Aerosol pirfenidone and pyridone analog compounds and uses thereof
Disclosed herein are formulations of pirfenidone or pyridone analog compounds for aerosolization and use of such formulations for aerosol administration of pirfenidone or pyridone analog compounds for the prevention or treatment of various fibrotic and inflammatory diseases, including disease associated with the lung, heart, kidney, liver, eye and central nervous system. In some embodiments, pirfenidone or pyridone analog compound formulations and delivery options described herein allow for efficacious local delivery of pirfenidone or pyridone analog compound. Compositions include all formulations, kits, and device combinations described herein. Methods include inhalation procedures, indications and manufacturing processes for production and use of the compositions described.
1. A unit dose of an aqueous solution for delivery by a liquid nebulizer for the daily treatment of interstitial lung disease in an adult human comprising: a respirable delivered dose comprising water and pirfenidone at a concentration from about 5.0 mg/mL to about 20 mg/mL, the aqueous solution having an osmolality of from about 50 mOsmol/kg to about 2000 mOsmol/kg, wherein the respirable delivered dose to lungs of the adult human per day is less than 1.933 mg/kg/day of pirfenidone to reduce a decline in forced vital capacity (FVC) in the lung of the adult human.
2. The unit dose of claim 1 , wherein the aqueous solution further comprises: an additional ingredient selected from the group consisting of co-solvents, tonicity agents, sweeteners, surfactants, wetting agents, chelating agents, anti-oxidants, salts, taste masking agents, and buffers and combinations thereof.
3. The unit dose of claim 1 , wherein the aqueous solution of each respirable delivered dose further comprises: a buffer selected from a citrate buffer and a phosphate buffer, and one or more salts selected from the group consisting of sodium chloride, magnesium chloride, sodium bromide, magnesium bromide, calcium chloride and calcium bromide and combinations thereof.
4. The unit dose of claim 1 , wherein the aqueous solution of each respirable delivered dose comprises: water; one or more salts, wherein the total amount of the one or more salts is from about 0.01% to about 2.0% by weight of the weight of aqueous solution; and optionally a phosphate buffer or a citrate buffer that maintains the pH of the solution below about pH 8; and the osmolality of the of the aqueous solution is from about 50 mOsmol/kg to about 2000 mOsmol/kg.
5. The unit dose of claim 1 , wherein the liquid nebulizer: (i) achieves lung deposition of at least 5% of the pirfenidone administered to the human; (ii) provides: a) a mass median aerodynamic diameter (MMAD) of droplet size of the aqueous solution emitted with the high efficiency liquid nebulizer of about 0.5 μm to about 5 μm; and/or b) a volumetric mean diameter (VMD) of about 0.5 μm to about 5 μm; (iii) provides a Geometric Standard Deviation (GSD) of emitted droplet size distribution of the aqueous solution of about 1.0 μm to about 3.4 μm; (iv) provides a fine particle fraction of droplets emitted from the liquid nebulizer of at least about 30%; (v) provides an output rate of at least 0.1 mL/min; and/or (vi) provides at least about 25% of the aqueous solution to the human.
6. The unit dose of claim 1 , wherein: the blood AUC0-24 of pirfenidone achieved upon administration of each respirable delivered dose to the lungs of the adult human is less than or equivalent to the blood AUC0-24 achieved upon administration of an 801 mg orally administered dosage of pirfenidone to the adult human.
7. The unit dose of claim 1 , wherein the unit dose is formulated for administration on a continuous daily dosing schedule.
8. The unit dose of claim 1 , wherein the unit dose is formulated for administration once a day, twice a day, three times a day, or four times a day.
9. The unit dose of claim 1 , wherein the unit dose is further comprises one or more additional therapeutic agents.
10. The unit dose of claim 1 , wherein: a) the lung tissue Cmax of pirfenidone obtained in the human upon administration of each respirable delivered dose is at least equivalent to or greater than a lung Cmax achievable upon administration of 801 mg of an orally administered dosage of pirfenidone to the human; and/or b) the blood AUC0-24 of pirfenidone obtained in the human upon administration of each respirable delivered dose is less than a blood AUC0-24 achievable upon administration of 801 mg of an orally administered dosage of pirfenidone to the adult human.
11. The unit dose of claim 1 , wherein: each respirable delivered dose from the liquid nebulizer is formulated for delivery in less than about 30 minutes with mass median diameter (MMAD) particles sizes from about 1 to about 5 microns.
12. The unit dose of claim 1 , wherein the one or more respirable delivered dose is formulated to delivered within 20 minutes.
13. The unit dose of claim 1 , further comprising an additional therapeutic agents selected from the group consisting of interferon gamma, interferon beta-1a, pentraxin-2, N-acetyl-L-cysteine, GS-6624, IW001, PRM-151, STX-100, CC-930, QAX576, FG-3019, CNTO-888, BIBF-1120, antibodies targeting IL-13 ligand or receptor, antibodies targeting alpha-v beta-6 integrin, antibodies targeting CTGF ligand or receptor, antibodies targeting CCL2 ligand or receptor, small molecules targeting vascular endothelial growth factor (VEGF) ligand or receptor, small molecules targeting platelet-derived growth factor (PDGF) ligand or receptor, small molecules targeting fibroblast growth factor (FGF) ligand or receptor, antibodies targeting LOXL2, small molecules targeting Jun kinase, and small molecules targeting TGF-beta and combinations thereof.
14. The unit dose of claim 1 , wherein the volume is between about 0.5 mL and about 10 mL of the aqueous solution loaded into the liquid nebulizer and the aqueous solution comprises pirfenidone at a concentration of from about 5.0 mg/mL to about 20 mg/mL.