1
|
Boyd P, Merkatz R, Variano B, Malcolm RK. The ins and outs of drug-releasing vaginal rings: a literature review of expulsions and removals. Expert Opin Drug Deliv 2020; 17:1519-1540. [DOI: 10.1080/17425247.2020.1798927] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Peter Boyd
- School of Pharmacy, Queen’s University Belfast, Belfast, UK
| | - Ruth Merkatz
- Population Council, One Dag Hammarskjold Plaza, New York, NY, USA
| | - Bruce Variano
- Population Council, One Dag Hammarskjold Plaza, New York, NY, USA
| | | |
Collapse
|
2
|
In vitro release testing methods for drug-releasing vaginal rings. J Control Release 2019; 313:54-69. [PMID: 31626862 DOI: 10.1016/j.jconrel.2019.10.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 10/05/2019] [Accepted: 10/08/2019] [Indexed: 12/28/2022]
Abstract
Drug-releasing vaginal rings are torus-shaped devices, generally fabricated from thermoplastic polymers or silicone elastomers, used to administer pharmaceutical drugs to the human vagina for periods typically ranging from three weeks to twelve months. One of the most important product performance tests for vaginal rings is the in vitro release test. Although it has been fifty years since a vaginal ring device was first described in the scientific literature, and despite seven drug-releasing vaginal rings having been approved for market, there is no universally accepted method for testing in vitro drug release, and only one non-compendial shaking incubator method (for the estradiol-releasing ring Estring®) is described in the US Food and Drug Administration's Dissolution Methods Database. Here, for the first time, we critically review the diverse range of test methods that have been described in the scientific literature for testing in vitro release of drug-releasing vaginal rings. Issues around in vitro-in vivo correlation and modelling of in vitro release data are also discussed.
Collapse
|
3
|
McBride JW, Boyd P, Dias N, Cameron D, Offord RE, Hartley O, Kett VL, Malcolm RK. Vaginal rings with exposed cores for sustained delivery of the HIV CCR5 inhibitor 5P12-RANTES. J Control Release 2019; 298:1-11. [PMID: 30731150 PMCID: PMC6414755 DOI: 10.1016/j.jconrel.2019.02.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 01/28/2019] [Accepted: 02/02/2019] [Indexed: 11/29/2022]
Abstract
Antiretroviral-releasing vaginal rings are at the forefront of ongoing efforts to develop microbicide-based strategies for prevention of heterosexual transmission of the human immunodeficiency virus (HIV). However, traditional ring designs are generally only useful for vaginal administration of relatively potent, lipophilic, and small molecular weight drug molecules that have sufficient permeability in the non-biodegradable silicone elastomer or thermoplastic polymers. Here, we report a novel, easy-to-manufacture 'exposed-core' vaginal ring that provides sustained release of the protein microbicide candidate 5P12-RANTES, an experimental chemokine analogue that potently blocks the HIV CCR5 coreceptor. In vitro release, mechanical, and stability testing demonstrated the utility and practicality of this novel ring design. In a sheep pharmacokinetic model, a ring containing two ¼-length excipient-modified silicone elastomer cores - each containing lyophilised 5P12-RANTES and exposed to the external environment by two large windows - provided sustained concentrations of 5P12-RANTES in vaginal fluid and vaginal tissue between 10 and 10,000 ng/g over 28days, at least 50 and up to 50,000 times the reported in vitro IC50 value.
