USE

RELATED APPLICATIONS

[0001] This application claims priority to US Provisional Patent Application No. 62/812, 140, filed on February 28, 2019, the entire contents of which is expressly incorporated herein by this reference.

TECHICAL FIELD

[0002] The technical field is treatment of osteoporosis and other disorders, e.g. , fracture repair, with a trans dermal formulation of abaloparatide.

BACKGROUND

[0003] Abaloparatide, ahuman parathyroid hormone related peptide [PTHrP(l-34)] analog, is FDA approved as a once daily subcutaneous 80 meg injection for postmenopausal women with osteoporosis at a high risk for fracture. Provided herein is an alternative to daily self- injection of abaloparatide without compromising the safety and efficacy of treatment with abaloparatide.

SUMMARY OF THE INVENTION

[0004] Abaloparatide is a synthetic PTHrP analogue having the amino sequence:

Ala-Va -Ser-Glu-His-Gln-Leu-Leu-His-Asp-Lys-Gly-Lys-Ser-Ile-Gln- Asp-Leu- Arg-Arg-

Arg-Glu-Leu-Leu-Glu-Lys-Leu-Leu-Aib-Lys-Leu-His-Thr-Ala-N H

SEQ ID NO: 1 (TYMLOS abaloparatide injection label). Abaloparatide has shown potent anabolic activity with decreased bone resorption, less calcium-mobilizing potential, and improved room temperature stability. Subcutaneous administration of 80 pg abaloparatide has been shown to significantly reduce incidences of new vertebral, non- vertebral, major osteoporotic and clinical fractures. Subcutaneous abaloparatide administration has also been shown to improve bone mineral density (BMD) and/or trabecular bone score (TBS) of treated subjects at the lumbar spine, total hip, and femoral neck.

[0005] Transdermal administration of abaloparatide is an attractive alternative to subcutaneous administration due to its less invasive nature. In particular, it might be advantageous in some contexts to develop transdermal abaloparatide administrations that are substantially bioequivalent or bioequivalent to the subcutaneous (SC) abaloparatide administration in order to benefit from its proven SC efficacy.

[0006] Disclosed herein are formulations, delivery devices, and dosing regimens that allow transdermal delivery of abaloparatide, providing equivalent benefits to the currently-available self- injection delivery option for abaloparatide. [0007] In one aspect, a method for treating osteoporosis in a subject in need thereof is provided.

The method includes administering daily atransdermal patch applied to the subject’s thigh for about 5 minutes, the patch comprising: 300 pg of abaloparatide, and ZnCT. at a molar ratio of 2.2:1 of

ZnCtabaloparatide, wherein the subject is treated for osteoporosis.

[0008] In another aspect, a method of increasing bone mass density (BMD) in a subject in need thereof is provided. The method includes administering daily atransdermal patch applied to the subject’s thigh for about 5 minutes, the patch comprising: 300 pg of abaloparatide, and ZnCT. at a molar ratio of 2.2:1 of ZnCkabaloparatide, wherein the subject achieves at least a 5% increase in BMD by 6 months.

[0009] In another aspect, a once-daily transdermal systemfor the delivery of abaloparatide is provided that includes a plurality of single-use transdermal patches, each loaded with about 300 pg of abaloparatide, and ZnCT at a molar ratio of 2.2:1 ofZnCtabaloparatide; and instructions to administer one of the transdermal patches once daily to the thigh for about 5 minutes. In some embodiments, the once- daily transdermal system further includes a multi-use applicator. In some embodiments, the once-daily transdermal system further includes a plurality of single use applicators.

[0010] In yet another aspect, a method for transdermally delivering abaloparatide to a subject in an amount bioequivalent to subcutaneous injection of 80 meg abaloparatide is provided. The method includes administering daily a transdermal patch applied to the subject’s thigh for about 5 minutes, the patch comprising: 300 pg of abaloparatide, and ZnCT. at a molar ratio of 2.2:1 of ZnCkabaloparatide, wherein an amount of abaloparatide is transdermally delivered to the subject that is bioequivalent to subcutaneous injection of 80 meg abaloparatide.

