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`MYLAN - EXHIBIT 1004 (Part 4 of 4)
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`US 8,629,111 B2
`Page 3
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`(56)
`
`References Cited
`OTHER PUBLICATIONS
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`Gremse, David et al, Ulcerative Colitis in Children,EPediatr§Drugs,
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`Hunter, P.A. et al, Cyclosporin A Applied Topically to the Recipient
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`Jumaa, Muhannad et al. Physicochemical Properties and Hemolytic
`Effect of Different Lipid Emulsion Formulations Using a Mixture of
`Emulsifiers, Pharmaceutica Acta Helvetiae, 1999, 293-301, 73.
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`Kaur, Rabinder et al, Solid Dispersions of Drugs in§Polyocyethylene§
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`Kuwano, Mitsuaki et al, Cyclosporine A Formulation Affects Its
`Ocular Distribution in Rabbits, Pharmaceutical Research, Jan. 2002,
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`Lambert Technologies Corp. Material Safety Data Sheet
`LUMULSETM POE-40 MS KP, last revision Aug. 22, 2003. 3 pages.
`Leibovitz, Z. et al., Our Experience in Processing Maize (Corn) Germ
`Oil, Journal of the American Oil Chemists Society, Feb. 1983. 395-
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`Lixin, Xie et al, Effect of Cyclo sporine A Delivery System in Corneal
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`Lopatin, D.E., Chemical Compositions and Functions of Saliva, Aug.
`24, 2001,31 Pages.
`Lyons, R.T. et al, Influence of Three Emulsion Formulation Param-
`eters on the Ocular Bioavailability of Cyclosporine A in Albino
`Rabbits, AmAssoc Pharm Sci, 2000, 1 Page, 2(4).
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`Aspects on Pathogenesis, Diagnostic Criteria, Clinical Features and
`Approaches for Therapy, Expert Opin Pharma, 2001, 1415-1436,
`2(9).
`Phillips, Thomas et al. Cyclosporine Has a Direct Effect on the
`Differentiation of a Mucin-Secreting Cell Line, Journal of Cellular
`Physiology, 2000, 400-408, 184.
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`Present, D.H. et al, Cyclosporine and Other Immunosuppressive
`Agents: Current and Future Role in the Treatment of Inflarr1rnatory
`Bowel Disease, American Journal of Gastroenterology, 1993, 627-
`630, 88(5).
`Restasis® Product Information Sheet, Allergan, Inc., 2009, 5 Pages.
`Restasis® Increasing Tear Production, Retrieved on Aug. 14, 2009,
`http://www.restasisprofessional.com/_clinical/clinical_increasing.
`htm 3 pages.
`Robinson, N. A. et al, Desquamative Gingivitis: A Sign of
`Mucocutaneous Disorders—a Review, Australian Dental Journal,
`2003, 205-211, 48(4).
`Rudinger, J., Characteristics of the Amino Acids as Components of a
`Peptide Hormone Sequence, Peptide Hormones, 1976, 1-7.
`Sall, Kenneth et al, Two Multicenter, Randomized Studies of the
`Eflicacy and Safety of Cyclosporine Ophthalmic Emulsion in Mod-
`erate to Severe Dry Eye Disease, Ophthalmology, 2000, 631-639,
`107.
`Sandborn, William et al, A Placebo -Controlled Trial of Cyclo sporine
`Enemas for Mildly to Moderately Active I_eft-Sided Ulcerative
`Colitis, Gastroenterology, 1994, 1429-1435, 106.
`Sandborn, William et al, Cyclosporine Enemas for Treatment-Resis-
`tant, Mildly to Moderately Active, Left-Sided Ulcerative Colitis,
`American Journal of Gastroenterology, 1993, 640-645, 88(5).
`Schwab, Matthias et al, Pharmacokinetic Considerations in the Treat-
`ment of Inflarr1rnatory Bowel Disease, Clin Pharm, 2001, 723-751,
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`ofVernal Keratoconjunctivitis, American Journal of Ophthalmology,
`Dec. 1990, 641-645, 110.
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`Albino Rabbits and Beagle Dogs, Ocular Drug Delivery and Metabo-
`lism, 1999, 54.
`Small, David et al, Blood Concentrations of Cyclosporin A During
`Long-Term Treatment With Cyclo sporin A ophthalmic Emulsions in
`Patients with Moderate to Severe Dry Eye Disease, Journal of Ocular
`Pharmacology and Therapeutics, 2002, 411-418, 18(5).
