SKIN DRUG DELIVERY: P10 - P22 - ONdrugDelivery
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P10 P22 P26 MICRONEEDLE A SMART PATCH FOR AIRLESS DISPENSERS ARRAY CHALLENGES PAINLESS DRUG DELIVERY FOR DERMAL DRUG DELIVERY ARE DISSOLVING FAST SKIN DRUG DELIVERY: DERMAL, TRANSDERMAL & MICRONEEDLES JANUARY 25TH 2021 • ISSUE NO 116
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Contents ONdrugDelivery Issue No 116, January 25th, 2021 Microneedles for Intradermal Delivery of Cancer Vaccines SKIN DRUG DELIVERY: DERMAL, 05 -09 John Vasilakos, Global Head of MTS Business Development and Senior Research Immunologist TRANSDERMAL & MICRONEEDLES Kindeva Drug Delivery This edition is one in the ONdrugDelivery series Why the Consistent Challenges Surrounding MAPs are Dissolving Fast of publications from Frederick Furness Publishing. Each issue focuses on a specific topic within the 10 - 14 Sebastian Braun, Head of Formulation Development and Manufacturing for Innovative Injection Systems LTS Lohmann field of drug delivery, and is supported by industry leaders in that field. Pharma Latch Angled Microneedle Patch EDITORIAL CALENDAR for Enhanced Drug and Vaccine Delivery Feb 2021 Prefilled Syringes & Injection Devices Mar Ophthalmic Drug Delivery 16 - 20 Nicky Bertollo, Co-Founder and Chief Technology Lead Ronan Byrne, Co-Founder; and Andrew Muddle, Advisory Board Member Mar/Apr Drug Delivery & Environmental Sustainability Latch Medical Apr Pulmonary & Nasal Drug Delivery May Injectable Drug Delivery Medicsen: Needle-Free Smartpatch for Painless Drug Delivery Jun Connecting Drug Delivery Eduardo W Jørgensen, Chief Executive Officer; Jul Novel Oral Delivery Systems 22 - 25 Juan César de Mercado, Chief Operations Officer; and José Carlos Montesinos, Chief Technology Officer Aug Industrialising Drug Delivery Medicsen Sep Wearable Injectors Sep/Oct Drug Delivery & Environmental Sustainability Ensuring Formulation Protection and Patient Care With Airless Dispensers Oct Prefilled Syringes & Injection Devices Audrey Chandra, Category Project Manager; Nov Dec Pulmonary & Nasal Drug Delivery Connecting Drug Delivery 26 - 28 Manuela Basso, Communications Manager; and Raphaële Audibert, Global Category Manager, Inhalation and Dermal Nemera Jan 2022 Skin Drug Delivery: Dermal, Transdermal & Microneedles Product Showcase: Logan Instruments’ Transdermal Testing Portfolio EDITORIAL: 30 - 31 Jensen Lee, Vice-President of Operations Logan Instruments Guy Furness, Proprietor & Publisher E: guy.furness@ondrugdelivery.com Airless Drug Delivery: Widely Accepted, Accessible and Available CREATIVE DESIGN: 32 - 36 Stefan Hellbardt, Vice-President Business Development and Scientific Affairs Aptar Pharma Simon Smith, Creative Director (Freelance) E: simon.smith@ondrugdelivery.com SUBSCRIPTIONS: Audrey Furness, Marketing Executive E: subscriptions@ondrugdelivery.com Print + Digital subscription: £99/year + postage. Digital Only subscription: free. ADVERTISING: Guy Furness, Proprietor & Publisher E: guy.furness@ondrugdelivery.com ONdrugDelivery is published by Frederick Furness Publishing Ltd The Candlemakers, West Street, Lewes East Sussex, BN7 2NZ, United Kingdom T: +44 1273 47 28 28 PHARMA’S Registered in England: Company No 8348388 ISSN 2049-145X print / ISSN 2049-1468 pdf GO-TO SOURCE Copyright © 2021 Frederick Furness Publishing Ltd FOR DRUG DELIVERY All rights reserved INDUSTRY INFORMATION & INTELLIGENCE The ONdrugDelivery logo is a registered trademark of Frederick Furness Publishing Ltd. SUBSCRIBE TODAY The views and opinions expressed in this issue are those of the authors. Due care has been used in producing this publication, but the publisher makes no claim that it is free of error. Nor does the publisher accept liability for the consequences of any decision or action taken (or not taken) as a result of any information contained in this publication. Front cover image, credit GustoImages/Science Photo Library. Reproduced with permission. www.ondrugdelivery.com
Kindeva MICRONEEDLES FOR INTRADERMAL DELIVERY OF CANCER VACCINES In this article, John Vasilakos, PhD, Global Head of MTS Business Development and Senior Research Immunologist at Kindeva Drug Delivery, discusses the immuno-oncology market. He examines the role of cancer vaccines in supplementing other immuno-oncology therapies, as well as the value of delivering cancer vaccines intradermally. Throughout 2020, the pharmaceutical industry received ample public “A series of studies suggests that scrutiny around its search patients treated with checkpoint for covid-19 vaccines and inhibitors are more than twice as likely therapeutics. However, even with so much focus rightfully to experience a durable response.” centred on the race to develop therapies that address the pandemic, covid has not diminished immuno-oncology therapies and the value oncology drugs’ colossal importance in the of delivering cancer vaccines intradermally. industry. This importance can be measured Kindeva Drug Delivery’s microneedle-based both in research and development spend and drug delivery platform will be used as an in drug sales. Clinical development spend on example of how to address many of the oncology therapies in the US is estimated to industry’s unmet needs with respect to be more than US$80 billion (£59 billion), intradermal delivery. which is more than a third of total pharma development spend.1 Meanwhile, drug THE CURRENT LANDSCAPE OF sales for oncology are expected to exceed IMMUNO-ONCOLOGY THERAPEUTICS $300 billion by 2026, representing roughly a fifth of the total pharma market.1 In the last decade, immune checkpoint The sustained investment and inhibitors, such as pembrolizumab opportunity in oncology matters because (Keytruda, PD-1 antagonist) and ipilimumab cancer remains a public health crisis. Existing (Yervoy, CTLA-4 antagonist), have emerged drugs and treatment regimens still have many as a dominant class of immuno-oncology gaps and much room for improvement. therapeutics. There is a strong case to be These gaps should be addressed by not only made in favour of checkpoint inhibitors Dr John Vasilakos optimising the drugs that are used to treat based on the durability of the patient Global Head of MTS Business cancer, but also optimising the devices that response. In essence, this means that a Development and Senior Research deliver these drugs. patient can meaningfully extend their life Immunologist This article focuses on the sizable expectancy when these drugs work. E: john.vasilakos@kindevadd.com immuno-oncology subsegment, which is A series of studies suggests that patients expected to grow to nearly $100 billion by treated with checkpoint inhibitors are Kindeva Drug Delivery 2026 – growth of over 20% per annum.1 more than twice as likely to experience a 42 West Water Street It discusses a dominant immuno-oncology durable response – and roughly 30% of St Paul MN 55107 drug class (checkpoint inhibitors) and these patients experienced overall survival United States their shortcomings, considers the role of (OS) that was more than twice the patient cancer vaccines in supplementing other population’s median OS.2 Moreover, www.kindevadd.com Copyright © 2021 Frederick Furness Publishing Ltd www.ondrugdelivery.com 5
