WO1987007140A1

WO1987007140A1 - Sustained-release pharmaceutical compositions

Info

Publication number: WO1987007140A1
Application number: PCT/US1987/001123
Authority: WO
Inventors: Michael Friedman; Doron Steinberg; Aubrey Soskolne; Michael Sela
Original assignee: Yissum Research Development Company Of The Hebrew
Priority date: 1986-05-19
Filing date: 1987-05-13
Publication date: 1987-12-03
Also published as: IL78826A0; EP0246809A3; DE3781928D1; EP0246809B1; ES2044925T3; JPH01501621A; JP2798386B2; IL78826A; ATE80996T1; DK20488D0; AU605487B2; EP0246809A2; DK20488A; DE3781928T2; IL86338A0; DK175590B1; US5023082A; GR3006681T3; AU7480687A; CA1307463C

Abstract

Biodegradable sustained release pharmaceutical compositions. The compositions can be formed into implant devices which may be used to treat a wide variety of diseases and conditions. The implants are especially useful in treating diseases such as periodontal disease which require prolonged drug release.

Description

TITLE OF THE INVENTION:

SU STAINED -RELEASE PHARMACEUTICAI, COMPOSITIONS

FIELD OF THE INVENTION:

The present invention pertains to sustained-release pharmaceutical compositions, and more specifically to a biodegradable film which may be employed in the treatment of periodontal and other disease.

BACKGROUND OF THE INVENTION

A. Periodontal Disease

The two major diseases of the oral cavity are dental caries, a disease process by which cavities are produced in the tooth surface, and periodontal disease, a process in which the bone and soft tissues supporting the tooth are destroyed. Periodontal diseases are a very common occurrence affecting, at a conservative estimate, between 70-90% of the world population and is the major cause of tooth loss in people over 35 years of age.

Periodontal disease is an all-inclusive term for a variety of clinical conditions that are forms of either gingivitis or periodontis. Gingivitis is an inflammation of the gingiva (or gums) that can be associated with poor oral hygiene and/or the hormonal state of the patient. It is believed that gingivitis, if untreated, will develop into periodontis.

Periodontis is a bacterial disease in which the infection has progressed to involve the oral tissues which retain the teeth in the jawbone. Periodontis, if untreated, will eventually result in the loss of the affected tooth.

Although dental caries may be effectively treated with a combination of proper hygiene and fluoride, periodontal disease is often more refractile to treatment. This difference in amenability to treatment reflects the markedly different environments of the oral and periodontal cavities. The oral cavity is essentially an aerobic environment, which is constantly perfused by saliva. In contrast, the periodontal microenvironment is more anaerobic and is perfused by a plasma filtrate, known as the "gingival crevice fluid." The growth of microorganisms within this microenvironment has been shown to be the cause of periodontal disease (Loe, et al., J. Periodontol. 36: 177 (1965); Slots, Scand. J. Dent. Res.. 85:247 (1977); Socransky, S.S., J. Periodontol. 48:497-504 (1977); Axelsson, P., et al., J. Clin. Periodon. 5 : 133-151 (1978)). Hence, the treatment of the disease is directed toward controlling this growth. As the periodontal disease becomes more established, the periodontal microenvironment becomes more anaerobic and the flow of gingival crevice fluid increases. An excellent review of periodontal disease, and the methods for its treatment, is provided by Goodson, J.M. (In: Medical

Applications of Controlled Release, Vol. II,

Applications and Evaluation (Langer, R.S., et al.,

Eds.), CRC Press, Inc., Boca Raton, FL (1984), pp. 115- 138), which reference is incorporated by reference herein.

Efforts to treat periodontal disease have been impeded by several factors. Because the site of the bacterial infection is largely inaccessible to agents present in the oral cavity, antimicrobial agents provided to the oral cavity are generally ineffective. The increased flow of gingival crevice fluid, which accompanies periodontal disease, has the effect of diluting and removing therapeutic agents placed within the periodontal crevice. Systemic administration of antibiotics has been shown to be a useful method of controlling the subgingival flora (Listgarten et al., J. Clin. Periodont. 5: 246 (1978)), however discontinuation of therapy is often associated with the return of the potential pathogens to the pockets. Systemic administration, therefore, has had only variable success in treating periodontal disease (Genco, R.J., J. Periodontol. 52: 545 (1981)). Long-term antibacterial therapy has been used, but the potential dangers associated with this form of treatment, which include the development of resistant strains and super-imposed infections, do not warrant its serious consideration. Antibacterial agents such as chlorhexidine and quaternary ammonium salts in the form of mouth rinses have proved to be successful in preventing periodontal disease (Loe et al., J. Periodont. Res. 5:78 (1970)). These agents, however, are unable to affect the subgingival flora when administered in this form as they do not penetrate into the pockets which are the result of the disease. Hence, they cannot be used in mouth rinses to treat an established periodontal disease. Patient acceptance has significantly limited the utility of non-pharmacological treatments of periodontal disease. The most widely used non-pharmacological approach to date has been mechanical cleaning methods combined with surgery. Although this method has proved to be fairly successful in treating individuals, there is still a high recurrence rate. There is also the problem of motivating people to good oral hygiene habits that they will maintain throughout their lives.

B. Use of Sustained Release Pharmaceutical

Compositions in the Treatment of Periodontal and

Other Diseases

In response to the importance of treating periodontal disease, and the failure of conventional control therapies, researchers have developed control-release pharmaceutical compositions which are capable of being inserted into the periodontal cavity and of slowly releasing an antimicrobial agent. Goodson et al. (J. Clin. Periodont. 6: 83 (1979); J. Periodont. Supp.- Special Issue 81-87 (1985)) proposed the use of a device that could be placed within the pockets and that would provide a sustained release of antibacterial agents to control the pocket flora. The system they described released the drug for up to 10 days. It appeared to cause marked changes in the pocket flora. The most investigated systems for controlled release comprise incorporating such a drug into a polymeric matrix, which is then shaped into a convenient form and implanted into the periodontal cavity.

