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WO2012076194A1 - Préparations combinées contenant un antagoniste de la cytokine et un corticostéroïde - Google Patents

Préparations combinées contenant un antagoniste de la cytokine et un corticostéroïde Download PDF

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Publication number
WO2012076194A1
WO2012076194A1 PCT/EP2011/057645 EP2011057645W WO2012076194A1 WO 2012076194 A1 WO2012076194 A1 WO 2012076194A1 EP 2011057645 W EP2011057645 W EP 2011057645W WO 2012076194 A1 WO2012076194 A1 WO 2012076194A1
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Prior art keywords
pharmaceutical composition
antagonist
corticosteroid
cytokine antagonist
osteoarthritis
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Ceased
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PCT/EP2011/057645
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German (de)
English (en)
Inventor
Peter Wehling
Julio Reinecke
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Orthogen AG
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Orthogen AG
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Priority claimed from PCT/EP2010/069427 external-priority patent/WO2011082951A1/fr
Application filed by Orthogen AG filed Critical Orthogen AG
Publication of WO2012076194A1 publication Critical patent/WO2012076194A1/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K38/00—Medicinal preparations containing peptides
    • A61K38/16—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
    • A61K38/17—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans
    • A61K38/22—Hormones
    • A61K38/30—Insulin-like growth factors, i.e. somatomedins, e.g. IGF-1, IGF-2
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/56—Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids
    • A61K31/57—Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids substituted in position 17 beta by a chain of two carbon atoms, e.g. pregnane or progesterone
    • A61K31/573—Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids substituted in position 17 beta by a chain of two carbon atoms, e.g. pregnane or progesterone substituted in position 21, e.g. cortisone, dexamethasone, prednisone or aldosterone
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K38/00—Medicinal preparations containing peptides
    • A61K38/16—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
    • A61K38/17—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans
    • A61K38/177—Receptors; Cell surface antigens; Cell surface determinants
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K38/00—Medicinal preparations containing peptides
    • A61K38/16—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
    • A61K38/17—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans
    • A61K38/18—Growth factors; Growth regulators
    • A61K38/1833—Hepatocyte growth factor; Scatter factor; Tumor cytotoxic factor II
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K38/00—Medicinal preparations containing peptides
    • A61K38/16—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
    • A61K38/17—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans
    • A61K38/18—Growth factors; Growth regulators
    • A61K38/1841—Transforming growth factor [TGF]
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K38/00—Medicinal preparations containing peptides
    • A61K38/16—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
    • A61K38/17—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans
    • A61K38/18—Growth factors; Growth regulators
    • A61K38/1858—Platelet-derived growth factor [PDGF]
    • A61K38/1866—Vascular endothelial growth factor [VEGF]
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K38/00—Medicinal preparations containing peptides
    • A61K38/16—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
    • A61K38/17—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans
    • A61K38/18—Growth factors; Growth regulators
    • A61K38/1875—Bone morphogenic factor; Osteogenins; Osteogenic factor; Bone-inducing factor
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K45/00—Medicinal preparations containing active ingredients not provided for in groups A61K31/00 - A61K41/00
    • A61K45/06—Mixtures of active ingredients without chemical characterisation, e.g. antiphlogistics and cardiaca
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P19/00—Drugs for skeletal disorders
    • A61P19/02—Drugs for skeletal disorders for joint disorders, e.g. arthritis, arthrosis

Definitions

  • the present invention relates to pharmaceutical compositions for combination therapy with a cytokine antagonist and a corticosteroid.
  • the combination therapy may treat diseases such as osteoarthritis (including inflammatory forms of osteoarthritis), tendon disorders and / or degenerative spinal disorders, preferably with local treatment.
  • Osteoarthritis refers to a "joint wear and tear" that exceeds the age-customary level, it is associated with loss of cartilage in the affected joint, resulting in pain and functional deterioration caused by an excess of stress, congenital or traumatic causes, such as malalignment of the joints, or Bone deformity due to bone disease, such as osteoporosis, may also result from other conditions such as joint inflammation or may be accompanied by congestion associated with overgrowth.
  • all joints can be affected by arthritic changes.
  • the disease In Germany, the disease is most often located in the knee joint.