Kindeva combination therapies, in which the patient is treated with two or more checkpoint “The number of T-cell targeted immunomodulators in the inhibitors, have had an even more promising impact on patient survival.3 pipeline has more than doubled since 2017, with over 200 Among the most prevalent of the programmes targeting either PD-1 or PD-L1.” checkpoint inhibitors are programmed cell death protein 1 (PD-1) and programmed cell death ligand 1 (PD-L1) inhibitors. immune system, which could result in As evidence for their durability PD-1 is a T-cell receptor that helps deleterious effects on healthy tissues. Cancer grows, checkpoint inhibitors have downregulate or inhibit immune responses. has found a way to take advantage of been commercially successful for many In the normal course of events, PD-1 this normal regulatory system. Cancer cells types of cancer, and their popularity in engages with PD-L1 on antigen-presenting can produce PD-L1, which downregulates clinical trials has continued to grow. cells – resulting in the inhibition of T-cell T-cell function following PD-1 engagement. Specifically, the number of T-cell targeted function, such as cytotoxicity. Therefore, Therefore, tumour cells that express the immunomodulators in the pipeline has PD-1 functions as a brake on T-cell activity, ligand PD-L1 block the tumour-killing more than doubled since 2017 (Figure 1), thereby preventing overactivation of the function of T-cells by engaging T-cell PD-1. with over 200 programmes targeting either PD-1 or PD-L1 (Figure 2).4 However, despite the promise, there is still a clear need for improvement. The approximately 30% of patients who experience higher OS represent a significant achievement, but approximately 70% of patients require additional therapy.5 Indeed, combination therapy has become the norm for oncology patients. Moreover, checkpoint blockade therapies have recently been approved for use for several cancers. For example, the US FDA has approved Keytruda (Merck, Kenilworth, NJ, US) for use with chemotherapy (carboplatin) to treat metastatic head and neck cancer. In addition to chemotherapeutics, other combination strategies are being evaluated with checkpoint blockade therapies, such as kinase inhibitors, anti angiogenics, immune-stimulating cytokines and multiple combinations of checkpoint blockade Figure 1: Number of T-cell targeted immunomodulators and cancer vaccines in therapies and vaccines. development globally. THE ROLE OF CANCER VACCINES AND COMBINATION THERAPY WITH CHECKPOINT BLOCKADE Within the immuno-oncology space, there is lots of energy around cancer vaccines. There are an estimated 840 cancer vaccines currently in development (Figure 1),4 with up to 600 companies developing them. In most situations, these vaccines are being developed as combination therapies, intended to be delivered to patients in conjunction with checkpoint inhibitors. Cancer vaccines are compelling because checkpoint blockade therapies are not successful at eliminating all tumours in all patients, especially when used in isolation. These immunotherapeutics are most effective when the tumour microenvironment (TME) contains tumour- Figure 2: Number of immunomodulators targeting PD-1/PD-L1 in development globally. infiltrating T-cells (TILs).6 The TME can be 6 www.ondrugdelivery.com Copyright © 2021 Frederick Furness Publishing Ltd
Kindeva characterised as cold (non-T-cell inflamed) seems ideal, its biggest limitation is or hot (T-cell inflamed). Hot tumours are a practical one: it is difficult to achieve “The question of how and characterised by T-cell infiltration and precise and reproducible delivery to the molecular signatures associated with immune where cancer vaccines are intradermal layer using traditional delivery activation, whereas cold tumours exhibit delivered to the body should devices. One challenge is that the dermis is T-cell absence or exclusion. In general, hot thin – approximately 1,800 μm in depth. not be overlooked. The tumours present higher response rates to To achieve this, the delivery device would checkpoint blockade therapies. Therefore, route of administration may need to deliver the vaccine to a depth of various efforts have focused on converting impact the ultimate success 500–1,500 μm and do so reliably. The lack non-inflamed cold tumours into hot tumours of a reliable delivery method has limited the rates of these vaccines.” to achieve a better clinical response. use of intradermal vaccination.9 To solve the problem of converting cold Kindeva has advanced the development tumours to hot ones, numerous strategies of delivery devices that help overcome have been employed, such as targeting question of how and where cancer vaccines the challenge of intradermal delivery. tumours with immune stimulators or are delivered to the body should not be With microneedles, Kindeva’s hollow inhibitors of immune suppressor cells. overlooked. The route of administration microstructured transdermal system (hMTS) Another approach currently being evaluated may impact the ultimate success rates of facilitates the reliable and reproducible is cancer vaccination in combination with these vaccines. delivery to the dermis. Kindeva’s hMTS checkpoint blockade. Vaccination makes device is an injector that includes a drug sense in the context where the patient INTRADERMAL DRUG DELIVERY cartridge to contain the liquid formulation exhibits minimal cancer-specific T-cell OF CANCER VACCINES and an array comprised of 12 hollow immunity. The idea is to increase the microneedles (Figure 3). The cartridge number of tumour-specific T-cells with As previously discussed, cancer vaccines can be loaded up-front or at the time of the vaccine and prevent or inhibit their induce tumour-specific immunity. In an use, depending on the drug’s requirement. inactivation, or enhance their proliferation, ideal world, cancer vaccines would be At the time of use, the applicator delivers using checkpoint blockade therapies. delivered directly into immune organs such the microneedle array into the skin; the In other words, cancer vaccines can induce as the lymph nodes, the spleen or the liquid formulation will then move through tumour-specific T-cells in those patients skin itself. When delivered subcutaneously the hollow microneedles and deliver the that lack anti-tumour T-cells. or intramuscularly, cancer vaccines are drug into the dermis. The drug delivery Some of the earliest cancer vaccines deposited into parts of the body where system is intended for the intradermal available on the market proved to be only immune cells do not normally reside. By space, which makes the injection time marginally effective. Now, the industry has contrast, intradermal delivery would deliver longer than is typically experienced with become much wiser about cancer vaccines the vaccine directly into the dermis, where standard vaccine injections. Depending on with respect to antigen selection, patient immune cells do reside. There is evidence the formulation, the patient and the delivery selection and combination therapies to use that demonstrates a comparative advantage site, total hMTS injection time is typically with vaccines, which adds to their promise. of