), pegylated rIFN-alpha 2a (Pegasys), rIFN-alpha 2b (Intron A), rIFN-alpha 2a (Roferon-A), interferon alpha (MOR-22, OPC-18, Alfaferone, Alfanative, Multiferon, subalin), interferon alfacon-I (Infergen), interferon alpha-nl (Wellferon), interferon alpha-n3 (Alferon), interferon-beta (Avonex, DL-8234), interferon-omega (oméga DUROS, Biomed 510), albinterferon alpha-2b (Albuferon), IFN alpha XL, BLX-883 (Locteron), DA-3021, glycosylated interferon alpha-2b (AVI-005), PEG-Infergen, PEGylated interferon lambda (PEGylated IL-29), or belerofon, EFN alpha-2b XL, rIFN-alpha 2a, consensus IFN alpha, infergen, rebif, pegylated IFN-beta, oral interferon alpha, feron, reaferon, intermax alpha, r-IFN-beta, and infergen + actimmuneribavirin and ribavirin analogs, e.g., rebetol, copegus, VX-497, and viramidine (taribavirin),
B. NS5A inhibitors, for example, Compound B (described below), Compound C (described below), ABT-267, Compound D (described below), JNJ-47910382, daclatasvir (BMS-790052), ABT-267, MK-8742, EDP-239, IDX-719, PPI-668, GSK-2336805, ACH3102, A-831, A-689, AZD-2836 (A-831), AZD-7295 (A-689), and BMS-790052;
C. NS5B polymerase inhibitors, for example, Compound E (described below), Compound F (described below), ABT-333, Compound G (described below), ABT-072, Compound H (described below), tegobuvir (GS-9190), GS-9669, TMC647055, setrobuvir (ANA-598), filibuvir (PF-868554), VX-222, IDX-375, IDX-184, IDX-102, BI-207127, valopicitabine (NM-283), PSI-6130 (R1656), PSI-7851, BCX-4678, nesbuvir (HCV-796), BILB 1941, MK-0608, NM-107, R7128, VCH-759, GSK625433, XTL-2125, VCH-916, JTK-652, MK-3281, VBY-708, A848837, GL59728, A-63890, A-48773, A-48547, BC-2329, BMS-791325, and BILB-1941;
D. NS3 protease inhibitors, for example, Compound I, Compound J, Compound K, ABT-450, Compound L (described below), simeprevir (TMC-435), boceprevir (SCH503034), narlaprevir (SCH-900518), vaniprevir (MK-7009), MK-5172, danoprevir (ITMN191), sovaprevir (ACH-1625), neceprevir (ACH-2684), Telaprevir (VX-950), VX-813, VX500, faldaprevir (BI-201335), asunaprevir (BMS-650032), BMS-605339, VBY-376, PHX1766, YH5531, BILN-2065, and BILN-2061;
E. alpha-glucosidase 1 inhibitors, for example, celgosivîr (MX-3253), Miglitol, and UT-231B;
F. hepatoprotectants, e.g., IDN-6556, ME 3738, MitoQ, and LB-84451;
G. non-nucleoside inhibitors ofHCV, e.g., benzîmidazole dérivatives, benzo1,2,4-thiadiazme dérivatives, and phenylalanine dérivatives; and
H. other anti-HCV agents, e.g., zadaxin, nitazoxanide (alinea), BIVN-401 (virostat), DEBIO-025, VGX-410C, EMZ-702, AVI4065, bavituximab, oglufanide, PYN-I7, KPE02003002, actilon (CPG-10101), KRN-7000, civacir, GI-5005, ANA-975, XTL-6865, ANA 971, NOV-205, tarvacin, EHC-18, and NIM811.
[0112] Compound B is an NS5A inhibitor and is represented by the following chemical structure:
[0113] Compound C is an NS5A inhibitor and is represented by the following chemical structure:
[0114] Compound D is an NS5A inhibitor and is represented by the following chemical structure:
[0115] See U.S. Publication No. 2013/0102525 and references cited thereîn.
[0116] Compound E is an NS5B Thumb II polymerase inhibitor and is represented by the following chemical structure:
[0117] Compound F is a nucléotide inhibitor prodrug designed to inhibit réplication of viral RNA by the HCV NS5B polymerase, and is represented by the following chemical structure:
[0118] Compound G is an HCV polymerase inhibitor and is represented by the following structure:
[0119] See U.S. Publication No. 2013/0102525 and references therein.
[0120] Compound H is an HCV polymerase inhibitor and is represented by the following structure:
[0121] See U.S. Publication No. 2013/0102525 and references therein.
[0122] Compound I is an HCV protease inhibitor and is represented by the following chemical structure:
[0123] See U.S. Publication No. 2014/0017198 and references therein.
[0124] Compound J is an HCV protease inhibitor and is represented by the following chemical structure:
[0125] See U.S. Patent No. 8,178,491 and references therein.
[0126] Compound K is an HCV protease inhibitor and îs represented by the following chemical structure:
[0127] Compound L is an HCV protease inhibitor and is represented by the following chemical structure:
[0128] See U.S. Publication No. 2013/0102525 and référencés therein.
[0129] In one embodiment, the additional therapeutic agent used in combination with the pharmaceutical compositions as described herein is a HCV NS3 protease inhibitor. Nonlimiting examples include one or more compounds selected from the group consisiting of:
[0130] In another embodiment, the présent application is provided a method of treating hepatitis C in a human patient in need thereof comprising administering to the patient a therapeutically effective amount of a pharmaceutical composition as described herein and an additional therapeutic selected from the group consisting of pegylated rIFN-alpha 2b, pegylated rIFN-alpha 2a, rIFN-alpha 2b, IFN alpha-2b XL, rIFN-alpha 2a, consensus IFN alpha, infergen, rebif, locteron, AVI-005, PEG-infergen, pegylated IFN-beÎa, oral interferon alpha, feron, reaferon, intermax alpha, r-IFN-beta, infergen + actimmune, IFN-omega with DUROS, albuferon, rebetol, copegus, levovirin, VX-497, viramidine (taribavirin), A-831, A689, NM-283, valopicitabine, R1626, PSI-6130 (R1656), HCV-796, BILB 1941, MK-0608, NM-107, R7128, VCH-759, PF-868554, GSK625433, XTL-2125, SCH-503034 (SCH-7), VX-950 (Telaprevir), ITMN-191, and BILN-2065, MX-3253 (celgosivir), UT-23 IB, IDN6556, ME 3738, MitoQ, and LB-84451, benzimidazole dérivatives, benzo-l,2,4-thiadiazine dérivatives, and phenylalanine dérivatives, zadaxin, nitazoxanide (alinea), BIVN-401 (virostat), DEBIO-025, VGX-410C, EMZ-702, AVI 4065, bavituximab, oglufanide, PYN-17, KPE02003002, actilon (CPG-10101), KRN-7000, civacir, GI-5005, ANA-975 (isatoribine), XTL-6865, ANA 971, NOV-205, tarvacin, EHC-18, and NIM811 and a pharmaceutically acceptable carrier or excipient.
[0131] In yet another embodiment, the présent application provides a combination pharmaceutical agent comprising:
a) a first pharmaceutical composition comprising an effective amount of wherein ledipasvir is substantially amorphous; and an effective amount of sofosbuvir wherein sofosbuvir is substantially crystalline as described herein and
b) a second pharmaceutical composition comprising at least one additional therapeutic agent selected from the group consisting of HIV protease inhîbiting compounds, HIV non-nucleoside inhibitors of reverse transcriptase, HIV nucleoside inhibitors of reverse transcriptase, HIV nucléotide inhibitors of reverse transcriptase, HIV integrase inhibitors, gp41 inhibitors, CXCR4 inhibitors, gpl20 inhibitors, CCR5 inhibitors, interferons, ribavirin analogs, NS3 protease inhibitors, alpha-glucosidase 1 inhibitors, hepatoprotectants, nonnucleoside inhibitors of HCV, and other drugs for treating HCV, and combinations thereof.
[0132] The additional therapeutic agent may be one that treats other conditions such as
HIV infections. Accordingly, the additional therapeutic agent may be a compound useful in treating HIV, for example HIV protease inhîbiting compounds, non-nucleoside inhibitors of
HIV reverse transcriptase, HIV nucleoside inhibitors of reverse transcriptase, HIV nucléotide inhibitors of reverse transcriptase, HIV integrase inhibitors, gp41 inhibitors, CXCR4 inhibitors, gp!20 inhibitors, CCR5 inhibitors, interferons, ribavirin analogs, NS3 protease inhibitors, NS5b polymerase inhibitors, alpha-glucosidase l inhibitors, hepatoprotectants, non-nucleoside inhibitors of HCV, and other drugs for treating HCV.
[0133] More specifically, the additional therapeutic agent may be selected from the group consisting of
1) HIV protease inhibitors, e.g., amprenavir, atazanavir, fosamprenavîr, indinavir, lopinavir, ritonavir, lopinavir + ritonavir, nelfinavir, saqumavîr, tipranavir, brecanavir, darunavir, TMC-126, TMC-114, mozenavîr (DMP-450), JE-2147 (AGI 776), AG1859, DG35, L-756423, RO0334649, KNI-272, DPC-681, DPC-684, and GW640385X, DG17, PPL-100,
2) a HIV non-nucleoside inhibitor of reverse transcriptase, e.g., capravirine, emivirine, delàviridîne, efavirenz, nevirapine, (+) calanolide A, etravirine, GW5634, DPC083, DPC-961, DPC-963, MIV-150, and TMC-120, TMC-278 (rilpivirine), efavirenz, BILR 355 BS, VRX 840773, UK-453,061, RDEA806,
3) a HIV nucleoside inhibitor of reverse transcriptase, e.g., zidovudine, emtricitabine, didanosine, stavudine, zalcitabine, lamivudine, abacavîr, amdoxovir, elvucitabine, alovudine, MIV-210, racivir (+-FTC), D-d4FC, emtricitabine, phosphazide, fozîvudine tidoxil, fosalvudine tidoxil, apricitibine (AVX754), amdoxovir, KP-1461, abacavîr + lamivudine, abacavîr + lamivudine + zidovudine, zidovudine + lamivudine,
4) a HIV nucléotide inhibitor of reverse transcriptase, e.g., tenofovir, tenofovir disoproxil fumarate + emtricitabine, tenofovir disoproxil fumarate + emtricitabine + efavirenz, and adefovîr,
5) a HIV integrase inhibitor, e.g., curcumin, dérivatives of curcumin, chicoric acid, dérivatives of chicoric acid, 3,5-dicaffeoylquinic acid, dérivatives of 3,5-dîcaffeoylquinic acid, aurintricarboxylic acid, dérivatives of aurintricarboxylic acid, caffeic acid phenethyl ester, dérivatives of caffeic acid phenethyl ester, tyrphostin, dérivatives of tyrphostin, quercetin, dérivatives of quercetin, S-1360, zintevir (AR-177), L-870812, and L-870810, MK-0518 (raltegravir), BMS-707035, MK-2048, BA-011, BMS-538158, GSK364735C,
6) a gp41 inhibitor, e.g., enfuvirtide, sifuvirtide, FB006M, TRI-1144, SPC3, DES6, Locus gp41, CovX, and REP 9,
7) a CXCR4 inhibitor, e.g., AMD-070,
8) an entry inhibitor, e.g., SP01 A, TNX-355,
9) a gpl20 inhibitor, e.g., BMS-488043 and BlockAide/CR,
10) a G6PD and NADH-oxidase inhibitor, e.g., immunitin, 10) a CCR5 inhibitor, e.g., aplaviroc, vicriviroc, INCB9471, PRO-140, INCB15O5O, PF-232798, CCR5mAb004, and maraviroc,
11) an interferon, e.g., pegylated rIFN-alpha 2b, pegylated rIFN-alpha 2a, rIFN-alpha 2b, IFN alpha-2b XL, rIFN-alpha 2a, consensus IFN alpha, infergen, rebif, locteron, AVI005, PEG-infergen, pegylated IFN-beta, oral interferon alpha, feron, reaferon, intermax alpha, r-IFN-beta, infergen + actimmune, IFN-omega with DUROS, and albuferon,
12) ribavirin analogs, e.g., rebetol, copegus, levovirin, VX-497, and viramidine (taribavirin)
13) NS5a inhibitors, e.g., A-831, A-689, and BMS-790052,
14) NS5b polymerase inhibitors, e.g., NM-283, valopicitabine, R1626, PSI-6130 (R1656), HCV-796, BILB 1941, MK-0608, NM-107, R7128, VCH-759, PF-868554, GSK625433, and XTL-2125,
15) NS3 protease inhibitors, e.g., SCH-503034 (SCH-7), VX-950 (Telaprevir), ITMN-191, and BILN-2065,
16) alpha-glucosidase 1 inhibitors, e.g., MX-3253 (celgosivir) and UT-231B,
17) hepatoprotectants, e.g., IDN-6556, ME 3738, MitoQ, and LB-84451,
18) non-nucleoside inhibitors of HCV, e.g., benzimidazole dérivatives, benzo-1,2,4thîadiazine dérivatives, and phenylalanine dérivatives,
19) other drugs for treating Hepatitis C, e.g., zadaxin, nitazoxanide (alinea), BIVN401 (virostat), DEBIO-025, VGX-410C, EMZ-702, AVI 4065, bavituximab, oglufanide, PYN-17, KPE02003002, actilon (CPG-10101), KRN-7000, civacir, GI-5005, ANA-975 (isatoribine), XTL-6865, ANA 971, NOV-205, tarvacin, EHC-18, and NTM811,
20) pharmacokinetic enhancers, e.g., BAS-100 and SPI452, 20) RNAse H inhibitors, e.g., ODN-93 and ODN-112, and
21) other antî-HIV agents, e.g., VGV-1, PA-457 (bevirimat), ampligen, HRG214, cytolin, polymun, VGX-410, KD247, AMZ 0026, CYT 99007, A-221 HIV, BAY 50-4798, MDX010 (iplimumab), PBS119, ALG889, and PA-1050040.
