Extended cycle multiphasic oral contraceptive method
Abstract
A multiphase combination of prolonged cycle and contraceptive kit comprising a plurality of single cycle packages, each single cycle package containing a group of daily doses of each of the Phase I, II, and III compositions, or a single package containing a plurality of groups of daily doses of each of the Phase I, II and III compounds, in which: (a) the daily doses of the Phase I composition contain a progestogen in an amount equivalent to 0.3 to 1.5 mg of norethindrone acetate and an estrogen in an amount equivalent to 5 to 30 μg of ethinyl estradiol; (b) the Daily doses of the Phase II composition contain a progestogen in an amount equivalent to 0.3 to 1.5 mg of norethindrone acetate and an estrogen in an amount equivalent to 10 to 40 μg of ethinyl estradiol; and (c) the daily doses of Phase III composition they contain a progestogen in an amount equivalent to 0.3 to 1.5 mg of norethindrone acetate and an estrogen in an amount equivalent to 5 to 30 µg of ethinyl estradiol; and wherein the plurality of single cycle containers or the single package optionally contains a Phase IV composition containing a placebo or an iron supplement; and wherein the amount of the estrogen equivalent to ethinyl estradiol in the Phase II composition is at least 5 µg greater than the amount of the estrogen equivalent to ethinyl estradiol in each of the Phase I and III compositions; wherein said estrogen is selected from the group consisting of ethinyl estradiol, 17-β-estradiol, estrogen acetate, conjugated estrogens, mestranol, estrone and salts thereof; and wherein said progestin is selected from the group consisting of norethindrone acetate, drospirenone, desogestrel, trimegestone, norethindrone, levonorgestrel, 3-ketodesogestrel, gesturedeno, demegestone, didrogesterone, medrogestone and methoxyprogesterone.
Term
Term ended
Projected expiry passed 14 March 2025, 1.5 years ago.
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41 claims: 4 independent, 37 dependent
- 1ES 2 397 983 T3 REIVINDICACIONES 1. Una combinación multifásica de ciclo prolongado y kit anticonceptivo que comprende una pluralidad de envases de ciclo único, conteniendo cada envase de ciclo único un grupo de dosis diarias de cada una de las composiciones de Fase I, II, y III, o bien un paquete único que contiene una pluralidad de grupos de dosis diarias de cada una de las composiciones de Fase I, II y III, en la que:(a) las dosis diarias de la composición de Fase I contienen un progestágeno en una cantidad equivalente a 0,3 a 1,5 mg de acetato de noretindrona y un estrógeno en una cantidad equivalente a 5 a 30 pg de etinilestradiol;(b) las dosis diarias de la composición de Fase II contienen un progestágeno en una cantidad equivalente a 0,3 a 1,5 mg de acetato de noretindrona y un estrógeno en una cantidad equivalente a 10 a 40 pg de etinilestradiol;y (c) las dosis diarias de la composición de Fase III contienen un progestágeno en una cantidad equivalente a 0,3 a 1,5 mg de acetato de noretindrona y un estrógeno en una cantidad equivalente a 5 a 30 pg de etinilestradiol;y en la que la pluralidad de envases de ciclo único o el envase único contiene de forma opcional una composición de Fase IV que contiene un placebo o un suplemento de hierro;y en la que la cantidad del estrógeno equivalente a etinilestradiol en la composición de Fase II es por lo menos 5 pg mayor que la cantidad del estrógeno equivalente a etinilestradiol en cada una de las composiciones de Fase I y III;en la que dicho estrógeno está seleccionado del grupo que consiste en etinilestradiol, 17-p-estradiol, acetato de estradiol, estrógenos conjugados, mestranol, estrona y sales de los mismos;y en la que dicho progestágeno está seleccionado del grupo que consiste en acetato de noretindrona, drospirenona, desogestrel, trimegestona, noretindrona, levonorgestrel, 3-cetodesogestrel, gestodeno, demegestona, didrogesterona, medrogestona y medroxiprogesterona.
- 2El kit de acuerdo con la reivindicación 1, en el que el progestágeno es acetato de noretindrona.
- 3El kit de acuerdo con la reivindicación 1, en el que el estrógeno está seleccionado del grupo que consiste en etinilestradiol y sales del mismo, en el que el estrógeno es, de forma opcional, etinilestradiol.
- 4El kit de acuerdo con la reivindicación 1, en el que el kit comprende además de 2 a 9 dosis de la composición de Fase IV.
- 5El kit de acuerdo con la reivindicación 4, en el que la cantidad del progestágeno equivalente a acetato de noretindrona en las composiciones de Fase I, II y III es 1 mg de acetato de noretindrona.
- 6El kit de acuerdo con la reivindicación 5, en el que la cantidad del estrógeno equivalente a etinilestradiol en la composición de Fase I es 25 pg de etinilestradiol, la cantidad del estrógeno equivalente a etinilestradiol en la composición de Fase II es 30 pg de etinilestradiol, la cantidad del estrógeno equivalente a etinilestradiol en la composición de Fase III es 25 pg de etinilestradiol, y la composición de Fase IV contiene 75 mg de fumarato ferroso.
- 7El kit de acuerdo con la reivindicación 5, en el que la cantidad del estrógeno equivalente a etinilestradiol en la composición de Fase I es 20 pg de etinilestradiol, la cantidad del estrógeno equivalente a etinilestradiol en la composición de Fase II es 25 pg de etinilestradiol, la cantidad del estrógeno equivalente a etinilestradiol en la composición de Fase III es 20 pg de etinilestradiol, y la composición de Fase IV contiene 75 mg de fumarato ferroso.