Ethyl cellulose has been successfully employed as a polymeric matrix of a periodontal implant (Friedman, M., et al., J. Periodon. Res. 17: 323-328 (1982); Soskolne, A., et al., J. Periodon. Res. 18:330-336 (1983);

Stabholz, A., et al., J. Clin. Perjodon. 13:783-788

(1986)). Various antibacterial agents, such as chlorhexidine, metronidazole, iodine, cetyl puridinium chloride, have been incorporated into such ethyl cellulose films. Loesche, W.J. (U.S. Patent No. 4,568,535) discloses the use of periodontal implants composed of ethyl cellulose which contain metronidazole in the treatment of periodontal disease. Although such films were found to be effective in treating periodontal disease, their non-biodegradable nature required their removal after the conclusion of therapy.

The usefulness of silicon rubbers as an implant material is well established (Folkman, J., et al., Ann. N. Y. Acad. Sci. 111: 857 (1964)). However, even though such polymers are well tolerated by the tissue and are useful for a variety of drugs, their suitability as implants is seriously limited because the device must be surgically removed after use. Hence, a major therapeutic goal is the development of a biodegradable implant which would not need to be removed from the patient.

Degradable polymers and copolymers which have been substantially investigated as potential implant compositions include poly(lactic acid) (Kulkarni et al., Arch. Surg. 93: 839 (1966)), poly(glycolic acid) (Miggins, U.S. Patent 2,676,995 (1954)), and poly(lactic acid)-poly(glycolic acid) copolyaer (Schmitt et al., U.S. Patent 2,397,033 (1967)). The properties and uses of such polyamides and of copolymers of polyamides and polyesters have been extensively disclosed (Kurtz, French Patent No. 2,059,690 (1971); Kurtz, French Patent No. 2,059,691 (1971); Mori et al., Japanese Patent No. 72-43,220 (1972); Kurtz, U.S. Patent No. 3,642,003 (1970)). The biodegradation of poly(lactic acid) and poly(glycolic acid) can require three to five months (Schneider, French Patent No. 1,478,694 (1967); Darkik, Am. J. Surg. 121:656 (1971)). Thus, it would not be preferable to employ implants composed of such polymers in situations where more rapid biodegradation is desired.

Absorbable periodontal implants have been described by Noguchi, et al. (Bull. Tokvo, Med. Dent. Univ. 31: 145 (1984)), which used a hydroxypropylcellulose polymer. Suzuki, Y., et al. (U.S. Patent No. 4,569,837) discloses the use of water-soluble polymeric substances (such as methyl cellulose, gelatin, etc.) as a polymeric matrix for a periodontal implant.

Pharmaceutical compositions containing gelatin have been described by Lieb, H., et al. (U.S. Patent No. 2,961,374) and by Easton, I.A. (U.S. Patent No. 4,344,967).

Despite the existence of the above-described sustained drug release compositions, a need still exists for a biodegradable sustained-release composition which is capable of delivering a pharmacological composition for a period of time sufficient to treat a periodontal infection.

SUMMARY OF THE INVENTION

The present invention relates to pharmaceutical compositions suitable for implantation into the periodontal crevice and capable of treating periodontal or other disease. In detail, the invention comprises a solidified pharmaceutical composition for permitting the sustained release of a pharmacological agent which comprises a polymeric matrix containing a plasticizing agent, and the pharmacological agent, wherein the polymeric matrix comprises a cross-linked, water-insoluble protein.

The invention further pertains to a solidified pharmaceutical composition for permitting the sustained release of a pharmacological agent which comprises a polymeric matrix containing a plasticizing agent, and the pharmacological agent, wherein the polymeric matrix comprises a cross-linked, water-insoluble protein, and wherein the pharmaceutical composition additionally contains a cross-linking agent.

The invention is further directed toward a method of administering a pharmacological agent (a) to a patient in need of such administration, which method comprises providing to the patient either of the above two pharmaceutical compositions, wherein the pharmacological agent of the pharmaceutical composition is the pharmacological agent (a)

The invention further includes a method for treatment for a disease which comprises providing to a patient in need of such treatment either of the above two pharmaceutical compositions, wherein the pharmaceutical composition contains a pharmacological agent capable of providing the treatment and is present in an amount sufficient to impart therapeutic effect to the composition. DESCRIPTION OF THE PREFERRED EMBODIMENTS

The sustained-release pharmaceutical compositions of the present invention are polymeric films capable of being inserted into the gingival crevice. As used herein, the terms "device," "implant," "sustained release composition," and "compositions," are intended to be equivalent and to refer to essentially film-like materials suitable for insertion and retention in the periodontal cavity. The term "gingival crevice" is meant to be equivalent to the terms "periodontal crevice," "periodontal cavity," or "periodontal pocket." As such, the term is intended to refer to the space between the tooth and gum of an individual.

The nature of the preferred components of the pharmaceutical compositions of the present invention are described in greater detail below.

I. THE COMPONENTS OF THE PHARMACEUTICAL COMPOSITIONS OF THE PRESENT INVENTION

A. THE POLYMERIC MATERIAL OF THE COMPOSITION

In order to provide a biodegradable polymeric matrix for sustained drug release, it is preferable to employ a polymeric matrix composed of cross-linked protein. Suitable polymers include proteins derived from connective tissue (such as gelatin and collagen), albumin proteins (such as serum albumin, milk albumin, soy albumin, etc.), enzymes (such as papain, chymotrypsin, etc.), serum proteins (such as fibrinogen), and the proteolytic degradation products of bacterial, plant, or animal cells (i.e., tryptone, peptone, etc.). It is not necessary to employ a single protein; thus, the compositions of the present invention may contain two or more different proteins. The present invention does not require the use of protein having a specific level of purity. Thus, protein of any grade of purity may be employed. It is, however, preferable to employ protein having a high degree of purity, and especially preferable to employ protein having a defined (i.e., specifiable) composition, since the use of such proteins increases the degree with which the release of the pharmaceutical agent may be controlled. Thus, it is more preferable to employ a protein such as gelatin or albumin, than a proteolytic degradation product such as tryptone.

Although any of a variety of proteins may be employed, it is preferable to employ gelatin, and most preferable to employ a gelatin which has been partially hydrolyzed by enzymatic action. The molecular weight of the preferred partially hydrolyzed gelatin is preferably between 1,000-12,000 d. Byco^R proteins (a trademark of Croda Colloids, Ltd.) and in particular Byco^R E.C.A. and O. have been found to be the most preferred proteins for use as the polymeric matrix of the present invention. The molecular weights of these proteins range from about 7,600 to about 50,000 d.