[0134] In one embodiment, the additional therapeutic agent is ribavirin. Accordingly, methods described herein include a method of treating hepatitis C in a human patient in need thereof comprising administering to the patient a therapeutically effective amount of ribavirin and a therapeutically effective amount of a pharmaceutical composition, pharmaceutical dosage form, or tablet as described herein. In a further embodîment, the ribavirin and pharmaceutical composition, pharmaceutical dosage form, or tablet comprising sofosbuvir and ledipasvir is administered for about 12 weeks or less. In further embodiments, the ribavirin and pharmaceutical composition, pharmaceutical dosage form, or tablet comprising sofosbuvir and ledipasvir is administered for about 8 weeks or less, for about 6 weeks or less, or for about 4 weeks or less.
[0135] It is contemplated that the additional therapeutic agent will be administered in a manner that is known in the art and the dosage may be selected by someone of skill in the art. For example, the additional agent may be administered in a dose from about 0.01 milligrams to about 2 grams per day.
EXAMPLES [0136] In the following examples and throughout this disclosure, abbreviations as used herein hâve respective meanings as follows:
ACN Acetonitrile
AE Adverse Event
API Active Pharmaceutical Ingrédient
AUC Area Under the Curve
AUCinf Area under the concentration versus time curve extrapolated to infinité time, calculated as AUC0~last + (Clast/λζ)
AUC last Area under the concentration versus time curve from time zéro to the last quantifiable concentration
BMI Body Mass Indec
BT Breakthrough Rate
CI Confidence Interval
CL/F Apparent oral clearance after administration of the drug: CL/F = Dose/AUC
Clast Last observed quantifiable concentration of the drug
cm Centimeter
Cmax Maximum Concentration
cP Centipoise
cP Centipoise
CV Coefficient of Variation
Dgo Particle Size
DCF Drug Content Factor
DCF Drug Content Factor
DCM Dichloromethane
dL Deciliter
DRM Drug Related Material
DSC Differential Scanning Calorimetry
Emax Maximum Effect
F% Percent Bioavailability
FaSSIF Fasted State Simulated Intestinal Fluids
FB Free Base
FDC Fixed-Dose Combination
FeSSIF Fed State Simulated Intestinal Fluid
FT Fourier Transform
g Gram
GLSM Géométrie Least Squares Mean
GMR Géométrie Mean Ratio
GT Génotype
h or hr Hour
HCV Hepatitis C virus
HDPE High Density Polyethylene
HPC Hydroxypropylcellulose
HPLC High-performance Liquid Chromatography
HPMC Hydroxymethylcellulose
ICH International Conférence on Harmonisation; Impurities guidelines
IFN Interferon
IU International Unit
KF Karl Fischer
kg Kilogram
L Liter
LCT Long Chain Triglycérides
LDV Compound I, GS-5885, Ledipasvir
LLOD Lower limit of détection
LLOQ Lower Limit of Quantification
LOD Limit of Détection
M Molar
mg Mîlligram
min Minute
mL Mil li liter
mm Millimeter
mM Millimolar
N Population Size
n Number of Patients
ng Nanogram
nM Nanomolar
nm Nanometer
°C Degrees Celsius
PD Pharmacodynamic(s)
PEG or PG Polyethylene Glycol
P-gp or Pgp P-glycoprotein
PI Protease-Inhibitor
PK Pharmacokînetic
PLS Partial Least Squares
PPI Proton-Pump Inhibitors
PS Particle Size
PVP Povidone
PVP/VA Copovidone
QS Quantum Satis
RAV Résistance Associated Variants
RBV Ribavirin
RH Relative Humidity
RNA Rîbonucleic Acid
RSD Relative Standard Déviation
RT Room Température
So Intrinsic Solubility
SAE Serious Adverse Event
SCT Short Chain Triglycérides
SIBLM Simulated Intestinal Bile Sait and Lecithin Mixture
SIF Simulated Intestinal Fluids
SLS Sodium Lauryl Sulfate
SOF Sofosbuvir (GS-7977, formerly PSI-7977)
SS-NMR Solid State Nuclear Magnetic Résonance
SVR Sustained Virologie Response
t Time
tl/2 Half-life (h)
TFA Trifluoroacetic acid
T imax Time (observed time point) of Cmax
UPLC Ultra Performance Uiquid Chromatography
Upper Resp Tract Infx Upper Respiratory Tract Infection
USP Uni form Standards and Procedures
UV Ultraviolet
VL Viral Load
vRVR Very Rapid Viral Response
Vz/F Apparent volume of distribution
wt or w Weight
XRPD Xray Powder Diffraction
Pg Microgram
pL Microliter
pm Micrometer
Example 1: Synthesis of Amorphous Ledipasvir [0137] Methods for making various forms of ledipasvir may be found in U.S. Publication Nos. 2013/0324740, and 2013/0324496. Both of these applications are incorporated herein by reference. Following is a method for isolating amorphous free base of ledipasvir.
[0138] Combine ledipasvir acetone solvaté (191.4 g) and acetonitrile (1356 g) in a réaction vessel and mix contents until a solution is achieved. Add this ledipasvir in acetonitrile solution slowly to another reaction vessel containing vigorously agitated water (7870 g). Agitate contents at about 23 °C for about 30 minutes. Filter the contents and dry at about 4045 °C until constant weight is achieved to afford ledipasvir amorphous solid (146.4 g, 82% yield).
Example 2: Tablet Préparation and Formulation
A. Dose Sélection of Tablets
i. Sofosbuvir [0139] The sofosbuvir dose selected for the tablet formulation is 400 mg once daily. Support for the 400 mg sofosbuvir dose can be derived from Emax PK/PD modeling with early virological and human exposure data which also supports the sélection of a 400 mg sofosbuvir dose over others tested.
[0140] The mean sofosbuvir major métabolite AUCtau for the 400 mg sofosbuvir dose is associated with approximately 77% of the maximal HCV RNA change from baseline achîevable as determined by this model, a value which is on the cusp of the plateau of the exposure-response sigmoidal curve. In a sigmoidal Ema.x model, there is a relatively linear exposure-response relationship in the 20 to 80% maximal effect range. Therefore, given that sofosbuvir exposure with 200 mg tablets appears dose-proportional with single doses up to 1200 mg, doses below 400 mg are expected to yield considérable réductions in the magnitude of HCV RNA change from baseline. Simîlarly, in order to împrove upon an efïicacy prédiction of 77% in the plateau of the exposure-response curve, substantial increases in exposure (and hence dose) would be needed for an appréciable increase in antiviral effect.
[0141] The sofosbuvir dose of 400 mg once daily was associated with higher SVR rates in génotype 1 HCV infected patients as compared to the 200 mg once daily dose when given in conjunction with additional HCV therapeutics for 24 weeks. Safety and tolerability appeared similar across both dose levels. In addition, when sofosbuvir 400 mg once daily plus other HCV therapeutics were given to génotype 2 or 3 HCV infected patients, 100% SVR24 was observed.
ii. Ledipasvir |0142] The maximum médian HCV RNA loglO réduction was 3 or greater for ail cohorts dosed with > 3 mg of ledipasvir. An Emax PK/PD model indicates that the exposures achieved following administration of the 30 mg dose provides > 95% of maximal antiviral response in génotype 1 a HCV infected patients. It was also observed that 30 mg or greater of ledipasvir likely provided coverage of some drug related mutations that doses less than 30 mg did not, based on an analysis of NS5A mutants that arase in response to exposure to ledipasvir.
Therefore, 30 mg and 90 mg of ledipasvir were selected as the dose for the formulations described herein.
[0143] Further studies suggest that, when ledipasvir is administered in combination with other therapeutic agents, the breakthrough (BT) rate (number of patients with HCV RNA > lower limit of quantification (LLOQ) after having achieved vRVR/total number of patients who achieved vRVR), is higher with doses of 30 mg (BT = 33%, 11/33; 30 mg ledipasvir), than with doses of 90 mg (BT = 12%, 9/74; 90 mg ledipasvir). Therefore, the 90 mg dose of ledipasvir may confer a greater antiviral coverage that prevents viral breakthrough.
B, Solid Dispersion Comprising Ledipasvir [0144] To make the tablets comprising the combination of sofosbuvir and ledipasvir as described herein, a solid dispersion comprising ledipasvir was co-formulated with crystalline sofosbuvir. The starting material of the solid dispersion can be a variety of forms of ledipasvir including crystalline forms, amorphous form, salts thereof, solvatés and free base, as described herein. Because of the high solubility in organic solvents and excipients and the ability to isolate the ledipasvir free base crystalline acetone solvaté, this form was used in the amorphous solid dispersion of ledipasvir.
[0145] The spray dried solid dispersion approach achieved the most désirable characteristics relative to the other formulation approaches, which included improved in vivo and in vitro performance and manufacturability/scalability.
[0146] The spray dry feed solution was prepared by solubilizing ledipasvir acetone solvaté and polymer in the feed solvent. Aggressive mixing or homogenization was used to avoid dumping of the composition.
[0147] Different polymers were tested for preferred characteristics in the solid dispersions. Non-ionic polymers such as hypromellose and copovidone solid dispersions both showed adéquate stability and physical characteristics.
[0148] The feed solution was initially evaluated for appropriate solvent with regard to solubility, stability, and viscosity. Ethanol, methanol, and dichloromethane (DCM) ail demonstrated excellent solubility (ledipasvir solubility >500 mg/mL). Ethanolic and
DCM-based feed stocks were assessed for préparation ease and spray dried at a range of inlet and outlet températures to assess the robustness of the spray dry process. Both solvents gave rapid dissolution of ledipasvir and copovidone.
[0149] Spray drying out of éthanol resulted in high yields (88, 90, 92, 94, 95, 97, 98, 99%) across a wide range of spray-drying outlet températures (49-70 °C) with no material accumulation on the spray dry chamber. Spray drying out of DCM resulted in yields of 60%, 78%, and 44%. Overall, the ledipasvir Solid Dispersion (50% w/w) in a ledipasvir to copovidone ratio of 1:1 demonstrated good chemical stability in the ethanolic feed solution.
[0150] An ethanolic solution of 10% ledipasvir acetone solvaté and 10% copovidone was prepared using homogenization. Viscosity of ethanolic solutions of ledipasvir: copovidone were low, measured through 30% solids content (-65 cP).
[0151] Spray drying was conducted using two fluid nozzle or a hydrolytic pressure nozzle. Table 1 présents the spray dry process parameters evaluated at 100 g-4000 g of total feed solution using the Anhydre MS35 spray dryer and Table 2 shows the spray dry process parameters using the hydrolytic pressure nozzle. Particle size data suggested sufficiently large particle size (10-14 gm mean PS) and was minimally affected by using higher spray rates or a larger diameter spray nozzle. Nozzle gas flow was not modulated to increase particle size.
Table 1. Ledipasvir Spray Dry Parameters on Anhydro MS35 Spray Dryer Using a Two Fluid Nozzle
Parameter Trial 1 Trial 2 Trial 3 Trial 4
Batch Size (g) 100 250 250 4000
Solids % 20 20 20 20
Feed Rate (mL/min) 30 40 40 40
Spray Nozzle (mm) 1.0 1.0 1.2 1.2
Nozzle Gas Flow (kg/hr) 6.0 6.0 6.0 6.0
Chamber Gas Flow (kg/hr) 35.0 35.0 35.0 35.0
Inlet Temp (°C) 125 165 165 165
Outlet Temp (°C) 70 73 72 76
PS dio/dîo/dgo/mean (gm) 4/9/18/10 5/10/20/12 5/10/19/11 6/12/22/14
Post Spray LOD (%) 5.56 4.86 4.29 3.42
Table 2. Example of Ledipasvir Spray Dry Parameters Using a Hydrolyic Pressure
Nozzle
Parameter Trial 1
Batch Size (kg) 200
Solids % 20
Feed Rate (kg/hr) 178
Pressure Feed (bar) 52
Inlet Temp (°C) 158
Outlet Temp (°C) 65
PS dio/dio/dWmean (pm) 3/14/34
Post Spray LOD (%) 0.6
[0152] Organic volatile impurities, including the spray dry solvent éthanol and residual acetone from ledipasvir acetone solvaté are rapidly removed during secondary drying at 60 °C. Smaller scale production can be tray dried. On larger scale batches, a double cône dryer or an agitated dryer can be used. Loss on drying (LOD) was proportionately slower and is attributable to water, which was later confirmed by Karl Fischer titration.