- 8El kit de acuerdo con la reivindicación 6 o 7, en el que el estrógeno y el progestágeno de las composiciones de Fase I, II y II son etinilestradiol y acetato de noretindrona respectivamente.
- 9El kit de acuerdo con la reivindicación 1, en el que cada grupo de dosis de composición de Fase I contiene de 4 a 7 dosis, cada grupo de dosis de composiciones de Fase II contiene de 8 a 16 dosis y cada grupo de dosis de composiciones de Fase III contiene de 4 a 7 dosis.
- 10El kit de acuerdo con la reivindicación 9, en el que el número de grupos de dosis de las composiciones de Fase I, II y III es de 2 a 9.
- 11El kit de acuerdo con la reivindicación 10, en el que dicho kit contiene un grupo de dosis de una composición de Fase IV que equivale de 2 a 9 dosis diarias.
- 12El kit de acuerdo con la reivindicación 11, en el que la cantidad de progestágeno equivalente a acetato de noretindrona en las composiciones de Fase I, II y IIII es 1 mg de acetato de noretindrona.
- 13El kit de acuerdo con la reivindicación 12, en el que la cantidad del estrógeno equivalente a etinilestradiol en la composición de Fase I es 20 pg de etinilestradiol, la cantidad del estrógeno equivalente a etinilestradiol en la composición de Fase II es 25 pg de etinilestradiol, y la cantidad del estrógeno equivalente a etinilestradiol en la composición de Fase III es 20 pg de etinilestradiol.
- 14El kit de acuerdo con la reivindicación 12, en el que la cantidad del estrógeno equivalente a etinilestradiol en la ES 2 397 983 T3 composición de Fase I es 25 pg de etinilestradiol, la cantidad del estrógeno equivalente a etinilestradiol en la composición de Fase II es 30 pg de etinilestradiol, y la cantidad del estrógeno equivalente a etinilestradiol en la composición de Fase III es 25 pg de etinilestradiol.
- 15El kit de acuerdo con la reivindicación 13 o 14, en el que el estrógeno y el progestágeno en las composiciones de Fase I, II y II son etinilestradiol y acetato de noretindrona respectivamente.
- 16El kit de acuerdo con la reivindicación 15, en el que cada grupo de dosis de la composición de Fase I contiene 5 dosis, cada grupo de dosis de la composición de Fase II contiene de 11 a 14 dosis, y cada grupo de dosis de la composición de Fase III contiene 5 dosis.
- 17El kit de acuerdo con la reivindicación 1, en el que cada una de las composiciones de Fase I, II y III contiene de forma independiente el progestágeno en una cantidad equivalente a 0,5 a 1,5 mg de acetato de noretindrona.
- 18Un medicamento multifásico de ciclo prolongado para su uso en un procedimiento anticonceptivo en mujeres en edad fértil, comprendiendo el medicamento multifásico de ciclo prolongado la administración secuencial de:(a) una composición de Fase I que contiene el progestágeno en una cantidad equivalente a 0,3 a 1,5 mg de acetato de noretindrona y el estrógeno en una cantidad equivalente a 5 a 30 pg de etinilestradiol durante 4 a 7 días;(b) una composición de Fase II que contiene el progestágeno en una cantidad equivalente a 0,3 a 1,5 mg de acetato de noretindrona y el estrógeno en una cantidad equivalente a 10 a 40 pg de etinilestradiol durante 8 a 16 días;y (c) una composición de Fase III que contiene el progestágeno en una cantidad equivalente a 0,3 a 1,5 mg de acetato de noretindrona y el estrógeno en una cantidad equivalente a 5 a 30 pg de etinilestradiol durante 4 a 7 días, y en el que el medicamento multifásico de ciclo prolongado contiene de forma opcional una composición de Fase IV que contiene un placebo o un suplemento de hierro;en el que la administración secuencial de las composiciones de Fase I, II y III se repite al día siguiente de completar la administración de la composición de Fase III para proporcionar dicho medicamento multifásico de ciclo prolongado, y en el que la cantidad del estrógeno equivalente a etinilestradiol en la composición de Fase II es por lo menos 5 pg mayor que la cantidad del estrógeno equivalente a etinilestradiol en cada una de las composiciones de Fase I y III;en el que dicho estrógeno está seleccionado del grupo que consiste en etinilestradiol, 17-p-estradiol, acetato de estradiol, estrógenos conjugados, mestranol, estrona y sales de los mismos;y en el que dicho progestágeno está seleccionado del grupo que consiste en acetato de noretindrona, drospirenona, desogestrel, trimegestona, noretindrona, levonorgestrel, 3-cetodesogestrel, gestodeno, demegestona, didrogesterona, medrogestona y medroxiprogesterona.
- 19El medicamento multifásico de ciclo prolongado para su uso de acuerdo con la reivindicación 18, en el que el ciclo anticonceptivo prolongado es de 42 a 140 días.
- 20El medicamento multifásico de ciclo prolongado para su uso de acuerdo con la reivindicación 19, en el que la composición de Fase IV, que es un placebo o un suplemento de hierro, se administra durante 2 a 9 días tras completar el ciclo anticonceptivo prolongado.
- 21El medicamento multifásico de ciclo prolongado para su uso de acuerdo con la reivindicación 20, en el que dicho suplemento de hierro comprende fumarato ferroso.