B. THE CROSS-LINKING AGENT OF THE COMPOSITIONS

To be effective in treating (i.e., reversing the progress of, or eliminating) a disease such as periodontal disease, it is necessary that the drugreleasing compositions of the present invention be maintained for a prolonged period of time (i.e., 2-10 days). Since the above-described polymeric materials are water-soluble, they will, if unaltered, dissolve too rapidly to provide an effective therapy for a disease such as periodontal disease. To render such compositions suitable for use in the present invention, it is desirable to treat the compositions in a manner which will make them water-insoluble. Any means capable of accomplishing this goal may be employed; however, it is preferable to employ an agent which is capable of cross-linking protein chains.

Suitable cross-linking agents include aldehydes (such as formaldehyde, glutaraldehyde, etc.), alcohols, di-, tri-, or tetravalent ions (such as aluminum, chromium, titanium, or zirconium ions), acyl chlorides (such as sepacoyl chloride, tetraphthaloyl chloride), or agents such as bis-diazobenzidine, phenol-2,4-disulfonyl chloride, 1,5-difluoro-2,4-dinitrobenzene, urea, 3,6- bis(mercurimethyl)-dioxane urea, dimethyl adipimidate, N,N'-ethylen-bis-(iodoacetamide).

In addition to the above-described chemical agents, any physical means capable of producing cross-links in proteins may alternatively be employed. Such means include heat, pressure, or radiation. The type and the amount of cross-linking agent will control both the rate of release of the drug and the rate of degradation of the device. Thus, increasing the extent of cross- linking increases the duration of the implant and decreases the rate of drug release. Since the cross- linked protein polymer is no longer water-soluble, its degradation is mediated by the proteolytic activity of enzymes normally present in the gingival crevice fluid and/or by chemical degradation. C. THE PLASTICIZING AGENT OF THE SUSTAINED-RELEASE COMPOSITIONS

To improve the flexibility of the sustained-release device, a plasticizing agent is preferably added. Examples of suitable plasticizing agents include phthalate esters, phosphate esters, glycol derivatives, hydrocarbons, oils, or fatty acids. Glycerin and sorbitol have been found to be preferred plasticizing agents. The most preferred plasticizing agent is glycerin. The type and amount of plasticizing agent incorporated into the composition will control the flexibility of the implant film.

D. THE PHARMACOLOGICAL AGENT OF THE COMPOSITIONS

A large variety of pharmacological agents may be incorporated into the compositions of the present invention. Generally, the amount of drug necessary to obtain the desired therapeutic effect will vary, depending upon the particular drug used and its therapeutic usage.

Suitable drugs which can be administered using the sustained drug release compositions of the present invention include drugs belonging to the following groups of therapeutic agents: -- diuretics, e.g., benzthiazide, chlorothiazide, hydrochlorothiazide, cyclothiazide, flumethiazide, furosemide, thiamterene, ethacrynic acid, bumetanide, and the like; -- sedatives and hypnotics, e.g., barbiturates such as phenobarbital, sodium phenobarbital, and the like; chloral hydrate; glutethimide, methylprylon methaqualone and the like; -- tranquilizers, such as chloropromazine, promazine, prochlorperazine, reserpine, meprobamate, benzodiazepines, such as chlordiazepoxide, diazepam, oxazepam, bromazepam and the like; -- antibiotics such as penicillins, cephalosporins, tetracyclines, oxytetracyclines, chlorotetracycline, metronidazole, chloramphenicol, streptomycin, neomycin and the like; -- antibacterials such as sulfonamides, phenolics, mercurials, quarternary ammonium compounds, chlorhexidine and the like; analgesics such as codeine, morphine, meperidine, phenazocime, propoxyphene pentazocine and the like; -- antipyretics and anti-inflammatory agents, such as aspirin, salicylamide, naproxen, indomethacin, fenoprofen, indoprofen, diclofenac, carprofen and the like; -- anti-tumor agents such as 5-fluorouracil, floxuridine, cyclophosphamide, estramustine phosphate cytosine, arabinoside and the like; -- cardiovascular drugs, such as nitroglycerin, amyl nitrite, pentaerythritol tetranitrate, isosorbide dinitrate, pyridamole, propranolol, digitalis, digitoxin, digoxin and the like; -- anti-arrhythmic drugs such as quinidine, lidocaine, procainamide, disopyramide and the like; -- hypotensive drugs such as hydralazine and the like; -- an t ic onvul s ants such as phenyto in , methsuximide, phenazepam, carbamazepine , ethotoin, clonopin and the like ; -- anti-ulcer drugs such as cimetidine , tranitidine and the like; and -- hypoglycemic drugs such as the thiazides and the like.

II. FORMULATION OF THE SUSTAINED-RELEASE DRUG DELIVERY IMPLANTS OF THE PRESENT INVENTION

It is possible to mix the above-described components in any ratio which is capable of producing a solution which, when dried, forms a long-lasting, physiologically acceptable implant. The desired characteristics of such an implant include flexibility, biodegradability, sustained retention, and the capacity to permit the diffusion of a therapeutically active agent. The components of the sustained-release drug delivery implants may be mixed as liquids, or as solids to be dissolved in a suitable solvent. Especially suitable solvents include water, ethanol, and water- ethanol mixtures.

It is preferable to prepare the sustained-drug release compositions of the present invention by pouring a liquid form of the present invention into molds which may be dried into large film-like sheets. These sheets may then be cut to the desired implant size. If the concentration of protein used in the compositions is too high, it will affect the pourability of the solution. If the protein concentration is too low, the release rate of the sustained-release composition will be too rapid. This excessive drug release rate may, however, be lowered through the use of lower concentrations of the pharmacological agent. It is, therefore, preferable to employ a protein concentration range which results in the formation of a solution having acceptable pourability, but which, when dried into a film-like material, is capable of releasing a pharmacological agent over a sustained period of time. When dried to produce the implants of the present invention, such compositions must have a high enough concentration of protein to produce a non-gel-like film having structural stability. Such suitable compositions can be formulated from a liquid which contains from about 10-50% (by weight) protein. Upon evaporation of about 90% of solvent, such compositions would contain from about 16% to about 91% (w/w) protein. It is preferable that the solidified composition have a flexibility of from about 0.1 kg/mm² to about 50 kg/mm².