[0011] In another aspect, a method for treating osteoporosis in a subject in need thereof is provided that includes administering daily a transdermal patch applied to the subject’s thigh for about 5 minutes, the patch comprising: 300 pg of abaloparatide, and one or more pharmaceutically acceptable zinc salts, at a molar ratio of 2.2:1 of the pharmaceutically acceptable zinc salts to abaloparatide, wherein the subject is treated for osteoporosis. In one embodiment the one or more pharmaceutically acceptable zinc salts includes zinc chloride. In another embodiment the one or more pharmaceutically acceptable zinc salts is or includes zinc acetate.

[0012] In another aspect, a method of increasing bone mass density (BMD) in a subject in need thereof is provided that includes administering daily atransdermal patch applied to the subject’s thigh for about 5 minutes, the patch comprising: 300 pg of abaloparatide, and one or more pharmaceutically acceptable zinc salts, at a molar ratio of 2.2:1 of pharmaceutically acceptable zinc salts to abaloparatide, wherein the subject achieves at least a 5% increase in BMD by 6 months. In one embodiment the one or more pharmaceutically acceptable zinc salts includes zinc chloride. In another embodiment the one or more pharmaceutically acceptable zinc salts is or includes zinc acetate. [0013] In yet another aspect, a once-daily transdermal system for the delivery of abaloparatide is provided that includes a plurality of single-use transdermal patches, each loaded with about 300 pg of abaloparatide, and one or more pharmaceutically acceptable zinc salts at a molar ratio of 2.2:1 of pharmaceutically acceptable zinc salts:abaloparatide, and instructions to administer one of said transdermal patches once daily to the thigh for about 5 minutes. In one embodiment the one or more pharmaceutically acceptable zinc salts includes zinc chloride. In another embodiment the one or more pharmaceutically acceptable zinc salts is or includes zinc acetate. In another embodiment the one or more pharmaceutically acceptable zinc salts is or includes zinc acetate, zinc carbonate, zinc chloride, zinc gluconate, zinc oxide, zinc sulfate and combinations thereof. In one embodiment the system includes a multi-use applicator. Alternatively, the once-daily transdermal system includes a plurality of single use applicators.

[0014] In yet another aspect, a method for transdermally delivering abaloparatide to a subject in an amount bioequivalent to subcutaneous injection of 80 meg abaloparatide is provided. The method includes administering daily a transdermal patch applied to the subject’s thigh for about 5 minutes, the patch comprising: 300 pg of abaloparatide, and one or more pharmaceutically acceptable zinc salts, at a molar ratio of 2.2:1 of pharmaceutically acceptable zinc saltabaloparatide, wherein an amount of abaloparatide is transdermally delivered to the subject that is bioequivalent to subcutaneous injection of 80 meg abaloparatide.

[0015] In one embodiment the one or more pharmaceutically acceptable zinc salts includes zinc chloride. In another embodiment the one or more pharmaceutically acceptable zinc salts is or includes zinc acetate. In another embodiment the one or more pharmaceutically acceptable zinc salts is or includes zinc acetate, zinc carbonate, zinc chloride, zinc gluconate, zinc oxide, zinc sulfate and combinations thereof.

[0016] In another aspect, an aqueous formulation suitable for coating a transdermal patch is provided wherein the aqueous formulation comprises 300 pg of abaloparatide, zinc at a molar ratio of 2.2:1 of Zmabaloparatide, and hydrochloric acid. In some embodiments, the pH of the aqueous formulation is between about 4.5 and about 5. In some embodiments, the pHis between about 4 and about 4.75. In some embodiments , the pH is about 4.5. In s ome embodiments , the pH is les s than 4.75. In s ome embodiments the mole ratio of HC1 to zinc chloride is about 0.025, at least about 0.025, between about 0.02 to about 0.1, or between about 0.02 and about 0.07.

[0017] In yet another aspect, a transdermal system for the delivery of abaloparatide is provided. The system includes an abaloparatide transdermal patch made by coating a plurality of microprojections defined by a surface of a transdermal patch with the above aqueous formulation; and instructions to administer one of said transdermal patches once daily to the thigh for about 5 minutes. BRIEF DESCRIPTION OF THE DRAWINGS

[0018] FIG. 1 A and FIG. IB are a graph of plasma concentrations over time and a table of pharmacokinetic parameters, respectively, for Cohort 1, Formula Aat 100 meg, 150 meg and 200 meg doses.