[0153] Residual éthanol was reduced below ICH guidelines of 0.5% w/w by 6 hours of drying (or 8 hours for larger scale). Ethanol content upon completion of drying was 0.08% w/w, and residual acetone was 0.002%, indicating that the secondary drying process is adéquate for removal of residual solvent.
C. Tablet Préparation
i. Monolayer Tablet [0154] Ledipasvir copovidone solid dispersion (1:1) was made by dissolving ledipasvir and copovidone into éthanol, and then spray drying the mixture. The spray dried ledipasvir: copovidone solid dispersion is further dried in a secondary dryer. The amorphous solid dispersion comprising ledipasvir was blended with sofosbuvir and excipients and milled to facilîtate mixing and blend uniformity. Either a coblend or codry granulation process can be used. Coblend granulation is a multi-step process consisting of separate dry granulations for each active ingrédient with excipients followed by the blending of the two granulations together. Codry granulation consisted of dry granulating both active ingrédients and excipients together. The coblend and codry processes demonstrated comparable physical and chemical tablet properties. Exemplary coblend and codry formulations are provided in Table and Table 4 shown below.
Table 3. Représentative Example Composition of Sofosbuvir/Ledipasvir Codry (Cogranulated) Tablets at Varions Fill Weîghts
Intra-granular % w/w Tablet
Sofosbuvir 50,00 40.00 36.36 33.33
Ledipasvir. Copovidone Solid Dispersion (kl) 22.50 18.00 16.36 15.00
Lactose Monohydrate 6.67 16.33 23.19 26.11
Microcrystalline cellulose 3.33 8.17 11.60 13.05
Croscarmellose Sodium 2.50 2.50 2.50 2.50
Silicon Dioxide 1.00 1.00 1.00 1.00
Magnésium stéarate 0.75 0.75 0.75 0.75
Extra-granular
Microcrystalline cellulose 10.00 10.00 5.00 5.00
Croscarmellose Sodium 2.50 2.50 2.50 2.50
Magnésium stéarate 0.75 0,75 0.75 0.75
Fill wt (mg) 800 1000 1100 1200
Table 4. Représentative Example Composition of Sofosbuvir/Ledipasvir Coblend (Bigranulated) Tablets
Composition % w/w Intragranular Blend % w/w Tablet mg/Tablet
Sofosbuvir Intra-granular Blend Sofosbuvir 80 40 400
Microcrystalline cellulose 6 3 30
Lactose Monohydrate 6 3 30
Croscarmellose Sodium 4 2 20
Silicon Dioxide 3 1.5 15
Magnésium stéarate 1 0.5 5
Intra-granular Subtotal 100 50 500
Ledipasvir Intra-granular Blend Ledipasvir: Copovidone Solid Dispersion 42.4 18 180
Microcrystalline cellulose 43,5 18.5 185
Croscarmellose Sodium 9.4 4 40
Silicon Dioxide 3.5 1.5 15
Magnésium stéarate 1.2 0.5 5
Intra-granular Subtotal 100 42.5 425
Extra-granular Microcrystalline cellulose 5 50
Croscarmellose Sodium __ 2 20
Magnésium stéarate — 0.5 5
Total — 100 1000
Coating Film Coat — 3 30
Purified water — — —
[0155] The granules were then mixed with a lubricant prior to tablet compression. The total resulting core tablet weight was 1000 mg.
[0156] Film-coating of the tablets is provided to reduce photolytic dégradation. Tablets were coated to a target 3% weight gain. The film-coating material was a polyvinylalcohol-based coating. Exemplary tablet formulation is provided in Table 5.
Table 5. Représentative Example of the Composition of Tablets Comprising the Solid Dispersion of Ledipasvir and Sofosbuvir
Ingrédient % w/w Component Weight (mg/tablet)
Sofosbuvir 40.00 400
Ledipasvir Solid Dispersion 18.00 180.0
Lactose Monohydrate 16.50 165.0
Microcrystalline Cellulose 18.00 180.0
Croscarmellose Sodium 5.00 50.0
Colloïdal Silicon Dioxide 1.00 10.0
Magnésium Stéarate 1.50 15
Total Tablet Core Weight 100.0 1000.0
Film coating 3.00 30.0
Purified Water — --
Total Coated Tablet Weight 1030.0
ii. Bilayer Tablet [0157] Tablets comprising the co-formulation of a solid dispersion comprising ledipasvir and crystalline sofosbuvir can also be made as a bilayer tablet wherein each active ingrédient is in a separate layer. To make the bilayer tablet, a ledipasvir: copovidone (1:1) solid dispersion is made by dîssolving ledipasvir and copovidone into éthanol, and then spray drying the mixture. The spray dried ledipasvir:copovidone solid dispersion is further dried in a secondary dryer. Next, the spray dried ledipasvir:copovidone solid dispersion is then blended with excipients. The mixture is milled and then blended with lubricant prior to dry granulation. The ledipasvir granules are blended with extragranular lubricant. Separately, the sofosbuvir drug substance is blended with excipients, and then the mixture is milled and then blended with lubricant prior to dry granulation. The sofosbuvir granules are then blended with extragranular lubricant. Finally, the sofosbuvir powder blend and ledipasvir powder blend are compressed into bilayer tablet cores. The bilayer tablet cores are then filmcoated prior to packaging. A représentative example composition of a bilayer tablet comprising the solid dispersion of ledipasvir and sofosbuvir is shown in Table 6. In this table, the solid dispersion comprises ledipasvir:copovidone in a 1:1 ratio.
Table 6. Représentative Example of Composition of Bilayer Tablets Comprising the Solid Dispersion of Ledipasvir and Sofosbuvir
Ingrédient % w/w Component Weïght (mg/tablet)
Layer 1
Sofosbuvir 33.34 400.0
Lactose Monohydrate 5.66 68.0
Microcrystalline Cellulose 7.50 90.0
Croscarmellose Sodium 2.00 24.0
Colloïdal Silicon Dioxide 0.50 50.0
Magnésium Stéarate 1.00 12.0
Layer 2
Ledipasvir Solid Dispersion 15.00 180.0
Lactose Monohydrate 15.00 180.0
Microcrystalline Cellulose 17.00 204.0
Croscarmellose Sodium 2.50 30.0
Magnésium Stéarate 0.50 6.0
Total Tablet Core 100.00 1200
Example 3: PK, Stability and Dissolution Properties of Ledipasvir Single-Agent Tablets and Ledipasvir/Sofosbuvir Tablets and Réduction of Food-Effect and Effects of Gastric Acid Suppressants
A. Ledipasvir Single-Agent Tablets Bioavailability [0158] A sériés of in vivo experiments were conducted to evaluate the potential benefit of the solid dispersion approach relative to conventîonal formulations, as well as to optimize the solid dispersion by identifying the most bénéficiai polymer type and relative polymer concentration within the dispersion.
[0159] Equivalent bioavailability was achieved between formulations comprising the free base amorphous form (4% w/w, 10 mg amorphous free base tablet) and formulations comprising the D-tartrate sait of ledipasvir (5.85% w/w, 10 mg D-tartrate sait tablet), both using conventîonal formulations, in the pentagastrin pretreated dog model, as shown in Table 7. Pentagastrin is a synthetic polypeptide that stimulâtes the sécrétion of gastric acid, pepsin, and intrinsic factor.
Table 7. Mean (RSD) Pharmacokinetic Parameters of Ledipasvir Following Oral Administration of Tablets, 25 mg, in Beagle Dogs (n 6)
Drug Substance Form Pretreatmen t Cniax (nM) AUCo-24 (nM*hr) F (%)
Amorphous Free base Pentagastrin 743 (17) 8028(22) 71
Crystalline D-tartrate Pentagastrin 665 (38) 7623 (44) 67
|0160] Because these formulations displayed similar PK properties and the isolation properties of the D-tartrate sait were préférable to the free base amorphous form, the crystalline D-tartrate sait formulation was chosen to compare to the amorphous solid dispersion compositions. For these studies, 30 mg tablets comprising the crystalline Dtartrate sait of ledipasvir and 30 mg or 90 mg tablets comprising the amorphous solid dispersion of ledipasvir were used. Dog pharmacokinetic results for select immédiate release ledipasvir tablets comprising ledipasvir solid dispersions are shown in Table 8.
Table 8. Mean (RSD) Pharmacokinetic Parameters of Ledipasvir after Oral Administration of Ledipasvir Tablets, Fasted Beagle Dogs (n=6)
Polymer Ledipasvir: polymer Ratio Dose (mg) Pretreatment Cmax (nM) AUCo-24 (nM*hr) F (%)
Crystalline Dtartrate Ledipasvir Tablets N/A 30 Pentagastrin 665 (38) 7623 (44) 67
Famotidine 154 (44) 1038 (41) 9
90 Pentagastrin 1831 (28) 18086 (36) 54
Famotidine 349 (37) 3322(40) 10
Amorphous Solid Dispersion Ledipasvir Tablet: HPMC 2:1 30 Famotidine 251 (51) 2553 (54) 22
Amorphous Solid Dispersion Ledipasvir Tablet: Copovidone 2:1 30 Famotidine 369 (26) 3383 (36) 30
1:1 Pentagastrin 983 (22) 10541 (24) 93
1:1 Famotidine 393 (30) 3930 (20) 35
1:1 90 Pentagastrin 1644 (38) 20908 (41) 62
1:1 Famotidine 740 (24) 7722 (28) 23
[0161 ] Compared to the crystalline D-tartrate ledipasvir formulations, the amorphous solid dispersion tablets displayed higher bioavailability with lower variability. In pentagastrin pretreated animais, an approximate 40% increase in exposure and a 2-fold decrease in variability were noted. More importantly in famotidine pretreated animais, up to a 3.5-fold increase in bioavailability was observed compared to the D-tartrate sait tablet formulations.
[0162] A copovidone-based dispersion increased bioavailability more than the équivalent hypromellose-based formulation (F = 30% and 22%, respectively) when spray dried at 2:1
API:polymer ratio. Bioavailability of the copovidone-based formulation was further enhanced by increasing the fraction of polymer to a 1:1 ratio, resulting in a bioavailability of
35% in famotidine pretreated dogs.
[0163] Because of the improved in vivo performance and acceptable stability and physical properties, a 1 ; 1 mixture of ledipasvir:copovidone was chosen as the spray-dried material.
[0164] Formulations comprising the amorphous solid dispersions proved to be advantageous over formulations comprising either the amorphous free base or the D-tartrate sait. It was observed that the bioavailability of amorphous free base formulations was similar to D-tartrate sait formulations. Additional data showed a decrease in bioavailability when ledipasvir was dosed with gastric acid suppressing agents (famotidine), indicating an unfavorable drug-drug interaction in free base amorphous and D-tartrate sait formulations of ledipasvir. A solid dispersion using spray drying with a hydrophilic polymer was identified to hâve acceptable stability, physical characteristics, and in vivo performance. A rapidly disintegrating tablet was developed using a dry granulation process and commonly used excipients. A bioavailability study comparing formulations comprising the D-tartrate sait with formulations comprising the amorphous solid dispersion showed improved biopharmaceutical performance and overcame much of the négative drug-drug interactions with acid suppressîve thérapies seen in the D-tartrate sait formulations.
B. Ledipasvir+Sofosbuvir Tablets Bioavailability [0165] PK results for the combination of sofosbuvir with ledipasvir (wherein the ledipasvir is in solid dispersion with copovidone in a 1:1) are shown in Table 9, and demonstrate lack of a significant interaction between sofosbuvir and ledipasvir.
Table 9: Pharmacokinetic Data for Sofosbuvir and Ledipasvir on Administration of Sofosbuvir and Ledipasvir Alone or in Combination
Sofosbuvir (n=17)
Mean (%CV) Sofosbuvir alone Sofosbuvir + Ledipasvir %GMR (90%CI)
AUCinf (ng.hr/mL) 794 (36.4) 1750 (27.8) 229 (191, 276)
AUC last (ng.hr/mL) 788 (36.6) 1740 (27.8) 230(191,277)
Cmax (ng/mL) 929 (52,3) 1870 (27.9) 221 (176, 278)
Métabolite I (n=17)
Mean (%CV) Sofosbuvir alone Sofosbuvir + Ledipasvir %GMR (90%CI)
AUCinf (ng.hr/mL) 1110(31.6) 1950 (22.8) 182(157, 210)
AUClasi (ng.hr/mL) 1060 (32.7) 1890 (22.8) 179(155, 207)
Cmax (ng/mL) 312(38.7) 553 (26.6) 182(154,216)
Métabolite II (n=17)
Mean (%CV) Sofosbuvir alone Sofosbuvir + Ledipasvir %GMR (90%CI)
AUCinf (ng.hr/mL) 10900(17.5) 13000(16.7) 119(113, 125)
AUClast (ng.hr/mL) 10200(17.9) 12100(15.5) 119 (113, 126)
Cmax (ng/mL) 1060(17.3) 864 (20.1) 81.2(76.9, 85.8)
Ledipasvir (n=17)
Mean (%CV) Ledipasvir alone Sofosbuvir + Ledipasvir %GMR (90%CI)
AUCinf (ng.hr/mL) 11900 (26.2) 11400 (27.0) 95.7(92.1,99.5)
AUClast (ng.hr/mL) 755 (24.7) 734 (27.0) 96.5 (89.9, 104)
Cmax (ng/mL) 375 (28.8) 360 (31.2) 95.5 (91.9, 99.1)
[0166] Sofosbuvir plasma exposure was increased by ~ 2.3-fold by ledipasvir. The effect of ledipasvir on sofosbuvir is likely due to inhibition of P-gp, of which Sofosbuvir is a known substrate. The increase in sofosbuvir was not considered significant due to its very low and transient exposure relative to total drug related material (DRM) exposure (DRM, calculated as the sum of the AUCs for each of the analytes, corrected for molecular weight). Based on this calculation, the AUC of sofosbuvir with ledipasvir is only ~ 5.7% of DRM AUC. The exposure of métabolite II, the major circulating sofosbuvir métabolite, was not impacted by the administration of ledipasvir, and demonstrates the lack of significant interaction between sofosbuvir and ledipasvir.