Collapse
Affiliation(s)
- John W McBride
- School of Pharmacy, Queen's University Belfast, Belfast BT9 7BL, UK
| | - Peter Boyd
- School of Pharmacy, Queen's University Belfast, Belfast BT9 7BL, UK
| | | | | | - Robin E Offord
- Mintaka Foundation for Medical Research, Geneva, Switzerland
| | - Oliver Hartley
- Mintaka Foundation for Medical Research, Geneva, Switzerland; Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Vicky L Kett
- School of Pharmacy, Queen's University Belfast, Belfast BT9 7BL, UK
| | - R Karl Malcolm
- School of Pharmacy, Queen's University Belfast, Belfast BT9 7BL, UK.
| |
Collapse
|
4
|
Fernando HV, Chan LL, Dang N, Santhanes D, Banneheke H, Nalliah S, Coombes AGA. Controlled delivery of the antiprotozoal agent (tinidazole) from intravaginal polymer matrices for treatment of the sexually transmitted infection, trichomoniasis. Pharm Dev Technol 2018; 24:348-356. [PMID: 29799300 DOI: 10.1080/10837450.2018.1481430] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Microporous polymeric matrices prepared from poly(ɛ-caprolactone) [PCL] were evaluated for controlled vaginal delivery of the antiprotozoal agent (tinidazole) in the treatment of the sexually transmitted infection, trichomoniasis. The matrices were produced by rapidly cooling co-solutions of PCL and tinidazole in acetone to -80 °C to induce crystallisation and hardening of the polymer. Tinidazole incorporation in the matrices increased from 1.4 to 3.9% (w/w), when the drug concentration in the starting PCL solution was raised from 10 to 20% (w/w), giving rise to drug loading efficiencies up to 20%. Rapid 'burst release' of 30% of the tinidazole content was recorded over 24 h when the PCL matrices were immersed in simulated vaginal fluid. Gradual drug release occurred over the next 6 days resulting in delivery of around 50% of the tinidazole load by day 7 with the released drug retaining antiprotozoal activity at levels almost 50% that of the 'non-formulated' drug in solution form. Basic modelling predicted that the concentration of tinidazole released into vaginal fluid in vivo from a PCL matrix in the form of an intravaginal ring would exceed the minimum inhibitory concentration against Trichomonas vaginalis. These findings recommend further investigation of PCL matrices as intravaginal devices for controlled delivery of antiprotozoal agents in the treatment and prevention of sexually transmitted infections.
Collapse
Affiliation(s)
| | - Li Li Chan
- a School of Medicine, The International Medical University , Kuala Lumpur , Malaysia
| | - Nhung Dang
- b Dermatology Research Centre, School of Medicine , The University of Queensland, Translational Research Institute , Brisbane , Australia
| | | | - Hasini Banneheke
- d Department of Parasitology, Faculty of Medical Sciences , University of Sri Jayewardenepura , Nugegoda , Sri Lanka
| | - Sivalingam Nalliah
- a School of Medicine, The International Medical University , Kuala Lumpur , Malaysia
| | - Allan G A Coombes
- a School of Medicine, The International Medical University , Kuala Lumpur , Malaysia.,e ULTI Pharmaceuticals , Hamilton , New Zealand
| |
Collapse
|
5
|
Jug M, Hafner A, Lovrić J, Kregar ML, Pepić I, Vanić Ž, Cetina-Čižmek B, Filipović-Grčić J. An overview of in vitro dissolution/release methods for novel mucosal drug delivery systems. J Pharm Biomed Anal 2018; 147:350-366. [DOI: 10.1016/j.jpba.2017.06.072] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 06/19/2017] [Accepted: 06/19/2017] [Indexed: 01/12/2023]
|
6
|
Pathak M, Coombes AGA, Ryu B, Cabot PJ, Turner MS, Palmer C, Wang D, Steadman KJ. Sustained Simultaneous Delivery of Metronidazole and Doxycycline From Polycaprolactone Matrices Designed for Intravaginal Treatment of Pelvic Inflammatory Disease. J Pharm Sci 2017; 107:863-869. [PMID: 29100864 DOI: 10.1016/j.xphs.2017.09.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 09/04/2017] [Accepted: 09/19/2017] [Indexed: 11/18/2022]
Abstract