- 22El medicamento multifásico de ciclo prolongado para su uso de acuerdo con la reivindicación 18, en el que la cantidad del estrógeno equivalente a etinilestradiol en la composición de Fase II es por lo menos 10 pg mayor que la cantidad del estrógeno equivalente a etinilestradiol en cada una de las composiciones de Fase I y III.
- 23El medicamento multifásico de ciclo prolongado para su uso de acuerdo con la reivindicación 18, en el que la cantidad del progestágeno equivalente a acetato de noretindrona en las composiciones de Fase I, II y III es 1 mg de acetato de noretindrona.
- 24El medicamento multifásico de ciclo prolongado para su uso de acuerdo con la reivindicación 23, en el que la cantidad del estrógeno equivalente a etinilestradiol en la composición de Fase I es 20 pg de etinilestradiol, la cantidad del estrógeno equivalente a etinilestradiol en la composición de Fase II es 25 pg de etinilestradiol, y la cantidad del estrógeno equivalente a etinilestradiol en la composición de Fase III es 20 pg de etinilestradiol.
- 25El medicamento multifásico de ciclo prolongado para su uso de acuerdo con la reivindicación 23, en el que la cantidad del estrógeno equivalente a etinilestradiol en la composición de Fase I es 25 pg de etinilestradiol, la cantidad del estrógeno equivalente a etinilestradiol en la composición de Fase II es 30 pg de etinilestradiol, y la cantidad del estrógeno equivalente a etinilestradiol en la composición de Fase III es 25 pg de etinilestradiol. ES 2 397 983 T3
- 26El medicamento multifásico de ciclo prolongado para su uso de acuerdo con una cualquiera de las reivindicaciones 24 y 25, en el que el estrógeno y el progestágeno de las composiciones de Fase I, II y III son etinilestradiol y acetato de noretindrona respectivamente.
- 27El medicamento multifásico de ciclo prolongado para su uso de acuerdo con la reivindicación 26, en el que la composición de Fase I se administra durante 5 días en cada administración secuencial, la composición de Fase II se administra durante 11 a 14 días en cada administración secuencial, y la composición de Fase III se administra durante 5 días en cada administración secuencial.
- 28El medicamento multifásico de ciclo prolongado para su uso de acuerdo con la reivindicación 27, en el que la composición de Fase IV se administra durante 2 a 9 días hasta completar la administración secuencial repetida de las composiciones de Fase I, II y III.
- 29El medicamento multifásico de ciclo prolongado para su uso de acuerdo con la reivindicación 21, en el que, durante la administración secuencial de las composiciones de Fase I, II y III, la cantidad del progestágeno equivalente a acetato de noretindrona en la composición de Fase I es 1,0 mg de acetato de noretindrona y se administra durante 5 días, la cantidad del progestágeno equivalente a acetato de noretindrona en la composición de Fase II es 1,0 mg de acetato de noretindrona y se administra durante 11 días, la cantidad de progestágeno equivalente a acetato de noretindrona en la composición de Fase III es 1,0 mg de acetato de noretindrona y se administra durante 5 días, y la composición de Fase IV contiene 75 mg de fumarato ferroso y se administra durante 7 días.
- 30El medicamento multifásico de ciclo prolongado para su uso de acuerdo con la reivindicación 21, en el que, durante la administración secuencial de las composiciones de Fase I, II y III, la cantidad del progestágeno equivalente a acetato de noretindrona en la composición de Fase I es 1,0 mg de acetato de noretindrona y se administra durante 5 días, la cantidad del progestágeno equivalente a acetato de noretindrona en la composición de Fase II es 1,0 mg de acetato de noretindrona y se administra durante 14 días, la cantidad del progestágeno equivalente a acetato de noretindrona en la composición de Fase III es 1,0 mg de acetato de noretindrona y se administra durante 5 días, y la composición de Fase IV contiene 75 mg de fumarato ferroso y se administra durante 4 días.
- 31El medicamento multifásico de ciclo prolongado para su uso de acuerdo con una cualquiera de las reivindicaciones 29 y 30, en el que la cantidad del estrógeno equivalente a etinilestradiol en la composición de Fase I es 25 pg de etinilestradiol, la cantidad del estrógeno equivalente a etinilestradiol en la composición de Fase II es 30 pg de etinilestradiol, y la cantidad del estrógeno equivalente a etinilestradiol en la composición de Fase III es 25 pg de etinilestradiol.
- 32El medicamento multifásico de ciclo prolongado para su uso de acuerdo con la reivindicación 31, en el que el estrógeno y el progestágeno en las composiciones de Fase I, II y III son etinilestradiol y acetato de noretindrona respectivamente.
- 33El medicamento multifásico de ciclo prolongado para su uso de acuerdo con una cualquiera de las reivindicaciones 29 y 30, en el que la cantidad del estrógeno equivalente a etinilestradiol en la composición de Fase I es 20 pg de etinilestradiol, la cantidad del estrógeno equivalente a etinilestradiol en la composición de Fase II es 25 pg de etinilestradiol, y la cantidad del estrógeno equivalente a etinilestradiol en la composición de Fase III es 20 pg de etinilestradiol.
- 34El medicamento multifásico de ciclo prolongado para su uso de acuerdo con la reivindicación 33, en el que el estrógeno y el progestágeno en las composiciones de Fase I, II y III son etinilestradiol y acetato de noretindrona respectivamente.
