Oral cholestyramine formulation and use thereof

1. An oral formulation for targeted delivery of cholestyramine to the colon, comprising:

a) a plurality of extruded and spheronized pellets, each extruded and spheronized pellet comprising cholestyramine and

i. at least 7% w/w of a vinylpyrrolidone-based polymer; or

ii. a combination of at least 6% w/w of a vinylpyrrolidone-based polymer and at least 2% w/w of an acrylate copolymer; or

iii. a combination of at least 5% w/w of a vinylpyrrolidone-based polymer and at least 3% w/w of an acrylate copolymer; or

iv. a combination of at least 6% w/w of a vinylpyrrolidone-based polymer, at least 1% w/w of an acrylate copolymer and at least 10% w/w microcrystalline cellulose;

wherein the vinylpyrrolidone-based polymer is selected from the group consisting of copovidone, povidone, and combinations thereof; wherein the pellets exhibit a friability of less than 2.1% as measured using the European Pharmacopoeia 8.0, test 2.9.7; and

b) a coating surrounding each extruded and spheronized pellet, wherein the coating is capable of targeting release of the cholestyramine in the colon.

2. The formulation according to claim 1 , wherein the coating is elastic.

3. The formulation according to claim 1 , wherein the coating comprises starch.

4. The formulation according to claim 3 , wherein the starch is resistant starch type 2 (RS2).

5. The formulation according to claim 1 , wherein the coating further comprises poly(methyl acrylate-co-methyl methacrylate-co-methacrylic acid) 7:3:1.

6. The formulation according to claim 1 , wherein the diameter of each of the uncoated extruded and spheronized pellets is from 1000 to 1400 μm.

7. The formulation according to claim 1 , wherein the uncoated extruded and spheronized pellet also comprises microcrystalline cellulose.

8. The formulation according to claim 1 , wherein the uncoated extruded and spheronized pellets are free of microcrystalline cellulose.

9. The formulation according to claim 1 , wherein each of the uncoated extruded and spheronized pellets comprise from 70% to 93% w/w cholestyramine.

10. The formulation according to claim 9 , wherein each of the uncoated extruded and spheronized pellets comprise at least 80% w/w cholestyramine.

11. The formulation according to claim 10 , wherein each of the uncoated extruded and spheronized pellets comprise at least 85% w/w cholestyramine and

i. at least 7% w/w of a vinylpyrrolidone-based polymer; or

ii. a combination of at least 6% w/w of a vinylpyrrolidone-based polymer and at least 2% w/w of an acrylate copolymer; or

iii. a combination of at least 5% w/w of a vinylpyrrolidone-based polymer and at least 3% w/w of an acrylate copolymer.

12. The formulation according to claim 1 , wherein the formulation is capable of releasing more than 70% of the cholestyramine in the colon.

13. The formulation according to claim 1 , wherein the formulation is capable of releasing less than 30% of the cholestyramine in the small intestine.

14. The formulation according to claim 1 , wherein the formulation is contained within a capsule.

15. The formulation according to claim 1 , wherein the formulation is contained within a sachet.

16. A method for treating bile acid malabsorption in a patient in need thereof, the method comprising administering to the patient a therapeutically effective amount of an oral formulation comprising:

a) a plurality of extruded and spheronized pellets, each extruded and spheronized pellet comprising cholestyramine and

i. at least 7% w/w of a vinylpyrrolidone-based polymer; or

ii. a combination of at least 6% w/w of a vinylpyrrolidone-based polymer and at least 2% w/w of an acrylate copolymer; or

iii. a combination of at least 5% w/w of a vinylpyrrolidone-based polymer and at least 3% w/w of an acrylate copolymer; or

iv. a combination of at least 6% w/w of a vinylpyrrolidone-based polymer, at least 1% w/w of an acrylate copolymer and at least 10% w/w microcrystalline cellulose;

wherein the vinylpyrrolidone-based polymer is selected from the group consisting of copovidone, povidone, and combinations thereof; wherein the pellets exhibit a friability of less than 2.1% as measured using the European Pharmacopoeia 8.0, test 2.9.7; and

b) a coating surrounding each extruded and spheronized pellet, wherein the coating is capable of targeting release of the cholestyramine in the colon.