  • Osteoarthritis is one of the most common consultations in a general medical practice. About 10% of the population in western countries suffers from osteoarthritis. If one calculates the osteoarthritis disorders of the small vertebral joints and the degenerative ones Disk Diseases, even about 15% -20% of the population are affected. The risk of developing osteoarthritis increases with age. About two-thirds of people over 65 are affected by the disease, but not all sufferers also suffer from the symptoms.
  • cortisone and related corticosteroids An often used medicinal agent for the treatment of osteoarthritis is cortisone and related corticosteroids. However, these are usually administered systemically locally as an injection into the affected joint. However, this shows that the positive effect of corticosteroids decreases after just one week. This is clinically proven through randomized trials and clinical experience.
  • IL-1 Ra interleukin-1 receptor antagonist
  • IL-1 Ra interleukin-1 receptor antagonist
  • IL-1Ra Block the binding of IL-1, thus preventing its signal transduction and thus the pro-inflammatory effect of IL-1 on the target cells.
  • IL-1 Ra The treatment of patients with endogenous serum in which IL-1 Ra has been enriched and among other factors is known in the art.
  • the IL-1 Ra thus used is also called Orthokin.
  • a recombinant IL-1 Ra fragment, anakinra had no effect on the treatment of osteoarthritis compared to placebo treatment.
  • Anakinra is a truncated to the amino acids 26-177 and terminal L-methionylated isoform of the human interleukin-1 receptor antagonist and has a sequence length of 153 amino acids. The production takes place for example by Escherichia coli strains with recombinant methods.
  • the invention therefore an object of the invention to provide a drug osteoarthritis treatment, which has a better efficacy and in particular has a good long-term efficacy.
  • the efficacy, in particular the long-term efficacy, of corticosteroids such as cortisone in osteoarthritis, inflammatory forms of osteoarthritis and degenerative spinal disease can be significantly and synergistically improved by the additional administration of a cytokine antagonist such as Orthokin and Anakinra. This is particularly evident in the local administration of the therapeutic agents directly into the joint to be treated.
  • the cytokine antagonists have an anabolic effect and can abrogate or even reverse the harmful catabolic effects of the corticosteroid known in the affected joints. Therefore, in the treatment of, for example, osteoarthritis in addition to the cytokine antagonists, the corticosteroids may alternatively or additionally be combined with anabolic growth factors to achieve a similar or even potentiating effect.
  • the invention thus makes it possible to develop a corticosteroid which does not have the known harmful effects in osteoarthritis, which may consist of enhancing cartilage destruction, by combining it with a cytokine antagonist.
  • the present invention provides a pharmaceutical composition
  • a pharmaceutical composition comprising a corticosteroid together with a cytokine antagonist and optionally a growth factor, wherein the cytokine antagonist is the naturally occurring or recombinant interleukin antagonist IL-1Ra protein in particular orthokin or anakinra, and wherein the pharmaceutical composition is suitable for local administration.
  • the therapeutics can also be administered in two different pharmaceutical compositions simultaneously or in chronological order.
  • a pharmaceutical composition comprising a cytokine antagonist and optionally a growth factor for use in a combination therapy together with a corticosteroid and a pharmaceutical composition containing a corticosteroid for use in a combination therapy together with a cytokine.
  • Antagonists and optionally provided a growth factor are provided in both the second and third aspects of the invention.
  • the cytokine antagonist is the naturally occurring or recombinant interleukin antagonist IL-1Ra protein, especially orthokin or anakinra, and the pharmaceutical composition is suitable for local administration.
  • kits comprising a pharmaceutical composition containing a cytokine antagonist and optionally a growth factor, and a pharmaceutical composition containing a corticosteroid.
  • the cytokine antagonist is the naturally occurring or recombinant interleukin antagonist IL-1Ra protein, especially orthokine or anakinra, and the pharmaceutical compositions are suitable for local administration.
  • the invention relates to the use of a cytokine antagonist and optionally a growth factor for the manufacture of a pharmaceutical composition for use in a combination therapy together with a corticosteroid, and in a sixth aspect the use of a corticosteroid for the preparation of a pharmaceutical composition for use in a combination therapy together with a cytokine antagonist and optionally a growth factor.
  • the cytokine antagonist is the naturally occurring or recombinant interleukin antagonist IL-1Ra protein, especially orthokine or anakinra, and the pharmaceutical composition is suitable for local administration. Further embodiments of the invention are given in the following detailed description and in the claims.
