AU2013203248A1 - Substituted carbostyril derivatives as 5-HT 1A receptor subtype agonists - Google Patents

Abstract

The present invention relates to use of a compound for the production of a medicament for treating a patient suffering from a disorder of the central nervous system associated with 5-HT receptor subtype, which the medicament comprising as an active ingredient a carbostyril derivative or a salt thereof represented by the formula (1): H(1) O(CH2)4-N4 N wherein the carbon-carbon bond between 3- and 4 positions in the carbostyril skeleton is a single or a double bond; and a pharmaceutically acceptable salt or solvate thereof.

Description

Australian Patents Act 1990 - Regulation 3.2A ORIGINAL COMPLETE SPECIFICATION STANDARD PATENT Invention Title "Substituted carbostyril derivatives as 5-HT1A receptor subtype agonists" The following statement is a full description of this invention, including the best method of performing it known to us: H:\rbr\Interwoven\NRPortbl\DCC\RBR\5041687_1.DOC - 4/4/13 H:W iterJwovn\NRPorb\DCC\RBR\5039323_doc-4/04/2.13 -1-. DESCRIPTION Substituted carbostyril derivatives as 5-HTiA receptor subtype agonists This application is a divisional application 5 derived from Australian Patent Application No. 2009233591, the entire contents of which, as originally filed, are incorporated herein by reference. BACKGROUND OF THE INVENTION FIELD OF THE INVENTION 10 The present invention relates to a method of treating a patient suffering from a disorder of the central nervous system associated with the 5-HTiA receptor subtype. The active ingredient comprises a carbostyril derivative or a salt thereof. 15 RELATED ART U.S. Patent No. 5,006,528; European Patent No. 367,141 and Japanese Patent Kokai (Laid-open)7-304,740 (1995) contain the same chemical structural formula as the carbostyril derivatives in the present invention, and their 20 pharmacological properties are beneficial drug treatments for schizophrenia. Carbostyril compounds, as well as those disclosed in Japanese Patent Kokai (Laid-open)9-301,867 (1997) are useful for the treatment of anxiety. 25 The carbostyril derivatives disclosed in European Patent No. 226,441 have the genus of the carbostyril derivatives in the present invention, and they are useful for the treatment of hypoxia. In addition to the above, the carbostyril 30 derivatives disclosed in U.S. Patent No. 4,734,416; Canadian Patent No. 1,117,110; British Patent No. 2,017,701; German Patent Nos. 2,912,105 and -2 2,953,723; Japanese Patent Kokai(Laid-open)Nos. 54 130,587 (1979), 55-127,371 (1980) and 62-149,664 (1987) have the genus of the carbostyril derivatives in the present invention, and they have antihistaminic 5 activities and central nervous controlling activities. It is reported that aripiprazole (7-(4-[4 (2, 3-dichlorophenyl)-1-piperazinylbutoxy)-3, 4-dihydro carbostyril, also known as, OPC-14597, BMS-337,039 and OPS-31) binds with high affinity to dopamine D 2 10 receptors and with moderate affinity to dopamine D, and 5-HT, receptors (Masashi Sasa et al., CNS Drug Reviews, Vol. 3, No. 1, pp. 24-33). Further, it is reported that aripiprazole possesses presynaptic dopaminergic autoreceptor 15 agonistic activity, postsynaptic D 2 receptor antago nistic activity, and D 2 receptor partial agonistic activity (T. Kikuchi, K. Tottori, Y. Uwahodo, T. Hirose, T. Miwa, Y. Oshiro and S. Morita: J. Pharmacol. Exp. Ther., Vol. 274, pp. 329, (1995); T. Inoue, M. 20 Domae, K. Yamada and T. Furukawa: J. Pharmacol. Exp. Ther., Vol. 277, pp. 137, (1996)). However, it has not been reported that compounds in the present invention have agonistic activity at 5-HTA receptor subtype. 25 It has been reported that therapeutic interventions using 5-HTA receptor ligands may be useful drug treatments for alcohol abuse (Mark Kleven et al., European Journal of Pharmacology, Vol. 281, -3 (1995) pp. 219-228). It is also reported that 5-HT agonist drugs may be useful for the treatment and/or prophylaxis cf disorders associated with neuronal degeneration result 5 ing from ischemic events in mammals (U.S. Patent No. 5,162,375). It is also reported that 5-HTIA receptor hypersensitivity could be the biological basis for the increased frequency of migraine attack in stressful and 10 anxious conditions (Massimo Leone et al., Neuro Report, Vol. 9, pp. 2605-2608(1998)). It has recently been reported that (-)-(R)-2 [4-( (3,4-dihydro-2H-1-benzopyran-2-yl)methyllamino) butyl]-1,2-benzisothiazol-3(2H)-one 1,1-dioxide 15 monohydrochrolide (BAY-3702), a 5-HTIA receptor agonist, has neuroprotective, anxiolytic- and antidepressant like effects in animal models (Jean De Vry et al., European Journal of Pharmacology, Vol. 357, (1998), pp. 1-8). 20 It is also reported that 5-HTIA receptor agonists appear to be broad spectrum antiemetic agents (Mary C. Wolff et al., European Journal of Pharma cology, Vol. 340, (1997), pp. 217-220; AB Alfieri et al., British Journal of Cancer, (1995), Vol. 72, pp. 25 1013-1015; Mary C. Wolff et al., Pharmacology Biochemistry and Behavior, 1995, Vol. 52, No. 3, pp. 571-575; James B. Lucot, European Journal of Pharma cology, 1997, Vol. 253, pp. 53-60).