Poly(ɛ-caprolactone) (PCL) intravaginal matrices were produced for local delivery of a combination of antibacterials, by rapidly cooling a mixture of drug powders dispersed in PCL solution. Matrices loaded with different combinations of metronidazole (10%, 15%, and 20% w/w) and doxycycline (10% w/w) were evaluated in vitro for release behavior and antibacterial activity. Rapid "burst release" of 8%-15% of the doxycycline content and 31%-37% of the metronidazole content occurred within 24 h when matrices were immersed in simulated vaginal fluid at 37°C. The remaining drug was extracted gradually over 14 days to a maximum of 65%-73% for doxycycline and 62%-71% for metronidazole. High levels of antibacterial activity up to 89%-91% against Gardnerella vaginalis and 84%-92% against Neisseria gonorrhoeae were recorded in vitro for release media collected on day 14, compared to "nonformulated" metronidazole and doxycycline solutions. Based on the in vitro data, the minimum levels of doxycycline and metronidazole released from PCL matrices in the form of intravaginal rings into vaginal fluid in vivo were predicted to exceed the minimum inhibitory concentrations for N. gonorrhea (reported range 0.5-4.0 μg/mL) and G. vaginalis (reported range 2-12.8 μg/mL) respectively, which are 2 of the major causative agents for pelvic inflammatory disease.
Collapse
Affiliation(s)
- Meenakshi Pathak
- The University of Queensland, School of Pharmacy, 20 Cornwall Street, Woolloongabba, Brisbane, Queensland 4102, Australia.
| | - Allan G A Coombes
- The University of Queensland, School of Pharmacy, 20 Cornwall Street, Woolloongabba, Brisbane, Queensland 4102, Australia
| | - BoMi Ryu
- The University of Queensland, School of Pharmacy, 20 Cornwall Street, Woolloongabba, Brisbane, Queensland 4102, Australia
| | - Peter J Cabot
- The University of Queensland, School of Pharmacy, 20 Cornwall Street, Woolloongabba, Brisbane, Queensland 4102, Australia
| | - Mark S Turner
- The University of Queensland, School of Agriculture and Food Sciences, St. Lucia, Brisbane, Queensland 4072, Australia
| | - Cheryn Palmer
- Princess Alexandra Hospital, Department of Sexual Health, Ipswich Road, Woolloongabba, Queensland 4102, Australia
| | - Dongjie Wang
- The University of Queensland, School of Agriculture and Food Sciences, St. Lucia, Brisbane, Queensland 4072, Australia
| | - Kathryn J Steadman
- The University of Queensland, School of Pharmacy, 20 Cornwall Street, Woolloongabba, Brisbane, Queensland 4102, Australia
| |
Collapse
|
7
|
Malcolm RK, Boyd PJ, McCoy CF, Murphy DJ. Microbicide vaginal rings: Technological challenges and clinical development. Adv Drug Deliv Rev 2016; 103:33-56. [PMID: 26829289 DOI: 10.1016/j.addr.2016.01.015] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 01/13/2016] [Accepted: 01/20/2016] [Indexed: 10/22/2022]
Abstract
Vaginal rings (VRs) are flexible, torus-shaped, polymeric devices designed to sustain delivery of pharmaceutical drugs to the vagina for clinical benefit. Following first report in a 1970 patent application, several steroid-releasing VR products have since been marketed for use in hormone replacement therapy and contraception. Since 2002, there has been growing interest in the use of VR technology for delivery of drugs that can reduce the risk of sexual acquisition of human immunodeficiency virus type 1 (HIV-1), the causative agent of acquired immunodeficiency syndrome (AIDS). Although no vaginally-administered product has yet been approved for HIV reduction/prevention, extensive research efforts are continuing and a number of VR devices offering sustained release of so-called 'HIV microbicide' compounds are currently being evaluated in late-stage clinical studies. This review article provides an overview of the published scientific literature within this important field of research, focusing primarily on articles published within peer-reviewed journal publications. Many important aspects of microbicide-releasing VR technology are discussed, with a particular emphasis on the technological, manufacturing and clinical challenges that have emerged in recent years.