C. Réduction of Food Effect în Solid Dispersions of Ledipasvir and Ledipasvir/Sofosbuvir Tablets [0167] Ledipasvir alone in a conventional formulation (not the solid dispersion) has been demonstrated to hâve a négative food effect. Table 10 summarizes PK parameters of ledipasvir following a single dose of ledipasvir, 30 mg, under fasted and fed conditions. The ledipasvir PK profile was altered in the presence of food. Specifically, the high-fat meal appeared to delay ledipasvir absorption, prolong Tmax (médian Tmax of 8 hours), and decreased ledipasvir plasma exposure (approximately 45% decrease each in mean Cmax,
AUCiast, and AUCinf, respectively).
Table 10: Plasma Ledipasvir PK Parameters Following Single-dose Administration of Ledipasvir by Concomitant Food Intake Status
Mean (%CV)
PK Parameter Ledipasvir 30 mg (N=8) Ledipasvir 30 mg Fed (N=8)
Cmax (ng/mL) 73.1 (50.8) 36.5 (22.6)
Tmax (h) 6.00 (5.00, 6,00) 8.00 (7.00, 8.00)
AUC last (ngh/mL) 1988.2 (58.2) 996.5 (21.6)
AUCinf (ngh/mL) 2415.9(60.3) 1175.0(25.3)
1½ (h) 39.82 (33.15,41.65) 36,83 (22.19, 49,08)
CL/F (mL/h) 17,034.5(58.6) 26,917.9(23.6)
Vï/F (mL) 876,546.3 (44.2) 1,386,469 (24.9)
Ciast (ng/mL) 6.8 (68.0) 3.1 (42.2)
[0168] Table 11 présents the ratio of the GLSMs (ledipasvir 30 mg under fasted conditions/ledipasvir 30 mg under fed conditions) for each of the primary PK parameters.
Table 11: Statistical Evaluations of Ledipasvir PK Parameters for Food Effect
Géométrie Least Squares Mean (GLSM) GLSM Ratio (Fed/Fasted) % 90% Confidence Interval
Ledipasvir 30 mg Fed (N=8) Ledipasvir 30 mg Fasted (N 8)
Cmax (ng/mL) 35.87 65.33 54.90 39.10, 77.08
AU C]asl (ng hr/mL) 977.76 1724.28 56.71 38.87, 82.73
AUCinf (ng-hr/mL) 1143.64 2058.78 55.55 36.88,83.67
[0169] Similar médian half-lives of ledipasvir were observed independent of administration under fasted or fed conditions (ti/2of 39.82 hours under fasted conditions vs 36.83 hours under fed conditions) indicating that food decreased the bioavailability of ledipasvir by reducing its solubîlity and/or absorption.
[0170] Because ledipasvir has been demonstrated to hâve a négative food effect, the composition comprising both sofosbuvir and ledipasvir (as solid dispersion in copovidone (kl)) was tested for a food effect. These results are shown in Table 12. Food slowed the rate of absorption of sofosbuvir (médian Tmax: 1,00 vs 2.00 hours) with only modest alteration in the bîoavailability, as evidenced by increases of 2-fold or less in sofosbuvir and sofosbuvir métabolite I plasma exposure. For sofosbuvir métabolite II, an approximately 20-30% lower Cmax was observed upon sofosbuvir administration with food with no change in AUC. The %GMR and associated 90% CI (fed/fasted treatments) for AUC of sofosbuvir métabolite II were within the équivalence bounds of 70% to 143%. Since the decrease in sofosbuvir métabolite II Cmix was modest and the AUC parameters met the équivalence criteria, the effect of food on sofosbuvir métabolite II was not considered significant.
10171 ] Similar ledipasvir plasma exposures (AUC and Cmax) were achieved upon administration of ledipasvir under fasted or fed conditions. The %GMR and associated 90% CIs (fed/fasted treatments) were within the équivalence bounds of 70-143%. While a “négative” food effect was previously observed on ledipasvir when administered alone (as the amorphous free base, not solid dispersion), the pharmacokinetics of ledipasvir (amorphous solid dispersion; copovidone (kl)) administered in combination with sofosbuvir does not appear to be altered by food. As such, the combination of sofosbuvir and ledipasvir may be administered without regard to food.
Table 12: Pharmacokinetic Data for Sofosbuvir, Sofosbuvir Métabolites 1 and II, and Ledipasvir on Administration of Sofosbuvir/Ledipasvir Tablets Fasted or with a Moderate-Fat Meal or with a High-Calorie/High Fat Meal
Sofosbuvir (n=29)
Mean (%CV) Sofosbuvir/Ledipasvir Tablet Fasted Sofosbuvir/Ledipasvir Tablet Moderate-Fat Meal % GMR (90% CI) [ModerateFat/Fasted |
AUCinf (ng.hr/mL) 1520 (39.5) 2860 (33 .4) 195 (176, 216)
AUCiast (ng.hr/mL) 1520 (39.7) 2850(33.5) 195(176,216)
Cmax (ng/mL) 1240 (49.6) 1520 (39.8) 126(109, 147)
Sofosbuvir/Ledipasvir Tablet Fasted Sofosbuvir/Ledipasvir Tablet High-Calorie/High-Fat Meal GMR (90% CI) [High-Fat/F asted]
AUCinf (ng hr/mL) 1520 (39.5) 2570 (34.0) 179(162, 198)
AUCiast (ng.hr/mL) 1520 (39.7) 2550(34.6) 178 (161, 198)
Cmax (ng/mL) 1240 (49.6) 1350(42.5) 115 (99.0, 134)
Sofosbuvir Métabolite I (n=29)
Mean (%CV) Sofosbuvir/Ledïpasvir Tablet Fasted Sofosbuvir/Ledïpasvir Tablet Moderate-Fat Meal % GMR (90% Cl) [ModerateFat/Fasted]
AUCinf (ng.hr/mL) 1520 (42.0) 2520(21.4) 177 (163, 192)
AUCiast (ng.hr/mL) 1470 (43.3) 2460 (21.8) 180(164, 196)
Cmax (ng/mL) 352 (42.7) 495 (22.2) 151 (136, 167)
Sofosbuvir/Ledïpasvir Tablet Fasted Sofosbuvir/Ledipasvir Tablet High-Calorie/High-Fat Meal GMR (90% CI) [High-Fat/Fasted]
AUCinf (ng.hr/mL) 1520 (42.0) 2550 (22.2) 181 (166, 196)
AUCiasi (ng.hr/mL) 1470 (43.3) 2500 (22.5) 184(168, 201)
Cmax (ng/mL) 352 (42.7) 501 (26.8) 154(139, 171)
Sofosbuvir Métabolite 11 (n=29)
Mean (%CV) Sofosbuvir/Ledïpasvir Tablet Fasted Sofosbuvir/Ledipasvir Tablet Moderate-Fat Meal % GMR (90% CI) [ModerateFat/Fasted]
AUCinf (ng.hr/mL) 11800 (23.0) 13800(17.7) 117(112, 123)
AUCiast (ng.hr/mL) 11300 (23.4) 12900(18.2) 114(108, 121)
Cmax (ng/mL) 865 (26.6) 700 (19.5) 81,5 (75.6, 87.9)
Sofosbuvir/Led i pasvî r Tablet Fasted Sofosbuvir/Ledipasvir Tablet High-Calorie/High-Fat Meal GMR (90% CI) [High-Fat/Fasted]
AUCmf (ng.hr/mL) 11800 (23.0) 12900 (18 .5) 112(107,118)
AUC^t (ng.hr/mL) 11300 (23.4) 12100 (20.1) 110(103, 116)
Cmax (ng/mL) 865 (26.6) 600 (22.9) 70.2 (65.0, 75.8)
Ledipasvir (n=29)
Mean (%CV) Sofosbuvir/Ledipasvir Tablet Fasted Sofosbuvir/Ledipasvir Tablet Moderate-Fat Meal % GMR (90% CI) [ModerateFat/Fasted|
AUCmf (ng.hr/mL) 10600 (57.2) 10600 (35.6) 115 (99.4, 134)
AUCiaat (ng.hr/mL) 8600 (53.8) 8650(32.1) 114 (98.0, 133)
Cmax (ng/mL) 324 (44.8) 319(24.8) 109 (93.5, 126)
Sofosbuvir/Ledipasvîr Tablet Fasted Sofosbuvir/Ledipasvîr Tablet High-Calorie/High-Fat Meal GMR (90% CI) [High-Fat/Fasted]
AUC.,., (ng.hr/mL) 10600 (57.2) 9220 (36.1) 103 (88.5, 119)
AUCjast (ng.hr/mL) 8600 (53.8) 7550 (33.9) 104 (88.8, 121)
Cmax (ng/mL) 324 (44.8) 255 (25.9) 88.2 (75.8, 103)
D. Réduction of Effects of Gastric Acid Suppressants in Ledipasvir/Sofosbuvir Tablets [0172] Ledipasvir, 30 mg, alone in both a conventional formulation (as the D-tartrate sait) and as the solid dispersion has been demonstrated to hâve a decrease in bioavailability when administered with some gastric acid suppressants; most significantly, proton-pump inhibitors (PPI’s, e.g., omeprazole), but also including histamine-2 antagonsists (H2RA’s, e.g., famotidine, data not included). Table 12A summarizcs PK parameters of ledipasvir following administration of ledipasvir conventional single agent tablets, 30 mg, ledipasvir tablets as solid dispersion (ledipasvir:copovidone 1:1), 30 mg, and sofosbuvir/ledipasvir FDC tablets (90 mg of ledipasvir solid dispersion comprising copovidone 1:1) with and without omeprazole. The bioavailability of ledipasvir as single agent tablets was reduced approximately 2-fold when administered with omeprazole; however, administration of ledipasvir as part of the sofosbuvir/ledipasvir FDC tablet with omeprazole resulted in no significant decrease in ledipasvir exposure (AUC and Cmax) compared to sofosbuvir/ledipasvir FDC tablet administration in absence of omeprazole.
Table 12A. Pharmacokinetic Data for Ledipasvir on Administration of Ledipasvir Single Agent Tablets or Sofosbuvir/Ledipasvîr Tablets with and without Omeprazole
Ledipasvir, Conventional Formulation (N = 10)
Mean (%CV) Ledipasvir alone Ledipasvir + Omeprazole %GMR (90%CI)
AUCtau (ng.hr/mL) 1640(18.5) 865 (37.7) 50.7(43.4, 59.3)
Cmax (ng/mL) 99.0 (20.1) 51.2(39.2) 49.7(41.7, 59.1)
Ctau (ng/mL) 52.2(22.1) 28.3 (36.0) 52.4(44.3,61.9)
Ledipasvir* Solid Dispersion (N = 17)
Mean (%CV) Ledipasvir alone Ledipasvir + Omeprazole %GMR (90%CI)
AUCinf (ng.hr/mL) 2140 (38.8) 1300 (50.7) 58.5 (48.3, 70.8)
AUClasl (ng.hr/mL) 1850(33.5) 1070 (45.5) 56.3 (46.4, 68.3)
Cmax (ng/mL) 64.8 (32.9) 36.2(55.9) 52.2(41.4, 65.9)
Ledipasvir, SOF/LDV FDC (N = 16)
Mean (%CV) SOF/LDV FDC Alone SOF/LDV FDC + Omeprazole %GMR (90%CI)
AUCinf (ng.hr/mL) 7990 (66.2) 6660 (51.8) 96.0(66.5, 139)
AUCjasl (ng.hr/mL) 7160 (65.8) 5700 (51.8) 92.5 (64.8, 132)
Cmax (ng/mL) 242 (68.6) 176 (51.1) 89.1 (60.9, 130)
E. Dissolution of Ledipasvir/Sofosbuvir Tablets [0173] Dissolution studies were conducted comparing the sofosbuvir 400 mg/ledipasvir 90 mg tablets (ledipasvir:copovidone (1:1). The sofosbuvîr/ledipasvîr tablets (LOT 1-5) display greater than 85% sofosbuvir (FIG. 5) and ledipasvir (FIG. 6) dissolved in 30 minutes for both tablet formulations. These results are shown in FIGs. 5 and 6.
Exampic 4: Stability of Sofosbuvir/Ledipasvir Co-formulation [0174] The compatîbilîty of sofosbuvir anhydrous crystalline drug substance was evaluated with the ledipasvir:copovidone solid dispersion. A blend ofthe sofosbuvir and ledipasvir: copovidone (1:1) solid dispersion was prepared at a ratio représentative ofthe final 400 mg sofosbuvir/90 mg ledipasvir tablets. The blend was compressed into pellets and placed in stability chambers at 40 °C/75% RH and 60 °C/ambient humîdity and tested after two and four weeks of storage in open glass vials. The results summarized in Table 13 show that no dégradation was observed for either sofosbuvir or ledipasvir, demonstrating the chemical compatibility of sofosbuvir and the ledipasvir:copovidone solid dispersion with each other.