Serotonin plays a role in several neuro logical and psychiatric disorders, including Alzheimer's disease, depression, nausea and vomiting, eating disorders, and migraine. (See Rasmussen et al., 5. "Chapter 1. Recent Progress in Serotonin 5HTIA Receptor Modulators", in Annual Reports in Medicinal Chemistry, Vol. 30, Section I, pp. 1-9, 1995, Academic Press, Inc.). WO 00/16777 discloses that a 5HTIA receptor agonist, buspirone is efficacious in treating a variety 10 of symptoms associated with ADHD, and that combined use of a D2 receptor agonist and 5-HTIA agonist provides effective treatments for ADHD and Parkinson's disease. 5HTIA agonists are effective in the treatment of cognitive impairment in Alzheimer's disease, 15 Parkinson's disease or senile dementia. US 5824680 discloses that a 5-HTIA agonist, ipsapirone, is effec tive in treating Alzheimer's disease by improving memory. US 4687772 describes that a 5-HTIA partial agonist, buspirone, is useful for improving short term 20 memory in patients in need of treatment. WO 93/04681 discloses that use of 5-HTA partial agonists have been used for the treatment or prevention of cognitive disorders associated with Alzheimer's disease, Parkinson's disease or senile dementia. 25 SHTIA agonists are also effective in the treatment of depression. US 4771053 describes that a 5-HTA receptor partial agonist, gepirone, is useful in alleviation of certain primary depressive disorders, - 5 -I such as severe depression, endogenbus depression, major depression with melancholia, and atypical depression. WO 01/52855 discloses that the combined use of the 5 HTA receptor partial agonist gepirone with an 5 antidepressant can effectively treat depression. The 5-HTIA receptor partial-agonist buspirone alleviates motor disorders such as neuroleptic induced parkinsonism and extrapyramidal symptoms. These observations are disclosed in US 4438119. Furthermore 10 5-HT1A agonists reverse neuroleptic-induced catalepsy in rodents, which mimic movement impairments observed in Parkinson's disease (Mark J. Millan, Journal of Pharmacology and Experimental Therapeutics, 2000, Vol. 295, p853-861) . Thus, aripiprazole can be used to 15 manage psychosis in geriatric patients, Alzheimer's disease, Parkinson's disease or senile dementia, since it possesses potent, partial agonistic activities at D 2 and 5-HTA receptors. In addition, these patients might not experience extrapyramidal symptoms due to this 20 property of aripiprazole. Heretofore, schizophrenia is understood to be caused by hyperactivity in the brain dopaminergic system. For this reason, some drugs were developed with strong dopaminergic receptor blocking activity. 25 These typical antipsychotic drugs are effective in the treatments for the positive symptoms of schizophrenia, which include hallucinations, delusions and the like. During the last decade, a variety of atypical anti- -6 psychotic drugs have been developed, which include clozapine, risperidone, olanzapine, quetiapine. These drugs have less extrapyramidal side effects, and have other activities in addition to their DA-receptor 5 blocking activities. In contrast to typical anti psychotic drugs, such as chlorpromazine, haloperidol, etc., it is reported that atypical antipsychotic drugs are more effective against the negative symptoms and cognitive impairments associated with schizophrenia 10 than typical antipsychotic drugs, and atypical antipsychotic drugs also have less extrapyramidal side effects (S. Miyamoto, G. E. Duncan, R. B. Mailman and J. A. Lieberman: Current Opinion in CPNS Investiga tional Drugs, Vol. 2, pp. 25, (2000)). However, even 15 though atypical antipsychotic drugs provide a.suitable pharmacotherapy for schizophrenia, certain patients are resistant to the antipsychotic therapies of these drugs. These patients may either not respond or may become refractory (i.e. may feel more anxious, 20 depressed or cognitive dysfunction) in response to antipsychotic therapy. These treatment-resistant patients pose a problem for how a physician may provide an appropriate therapy. At present, a number of treatment-resistant 25 and treatment-refractory schizophrenic patients display symptoms that do not respond adequately to a variety of known effective classes and doses of typical or atypical antipsychotic drugs. Furthermore, these patients may also be inveterate schizophrenia cr chronic schizophrenics who are often repeatedly admitted to and discharged from hospitals (R. R. Conely and R. W. Buchanan: Schizophr. Bull., Vol. 23, pp. 663, 5 (1997)). Symptoms of patients corresponding to treatment-resistant and treatment-refractory schizophrenics involve not only the positive symptoms, but also the negative symptoms and emotional disorders, 10 as well as cognitive impairments (i.e., cognitive dysfunction or cognitive disturbance-s) (K. Akiyama and S. Watanabe: Jpn. J. Clin. Psychopharmacol., Vol. 3, pp. 423, (2000)). Cognitive impairment exists separately from 15 the psychic symptoms in a schizophrenic individual. Thus, medical treatment is therefore quite important, because the cognitive impairment may disturb the socially adaptable behavior of these individuals (C. Hagger, P. Buckley, J. T. Kenny, L. Friedman, D. Ubogy 20 and H. Y. Meltzer: Biol. Psychiatry, Vol. 34, pp. 702, (1993); T. Sharma and D. Mockler: J. Clin. Psycho pharmacol., Vol. 18, (Suppl. 1), pp. 128, (1998)). At present, clozapine is an antipsychotic drug that is effective against treatment-resistant 25 schizophrenia. Clozapine (marketed under the name of Clozaril) was approved in 1990 by FDA for the treatment and management of severely ill schizophrenics who failed to respond adequately to standard antipsychotic therapy (M. W. Jann: Pharmacotherapy, Vol. 11, pp. 279, (1991)). Clozapine has been reported to be effective against cognitive impairments in treatment-resistant schizophrenics (C. Hagger, P. Buckley, J. T. Kenny, L. 5 Friedman, D. Ubogy and H. Y. Meltzer: Biol. Psychiatry, Vol. 34, pp. 702, (1993); M. A. Lee, P. A. Thompson and H. Y. Meltzer: J. Clin. Psychiatry, Vol. 55 (Suppl. B), pp. 82, (1994); D. E. M. Fujii, I. Ahmed, M. Jokumsen and J. M. Compton: J. Neuropsychiatry Clin. Neurosci., 10 Vol. 9, pp. 240, (1997)). For example, it is reported that clozapine improves cognitive impairments in attention, response time, fluent-speech, etc. in treatment-resistant schizophrenics (M. A. Lee, P. A. Thompson and H. Y. Meltzer: J. Clin. Psychiatry, Vol. 15 55 (Suppl. B), pp. 82, (1994)). It has been also reported that clozapine provides effective improvements in cognitive impairments in an objective evaluation scale of the Wechsler Adult Intelligence Scale-Revised Full Scale (D. E. M. Fujii, I. Ahmed, M. Jokumsen and 20 J. M. Compton: J. Neuropsychiatry Clin. Neurosci., Vol. 9, pp. 240, (1997)). The 5-HTA receptor has been demonstrated to play a role in the therapeutic efficacy of clozapine against treatment-resistant schizophrenia and cognitive 25 impairments. This relation ship was -revealed by a binding experiment using human the 5-HTA receptors (S. L. Mason and G. P. Reynolds: Eur. J. Pharmacol., Vol. 221, pp. 397, (1992)). Further, in accordance with -9 progress in molecular pharmacology, it is clearly understood that 5-HTIA receptor agonistic activity or 5-HTIA receptor partial agonistic activity plays an important role in treatment-resistant schizophrenia and 5 cognitive impairments (A. Newman-Tancredi, C. Chaput, L. Verriele and M. J. Millan: Neuropharmacology, Vol. 35, pp. 119, (1996)). Additionally, it was reported that the number of 5-HT receptor is increased in the prefrontal cortex of chronic schizophrenics who were 10 classified treatment-resistant. This observation was explained by a compensatory process where by the manifestation of severe symptoms of chronic schizophrenia are a result of impaired neuronal function mediated by hypofunctional 5-HTA receptors (T. 15 Hashimoto, N. Kitamura, Y. Kajimoto, Y. Shirai, 0. Shirakawa, T. Mita, N. Nishino and C. Tanaka: Psycho pharmacology, Vol. 112, pp. S35, (1993)). Therefore, a lowering in neuronal transmission mediated through 5 HTA receptors is expected in treatment-resistant 20 schizophrenics. Thus the clinical efficacy of clozapine may be related to its partial agonist efficacy at the 5-HTA receptors (A. Newman-Tancredi, C. Chaput, L. Verriele and M. J. Millan: Neuropharma cology, Vol. 35, pp. 119, (1996)). 5-HTA receptor 25 agonistic activity may be related to the clinical effects of clozapine, and this hypothesis is supported by a positron emission tomography study in primates which showed that clozapine interacts with brain 5-HTA - 10 receptors at a therapeutically effective dose (Y. H. Chou, C. Halldin and L. Farde: int. J. Neuropsycho pharmacol., Vol. 4 (Suppl. 3), pp. S130, (2000)). Furthermore tandospirone, which is known as a selective 5 5-HT, receptor agonist, improved cognitive impairments in chronic schizophrenic patients (T. Sumiyoshi, M. Matsui, I. Yamashita, S. Nohara, T. Uehara, M. Kurachi and H. Y. Meltzer: J. Clin. Pharmacol., Vol. 20, pp. 386, (2000)). While, in animal tests, all reports do 10 not always suggest that 5-HTA receptor agonist activity may be related to cognitive impairment, however, 8-OH DPAT (8-hydroxy-2-(di-n-propylamino)tetralin), which is known as a selective 5-HTA receptor agonist, improves learning and memory impairments induced by scopolamine 15 known as a muscarinic receptor antagonist, suggesting a relationship between 5-HT receptor agonistic activity and improvements in cognitive impairments (M. Carli, P. Bonalumi, R. Samanin: Eur. J. Neurosci., Vol. 10, pp. 221, (1998); A. Meneses and E. Hong: Neurobiol. Learn. 20 Mem., Vol. 71, pp. 207, (1999)). Atypical antipsychotic drugs, such as risperidone and olanzapine, were marketed after clozapine, and it is reported that these drugs improve treatment-resistant schizophrenia or cognitive impair 25 ments in treatment-resistant schizophrenics (M. F. Green, B. D. Marshall, Jr., W. C. Wirshing, D. Ames, S. R. Marder, S. McGurck, R. S. Kern and J. Mintz: Am. J. Psychiatry, Vol. 154, pp. 799, (1997); G. Bondolifi, H.