Collapse
|
8
|
Pathak M, Coombes AG, Turner MS, Palmer C, Wang D, Steadman KJ. Investigation of Polycaprolactone Matrices for Intravaginal Delivery of Doxycycline. J Pharm Sci 2015; 104:4217-4222. [DOI: 10.1002/jps.24652] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Revised: 08/24/2015] [Accepted: 08/26/2015] [Indexed: 11/05/2022]
|
9
|
Chingwaru W, Vidmar J, Kapewangolo PT. The Potential of Sub-Saharan African Plants in the Management of Human Immunodeficiency Virus Infections: A Review. Phytother Res 2015; 29:1452-87. [PMID: 26337608 DOI: 10.1002/ptr.5433] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Revised: 07/09/2015] [Accepted: 07/22/2015] [Indexed: 12/28/2022]
Abstract
Acquired immunodeficiency syndrome, caused by human immunodeficiency virus (HIV), is a leading cause of mortality and morbidity in Sub-Saharan Africa, particularly in Southern Africa. Phytomedicines are an integral part of African health care. The Southern African flora is composed of at least 23 400 taxa. Despite this richness, only a handful of botanical products have been assessed for activities against HIV. This study aimed to summarize the potential of Sub-Saharan African plants, based on their composition and the established bioactivities, as sources of agents to manage HIV symptoms and as retroviral therapy. At least 109 plant species from 42 families and 94 genera that are found in Southern Africa were shown to have potential or actual activities against HIV. Only 12 of these plant species from 6 families and 10 genera were shown to harbour anti-HIV properties. Phytochemicals that include β-sitosterols, terpenoids, glycosides, saponins, flavonoids, triterpenoids, tannins and alkaloids, which harbour anti-HIV properties, were found to have a near cosmopolitan presence across the plant families in the region. Bioactivities of multiple phytochemicals are comparable to those for standard allopathic antiretroviral drugs. Research to determine the anti-HIV activities of the identified and other plants, including clinical trials, is long overdue.
Collapse
Affiliation(s)
- Walter Chingwaru
- Department of Biological Sciences, Faculty of Science, Bindura University of Science Education, P. Bag 1020, Bindura, Zimbabwe.,Institute Ceres/Zavod Ceres, Lahovna 16, 3000, Celje, Slovenia
| | - Jerneja Vidmar
- Institute Ceres/Zavod Ceres, Lahovna 16, 3000, Celje, Slovenia.,Department of Plastic and Reconstructive Surgery, University Medical Centre Maribor, Ljubljanska 5, 2000, Maribor, Slovenia
| | - Petrina T Kapewangolo
- Department of Chemistry and Biochemistry, University of Namibia, P/Bag 13301, 340 Mandume Ndemufayo Avenue, Pionierspark, Windhoek, Namibia
| |
Collapse
|
10
|
Dang NT, Sivakumaran H, Harrich D, Shaw PN, Davis-Poynter N, Coombes AG. Synergistic activity of tenofovir and nevirapine combinations released from polycaprolactone matrices for potential enhanced prevention of HIV infection through the vaginal route. Eur J Pharm Biopharm 2014; 88:406-14. [DOI: 10.1016/j.ejpb.2014.05.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 05/16/2014] [Accepted: 05/20/2014] [Indexed: 01/07/2023]
|
11
|
Dang N, Sivakumaran H, Harrich D, Shaw PN, Coombes AG. Evaluation of Polycaprolactone Matrices for Sustained Vaginal Delivery of Nevirapine in the Prevention of Heterosexual HIV Transmission. J Pharm Sci 2014; 103:2107-2115. [DOI: 10.1002/jps.24030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Revised: 03/24/2014] [Accepted: 05/05/2014] [Indexed: 11/07/2022]
|