[0019] FIG. 2A and FIG. 2B are a graph of plasma concentrations over time and a table of pharmacokinetic parameters, respectively, for Cohort 2, Formula B at 100 meg, 150 meg and 200 meg doses.

[0020] FIG. 3A and FIG. 3B are a graph of plasma concentrations over time and a table of pharmacokinetic parameters, respectively, for Cohort 3, Formula C at 100 meg, 150 meg and 200 meg doses.

[0021] FIG. 4A and FIG. 4B are a graph of plasma concentrations over time and a table of pharmacokinetic parameters, respectively, for Cohort 4.

[0022] FIG. 5A and FIG. 5B are a graph of plasma concentrations over time and a table of pharmacokinetic parameters, respectively, for Cohort 5.

[0023] FIG. 6A-6E are graphs of plasma concentrations for Cohort 6 in linear scale (FIG. 6A) and semi-log scale (FIG. 6B); and tables of pharmacokinetic parameters for Cohort 6 (FIG. 6C), a within cohort comparison (FIG. 6D), and relative bioavailability parameters between doses, application sites, and wear times (FIG. 6E).

[0024] FIG. 7Aand FIG. 7B are graphs of plasma concentrations over time for Cohort 7 in linear and semi-log scale, respectively.

DETAILED DESCRI PTION

[0025] Provided herein is a safe, effective, and pain-free alternative to daily self-injection of abaloparatide in the form of atransdermal device. Application time is only about 5 minutes, yet surprisingly provides a bioequivalent amount of abaloparatide to that achieved with self-injection. The device is a once- daily transdermal patch that includes 300 pg of abaloparatide disposed on the patch with a release modulating agent, ZnCb. This release modulating agent is present on the transdermal device at a molar ratio of 2.2:1 of ZnCb :abaloparatide. That delivery of an effective and safe amount can be achieved with a residence time of about 5 minutes for the patch is unexpected and surprising as demonstrated in the exemplification.

Definition and Abbreviations

[0026] The terms ZnCb and“zinc chloride” are used interchangeably, and refer to the molecule of zinc chloride including all hydrates and solvates. [0027] The term“pharmaceutically acceptable zinc salts” refers to pharmaceutically acceptable zinc salts, including solvates and hydrates that are generally recognized, by qualified experts, to be safe under the intended conditions of use (e.g., GRAS as recognized by the FDA). Zinc salts include zinc acetate, zinc carbonate, zinc chloride, zinc gluconate, zinc oxide and zinc sulfate. While the zinc in the zinc salts may (or may not) disassociate from the chloride in water and be dried to include forms that are different from the original compound, it is still referred to as zinc salt for ease of reference and clarity.

[0028] In this application, the amount of pharmaceutically acceptable zinc salt to abaloparatide is described as a mole ratio which is represented herein as "M" unless stated otherwise. For example, a coating solution described as 2.2 M ZnCb indicates a mole ratio of ZnCb to abaloparatide of 2.2:1. The molar ratio is determined, e.g., by calculation of the ratio of ZnCb to abaloparatide added to the coating solution on a molar basis. While the zinc in ZnCb may disassociate from the chloride in water and be dried to include various hydrates, solvates and other forms, the amount of zinc on a molar basis will not substantially differ from that added, and as a result, is still referred to as ZnCb in the transdermal patch.

[0029] The terms“transdermal device” and“patch” are used interchangeably in this application. Suitable transdermal devices include devices having an array of microstructures that pierce the stratum comeum when pressed against the skin to deliver an agent to the tissues below. Microneedles in the form of micro-blades or microstructures (e.g. , as disclosed in WO2017/184355 published 26 October 2017 and filed as PCT/US2017/026462 on 6 April 2017), pierce the stratum corneumupon application of force, making a plurality of tiny openings or slits which serve as passageways through which abaloparatide can be delivered to the body. Alternatively, the microneedles can be hollow to provide a liquid flow path from a reservoir to the microneedles. These transdermal devices can be deployed with a single-use applicator or an application capable of being used multiple times. The transdermal patch or device can be any of the patches described herein, or described in International Application Nos. PCT/US2016/056196, filed on October 8, 2016 and published as WO2017/062922, PCT/2017/026462, filed April 6, 2017 and published as WO 2017/184355, or PCT/US2016/055924, filed October 7, 2016 and published as WO2017/062727. The entire content of which as expressly incorporated herein by this reference.

