Method of use of monomeric insulin as a means for improving the reproducibility of inhaled insulin

• US 20060093556A1
• Filed: 11/21/2005
• Published: 05/04/2006
• Est. Priority Date: 01/29/1993
• Status: Active Grant

• Current Assignee: Aradigm Corporation
• Original Assignee: Aradigm Corporation
• Inventors: Farr, Stephen J., Gonda, Igor, Rubsamen, Reid M.
• Granted Patent: US 7,490,603 B2
• Time in Patent Office: Days
• US Class Current: 424/46
• CPC Class Codes: A61J 7/0418 with electronic history memory
• CPC Class Codes: A61J 7/0427 with direct interaction with a dispensing or delivery system
• CPC Class Codes: A61J 7/0445 for preventing drug dispensing during a predetermined time period
• CPC Class Codes: A61K 38/28 Insulins
• CPC Class Codes: A61K 9/007 Pulmonary tract; Aromatherapy
• CPC Class Codes: A61K 9/0073 Sprays or powders for inhalation; Aerolised or nebulised preparations generated by other means than thermal energy; nasal sprays A61K9/0043; inhalation of vapours of volatile or heated drugs, e.g. essential oils or nicotine, A61K9/007; devices A61M
• CPC Class Codes: A61K 9/0075 for inhalation via a dry powder inhaler [DPI], e.g. comprising micronized drug mixed with lactose carrier particles
• CPC Class Codes: A61M 11/001 Particle size control
• CPC Class Codes: A61M 15/00 Inhalators drug delivery in endotracheal tubes A61M16/04
• CPC Class Codes: A61M 15/0031 by bursting or breaking the package, i.e. without cutting or piercing
• CPC Class Codes: A61M 15/0045 using multiple prepacked dosages on a same carrier, e.g. blisters
• CPC Class Codes: A61M 15/0051 the dosages being arranged on a tape, e.g. strips
• CPC Class Codes: A61M 15/0065 Inhalators with dosage or measuring devices A61M15/0028 takes precedence; dosage devices incorporated in aerosol cans B65D83/52
• CPC Class Codes: A61M 15/0066 with means for varying the dose size
• CPC Class Codes: A61M 15/008 Electronic counters
• CPC Class Codes: A61M 15/0085 using ultrasonics spraying or atomising liquids using ultrasonic vibrations in general B05B17/06
• CPC Class Codes: A61M 15/009 using medicine packages with incorporated spraying means, e.g. aerosol cans pocket atomiser of the injector type A61M11/08
• CPC Class Codes: A61M 16/142 with semi-permeable walls separating the liquid from the respiratory gas
• CPC Class Codes: A61M 2016/0021 with a proportional output signal, e.g. from a thermistor
• CPC Class Codes: A61M 2016/0036 in the breathing tube and used in both inspiratory and expiratory phase
• CPC Class Codes: A61M 2202/062 : Desiccants
• CPC Class Codes: A61M 2202/064 : Powder
• CPC Class Codes: A61M 2205/50 : with microprocessors or computers
• CPC Class Codes: A61M 2205/8206 : battery-operated

Abstract

The need for the delivery of insulin by injection can be reduced or eliminated by delivering an aerosolized monomeric insulin formulation. Repeatability of dosing and more particularly the repeatability of the blood concentration versus time profile is improved relative to regular insulin. The blood concentration versus time profile is substantially unaffected by specific aspects of the patient'"'"'s breathing maneuver at delivery. Further, the rate at which blood glucose is lowered is increased by the use of monomeric insulin. Particles of insulin and in particular monomeric insulin delivered to the surface of lung tissue will be absorbed into the circulatory system. The monomeric insulin may be a dry powder but is preferably in a liquid formulation delivered to the patient from a hand-held, self-contained device which automatically releases an aerosolized burst of formulation. The device includes a sensor which is preferably electronic which measures inspiratory flow and volume which measurement can be used to control the point of drug release.