The plasticizer which may be added to the abovedescribed solution to control the flexibility of the final dried film implant, must be present in an amount sufficient to prevent the final film from being brittle, or too flexible. The plasticizer must not be present in an amount which prevents the release of the pharmacological agent. Thus, such a plasticizer should be present between from about 0.01% to about 15% (w/w) prior to the drying of the compositions. Upon evaporation of about 90% of solvent, such compositions would contain from about 0.010% to about 41% (w/w) plasticizing agent.

The pharmacological agent of the composition may be added to the implant by any of several processes. In one embodiment, a powder form of the pharmacological agent is introduced into the compositions (which are in liquid form) and permitted to dissolve in situ. In a second embodiment, the pharmacological agent is dissolved in a suitable solvent prior to its addition to a liquid form of the composition. In yet another embodiment, a liquified form of the pharmacological agent is introduced into a solidified implant. Such introduction may be accomplished by immersing the solidified implant in a solution which contains the pharmacological agent, or by placing a suitable amount of the pharmacological agent in contact with the solidified implant and permitting the implant to absorb the pharmacological agent.

The amount of the pharmacological agent added to the implant will vary, in a manner understood by those of ordinary skill in the art, depending upon such criteria as: (1) the desired total dosage, (2) the desired release kinetics, (3) the desired duration of treatment, (4) the desired size of the implant and its intended location, or (5) possible interactions between the pharmaceutical agent of the implant and any other medicament being administered. The above criteria will depend upon such factors as the patient's age, height, weight, sex, medical history, etc. The pharmacological agent must be present in an amount sufficient to impart therapeutic effect to the pharmaceutical composition. The nature of the active agent in the film also plays an important role in the control release mechanism. A film containing 20% w/w of chlorhexidine acetate per protein has been found to release the agent more slowly than the same film containing 20% w/w of tetracycline HCl. Different salts of the same active agent are released at different rates. For example, chlorhexidine acetate has been found to be released more slowly than chlorhexidine HCl from films having the same formulation and containing 20% (w/w) chlorhexidine per protein.

In general, the concentration of pharmacological agent will vary from 0.01 mg-2 g per therapeutic treatment. The pharmaceutical compositions (when in liquid form) will, in general, contain between 0.01-25% pharmacological agent (by weight). Upon evaporation of approximately 90% of the liquid solvent, the resulting film-like implant will contain between approximately 0.013-61% pharmacological agent (by weight).

The implants of the present invention may contain only a single pharmacological agent or may contain a combination of two or more pharmacological agents. For example, an implant used in the treatment of periodontal disease may contain several antimicrobial agents or may contain both (i) (one or more) antimicrobial agent(s) and (ii) an analgesic and/or an anti-inflammatory agent.

In a preferred embodiment, the weight ratios of pharmacological agent to protein in the films will vary from about 0.01:7 (respectively) to about 3:1 (respectively). In a preferred embodiment, the weight ratio of plasticizing agent to protein will vary from about 0.01:7 (respectively) to about 4:7 (respectively).

When a cross-linking agent is to be added to the non-evaporated liquid form of the composition, it should be present in an amount capable of rendering the protein polymer water-insoluble. If, however, excessive amounts of the cross-linking agent are introduced, the resulting implant will have an unacceptably slow drug release rate. Thus, if a cross-linking agent is provided to the composition in liquid form (prior to the formation of the film-like solid implants), it should be provided in an amount sufficient to render the resulting implant insoluble, but not in an amount which prevents the release of the pharmacological agent from the pharmaceutical composition. The action of the cross- linking agent may result in the denaturation of the protein. The degree of denaturation of the protein caused by the cross-linking agent provides a means of controlling the degradability of the films in vivo and in vitro. there being an inverse relationship between the degree of denaturation and the degradability of the film. The release of the pharmacological agents from the films can be manipulated by the degree of cross- linking and denaturation of the protein, there being a direct relationship between the degree of cross-linking or denaturation and the rate of release of the active agent from the film.

In general, if one desires to add a cross-linking agent to the composition prior to its drying into the desired film-like material, the cross-linking agent should be added to the liquid in an amount of from about 0.0001% to about 5% (weight by weight). Upon evaporation of about 90% of solvent, the resulting film would contain from about 0.0001% to about 22% (weight by weight) cross-linking agent.

Although, as described above, it is possible to incorporate a cross-linking agent into a liquid solution which, upon drying, forms the film-like implants of the present invention, it is also possible to dry the liquid compositions, and to then cross-link the protein polymer films. The most preferable way of cross-linking is a combination of the method where a partially cross-linked film is further incubated in the presence of glutaraldehyde vapors. Such treatment is preferable. since it minimizes the time necessary to attain sufficient cross-linking. Sufficient cross-linking is considered to have been achieved when the final, filmlike implant cannot be dissolved in water within 10 days. The amount of the cross-linking agent which is ultimately incorporated into an implant treated in the above-described manner is extremely small, and results in almost no change in weight.

Any means capable of solidifying the liquid compositions of the present invention may be employed. Thus, solidification may be accomplished by evaporating solvent until a desired degree of rigidity is obtained. This evaporation may be accomplished by incubating the liquid compositions at ambient or elevated temperatures, either at atmospheric pressure or in vacuo. Evaporation which occurs in the presence of elevated temperatures, or in vacuo. may result in surface defects (such as air pockets, etc.). Thus, if such defects are undesirable, it is preferable to dry the liquid compositions at ambient temperatures under atmospheric pressure. It is most preferable to form the implants of the present invention by evaporating a liquid form of the composition into a solidified film-like material. Such evaporation is most preferably conducted at room termperature or temperatures between 40-50ºC, at atmospheric pressure.