Table 13: Strength and Impurity Content of Sofosbuvir and Ledipasvir:Copovidone
Solid Dispersion Blend Stored at 40 °C/75% RH and 60 °C
Ledi pasvir Sofosbuvir
Condition Time (weeks) Strength (%) Total Impurity Content (%) Strength (%) Total Impurity Content (%)
45 °C/75 % RH 0 98.8 0.0 102,9 0.4
2 96.9 0.0 101.6 0.3
4 97.1 0.0 100.5 0.2
60 °C 0 98.8 0.0 102.9 0.4
1 99.2 0.0 102.4 0.3
2 99.6 0.0 103.2 0.3
4 98.9 0.0 102.8 0.2
Exarnple 5: Efïicacy of Sofosbuvir/Ledipasvir/Ribavirin Treatment in Patients with HCV Infections [0175] Patients with HCV infections were treated with either the combination of sofosbuvir, ledipasvir, and ribavirin or the combination of sofosbuvir and ribavirin. Patients used in the study included those that were treatment naïve, i.e. had not prevtously been treated for HCV and those that were null responders, i.e. had previously been treated for HCV but faiied to respond to the treatment. Standard doses (90 mg of ledipasvir, 400 mg of sofosbuvir, and 1000 mg of ribavirin, for example) were given of each drug to the patients for a duration of 12 weeks. Throughout treatment, HCV RNA was measured, and the Sustained Virologie Response (SVR) was measured after treatment was discontinued. By four weeks of treatment, almost ail patients had achieved an HCV RNA measurement below the limit of détection (LOD of 15 IU/mL), and by the end of treatment, 100% of patients achieved an HCV RNA level below the LOD (Table 14).
Table 14: Patients with HCV RNA below the limit of détection over time.
Sofosbuvir + Ribavirin Sofosbuvir + Ribavirin + Ledipasvir
T reatment-naïve (n = 25) Null responder (n-'O) Treatment-naïve (n = 25) Null responder in = 9)
Week 1 32% 10% 44% 0%
Week 2 68% 70% 88% 44%
Week 4 100% 100% 100% 89%
End of Treatment 100% 100% 100% 100%
[0176] Surprisingiy, 100% of patients receiving the combination of sofosbuvir, ledipasvir, and ribavirin achieved a sustained virologie response at four and twelve weeks post treatment. In contrast, only 88% of treatment naïve and 10% of null responder patients treated with the combination of sofosbuvir and ribavirin achieved a SVR at four weekes post treatment, and only 84% of treatment naïve and 10% of null responder patients treated with the combination of sofosbuvir and ribavirin achieved SVR at twelve weekes post treatment (Table 15).
Table 15: Sustained Virologie Response
Sofosbuvir + Ribavirin Sofosbuvir + Ribavirin + Ledipasvir
Treatment-naïve (n = 25) Null responder (n= 10) Treatment-naïve (n = 25) Null responder (n = 9)
SVR4 88% 10% 100% 100%
SVR12 84% 10% 100% 100%
[0177] These results are graphically depicted as FIG. 7A-D and demonstrate that the addition of ledipasvir in the treatment regimen gave 100% SVR at weeks 4 and 12. Example 9, below, shows similar results are obtained with treatment regimens of less than twelve weeks (i.e. treatment regimens of about 8 or 6 weeks), and that similar results are obtained with treatment regimens of sofosbuvir and ledipasvir without the addition of ribavirin.
Example 6. Stability of SOF 400 mg/ Ledipasvir 90 mg Fixed-Dose Combination Tablets [0178] This example summarizes the physicochemical stability of packaged Sofosbuvir (SOF) 400 mg/ ledipasvir 90 mg blue film-coated fixed-dose combination (FDC) tablets at 25 °C/60% relative humidity (RH) and 40 °C/75% RH as a function of desiccant. The ledipasvir portion of the table comprised ledipasvir:copovidone in a 1:1 ratio. In addition the chemical and physical stability of SOF/ledipasvîr FDC tablets were evaluated at 40°C/75% RH under open condition for up to 4 weeks.
[0179] The physico-chemical properties that were evaluated included appearance, potency, dégradant formation, dissolution rate and water content. Physical stability ofthe tablets in the absence of desiccant was evaluated after 24 weeks using FT-Raman spectroscopy and modulated differentîal scanning calorimetry (mDSC).
[0180] SOF 400 mg/ledipasvir 90 mg blue film-coated FDC tablets exhibited satisfactory stability at 25°C/60% RH and 40°C/75%RH for up to 24 weeks in the presence of 0, 1, and 3 g of desiccant. No significant changes were observed in potency, impurity content or dissolution rate. However, a ledipasvir photodegradant was présent at 0.1% for ail conditions.
FT-Raman analysis for the tablets stored in the absence of desiccant showed no détectable crystallization after 24-weeks.
Methods and Materials
Materials [0181] Table 16 lists the physicochemical properties for SOF drug substance and ledipasvir solid dispersion used to produce tablets. The quantities of SOF drug substance and ledipasvir solid dispersion were adjusted based on their respective drug content factor (DCF) with concomitant adjustment in the quantity of lactose monohydrate. The DCF used for SOF and ledipasvir solid dispersion powder, 50% w/w were 0.997 and 0.497 (0.994 when adjusted for the amount of copovidone), respectively.
Table 16. Physicochemical Properties of SOF Drug Substance and Ledipasvir Solid Dispersion, 50% w/w, Bulk Powder Used to Produce SOF 400 mg/Ledipasvir 90 mg Film-Coated FDC Tablets
Active Ingrédient Crystal Form Assay by HPLC (%) Impurities (%) Drug Content Factor Water Content by Karl Fischer (%) Particle Size (μιη)
dlO d50 d90
SOF Anhydrous Form II 99.8 0.1 0.996 0.1 3 10 29
Ledipasvir Solid Dispersion, 50% w/w, Bulk Powder Amorphous 49.7 0.2 0.497 1.09 5 22 44
Equipment [0182] The primary equipment used to manufacture SOF 400 mg/Ledipasvir 90 mg film-coated FDC tablets included an 12 qt. V- Blender, a screening mill (Comil 197S, Quadro, Waterloo, Canada) equipped with a 0.094 in grated screen, a roller compactor/granulator (MiniPactor, Gerteis, Jona, Switzeriand) equipped equipped with a
1.0 mm milling screen and a smooth/smooth roller configuration, a 12-station instrumented rotary tablet press (XM-12, Korsch, Berlin, Germany), and a tablet coater (LabCoat, O'Hara Technologies Inc., Ontario, Canada). The diamond-shaped tablet tooling (Elizabeth Carbide Die Co., Inc., McKeesport, PA, USA) consisted of diamond, standard concave Dtype punches with dimensions of 0.7650 in x 0.4014 in (19.43 mm x 10.20 mm). A 15 inch perforated pan film coater was used to coat the tablet cores.
Container Closure [0183] Sofosbuvir/Ledipasvir FDC tablets are packaged in 100 mL white, high density polyethylene (HDPE) bottles. Each bottle contained 30 tablets and 0, 1 or 3 g silica gel desiccant canister or sachet and polyester packing materiai. Each bottle was enclosed with a white, continuons thread, child-resistant screw cap with an induction-sealed, aluminumfaced liner.
[0184] A selected number of bottles were left open and packaged without desiccant to evaluate the physical and chemical stability at 40°C/75% RH under accelerated heat and humidity conditions.
General Study Design [0185] The solid state and chemical stability of the packaged lot were evaluated in the following configurations:
1) At 25 °C/60% RH and 40 °C/75% RH as a function of desiccant. The samples were stored under closed condition for a minimum of 24 weeks.
2) At 40°C/75% RH under open condition for up to 4 weeks.
[0186] Samples were pulled at predetermined time points. Chemical stability testing for appearance, potency, dégradant formation, dissolution rate and water content was conducted. Additional physical stability assays to monitor potential crystallization and phase séparation were conducted.
Physical Stability Evaluation [0187] Physical stability tests included appearance and FT-Raman. The visual inspection was performed on stressed film-coated tablets to identify changes in tablet color and coating integrity. FT-Raman spectroscopy was used to detect potential crystalline ledipasvir (Form
III) in the film-coated tablets.
[0188] Tablets were visually inspected for changes in appearance at ail time points and storage conditions. In contrast, FT-Raman was only performed on tablets with 0 g desiccant at 24 weeks (25°C/60% RH and 40°C/75% RH).
Appearance [0189] At ali time points tablets were examined for physical integrity (i.e. color, shape, coating integrity and debossing).
FT-Raman [0190] FT-Raman experiments were conducted. The 24-week SOF/ledipasvir film-coated FDC tablets stored in closed containers at 25°C/60% RH and 40°C/75% RH were analyzed using FT-Raman spectroscopy to detect the formation of crystalline ledipasvir (Form III). Briefly, the coating from the tablets was carefully removed using an Xacto™ knife followed by grinding of the tablet in a mortar and pestle. Tablet powder was then packed into cups and spectra were collected using a backscattering geometry.
Chemical Stability Evaluation [0191] Chemical stability assays încluded measuring water content by Karl Fischer (KF), potency, formation of impurity/degradation products and dissolution rate were conduced.
KF Water Content [0192] The water content was reported for SOF 400 mg/iedipasvir 90 mg film-coated FDC tablets following USP <921>.
Potency and Impurity/Degradant Formation by UPLC [0193] The potency and dégradation product formation of SOF/ledipasvir film-coated FDC tablets were evaluated by analysis of composite sample solution of 10 tablets according to STM-2542 [5], The reference standard concentration for SOF and ledipasvir is 2.0 mg/mL and 0.45 mg/mL, respectively. The strength and dégradation product content of SOF and ledipasvir was determined by UPLC using extemal reference standard and area normalization at wavelengths of 262 nm and 325 nm, respectively.
Dissolution Methodology [0194] Dissolution testing was performed on SOF/ledipasvir film-coated FDC tablets. A
USP type 2 dissolution apparatus with 900 mL of dissolution medium and a paddle speed of rpm was used. The medium was 1.5% polysorbate 80 in 10 mM potassium phosphate buffer at pH 6.0 and the température was maintained at 37 °C for the duration of the assay.
The extent of SOF and ledipasvir released as a function of time was monitored by UPLC using area normalization and an extemal reference standard at a wavelength of 250 nm.
RESULTS
A. Physical Stability
Al. Appearance [0195] Samples at ail stability conditions and desiccant levels were visually inspected for ail time points and found to resemble blue, diamond-shaped fïlm-coated tablets.
A2. FT-Raman [0196] The FT-Raman analysis was performed on powder extracted from tablets stored in the absence of desiccant after 24 weeks. Calculations of % crystallinity using the PLS model did not show signs of crystalline ledipasvir (Form III) above the LOD of 3% at either storage condition.This was consistent with the original sample (t = 0) in which ledipasvir (Form III) was also below the LOD. Spectra from selected samples were included in a chart, from 1577 cm'1 to 1514 cm'1 with the baselines artificially adjusted for clarity. This région is in one of the four spectral régions used to estimate the % ledipasvir (Form III) in tablets by PLS model.
[0197] The top two spectra (used as standards in the PLS model), in the chart, were from tablets spiked with 10% w/w and 3% w/w, of crystalline ledipasvir (Form III). The next two spectra represent stressed tablets stored for 24 weeks at 40 °C/75% RH and 25 °C/60% RH. The last spectrum represents the initial time point (t = 0). Ledipasvir (Form ΙΠ) has a distinct peak at 1552 cm'1, which can clearly be seen in the spiked tablets with increasing intensity from 3% to 10%. The intensity in this région for the stressed samples stored for 24 weeks does not increase from the t = 0 sample, indicating no change in crystallinity. Ledipasvir (Form III) in the t = 0 sample and the 24 week samples is below that présent in the tablets spiked with 3% Form III ledipasvir, the current limit of détection for this analytical technique.
B. Chemical Stability
B. 1 KF Water Content [0198] The water content of stressed samples stored for 4 weeks under open condition increased from 2.28% to 5.23%. The amount of water content of stressed samples stored at 25 °C/60%RH decreased to 1.91%, 1.58%, and 1.65% for tablets with no desiccant, with lg desiccant, and 3g desiccant, respectively. At 40 °C/75%RH, the amount of water content decreased to 2.03%, 1.79%, and 1.46% for tablets without desiccant, with lg desiccant, and
3g desiccant, respectively.
B. 2 Potency and Impurity/Degradation Product Formation [0199] The potency and impurity/degradation content for SOF 400 mg/ledipasvir 90 mg film-coated FDC tablets were determined at 25 °C/60%RH and 40 °C/75%RH.
Représentative chromatograms of stability samples stored at 40 °C/75%RH were obtained. The data showed that SOF and ledipasvîr remained chemically stable in SOF 400 mg/ledipasvir 90 mg film-coated FDC tablets stored for 24 weeks at 25 °C/60%RH and 40 °C/75%RH. The label strength for SOF and ledipasvîr remains unchanged at 25°C/60%RH and 40°C/75%RH.