intradermal delivery over intramuscular less than two minutes per mL. Regarding patient selection or targeting, delivery.7 Of salience to cancer vaccines, The two main features that make a better understanding of the patient’s intradermal vaccinations have led to Kindeva’s hMTS platform well suited tumour burden and immune status help enhanced immune responses in many cases.8 to deliver cancer vaccines are the depth define which patients may benefit from While intradermal delivery of of delivery and the volume of delivery. vaccination. Conducting vaccine trials only cancer vaccines For depth, Kindeva has refined the device on patients with late-stage cancer is not design to achieve reproducible intradermal ideal, because those patients often have severely compromised immune systems. For cancer vaccines to work, the patient needs to have a functional immune system. Therefore, cancer vaccines should be delivered to and tested on patients in earlier stages of the disease. Other improvements in the development of cancer vaccines have resulted from the use of more optimal adjuvants or viral vectors that enhance cytotoxic T-cells and interferon-gamma producing T-helper cells, and the use of cancer antigens that are more commonly expressed on multiple tumour Figure 3: types or antigens that are unique to the Kindeva’s hollow patient (neoantigens). microstructured Continued innovation in cancer vaccines transdermal and their formulations is essential – but the system (hMTS). Copyright © 2021 Frederick Furness Publishing Ltd www.ondrugdelivery.com 7
Kindeva “Devices that enable reproducible intradermal delivery should be seriously considered by biopharma companies developing cancer vaccines.” delivery, using microneedles with a been used in partners’ Phase I and IIa length of either 1,000 μm or 1,500 drug clinical studies in the US,10-13 and μm. Cancer vaccines administered via the development of a device suitable for hMTS will be delivered to a shallower Phase III/commercial use is progressing. part of the skin compared with Moreover, Kindeva’s manufacturing vaccines delivered subcutaneously capabilities are in place to meet preclinical (Figure 4), thus delivering the vaccine and clinical needs. to the immune-cell-rich dermis and elicit a more robust immune response. CONCLUSION In terms of volume, hMTS can deliver up to 2 mL. This is Immuno-oncology therapies, such as a meaningful increase in capacity checkpoint inhibitors, are designed compared with other intradermal to facilitate the ability of the patient’s and non-intradermal delivery devices immune system to effectively attack and currently used to deliver vaccines. kill tumours. Over the last decade, there While the hMTS device is currently has been demonstrable success, with in development, it is already well blockbuster therapies achieving significant positioned to be the device-of-choice increases in patient survival rates. Cancer for biopharma companies developing vaccines can be used in combination with Figure 4: Anatomy of the skin. cancer vaccines. Kindeva’s device has these checkpoint inhibitors to make cold 8 www.ondrugdelivery.com Copyright © 2021 Frederick Furness Publishing Ltd
Kindeva tumours hot, thereby increasing the overall COVID-19.” Nat Rev Drug Discov, Label, Multi-Center Trial of SNS-301 success rate. New oncology drug classes 2020, Vol 19, pp 751–752. Added to Pembrolizumab in Patients continue to crop up and gain momentum, 5. Haslam A, Prasad V, “Estimation of with Advanced Squamous Cell which provides a reason for optimism. the Percentage of US Patients with Carcinoma of the Head & Neck.” However, innovation in the Cancer Who Are Eligible for and Poster Presentation, pharmaceutical industry is not exclusive to Respond to Checkpoint Inhibitor 2020 SITC Annual Meeting. the discovery of novel drugs and vaccines. Immunotherapy Drugs.” JAMA Netw 11. Algazi A et al, “Early Safety and Innovation in drug delivery devices can Open, 2019, Vol 2(5), e192535. Efficacy of a Phase 1/2 Open-Label, also play a meaningful role in improving 6. Duan Q et al, “Turning cold into Multi-Center Trial of SNS-301 how the medical industry treats cancer. For hot: firing up the tumor.” Trends in Added to Pembrolizumab in Patients example, devices that enable reproducible Cancer, 2020, Vol 6(7), pp 605–618. with ASPH+ Locally Advanced intradermal delivery should be seriously 7. Teunissen MB, Haniffa M et al, Unresectable or Metastatic/Recurrent considered by biopharma companies “Insight into the immunobiology Squamous Cell Carcinoma of the developing cancer vaccines. Devices like of human skin and functional Head and Neck.” Poster Presentation, Kindeva’s hMTS platform are capable specialization of skin dendritic cell 2020 EMSO Annual Meeting. of delivering cancer vaccines directly to subsets to innovate intradermal 12. Block MS et al, “Th17-inducing the dermis, with its relative abundance of vaccination design.” Curr Top autologous dendritic cell vaccination immune cells, increasing the potential that Microbiol Immunol, 2012, Vol 351, promotes antigen-specific cellular and the drug is effective in improving patient pp 25–76. humoral immunity in ovarian cancer survival rates. 8. Ogai N, Nonaka I et al, patients.” Nature Communications, “Enhanced immunity in intradermal 2020, Vol 11(1), Article 5173. REFERENCES vaccination by novel hollow 13. Gustafson MP et al, “Preliminary microneedles.” Skin Res Technol, manufacturing, safety, and immune 1. “World Preview 2020, Outlook to 2018, Vol 24(4) pp 630–635. monitoring results of an allogeneic 2026.” EvaluatePharma, 2020. 9. Kim YC, Jarrahian C et al, “Delivery tumor lysate-pulsed dendritic 2. Pons-Tostivint E et al, “Comparative systems for intradermal vaccination.” cell vaccine for patients with Analysis of Durable Responses on Curr Top Microbiol Immunol, 2012, newly diagnosed glioblastoma.” Immune Checkpoint Inhibitors Vol 351, pp 77–112. Poster Presentation, 2016 SITC Versus Other Systemic Therapies: 10. Gramza A et al, “Phase 1/2 Open- Annual Meeting. A Pooled Analysis of Phase III Trials.” JCO Precision Oncology, 2019, Vol 3, pp 1–10. ABOUT THE AUTHOR 3. Larkin J et al, “Five-Year Survival John Vasilakos is the Global Head of MTS Business Development and Senior Research with Combined Nivolumab and Immunologist at Kindeva Drug Delivery. His previous industry roles include Senior Ipilimumab in Advanced Melanoma.” Research Immunologist and Business Development of TLR Ligands at 3M Drug N Engl J Med, 2019, Vol 381, Delivery Solutions Division and Vice-President of Immunology at Biothera. He has pp 1535–1546. spent more than 25 years in the biopharmaceutical industry, focusing on vaccines and 4. Upadhaya S, Hubbard-Lucey VM, immunotherapy for cancer and chronic viral diseases. He holds a PhD from the University Yu JX, “Immuno-oncology drug of Cincinnati School of Medicine (OH, US). development forges on despite We know drug delivery www.ondrugdelivery.com/subscribe Copyright © 2021 Frederick Furness Publishing Ltd www.ondrugdelivery.com 9