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`Protein Peptide Confers the Capacity to Prevent Rather Than Induce
`Experimental Autoimmune Encephalomyelitis, Proc. Natl. Acad.
`Sci., Nov. 1991, 9633-9637, 88.
`Stephenson, Michelle, The Latest Uses of Restasis, Review of Oph-
`thalmology, Dec. 30, 2005, 7 Pages, US.
`Stevenson, Dara et al, Eflicacy and Safety of Cyclosporin A
`ophthalmic Emulsion in the Treatment of Moderate-to-Severe Dry
`Eye Disease, Ophthalmology, 2000, 967-974, 107.
`Tesavibul, N. et al, Topical Cyclosporine A (CsA) for Ocular Surface
`Abnormalities
`in Graft Versus Host Disease Patients,
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`Sj ogren’s Syndrome Mouse Model, Invest Ophthalmol Vis Sci, Aug.
`1998, 1551-1559, 39(9).
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`Complaints (Xerostomia) in Sjogren’s Syndrome, Ann Rheum Dis,
`1999, 465-473, 58.
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`
`* cited by examiner
`
`0504
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`0504
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`US 8,629,111 B2
`
`1
`METHODS OF PROVIDING THERAPEUTIC
`EFFECTS USING CYCLOSPORIN
`COMPONENTS
`
`RELATED APPLICATION
`
`This application is a continuation of copending U.S. appli-
`cation Ser. No. 13/961,828 filed Aug. 7, 2013, which is a
`continuation of copending U.S. application Ser. No. 11/897,
`177, filed Aug. 28, 2007, which is a continuation of U.S.
`application Ser. No. 10/927,857, filed Aug. 27, 2004, now
`abandoned, which claimed the benefit of U.S. Provisional
`Application No. 60/503,137 filed Sep. 15, 2003, which are
`incorporated in their entirety herein by reference.
`
`BACKGROUND OF THE INVENTION
`
`The present invention relates to methods of providing
`desired therapeutic effects to humans or animals using com-
`positions including cyclosporin components. More particu-
`larly, the invention relates to methods including administer-
`ing to an eye of a human or animal a therapeutically effective
`amount of a cyclosporin component to provide a desired
`therapeutic effect, preferably a desired ophthalmic or ocular
`therapeutic effect.
`The use of cyclosporin-A and cyclosporinA derivatives to
`treat ophthalmic conditions has been the subject of various
`patents, for example Ding et al U.S. Pat. No. 5,474,979; Garst
`U.S. Pat. No. 6,254,860; and Garst U.S. Pat. No. 6,350,442,
`this disclosure of each of which is incorporated in its entirely
`herein by reference. In addition, cyclosporin A compositions
`used in treating ophthalmic conditions is the subject of a
`number of publications. Such pub§Liga1;ion\s““LngLL§ie,
`for
`example, “Blood concentrations of §cyclosporin a§during
`long-term treatment with§B§E‘i8§i33B*fi"§“fpritnaimi€ emul-
`sions in patients with moétera‘te“to“s‘e‘v‘ere“dry eye disease,”
`Small et al, J Ocul Pharmacol Ther, 2002 October, 18(5):41 1-
`8; “Distribution of cyclosporin A in ocular tissues after topi-
`cal administration to albino rabbits and beagle dogs,”
`Acheampong et al, Curr Eye Res, 1999 February, 18(2):91-
`103b; “Cyclosporine distribution into the conjunctiva, cor-
`nea, lacrimal gland, and systemic blood following topical
`dosing of cyclosporine to rabbit, dog, and human eyes,”
`Acheampong et al, Adv Exp Med Biol, 1998, 438:1001-4;
`“Preclinical safety studies of cyclosporine ophthalmic emul-
`sion,” Angelov et al, Adv Exp Med Biol, 1998, 4382991-5;
`“Cyclosporin & Emulsion & Eye,” Stevenson et al, Ophthal-
`mology, 2000 May, 107(5):967-74; and “Two multicenter,
`randomized studies of the efficacy and safety of cyclosporine
`ophthalmic emulsion in moderate to severe dry eye disease.
`CsA Phase 3 Study Group,” Sall et al, Ophthalmology, 2000
`April, 107(4):631-9. Each of these publications is incorpo-
`rated in its entirety herein by reference.