Dissolution [0200] The dissolution profiles of SOF and ledipasvîr in SOF 400 mg/ledipasvir 90 mg film-coated FDC tablets were obtained. At the 24 week time point, the tablets ranged between 99% and 100% dissolution at 45 minutes for SOF, and between 99% and 98% for ledipasvîr at both 25°C/60%RH and 40°C/75% RH for ail desiccant levels tested.
[0201] From the foregoing, this example shows that SOF 400 mg/ledipasvir 90 mg FilmCoated FDC tablets exhibited satisfactory stability at 25°C/60% RH and 40 °C/75%RH for up to 24 weeks in the presence of 0, 1, and 3 g of desiccant.In addition, crystalline ledipasvîr (Form HI) was not detected by FT-Raman analysis after 24 weeks of storage.
Example 7. Formulation Development of a Fixed Dose Combination (FDC) Tablet SOF 400 mg/Ledipasvir 90 mg [0202] This example shows the development of a SOF 400 mg/ledipasvir 90 mg fixed dose combination (FDC) tablet comprising ledipasvîr: copovidone (1:1). There were expected difficulties with such a development, one of which was the expected poor powder flow and the other relates to non-homogenous blend, given the existing formulations of each individual agent.
[0203] Three tablet formulations were tested, including (1) a monolayer co-granulated tablet formulation, (2) a monolayer co-blended tablet formulation and (3) a bilayer tablet formulation. In ail of these formulations, SOF was in anhydrous crystalline form II and ledipasvîr was in amorphous solid dispersion (ledipasvîr:copovidone (1:1)).
[0204] Formulation (1) is typically associated with the highest risk of drug-drug interaction but is the most cost-effective during manufacturing. The bîlayer formuation of (3), by constrast, is perceîved to hâve the lowest drug-drug interaction risk.
[0205] The dissolution performance ofthe formulations were tested in a dissolution media that included 10 mM phosphate buffer at pH 6.0 (1.5% Tween® 80). As shown in FIG. 8AB, ail three formulations had comparable dissolution performance, similar to that ofthe single-agent controls.
[0206J The pharmacokinetic (PK) performance of each formulation was also tested. Plasma Concentration of SOF/ledipasvir after oral administration of SOF/ledipasvîr FDC and control tablets in fasted dogs (100 mg/22.5 mg fixed/dog). Table 17 below shows the PK results.
Table 17. Phamacokinetic performance of the forumations in famotidine pretreated dogs
Total Tablet weight /Formulation Treatment SOF Ledipasvir
AUCo-t (ng*hr/inL) Cmai (ng/mL) AUCo-last (itg*hr/mL) Cmax (ng/mL)
Control SOF tablet + Ledipasvir SD tablet Famotidine 314 ± 207 503 ±363 3260± 1312 345±132
Monolayer, Cogranulated Famotidine 501± 249 729 ± 434 3236 ±730 333 ± 56
Monolayer, Coblended Famotidine 483 ±406 652 ± 527 4208 ±2216 444 ±215
Bilayer Famotidine 283 ±193 288 ±201 4,712 ±2,270 421.7 ±203.7
[0207J Based on these results, the monolayer co-granulated tablet was selected for further analysis. The composition of this formulation is provided in Table 18.
Table 18. Composition of SOF 400 mg/Ledipasvir 90 mg FDC Tablets
Composition % w/w
Intra-granular
SOF 40.00%
Ledipasvir SD 18.00%
Lactose Fast Flow 316 16.50%
MCC 101 8.00%
Croscarmellose 2.50%
Silicon Dioxide 1.00%
Magnésium Stéarate 0.75%
Extragranular
MCC 101 10.00%
Croscarmellose 2.50%
Magnésium stéarate 0.75%
Total Fill weight Core Tablet (mg) 1000
Coating
Opadry II Orange 85F13912 3.0%
Water QS
]0208| A bioavaîlability clinical study was carried out with this formulation, with single agent tablets as control, in 24 healthy patients under fasted conditions. The results are shown in Table 19
Table 19. Bioavailability of SOF/Ledipasvir fixed dose combination and single agent tablets
Total Tablet weight /Formulation Dose (mg) SOF Ledipasvir
AUCinf (ng*hr/mL) Cmax (ng/mL) AUCinf (ng*hr/mL) Cmax (ng/mL)
Signle Agent Control SOF tablet + Ledipasvir SD tablet SOF 400 mg Ledipasvir 90 mg 11900 (23.5) 764 (27.3) 9620 (45.6) 314(40.5)
SOF/Ledipasvir FDC Tablet 12500 (23.1) 784 (36.2) 9570 (46.6) 314 (45.2)
[0209] These results, therefore, show that SOF/ledipasvir fixed dose combination (cogranulated) and single agent tablets are bioequîvalent.
Example 8. Solubility Studies for Amorphous Ledipasvir [0210] This example examines the physicochemical properties different ledipasvir forms, including amorphous and crystalline free base, solvatés, and salts, with respect to solubility.
A. Materials and Methods pH-Solubility Profile [0211] The aqueous solubility of ledipasvir amorphous free base was determined across the pH range of 1 to 10. Excess solid ledipasvir was added to a range of pH-adjusted aqueous solutions (titrated with HCl or NaOH) and stirred for 48 hours at room température. The suspensions were then fîltered through regenerated cellulose syringe filters. The pH value of the supematant was measured, and the supernatant was diluted as appropriate with 50:50 H2Û+0.1% TFA:ACN and assayed for ledipasvir content by the HPLC-UV method.
Solubility in Simulated Intestinal Media [0212] Solubility of ledipasvir amorphous free base was assessed in three types of simulated intestinal fluids at pH 6.5 or pH 5.0; and simulated intestinal bile sait and lecithin mixture (SIBLM), pH 6.4. Excess solid ledipasvir was added to the respective SIFs and stirred for 48 hours at room température. The resulting suspensions were then filtered through regenerated cellulose syringe filters. The supernatant was diluted as appropriate with 50:50
ΗίΟ+Ο.Ιθ/ο TFA: ACN and assayed for ledipasvir content by the HPLC-UV method.
Excipient Solubility [0213] Solubility of ledipasvir amorphous free base and ledipasvir crystalline D-tartrate was measured in a wide range of pharmaceutically acceptable solvents, including cosolvents, surfactants, fatty acids, triglycérides, or blends thereof. Material was weighed into scintillation vials and stirred for up to 48 hours at room température. In many cases, solubility was higher than the amount of solid used in the sample, thus many results are reported as ‘greater than’ or ‘greater than or equal to’ if the concentration was not quantitatively determîned by HPLC-UV.
[0214] Additionally, aqueous solubility was measured as a function of time in the presence of 0.1% w/w surfactants and polymers in pH 2 (50 mM citrate) and pH 5 (50 mM citrate), ledipasvir crystalline forms (acetone solvaté Form II; anhydrous FB Form III; D-tartrate) and amorphous form were evaluated to identify différences in dissolution behavior. Excess solid was added to aqueous buffered solutions; samples were withdrawn at predetermined intervals (2, 5, 8, 10, 15, 20, 30, 45, 60 minutes, and 24 hours), filtered through regenerated cellulose filters, and diluted for concentration measurement by the HPLC-UV method.
B. Results
Solubility and Dissolution Rate [0215J The pH-solubility profiles of ail available ledipasvir forms were determîned at room température and are graphically shown in FIG. 9. The fiat portion of the solubility profile (pH >5) represents the intrinsic aqueous solubility of the free base. The aqueous solubility of ledipasvir significantly increases as the pH of the solution is lowered below the pKa of the ionizable groups. Ail forms lose crystallinity, reverting to the amorphous free base în aqueous solution, and thus show similar aqueous solubility properties at steady-state. However, dissolution properties are form dépendent and are described in further detail below,
Ledipasvir Amorphous Free Base [0216] The intrinsic solubility of ledipasvir amorphous free base (FB) is approximately
0.04 pg/mL. Under acidic conditions, the solubility increases to 1 mg/mL at pH 2.3, and peaks at about 7 mg/mL at pH 1.6, as shown in Table 20 and FIG. 9. Solubility of ledipasvir in simulated intestinal fluids is govemed by both the pH of the medium and the presence of bile salts and lecithin. In fasted state simulated intestinal fluids (FaSSIF) at pH 6.5 and room température, the solubility is 0.025 mg/mL, and this is increased approximately 10-fold to
0.232 mg/mL in simulated bile and lecithin mixture (SIBLM, pH 6.5) due to the increased concentration of bile salts and lecithin. A similar solubility enhancement to 0.230 mg/mL is observed in fed state simulated intestinal fluid (FeSSIF, pH 5), containîng lower bile sait and lecithin mixtures than SIBLM. The solubility increase in this mixture is predominantly attributed to the ionization sate of the molécule at pH 5.
Table 20, Solubility of Ledipasvir amorphous free base as a function of pH at room température
Aqueous Media Solubility (mg/mL)
Aqueous, pH 1.6 (HCl) 6.855
Aqueous, pH 2.3 (HCl) 1.096
Aqueous, pH 3.1 (HCl) 0.0132
Aqueous, pH 4 .1 (HCl) 0.00011
Aqueous, pH 5.5 (HCl) 0.00003
Aqueous, pH 6.2 (unaltered) 0,00003
Aqueous, pH 7.2 (NaOH) 0.00001
FaSSIF1 pH = 6.5 0.025
FeSSIF2 pH = 5.0 0.230
SIBLM3 pH = 6.4 0.232
1 FaSSIF is water with 3mM sodium taurocholate and 0.75 mM lecithin, pH adjusted to 6.5 with phosphate buffer, ionic strength adjusted to 0.15M with NaCl.
2 FeSSIF is water with 15 mM sodium taurocholate and 3.75 mM lecithin, pH adjusted to 6.5 with phosphate buffer, ionic strength adjusted to 0.15M with NaCl.
3 SIBLM is water with 30 mM sodium glycocholate, 30 mM sodium glycochenodesoxycholate, 15 mM sodium glycodesoxycholate, 10 mM sodium taurocholate, 10 mM sodium taurochenodesoxycholate, 5 mMsodium taurodesoxycholate, 50 mM sodium chloride, and 11 mM lecithin, pH adjusted to 6.4 with phosphate buffer, ionic strength adjusted to 0.15M with NaCl.
[0217] The dissolution rate of ledipasvir amorphous free base at pH 3 and 6 was also tested. At pH 3, the dissolution of the amorphous free base form is faster than that of the crystalline free base and acetone solvaté forms. However, at pH 6, ail free base forms show similar dissolution rate profiles.
[0218] As shown in Table 21, ledipasvir amorphous free base is ffeely soluble (>500 mg/mL) in éthanol and other organic solvents such as propylene glycol and PEG 400. Its solubility is greater than 200 mg/mL in surfactants (e.g., polysorbate 80, Cremophor EL,
Labrasol) and lipid blends. Its solubility in oleic and octanoic acids is greater than 500 mg/mL. Solubility of ledipasvir in shorl-chain triglycérides (SCTs, tributyrin) is limited to 20 mg/mL, and decreases to less than I mg/mL in long-chain triglycérides (LCTs, soybean oil).
It has a solubility of25 mg/mL in the vehicle chosen for toxicological studies: 45% propylene glycol, 15% caprylocaproyl macrogol-8 glycerides (Solutol HS 15®), and 40% water (pH 2.5 by HCl).
Table 21. Solubility of Ledipasvir free base forms and Ledipasvir D-tartrate in organic solvents and excipients at room température
Solubility (mg/mL)
Amorphous Free Base Crystalline Acetone Solvaté Anhydrous Crystalline Free Base Crystalline D-tartrate Sait
(Ledipasvir) (Ledipasvir03) (Ledipasvir Form m) (Ledipasvir-02)
Acetone 5 5 -- <1
Acetonitrile >500 — — 12
Methanol >500 >500 — 23
95% Methanol + 5% water — — — 19
Ethanol >500 >500 >500 4
95% Ethanol + 5% water — — — 5
PEG 400 >500 >500 >500 4
Propylene glycol >500 >500 >500 6
Octanoic acid >500 >500 — <1
Oleic acid >500 >500 >500 <1
Polyoxyl 35 Castor Oil (Cremophor EL) >200 — —
Polysorbate 80 (Tween 80) >200 >200 >200 3
Caprylocaproyl macrogolglyceri des (Labrasol) >300 >300 >300 3
Tributyrin 9 — — —
Soybean oil 2 2 2 —
RSSEDDS1 >500 — 10
1 RSSEDDS: 10% Ethanol, 10% PG, 40% Solutol HS-15, 40% Labrasol [0219] Dîlute nonionic surfactants generally increase ledipasvir solubility at both pH 2 and 5, as presented in Table 22. Similar effects were observed with nonionic polymers, though to a lesser extent. Sodium lauryl sulfate (SLS), an anionic surfactant, improves the solubility of ledipasvir at pH 5. However, a significant decrease in solubility is noted in presence of SLS under acidic conditions (pH 2). This observation is consistent with weakly basic compounds that hâve low intrinsic aqueous solubility, presumably forming an insoluble estolate sait.