17. The method according to claim 16 , wherein the bile acid malabsorption is the result of ileal disease (Crohn's disease), ileal resection or ileal bypass, the result of overproduction of bile acids or defective feedback inhibition of hepatic bile acid synthesis, or the result of cholecystectomy, vagotomy, small intestinal bacterial overgrowth (SIBO), coeliac disease, pancreatic insufficiency (chronic pancreatitis, cystic fibrosis), pancreatic transplant, radiation enteritis, collagenous colitis, microscopic colitis, lymphocytic colitis, ulcerative colitis or irritable bowel syndrome (IBS-D).

18. A method for treating bile acid diarrhoea in a patient in need thereof, the method comprising administering to the patient a therapeutically effective amount of an oral formulation comprising:

a) a plurality of extruded and spheronized pellets, each extruded and spheronized pellet comprising cholestyramine and

i. at least 7% w/w of a vinylpyrrolidone-based polymer; or

ii. a combination of at least 6% w/w of a vinylpyrrolidone-based polymer and at least 2% w/w of an acrylate copolymer; or

iii. a combination of at least 5% w/w of a vinylpyrrolidone-based polymer and at least 3% w/w of an acrylate copolymer; or

iv. a combination of at least 6% w/w of a vinylpyrrolidone-based polymer, at least 1% w/w of an acrylate copolymer and at least 10% w/w microcrystalline cellulose;

wherein the vinylpyrrolidone-based polymer is selected from the group consisting of copovidone, povidone, and combinations thereof; wherein the pellets exhibit a friability of less than 2.1% as measured using the European Pharmacopoeia 8.0, test 2.9.7; and

b) a coating surrounding each extruded and spheronized pellet, wherein the coating is capable of targeting release of the cholestyramine in the colon.

19. The method according to claim 18 , wherein the patient is also administered an IBAT inhibitor via oral.

20. The method according to claim 19 , wherein the patient has a cholestatic liver disease.

21. The method according to claim 19 , wherein the IBAT inhibitor is

1,1-dioxo-3,3-dibutyl-5-phenyl-7-methylthio-8-(N—{(R)-α-[N—((S)-1-carboxypropyl)-carbamoyl]-4-hydroxybenzyl}carbamoylmethoxy)-2,3,4,5-tetrahydro-1,2,5-benzothiadiazepine; or

1,1-dioxo-3,3-dibutyl-5-phenyl-7-methylthio-8-(N—{(R)-1′-phenyl-1′-[N′-(carboxymethyl)carbamoyl]methyl}carbamoylmethoxy)-2,3,4,5-tetrahydro-1,5-benzothiazepine;

or a pharmaceutically acceptable salt thereof.

22. A process for the preparation of coated extruded and spheronized pellets comprising:

a) a plurality of extruded and spheronized pellets, each extruded and spheronized pellet comprising cholestyramine and

i. at least 7% w/w of a vinylpyrrolidone-based polymer; or

ii. a combination of at least 6% w/w of a vinylpyrrolidone-based polymer and at least 2% w/w of an acrylate copolymer; or

iii. a combination of at least 5% w/w of a vinylpyrrolidone-based polymer and at least 3% w/w of an acrylate copolymer; or

iv. a combination of at least 6% w/w of a vinylpyrrolidone-based polymer, at least 1% w/w of an acrylate copolymer and at least 10% w/w microcrystalline cellulose;

wherein the vinylpyrrolidone-based polymer is selected from the group consisting of copovidone, povidone, and combinations thereof; wherein the pellets exhibit a friability of less than 2.1% as measured using the Eurpoean Pharmacopoeia 8.0, test 2.9.7; and

b) a coating surrounding each extruded and spheronized pellet, wherein the coating is capable of targeting release of the cholestyramine in the colon,

the process comprising the steps of:

a) preparing the pellets in a method comprising:

i) mixing the dry ingredients;

ii) adding water, and optionally the acrylate copolymer, to obtain a wet mass;

iii) extruding the wet mass;

iv) spheronizing the extrudate; and

v) drying the obtained extruded and spheronized pellets, wherein the pellets exhibits a friability of less than 2.1% as measured using the European Pharmacopoeia 8.0, test 2.9.7; and

b) applying the coating to the extruded and spheronized pellets.