  • the invention is based on the surprising discovery that the treatment of diseases of the joints and the spine such as osteoarthritis / arthritis, arthritis, inflammatory forms of osteoarthritis and degenerative spinal disease, as well as in autoimmune diseases using corticosteroids by the additional administration of a cytokine antagonist and optionally a growth factor can be significantly improved.
  • a cytokine antagonist and optionally a growth factor can be significantly improved for the treatment with the recombinant IL-1 Ra anakinra only by the combination with a corticosteroid efficacy, which is much higher than the sole effect of corticosteroids or the anakinra in combination with a corticosteroid in the first place to one makes effective agent in the treatment of these diseases.
  • the invention is directed to the combination therapy of such diseases by means of a corticosteroid together with a cytokine antagonist such as Anakinra or Orthokin and optionally a growth factor.
  • compositions according to the invention which contain only one of the two different active ingredients, as well as the kit according to the invention, can therefore be intended, on the one hand, for a simultaneous administration and, on the other hand, for a sequential administration of the cytokine antagonist and the corticosteroid.
  • simultaneous administration is preferred, especially in only one formulation.
  • the two pharmaceutical compositions of the kit of the invention may be appropriately mixed before administration to the patient and then administered as a formulation.
  • the various drugs are preferably administered within a period of one week, preferably within 5 days, 3 days, one day, or within 12 hours.
  • the cytokine antagonist can also be combined with a growth factor.
  • another cytokine antagonist is contained in the pharmaceutical composition or kit according to the invention.
  • the cytokine antagonist used in the invention may be any substance or mixture of substances that reduces or inhibits at least one, preferably substantially all, of the biological activities of one or more cytokines in the body of the patient.
  • the antagonistic effect can be done directly by the antagonist or indirectly, for example by activation or inhibition of other signaling pathways, which in turn act on the biological activity of the cytokine.
  • the biological activity of the cytokine is inhibited by blocking its interaction with one or more of the receptors to which it is capable of binding. This can be achieved, for example, by competitive binding of the antagonist to the corresponding receptor or by binding of the antagonist to the cytokine itself.
  • the cytokine antagonist inhibits the action of the cytokine IL-1.
  • the cytokine antagonist may be, for example, a protein, a peptide, a nucleic acid, a lipid or an organic compound. Also, the cytokine antagonist may consist of a mixture of two or more cytokine antagonists as described herein. In particular, the cytokine antagonist may be a naturally occurring peptide or protein or even a recombinantly produced peptide or protein. In addition, the cytokine antagonist may be or contain an antibody or an antigen-binding fragment of an antibody, particularly an antibody or antibody fragment capable of binding the particular cytokine or cytokine receptor.
  • cytokine antagonists are interleukin antagonists, in particular IL-1 antagonists such as IL-1 Ra, tumor necrosis factor (TNF) antagonists, in particular a TNF-o antagonist such as an anti-TNF-a antibody, interferon Antagonists, and chemokine antagonists.
  • IL-1 antagonists such as IL-1 Ra
  • TNF tumor necrosis factor
  • TNF-o antagonist such as an anti-TNF-a antibody
  • chemokine antagonists particularly preferred is naturally occurring or recombinant IL-1 Ra protein, preferably human IL-1 Ra.
  • IL-1 Ra preferably comprises or consists preferably of the amino acid sequence of an isoform or a homologue of human IL-1 Ra according to SEQ ID NOs: 1, 2, 3, 4 or 5, an isoform of equine IL-1 Ra according to SEQ ID NOs : 6 or 7, or an isoform of canine IL-1 Ra according to SEQ ID NO: 8.
  • the pharmaceutical composition or the kit according to the invention comprises such a cytokine antagonist in addition to the naturally occurring or recombinant IL-1 Ra protein.
  • fragments or derivatives of IL-1Ra can be used as cytokine antagonists as long as they can perform the desired function, that is, reduce or inhibit one or more biological functions of IL-1.
  • Fragments of IL-1 Ra preferably comprise at least 20, more preferably at least 40, 60, 80, or at least 100 amino acids of a natural IL-1 Ra sequence.
  • the fragments are naturally occurring secreted fragments of IL-1 Ra.
  • the IL-1 Ra comprises amino acids 26 to 177 of human IL-1 Ra, preferably amino acids 26 to 177 of the sequence of SEQ ID NO: 1.
  • Derivatives of IL-1 Ra are preferably homologous to natural IL-1 Ra and preferably have a homology or identity to natural IL-1 Ra of at least 60%, more preferably at least 70%, 75%, 80%, 85%, 90%, 95% and most preferably at least 98% over a range of at least 20 contiguous amino acids, preferably at least 40, 60, 80 or at least 100 contiguous amino acids, most preferably the entire length of IL-1 Ra.