- 35El medicamento multifásico de ciclo prolongado para su uso de acuerdo con la reivindicación 18, en el que, durante la administración secuencial de las composiciones de Fase I, II y III, la cantidad del progestágeno equivalente a acetato de noretindrona en la composición de Fase I es 1,0 mg de acetato de noretindrona y se administra durante 5 días, la cantidad del progestágeno equivalente a acetato de noretindrona en la composición de Fase II es 1,0 mg de acetato de noretindrona y se administra durante 11 días, la cantidad del progestágeno equivalente a acetato de noretindrona en la composición de Fase III es 1,0 mg de acetato de noretindrona y se administra durante 5 días, y en el que la cantidad del estrógeno equivalente a etinilestradiol en la composición de Fase I es 25 pg de etinilestradiol, la cantidad del estrógeno equivalente a etinilestradiol en la composición de Fase II es 30 pg de etinilestradiol, y la cantidad del estrógeno equivalente a etinilestradiol en la composición de Fase III es 25 pg de etinilestradiol.
- 36El medicamento multifásico de ciclo prolongado para su uso de acuerdo con la reivindicación 18, en el que, durante la administración secuencial de las composiciones de Fase I, II y III, la cantidad del progestágeno equivalente a acetato de noretindrona en la composición de Fase I es 1,0 mg de acetato de noretindrona y se administra durante 5 días, la cantidad del progestágeno equivalente a acetato de noretindrona en la composición de Fase II es 1,0 mg de acetato de noretindrona y se administra durante 14 días, la cantidad del progestágeno ES 2 397 983 T3 equivalente a acetato de noretindrona en la composición de Fase III es 1,0 mg de acetato de noretindrona y se administra durante 5 días, y en el que la cantidad del estrógeno equivalente a etinilestradiol en la composición de Fase I es 25 pg de etinilestradiol, la cantidad del estrógeno equivalente a etinilestradiol en la composición de Fase II es 30 pg de etinilestradiol, y la cantidad del estrógeno equivalente a etinilestradiol en la composición de Fase III es 25 pg de etinilestradiol.
- 37El medicamento multifásico de ciclo prolongado para su uso de acuerdo con una cualquiera de las reivindicaciones 18, 35 o 36, en el que el progestágeno es acetato de noretindrona.
- 38El medicamento multifásico de ciclo prolongado para su uso de acuerdo con una cualquiera de las reivindicaciones 18, 35 o 36, en el que el estrógeno está seleccionado del grupo que consiste en etinilestradiol y sales del mismo, en el que el estrógeno es, opcionalmente, etinilestradiol.
- 39El medicamento multifásico de ciclo prolongado para su uso de acuerdo con una cualquiera de las reivindicaciones 18 a 22, en el que cada una de las composiciones de Fase I, II y III contiene de forma independiente el progestágeno en una cantidad equivalente a 0,5 a 1,5 mg de acetato de noretindrona.
- 40El kit de acuerdo con la reivindicación 1, en el que la cantidad del progestágeno equivalente a acetato de noretindrona en la composición de Fase I es 1,0 mg de acetato de noretindrona y se administra durante 5 días, la cantidad del progestágeno equivalente a acetato de noretindrona en la composición de Fase II es 1,0 mg de acetato de noretindrona y se administra durante 11 días, la cantidad del progestágeno equivalente a acetato de noretindrona en la composición de Fase III es 1,0 mg de acetato de noretindrona y se administra durante 5 días, y en el que la cantidad del estrógeno equivalente a etinilestradiol en la composición de Fase I es 25 pg de etinilestradiol, la cantidad del estrógeno equivalente a etinilestradiol en la composición de Fase II es 30 pg de etinilestradiol, y la cantidad del estrógeno equivalente a etinilestradiol en la composición de Fase III es 25 pg de etinilestradiol.
- 41El kit de acuerdo con la reivindicación 1, en el que la cantidad del progestágeno equivalente a acetato de noretindrona de la composición de Fase I es 1,0 mg de acetato de noretindrona y se administra durante 5 días, la cantidad del progestágeno equivalente a acetato de noretindrona en la composición de Fase II es 1,0 mg de acetato de noretindrona y se administra durante 14 días, la cantidad del progestágeno equivalente a acetato de noretindrona en la composición de Fase III es 1,0 mg de acetato de noretindrona y se administra durante 5 días, y en el que la cantidad del estrógeno equivalente a etinilestradiol en la composición de Fase I es 25 pg de etinilestradiol, la cantidad del estrógeno equivalente a etinilestradiol en la composición de Fase II es 30 pg de etinilestradiol, y la cantidad del estrógeno equivalente a etinilestradiol en la composición de Fase III es 25 pg de etinilestradiol.
Independent claims41
55 paragraphs in 6 sections, as filed
ES 2 397 983 T3
DESCRIPTION
Long-cycle multiphase oral contraceptive procedure
Background of the invention
Field of the invention
The present invention relates to a multiphasic estrogenic / progestogenic contraceptive regimen that can be used for an extended period of time. In the multiphase regimen of the present invention, the amount of estrogen administered in the intermediate phase is greater than the amount of estrogen administered in the initial and final phases. The regimen of the invention provides contraceptive efficacy and allows the user to have control over the menstrual cycle. A multiphasic contraceptive kit that can be used to implement the contraceptive procedure is also contemplated.