`In addition,
`cyclosporin A-containing oil-in-water emulsions have been
`clinically tested, under conditions of confidentiality, since the
`mid 1990’s in order to obtain U.S. Food and Drug Adminis-
`tration (FDA) regulatory approval.
`Examples of useful cyclosporin A-containing emulsions
`are set out in Ding et al U.S. Pat. No. 5,474,979. Example 1 of
`this patent shows a series of emulsions in which the ratio of
`cyclosporin A to castor oil in each of these compositions was
`0.08 or greater, except for Composition B, which included
`0.2% by weight cyclosporinA and 5% by weight castor oil.
`The Ding et al patent placed no significance in Composition
`B relative to Compositions A, C and D of Example 1.
`Over time, it has become apparent that cyclosporinA emul-
`sions for ophthalmic use preferably have less than 0.2% by
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`weight of cyclosporin A. With cyclosporin A concentrations
`less than 0.2%, the amount of castor oil employed has been
`reduced since one of the functions of the castor oil is to
`
`solubilize the cyclosporin A. Thus, if reduced amounts of
`cyclosporin are employed, reduced amounts of castor oil are
`needed to provide effective solubilization of cyclosporin A.
`There continues to be a need for providing enhanced meth-
`ods of treating ophthalmic or ocular conditions with
`cyclosporin-containing emulsions.
`
`SUMMARY OF THE INVENTION
`
`New methods of treating a human or animal using
`cyclosporin component-containing emulsions have been dis-
`covered. Such methods provide substantial overall efficacy in
`providing desired therapeutic effects.
`In addition, other
`important benefits are obtained employing the present meth-
`ods. For example, patient safety is enhanced. In particular, the
`present methods provide for reduced risks of side effects
`and/or drug interactions. Prescribing physicians advanta-
`geously have increased flexibility in prescribing such meth-
`ods and the compositions useful
`in such methods,
`for
`example, because of the reduced risks of harmful side effects
`and/or drug interactions. The present methods can be easily
`practiced. In short, the present methods provide substantial
`and acceptable overall efficacy, together with other advan-
`tages, such as increased safety and/or flexibility.
`In one aspect of the present invention, the present methods
`comprise administering to an eye of a human or animal a
`composition in the form of an emulsion comprising water, a
`hydrophobic component and a cyclosporin component in a
`therapeutically effective amount of less than 0.1% by weight
`of the composition. The weight ratio of the cyclosporin com-
`ponent to the hydrophobic component is less than 0.08.
`It has been found that the relatively increased amounts of
`hydrophobic component together with relatively reduced, yet
`therapeutically effective, amounts of cyclosporin component
`provide substantial and advantageous benefits. For example,
`the overall efficacy of the present compositions, for example
`in treating dry eye disease, is substantially equal to an iden-
`tical composition in which the cyclosporin component is
`present in an amount of 0. 1% by weight. Further, a relatively
`high concentration of hydrophobic component is believed to
`provide for a more quick or rapid breaking down or resolving
`of the emulsion in the eye, which reduces vision distortion
`which may be caused by the presence of the emulsion in the
`eye and/or facilitates the therapeutic effectiveness ofthe com-
`position. Additionally, and importantly, using reduced
`amounts of the active cyclosporin component mitigates
`against undesirable side effects and/or potential drug interac-
`tions.
`
`In short, the present invention provides at least one advan-
`tageous benefit, and preferably a plurality of advantageous
`benefits.
`
`The present methods are useful in treating any suitable
`condition which is therapeutically sensitive to or treatable
`with cyclo sporin components. Such conditions preferably are
`ophthalmic or ocular conditions, that is relating to or having
`to do with one or more parts of an eye of a human or animal.
`Included among such conditions are, without limitation, dry
`.
`.
`.
`.
`.
`\\\\\\\\\\\\\\\\\\\\\ ,“m““,“,“,“\
`eye syndrome, phacoanaphylactic endophthalmitis ‘uveitis,
`vernal conjunctivitis, atOp1Cil(eI‘apOCOI1]11I1Ct1V1t1S,§COI‘I1eal
`graft rejection and the like coiiEti?fi§T“I‘Ii‘é‘pFe‘sefit‘i?ivention
`is particularly effective in treating dry eye syndrome.
`Cyclosporin has been found as effective in treating immune
`.