LTS Lohmann WHY THE CONSISTENT CHALLENGES SURROUNDING MAPS ARE DISSOLVING FAST In this article, Sebastian Braun, PhD, Head of Formulation Development and Manufacturing for Innovative Injection Systems at LTS, discusses the current state of microneedle-based transdermal drug delivery, covering available microneedle delivery methods, the US FDA’s current stance on microneedle technologies and LTS’s microarray patch system and the possibilities it represents. INTRODUCTION This article will cover the relative merits in each form of microneedle technology; For the past decade, innovation in review the specific requirements set out microneedles has been a focus within the by the FDA in October 2020; present the pharmaceutical world. Today, microneedles case for the specification of dissolvable are seen as a viable option for the delivery microarray patch (MAP) technology of drugs such as biologicals, vaccines and (Figure 1), which uniquely addresses the difficult-to-deliver small molecules through FDA’s requirements; and finally evaluate the skin, in both immediate-release and the benefits of MAP technology to each long-acting products. The widely recognised stakeholder group, including pharma benefits of transdermal administration in partners, payers, healthcare professionals terms of pain-free delivery, convenience and (HCPs) and patients. patient compliance, make microneedles an The skin is an important protective ideal platform for an increasing number of barrier with an innate reactive capability therapeutic areas. (Figure 2). Its protective, inflammatory However, the journey has not been pain- and immunological properties make it an free. The US FDA has clearly struggled with attractive target for efficient drug delivery. the quality of submissions received from It has been well documented over the combination products using microneedles, years that, for various drugs, there are specifically around stability testing, content many advantages to intradermal delivery uniformity, risk analysis, sterility validation compared with the intramuscular and and manufacturing. subcutaneous routes. However, the use of a traditional needle mostly requires a relatively sophisticated cold chain supply, Dr Sebastian Braun as well as the time and effort of an HCP. Head of Formulation Development It also presents issues for the patient and Manufacturing for Innovative as it is quite invasive, particularly Injection Systems T: +49 2632 99 2770 E: sebastian.braun@ltslohmann.de Figure 1: LTS’s MAP system. LTS Lohmann Therapie-Systeme AG Lohmannstraße 2 56626 Adernach Germany www.ltslohmann.de/en 10 www.ondrugdelivery.com Copyright © 2021 Frederick Furness Publishing Ltd
LTS Lohmann Figure 2: Skin composition. for the large portion of patients who suffer NEED FOR A LESS PAINFUL mechanism of choice for many therapies. from needle phobia. WAY THROUGH THE SKIN The challenge is, of course, that at present As an alternative approach, MAPs the choice of API is limited to small can reproducibly deliver APIs into the The pharmaceutical industry is very much molecules, with today less than 30 APIs dermal and epidermal layers of the skin, aware of the benefits of drug delivery by having been successfully commercialised for which contain high densities of immune injection in terms of its capability to deliver transdermal therapeutic systems (TTSs). cells.1 Microneedle technology was first to the dermis, subcutaneous tissue and These limitations have been addressed conceptualised, and subsequently patented, muscle layers under the skin. For a number by several microneedle technologies which in the 1950s,2 but it took some time for of drugs, it is, in many ways, an ideal enable the drug to overcome the skin barrier the benefits of microneedles to be fully delivery route. However, there are evident (Figure 3). Here, the currently available recognised. It was not until 1998 that a issues too, specifically related to patient transdermal microneedle options are: paper was published exploring the compliance, usability and safety for HCPs. possibility of using microneedles for Aversion to needles, pain and needle size • Solid removable microneedles dispense vaccination in the future.3 Since that early are all very real concerns for many patients. only a limited drug load and deliver a work, the WHO has identified microneedles Needlestick injuries are a source of great short, sustained release of drug due to the as a potential game-changer for vaccine concern for HCPs, indeed the WHO stated speed of the skin healing. distribution and coverage in low-to-middle- in its World Health Report 2002 that of • Coated microneedles deliver an immediate income countries (LMICs).4 35 million HCPs, two million experience release of API and require only a short percutaneous exposure to infectious diseases application time on the skin. They do, each year. The WHO further noted that however, only carry a very limited drug load. 37.6% of Hepatitis B, 39% of Hepatitis C • Hollow microneedles can carry a higher “The pharmaceutical and 4.4% of HIV/AIDS in HCPs globally drug load and be used for immediate or industry is very much are due to needlestick injuries.5 As well as sustained release, but there are limitations aware of the benefits of the human cost, there is a financial cost too, in the types of API solution that can be with each needlestick injury case costing delivered this way. drug delivery by injection the local healthcare system around US$350 • Dissolvable microneedles offer very little in in terms of its capability (£259).6 Although MAPs do not entirely terms of compromise, and a great deal in to deliver to the dermis, eradicate the potential for needlestick terms of benefit. Dissolvable microneedles injuries, they are certainly a big step in the will be returned to later in this article. subcutaneous tissue and right direction towards protecting HCPs. Hydrogel-forming microneedles have the • muscle layers under the capacity to carry a higher drug load to skin. For a number of THE EVOLUTION OF MICRONEEDLES be delivered over a sustained period. Although they present no sharp-edge drugs, it is, in many ways, Transdermal patches offer a demonstrable waste issues, they are limited by diffusion an ideal delivery route.” improvement in patient compliance, safety of the API in the polymer matrix and by and usability, and represent the delivery the number of polymers that can be used. Copyright © 2021 Frederick Furness Publishing Ltd www.ondrugdelivery.com 11