The above-described evaporation process removes a substantial amount of the solvent initially present in the liquid composition. The film is, however, not completely solvent-free. Thus, in a preferred embodiment in which the solvent is water or a water- ethanol mixture, the film is hydrated and non-anhydrous. In general, it is desirable to evaporate sufficient solvent to produce a film-like solid, but not so much solvent as to impair the flexibility of the resulting film. Thus, in general, it is desirable to evaporate between 70-95% of the solvent initially present in the liquid compositions. It is most preferable that the obtained film will contain about 7.5% to about 17.5% w/w of solvent. The evaporation of solvent results in a loss of both weight and volume, and thus alters the concentration percentages of the components of the pharmaceutical composition. The effect of evaporation on the concentration of components is shown in Table 1.

Compo sition

In order to be inserted into a patient ' s periodontal pocket to treat periodontal or other disease, the implant should preferably have a thickness which ranges from 0.01-0.5 millimeters, and preferably have a thickness of between 0.1 and 0.3 millimeters. In order to be inserted in the periodontal pocket, it is preferable that the implant shape be oval. Although the width and length of the implant may vary depending upon the size of the periodontal pocket of the recipient patient, it is preferable to use implants having a width of between 1-5 millimeters, and preferably between 2-4 millimeters. It is preferable to employ implants having a length of between 3-10 millimeters, and most preferable to employ implants having a length of between 5-8 millimeters. Implants having such dimensions, and, therefore, suitable for insertion into the periodontal pocket of a patient may be employed to treat or prevent periodontal disease (as by containing an anti-microbial agent, etc.). Alternatively, such implants may be used to provide a pharmacological agent unrelated to periodontal disease to a recipient patient. In such an embodiment, the periodontal pocket is employed as a convenient site into which the sustained release implant of the invention may be inserted. The implant may be used to provide any of the large variety of pharmacological agents whose prolonged release may be desired in the treatment of disease.

It is alternatively possible to prepare an implant of greater thickness or of different dimensions which will not be inserted into the periodontal cavity. The size and shape of such an implant will depend upon (a) the dimensions of the site into which it is to be inserted, (b) the desired duration of therapy, (c) the desired amount and concentration of the pharmacological agent which it contains or (d) the desired drug release kinetics. Such implants may be used to provide sustained drug release for any of a variety of diseases or conditions. Implants may be used to treat (or prevent) microbial infections at wounds (either accidental or as a consequence of surgery or other medical treatments), burns, abrasions, etc. Such implants may be used alone, in combination with bandages or dressings, or as an adjunct to other treatments. Implants that contain antitumor agents may be placed at the site of the tumor, thereby providing a therapy for cancer. Implants containing analgesics or antipyretics could be used to alleviate pain or inflammation. Implants containing cardiovascular drugs or antiarrhythmic drugs may be used in the treatment of heart disease. In a similar manner, by employing implants which contain a suitable pharmacological agent, it is possible to provide effective therapy for the large variety of diseases that may be treated by a sustained drug therapy regime.

The implants of the present invention may be individually produced, or may be cut from a larger filmlike sheet. When employing Byco^R as the protein polymer, it is preferable to prepare a liquid composition which contains from about 15% to about 30% Byco^R protein and from about 0.0006% to about 0.15% of cross-linking agent, preferably glutaraldehyde. It is preferable to dry such a composition by evaporating the solvent to produce a film of about 7.5% to about 17.5% w/w of solvent and about 48% to about 83% w/w of cross- linked Byco^R and from about 3.8% to about 21% w/w of plasticizer agent and from about 4% to about 24% w/w of pharmaceutical agent. This film-like material is then incubated in the presence of a cross-linking agent (preferably glutaraldehyde) until a sufficient degree of cross-linking has been obtained.

Having now generally described this invention, the same will be better understood by reference to certain specific examples which are included herein for purposes of illustration only and are not intended to be limiting of the invention, unless specified.

Sustained pharmaceutical implants were prepared according to the procedures described in the following examples.

EXAMPLE 1

1. 9.75 g of Byco E was dissolved in distilled water to make 26 g and allowed to stand.

2. 1.5 g of chlorhexidine acetate was solubilized in 5 ml of absolute ethanol.

3. 20 g of the clear Byco solution was added to the chlorhexidine solution while stirring constantly.

4. 1.0 g of glycerine was added to the solution while stirring constantly.

5. 5 g of the liquid was poured into plastic petri dishes (9.5 cm in diameter).

6. The petri dishes were placed in an evaporator for 48 hours and the liquid was allowed to evaporate.

EXAMPLE 2

1. 9.75 g of Byco E was dissolved in distilled water to make 26 g and allowed to stand. 2. 1.5 g of chlorhexidine acetate was solubilized in 5 ml of absolute ethanol.

3. 20 g of the clear Byco solution was added to the chlorhexidine solution, while stirring constantly.

4. 1.0 g of glycerine was added to the solution while stirring constantly.

5. 50 ul of formaldehyde solution was added slowly to 5 g of the liquid.

6. The liquid was poured into plastic petri dishes (9.5 cm in diameter).

7. The petri dishes were placed in an evaporator for 48 hours and the liquid was allowed to evaporate.

EXAMPLE 3

2. 1.5 g of chlorhexidine acetate was solubilized in 5 ml of absolute alcohol.

4. 1.0 g of glycerine was added to the solution while stirring constantly.

5. 100 ul of formaldehyde solution was added slowly to 5 g of the liquid.

6. The liquid was poured into plastic petri dishes (9.5 cm in diameter).

7. The petri dishes were placed in an evaporator for 48 hours and the liquid was allowed to evaporate. EXΛMPLE 4

2. 1.5 g of chlorhexidine acetate was solubilized in 5 ml of absolute alcohol.

4. 1.0 g of glycerine was added to the solution while stirring constantly.

5. 150 ul of formaldehyde solution was added slowly to 5 g of the liquid.

6. The liquid was poured into plastic petri dishes (9.5 cm in diameter).

EXAMPLE 5

2. 1.5 g of chlorhexidine acetate was solubilized in 5 ml of absolute ethanol.

4. 1.0 g of glycerine was added to the solution while stirring constantly.

5. 200 ul of formaldehyde solution was added slowly to 5 g of the liquid.