Claims

1-20. -20. (canceled)

21. A method, comprising the steps of:

(a) measuring a patient'"'"'s glucose level;

(b) aerosolizing a formulation comprising monomeric insulin;

(c) inhaling the aerosolized formulation into the lungs of the patient, the formulation being inhaled with a first total inhaled volume;

(d) allowing particles of formulation to settle in the lungs, migrate into the patient'"'"'s circulatory system and thereby increase the concentration to a first maximum level in the patient'"'"'s blood in a first period of time;

(e) repeating the aerosolizing of a formulation comprised of monomeric insulin;

(f) inhaling the aerosolized formulation of (e) into the lungs of a patient, the formulation being inhaled with a second total inhaled volume different from the first total inhaled volume;

(g) allowing particles of formulation to settle in the lungs, migrate into the patient'"'"'s circulatory system and thereby increase the concentration of formulation to a second maximum level in the patient'"'"'s blood in a second period of time;

whereby the difference between the first total inhaled volume and the second total inhaled volume effects the difference between the first maximum level of formulation and the second maximum level of formulation less than if the formulation were comprised of regular recombinant insulin.

22. The method of claim 21, wherein the monomeric insulin is insulin lispro.

23. The method of claim 21, further comprising:

repeating the (a) measuring, (b) aerosolizing, (c) inhaling and (d) allowing steps in a manner so as to maintain the patient'"'"'s glucose level in a desired range.

24. The method of claim 23, wherein each aerosolizing (b) step is carried out to create an aerosolized dose containing substantially the same amount of monomeric insulin.

25. The method of claim 24, wherein the monomeric insulin is insulin lispro.

26. The method of claim 23, further comprising:

orally administering a sulfonylurea drug to the patient.

27. The method of claim 26, wherein the sulfonylurea drug is chosen from acetohexamide, chlorpropamide, tolazamide, tolbutamide, glipzide and glyburide.

28. The method of claim 23, wherein the monomeric insulin is insulin lispro.

29. The method of claim 23, further comprising:

heating air surrounding the aerosolized formulation.

30. The method of claim 23, wherein the aerosol comprises particles having a diameter in the range of about 1.0 to about 4.0 microns.

31. The method of claim 21, further comprising:

repeating the (b) aerosolizing;

(c) inhaling and (e) allowing steps a plurality of times wherein the total inhaled volume is different in each of any different inhaling steps.

32. The method of claim 31, wherein the formulation is aerosolized by being forced through a porous membrane from a disposable container.

33. The method of claim 23, wherein the formulation is a liquid formulation comprised of a pharmaceutically acceptable carrier and insulin lispro and is present in a container comprising an opening covered by a porous membrane;

and

wherein the aerosolizing (b) is carried out by moving the formulation through the pores of the membrane, the pores having a cross-sectional configuration with a small end opening of 0.25 to 6.0 microns in diameter and a large end opening of 2 to 20 times the diameter of the small end.

34. The method of claim 21, wherein the first total inhaled volume is about half the second total inhaled volume.

35. The method of claim 21, wherein the first total inhaled volume is in a range of about 2 to 2.5 liters and the second total inhaled volume is in a range of from about 4 to 5 liters.

36. A method of treating a diabetic patient, comprising:

(a) measuring a patient'"'"'s glucose level;

(b) aerosolizing a formulation comprising monomeric insulin and a carrier to make an aerosol;

(c) inhaling a volume of the aerosol into a patient'"'"'s lungs, thereby obtaining a maximum monomeric insulin concentration (CMAX) for the patient in a time needed to obtain a maximum concentration (TMAX) for the patient wherein said CMAX and TMAX are less affected by an amount of air inhaled during inhalation of or after aerosolizing the formulation as compared to an effect on CMAX and TMAX obtained with a formulation of regular hexameric recombinant insulin;

(d) measuring the patient'"'"'s inspiratory flow rate and inspiratory volume; and

(e) repeatedly aerosolizing the formulation at the same measured inspiratory flow rate and inspiratory volume as measured in step (d); and

(f) maintaining serum glucose levels in the patient in a range of greater than 60 mg/dl and less than 125 mg/dl.

37. The method of claim 36, wherein the monomeric insulin is insulin lispro in a zinc salt form.

38. The method of claim 36, wherein the formulation is an aqueous solution.

39. The method of claim 36, wherein the formulation is a dry powder.