  • Particularly preferred are the IL-1 Ra, also called orthokin, which can be isolated from natural biological samples, such as blood, and the IL-1 Ra fragment with the amino acids 26 to 177 of human IL-1 Ra, also called anakinra.
  • the recovery of orthokine is described inter alia in the patent applications WO 00/46249 A1 and WO 03/080122 A1.
  • Anakinra and other IL-1 antagonists that can be used in this invention are described, inter alia, in patent application EP 0 343 684 A1.
  • the IL-1 Ra solution obtained preferably also contains growth factors, which may also be responsible for the surprising effectiveness of the combination of active substances according to the invention. Therefore, according to the invention, the cytokine antagonist may also be present in combination with one or more growth factors or replaced by one or more growth factors.
  • the growth factor according to the invention preferably has an anabolic effect.
  • growth factors examples include TGF- ⁇ , IGF, BMP, HGF and VEGF. Also included are analogues, derivatives and fragments of these growth factors, as long as they have the desired effect, ie in particular their effect as a growth factor.
  • the corticosteroid used in the invention may be any naturally occurring or synthetically produced corticosteroid.
  • it may be a glucocorticoid, a mineralocorticoid or an androgen, with glucocorticoids preferably being used.
  • glucocorticoids preferably being used.
  • a mixture of two or more corticosteroids may be used as described herein.
  • glucocorticoids examples include cortisone, hydrocortisone, prednisone, prednisolone, cloprednol, deflazacort, fluocortin, triamcinolone, dexamethasone, methylprednisolone, fluprednisolone, clocortolone, clobetasone, alclomethasone, flumethasone, fluopredniden, fluorandrenolone, betamethasone, beclomethasone, fluocortolone, mometasone, fluticasone, Halomethasone, fluocinolone, diflobarone, desoximethasone, fluocinonide, amcinonide, halcinonide, diflucortolone, clobetasol and paramethasone.
  • mineralocorticoids examples include aldosterone, desoxycorticosterone and fludrocortisone, and examples of androgens are dehydroepiandrosterone (DHEA) and estrogens.
  • DHEA dehydroepiandrosterone
  • the corticosteroid can be used as a free compound or in the form of a salt, ester or prodrug.
  • the corticosteroid used is triamcinolone, cortisone, hydrocortisone, prednisolone or prednisone.
  • the corticosteroid is preferably crystalloid.
  • compositions or kit of the invention are for use in the treatment of joint diseases such as osteoarthritis, arthritis, arthritis and inflammatory cartilage loss, tendon disease, degenerative joint diseases, such as osteoarthritis, arthritis, arthritis and inflammatory cartilage loss, tendon disease, degenerative joint diseases, such as osteoarthritis, arthritis, arthritis and inflammatory cartilage loss
  • the osteoarthritis to be treated may be due to overwork, congenital or traumatic causes, or the result of another condition such as inflammation.
  • the osteoarthritis to be treated is preferably an activated osteoarthritis or an inflammatory osteoarthritis.
  • the pharmaceutical compositions of the invention may be used for the treatment of osteoarthritis and arthritis are used on any joint, such as knee joint, hip joint, ankle, shoulder joint, vertebral joints, finger joints, elbow joint, toe joints, temporomandibular joint and wrist.
  • the arthritis to be treated may be an infection-related arthritis such as bacterial arthritis or a noninfection-related arthritis such as rheumatoid arthritis, psoriatic arthritis or gouty arthritis.
  • the pharmaceutical composition of the invention and / or the kit of the invention may also be for use in the treatment of a disease other than one or more of said diseases (such as rheumatoid arthritis).
  • the degenerative spinal disease to be treated may be, for example, a herniated disc.
  • Autoimmune diseases include, among others, autoimmune diseases of the joints such as ankylosing spondylitis, rheumatoid arthritis and systemic lupus erythematosus, as well as other autoimmune diseases such as atopic dermatitis and alopecia areata (circular hair loss).
  • compositions of the invention or the kit according to the invention are preferably intended for local administration. Therefore, they are in preferred embodiments for injection, in particular for injection into the body region to be treated, in particular in the affected joint, to the affected nerve root or in the affected disc, or determined in the local environment thereof.