[0030] The term“applicator” refers to a device for applying a transdermal device or patch to the skin with sufficient force for the microneedle array to pierce the stratum corneum and deliver abaloparatide to the subject.

[0031] The abbreviations employed in this application are provided in Table 1 : List of

Abbreviations.

EXEMPLIFICATION

[0032] An open-label, partially randomized, single-dose crossover, pilot PK, safety and tolerability study was conducted in healthy postmenopausal women to select the formulation, dose, application site, and wear time for transdermal abaloparatide (abaloparatide-TD) with a PK profile comparable to TYMLOS abaloparatide subcutaneous injection (abaloparatide-SC).

[0033] Formulations used in the Cohorts are shown in Table 2: Study Formulations.

[0034] The formulated patch is made by coating with the coating solution in one or multiple coating iterations and then drying the patch or allowing the patch to dry to a fairly constant weight.

[0035] Formulation A 0.7 M ZnCh abaloparatide coating solution (Table 3.1).

[0036] Formulation A 0.7 M ZnCb abaloparatide formulation on patch ready to use (after drying) (Table 3.2).

[0037] Formulation B: abaloparatide PEG coating solution (Table 3.3).

[0038] Formulation B: abaloparatide PEG formulation on patch ready to use (after drying) (Table.

[0039] Formulation C: Abaloparatide: ZnCb 1 :0.7 molar ratio plus PEG coating solution (Table.

[0040] Formulation C: Abaloparatide:ZnCl2 1 :0.7 molar ratio plus PEG formulation on patch readye (after drying) (Table 3.6).

Formulation W: 2.2M ZnCb abaloparatide coating solution (Table 3.7). [0041] Formulation W: 2.2M ZnCb abaloparatide formulation on patch ready to use (after drying)

(Table 3.8).

[0042] Formulation W-l : 2.2M ZnCb abaloparatide formulation with HC1 on patch ready to use (after drying) (Table 3.8.1).

[0043] Formulation X: ZnAc abaloparatide coating solution (Table 3.9).

[0044] Formulation X: ZnAc abaloparatide formulation on patch ready for use (after drying) (Table 3. 10).

Transdermal system

[0045] Subjects received a single application of a transdermal patch (500x550 patch; needles had a length of 500pm and needle tips were spaced 550pmfrom each other). Microneedle transdermal patches coated with the formulations of abaloparatide were stored refrigerated at 2-8°C. At least one hour prior to use, the trans dermal patches in individual pouches were placed at room temperature. The area of a single patch with microneedles was typically about 1.26 cm ² . If two patches were used, they had a combined area of about 2.52 cm ² . The patch was applied by pushing the delivery device containing the patch to the skin at a force of, e.g., 15-25 newtons. The energy at impact to the patch upon delivery is delivered very quickly to the stratum corneum with a penetration time of less than, for example 50 milliseconds or even less than 10 milliseconds and energy sufficient to penetrate the stratum corneum

Pharmacokinetic Assessments

[0046] In Cohorts 1-5, atotal of 10 venous blood samples were drawn from each subject in each treatment period to measure abaloparatide plasma concentrations at the following time points (clock starts from time of application/injection): 0 (pre-dose), 5, 10, 20, 30, and 60 minutes and 1.5, 2, 3, and 24 hours post-dose.

[0047] Beginning in Cohort 6, a total of 11 venous blood samples were drawn from each subject in each treatment period to measure abaloparatide plasma concentrations at the following time points : 0 (pre dose), 5, 10, 20, 30, and 60 minutes and 1.5, 2, 3, 4, and 24 hours post-dose.

[0048] In Cohort 7, a total of 12 venous blood samples were drawn from each subject in each treatment period to measure abaloparatide plasma concentrations at the following time pointsO (pre-dose), 5, 10, 20, 30, and 60 minutes and 1.5, 2, 3, 4, 8, and 24 hours post-dose.

[0049] PK parameters of plasma abaloparatide were calculated using a validated PhoenixTM

WinNonlin® 7. Summary tables and figures of abaloparatide in plasma were generated using a validated version of PhoenixTM WinNonlin® 7 or R Version 3.4.4. Inferential statistical analyses were performed using validated version of PhoenixTM WinNonlin® 7 (Average Bioequivalence Module).