- 11 Dufour, M. Patris, J. P. May, U. Bi 'eter, C. B. Eap and P. Baumann, on behalf of the risperidone Study Group: Am. J. Psychiatry, Vol. 155, pp. 499, (1998); A. Breier, S. H. Hamilton: Biol. Psychiatry, Vol. 45, pp. 5 403, (1999)). In contrast to reports that clozapine was moderately effective against treatment-resistant schizophrenia, risperidone and olanzapine were not consistently superior to typical antipsychotic drugs in 10 their effectiveness against treatment-resistant schizophrenia. Thus, risperidone and olanzapine bind with lower affinity to human 5-HT receptors (S. Miyamoto, G. E. Duncan, R. B. Mailman and J. A. Lieberman: Current Opinion in CPNS Investigational 15 Drugs, Vol. 2, pp. 25, (2000)), and as such these drugs can not clearly perform activities through human 5-HTIA receptors at clinical effective doses. Therefore, at present, it is understood that clozapine is effective against treatment-resistant 20 schizophrenia (D. W. Bradford, M. H. Chakos, B. B. Sheitman, J. A. Lieberman: Psychiatry Annals, Vol. 28, pp. 618, (2998); A. Inagaki: Jpn. J. Clin. Psycho pharmacol., Vol. 3, pp. 787, (2000)). As explained above, 5-HTA receptor agonistic 25 activity is important for improving treatment-resistant schizophrenia or cognitive impairment caused by treatment-resistant schizophrenia. Clozapine is effective against treatment-resistant schizophrenia, - 12 however, its use is limited due to its severe side effect of producing agranulocytosis which requires patients to undergo periodical blood tests. Under these circumstances, the development of a safe anti 5 psychotic drug with potent, full or partial agonist activity at 5-HTIA receptors is earnestly desired. The carbostyril compound in the present invention binds with high affinity and displays a potent, partial agonist activity at the 5-HTA receptors 10 and it has higher intrinsic activity (about 68%) as compared with that of clozapine. Therefore, the compound in the present invention has a 5-HTA receptor agonistic activity that is more potent than the agonistic activity of clozapine. Thus, the present 15 carbostyril compound may represent a more potent and highly safe drug for curing treatment-resistant schizophrenia, cognitive impairments caused by treatment-resistant schizophrenia, inveterate schizophrenia, cognitive impairments caused by 20 inveterate schizophrenia, chronic schizophrenia, cognitive impairments caused by chronic schizophrenia and the like, as compared with other currently available pharmacotherapeutic treatments. That is, the compound in the present invention may prove to be a 25 potent and safer drug therapy for treatment-resistant schizophrenia, cognitive impairments caused by treatment-resistant schizophrenia, inveterate schizo phrenia, cognitive impairments caused by inveterate - 13 schizophrenia, chronic schizophrenia, or cognitive impairments caused by chronic schizophrenia, etc., which fail to respond adequately to currently available antipsychotic drugs such as chlorpromazine, 5 haloperidol, sulpiride, fluphenazine, perphenazine, thioridazine, pimozide, zotepine, risperidone, olanzapine, quetiapine, amisulpride, etc. In particular, the carbostyril compound in the present invention may be a potent and highly safe 10 drug therapy against treatment-resistant schizophrenia, cognitive impairments caused by treatment-resistant schizophrenia, inveterate schizophrenia, cognitive impairments caused by inveterate schizophrenia, chronic schizophrenia or cognitive impairments caused.by 15 chronic schizophrenia, etc. which fail to respond adequately to both of 1 to 3 typical antipsychotic drugs selected from the group consisting of chlorpromazine, haloperidol and perphenazine, and one atypical antipsychotic drug selected from the group 20 consisting of risperidone, olanzapine, quetiapine and amisulpride. Moreover, the compound in the present inven tion may be a potent and highly safe drug therapy against treatment-resistant schizophrenia, cognitive 25 impairments caused by treatment-resistant schizo phrenia, inveterate schizophrenia, cognitive impairment caused by inveterate schizophrenia, chronic schizo phrenia or cognitive impairment caused by chronic - 14 schizophrenia, etc. which fail to respond adequately to both of 2 typical antipsychotic drugs selected from the group consisting of chlorpromazine, haloperidol and perphenazine, and one atypical antipsychotic drug 5 selected from the group consisting of risperidone, olanzapine, quetiapine and amisulpride. Moreover, the compound in the present inven tion may be a potent and highly safe drug therapy against treatment-resistant schizophrenia, cognitive 10 impairments caused by treatment-resistant schizo phrenia, inveterate schizophrenia, cognitive impair ments caused by inveterate schizophrenia, chronic schizophrenia, cognitive impairments caused by chronic schizophrenia, etc. which fail to respond adequately to 15 both of 1 to 2 typical antipsychotic drugs selected from the group consisting of chlorpromazine and haloperidol, and one atypical antipsychotic drug selected from the group consisting of risperidone, olanzapine, quetiapine and amisulpride. 20 Moreover, the compound in the present inven tion may be a potent and highly safe drug therapy against treatment-resistant schizophrenia, cognitive impairments caused by treatment-resistant schizc phrenia, inveterate schizophrenia, cognitive impairment 25 caused by inveterate schizophrenia, chronic schizo phrenia or cognitive impairment caused by chronic schizophrenia, etc. which fail to respond adequately to both of 2 typical antipsychotic drugs selected from the -15 group consisting of chlorpromazine and haloperidol, and one atypical antipsychotic drug selected from the group consisting of risperidone, olanzapine, quetiapine and amisulpride. SUMMARY OF THE INVENTION In a first aspect, the invention provides a use of a carbostyril compound of formula (1): N 0 H (1) C, C1 \ /