`mediated keratoconjunctivitis sicca (KCS or drygye disease)‘
`\\\\\\\\\\\\\\\\\\\\\V:\\\\
`in a patient suffering therefrom. The activity of§cyc osporineg
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`US 8,629,111 B2
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`sEsss.
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`is as:$1n immuno suppressant and in the enhancement or restor-
`1ng of lacrimal gland tearing. Other conditions that can be
`treated with cyclosporin components include an absolute or
`partial deficiency in aqueous tear production (keratocor1junc-
`tivitis sicca, or KCS). Topical administration to a patient’s
`tear deficient eye can increase tear production in the eye. The
`treatment can further serve to correct corneal and conjuncti-
`val disorders exacerbated by tear deficiency and KCS, such as
`corneal scarring, corneal ulcerat‘i“o‘g,‘i‘rl_11a‘r‘I_1rnation of the cor-
`nea or conjunctiva, filamentaryikeratisis,gmucopurulent dis-
`charge and vascularization of th\‘€‘C‘t‘f‘f‘IT€"2I‘.‘§
`Employing reduced concentrations of cyclosporin compo-
`nent, as in the present invention, is advantageously effective
`to provide the blood of the human or animal under treatment
`with reduced concentrations of cyclosporin component, pref-
`erably with substantially no detectable concentration of the
`cyclosporin component. The cyclosporin component concen-
`tration of blood can be advantageously measured using a
`validated liquid chromatography/mass spectrometry-mass
`spectrometry (VLC/MS-MS) analytical method, such as
`described elsewhere herein.
`
`4
`
`of such other components include, without limitation, emul-
`sifier components,
`tonicity components, polyelectrolyte
`components, surfactant components, viscosity inducing com-
`ponents, acids and/or bases to adjust the pH of the composi-
`tion, buffer components, preservative components and the
`like. Components may be employed which are effective to
`perform two or more functions in the presently useful com-
`positions. For example, components which are effective as
`both emulsifiers and surfactants may be employed, and/or
`components which are effective as both polyelectrolyte com-
`ponents
`and viscosity inducing components may be
`employed. The specific composition chosen for use in the
`present
`invention advantageously is selected taking into
`account various factors present in the specific application at
`hand,
`for example,
`the desired therapeutic effect
`to be
`achieved, the desired properties of the compositions to be
`employed, the sensitivities of the human or animal to whom
`the composition is to be administered, and the like factors.
`The presently useful compositions advantageously are
`ophthalmically acceptable. A composition, component or
`material is ophthalmically acceptable when it is compatible
`with ocular tissue, that is, it does not cause significant or
`undue detrimental effects when brought into contact with
`ocular tissues.
`
`Such compositions have pH’s within the physiological
`range ofabout 6 to about 10, preferably in a range ofabout 7.0
`to about 8.0 and more preferably in a range of about 7.2 to
`about 7.6.
`
`The present methods preferably provide for an administer-
`ing step comprising topically administering the presently use-
`ful compositions to the eye or eyes of a human or animal.
`Each and every feature described herein, and each and
`every combination of two or more of such features,
`is
`included within the scope of the present invention provided
`that the features included in such a combination are not mutu-
`
`ally inconsistent.
`These and other aspects and advantages of the present
`invention are apparent in the following detailed description,
`example and claims.
`
`DETAILED DESCRIPTION
`
`The present methods are effective for treating an eye of a
`human or animal. Such methods, in general, comprise admin-
`istering, preferably topically administering, to an eye of a
`human or animal a cyclosporin component-containing emul-
`sion. The emulsion contains water, for example U.S. pure
`water, a hydrophobic component and a cyclosporin compo-
`nent in a therapeutically effective amount ofless than 0.1% by
`weight of the emulsion. In addition, beneficial results have
`been found when the weight ratio of the cyclosporin compo-
`nent to the hydrophobic component is less than 0.08.
`As noted above, the present administering step preferably
`includes topically administering the emulsion to the eye of a
`patient of a human or animal. Such administering may
`involve a single use of the presently useful compositions, or
`repeated or periodic use of such compositions, for example,
`as required or desired to achieve the therapeutic effect to be
`obtained. The topical administration of the presently useful
`composition may involve providing the composition in the
`form of eye drops or similar form or other form so as to
`facilitate such topical administration.