[0050] The total dose of abaloparatide released from the patch was used for PK parameter calculation following abaloparatide-TD. The total released dose was calculated in the source dataset as: Total Released Dose (pg) = Initial Patch Content (pg) - Patch Residual Drug (pg) - Skin Swab Residual Drug (pg). The nominal dose of abaloparatide (/. e. , 80 pg) was used for PKparameter calculations following abaloparatide-SC.

Cohorts 1-3: Study Design

[0051] The study design of Cohorts 1 through 3 followed a 4 period Williams Latin Square Design in which an equal number of subjects in each cohort were randomized to 1 of the 4 treatment sequences. In this design, each subject received each of the 4 treatments in the cohort over the course of the 4 treatment periods (Table 4). All abaloparatide-TD formulations were applied to the periumbilical region of the abdomen for 15 minutes.

[0052] Subjects were randomized to receive 1 of the 4 possible dosing sequences shown using equal allocation ratio in each cohort. This design was used for Cohorts 1, 2, and 3 with an evaluation period after each cohort. A different TD patch formulation was used for each cohort. Subjects were enrolled into 1 of 3 cohorts, with each cohort receiving a different TD formulated patch. Each treatment period was separated by a washout period of at least 7 days.

Cohort 1 Results

[0053] Referring to FIG. 1 A and FIG. IB, following a single dose of abaloparatide-TD Formulation

A at 3 dose levels, geometric mean plasma abaloparatide AUC and C _mix increased from the 100 to 150 pg dose levels and remained stable from the 150 to 200 pg dose levels. Systemic exposure parameters following abaloparatide-TD Formulation A achieved 25 to 44% of abaloparatide-SC AUC and 41 to 56% of abaloparatide- SC C _m»

[0054] Assuming a dose proportional increase in systemic exposure, the observed CL/F suggested that a patch of 350 pg would be required to achieve similar systemic exposure to the SC 80 pg treatment. Given that the systemic exposure (C _m ,x and AUCo-t) appeared to plateau between 150 and 200 pg TD, the likelihood of successfully matching the target 80 pg SC results with Formulation A appeared low.

[0055] Based on AUCo-t, AUCo-inf, and C _m ,x values, the relative bioavailability of abaloparatide following a single administration of abaloparatide-TD Formulation A at dose levels of 100, 150 and 200 pg was 44.1 to 73.6% lower than that of abaloparatide-SC and the 90% Cl were outside the 80 to 125% acceptance criteria for similarity for all comparisons.

Cohort 2 Results

[0056] Referring to FIG. 2A and FIG. 2B, following abaloparatide-TD Formulation B, mean plasma abaloparatide concentrations were similar across the 100 to 200 pg dose levels. Mean plasma abaloparatide concentrations were lower following abaloparatide-TD Formulation B for all dose levels compared to abaloparatide-SC.

[0057] Systemic exposure parameters following abaloparatide-TD Formulation B achieved 19 to 29% of abaloparatide-SC AUC and 52 to 56% of abaloparatide-SC Cimx. Based on AUCo-t, AUCo-inf, and C _mx values, the relative bioavailability of abaloparatide following a single administration of abaloparatide- TD Formulation B at dose levels of 100, 150 and 200 pg was 46.6 to 83.0% lower than that of

abaloparatide-SC and the 90% Cl were outside the 80 to 125% acceptance criteria for similarity for all comparisons.

Cohort 3 Results

[0058] Referring to FIG. 3A and FIG. 3B, following abaloparatide-TD Formulation C, mean plasma abaloparatide concentrations were similar across the 100 to 200 pg dose levels. Mean plasma abaloparatide concentrations were lower following abaloparatide-TD Formulation C for all dose levels compared to abaloparatide-SC.

[0059] Systemic exposure parameters following abaloparatide-TD Formulation C achieved 14 to 33% of abaloparatide-SC AUC and 30 to 43% of abaloparatide-SC Cmax. And based on AUCo-t, AUCo-inf, and Cm _ax values, the relative bioavailability of abaloparatide following a single administration of abaloparatide-TD Formulation C at dose levels of 100, 150 and 200 pg was 59.1 to 86.9% lower than that of abaloparatide-SC and the 90% Cl were outside the 80 to 125% acceptance criteria for similarity for all comparisons.