O(CH

2

)

4 -N N-( 10 wherein the carbon-carbon bond between 3- and 4- positions in the carbostyril skeleton is a single or a double bond; or a pharmaceutically acceptable salt or solvate thereof, for the production of a medicament effective in the treatment of 15 disorders of the central nervous system associated with 5 HTIA receptor subtype, wherein the disorders are selected from treatment resistant schizophrenia, inveterate schizophrenia, or chronic schizophrenia, each with or without cognitive impairment, which fails to respond to 20 antipsychotic drugs selected from chlorpromazine, haloperidole, sulpiride, fluphenazine, perphenazine, thioridazine, pimozide, zotepine, risperidone, olanzapine, quetiapine, or amisulpride. In a second aspect, the invention provides a 25 method for treating a patient suffering from disorders of the - 15a central nervous system associated with 5-HTiA receptor subtype, wherein the disorders are selected from treatment resistant schizophrenia, inveterate schizophrenia, or chronic schizophrenia, each with or without cognitive 5 impairment, which fails to respond to antipsychotic drugs selected form chlorpromazine, haloperidol, sulpiride, fluphenazine, perphenazine, thioridazine, pimozide, zotepine, risperidone, olanzapine, quetiapine, or amisulpride, which comprises administering to said patient a 10 therapeutically effective amount of a carbostyril compound of formula (1), N O H (1)