Table 22. Solubility of Ledipasvir amorphous free base in surfactant or polymeric excipients (0.1% w/w) diluted into aqueous media at pH 2 and 5 at room température
Excipient (0.1% w/w in aqueous media) Solubility (mg/mL)
pH 2 pH 5
No excipient 4.94 0.0001
Sodium lauryl sulfate 0.05 0.243
Labrasol 7.44 --
Cremaphor EL 9.11 0.0699
Polysorbate 80 9.27 0.0624
Poloxamer 188 7.19 0.0005
HPC (hydroxypropylcellulose) 4.67 0.0001
HPMC (hydroxymethylcellulose) 5.27 0.0003
PVP (povidone) 5.47 0.0004
PVP/VA (copovidone) 6.73 0.0010
Ledipasvir Crystalline Acetone Solvaté (Ledipasvir-03) [0220] The ledipasvir acetone solvaté (ledipasvir-03) showed similar steady-state solubility as the other forms. Ledîpasvir-03 has the siowest dissolution of ail forms tested. Its dissolution at pH 6 was indistinguishable fforn that of other forms due to poor intrinsic solubility (<0.1 pg/mL).
[0221] Ledipasvir-03 is soluble in many organic solvents and pharmaceutically acceptable solvents, and the solubilities are comparable to those listed for ledipasvir amorphous free base, as also shown in Table 21.
Ledipasvir Crystalline Free Base (Form III) [0222] Ledipasvir crystalline free base Form III showed similar steady-state solubility as the other forms (FIG. 9). This form dissolves more slowly than the amorphous free base, but faster than ledipasvir-03. Dissolution at pH 6 was indistinguishable from that ofthe other forms due to poor intrinsic solubility (<0,1 pg/mL). Solubilîty in a wider range of organic vehicles has not been explored, though is anticipated to be similar to other free base forms.
Ledipasvir Crystalline D-tartrate Sait (Ledipasvir-02) [0223] Ledipasvir crystalline D-tartrate sait (ledipasvir-02) showed similar steady-state solubility as the other forms (FIG. 9). Dissolution behavior ledipasvîr-02îs improved relative to ail free base forms. At pH 3, ledïpasvir-02shows a roughly 5- to 10-fold faster initial dissolution rate than the free base forms, and roughly doubled the amount of ledipasvir in solution through 60 minutes compared to the amorphous form. At pH 6, the increased dissolution rate was also apparent. However, rapid dissociation ofthe sait at this pH resulted in équivalent solubility values to other forms within minutes.
[0224] Ledipasvir-02 is not soluble in various organic media, as shown in Table 21. Maximal solubility of ledipasvir-02 in any organic vehicle is 20 mg/mL in methanol; this limits the use of ledipasvir-02 in solubilized formulations or processes that require solubilization in organic media.
[0225] Ledipasvir has low aqueous solubility and high permeabîlity, and is considered a BCS Class 2 compound. The data presented in this example indicate that in water, ail forms of ledipasvir: the amorphous free base, crystalline free base acetone solvaté (ledipasvir-03), crystalline anhydrous free base (Form III), and crystalline D-tartrate sait (ledipasvir-02), convert to the amorphous free base, and hâve similar aqueous solubility at steady state. The aqueous solubility of ledipasvir is less than 0.1 pg/mL in its neutral form (pH > 5), but substantially încreases under acidic conditions due to protonation of two basic moietîes. The aqueous dissolution rate of ledipasvir amorphous free base is faster than that of crystalline free base forms. However, ail free base forms hâve slower dissolution rates than the crystalline D-tartrate sait (ledipasvir-02). Ledipasvir-02 also shows improved wetting in aqueous media, ledipasvir free base forms, crystalline and amorphous, are highly soluble in a range of cosolvents and surfactants. In contrast, ledipasvir-02 is poorly soluble in organic excipients, and this property potentially limits its utility.
[0226] Ledipasvir amorphous free base was used in Phase 1 clinical studies, but drug substance manufacturing was identified as a critical limitation ofthe form. Ledipasvir crystalline D-tartrate sait (ledipasvir-02) was then identified as part of a more extensive sait and form screen and was used in Phase 2, however, poor solubility in organic excipients limits its utility in non-conventional formulations. Crystalline ledipasvir acetone solvaté (ledipasvir-03) is used to develop a spray dried dispersion formulation to support future clinical studies due to its solubility in organic solvents and excipients relative to crystalline ledipasvir D-tartrate sait and improved manufacturability over the other free base forms.
Example 9: Efficacy of a Fixed Dose Combination of Sofosbuvir and Ledipasvir With and Without Ribavirin in Patients with HCV Infections |0227] Patients with HCV infections were treated with the fixed dose combination of sofosbuvir and ledipasvir, with and without ribavirin. Patients used in the studies include those that were treatment naïve (non-cirrhotic), i.e. had not previously been treated for HCV, and those that were prior protease-inhibitor (PI) failures and null responders (with and without cirrhosis), i.e. had previously been treated for HCV but failed to respond to the treatment. The treatment naïve pateints were treated for 6, 8, and 12 weeks and the null responders were treated for 12 weeks.
Study 1 [0228| Cohort 1 of study 1 included treatment-naïve, Genotype-1 patients without cirrhosis. The patients were randomized 1:1:1 into three groupds to receive 1) SOF/Iedipasvir fixed dose combination for 8 weeks, 2) SOF/ledipasvir fixed dose combination with ribavirin for 8 weeks, or 3) SOF/ledipasvir fixed dose combination for 12 weeks (FIG. 10).
[0229] Cohort 2 of study 1 included Protease-inhibitor treatment-experienced, Génotype -1 patients (Prior Protease-inhibitor treatment failures, 50% of whom had compensated cirrhosis). The pateints were randomized to receive 12 weeks of: 1) SOF/ledipasvir fixed dose combination or 2) SOF/ledipasvir fixed dose combination with ribavirin (FIG. 10). In Cohort 2, the patients must not hâve discontinued prior therapy due to an adverse event.
[0230] In study 1, there was a broad inclusion criteria, namely, there was no upper limît to âge or BMI. Platelets were >50,000/mm3. The demographics of study 1 are shown in Table
23, below.
Table 23. Demographics
SOF/Ledipasvir fixed dose combination ± ribavirin (Cohort 1 and 2) N=100
Mean âge, y (range) 50 (21-73)
Male, n (%) 66 (66)
Black, n (%) 9(9)
Hispanic, n (%) 40 (40)
2 Mean BMI, kg/m (range) 29.9(18-48)
IL28B CC, n (%) 15(15)
GT la, n (%) 87 (87)
Mean baseline HCV RNA, log10 IU/mL (range) 6.1 (3.7-7.2)
Cohort 2 (N=40)
Cirrhosis, n (%) 22/40 (55)
3 Mean Platelet Count (xlO /pL) 107
Mean Albumin (g/dL) 3.8
[0231] Of 100 patients enrolled în study 1, 97% achieved sustained viral response. Of the failures, two patients relapsed (one from Group 1 (i.e., SOF/Ledipasvir x 8 Weeks) and one from Group 4 (i.e., SOF/ledîpasvir x 12 Weeks), and one patient was lost to follow up from Group 3 (i.e,, SOF/ledîpasvir x 12 Weeks). However, the patient lost to follow up had achieved SVR at week 8 and declined further retum visits.
[0232] In Cohort 1 of study 1 (i.e. Treatment Naïve, Non-Cirrhotic Patients), 58 out of the 60 patients treated for 8 or 12 Weeks achieved SVR. In corhort 2 of study 1 (i.e. Treatment Experienced, PI failure Patients), 39 out of the 40 patients treated for 12 Weeks achieved SVR12. 21 out of the 21 patients with cirrhosis achieved SVR 12 (FIG. 11).
[0233] In study 1, seven out ofthe nine patients with NS5A Résistance Associated
Variants (RAVs) achieved sustained viral response. In addition, ail patients with NS3/4A
Résistance Associated Variants achieved sustained viral response. Interestingly, S282T mutation and multiple NS5A RAVs were detected at relapse in the patient who failed from the Group 1 (Table 24). The safety summary and a breakdown of the adverse effects are shown în Tables 25 and 26, respectively.
Table 24. Résistance analysis
SOF/Ledipasvir fixed dose combination ± ribavirin
NSSARAVs, n% 9/100 (9)
NS3/4A RAVs, n % 29/40 (73)*
*number of patients in Cohort 2 with prior exposure to a protease inhibitor
Table 25. Safety Suminary
Patients, n (%) SOF/Ledipasvir fixed dose combination N=58 SOF/Ledipasvir fixed dose combination + ribavirin N=42
Overall safety AEs 24 (41%) 24 (57%)
Grade 3-4 AEs 0 6 (14%)
Serious AEs 2* (3%) 2** (5%)
Treatment discontinuation due to AEs 0 0
Laboratory abnormalities Grade 3-4 laboratory abnormal ity 4 (7%) 6 (14%)
Hemoglobin <10 g/dL 0 8 (19%)
Hemoglobin <8.5 g/dL 0 2 (5%)
*peptic ulcer, spinal compression fracture **delerium, suicidai idéation
Table 26. Adverse Events ( > 5% of patients overall)
Preferred term, n (%) SOF/Ledipasvir fixed dose combination N=58 SOF/Ledipasvir fixed dose combination + ribavirin N=42
Any adverse event 24 (41%) 24 (57%)
Nausea 3 (5%) 6 (14%)
Anémia 0 8 (19%)
Upper Resp Tract Infx 4 (7%) 4 (10%)
Headache 3 (5%) 4(10%)
Study 2 [0234] In study 2, the treatment-naïve patients received SOF/ledipasvir fixed dose combination with ribavirin and prior null responders, ail of whom had cirrhosis, were randomized to receive twelve weeks of: 1) SOF/ledipasvir fixed dose combination or 2)
SOF/ledipasvir fixed dose combination with ribavirin.
Results [0235] Of the 144 patients treated in both studies 1 and 2, 136 out of 144 (94%) achieved SVR at four weeks post treatment. Of the 85 treatment-naïve patients in these two studies, three of 25 patients failed to achieve SVR after 6 weeks of SOF/ledipasvir fixed dose combination with ribavirin therapy, whereas 100% (60/60) patients achieved SVR after 8 or 12 weeks of SOF/ledipasvir fixed dose combination with and without ribavirin therapy. Of the 59 treatment-experienced patients in these two studies, three cirrhotic patients relapsed after receiving 12 weeks of SOF/ledipasvir fixed dose combination without ribavirin. Conversely, no virologie failures were observed in the SOF/ledipasvir fixed dose combination with ribavirin treatment groups, but two patients in these groups were lost to follow-up. SOF/ledipasvir fixed dose combination with and without ribavirin was well tolerated, with few SAEs and minimal adverse events.
Conclusion [0236] SOF/ledipasvir fixed dose combination +/- ribavirin may be given for as lîttle as 8 weeks to treatment-naïve non-cirrhotic patients. Treatment-experienced patients, even those with cirrhosis, achieved high SVR rates with 12 weeks of the of SOF/ledipasvir fixed dose combination with and without ribavirin therapy.
Example 10: Eflïcacy of Multiple Anti-HCV Combination Therapy in Chronically Infected Hepatitis C Patients [0237] To evaluate the safety, tolerability, and eflïcacy of 4 to 12 weeks of SOF with ledipasvir, alone or in combination with Compound E and/or Compound J in patients with HCV, patients with HCV will be dosed as shown in Table 27.
Table 27. Dosing
Group Treatment Dosing Patient description
Group A 12 weeks of SOF/ledipasvir SOF with ledipasvir (400 mg/90 mg respectively once a day in a fixed dose combination) administered orally for 12 weeks Patients (n=20) monoinfected with HCV génotype 1 who are HCV treatment naïve
Group B 6 weeks of SOF/ledipasvir/ Compound E SOF with ledipasvir (400 mg/90 mg respectively once a day in a fixed dose combination) in combination with Compound E (500 mg once daily) for 6 weeks Patients (n=20) monoinfected with HCV génotype 1 who are HCV treatment naïve
Group C 6 weeks of SOF/ledipasvir/ Compound J SOF with ledipasvir (400 mg/90 mg respectively once a day in a fixed dose combination) in combination with Compound J (80 mg once daily) for 6 weeks. Patients (n=20) monoinfected with HCV génotype 1 who are HCV treatment naïve
Group D 12 weeks of SOF/ledipasvir SOF with ledipasvir (400 mg/90 mg respectively once a day in a fixed dose combination) administered orally for 12 weeks Patients (n=up to 25) monoinfected with HCV génotype 1 who were previously treated in Group B, C, F, G or H of this study or a similar study
Group E 12 weeks of SOF/ledipasvir SOF with ledipasvir (400 mg/90 mg respectively once a day in a fixed dose combination) administered orally for 12 weeks Patients (n=20) monoinfected with HCV génotype 4 who are HCV treatment naïve or treatment experienced
Group F 6 weeks of SOF/ledipasvir/ Compound J SOF with ledipasvir (400 mg/90 mg respectively once a day în a fixed dose combination) in combination with Compound J (80 mg once daily) for 6 weeks. Patients (n=50) monoinfected with HCV génotype 1 with advanced liver disease who are HCV treatment naïve (n=25) or treatment experienced (n=25)
Group G 4 weeks of SOF/ledipasvir/ Compound J SOF with ledipasvir (400 mg/90 mg respectively once a day in a fixed dose combination) in combination with Compound J (80 mg once daily) for 4 weeks Patients (n=25) monoinfected with HCV génotype 1 who are HCV treatment naïve, Stage 0-2 liver disease
Group Treatment Dosing Patient description
Group H 4 weeks of SOF/ledipasvîr/ Compound J/Compound E SOF with ledipasvir (400 mg/90 mg respectively once a day in a fixed dose combination) in combination with Compound J (80 mg once daily) and Compound E (250 mg once daily) for 4 weeks Patients (n=25) monoinfected with HCV génotype 1 who are HCV treatment naïve, Stage 0-2 liver disease
[0238] The primary analysis set for safety analyses will include patients who received at least one dose of study drug. On treatment data will be analyzed and defîned as data collected from the first dose of study drug through the date of last dose of study drug plus 30 days. Patients who receive study drug other than that to which they were assigned will be analyzed according to the study drug received.