6. The liquid was poured into plastic petri dishes (9.5 cm in diameter).

7. The petri dishes were placed in an evaporator for 48 hours and the liquid was allowed to evaporate. The following examples were prepared using the same procedure as that described above -- amounts are in grams unless indicated otherwise and refer to the liquid compositions.

EXAMPLE 6

Byco E 7.5

Water ad 20

Glycerine 1.0

Chlorhexidine acetate 0.75/5 ml Ethanol

Formaldehyde 100 ul/5 g

EXAMPLE 7

Byco E 7.5

Water ad 20

Glycerine 1.0

Chlorhexidine acetate 3.0/5 ml ethanol

Formaldehyde 100 ul/5 g

EXAMPLE 8

Byco E 7.5

Water ad 20

Glycerine 1.0

Chlorhexidine acetate 4.5/5 ml Ethanol

Formaldehyde 100 ul/5 g EXAMPLE 9

Byco E 7.5

Water ad 20

Glycerine 1.0

Chiorhexidine HCl 0.75

Formaldehyde 100 ul/5 g

EXAMPLE 10

Byco E 7.5

Water ad 25

Glycerine 1.0

Chlorhexidine HCl 1.5

Formaldehyde 100 ul/5 g

EXAMPLE 11

Byco E 7.5

Water ad 25

Glycerine 1.0

Chlorhexidine HCl 3.0

Formaldehyde 100 ul/5 g

EXAMPLE 12

Byco E 7.5

Water ad 25

Glycerine _ 1.0

Chlorhexidine HCl 4.5

Formaldehyde 100 ul/5 g EXAMPLE 13

Byco E 7.5

Water ad 25

Glycerine 1.0 Tetracycline 1.5

Formaldehyde 100 ul/5 g

EXAMPLE 14

Byco E 7.5

Water ad 25

Glycerine 1.0

Tetracycline HCl 1.5

Formaldehyde 50 ul/5 g

EXAMPLE 15

Byco E 7.5

Water ad 25

Glycerine 1.0

Tetracycline HCl 1.5

Formaldehyde 100 ul/5 g

EXAMPLE 16

Byco E 7.5

Water ad 25

Glycerine 1.0

Tetracycline HCl 1.5

Formaldehyde 200 ul/5 g EXAMPLE 17

Byco E 7.5

Water ad 25

Sorbitol 0.0034

Chlorhexidine acetate 1.5/5 ml ethanol

Formaldehyde 200 ul/5 g

EXAMPLE 18

Byco E 7.5

Water ad 25

Sorbitol 0.5

Chlorhexidine acetate 1.5/5 ml ethanol

Formaldehyde 200 ul/5 g

EXAMPLE 19

Byco E 7.5

Water ad 25

Sorbitol 1.5

Chlorhexidine acetate 1.5/5 ml ethanol

Formaldehyde 200 ul/5 g

EXAMPLE 20

1. 7.5 g of gelatin were dissolved in 39.0 ml of hot distilled water. 2. 0.75 g of chlorhexidine acetate was solubilized in 5.0 ml of ethyl alcohol.

3. The alcohol solution was added to the aqueous solution.

4. 5 g of the liquid was poured into petri dishes, diameter 9.5 cm.

5. The petri dishes were placed in an evaporator for 48 hours and the liquid was allowed to evaporate.

EXAMPLE 21

1. 7.5 g of gelatin were dissolved in 39.0 ml of hot distilled water.

2. 0.75 g of chlorhexidine acetate was solubilized in 5.0 ml of ethyl alcohol.

3. The alcohol solution was added to the aqueous solution.

4. 50 ul of formaldehyde was added slowly to 5 g of the liquid.

5. The liquid was poured into petri dishes (9.5 cm in diameter).

EXAMPLE 22

1. 7.5 g of gelatin were dissolved in 39.0 ml of hot distilled water.

2. 0.75 g of chlorhexidine acetate was solubilized in 5.0 ml of ethyl alcohol.

3. The alcohol solution was added to the aqueous solution. 4. 100 ul of formaldehyde was added slowly to 5 g of the liquid.

5. The liquid was poured into petri dishes (9.5 cm in diameter).

EXAMPLE 23

In vitro release tests

Films were prepared by evaporating approximately 80% of the solvent from the compositions of the preceding examples.

The casted films were carefully cut into squares of 1 x 1 cm dimension. The thickness of each film was measured in five different places on the film, using a micrometer gauge. The average thickness of the films was 200 microns.

The films were placed in distilled water at 37ºC with constant shaking at 100 rpm. The solutions were circulated through a flow cell of a U.V. spectrophotometer, using a peristaltic pump. The amount of active ingredient released from the film was measured at 254 nm for chlorhexidine/protein or at 275 nm for tetracycline or tetracycline HCl. The results of this experiment are shown in Tables 2-5.

EXAMPLE 24 INHIBITION OF ORAL BACTERIAL GROWTH IN VITRO

Films were prepared using the compositions of Examples 1-4. The films were cut into circles and placed on Iso-sensitest agar plates seeded with the oral bacteria Streptococcus mutans. After incubating at 37ºC for 24 hours, the films were removed from the agar plates and placed on fresh plates seeded with Streptococcus mutans and incubated further for 24 hours. This procedure was repeated until no inhibition of bacterial growth was observed. The area of inhibition of growth around the films was measured. The results of this experiment are shown in Table 6.

EXAMPLE 25

A sustained release composition composed of chlorhexidine and Byco E protein and suitable for use as a periodontal implant was prepared in a preferred manner by incubating the non or the partially cross-linked films in the presence of a vapor containing a cross- linking agent. Films prepared in such a manner can be considered to have the following eight stages:

Stages in the Formation of the Film

1. Byco E is dispersed into a solution.

2. The solution is allowed to clear.

3. Chlorhexidine acetate is added to 5 ml of ethanol supplemented with glycerine. The solution is mixed for 10 minutes.

4. The Byco solution and the chlorhexidine solution are mixed together at 35ºC for 10 minutes.

5. Glutaraldehyde is added to 6.0 g of the above solution.

6. The mixture is poured into molds.

7. The solvent is allowed to evaporate from the mixture, thus forming a thin film.

8. The obtained film is placed in an atmosphere of glutaraldehyde vapor.

In producing the above film, the following considerations were made at the indicated stages: Stage 1 a. The range of Byco^R protein in the solution is 10%-60% w/w. b. The Byco^R is dissolved in bidistilled water, buffered to pH range of 3.0-9.0. c. Rose bengal is added to the solution concentration of 0.00001-1 mg/ml.