LTS Lohmann the required specification limits and then adequately demonstrate compliance. Some submissions showed that verification and validation testing was not using the final finished combination product in bench-top, clinical or human factors studies, and there was a lack of risk analysis to ensure leaving the system in place longer than prescribed would not result in injury or overdose. The guidance from the FDA in this regard is clear. Submissions must deliver: • A comprehensive design control package that identifies risks and hazards • A clearly defined control strategy for EPR, design verification and validation • A risk management plan • An iterative guide to risk management activities throughout the entire product lifecycle. Common Manufacturing Deficiencies One particular area of weakness has been incomplete facility responsibility listings on the 356h form. Process parameters and in-process controls are not supported by process development knowledge in the Figure 3: Overview of microneedle technologies. application. There have been significant failures with submitted batches, with no All these options offer tangible benefits the criteria for a successful submission.7 root cause analysis provided. In terms in terms of patient compliance and HCP In it, the FDA stated: “Regulation of of biologics, there have been incomplete safety compared with injection-based combination products must take into process performance qualifications administration. It is also worth noting account the safety and effectiveness questions (PPQs) submitted; the product not being that solid removable, coated and hollow associated with each constituent part and the manufactured within the review cycle and microneedles all result in sharps waste, product as a whole.” inspection times; the sterilisation validation whereas dissolvable and hydrogel-forming The FDA’s presentation sought to data delivered has been insufficient; and microneedles do not. clarify the common product, product-use there have been failures with equipment and manufacturing deficiencies, as well qualification, process simulation and MICRONEEDLES AND THE FDA as setting out what it needs to see from sterility testing methods. future applications. In terms of the common The FDA’s unequivocal requirement The FDA’s experience of submissions product and product-use deficiencies, the is for evidence of process development relating to microneedles to date could perhaps headlines related to stability testing in terms and the bridge to commercial scale. be described as disappointing, with quite of formulation/API migration and continued Submission documentation must deliver basic failures evident in many fundamental testing of mechanical attributes. commercial process descriptions, process aspects of submission. This increasing level Content uniformity is fundamental, and flow diagrams, master batch records (MBRs) of disappointment manifested itself in an there is some work to do for delivery and a sterilisation validation package for October 2020 presentation from the FDA device designers and the pharmaceutical sterile products. which sought to set out in very clear terms industry more broadly in order to establish The presentation also highlighted three clear objectives for prior approval inspection (PAI): “The requirements set out by the FDA are nothing more • Readiness for commercial manufacturing • Conformance to application than would be expected for any regulated drug delivery • Data integrity. device, and it is alarming that the quality of some submissions has been poor enough to necessitate such In LTS’s opinion, the requirements set out by the FDA are nothing more regulatory guidance, given the immediate and unparalleled than would be expected for any regulated opportunities this kind of technology presents.” drug delivery device, and it is alarming that the quality of some submissions has 12 www.ondrugdelivery.com Copyright © 2021 Frederick Furness Publishing Ltd
LTS Lohmann per administration – via reducing the dose administered after months one and three. (“dose sparing”) – and the removal of cold The results demonstrated that the recombinant “LTS’s goal was to develop chain distribution challenges. vaccine MAP system is safe and well tolerated, a transdermal delivery The LTS MAP system is based on and saw mild and moderate reactions in the method where, if the uncoated dissolvable microneedles, which subjects, comparable with those who received enables optimal API load without relying the vaccine via IM injection. API can be delivered on liquid reservoirs. There are three key via an injection, it can processing requirements for a homogeneous WHERE NEXT? be delivered by LTS’s microneedle product: MAPs are a novel vaccine delivery transdermal device. LTS has • Homogeneity of dispensing solution methodology that has the potential to developed such a device • Dosing precision become a game-changer for immunisation with its MAP system.” • Precise mould dimensions and geometry. programmes, especially in LMICs, which mostly rely on vaccine storage and LTS’s MAP technology can provide transportation at 2–8°C and trained HCPs been poor enough to necessitate such for improved stability because the API is to administer injectable vaccines by needle regulatory guidance, given the immediate embedded homogenously in the polymer, and syringe. Whilst the benefits are most and unparalleled opportunities this kind of ensuring 100% of the drug content obvious for programmes in LMICs, that technology presents. is dispensed. The API and polymer are does not mean they are irrelevant for the mixed with a solvent, dispensed into the rest of the world. Indeed, much of the Meeting FDA Guidance mould and then dried to remove the solvent development work LTS is undertaking right For 40 years, LTS has been regarded as (Figure 4). The dispensing heads deliver a now is for high-value APIs. a trusted partner and market leader in precise, reproducible volume of solution. Microneedle technology is considered innovative transdermal drug delivery Indeed, the dispensing heads are so precise an advantageous delivery route for existing systems. The company’s mission is to find that pharmaceutical partners can even vaccines, including influenza, tetanus alternatives for patients where conventional switch formulations and volumes within toxoid, measles-rubella, Hepatitis B and drug delivery presents challenges. As such, each MAP. Configured for the API to inactivated poliomyelitis vaccine (IPV), LTS constantly creates new technologies be delivered and desired release option, that support pharmaceutical development each MAP can feature up to 1,000 needles and improve patient outcomes. While LTS per cm2, with needle lengths ranging from is clear about the efficacious benefits of 200 μm to more than 1,000 μm – 900 μm “MAPs are a novel vaccine TTSs, it is also aware of their limitations being the threshold for pain sensation. delivery methodology in terms of API fit, and so is committed to research and development towards finding a RECOMBINANT VACCINE that has the potential technology where the compromises inherent HUMAN STUDY RESULTS to become a game- in current TTSs were reduced. changer for immunisation Essentially, LTS’s goal was to develop In this study, LTS aimed to investigate the a transdermal delivery method where, if safety and the general and local tolerability programmes, especially in the API can be delivered via an injection, of the recombinant vaccine delivered by a LMICs, which mostly rely it can be delivered by LTS’s transdermal microneedle system, as well as the efficacy of on vaccine storage and device. LTS has developed such a device vaccination. Four cohorts were established with its MAP system. This system delivers with 12 subjects in each. Three doses of the transportation at 2–8°C and a range of benefits to the entire healthcare recombinant vaccine were delivered with the trained HCPs to administer ecosystem in terms of increased patient LTS MAP system, according the standard injectable vaccines by comfort and better compliance, a faster “prime-boost-boost” scheme. One dose level onset, lower overall healthcare costs of recombinant vaccination via intramuscular needle and syringe.” through self-administration, lower costs (IM) injection was delivered, with boosts Figure 4: The MAP manufacturing process. Copyright © 2021 Frederick Furness Publishing Ltd www.ondrugdelivery.com 13