  • the pharmaceutical composition is thus intended in particular for intraarticular and / or periradicular injection.
  • the pharmaceutical compositions of the invention may be formulated for topical administration, particularly as a cream or gel, or for systemic administration, especially oral administration in the form of tablets, capsules or lozenges.
  • the mode of administration depends inter alia on the disease to be treated. In local osteoarthritis or degenerative spinal disease, therefore, local administration of the pharmaceutical compositions of the invention is preferred.
  • the pharmaceutical compositions of the invention or the kit of the invention are intended or suitable only for administration other than systemic administration.
  • compositions according to the invention are in each case suitably formulated in a manner known to the person skilled in the art for the various administration routes.
  • a suitable for injection pharmaceutical composition is preferably present as a solution or dispersion or in dry form, for example as a powder or lyophilisate, which must be dissolved prior to injection in a suitable solvent such as water.
  • the pharmaceutical compositions of the invention contain the cytokine antagonist and / or the corticosteroid in therapeutically effective amounts.
  • the cytokine antagonist is therefore preferably in a concentration of 0.5 to 150 mg / dose is present in the cytokine antagonist-containing pharmaceutical compositions, but may also be present in significantly lower concentrations such as 1 ng / dose or more, for example between 1 and 1000 ng / dose.
  • the corticosteroid is preferably present at a concentration of from 1 to 80 mg / dose, more preferably from 5 to 40 mg / dose in the corticosteroid-containing pharmaceutical compositions.
  • the pharmaceutical compositions of the invention may further contain one or more excipients and / or one or more excipients.
  • the pharmaceutical compositions of the invention may also be intended for the treatment of patients already receiving another treatment for the relevant disease, i. have been subjected to, for example, osteoarthritis, arthritis, and / or degenerative spinal disease, especially if this other treatment has not been successful or the disease symptoms have at least partially returned despite initially successful treatment.
  • this other treatment is a therapy with a cytokine antagonist such as Anakinra or Orthokin but without a corticosteroid, or a therapy with a corticosteroid, especially a glucocorticoid as described above, but without a cytokine antagonist.
  • Patients according to the invention may be humans as well as animals suffering from any of the diseases described herein.
  • the pharmaceutical compositions of the invention may be useful for the treatment of a human and / or an animal such as a dog, a cat, a horse, a cow, a pig, a goat, a camel or the like.
  • the pharmaceutical compositions of the invention are intended for use in combination therapy with exosomes.
  • Exosomes are small, lipid-membrane-enveloped vesicles found in the extracellular space of, for example, the human body. They are formed by cells by cleavage from the cellular plasma membrane and secreted. Normally, these exosomes also contain proteins taken from their cell of origin.
  • the exosomes may be contained directly in the pharmaceutical composition of the present invention or may be administered simultaneously or sequentially in a separate composition.
  • the exosomes are obtained from a blood sample.
  • the exosomes are preferably autologous or allogenic with respect to the patient to be treated. Methods for obtaining and administering exosomes are described, for example, in patent application WO 2006/007529 A2.
  • the pharmaceutical compositions of the invention are for a treatment in which exosomes are first recovered from a patient's blood sample and subsequently re-administered to that patient together with a cytokine antagonist and a corticosteroid.
  • the combination therapy involves exosomes obtained from a blood sample of a patient, it is sometimes preferable to perform a centrifugation step of at least 100,000 g in order to concentrate the exosomes, since such high relative centrifugal accelerations are particularly are suitable for concentrating exosomes.
  • first, second, third, fourth, fifth and / or sixth aspects of the present invention a pharmaceutical composition containing a corticosteroid together with a cytokine antagonist, a pharmaceutical composition containing a cytokine antagonist for use in a combination therapy together with a corticosteroid
  • a pharmaceutical composition containing a corticosteroid for use in a combination therapy together with a cytokine antagonist, kit and / or uses of a cytokine antagonist or corticosteroid, respectively preferably, such a centrifugation step is carried out in the treatment of diseases in which an increased concentration of exosomes makes sense, preferably in the treatment of rheumatoid arthritis.
  • centrifugation step is generally performed in the event that the combination therapy involves exosomes derived from a blood sample of a patient.
  • the centrifugation step with at least 100,000 g is preferably carried out for at least 30 minutes, in particular at least 60 minutes, since the concentration is then particularly effective.
