J Korean Neurosurg Soc 43 : 143-148, 2008 Incidence and Risk Factors of Acute Yoon-Sik Oh, M.D.1 Postoperative Delirium in Geriatric Dong-Won Kim, M.D.2 Hyoung-Joon Chun, M.D.1 Hyeong-Joong Yi, M.D.1 Objective : Postoperative delirium (POD) is characterized by an acute change in cognitive function and canresult in longer hospital stays, higher morbidity rates, and more frequent discharges to long-term care facilities.In this study, we investigated the incidence and risk factors of POD in 224 patients older than 70 years ofage, who had undergone a neurosurgical operation in the last two years.Methods : Data related to preoperative factors (male gender, >70 years, previous dementia or delirium, alcoholabuse, serum levels of sodium, potassium and glucose, and co-morbidities), perioperative factors (type ofsurgery and anesthesia, and duration of surgery) and postoperative data (length of stay in recovery room,severity of pain and use of opioid analgesics) were retrospectively collected and statistically analyzed.Results : POD appeared in 48 patients (21.4%) by postoperative day 3. When we excluded 26 patients with
J_ID: CHI Customer A_ID: 08-0027 Cadmus Art: CHI20564 Date: 23-MAY-08 Stage: I CHIRALITY 00:000–000 (2008) Use of Large-Scale Chromatography in the Preparation of Armodafinil WILLY HAUCK,1 PHILIPPE ADAM,2 CHRISTELLE BOBIER,2* AND NELSON LANDMESSER3 1Novasep Inc., Boothwyn, Pennsylvania 2Novasep SAS, Pompey, France 3Cephalon Inc., West Chester, Pennsylvania Armodafinil, the (R)-enantiomer of modafinil, is a medication used to treat the excessive sleepiness associated with narcolepsy, obstructive sleep apnea/hypo-pnea syndrome, and shift work sleep disorder. We report here the chemical develop-ment of armodafinil and the investigations that led to a commercial route to prepare thispure enantiomer. Three synthetic approaches were used to provide the chiral sulfoxide.
Resolution via preferential crystallization was used for phase I clinical trials and was sub-sequently replaced by chiral chromatography, enabling us to pursue a rapid filing andregistration of the API. Finally, the commercial route was developed and employedasymmetric oxidation catalyzed by a titanium(IV) isopropoxide and diethyl tartrate sys-tem. The advantages of choosing a chromatographic development pathway to expediteregistration while concurrently developing an economical chiral synthesis route isdiscussed C 2008 Wiley-Liss, Inc.
KEY WORDS: continuous chromatography; chiral chromatography; asymmetric oxidation; asymmetric synthesis; preferential crystallization; armodafinil; chiral sulf-oxide; preparative HPLC; continuous processes tam (Keppra1), radafaxine, and pagoclone3 are produced via chromatography and demonstrate how powerful chiral chromatography can be. Commercial production at tons 1) is a wakefulness-promoting agent used for the treatment of excessive sleepiness associated with narco- to 100s tons scale shows it can be the most cost-effective lepsy, obstructive sleep apnea, and shift work sleep disor- production method for chiral manufacturing.
der. Armodafinil is a second generation therapy and is a Preparative HPLC can be easily scaled-up for production single enantiomer formulation of modafinil that has been of pure enantiomers by transposing analytical conditions approved for the same indications.
to a larger column and increasing amounts of feed The challenge in this process development was to find a injected. Continuous chromatography (SMB, VARICOL1) viable and economic synthetic route while also shortening is designed for binary separations and is very well adapted development times to introduce the product more quickly for chiral resolution of a racemate. The optimization of to the market. It was, therefore, interesting to choose a these processes is done after just a few laboratory meas- continuous chiral chromatographic process, to file the mol- urements and the application of modeling and simulation ecule as soon as possible and concurrently work on the software. The development and optimization of continuous asymmetric process development in the laboratory for the chromatography can take place in parallel with the first long-term commercial supply. This strategy can be suc- production by HPLC in order to save time.
cessful and allows the pharmaceutical company to reduce To prepare armodafinil by chiral chromatography, the the time to market launch by up to 2 yr.
simplest route was to resolve readily available racemic mod-afinil.4 The strategy that we developed was the following: • To determine solubility of substrate in common eluent • To screen a large number of chiral stationary phases HPLC is well known by analytical specialists as a power- (CSPs) and chiral intermediates, ful method for both optical and chemical purity measure-ment. Unfortunately, chromatography is rarely considered *Correspondence to: Christelle Bobier, Novasep SAS, Pompey, France.
as a way of pure enantiomer production, even if it is a E-mail: christelle [email protected] good alternative to the other techniques.1 Received for publication 7 February 2008; Accepted 13 February 2008 DOI: 10.1002/chir.20564Published online in Wiley InterScience (Zoloft1),2 escitalopram (Cipralex1/Lexapro1), levitirace- C 2008 Wiley-Liss, Inc.