Summary of Cohorts 1 to 3

[0060] Overall, for Cohorts 1 to 3, the AUCo-t, AUCo-inf, and Cimx of abaloparatide following a single administration of abaloparatide-TD Formulations A, B or C at dose levels of 100, 150 or 200 pg were lower than those observed for 80 pg abaloparatide-SC. The systemic exposure (C _m , _x and AUCo-t) of abaloparatide-TD Formulation A increased from the 100 to 150 pg dose levels and appeared to plateau between 150 and 200 pg. As for Formulations B and C (Cohort 2 and 3), the systemic exposure did not increase with increasing dose and appeared to have already plateaued at 100 pg. Assuming a dose- proportional increase in systemic exposure, a dose of 350 pg of Formulation A would be required to match the systemic exposure of 80 pg abaloparatide-SC.

Cohorts 4 and 5

[0061] In Cohort 4, subjects received abaloparatide-TD Formulation A and Formulation C at 200 pg dose applied to the ventral midline of the thigh with a wear time of 15 minutes. In Cohort 4, treatment period 3, each subject was given study medication through simultaneous application of two abaloparatide- TD 150 pg patches in separate quadrants of the abdomen (Applicator 1). The abaloparatide-TD microneedle patches were applied for 15 minutes, and each treatment period was separated by a washout period of at least 3 days.

[0062] Cohort 5 evaluated four formulations of abaloparatide-TD. Each patch contained a dose of either 200 pg or 260 pg of abaloparatide, applied as a single patch administration to the thigh, or a simultaneous double patch application of 200 pg applied to the ventral midline of thigh with a different patch applicator (Applicator 2). All abaloparatide-TD formulations were applied for 15 minutes. A summary of the design for Cohorts 4 and 5 is shown in Table 5.

[0063] Referring to FIG. 4A and FIG. 4B, mean plasma abaloparatide concentrations were higher following abaloparatide-TD Formulation A 200 pg applied to the thigh and 2 x 150 pg applied to the abdomen treatments compared to abaloparatide-TD Formulation C 200 pg. Mean plasma abaloparatide concentrations were higher with the double patch Formulation A2 x 150 pg applied to the abdomen compared with the 200 pg single patch applied to the thigh. Based on AUCo- _t , AUCo-inf and C _mix values, the relative bioavailability of abaloparatide following a single administration of abaloparatide-TD Formulations A and C at dose levels of 200 mg and 2 x 150 pg was 20.6 to 65.5% lower than that of abaloparatide-SC, except for similar C _m , _x (geometric ratio of 108%) achieved with Formulation A 2 x 150 pg.

[0064] Referring to FIG. 5A and FIG. 5B, the abaloparatide-TD Formulation W 2 x 200 pg double patches achieved the highest mean plasma abaloparatide concentrations followed by Formulation W 200 pg and then Formulation A 260 pg and Formulation X 200 pg with similar concentration levels. Based on AUCo- _t , AUCo-inf and C _m , _x values, the relative bioavailability of abaloparatide following a single

administration of abaloparatide-TD Formulations A, W and X at dose levels of 200 and 260 pg was 26.3 to 63.3% lower than that of abaloparatide-SC, except for similar C _mix (geometric ratio of 83.2%) achieved with Formulation A 260 pg.

[0065] Formulation W 2 x 200 pg applied 15 minutes to the thigh (Cohort 5) was the most similar to 80 pg abaloparatide SC with AUCo-t and C _mix values achieving 96.2 and 103% of those of abaloparatide SC, respectively. The double patch application Formulation A 2 x 150 pg (300 pg total) (Cohort 4) and Formulation W 2 x 200 pg (400 pg total) (Cohort 5) increased the systemic exposure in a dose- proportional manner compared to a single patch application of 200 pg. Although the application site was different, the AUCo-t was increased by -33% and C _mix by -42% with Formulation A after increasing the dose by 50% using double patches (i. e., 2 x 150 pg vs. 200 pg), by increasing the dose released from the patches, which could not be achieved via a greater patch loading dose.

[0066] The best performing abaloparatide formulation in Cohorts 1-5 was Formulation W 2 x 200 pg applied to the thigh for 15 minutes. And dose proportional systemic exposure for Formulation W was achieved by increasing the number of patches. Doses, application sites and wear times for Formulation W were evaluated further in Cohort 6.