Related Background Art
Contraceptive compositions containing both estrogenic and progestogenic compounds are known to be very effective in controlling ovulation and conception. The progestogenic component of the composition is the main cause of the contraceptive efficacy of the composition, while the estrogenic component is included to reduce unwanted side effects such as breakthrough menorrhagia or spotting. In fact, small amounts of estrogen can help stabilize the endometrium and allow cyclical withdrawal bleeding, similar to that of the natural menstrual cycle.
The first of these estrogenic / progestogenic contraceptive compositions was administered monophasically (fixed dose) and contained a relatively high level of estrogenic component. To minimize the main negative side effect on blood clotting factors, the estrogen dose was lowered over time. However, as estrogen doses have been reduced, incidences of breakthrough menstrual bleeding or unwanted spotting have increased across the board.
Multiphasic oral contraceptives were introduced to artificially simulate the natural rise in progesterone throughout the cycle to try to solve this problem. However, reducing the estrogenic potential of such compositions without reducing contraceptive efficacy and increasing unwanted adverse side effects has become a constant goal.
In US Patent No. 5,888,543, different regimens are disclosed in which a combination of progestin and estrogen is administered in monophasic and multiphasic treatment regimens (various doses, eg, biphasic or triphasic). In one embodiment, a combination of a progestin composition and an estrogen composition is administered such that the daily dosage of the second phase progestin is higher than the daily dosage of the progestin in the initial phase, and the dosage The daily dose of estrogen in the second phase is equal to or higher than the daily dosage of estrogen in the initial phase.
A particularly advantageous technique for reducing total estrogen delivery is disclosed in US Patent No. 4,962,098. This patent describes a triphasic method of contraception that uses a combination of progestogen and estrogen in which the amount of the latter is increased in a stepwise manner throughout the three phases. The first phase lasts from 4 to 7 days; the second from 5 to 8 days and the third from 7 to 12 days. Preferably, the administration of the contraceptive compositions for the three phases will be 21 days, followed by a period of 7 days with placebo. The amount of progestogen used in the three phases is 0.5 to 1.5 mg of norethindrone acetate, while the amount of ethinyl estradiol used in the initial phase is 10 to 30 pg, in the second it is from 20 to 40 pg and in the third it is from 30 to 50 pg.
United States Patent No. 5,010,070 is related to United States Patent No. 4,962,098 and discloses a multiphasic contraceptive kit containing ethinyl estradiol and norethindrone acetate in the first, second and third phase compositions.
A prolonged oral contraceptive regimen is disclosed in US Patent No. 5,898,032 where estrogen and progestin are administered in a combination dosage form, preferably monophasic, for 60 to 110 consecutive days, followed by a period without administration of 3 to 10 days. The amount of estrogen and progestin administered daily is equivalent to approximately 5-35 pg of ethinyl estradiol and approximately 0.025 to 10 mg of norethindrone acetate respectively. In a particular embodiment, the combined dosage form is administered for 84 days followed by 7 pill-free days. Following this particular regimen is claimed to involve four treatments and four menstrual cycles throughout the year.
However, there are drawbacks to using a long-term monophasic oral contraceptive regimen. Monophasic oral contraceptives given over a long period of time usually have poor initial cycle control. Another drawback is that once breakthrough menorrhagia is controlled, the user is functionally amenorrheic. Psychologically, this does not assure the client that she is not pregnant.
ES 2 397 983 T3
No long-cycle regimen using a multiphase contraceptive regimen has been described or suggested. A major concern is that multiphase regimens vary the ratio of estrogen to progestogen in such a way that the amount of estrogen and / or progestogen that is administered in the final phase, for example in Phase III, is much greater than the amount of estrogen. and / or progestogen that is administered in the initial phase, for example, in Phase I. In a prolonged cycle regimen, where the cycle continues sequentially from the first phase to the final phase and repeats again starting with the first phase, the pronounced decrease in estrogen and / or progestogen levels from the final phase to the initial phase could increase the potential for breakthrough menorrhagia, which is unacceptable.
A prolonged oral contraceptive regimen that reduces the risk of the user being functionally amenorrheic while taking advantage of the benefits of a multiphasic contraceptive procedure, for example, reducing the risk of breakthrough menorrhagia, improving blood pressure control, would be highly desirable for users. bleeding and effective means of contraception.
Summary of the invention
The present invention relates to a prolonged cycle multiphasic medicinal product for use in a contraceptive procedure for women of childbearing age, the prolonged cycle multiphasic medicinal product comprising the sequential administration of (a) a Phase I composition containing a progestin in an amount equivalent to about 0.3 to about 1.5 mg, preferably from about 0.5 to about 1.5 mg of norethindrone acetate and an estrogen in an amount equivalent to about 5 to about 30 pg of ethinyl estradiol for about 4 to about 7 days; (b) a Phase II composition containing a progestin in an amount equivalent to about 0.3 to about 1.5 mg, preferably about 0.5 to about 1.5 mg of norethindrone acetate and an estrogen in an amount equivalent to about 10 to about 40 pg of ethinyl estradiol for about 8 to about 16 days; (c) a Phase III composition containing a progestin in an amount equivalent to about 0.3 to about 1.3 mg, preferably about 0.5 to about 1.5 mg of norethindrone acetate and an estrogen in an amount equivalent to about 5 to about 30 pg of ethinyl estradiol for about 4 to about 7 days; and (d) optionally, a Phase IV composition that is a placebo or non-steroidal component, such as, for example, ferrous fumarate, for about 2 to about 9 days, wherein the amount of estrogen equivalent to ethinyl estradiol in the Phase II composition is at least 5 pg greater than the amount of estrogen equivalent to ethinyl estradiol in each of the Phase I and III compositions.