J_ID: CHI Customer A_ID: 08-0027 Cadmus Art: CHI20564 Date: 23-MAY-08 Stage: I HAUCK ET AL.
5 0.48 kg (R)-modafinil/kg CSP/day). The VARICOL1Lab was operated under these conditions for a period ofover 10 days in order to process 1 kg of feed material andto assess the eluent recycling. The parameters imple-mented in the VARICOL1 production were within therange of the predicted parameters as defined in the simu-lation study.
The numerical simulation showed that better perfor- mances (purity, productivity, and yield) were obtainedwith the VARICOL1 process when compared with theSMB process, and also defined an upper limit for (S)- and Fig. 1. Structure of Armodafinil (2-[(R)-(diphenylmethyl)sulfinyl]aceta- (R)-modafinil content in the recycled eluent. On the otherhand, maximum water content in the eluent was experi-mentally set at 5000 ppm. Content of nondesired enan- • To optimize the eluent system for use with the selected tiomer was set to a limit 60.007 g/l for the mobile phase and 61 g/l when the eluent is used for feed preparation.
• To demonstrate the selected conditions on analytical For phase III clinical supply, 540 kg of (R)-modafinil and pilot scale, and (99% o.p.) was produced on a VARICOL1 unit composed • To develop a process for large-scale separation.
of six columns of 20-cm I.D. packed with Chiralpak AD20 lm as stationary phase and using pure methanol as During the development study, the aim was to select mobile phase. The productivity obtained during the 8 mo the most productive and robust stationary phase and mo- production campaign was 0.5 kg (R)-modafinil/kg CSP/ bile phase for the separation of modafinil enantiomers.
day, chromatographic yield was 93% and recovery yield Our method development typically began with a screening of (R)-modafinil, including subsequent drying process, of different CSPs (from Daicel, Shiseido, Kromasil, Merck was 77.6%. The optical purity of the desired enantiomer KgaA or Regis) and a screening of different eluents was greater than 99.2% and the chemical purity was (ethanol, methanol, heptane, isopropanol, or a mix of them). Based on the analyte solubility (greatest in MeOH The next step of the study was to characterize the (R)- 20 g/l at 208C), selectivity and productivity, Chiralpak AD modafinil separation robustness from a racemate feed 20 lm (Chiral Technologies) was selected as the CSP for stock with a new impurity profile on a VARICOL1 Lab the process. Conditioning of the CSP with isopropanol pilot unit. This study provided the necessary information after column packing and prior to the VARICOL1 separation to define critical parameters and their proven acceptable in methanol was found to improve the efficiency and selec- ranges; to determine the maximum impurity levels needed tivity of the separation and contributed to the robustness to reach chemical purity specifications; to evaluate the of the final process.
new packing batches using the new feed stock (CSP stabil- A complementary study was performed to define the ity, protocol for IPA conditioning, residual content of IPA appropriate conditions on a 30-cm I.D. column HPLC.
in methanol); and to evaluate the stability of purified (R)- When 5 mg were injected onto the analytical column, ev- modafinil in its solid form (at 40 and 658C for 8 days under ery 4 min, (R)-modafinil was recovered within specifica- tions of yield (90%) and purity (99.0%). The corresponding A rationale was developed to define the residence time amount to be injected onto the 30-cm I.D. column is 21.27 of rac-modafinil, (R)-modafinil, and methanolic solutions to g per injection.
control the stability profile in the continuous chiral separa- With these studies in hand, the separation was carried tion process including process validation batches and pro- out using a 30-cm I.D. HPLC column installation. For the duction of commercial launch quantities. On an industrial early clinical studies, a total of 61.3 kg of (R)-modafinil VARICOL1 unit (composed of six columns of 30-cm I.D.), were produced with a yield of 93%. During three consecu- the stationary phase was stable after the processing of 10 tive batches of this first production campaign, the specific metric tons of racemate.
productivity obtained was 0.3 kg (R)-modafinil/kg CSP/ Chiral chromatography quickly produced the required day. The optical purity was between 99.2 and 99.7% and amount of armodafinil for clinical trials and registration of the chemical purity was more than 99.9%. This amount of the molecule. The development of the method from the (R)-modafinil was obtained over 3 mo.