`The present methods have been found to be very effective
`in providing the desired therapeutic effect or effects while, at
`the same time, substantially reducing, or even substantially
`eliminating, side effects which may result from the presence
`of the cyclosporin component in the blood of the human or
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`In one embodiment, in the present me:‘th‘qd“s“tli‘e‘:‘:t3‘l‘o‘od ofthe
`human or animal has concentrations of§clyclosporin\§compo-
`nent of 0.1 ng/ml or less.
`K“““““““““““‘§
`Any suitable cyclosporin component effective in the
`present methods may be used.
`Cyclosporins are a group of nonpolar cyclic oligopeptides
`with known immunosuppressant activity. Cyclosporin A,
`along with several other minor metabolites, cyclosporin B
`through I, have been identified. In addition, a number of
`synthetic analogs have been prepared.
`In general, commercially available cyclosporins may con-
`tain a mixture of several individual cyclosporins which all
`share a cyclic peptide structure consisting of eleven amino
`acidresidues with a total molecular weight ofabout 1,200, but
`with different substituents or configurations of some of the
`amino acids.
`
`The term “cyclosporin component” as used herein is
`intended to include any individual member ofthe cyclosporin
`group and derivatives thereof, as well as mixtures of two or
`more individual cyclosporins and derivatives thereof.
`Particularly preferred cyclosporin components include,
`without limitation, cyclosporin A, derivatives of cyclosporin
`A and the like and mixtures thereof. Cyclosporin A is an
`especially useful cyclosporin component.
`Any suitable hydrophobic component may be employed in
`the present invention. Advantageously, the cyclosporin com-
`ponent is solubilized in the hydrophobic component. The
`hydrophobic component may be considered as comprising a
`discontinuous phase in the presently useful cyclosporin com-
`ponent-containing emulsions.
`The hydrophobic component preferably is present in the
`emulsion compositions in an amount greater than about
`0.625% by weight. For example, the hydrophobic component
`may be present in an amount ofup to about 1.0% by weight or
`about 1.5% by weight or more of the composition.
`Preferably, the hydrophobic component comprises one or
`more oily materials. Examples ofuseful oil materials include,
`without limitation, vegetable oils, animal oils, mineral oils,
`synthetic oils and the like and mixtures thereof. In a very
`usefiil embodiment, the hydrophobic component comprises
`one or more higher fatty acid glycerides. Excellent results are
`obtained when the hydrophobic component comprises castor
`oil.
`
`The presently useful compositions may include one or
`more other components in amounts effective to facilitate the
`usefiilness and effectiveness of the compositions. Examples
`
`0506
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`US 8,629,111 B2
`
`6
`copy (LC-MS/MS), which test has a cyclosporin component
`detection limit of 0.1 ng/ml. Cyclosporin component concen-
`trations below or less than 0.1 ng/ml are therefore considered
`substantially undetectable.
`The LC-MS/MS test is advantageously run as follows.
`One ml of blood is acidified with 0.2 ml of 0.1 N HCl
`
`5
`animal being treated, and eye irritation which, in the past, has
`been caused by the presence ofcertain components in prior art
`cyclosporin-containing emulsions. Also,
`the use of the
`present compositions which include reduced amounts of the
`cyclosporin components allow for more frequent administra-
`tion of the present compositions to achieve the desired thera-
`solution, then extracted with 5 ml of methyl t-butyl ether.
`peutic effect or effects without substantially increasing the
`After separation from the acidified aqueous layer, the organic
`risk of side effects and/or eye irritation.
`phase is neutralized with 2 ml of 0.1 N NaOH, evaporated,
`The present methods are useful in treating any condition
`which is therapeutically sensitive to or treatable with 10 reconstituted in a water/acetonitrile-basedfifitilgahase, and
`cyclosporin components. Such conditions preferably are oph-
`injected onto a 2.lx50 mm, 3 pm pore size C-8 reverse phase
`thalmic or ocular conditions, that is relating to or having to do
`high pressure liquid chromatography (HPLC) colunm (Key-
`with one or more parts of an eye of a human or animal.