In a particularly significant embodiment of the invention, the administration of the Phase I, II and III compositions is repeated the day after completion of the administration of the Phase III composition for use in a prolonged cycle multiphasic oral contraceptive procedure. Preferably, the prolonged contraceptive cycle is in a range of from about 42 to about 140 days, and preferably from about 63 to about 120 days.
Yet another embodiment of the present invention relates to a multiphasic combination and contraceptive kit comprising a container containing the daily dosages of (a) a Phase I composition containing a progestin in an amount equivalent to about 0.3 to about 1.5 mg, preferably from about 0.5 to about 1.5 mg of norethindrone acetate and an estrogen in an amount equivalent to about 5 to about 30 pg of ethinyl estradiol; (b) a Phase II composition containing a progestin in an amount equivalent to about 0.3 to about 1.5 mg, preferably about 0.5 to about 1.5 mg of norethindrone acetate and an estrogen in an amount equivalent to about 10 to about 40 pg of ethinyl estradiol; (c) a Phase III composition containing a progestin in an amount equivalent to about 0.3 mg to about 1.5 mg, preferably about 0.5 to about 1.5 mg of norethindrone acetate and an estrogen in a amount equivalent to about 5 to about 30 pg of ethinyl estradiol; and (d) optionally, a Phase IV composition that is a placebo or non-steroidal component, wherein the amount of estrogen equivalent to ethinyl estradiol in the Phase II composition is at least 5 pg greater than the amount of estrogen. equivalent to ethinylestradiol in each of the Phase I and III compositions.
The kit can be designed for use as a single cycle or as an extended cycle. For use as a single cycle, the kit contains from about 4 to about 7 doses of the Phase I composition; from about 8 to about 16 doses of the Phase II composition; and from about 4 to about 7 doses of the Phase III composition. For use as an extended cycle, the kit preferably contains a plurality of dose groups of the Phase I, Phase II and Phase III compositions. Both the single cycle and extended cycle kits, optionally and preferably, may contain from about 2 to about 9 doses of a Phase IV composition. Of course, it is also possible to carry out an extended cycle of the present invention by employing a plurality of the kits described above for use as a single cycle.
Detailed description of the invention
For the purposes of the present invention, the designation "pg" refers to micrograms and mg to milligrams.
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By practicing the multiphasic contraceptive regimen described herein, the user advantageously improves her control over menstrual bleeding while taking the estrogenic / progestogenic contraceptive compositions of the present invention.
A remarkable feature of the present invention is that the amount of estrogen that is administered in the composition of the intermediate phase (Phase II) is greater than the amount of estrogen that is administered in each of the compositions of the initial and final phases ( Phase I and Phase III). Furthermore, the amount of estrogen that is administered in the initial phase composition (Phase I) should correspond to the amount of estrogen that is administered in the final phase composition (Phase III). In a particularly preferred embodiment, the amount of ethinyl estradiol in the Phase II composition is at least 5 pg greater, preferably at least about 10 pg greater, than the amount of ethinyl estradiol in each of the Phase I and Phase III compositions. .
In a particularly preferred embodiment, the amount of estrogen in Phase I is equivalent to approximately 20 pg of ethinyl estradiol, the amount of estrogen in Phase II is equivalent to approximately 25 pg of ethinyl estradiol, and the amount of estrogen in Phase III is equivalent. to approximately 20 pg of ethinyl estradiol. In another particularly preferred embodiment, the amount of estrogen in Phase I is equivalent to approximately 25 pg of ethinyl estradiol, the amount of estrogen in Phase II is equivalent to approximately 30 pg of ethinyl estradiol, and the amount of estrogen in Phase III is equivalent. to about 25 pg of ethinyl estradiol.
For example, the progestogen can be selected from the group consisting of norethindrone acetate, drospirenone, trimegestone, norethindrone, levonorgestrel, desogestrel, 3-ketodesogestrel, gestiondene, and the like. Other illustrative progestins include demegestone, dydrogesterone, medrogestone, and medroxyprogesterone. The most preferred progestin is norethindrone acetate. Estrogen can be selected, for example, from the group consisting of ethinyl estradiol, 17-p-estradiol, estradiol acetate, conjugated estrogens, mestranol, estrone, and salts thereof. An exemplary ester is estradiol acetate. The most preferred estrogen is ethinyl estradiol. The amount of progestogen and estrogen employed in each phase will be that amount that is equivalent in potency to the ranges of norethindrone acetate and ethinyl estradiol, respectively, which have been set forth hereinbefore. Determination of equivalent power is well known and can be readily accomplished by those skilled in the art.
In the female body, the blood-rich mucous membrane that lines the uterus, known as the endometrium, adapts to different levels of estrogen in the body. Without wishing to be bound by theory, it is believed that by cycling low amounts of estrogen (for example, reducing the amount of estrogen in the final phase of administration to levels corresponding to the initial phase), the integrity of the endometrium in a suitable state of at least about 3 to 5 mm thick, thereby reducing the unwanted events of breakthrough menorrhagia. By maintaining the integrity of the endometrium, the user can control the release of bleeding and prolong her cycle. By varying the estrogen dose, the endometrium does not get used to a constant estrogen dose. It is believed, without being bound by theory, that this up-and-down regulation of endometrial estrogen receptors results in the maintenance of the endometrium.