feasibility study to the scale-up and process validation at In parallel with the HPLC production campaign and with three different commercial production sites equipped with the perspective of large-scale production, a pilot study on a two unit sizes (30- and 45- cm I.D. columns) took only VARICOL1 Lab system, equipped with six columns of 2.5- cm I.D., was run to demonstrate the feasibility of the pro- Eventually, chiral chromatography will not be selected cess and to identify robust operating conditions for pro- as the route for long-term commercial production. Racemi- duction on the VARICOL1 6-200 (six columns of 20-cm zation of the undesired enantiomer was not possible for I.D.). The operating ranges were characterized by numeri- this molecule, and the starting material (modafinil) is cal simulations and the working conditions were found costly. We, therefore, had to develop a more cost-effective through this process demonstration (specific productivity Chirality DOI 10.1002/chir ID: veeraragavanb
J_ID: CHI Customer A_ID: 08-0027 Cadmus Art: CHI20564 Date: 23-MAY-08 Stage: I PREPARATION OF ARMODAFINIL BY CHROMATOGRAPHY Fig. 2. Formation of Modafinic acid and conversion to Modafinil.
theoretical yield for any crystallization process is only 50%.
A classical method useful for the separation of enantiom- Since it seemed that this process would not prove to be ers is the preparation and fractional recrystallization of adequately robust on commercial scale, it was decided to their respective diasteromeric salts. This well-known focus resources on an asymmetric synthesis.
method is only possible when the racemate to be resolvedis capable of forming a diasteromeric salt and when the ASYMMETRIC SYNTHESIS purified enantiomer can be regenerated from the salt.
A strategy for the asymmetric synthesis of armodafinil Another method for the separation of enantiomers involves was developed based upon the groundbreaking work of the preferential crystallization of a conglomerate, when a Kagan and coworkers.6 This chemistry utilizes a chiral tita- racemate exists as a true eutectic mixture. This situation is nium complex catalyzed cumene hydroperoxide oxidation estimated to apply to about 5% of all organic compounds.
of a sulfide substrate to provide chiral sulfoxides with During the early stage of armodafinil development, it good optical activity. We found the Kagan method to be was discovered that an intermediate in the synthesis of ra- quite useful but also to be substrate dependant. Several cemic modafinil could be easily converted to its carboxylic sulfide derivatives of modafinil were screened to deter- acid derivative and that the derivative, modafinic acid, mine a starting point for optimization. From this initial exists as a true eutectic mixture or conglomerate. This screen, the sulfide amide substrate provided excellent op- conglomerate could be separated into its correspondingenantiomers by preferential crystallization, utilizing anauto-seeded programmed polythermal preferential crystal-lization (AS3PC) method5 (see Fig.
The AS3PC method of preferential crystallization takes advantage of the unique quality of conglomerates and aprotocol that involves seeding a solution of the racematewith one of the pure enantiomers. This seeding processresults in the crystallization of the enantiomer that now ispresent in excess. Filtration to collect the solid providesthe first enantiomer in high chiral purity, while the motherliquor remaining is now highly enriched in the secondenantiomer. At this point in the process, additional race-mate is added to the mother liquor. The resulting solutionis now enriched in the second enantiomer which crystalli-zes again in high chiral purity. Upon collection of the sec-ond enantiomer by filtration, the mother liquor thatremains is now highly enriched in the first isomer. By add-ing additional racemate to the solution, the cycle isextended and both of the enantiomers can be harvested inalternating batches. In the case of modafinic acid, we haveprocessed enantiomers through over 35 cycles in a pilotplant cGMP environment. A total of 85 kg of (R)-modafinicacid was produced by this method over four batches. Theoptically pure acid was subsequently converted to the APIin a two-step synthetic process.
Although the AS3PC method of preferential crystalliza- tion allowed us to provide API for early preclinical and Fig. 3. Effect of substrate and solvent on the yield and enantiomeric clinical studies, we quickly realized that the process was excess of the asymmetric oxidation. (LCAP Armod. Is the liquid chroma- limiting and labor intensive. In the absence of a process tography area percent of Armodafinil. It is a measure of the chemicalpurity.) [Color figure can be viewed in the online issue, which is available for the racemization of the undesired enantiomer, the Chirality DOI 10.1002/chir ID: veeraragavanb
J_ID: CHI Customer A_ID: 08-0027 Cadmus Art: CHI20564 Date: 23-MAY-08 Stage: I HAUCK ET AL.