`stone Scientific, Bellefonte, Pa.). Compounds are gradient-
`Included among such conditions are, without limitation, dry 15 eluted at 0.2 mL/min and detected using an API Ill triple
`eye syndrome, phacoanaphylgctig“en\dophthalrnjti§,‘ uveitis,
`quadrupole mass spectrometer with a turbo-ionspray source
`vernal conjunctivitis, atopic§kerapoconjunctivitis, gcomeal
`(PE-Sciex, Concord, Ontario, Canada). Molecular reaction
`graft rejection and the like conditions. The present invention
`monitoring enhances the sensitivity and selectivity of this
`is particularly effective in treating dry eye syndrome.
`assay. Protonated molecules for the analyte and an internal
`The frequency of administration and the amount of the 20 standard are collisionally dissociated and product ions at n1/z
`presently useful composition to use during each administra-
`425 are monitored for the analyte and the internal standard.
`tion varies depending upon the therapeutic effect
`to be
`Under these conditions, cyclosporinA and the internal stan-
`obtained, the severity of the condition being treated and the
`dard cyclosporin G elute with retention times of about 3.8
`like factors. The presently useful compositions are designed
`minutes. The lower limit of quantitation is 0.1 ng/mL, at
`to allow the prescribing physician substantial flexibility in 25 which concentration the coefficient ofvariation and deviation
`treating various ocular conditions to achieve the desired
`from nominal concentration is <l5%.
`thera eutic effect or effects with reduced risk of side effects
`As noted reviousl , an suitable c clos orin com onent
`p
`.
`.
`.
`.
`.
`.
`.
`.
`p
`y
`y
`y
`p
`p
`and’or eye irritation. Such administration may occur on an as
`effective in the present methods may be employed. Very use-
`needed basis, for example, in treating or managing dry eye
`ful cyclosporin components include, without
`limitation,
`syndrome, on a one time basis or on a repeated or periodic 30 cyclosporin A, derivatives of cyclosporinA and the like and
`basis once, twice, thrice or more times daily depending on the
`mixtures thereof.
`needs of the human or animal being treated and other factors
`The chemical structure for cyclosporin A is represented by
`involved in the application at hand.
`Formula 1
`
`Formula l
`
`0H3
`
`H30
`H30
`
`\N
`
`H30
`
`CH3
`
`H30
`
`HO,,,,
`
`o
`TH3
`N\)k
`E
`5
`H30/\0H3
`
`o
`
`T
`CH3
`
`CH3
`
`0
`CH3
`NHA 0H3
`E
`N/
`2
`\0H3
`
`o
`
`0
`
`0
`0H3
`
`0
`
`H30
`
`0
`
`N—0H3
`
`CH3
`
`N
`
`H3C/
`
`N
`H
`
`o
`
`N
`
`‘
`
`0H3
`
`o
`
`N
`I
`CH
`3
`H3C
`
`N
`
`O
`
`0H
`
`3
`
`0H3
`
`As used herein the term “derivatives” ofa cyclo sporin refer
`One of the important advantages of the present invention is
`the reduced concentration of the cyclosporin component in 50 to compounds having structures sufiicjenfly sjmflar to the
`the blood of the human or animal as a result of administering
`cyclosporin so as to function in a manner substantially similar
`the present composition as described herein. One very useful
`to or substantially identical to the cyclosporin, for example,
`embodiment of the present administering step provides no
`cyclosporin A, in the present methods. Included, without
`substantial detectable concentration of cyclosporin compo-
`limitation, within the useful cyclosporin A derivatives are
`nent in the blood of the human or animal. Cyclosporin com-
`those selected from ((R)-methylthio-Sar)3-(4'-hydroxy-Me-
`ponent concentration in blood preferably is determined using
`a liquid chromatography-mass spectroscopy-mass spectros-
`Leu)
`cyclosporin A,
`((R)-(Cyclo)alkylthio-Sar)3-(4'-hy-
`
`65
`
`0507
`
`0507
`
`

`
`US 8,629,111 B2
`
`9
`alkoxycarbonyl, amino, alkylamino or dialkylarnino), benzyl
`or saturated or unsaturated heterocyclyl having 5 or 6 mem-
`bers and 1-3 heteroatoms; or NRIR2 is a 5 or 6 membered
`heterocycle which may contain a further N, O or S heteroatom
`and may be alkylated; R3 is H or alkyl and n is 2-4; and the
`alkyl moieties contain 1-4C.
`In one embodiment, the cyclo sporin component is effective
`as an immunosuppressant. Without wishing to be limited to
`anyparticulartheory ofoperation, it is believed that, in certain
`embodiments of the present invention, the cyclosporin com-
`ponent acts to enhance or restore lacrimal gland tearing in
`providing the desired therapeutic effect.