The extended cycle multiphasic drug for use in the multiphasic contraceptive procedure administers sequentially, to a woman of childbearing potential: (a) a Phase I composition comprising a progestin in an amount equivalent to about 0.3 to about 1 5 mg, preferably about 0.5 to about 1.5 mg of norethindrone acetate and an estrogen in an amount equivalent to about 5 to about 30 pg of ethinyl estradiol; (b) a Phase II composition comprising a progestin in an amount equivalent to about 0.3 to about 1.5 mg, preferably about 0.5 to about 1.5 mg of norethindrone acetate and an estrogen in an amount equivalent to about 10 to about 40 pg of ethinyl estradiol; (c) a Phase III composition comprising a progestin in an amount equivalent to about 0.3 mg to about 1.5 mg, preferably about 0.5 to about 1.5 mg of norethindrone acetate and an estrogen in a amount equivalent to about 5 to about 30 pg of ethinyl estradiol; and (d) optionally, a Phase IV composition that is a placebo or non-steroidal component. In addition, the amount of estrogen equivalent to ethinyl estradiol that is administered in the Phase II composition is at least about 5 pg greater, preferably at least about 10 pg greater, than the amount of estrogen equivalent to ethinyl estradiol that is administered in each of Phases I and III.
In a preferred embodiment, the regimen is carried out in the extended cycle fashion. In the first cycle, Phase I is administered for about 4 to about 7 days; Phase II is given for about 8 to about 16 days, and Phase III is given for about 4 to about 7 days. It is essential that the phases follow each other in increasing order (that is, it is I, II and III). After completing Phase III, the user repeats the cycle immediately by starting Phase I again. Preferably, this can be repeated for a period of from about 42 days to about 140 days, more preferably from about 63 to about 120 days. When the user decides to stop the regimen and bleeding occurs, she can either start taking the composition of
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Phase IV, or no pills for a period of about 2 to about 9 days, preferably about 4 to about 9 days. By putting this regimen into practice, the user can reduce the number of menstrual cycles, reaching only 3 per year.
In another embodiment, the user may choose to have the monthly bleeding occur to psychologically assure that she is not pregnant. To do this, you can practice the regimen of the invention in single-cycle form and after completing Phase III, either start taking the Phase IV composition, or simply take no pills for about 2 to about 9 days. For example, in a preferred embodiment of the single cycle procedure, the user would follow the regimen where Phase I is administered for about 4 to about 7 days, Phase II is administered for about 8 to about 16 days, Phase III is administered for about 4 to about 7 days, and Phase IV is given for about 2 to about 9 days. Most ideally, this embodiment of the method of the invention is practiced for a period of 28 days (menstrual cycle). It is essential that the phases follow one another in increasing order (that is, it is I, II, III and IV). After the Phase IV composition is administered, the user can restart the cycle by starting with the Phase I composition.
The Phase IV composition can serve as a cleansing period. In Phase IV, a placebo or a non-steroidal component can be administered.
In a particularly preferred embodiment, the Phase IV composition is a non-steroidal component comprising an iron supplement. For example, suitable iron supplements include ferrous fumarate, ferrous sulfate, ferrous gluconate, iron polysaccharides, and mixtures thereof. The preferred iron supplement is ferrous fumarate.
Preferably, the iron supplement is equivalent to no more than about 75 mg of ferrous fumarate.
As stated above, it is imperative that the extended cycle multiphase drug for use in a contraceptive procedure is carried out by administering the compositions in a numerical sequence by administering the Phase I composition first, then the Phase II composition, etc. If packaging and / or other requirements dictate, the extended cycle multiphase drug for use in the contraceptive procedure kit described herein may be used as part of a broader contraceptive or gynecologic disorder treatment plan. Although the sequence in which Applicant's combinations are administered is important to their operation, it should be noted that variations in timing and dosage can be tolerated when intermediate considerations dictate.
Although ethinyl estradiol is the exemplary estrogenic compound in the present invention, it should be understood that it can be substituted for other estrogenic compounds as long as the equivalent amount of estrogen is administered. For example, other estrogenic compounds include, for example, 17p-estradiol, estradiol acetate, conjugated estrogens, mestranol, estrone, and salts thereof. Preferred salts of estrone include, but are not limited to, the sodium and piperate salt. For conjugated estrogens, 1.25 mg of conjugated estrogens is equivalent to the daily dose of 15 pg of ethinyl estradiol.
Similarly, norethindrone acetate is the progestogenic compound exemplified in the present invention. However, it can be substituted for other suitable progestogenic compounds as long as the equivalent amount of progestogen is administered. Suitable progestogenic compounds include, but are not limited to, levonogestrel, desogestrel, drospirenone, trimegestone, 3-ketodesogestrel, gestiondene, and the like.
Compositions employed according to the invention in phases Phase I to IV will more preferably have the administration times and drug contents set forth in Tables 1 and 2, when a four phase system is used. Each table sets the relevant values for each of the applicant's preferred embodiments, or configurations, for administration of the system to women.