HPLC was used to supply the API for early clinical trials,while the optimization, validation, and multisite implemen-tation of a commercial production was achieved usingVARICOL1 continuous chromatography.
For this particular program, the chiral separation was the final process step, and the undesired enantiomer couldnot be recycled by racemization. Consequently, the globalyield and cost of goods were not the most favorable. Asthe chromatographic process guaranteed the scale-up andthe supply of Armodafinil, we could develop in parallel anefficient asymmetric synthesis that further improved costof goods and could be introduced as a postapproval Fig. 4. Asymmetric synthesis of Armodafinil.
change for long-term commercial production.
This example shows that chiral chromatography should tical purity and was identified as a starting point for further be systematically evaluated for large-scale API manufactur- optimization (see Fig.
ing to shorten the time to market even, if the ultimate cost Once the sulfide amide was identified as the preferred of goods targets cannot be achieved with the technology.
substrate, a group of several parameters were studied inan effort to optimize the conditions for maximizing yield and chiral purity. The parameters studied included were Cephalon: John Mallamo, Conrad Kowalski, Gilles Ser- the following: the choice of solvent, water stoichiometry, rure, Gerard Duret, Laurence Prat, Francois Rebiere, Ti catalyst stoichiometry, (S,S)-DET (diethyl tartrate) stoi- Pierre Leproust, Ste´phanie Graf, Laurent Courvoisier, chiometry, cumene hydroperoxide stoichiometry, and cat- Domonique Klien, Guy Piacenza, Sebastien Rose, Nelson alyst contact time. The final optimized conditions provided Landmesser, Stuart Dodson, and Michael Kress. Chiral an asymmetric oxidation process suitable for commercial Technologies: James Lee and Tom Lewis. Novasep: Jean scale manufacturing yielding the API in 75% isolated yield Ble´haut, Fe´licie Denet, Manuel Marques, Yvan Ruland, and >99.5% optical purity.7 Eric Lang, Kevin Duffield. IRCOF–University of Rouen: The asymmetric oxidation offers several advantages Prof. Ge´rard Coquerel, Marie-Noe ¨lle Petit, Franck Mallet, over the separation processes. The process begins with and Nicolas Wermester.
relativity cheap achiral raw materials and overall is a truecatalytic process. The result is a process that is economi-cally favorable as compared with separation methods. In addition, the armodafinil isolated from the asymmetric 1. Francotte ER. Enantioselective chromatography as a powerful alterna- synthesis process is typically >99% chemical purity and tive for the preparation of drug enantiomers. J Chromatogr A >99.5% optical purity and meets the specification in every way for API armodafinil. The final commercial manufactur- 2. Quallich GJ. Development of the commercial process for Zoloft/Ser- traline. Chirality 2005;17:S120–S126.
ing process is shown below (see Fig.
3. Stuk TL, Assink BK, Bates RC, Erdman DT, Fedij V, Jennings SM, Lassig JA, Smith RJ, Smith TL. An efficient and cost effective synthe-sis of Pagoclone. Org Process Res Dev 2003;7:851–855.
4. Hauck W, Ludemann-Hombourger O, Ruland Y, Landmesser N, Mallamo Chiral chromatography enabled us to shorten the time J. Methods for the separation of modafinil. Int. Patent WO 2006/030278.
to regulatory submission and approval of Nuvigil1 (armo- 5. Collet A, Brienne MJ, Jacques J. Optical resolution by direct crystalli- dafinil). The process also provides extremely pure API for zation of enantiomer mixtures. Chem Rev 1980;80:215–230.
clinical use. This is a testament to the purity of modafinil, 6. Brunel J-M, Diter P, Duestsch M, Kagan HB. Highly enantioselective the starting material for the process, and the value of oxidation of sulfides mediated by a chiral titanium complex. J OrgChem 1995;60:8086.
large-scale chiral chromatography as a purification tool.
7. Rebiere F, Duret G, Prat L. Process for enantioselective synthesis of The large-scale preparation of armodafinil was quickly single enantiomers of modafiniland related compounds by asymmetric achieved, thanks to chromatography. Classical batch oxidation. Int. Patent WO 2005/028428.
Chirality DOI 10.1002/chir ID: veeraragavanb
Jefferson Elementary School Our Mission Jefferson Elementary The Mission of Jefferson Elementary School is to provide all students with Student, Parent/Guardian educational opportunities which Handbook enable them to become 2007-2008 life-long learners. "My father has always taught