O(CH

2 4 -N N wherein the carbon-carbon bond between 3- and 4-positions in 15 the carbostyril skeleton is a single or a double bond; or a pharmaceutically acceptable salt or solvate thereof. DETAILED DESCRIPTION OF THE INVENTION As the 5-HT1A receptor subtype agonist compound for 20 use in accordance with the present invention, carbostyril derivatives represented by the following formula (1) are used: - 15b H (1) "C O(CH2) 4 -N N wherein the carbon-carbon bond between 3- and 4- positions in the carbostyril skeleton is a single or a double bond. The compounds of the forgoing general formula 20 5 (1) are known compounds, which are disclosed in publication such as U.S. Pat. No. 5,006,528 or which - 16 can be readily prepared by the processes described in the above publication. The carbostyril derivative represented by the formula (1) in the present invention. can easily be 5 converted into its acid-addition salt by reacting it with a pharmaceutically acceptable acid. Examples of such acid include inorganic acids, such as hydrochloric acid, sulfuric acid, phosphoric acid, hydrobromic acid and the like; organic acids, such as oxalic acid, 10 maleic acid, fumaric acid, malic acid, tartaric acid, citric acid, benzoic acid and the like. The solvent of solvates is a solvent conven tionally used in recrystallization. Examples of solvates include hemihydrates, hydrates, and alco 15 holates, such as ethanolates, methanolates, isopropanolates and the like. The desired compounds, prepared by the reactions mentioned above, can easily be isolated and purified by usual separation procedures such as solvent 20 extraction, dilution, recrystallization, column chromatography, preparative thin layer chromatography and the like. The potent, partial 5 -HTIA receptor agonist in the present invention is useful for various disorders 25 of the central nervous system associated with the 5-HTIA receptor subtype that induces bipolar disorders, such as bipolar I disorder with most recent hypomanic, manic, mixed, depressed or unspecified episode; bipolar - 17 II disorder with recurrent major depressive episodes with hypomanic episodes, and cyclothymic disorder; depression, such as endogenous depression, major depression, melancholia, and treatment-resistant 5 depression; panic disorder; obsessive compulsive disorder (OCD); sleep disorders; sexual dysfunction; alcohol abuse and drug addiction; cognitive impairment; neurodegenerative diseases, such as Alzheimer's disease, Parkinson's disease and the like, cognitive 10 impairments caused by neurodegenerative diseases such as Alzheimer's disease, Parkinson's disease and related disorders; emesis; motion sickness; obesity; migraine; autism; Down's syndrome; attention-deficit hyper activity disorder (ADHD); treatment-resistant, 15 inveterate or chronic schizophrenia, (which fail to respond adequately to currently available antipsychotic drugs); cognitive impairments caused by treatment resistant schizophrenia, inveterate schizophrenia or chronic schizophrenia and the like. 20. Compounds of the present invention may be suitably prepared into pharmaceutically acceptable formulations (see U.S. Patent No. 5,006,528, European Patent No. 367,141 and Japanese Kokai (Laid-open) 7 304,740 (1995), and Japanese Patent Application No. 25 2000-194976 incorporated by reference herein). The dosage of these pharmaceutical prepara tions of the invention may be selected appropriately depending on the method of administration, the - 18 patient's age, sex and other factors, severity of the disease and other factors. Generally, however, the daily dose of the active ingredient compound is preferably within the range of about 0.0001 to about 50 5 mg per kilogram of body weight. It is desirable that the active ingredient compound be contained in each unit dosage form in an amount of about 0.001 to about 1,000 mg, particularly 0.01 to 100 mg, more particu larly 0.1 to 50 mg, yet more particularly 1 mg to 20 10 mg. Pharmacological tests 1. MATERIALS AND METHODS 1.1 Test Compound 7-(4-[4-(2,3-Dichlorophenyl)-1-piperazinyl] 15 butoxy)-3,4-dihydrocarbostyril (aripiprazole) was used as test compound. 1.2 Reference Compounds Serotonin (5-HT) and WAY-100635 (N-[2-[4-(2 methoxyphenyl)-1-piperazinyl]ethyl]-N-(2-pyridimyl) 20 cyclohexanecarboxamide, a 5-HTIA receptor antagonist, manufactured by RBI (Natick, MA) were used as reference compounds. 1.3 Vehicle Dimet y1 sulfoxide (DMSO) manufactured by 25 Sigma Chemical Co. (St. Louis, MO) was used as vehicle. 1.4 Preparation of Test and Reference Compounds Test compound was dissolved in 100% dimethyl - 19 sulfoxide (DMSO) to yield 100 pM stock solutions (final concentration of DMSO in all tubes containing test compound was 1%, v/v). All other reference compounds were prepared by the same method using double-distilled 5 water rather than DMSO. 1.5 Experimental Procedure for the ("SGTPyS Binding Assay Test and reference compounds were studied in triplicate at 10 different concentrations (0.01, 0.1, 10 1, 5, 10, 50, 100, 1000, 10000 and 50000 nM) for their effects upon basal ("S]GTPyS binding to h5-HTA CHO cell membranes. Reactions were performed in 5 ml glass test tubes containing 8 pl of test/reference drug mixed with 792 pl of buffer (25 mM Tris HCl, 50 mM NaCl, 5 mM 15 MgCl,, 0.1 mM EGTA, pH = 7.4) containing GDP (1 pM), ("S)GTPyS (0.1 nM) and h5-HTA CHO cell membranes (10 pg protein/reaction; NEN Life Science Products, Boston, MA; catalog # CRM035, lot # 501-60024, GenBank # X13556) . Reactions proceeded for 60 min at room 20 temperature and were terminated by rapid filtration through Whatman GF/B filter paper, using a Brandel harvester and 4x3 ml ice-cold buffer washes. "S radio activity bound to the filter paper was measured using liquid scintillation counting (1272 Clinigamma, 25 LKB/Wallach). 