[0239] The analysis set for antiviral activity analyses will include patients who were enrolled into the study and received at least one dose of study drug.
[0240] The pharmacokinetic analysis set will include ail patients who are enrolled and hâve received at least one dose of study médication.
[0241] The patient will be started on study treatment after confirming elîgibîlity on Day 0 and after being informed fully about the remainder of the study, and then signing the spécifie consent for the treatment group (if not done previously). Blood will be drawn for HCV viral loads, study drug levels, lipid levels for research if not already drawn during screening, immunologie studies, and for storage prior to dosing as part of the screening consent. A pregnancy test will be done for females with childbearing potential and the pregnancy test must be négative on Day 0 prior to dosing with study drugs. Patients may be asked to fill out a baseline adhérence questionnaire and an electronîc pill bottle cap, which records pill bottle openings will be placed on ail study drug bottles. Assistance will be provided filling out the questionnaire as needed. Patients on Arms B and H, will also be provided with a diary at Day 0, Week 2, Week 4 (Arm B only) on which to record gastrointestinal side effects.
[0242] On arrivai at the clinic for scheduled study visits, patients will hâve their vital signs obtained, females will undergo a pregnancy test (if appropriate per schedule and of childbearing potential), clinical laboratories drawn, and a review of the study restrictions.
[0243] At each scheduled study visit (does not include Day 1, 3, 5, 10, Week 2, Week 3, Week 6 (not applicable for arm F, G or H) or post-treatment week 2 and 8 which are for lab collection only), patients will be asked about their state of health and use of any concomitant médication since the previous study visit. They will also be questioned about adverse events and their adhérence with study restrictions. Vital signs, weight and examination will be performed as per the study flow. A complété list of study procedures and lab tests to be performed is in the Schedule of Tests, below. In addition, patients may be seen at unscheduled visits for a grade 3 or 4 adverse event or any unexpected adverse event or potential toxicity.
[0244] Patients may be asked to fill out a follow-up adhérence questionnaire and pill bottle openings may be recorded from the electronic bottle cap at Day 7 (Group A), Week 4 (Group A), Week 6 (Groups B and C), Week 8 (Group A), and Week 12 (Group A). Assistance will be provided filling out the questionnaire as needed.
[0245] Patients in Groups B and H will be asked to bring their side-effect diaries to visits on Week 2, 4, 6 (B only).
[0246] Some of the visits hâve a small amount of flexibility regarding when they need to occur. Visits occurring during the interval when the patient is receiving study drug hâve limited flexibilîty since they occur so ffequently, so a visit skipped during this period may be considered a missed visit. The window period for visit schedules is as shown in Table 28.
Table 28. Window Period for Visit Schedule
For 12 week regimen, Group A:
Days 0, 1, 3 (no window) Days 5, 7, 10, 14 (+/- 2 days) Weeks 3, 4, 6 (+/- 3 days) Weeks 8, 12 (+/- 5 days) Optional Week 12 Research Liver Biopsy (+/-14 days)
For 6 week regimens, Groups B & C :
Days 0, 1, 3 (no window) Days 5, 7, 10, 14 (+/- 2 days) Weeks 3, 4, 6 (+/- 3 days) Optional Week 6 Research Liver Biopsy (+/-14 days)
For 12 week regimens, Groups D and Έ:
Day 0 (no window) Week 4 (+/- 3 days) Weeks 8, 12 (+/- 7 days)
For 6 week regimen, Group F:
Day 0 (no window) Weeks 2, 4 (+/- 3 days Week 6 (+/- 5 days) Optional Week 6 Research Liver Biopsy (+/-14 days)
For 4 week regimen, Group G or H:
Day 0 (no window) Day 7 (+/- 2 days) Group H only Weeks 2, 4 (+/- 3 days) Optional Week 4 Research Liver Biopsy (+/-14 days)
[0247] During the four week visit, HCV RNA may be obtained to détermine if virologicresponse based treatment stopping criteria hâve been met. Patients who fail to achieve >2 logIO HCV RNA drop at this time (unless > 2 log drop would be below LLOQ) should be discontinued from therapy unless a review by the PI/LAI/Sponsor Medical Monitor détermines otherwise (see 9.3.1).
[0248] At the end of treatment duration as determined by the study group, patients may discontinue dosing of SOF and ledipasvir, Compound E, and/or Compound J. In addition, if a patient’s participation terminâtes prior to completîon of pre-specified study drug duration, the End of Treatment assessments may be performed at any end-of-treatment visit. An optional research liver biopsy for research purposes may be performed at this time in up to 10 patients in each study group. The additional liver biopsy data will serve to explore hepatic HCV RNA sequence analysis. If patients are undergoing the optional research liver biopsy, they may hâve safety labs completed prior to the procedure and imaging as medically indicated. Patients who hâve a HCV VL< LLOQ may receive éducation about how to prevent reinfection with HCV.
[0249] Ail patients may be assessed for sustained virologie response at the 12 Weeks Post End of Treatment visit. Patients who hâve HCV VL< LLOD may be provided with éducation about how to prevent re-infection with HCV.
[0250] After discontinuation of the study drug, patients may be followed at 2, 4, 8, 12, 24,
36, and 48 weeks post-end of treatment. A sérum pregnancy test may be done with each visit, as appropriate. Week 2 and 8 Post-End of Treatment may include only collection of labs.
[0251] Subjects (n=18) received single doses of sofosbuvir (400 mg) alone or in combination with Compound E (500 mg QD) under fed conditions. Preliminary PK results for the combination of sofosbuvir with Compound E are presented in Table 29 and demonstrate lack of a clinically significant interaction between sofosbuvir and Compound E.
Table 29: Pharmacokinetic Data for SOF, Compound E, and ledipasvir alone and upon co-administration
SOF(n=18)
Mean (%CV) SOF alone SOF + Compound E %GMR(90%CI)
AUCinf (ng.hr/ml) 921(61.2) 1150(40.2) 135(116, 159)
SOF + Compound E+ ledipasvir %GMR(90%CI)
2560 (42.9) 297(253, 348)
AUClast (ng.hr/ml) 908 (62.2) SOF + Compound E %GMR(90%CI
1140 (41.4) 135(115, 159)
SOF + Compound E+ ledipasvir %GMR(90%CI)
2550(43.1) 301 (255,354)
Cmax (ng/ml) 515(78.3) SOF + Compound E %GMR(90%CI
587 (51.1) 130(97.1, 175)
SOF + Compound E+ ledipasvir %GMR(90%CI)
1260 (55.1) 283 ¢219.366)
* * * [0252] It should be understood that although the présent invention has been specifically disclosed by preferred embodiments and optional features, modification, improvement and variation of the inventions embodîed therein herein disclosed may be resorted to by those skilled in the art, and that such modifications, improvements and variations are considered to be within the scope ofthis invention. The materials, methods, and examples provided here are représentative of preferred embodiments, are exemplary, and are not intended as limitations on the scope of the invention.
[0253] The invention has been described broadly and generically herein. Each of the narrower species and subgeneric groupings falling within the generic disclosure also form part of the invention. This includes the generic description of the invention with a proviso or négative limitation removing any subject matter from the genus, regardless of whether or not the excised material is specifically recited herein.
[0254] In addition, where features or aspects of the invention are described in terms of Markush groups, those skilled in the art will recognize that the invention is also thereby described in terms of any individual member or subgroup of members of the Markush group.
[0255] Ail publications, patent applications, patents, and other references mentioned herein are expressly incorporated by reference in their entirety, to the same extent as if each were incorporated by reference individually. In case of conflict, the présent spécification, including définitions, will control.

Claims (30)

1. A pharmaceutical composition comprising:
wherein the ledipasvir is substantially amorphous; and
b) an effective amount of sofosbuvir having the formula:
wherein the sofosbuvir is substantially crystalline, and further wherein the composition exhibits unexpected properties.
2. The pharmaceutical composition of claim 1, wherein the ledipasvir is formulated as a solid dispersion comprising ledipasvir dispersed within a polymer matrix formed by a pharmaceutically acceptable polymer.
3. The pharmaceutical composition of claim 2, wherein the polymer îs copovidone.
4. The pharmaceutical composition of claim 3, wherein the weight ratio of ledipasvir to copovidone in the solid dispersion îs about 1:1.
5. The pharmaceutical composition of claim 4, comprising
a) about 40% w/w of sofosbuvir, and
b) about 18% w/w of the solid dispersion.
6. The pharmaceutical composition of claim 5, further comprising
a) about 5 to about 25% w/w lactose monohydrate,
b) about 5 to about 25% w/w microcrystalline cellulose,
c) about 1 to about 10% w/w croscarmellose sodium,
d) about 0.5 to about 3% w/w colloïdal silicon dioxide, and
e) about 0.1 to about 3% w/w magnésium stéarate.
7. A pharmaceutical dosage form comprising the pharmaceutical composition of claim 1, comprising about 90 mg of ledipasvir and about 400 mg of sofosbuvir.
8. The pharmaceutical dosage form of claim 7, wherein the ledipasvir is formulated as a solid dispersion within a polymer matrix of copovidone.
9. The pharmaceutical dosage form of claim 8, wherein the amount of copovidone is about 90 mg.
10. The pharmaceutical dosage form of claim 9, further comprising:
(a) about 165 mg of lactose monohydrate;
(b) about 180 mg of microcrystalline cellulose;
(c) about 50 mg of croscarmellose sodium;
(d) about 10 mg of colloïdal silicon dioxide; and (e) about 15 mg of magnésium stéarate.
11. The pharmaceutical dosage form of claim 9 which is in the form of a tablet comprising a film coating.
12. A method of treating a patient infected with hepatitis C virus comprising administering to the patient a therapeutically effective amount of a pharmaceutical composition of claim 1.
13. The method of claim 12, wherein the pharmaceutical composition is administered for about 24 weeks or less.
14. The method of claim 12, wherein the pharmaceutical composition is administered for about 12 weeks or less.
15. The method of claim 12, wherein the pharmaceutical composition is administered for about 8 weeks or less.
16. The method of claim 12, wherein the pharmaceutical composition is administered for about 6 weeks or less.
17. The method of claim 12, wherein the pharmaceutical composition is administered once daily for about 12 weeks or less and wherein the hepatitis C virus is génotype 1, 2, 3,4, 5, or 6.
18. The method of claim 12, wherein the pharmaceutical composition is administered once daily for about 8 weeks or less and wherein the hepatitis C viras is génotype 1, 2, 3, 4, 5, or 6.
19. The method of claim 12, wherein the pharmaceutical composition is administered once daily for about 6 weeks or less and wherein the hepatitis C viras is génotype 1, 2, 3, 4, 5, or 6.
20. The method of claim 17, wherein the hepatitis C virus is génotype la or lb.
21. The method of claim 18, wherein the hepatitis C viras is génotype la or lb
22. The method of claim 19, wherein the hepatitis C viras is génotype la or lb.
23 The method of claim 12, wherein the pharmaceutical composition is administered once daily for about 12 weeks and wherein the hepatitis C virus is génotype la, lb, 2a, 2b, 2c, 2d, 3a, 3b, 3c, 3d, 3e, 3f, 4a, 4b, 4c, 4d, 4e, 4f, 4g, 4h» 4i, 5a, or 6a.
24. The method of claim 12, wherein the pharmaceutical composition is administered once daily for about 8 weeks and wherein the hepatitis C virus is génotype la, lb, 2a, 2b, 2c, 2d, 3a, 3b, 3c, 3d, 3e, 3f, 4a, 4b, 4c, 4d, 4e, 4f, 4g, 4h, 4i, 5a, or 6a.
25. The method of claim 12, further comprising administering ribavirin.
26. The method of claim 12, wherein the treatment does not include interferon.
27. The method of claim 12, wherein the treatment does not include ribavirin.
28. The method of claim 12, wherein the treatment does not include interferon or ribavirin,
29. The method of claim 12, further comprising administering an NS3 protease inhibitor.
30. The method of claim 12, further comprising administering simeprevir.
OA1201500300 2014-01-30 Combination formulation of two antiviral compounds. OA17450A (en)

Publications (1)

Publication Number Publication Date
OA17450A true OA17450A (en) 2016-12-22

Family

ID=

Similar Documents

Publication Publication Date Title
AU2018203696B2 (en) Combination formulation of two antiviral compounds
AU2019264624B2 (en) Combination formulation of two antiviral compounds
OA17450A (en) Combination formulation of two antiviral compounds.