LTS Lohmann as well as vaccines still in development, such • For patients, the reduced pain and lower 3,964,482, 1976. as inactivated rotavirus and dengue. Given psychological challenge of administering 3. Henry S et al, “Microfabricated the challenges currently surrounding the microneedle technologies creates the microneedles: a novel approach to cold-chain distribution of covid vaccines, a potential for increased patient compliance transdermal drug delivery”. J Pharm great deal of consideration should be given and adherence. Sci, 1998, Vol 87(8), pp 922–925. to MAPs as an efficient method to mass- 4. “WHO Microarray Patch (MAP) immunise populations. ABOUT THE COMPANY Product Development Workshop”. Geneva, Switzerland, 2015. CONCLUSION LTS Lohmann Therapie-Systeme AG 5. “Needlestick injuries. Protecting is a leading pharmaceutical technology health-care workers – preventing MAPs have great potential, but it has been company that develops and manufactures needlestick injuries”. WHO website. untapped to date. The technology has innovative drug delivery systems such as 6. Mannocci A et al, “How Much accrued advocates since the 1970s, and transdermal therapeutic systems (TTSs) do Needlestick Injuries Cost? A today there is a growing weight of evidential and oral thin films (OTFs) for the Systematic Review of the Economic data to show the concerns around content pharmaceutical industry. The company’s Evaluations of Needlestick and Sharps uniformity have been largely eradicated. commercial offering encompasses more than Injuries Among Healthcare Personnel”. This is now a real and present opportunity 20 marketed products and a diverse pipeline Infect Control Hosp Epidemiol, 2016, for pharma partners to benefit and deliver of more than 30 development projects Vol 37(6), pp 635–646. real value across the healthcare ecosystem. targeting multiple disease indications. 7. Strasinger C, “Product Development The technology overcomes the various LTS’s innovation pipeline contains both and Quality Considerations challenges associated with conventional partner-funded and proprietary LTS- for Transdermal Systems and formulations and offers tangible benefits funded projects. LTS maintains its leading Microneedle Systems: A Regulatory for pharma partners, payers, HCPs and, of position through the continuous refinement Perspective”. PharmaEd Resources, course, patients: of its core TTS and OTF technologies Microneedle Drug Delivery Systems and by advancing emerging drug delivery Virtual Conference, Oct 27–28, 2020. • For pharma partners, there is now the technologies, including microarray patches necessary evidence to demonstrate that (MAPs) for the intradermal delivery of large MAPs are a safe and reliable dosage form molecule, biological actives. LTS has an ABOUT THE and that adequate patient dosing can be achieved. There are several advantages established dedicated state-of-the-art R&D centre for its parenteral and sterile MAP AUTHOR in terms of custom design too, with both technology platform, including a GMP area Sebastian Braun has worked in the field sustained and immediate release options for manufacturing of clinical supplies. of transdermal and dermal drug delivery available, as well as flexibility in needle Founded in 1984, LTS operates today for 15 years. A molecular biologist design, length, width and composition. from two sites in Andernach (Germany) and with a PhD in analytical chemistry There are also real options for patent West Caldwell (NJ, US), and a representative and molecular biology, he started his protection and brand differentiation, office in Shanghai (China). career at a transdermal drug delivery as well as lifecycle management and company, building a fundamental product extension opportunities. There REFERENCES understanding of the biological is also a very clear option to repurpose workings of the skin. Spending the existing products into a more patient- 1. Fernando GJP et al, “Safety, last 15 years at different transdermal friendly delivery mechanism. tolerability, acceptability and and dermal drug delivery companies • For payers, there is a real benefit to immunogenicity of an influenza in various positions, including head MAPs in that they can enable patient vaccine delivered to human skin by of formulation development, head of self-administration, creating the potential a novel high-density microprojection manufacturing and head of science for lower healthcare costs. array patch (Nanopatch™)”. Vaccine, and technology, he is now focused • For HCPs, they help to reduce the 2018, Vol 36(26), pp 3779–3788. on microneedle development and challenges and threats associated with 2. Gerstel MS, Place VA, “Drug manufacturing. needlestick injuries. Delivery Device”. US Patent No IN WHICH ISSUE SHOULD YOUR COMPANY APPEAR? www.ondrugdelivery.com/participate 14 www.ondrugdelivery.com Copyright © 2021 Frederick Furness Publishing Ltd
PROMISE TRANSDERMAL “NEXT BIG THING” MAP MICRO ARRAY PATCH Pain-free and easy to use For biologics, vaccines, and small molecules Reduced side effects due to transdermal application www.ltslohmann.com
Early Insight PHARMA LATCH ANGLED MICRONEEDLE PATCH FOR ENHANCED DRUG AND VACCINE DELIVERY Nicky Bertollo, PhD, Co-Founder and Chief Technology Lead, Ronan Byrne, Co-Founder, and Andrew Muddle, PhD, Advisory Board Member, all of Latch Medical, introduce Pharma Latch – a user-centric angled microneedle patch technology. They discuss its key benefits, such as dramatically increased payload potential, precision, low cost and variable patch-wear times, and highlight how Pharma Latch has the potential to overcome many of the limitations of existing routes of administration for therapeutics and vaccines. Intradermal delivery holds great a result. Invasive intradermal injections promise as an attractive alternative to using hypodermic needles, pen injectors traditional oral and parenteral routes of and even needle-free injectors are associated administration for the delivery of vaccines with the potential for discomfort and Dr Nicky Bertollo and therapeutics, including biologics. distress for the patient; have significant Co-Founder and Chief Technology Lead Systemic uptake of therapeutics via the requirements around infrastructure, training T: +353 1 716 3770 dermal blood capillaries has a host of of personnel and sterile settings; and have E: nicky.bertollo@latch-medical.com benefits, including avoiding the deleterious the ever-present risk of needlestick injuries. effects of first-pass metabolism, rapid Transdermal patches overcome some of drug onset and improved bioavailability these limitations but are confined to a of APIs, such as biologics, that are not relatively small number of compounds readily absorbed across the mucosal layers which are known to be able to successfully of the gastrointestinal tract. Furthermore, permeate the intact outer layer of skin – the the skin is replete with antigen presenting stratum corneum – either passively or in cells (APCs) and therefore represents an combination with permeation enhancers. optimal location for the delivery of vaccines These and other restrictions have Ronan Byrne (both traditional and novel DNA- and motivated the development of minimally Co-Founder mRNA-based vaccines) in order to elicit an invasive microneedle patch (MNP) T: +353 1 716 3770 enhanced immune response. technologies which not only overcome E: ronan.byrne@latch-medical.com Methods employed to deliver or diffuse many of these limitations but – as noted drugs into the dermis must compete against by the World Economic Forum in its list of the skin’s excellent barrier function – and Top 10 Emerging Technologies of 20201 are associated with known limitations as – have the potential to play a role in transforming healthcare. The enhanced intradermal delivery attributes offered by MNPs have the potential to cater for “Pharma Latch is a existing, repurposed or new ranges of revolutionary MNP compounds not suited to the established routes of administration. Dr Andrew Muddle technology that unlocks Advisory Board Member Pharma Latch is a revolutionary MNP a delivery solution that technology that unlocks a delivery solution addresses a wide variety of that addresses a wide variety of drug and vaccine delivery challenges faced by both drug and vaccine delivery conventional routes of administration and Latch Medical challenges faced by both current MNP technologies. NovaUCD conventional routes of Belfield Innovation Park INTRODUCING PHARMA LATCH University College Dublin administration and current Dublin Ireland MNP technologies.” Pharma Latch is an easily self-administered, self-anchoring, solid-coated MNP optimised www.pharmalatch.com 16 www.ondrugdelivery.com Copyright © 2021 Frederick Furness Publishing Ltd
Early Insight Figure 1: Pharma Latch microneedle patch technology. (Image courtesy Latch Medical. Reproduced with kind permission.) for therapeutic and vaccine delivery (Figure 1). Pharma Latch technology “The proprietary coating technology produces coatings exhibits opposing arrays of angled stainless- steel microneedles (MNs) coated using a at room temperature and without the need for linkers proprietary process performed at room or binders, meaning that APIs may be formulated and temperature which dries instantaneously and deposited at relatively higher concentrations.” is compatible with a range of compounds, including biologics. Pharma Latch is applied to the skin using a simple and intuitive clicking action. for linkers or binders, meaning that Highly user-centric design and ease of • This manual clicking moves the opposing APIs may be formulated and deposited use. The Pharma Latch is applied to the angled MNs towards one another, at relatively higher concentrations. skin using a simple and intuitive manual penetrating the outer skin layers and The process deposits API-containing clicking action and is easily removed. drawing the skin onto the MNs in a formulations in uniformly even and Built-in safety mechanisms prevent controlled, repeatable fashion. Robust, thin layers, which preserves MN accidental deployments, whilst visual, adhesive-free and instantly reversible tip geometry to a greater extent than tactile and audible feedback is provided attachment to skin can be achieved. traditional dip-coating techniques.. to the user on successful attachment. This, coupled with inherent tailorability • Increased payload potential. The The user-centric and intuitive design in both design and coating, means that combination of these geometry and has no training requirements, allowing Pharma Latch can facilitate both short- and coating factors can elevate the payload for administration by minimally trained longer-term patch wear and drug elution potential of the Pharma Latch far beyond medical personnel or self-administration times (seconds/minutes/days/weeks) across what is currently achieved by solid-coated by patients. a range of compound types at much higher and dissolvable MNP technologies. Repeatable, reliable penetration and • payloads than are currently achieved • Stable coatings. The proprietary coatings depth targeting. Uncontrolled and by existing solid-coated and dissolvable can potentially be stable at room variable skin deformation occurs during MNP technologies. temperature, which removes cold-chain the application of conventional MNPs Key features and benefits of Pharma and logistics requirements, facilitating to skin, resulting in partial, incomplete Latch’s technology include: global, remote distribution. Pharma and highly variable embedding of the Latch has demonstrated with a number full MN height.2,3 In some cases, only • Increased MN surface area available of biological APIs that the coating a small proportion (up to 30%) of MN for coating. When compared with the process does not affect its stability. height is routinely exposed to skin.4 conventional vertical approach taken by • Robust, adhesive-free attachment. The Variable, incomplete MN penetration MNPs, the angling of the Pharma Latch unique manner in which the angled MNs may potentially reduce payload delivery MNs – specified for a given depth target interdigitate with and anchor to the efficiency for both conventional solid- in the skin – results in greater surface skin removes the need for chemical- coated MNPs and dissolvable MNP area available for coating with the API. based adhesives. This also opens up the technologies.3,5 The unique method of • Superior coating concentration across a possibility of long-term patch wear from engagement applies subtle traction to range of compound types. The proprietary hours and days up to several weeks – skin during deployment, drastically coating technology produces coatings at a possibility not achievable using existing reducing deformation and ensuring near room temperature and without the need solid-coated MNP technologies. full-length (>95%) exposure of the angled Copyright © 2021 Frederick Furness Publishing Ltd www.ondrugdelivery.com 17
Early Insight MNs to skin.6 The superior penetration ENGINEERING THE PHARMA LATCH variability in MN penetration across efficiency of Pharma Latch’s angled MNs existing MNPs is well reported in the could result in reduced dosing variability, The Pharma Latch is optimised for skin scientific literature. Importantly, the extent which will be observed in drug absorption penetration and adhesive-free attachment. of this deformation can be exacerbated measured in the pharmacokinetic data of The unique solution ensures that each by the anatomical location and integrity its products. individual angled MN is repeatably inserted of the skin, as well as by subdermal fat.7 No • reliance on pre-energised to the same depth in the skin every time in The combination of these patient-related applicators. Many MNP solutions every patient. and skin biomechanics factors can be looking to deliver higher payloads need expected to give rise to dosing variability a high-density MN configuration. These Mechanism across repeated applications on the same need a high-velocity impact onto the Subtle traction is applied to the skin by the patient (i.e. intra-subject variability) and/ skin to aid penetration – requiring a opposing arrays of angled MNs keeping or between patients across a population pre-energised applicator. This also limits the skin taut and dramatically reducing (i.e. inter-subject variability) when treated potential patch size. Pharma Latch’s skin deformation during insertion. This using conventional MNP technologies. controlled mechanism of engagement novel mechanism of insertion is illustrated with skin removes the reliance on in Figure 2. Conceptually, the net effect Repeatability pre-energised applicators and increases of these attributes results in skin being The Pharma Latch deployment mechanism the range of permissible patch sizes from drawn up onto the Pharm Latch MNs in a is designed to produce repeatable MN 4 cm2 upwards. controlled, repeatable fashion. insertion, independent of skin type or C onfigurable to meet treatment • The mechanism of insertion differs anatomical location. This substantially objectives. The Pharma Latch platform fundamentally from many existing MNP reduces intra-subject and inter-subject can be readily adapted to meet varied technologies and application techniques dosing variability risks, which may be treatment objectives, including human (including both manual pressing and observed in pharmacokinetic data. The factors considerations, with one- or two- high-speed impact using pre-energised increased penetration efficiency achieved part configuration options to facilitate applicators) which effectively act to push by the Pharma Latch MNs, derived from a both short- and long-term wear and the skin away from the patch as it is combination of the angled MN geometry and delivering low-to-high payloads. being applied. As mentioned prior, the skin insertion mechanics, ensures repeatable, Figure 2: Schematic depicting Pharma Latch’s mechanism of engagement, the subsequent release of the API from the fully embedded angled microneedles and the method of removal. 18 www.ondrugdelivery.com Copyright © 2021 Frederick Furness Publishing Ltd
Early Insight The scalable approach to MN fabrication FUTURE OUTLOOK ensures that the Pharma Latch design “The Pharma Latch (i.e. MN geometry, tip height, number The Pharma Latch technology is technically deployment mechanism and density) is readily customisable to validated and currently moving towards a is designed to produce accommodate the desired payload and number of pre-clinical studies with a range intended release kinetics of the deposited of different compounds and vaccines. The repeatable MN insertion, coating. MN density can be tuned to simplicity of Pharma Latch, combined with independent of skin type or meet the payload objectives of the specific its payload potential, opens up a variety anatomical location.” application, which gives rise to a range of new possibilities – both in the MN of potential Pharma Latch configurations. drug delivery sphere and also in a broader Pharma Latch makes use of a two-part consideration of drug delivery opportunities near-full-length coated MN exposure and system (with reloading capabilities) for previously considered out of reach for release of API into the interstitial fluid of the high-density MN patch configurations MNP technologies. skin for systemic uptake. supporting high payloads, with the second The company is actively seeking part increasing the mechanical advantage collaborations with companies looking Manufacturing and promoting usability. A one-part system to develop novel products which meet The increased MN insertion efficiency of is available for lower payload, low-MN- currently unmet patient needs – be they Pharma Latch, coupled with a controlled, density applications. existing compounds or vaccines, generic manual application action, removes the APIs looking to differentiate through the need to employ costly, high-strength Coating 505(b)(2) route of registration in the US metal alloys. Pharma Latch uses low- Pharma Latch’s solid MNs coated with or new compounds or vaccines looking to cost, surgical-grade stainless steel and API offer an advantage over dissolvable be delivered intradermally, be they small can be produced using scalable, low-cost MNP technologies in that the solid MNs molecules, vaccines or biologics. production methods leveraging standard themselves provide the mechanical backbone pharmaceutical packaging materials and and requisite strength. This potentially ABOUT THE COMPANY processes. Coating of the MNs relies on a simplifies the mechanical considerations highly automated process with established around – and specific requirements of – Latch Medical is a venture-funded company high-volume, low-cost techniques. excipients in a given formulation. This with a platform microneedle technology. approach, coupled with the method of The technology is centred on opposing Tailorability coating, can simplify the formulation arrays of angled microneedles that can Pharma Latch is highly configurable and both process, whilst simultaneously increasing penetrate the outer layers of the skin the core MN platform and coating process the range of compound types that can be in a manner ensuring consistent needle can be readily tailored to meet the treatment readily incorporated into the platform. penetration and without the use of any objectives, in terms of desired payload, release adhesive. The platform can be used in a kinetics and wear times. Pharma Latch offers Payload number of different applications, including an unsurpassed ability to target specific depths The tailorability in the proprietary coating drug delivery, biosensing and wearables. in the skin, owing to its superior penetration process allows the delivery of payloads In 2019, Pharma Latch was awarded a efficiency (>95% length penetration),6 which far in excess of what is currently being substantial grant by the Irish government. may be important when treating certain achieved by solid-coated and dissolvable A rapid development plan ensued, allowing dermatological conditions or administering MNP technologies. Combined with the the Pharma Latch technology to progress. vaccines. The direct implication of a highly self-anchoring angled MN geometry, this efficient MN insertion is that vertical potentially allows Pharma Latch to rival the REFERENCES penetration depth is ultimately governed by the dosages currently being delivered through MN geometric parameters and, specifically, more traditional means. As a result, Pharma 1. “Top 10 Emerging Technologies of the vertical MN tip height from the substrate, Latch has the potential to offer a step 2020”. World Economic Forum, which can typically be engineered to be in the change in MN-mediated therapeutic and November 10, 2020. range of 250–600 μm or beyond. vaccine delivery. 2. Römgens AM et al, “Monitoring the penetration process of single microneedles with varying tip diameters”. J Mech Behav Biomed “Pharma Latch has the potential to offer a step change in Mater, 2014, Vol 40, pp 397–405. MN-mediated therapeutic and vaccine delivery.” 3. Donnelly RF et al, “Optical coherence tomography is a valuable IN 2021 WE’LL BE BRING YOU... MORE CONTENT THAN EVER! Copyright © 2021 Frederick Furness Publishing Ltd www.ondrugdelivery.com 19
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