`One important feature of the present invention is that the
`presently useful compositions contain less than 0.1% by
`weight ofthe cyclosporin component. The advantages of such
`low-concentrations of cyclosporin components have been
`discussed in some detail elsewhere herein. Low concentra-
`
`tions ofcyclo sporin component, together with concentrations
`of the hydrophobic component such that the weight ratio of
`cyclosporin component to hydrophobic component is greater
`than 0.08, provides one or more substantial advantages in the
`present methods.
`Any suitable hydrophobic component may be employed in
`the present invention. Such hydrophobic component may be
`considered as comprising a discontinuous phase in the pres-
`ently useful cyclosporin component-contaimng emulsions,
`with the water or aqueous phase being considered the con-
`tinuous phase in such emulsion. The hydrophobic component
`is preferably selected so as to solubilize the cyclosporin com-
`ponent, which is often substantially insoluble in the aqueous
`phase. Thus, with a suitable hydrophobic component
`included in the presently useful emulsions, the cyclosporin
`component is preferably solubilized in the emulsions.
`In one very useful embodiment, the hydrophobic compo-
`nent comprises an oily material, in particular, a material
`which is substantially not miscible in water. Examples of
`usefiil oily materials include, without limitation, vegetable
`oils, animal oils, mineral oils, synthetic oils, and the like and
`mixtures thereof. Thus, the present hydrophilic components
`may comprise naturally occurring oils, including, without
`limitation refined naturally occurring oils, or naturally occur-
`ring oils which have been processed to alter their chemical
`structures to some extent or oils which are substantially
`entirely synthetic. One very useful hydrophobic component
`includes higher fatty acid glycerides.
`Examples of useful hydrophobic components include,
`without limitation, olive oil, arachis oil, castor oil, mineral oil,
`silicone fluid and the like and mixtures thereof. Higher fatty
`acid glycerides such as olive oil, peanut oil, castor oil and the
`like and mixtures thereof are particularly useful in the present
`invention. Excellent results are obtained using a hydrophobic
`component comprising castor oil. Without wishing to limit
`the invention to any particular theory of operation, it is
`believed that castor oil includes a relatively high concentra-
`tion ofricinoleic acid which itself may be useful in benefiting
`ocular tissue and/or in providing one or more therapeutic
`effects when administered to an eye.
`The hydrophobic component is preferably present in the
`presently useful cyclosporin component-contaimng emul-
`sion compositions in an amount greater than about 0.625% by
`weight. For example, the hydrophobic component may be
`present in an amount up to about 0.75% by weight or about
`1.0% by weight or about 1.5% by weight or more of the
`presently useful emulsion compositions.
`The presently useful compositions may include one or
`more other components in amounts effective to facilitate the
`usefiilness and effectiveness of the present methods and/or
`
`10
`
`15
`
`20
`
`25
`
`10
`the presently useful compositions. Examples of such other
`components include, without limitation, emulsifier compo-
`nents, surfactant components,
`tonicity components, poly
`electrolyte components, emulsion stability components, vis-
`cosity inducing components, demulcent components, acid
`and/or bases to adjust the pH of the composition, buffer
`components, preservative components and the like.
`In one very useful embodiment, the presently useful com-
`positions are substantially free of preservatives. Thus, the
`presently useful compositions may be sterilized and main-
`tained in a sterile condition prior to use, for example, pro-
`vided in a sealed package or otherwise maintained in a sub-
`stantially sterile condition.
`Any suitable emulsifier component may be employed in
`the presently useful compositions, provided, that such emul-
`sifier component is effective in forming maintaining the
`emulsion and/or in the hydrophobic component in emulsion,
`while having no significant or undue detrimental effect or
`effects on the compositions during storage or use.
`In addition, the presently useful compositions, as well as
`each of the components of the present compositions in the
`concentration present in the composition advantageously are
`ophthalmically acceptable.
`Useful emulsifier components may be selected from such
`component which are conventionally used and well known in
`the art. Examples of such emulsifier components include,
`without limitation, surface active components or surfactant
`.
`.
`.
`s
`“\QQ,[QR\Q&§Q\L$V which may be anionic, cationic, noniomc or
`““\\\ \\\\ “-.“\\\\ “\
`§ amphorter1c