Cohort 6

[0067] Cohort 6 evaluated 3 wear times and 3 doses of abaloparatide-TD, each applied as a single patch administration to the thigh or abdomen using applicator 2. Subjects were randomized for Treatment Periods 1 and 2 to receive abaloparatide-TD 400 pg and abaloparatide-TD 300 pg in a crossover design, applied to the thigh for a 15 minute wear time. For Treatment Periods 3 and 4, subjects received abaloparatide-TD 400 pg applied to the thigh, either for a 5 minute or a 30 minute wear time, respectively. Based on previous cohorts, additional Treatment Periods (5A and/or 5B) were considered, but only Period 5B was evaluated. Subjects in Treatment Period 5B received the reference SC dose (abaloparatide- subcutaneous [SC] 80 pg). For Treatment Period 6, subjects received abaloparatide-TD 300 pg applied to one of the upper quadrants the abdomen for a 15 minute wear time. A summary of the design for Cohort 6 is shown in Table 6.

[0068] Referring to FIG. 6A-6C, abaloparatide was absorbed with mean tmax ranging from 20 to 60 minutes for TD treatments, compared to 30 minutes for SC. Formulation W 300 pg produced 25% to 40% higher abaloparatide C _mx and AUC than the Formulation W 400 pg (Thigh, 15 minutes). Similar to assessments in previous cohorts, Formulation W 300 pg application to the thigh produced 60% to 80% higher abaloparatide C _mx and AUC than application to the abdomen.

[0069] As shown in FIG. 6C, formulation W 400 pg applied for 5 minutes to the thigh provided similar AUC and C _mix compared to the SC 80 pg within the same cohort of subjects (4 to 20% higher AUC and 21.1% lower C _mx ).

[0070] However, compared to the SC 80 pg data pooled across 4 studies, FIG. 6E shows

Formulation W 400 pg applied for 5 minutes to the thigh provided 45 to 59% higher AUC and 3.7% lower C _mx ). When the Formulation W 300 pg patch was applied to the abdomen, the systemic exposure achieved was 34.6 to 46.8% lower than that of achieved for same patch applied to the thigh. For the Formulation W 400 pg patch, the highest systemic exposure levels were reached when the patch was applied for the shortest tested wear time with AUCo-t, AUCo-inf and Cimx values 52 to 74% higher after 5 minutes than after 15 minutes. Increasing the wear time to 30 minutes did not seem to have any impact on systemic exposure, with similar AUCo-t, AUCo-inf and Ci x values (13% to 23% higher geometric means) after 15 and 30 minutes.

[0071] Referring to FIG. 6D, for Formulation W 400 pg applied to the thigh, AUC, _min > AUC30 _min > AUC is _min (relative bioavailability compared to within-cohort SC was 104%-121%, 55%-70%, and 41%- 52%, respectively). Formulation W 300 pg (Thigh, 15 minutes) had a 73% relative bioavailability compared to within-cohort SC, better than 400 pg (Thigh, 15 minutes). Formulation W 300 pg (Thigh, 5 minutes) also had a 96%-99% relative bioavailability compared to pooled SC treatments.

[0072] These results suggested that wear time has a significant factor in the availability of abaloparatide, although the relationship between wear time and systemic exposures was unexpected. For example, at a common dose of 400 pg, the shortest wear time of 5 minutes produced higher systemic exposure than the wear time of 30 minutes, which was slightly greater than the systemic exposure for a wear time of 15 minutes. The reason for this unusual rank order based on wear time is not clear. Decreasing the wear time from 15 to 5 minutes essentially doubled the systemic exposure. However, increasing the wear time to 30 minutes had only a small impact on systemic exposure. The thigh appeared to be a better application site compared to the abdomen, as there was a ~50 to 60% increase in systemic exposure following administration at that site. Overall, administering a 400 pg patch of Formulation W for 5 minutes to the thigh produced systemic exposures comparable to an 80 pg SC administration. Although for the same 15-minute wear time and application to the thigh, the systemic exposure for Formulation W 300 pg was higher than the systemic exposure for Formulation W 400 pg.

[0073] Based on these results, Cohort 7 was designed to explore four different wear times (5 min, 15 min, 30 min, and 24 hours) for Formulation W-l 300 pg patch applied to the thigh.