1.6 Experimental Procedure to Determine the Binding Affinity of Test compound (aripiprazole) at the h5-HTA Receptor -20 Test compound was studied in triplicate at 10 different concentrations (0.01, 0.1, 1, 10, 50, 100, 500, 1000, 5000 and 10000 nM) to determine its displacement of ('H]8-OH-DPAT (1 nM; NEN Life Sciences; 5 catalog # NET 929, lot # 3406035, Specific Activity = 124.9 Ci/mmol) binding to'h5-HTA receptors in CHO cell membranes (15 - 20 pg protein; NEN Life Science Products, catalog 4 CRM035, lot 4 501-60024). Membranes (396 pl) were incubated in 5 ml glass tubes 10 containing ('H]8-OH-DPAT (396 pl), test compound or vehicle (8 pl) and buffer A (50 mM Tris.HC1, 10 mM MgSO,, 0.5 mM EDTA, 0.1% (w/v) ascorbic acid, pH = 7.4). All assays proceeded for 60 min at room temperature and were terminated by rapid filtration through Whatman 15 GF/B filter paper (presoaked in buffer B; 50 mM Tris.HCl, pH = 7.4), using a Brandel harvester and 4x1 ml ice-cold washes with buffer B. 'Non-specific binding was determined in the presence of 10 JJM (+)8-OH-DPAT. 1.7 Parameters Determined 20 Serotonin (5-HT) is a full 5-HTA receptor agonist which stimulates increases.in basal ["S]GTPyS binding to h5-HTIA receptors in recombinant CHO cell membranes. Test compound was studied at 10 concentra tions to determine their effects upon basal ('sS]GTPyS 25 binding relative to that produced by 10 p.M 5-HT. The relative potency (EC,,, 95% confidence interval) and intrinsic agonist activity (% of E., for 10 pM r-HT) was calculated for each compound by computerized non-linear - 21 regression analysis of complete concentration-effect data. The binding affinity of test compound at the h5 HTA receptor was determined by its ability to prevent ['H)8-OH-DPAT binding to CHO cell membranes that express 5 this receptor. Non-linear regression analysis of the competition binding data was used to calculate an inhibition constant (IC 0 , 95% confidence interval), which is the concentration of test compound that occupies half of the h5-HTIA sites specifically bound by 10 ('H]8-OH-DPAT. The affinity of h5-HTIA receptors for test compound (Ki, 95% confidence interval) was calculated by the equation, Ki = (IC 50 )/(1+ ('HJ8-OH DPAT]/Kd), where the Kd for ('H]8-OH-DPAT at h5-ITIA = 0.69 nM (NEN Life Sciences). All estimates of drug 15 binding affinity, potency and intrinsic efficacy at the h5-HTIA receptor were calculated using GraphPad Prism version 3.00 for Windows (GraphPad Software, San Diego, CA). 2. RESULTS 20 Test compound and 5-HT produced concentration-dependent increases above basal [3 5 S]GTPyS binding. 1% DMSO tested alone had no effect upcn basal or drug-induced [" 5 SJGTPVS binding. Test compound (EC 5 , = 2.12 nM), 5-HT (EC, =. 25 3.67 nM), potently stimulated basal ["S]GTP S binding. Potency and intrinsic agonist efficacy estimates were derived by non-linear regression analysis with correla- - 22 tion coefficients (r)>0.98 in each case (Table 1). Test compound exerted partial agonist efficacies in the 65 - 70% range. WAY-100635 produced no significant change (unpaired Student's t-test) in basal [ 35 S]GTPyS 5 binding at all concentrations tested (Table 1) . WAY 100635 did, however, completely inhibit the effects of 5-HT and test compound upon [3 5 S)GTPS binding to h5-HT, receptors in CHO cell membranes (Table 2). Tables 1 and 2 are shown below. 10 Test compound demonstrated high affinity binding to h5-HTA receptors in CHO cell membranes (IC 50 = 4.03 nM, 95% confidence interval = 2.67 to 6.08 nM; Ki = 1.65 nM, 95% confidence interval = 1.09 to 2.48 nM) . Table 1 Potency (EC 50 ) and Intrinsic Agonist Efficacy (E,,.) of Test compound and Reference Drugs in a h5-HT, (S]GTPyS CHO-cell Membrane Binding Assay. ECso, nM Em Goodness of Fit Drug (95% Confidence Interval) (% ± SEM) (r 2 ) Test 2.12 68.13 ± 3.16 0.986 Compound (0.87 to 5.16) 5-HT 3.67 98.35 ± 4.47 0.986 (1.56 to 8.63) WAY-100635 -- - 23 Table 2 Inhibitory Potency (IC,) of WAY-100635 versus 1 pM Concentration of 5-HT and Test compound in a h5-HTA ("'SjGTPyS CHO-cell Membrane Binding Assay. WAY-100635 Inhibition Goodness of Drug Combination Potency, ICs,nM Fit (95% Confidence Interval) (r) 5-HT + WAY-100635 217.1 0.988 (127.4 to 369.7) Test compound + 392.2 0.989 WAY-100635 (224.1 to 686.2) The reference in this specification to any prior publication (or information derived from it), or to any matter which is known, is not, and should not be taken as an acknowledgment or admission or any form of suggestion that that prior publication (or information derived from it) or known matter forms part of the common general knowledge in the field of endeavour to which this specification relates. Throughout this specification and the claims which follow, unless the context requires otherwise, the word "comprise", and variations such as "comprises" and "comprising", will be understood to imply the inclusion of a stated integer or step or group of integers or steps but not the exclusion of any other integer or step or group of integers or steps.