  • a cytokine antagonist e.g., recombinant IL-1 Ra recombinant or IL-1 Ra derived from autologous blood samples
  • corticosteroid e.g., corticosteroid
  • VAS visual analog scale for pain sensation (0 to 10)
  • CRP c-reactive protein a blood-detectable marker of inflammation
  • Diagnosis coxarthrosis re, grade III-IV in radiograph; Hip pain with limp for about 3 years, patient still does not want a hip replacement; clinical limp, IRO / ARO re hip 5/0/5, incidental Lyme disease known;
  • Diagnosis clinically and radiologically rhizarthrosis re moderate with severe pain (VAS 6) with functional impairment when gripping objects. Cortisone injections in the past without success.
  • Diagnosis Clinically and radiologically moderate knee arthrosis bds grade II-III for many years. Hyaluronic acid injections and injections of cortisone in the knee in the past without success
  • Diagnosis Radiological and Clinical Inpingement Ii Shoulder for about 2 years; previous cortisone injections without success; Abduction reduced by about 15 degrees
  • Diagnosis Clinically and radiologically medial knee osteoarthritis re grade IV and retropatellar for many years; From the outside, the attempt to have a remodeling osteotomy or a knee replacement on the right was recommended. However, the patient wanted a conservative therapeutic trial. In the past, injections of hyaluronic acid and cortisone (triamcinolone) had no clinical success.
  • Diagnosis Clinical and radiological (MRI) internal nerve damage right knee III with marked deterioration of function and pain medial right knee. OP was recommended, patient would like to not surgical alternative.
  • MRI Radiological
  • Diagnosis Clinically and radiologically lumbar facet arthrosis for many years, secondary to diverticulum. Inpatient treatment with cortisone injections into the lumbar facets without success.
  • the pain level was previously defined as 100.
  • the pain level afterward was 30, 0, 30, 0, 35, 0, 40, 60, 40, 50, 80 and 50 for the individual patients.
  • N 129
  • average follow-up period 3 months
  • average pain reduction 71% (i.e., reduction from 100% pain before treatment to 29% after treatment), strikingly rapid onset of action.
  • Diagnosis Clinically radiologically there is medial and retropatellar gonarthrosis Ii, grade IV. A total of knee replacement has already been planned on the left;
  • Diagnosis severe shoulder pain II for 6 months (VAS 8); since then significantly disturbed sleep. The patient has been unable to sleep for the past 6 months, which is why he is disturbed by general well-being. Numerous injections of cortisone into the left shoulder were unsuccessful. A surgery for the left shoulder was agreed. Here an attempt should be made to avoid the operation. Radiographic and clinical signs of partial rotator cuff rupture and subacromial tightness with complete left shoulder stiffness; Discomfort left arm with weakness of force of hand and forearm left, grade 4.
  • Diagnosis Complete right shoulder stiffness for approx. 8 months. All previous therapies were without success, an operation was planned. Patient wanted attempt of renewed conservative treatment. The night sleep was not possible for several weeks. Shoulder pain starting on the left side, main findings but right shoulder, there VAS 9 with severe acute attacks up to 10, as a result reduced general condition.
  • Therapy Treatment of the right shoulder from a combination of 2 ml Orthokin administered separately together with another syringe from a combination of 150 mg Anakinra and 5 mg Triamcinolone on 6 consecutive days.
  • Diagnosis Severe juvenile rheumatoid arthritis for approx. 15 years.
  • Blood was drawn for preparation of exosomes in a 6 ml syringe (Orthokin syringe). Thereafter, incubation at 37 degrees for 24 h, wherein when filling the syringe with blood previously 1 mg Anankinra (IL-1 Ra) and 2 mg prednisolone were applied to the syringe. After various centrifugation steps (up to 100,000 g), the mixture was then applied to the patient's OSGe and shoulders.
  • IL-1 Ra Anankinra
  • prednisolone prednisolone

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Abstract

La présente invention concerne des compositions pharmaceutiques destinées à une thérapie combinatoire associant un antagoniste de la cytokine et un corticostéroïde. Ladite thérapie combinatoire permet de traiter des maladies telles que l'arthrose, des affections des tendons et/ou des affections dégénératives de la colonne vertébrale
PCT/EP2011/057645 2010-12-10 2011-05-11 Préparations combinées contenant un antagoniste de la cytokine et un corticostéroïde Ceased WO2012076194A1 (fr)

Applications Claiming Priority (2)

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EPPCT/EP2010/069427 2010-12-10
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