Cohort 7

[0074] Cohort 7 evaluated 4 wear times for the 300 mg patch of abaloparatide-TD Formulation W-l each applied as a single patch administration to the thigh or abdomen using Applicator 3. There were 6 treatment periods for subjects in Cohort 7. Subjects were randomized to 1 of 4 treatment sequences in Treatment Period 1 to 4. Subjects in the randomization treatment stage were treated with 300 pg of abaloparatide-TD with different wear times to the thigh (5, 15, 30 minutes, or 24 hours). Subsequently, all subjects entered the sequential treatment stage starting in Treatment Period 5 and were treated with 300 pg of abaloparatide-TD in the periumbilical region of the abdomen for 15 minutes wear time. In the sixth and final treatment period, subjects were injected with 80 pg of abaloparatide-SC in the periumbilical region of the abdomen. Each treatment period was separated by a washout period of at least 3 days. The design is summarized in Table 7: Treatments for Cohort 7.

[0075] As shown in FIG. 7 A, 7B and 7C, abaloparatide was absorbed slowly, with mean tmax ranging from 27 to 35 minutes for TD treatments, compared to 24 minutes for SC. Similar to assessments in previous cohorts, Formulation W-l 300 pg application to the thigh produced 10% to 25% higher abaloparatide C, _mx and AUC than application to the abdomen.

[0076] For Formulation W-l 300 pg applied to the thigh, AUC, _mm = AUC ₂₄₁₁ > AUC _30min >

AUCi5min (relative bioavailability compared to within-cohort SC was 83%-93%, 81-96%, 73%-77%, and 70%-82%, respectively).

[0077] The relative bioavailability for Formulation W-l compared to SC was similar to that for Formulation W (73-77% vs. 73%, respectively, Thigh, 15 minutes).

[0078] Formulation W-l 300 pg applied 5 minutes and 24 hours to the thigh were the most similar to 80 pg abaloparatide-SC with AUCo- _t and AUCo-i _nf values achieving 81.1 to 95.8% of those of abaloparatide- SC, respectively. Additionally, compared to the SC 80 pg data pooled across 4 studies, Formulation W-l 300 pg applied for 5 minutes to the thigh provided 12.2% lower to 1% higher AUC and 31.0% lower C _mx ). The Formulation W-l 300 pg 5 minutes and 24 hours wear time C\ _mx were lower achieving 62.2 and 45.0% of abaloparatide-SC C _mx , respectively, for the within-cohort comparisons.

[0079] For the Formulation W-l 300 pg patch, the highest systemic exposure levels were reached when the patch was applied for the shortest tested wear time with AUCO-t, AUCO-inf and Cmax values 15 to 21% higher after 5 minutes than after 15 minutes. Increasing the wear time to 30 minutes did not seem to have any impact on systemic exposure, with similar AUCo- _t , AUCo-inf and C _mx values (geometric mean ratios 90 to 106%) after 15 and 30 minutes. As for increasing the wear time to 24 hours, AUCO-inf was increased by 28%, while AUCo- _t and the C _mx were more or less similar with geometric mean ratios of 117 and 88.4%, respectively.

[0080] For the Formulation W 400 pg patch (Cohort 6) and for Formulation W-l 300 pg (Cohort 7), higher abaloparatide systemic exposure levels were reached when the patch was applied 5 minutes compared to 15 and 30 minutes. However, when the Formulation W-l patch was applied for 24 hours, total released dose, and therefore total systemic exposure was increased compared to 15 minutes.

Model Prediction for BMD

[0081] Table 8: Model Prediction for the % Change in BMD in Typical Subject, depicts the model prediction for the percent change in BMD in a typical subject. This assumes a baseline T-score of -2.7, and draws upon dose response studies and population PK/PD modeling. Without wishing to be bound to any particular theory, it is believed that AUC is the key driver of BMD increases.

[0082] Overall, abaloparatide application to the thigh consistently provided greater abaloparatide AUC than application to the abdomen, although the difference was less dramatic for Formulation W- 1. And the wear-time of 5 minutes provided greater abaloparatide AUC than the wear times for 15 minutes and 30 minutes for both Formulation W 400 pg and Formulation W-l 300 pg. Formulation W-l 300 pg applied to the thigh for 5 minutes provided 83-93% relative bioavailability compared to SC 80 pg, with only slightly lower expected BMD response.