Table 1
<td>Phase</td><td>Days</td><td>norethisterone acetate mg</td><td>gg of ethinyl estradiol</td><td>Ferric fumarate mg</td>
<td>I</td><td> 5</td><td> 1,0</td><td> 25</td><td> 0</td>
<td>II</td><td> 11</td><td> 1,0</td><td> 30</td><td> 0</td>
<td>III</td><td> 5</td><td> 1,0</td><td> 25</td><td> 0</td>
<td>IV</td><td> 7</td><td> 0</td><td> 0</td><td> 75</td>
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Table 2
<td>Phase</td><td>Days</td><td>norethisterone acetate mg</td><td>pg ethinyl estradiol</td><td>Ferric fumarate mg</td>
<td>I</td><td> 5</td><td> 1,0</td><td> 20</td><td> 0</td>
<td>II</td><td> 14</td><td> 1,0</td><td> 25</td><td> 0</td>
<td>III</td><td> 5</td><td> 1,0</td><td> 20</td><td> 0</td>
<td>IV</td><td> 4</td><td> 0</td><td> -</td><td> 75</td>
It should be noted that these tables are presented for illustrative purposes only. For example, the cycles described in Table 1 and Table 2 could be modified by reducing the composition of Phase IV and sequentially administering Phase I, II and III, and then immediately repeating the administration of Phase I, II. and III for use in a prolonged cycle oral contraceptive procedure. Functionally equivalent amounts and types of reagent (s) are contemplated in this plan. For example, the use of sugar or another placebo is conceived in place of all or part of the ferrous fumarate.
The compositions used in the present invention are administered using a suitable daily dosage form, more preferably an oral dosage form. Tablets, pills, capsules, and caplets are examples of dosage forms. In addition, the use of other conventional additives, for example fillers, colorants, polymeric binders and the like is also contemplated. In general, any pharmaceutically acceptable additive that does not interfere with the function of the active components in one or more compositions can be used.
Suitable carriers with which the compositions can be administered include lactose, starch, cellulose derivatives, and the like, used in suitable amounts. Lactose is a preferred vehicle. Mixtures of vehicles can be used.
The terms "procedure" and "kit" are used herein to include any drug delivery system through the use of which the above 3 or 4 phase scheme can be effectively administered to women. Combinations of various dosage forms can be used.
The multiphasic combination and contraceptive kit of the present invention is a container containing the daily dosages of the Phase I, II and III compositions and, optionally, the daily dosages of the Phase IV composition to practice the procedure. of the present invention. Various types of containers for containing contraceptives are well known and it is contemplated that any such container may be used or altered for use in the practice of the present invention. For example, a single cycle pack of the present invention would preferably include from about 4 to about 7 doses of the Phase I composition; from about 8 to about 16 doses of the Phase II composition, and from about 4 doses to about 7 doses of the Phase III composition. A preferred embodiment of the single cycle pack may also include from about 2 to about 9 doses of the Phase IV composition. It should be readily appreciated that groups of dosages or a plurality of single cycle packs could be used to implement a long cycle multiphase oral contraceptive procedure. The different packages could be the same or different. For example, the user could have three or four containers each containing the above-described dosages of Phase I, II, and III compositions. Preferably, the kit would include from about 2 to about 9 groups, more preferably from about 3 to about 5 groups, of doses of the Phase I, II and III compositions. In another embodiment, each dose group of the Phase I composition contains about 5 doses, each dose group of the Phase II composition contains from about 11 to about 14 doses, and each dose group of the Phase III composition contains approximately 5 doses. If desired, the last of the packs to be used in the extended cycle administration could also contain the optional Phase IV composition that is taken prior to commencing the next extended cycle administration. Of course, an individual container can contain all the doses necessary for a long cycle administration. In this case, there would be a plurality of dose groups of the Phase I, II and III compositions, and optionally a last dose group of the Phase IV composition. In such a package, the doses would be taken sequentially and grouped in such a way that each group of doses was administered cyclically (for example I, II, III, I, II, III, I, II, III, II, III for a quad long cycle followed by optional IV).
Contents6
14 members in 7 offices
Priority claims9
| Document | Office | Kind | Date |
|---|---|---|---|
| 554621P | United States of America | – | |
| 55462104 | United States of America | P | |
| 55462104 | United States of America | P | |
| 2005008323 | United States of America | W | |
| 2005008323 | United States of America | W | |
| 554621P | – | – | – |
| PCTUS2005008323 | – | – | – |
| US20040554621P | – | – | – |
| WO2005US08323 | – | – | – |
Members14
| Document | Office | Kind | |
|---|---|---|---|
| CA2556459A1 | Canada | A1 | |
| WO2005092441A2 | World Intellectual Property Organization (WIPO) | A2 | |
| US2005227952A1 | United States of America | A1 | |
| WO2005092441A3 | World Intellectual Property Organization (WIPO) | A3 | |
| IL177475A0 | Israel | A0 | |
| EP1735056A2 | European Patent Office (EPO) | A2 | |
| CN1933873A | China | A | |
| US7569560B2 | United States of America | B2 | |
| US2009291927A1 | United States of America | A1 | |
| US7935691B2 | United States of America | B2 | |
| EP1735056B1 | European Patent Office (EPO) | B1 | |
| IL177475A | Israel | A | |
| CA2556459C | Canada | C | |
| ES2397983T3This record | Spain | T3 |
Numbers
- Publication
- 2397983
- Publication, DOCDB
- 2397983
- Publication, EPODOC
- ES2397983T
- Application
- 5725477
- Application, DOCDB
- 05725477
- Application, EPODOC
- ES20050725477T
Titles2
- Spanish
- Procedimiento anticonceptivo oral multifásico de ciclo prolongado
- English
- Long-cycle multiphase oral contraceptive procedure
Classification
- CPC, 6
- A61K31/565
- A61K31/56
- A61K31/567
- A61K31/573
- A61K33/26
- A61P15/18
- IPC, 5
- A61P15 18
- A61K33 26
- A61K31 567
- A61K31 565
- A61K31 56