Stage 3 a. 0-6.0 g of chlorhexidine acetate or chlorhexidine is solubilized in ethanol. b. The active ingredient, e.g., chlorhexidine or its salts, was added to the Byco^R solution in the form of a solid powder.

Staσe 7

The solvent is evaporated at a range of temperature of 20ºC-60ºC.

Staσe 8

The obtained films are placed in an atmosphere of glutaraldehyde for 0-72 hours at a range of temperature of 20ºC-60ºC.

Characteristics of the obtained film:

1. Concentration of water: 5-30% w/w

2. Concentration of cross-linked Byco^R: 14-95%w/w

3. Concentration of chlorhexidine or chlorhexidine acetate: 0-66% w/w

4. Concentration of glycerin: 0-52% w/w EXAMPLE 26

The steps of a preferred method for producing the periodontal implant of the present example are provided below:

1. 7.5 g Byco^R E was dispersed in a bidistilled water to make 22.0 g.

2. The mixture was allowed to clear.

3. 1.5 g of chlorhexidine acetate was added to 5 ml of ethanol absolute, supplemented with 1.3 g glycerine. The solution was mixed for 10 minutes.

4. The Byco^R and chlorhexidine solutions were mixed together at 35ºC for 10 minutes.

5. 300 ul of glutaraldehyde was added to 5.0 g of the above solution.

6. The mixture was poured into molds.

7. The solvent was allowed to evaporate at room temperature for 48 hours while forming a film.

8. The above-obtained film was placed in an atmosphere of glutaraldehyde vapor for 24 hours.

The obtained films had the following approximate concentrations:

1. concentration of water : 10%

2. concentration of Byco^R : 66%

3. Concentration of Chlorhexidine or chlorhexidine acetate : 13%

4. concentration of glycerin : 11%

EXAMPLE 27

Periodontal implants having various proportions of ingredients were prepared in accordance with the procedure of Example 25. The amounts and ingredients used to produce these implants are shown in Table 7.

EXAMPLE 28

The in vitro drug release profile of four of the implants produced in Example 25 were determined. The release profiles are presented in Table 8. [Note: Please verify that the release profiles in Table 8 are associated with the correct implant formulation number.]

EXAMPLE 29 CLINICAL TRIALS

Preliminary clinical trials were conducted on patients with periodontal diseases. Films prepared using the compositions of Examples 1, 2, 3, or 4 were inserted into periodontal pockets of volunteers in order to test the rate of degradation. Films prepared using the compositions disclosed in Example 1 degraded inside the periodontal pocket within four hours. Films prepared using the compositions disclosed in Examples 2 and 3 degraded within 20 hours. The film prepared from the composition of Example 4 degraded within approximately 36 hours.

Further tests were conducted on the effect of degradable films on the microflora of periodontal pockets.

Preliminary clinical studies have shown that there is a sharp decrease in the number of motile bacteria including spirochetes in the periodontal pocket, after treatment with the film. A reduction in the total count of anaerobic bacteria was observed, accompanied by a reduction in the black pigmented Bacteriodes.

Films prepared from the composition of Example 5 were inserted into periodontal pockets. Samples of subgingival flora were taken before and after the treatment. The samples were examined by using Dark Field Microscopy. It was found that after treatment with these films, there was a reduction in the number of motile bacteria. In three pockets, there was 100% decrease in the number of motile bacteria while in another two pockets there was a 75% reduction in the motile bacteria. As will be realized from the above description and results, the controlled release of an active antibacterial agent into the periodontal pocket is a prefered way of treating periodontal diseases.

The local placement of a device which provides the controlled release of an active agent from a degradable matrix minimizes the need for removal of the device from the periodontal pockets, when the treatment period is over. This minimizes the number of visits to the periodontist as well as the discomfort associated with the removal of the film.

It will be evident to those skilled in the art that the invention is not limited to the details of the foregoing illustrative examples and that the present invention may be embodied in other specific forms without departing from the essential attributes thereof, and it is therefore desired that the present embodiments and examples be considered in all respects as illustrative and not restrictive, reference being made to the appended claims, rather than to the foregoing description, and all changes which come within the meaning and range of equivalency of the claims are therefore intended to be embraced therein.

Claims

WHAT IS CLAIMED IS:

1. A pharmaceutical composition for permitting the sustained release of a pharmacological agent which comprises a polymeric matrix containing a plasticizing agent, and said pharmacological agent, wherein said polymeric matrix comprises a cross-linked, water- insoluble protein.

2. The pharmaceutical composition of claim 1 which additionally contains a cross-linking agent.

3. The pharmaceutical composition of claim 2 wherein said cross-linking agent is selected from the group consisting of: aldehydes, alcohols, divalent ions, trivalent ions, tetravalent ions, acyl chlorides, bis-diazobenzidine, phenol-2,4-disulfonyl chloride, 1,5- difluoro-2,4-dinitrobenzene, urea, 3,6- bis(mercurimethyl)-dioxane urea, dimethyl adipimidate, and N,N'-ethylen-bis-(iodo-acetamide).

4. The pharmaceutical composition of claim 2 wherein said cross-linking agent is present in an amount sufficient to render said protein insoluble but not in an amount which prevents the release of the pharmacological agent from the pharmaceutical composition.

5. The phajrmaceutical composition of claim 3 wherein said cross-linking agent is present in said composition in an amount of from about 0.01% to about 26%.

6. The pharmaceutical composition of claim 3 wherein said cross-linking agent is an aldehyde selected from the group consisting of formaldehyde and glutaraldehyde.

7. The pharmaceutical composition of claim 6 wherein said cross-linking agent is glutaraldehyde.

8. The pharmaceutical composition of claim 1 wherein said cross-linked protein is cross-linked by incubation in the presence of cross-linking means, said means being selected from the group consisting of: heat, pressure, radiation, and the vapors of a cross- linking agent.