Claims (24)

1. Use of a carbostyril compound of formula (1): NAO H (1) CI /CI O(CH 2 ) 4 -N 5 wherein the carbon-carbon bond between 3- and 4- positions in the carbostyril skeleton is a single or a double bond; or a pharmaceutically acceptable salt or solvate thereof, for the production of a medicament effective in the treatment of 10 disorders of the central nervous system associated with 5 HTiA receptor subtype, wherein the disorders are selected from treatment resistant schizophrenia, inveterate schizophrenia, or chronic schizophrenia, each with or without cognitive impairment, which fails to respond to 15 antipsychotic drugs selected from chlorpromazine, haloperidole, sulpiride, fluphenazine, perphenazine, thioridazine, pimozide, zotepine, risperidone, olanzapine, quetiapine, or amisulpride. 20

2. The use of Claim 1 wherein the disorder is treatment resistant schizophrenia, inveterate schizophrenia or chronic schizophrenia.

3. The use of Claim 1 wherein the disorder is treatment 25 resistant schizophrenia with cognitive impairments, -25 inveterate schizophrenia with cognitive impairments or chronic schizophrenia with cognitive impairments.

4. The use of Claim 2 wherein the disorder fails to 5 respond to (i) 1-3 typical antipsychotic drugs selected from chlorpromazine, haloperidol and perphenazine, and (ii) one atypical antipsychotic drug selected from risperidone, olanzapine, quetiapine, and amisulpride. 10

5. The use of Claim 3 wherein the disorder fails to respond to (i) 1-3 typical antipsychotic drugs selected from chlorpromazine, haloperidol and perphenazine, and (ii) one atypical antipsychotic drug selected from risperidone, olanzapine, quetiapine, and amisulpride. 15

6. The use of Claim 2 wherein the disorder fails to respond to (i) two typical antipsychotic drugs selected from chlorpromazine, haloperidol and perphenazine, and (ii) one atypical antipsychotic drug selected from risperidone, 20 olanzapine, quetiapine, and amisulpride.