9. The pharmaceutical composition of claim 8 wherein said cross-linked protein is cross-linked to an extent sufficient to render said protein insoluble but not to an extent which prevents the release of the pharmacological agent from the pharmaceutical composition.

10. The pharmaceutical composition of claim 8 wherein said cross-linking agent is selected from the group consisting of: aldehydes, alcohols, divalent ions, trivalent ions, tetravalent ions, acyl chlorides, bis-diazobenzidine, phenol-2,4-disulfonyl chloride, 1,5- difluoro-2,4-dinitrobenzene, urea, 3,6- bis(mercurimethyl)-dioxane urea, dimethyl adipimidate, and N,N'-ethylen-bis-(iodo-acetamide).

11. The pharmaceutical composition of claim 10 wherein said cross-linking agent is an aldehyde selected from the group consisting of: formaldehyde and glutaraldehyde.

12. The pharmaceutical composition of claim 11 wherein said cross-linking agent is glutaraldehyde.

13. The pharmaceutical composition of any one of claims 1-2 wherein said protein is present at a concentration sufficient to provide said composition with structural stability, but not at so great a concentration as to render said composition (i) incapable of biodegradation, or (ii) incapable of permitting the release of said pharmacological agent.

14. The pharmacological composition of any one of claims 1-2 wherein said protein is selected from the group consisting of: gelatin, collagen, albumin, an enzyme, and fibrinogen.

15. The pharmaceutical composition of claim 14 wherein said protein is gelatin.

16. The pharmaceutical composition of claim 15 wherein said gelatin is hydrolyzed gelatin.

17. The pharmaceutical composition of any one of claims 1-2 wherein said protein is present at a concentration of from about 14% to about 93%.

18. The pharmaceutical composition of any one of claims 1-2 wherein said plasticizing agent is present in an amount sufficient to effect brittleness but not at so great a concentration as to prevent the release of the pharmacological agent.

19. The pharmaceutical composition of any one of claims 1-2 wherein said plasticizing agent is selected from the group consisting of: a phthalate ester, a phosphate ester, a glycol derivative, a hydrocarbon, an oil, and a fatty acid.

20. The pharmaceutical composition of claim 19 wherein said plasticizing agent is a glycol derivative.

21. The pharmaceutical composition of claim 20 wherein said glycol derivative is selected from the group consisting of: glycerin and sorbitol.

22. The pharmaceutical composition of claim 21 wherein said glycol derivative is glycerin.

23. The pharmaceutical composition of any one of claims 1 and 2 wherein said plasticizing agent is present at a concentration of from about 0.01% to about 52%.

24. The pharmaceutical composition of any one of claims 1-2 wherein said pharmacological agent is selected from the group consisting of: a diuretic, a sedative, a hypnotic, a tranquilizer, an antibiotic, an antibacterial, an analgesic, an antipyretic, an antitumor agent, a cardiovascular drug, an anti-arrthymic drug, a hypotensive drug, an anti-ulcer drug, and a hypoclycemic drug.

25. The pharmaceutical composition of claim 24 wherein said pharmacological agent is an antibacterial agent.

26. The pharmaceutical composition of claim 25 wherein said antibacterial agent is selected from the group consisting of penicillin, cephalosporin, tetracycline, oxytetracycline, chlortetracycline, metronidazole, chloramphenicol, streptomycin, neomycin, a sulfonamide, a phenolic compound, a mercurial, a guarternary ammonium compound, and chlorhexidine.

27. The pharmaceutical composition of claim 26 wherein said antibacterial agent is chlorhexidine.

28. The pharmaceutical composition of any one of claims 1-2 wherein said pharmacological agent is present in an amount sufficient to impart therapeutic effect to said composition.

29. The pharmaceutical composition of any one of claims 1-2 wherein said composition contains more than one pharmacological agents, said agents being selected from the group consisting of: a diuretic, a sedative, a hypnotic, a tranquilizer, an antibiotic, an antibacterial, an analgesic, an antipyretic, an anti- tumor agent, a cardiovascular drug, an anti-arrthymic drug, a hypotensive drug, an anti-ulcer drug, and a hypoclycemic drug.

30. The pharmaceutical composition of claim 29 wherein all of said pharmacological agents are selected from the same group of therapeutic agents, and wherein said group of therapeutic agents is selected from the group consisting of: a diuretic, a sedative, a hypnotic, a tranquilizer, an antibiotic, an antibacterial, an analgesic, an antipyretic, an anti- tumor agent, a cardiovascular drug, an anti-arrthymic drug, a hypotensive drug, an anti-ulcer drug, and a hypoclycemic drug.

31. The pharmaceutical composition of any one of claims 1-2 wherein said composition is substantially a two-dimensional film.

32. The pharmaceutical composition of claim 31 wherein said film is from about 3 to about 10 mm in length, and from about 1 to about 5 mm in width, and from about 0.01 to 0.5 mm in depth.

33. A pharmaceutical composition of any one of claims 1-2, wherein said pharmacological agent and said protein are present at a relative weight ratio which ranges from about 0.01:7 to about 3:1.

34. The pharmaceutical composition of any one of claims 1-2, wherein said plasticizing agent and said protein are present at a relative weight ratio which ranges from about 0.01:7 to about 4:7.

35. The pharmaceutical composition of any one of claims 1-2, wherein said composition has a flexibility which ranges from about 0.1 kg/mm² to about 50 kg/mm².

36. A method of administering a pharmacological agent (a) to a patient in need of such administration, which method comprises providing to said patient the pharmaceutical composition of any one of claims 1-2, wherein said pharmacological agent of said pharmaceutical composition is said pharmacological agent (a).

37. A method of treatment for a disease which comprises providing to a patient in need of such treatment the pharmaceutical composition of any one of claims 1-2, wherein said pharmaceutical composition contains a pharmacological agent capable of providing said treatment and is present in an amount sufficient to impart therapeutic effect to said composition.

38. The method of claim 37 wherein said pharmaceutical composition is provided to said patient as an implant into a periodontal pocket of said patient.

39. The method of claim 38 wherein said pharmacological agent of said pharmaceutical composition is an antibacterial agent.

40. The method of claim 39 wherein said disease is periodontal disease, and wherein said antibacterial agent is effective in the treatment of said periodontal disease.