7. The use of Claim 3 wherein the disorder fails to respond to (i) two typical antipsychotic drugs selected from chlorpromazine, haloperidol and perphenazine, and (ii) one 25 atypical antipsychotic drug selected from risperidone, olanzapine, quetiapine, and amisulpride.

8. The use of Claim 2 wherein the disorder fails to respond to (i) one to two typical antipsychotic drugs 30 selected from chlorpromazine and haloperidol, and (ii) one -26 atypical antipsychotic drug selected from risperidone, olanzapine, quetiapine, and amisulpride.

9. The use of Claim 3 wherein the disorder fails to 5 respond to (i) one to two typical antipsychotic drugs selected from chlorpromazine and haloperidol, and (ii) one atypical antipsychotic drug selected from risperidone, olanzapine, quetiapine, and amisulpride.

10 10. The use of Claim 2 wherein the disorder fails to respond to (i) two typical antipsychotic drug selected from chlorpromazine and haloperidol, and (ii) one atypical antipsychotic drug selected from risperidone, olanzapine, quetiapine, and amisulpride. 15

11. The use of Claim 3 wherein the disorder fails to respond to (i) two typical antipsychotic drug selected from chlorpromazine and haloperidol, and (ii) one atypical antipsychotic drug selected from risperidone, olanzapine, 20 quetiapine, and amisulpride.

12. The use according to any one of Claims 1 to 11 wherein the carbostyril compound is 7-{4-[4-(2,3-dichlorophenyl)-l piperazinyl]butoxy}-3,4-dihydrocarbostyril. 25

13. A method for treating a patient suffering from disorders of the central nervous system associated with 5-HTIA receptor subtype, wherein the disorders are selected from treatment resistant schizophrenia, inveterate schizophrenia, or 30 chronic schizophrenia, each with or without cognitive impairment, which fails to respond to antipsychotic drugs -27 selected form chlorpromazine, haloperidol, sulpiride, fluphenazine, perphenazine, thioridazine, pimozide, zotepine, risperidone, olanzapine, quetiapine, or amisulpride, which comprises administering to said patient a 5 therapeutically effective amount of a carbostyril compound of formula (1), N O H (1) CI /CI O(CH 2 ) 4 -N N / wherein the carbon-carbon bond between 3- and 4-positions in 10 the carbostyril skeleton is a single or a double bond; or a pharmaceutically acceptable salt or solvate thereof.

14. The method of Claim 13 wherein the disorder is treatment-resistant schizophrenia, inveterate schizophrenia 15 or chronic schizophrenia.

15. The use of Claim 13 wherein the disorder is treatment resistant schizophrenia with cognitive impairments, inveterate schizophrenia with cognitive impairments or 20 chronic schizophrenia with cognitive impairments.

16. The method of Claim 14 wherein the disorder fails to respond to (i) 1-3 typical antipsychotic drugs selected from chlorpromazine, haloperidol and perphenazine, and (ii) one -28 atypical antipsychotic drug selected from risperidone, olanzapine, quetiapine, and amisulpride.

17. The method of Claim 15 wherein the disorder fails to 5 respond to (i) 1-3 typical antipsychotic drugs selected from chlorpromazine, haloperidol and perphenazine, and (ii) one atypical antipsychotic drug selected from risperidone, olanzapine, quetiapine, and amisulpride. 10

18. The method of Claim 14 wherein the disorder fails to respond to (i) two typical antipsychotic drugs selected from chlorpromazine, haloperidol and perphenazine, and (ii) one atypical antipsychotic drug selected from risperidone, olanzapine, quetiapine, and amisulpride. 15

19. The method of Claim 15 wherein the disorder fails to respond to (i) two typical antipsychotic drugs selected from chlorpromazine, haloperidol and perphenazine, and (ii) one atypical antipsychotic drug selected from risperidone, 20 olanzapine, quetiapine, and amisulpride.

20. The method of Claim 14 wherein the disorder fails to respond to (i) one to two typical antipsychotic drugs selected from chlorpromazine and haloperidol, and (ii) one 25 atypical antipsychotic drug selected from risperidone, olanzapine, quetiapine, and amisulpride.

21. The method of Claim 15 wherein the disorder fails to respond to (i) one to two typical antipsychotic drugs 30 selected from chlorpromazine and haloperidol, and (ii) one -29 atypical antipsychotic drug selected from risperidone, olanzapine, quetiapine, and amisulpride.

22. The method of Claim 14 wherein the disorder fails to 5 respond to (i) two typical antipsychotic drug selected from chlorpromazine and haloperidol, and (ii) one atypical antipsychotic drug selected from risperidone, olanzapine, quetiapine, and amisulpride. 10

23. The method of Claim 15 wherein the disorder fails to respond to (i) two typical antipsychotic drug selected from chlorpromazine and haloperidol, and (ii) one atypical antipsychotic drug selected from risperidone, olanzapine, quetiapine, and amisulpride. 15

24. The method according to any one of Claims 13 to 23 wherein the carbostyril compound is 7-{4-(4-(2,3 dichlorophenyl) -l-piperazinyl)butoxy)-3,4 dihydrocarbostyril. 20