CA2469702C - Darifenacin for use in the treatment of urgency induced by overactive bladder - Google Patents

Darifenacin for use in the treatment of urgency induced by overactive bladder Download PDF

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Publication number
CA2469702C
CA2469702C CA2469702A CA2469702A CA2469702C CA 2469702 C CA2469702 C CA 2469702C CA 2469702 A CA2469702 A CA 2469702A CA 2469702 A CA2469702 A CA 2469702A CA 2469702 C CA2469702 C CA 2469702C
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Prior art keywords
darifenacin
urgency
overactive bladder
pharmaceutically acceptable
patients
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Expired - Lifetime
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CA2469702A
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French (fr)
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CA2469702A1 (en
Inventor
Enrico Colli
Paul Quinn
Dzelal Serdarevic
Laurence Howard Skillern
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Searchlight Pharma Inc
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Novartis International Pharmaceutical Ltd
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61KPREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00Medicinal preparations containing organic active ingredients
    • A61K31/33Heterocyclic compounds
    • A61K31/395Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/40Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with one nitrogen as the only ring hetero atom, e.g. sulpiride, succinimide, tolmetin, buflomedil
    • A61K31/4025Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with one nitrogen as the only ring hetero atom, e.g. sulpiride, succinimide, tolmetin, buflomedil not condensed and containing further heterocyclic rings, e.g. cromakalim
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61KPREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00Medicinal preparations containing organic active ingredients
    • A61K31/33Heterocyclic compounds
    • A61K31/395Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/40Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with one nitrogen as the only ring hetero atom, e.g. sulpiride, succinimide, tolmetin, buflomedil
    • A61K31/4021-aryl substituted, e.g. piretanide
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61PSPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P13/00Drugs for disorders of the urinary system
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61PSPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P13/00Drugs for disorders of the urinary system
    • A61P13/10Drugs for disorders of the urinary system of the bladder
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61PSPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P7/00Drugs for disorders of the blood or the extracellular fluid
    • A61P7/12Antidiuretics, e.g. drugs for diabetes insipidus

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  • Health & Medical Sciences (AREA)
  • Veterinary Medicine (AREA)
  • Pharmacology & Pharmacy (AREA)
  • Public Health (AREA)
  • Chemical & Material Sciences (AREA)
  • General Health & Medical Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • Medicinal Chemistry (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Epidemiology (AREA)
  • Chemical Kinetics & Catalysis (AREA)
  • Organic Chemistry (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • General Chemical & Material Sciences (AREA)
  • Bioinformatics & Cheminformatics (AREA)
  • Engineering & Computer Science (AREA)
  • Urology & Nephrology (AREA)
  • Diabetes (AREA)
  • Hematology (AREA)
  • Pharmaceuticals Containing Other Organic And Inorganic Compounds (AREA)
  • Nitrogen Condensed Heterocyclic Rings (AREA)
  • Medicinal Preparation (AREA)
  • Plural Heterocyclic Compounds (AREA)
  • Chemical Treatment Of Metals (AREA)
  • Pyridine Compounds (AREA)
  • Inorganic Insulating Materials (AREA)
  • Crystals, And After-Treatments Of Crystals (AREA)
  • Diaphragms For Electromechanical Transducers (AREA)
  • Polysaccharides And Polysaccharide Derivatives (AREA)
  • Nitrogen And Oxygen Or Sulfur-Condensed Heterocyclic Ring Systems (AREA)
  • Document Processing Apparatus (AREA)
  • Processing Of Meat And Fish (AREA)

Abstract

The invention provides the use of darifenacin, or a pharmaceutically acceptable derivative thereof, in the manufacture of a medicament for the reduction of urgency in patients suffering from overactive bladder.

Description

DARIFENACIN FOR USE IN THE TREATMENT OF URGENCY INDUCED BY OVERACTIVE BLADDER
This invention relates to a new use of darifenacin, and its pharmaceutically acceptable derivatives.
S
Darifenacin is (S)-2-{1-[2-(2,3-dihydrobenzofuran-5-yl)ethyl]-3-pyrrolidinyl}-
2,2-diphenyl-acetamide and is disclosed in European Patent N° 0388054, Examples 1B and 8.
It is referred to therein as 3-(S)-(-)-(1-carbamoyl-1,1-diphenylmethyl)-1-[2-(2,3-dihydro-benzofuran-5-yl)ethyl]pyrrolidine. It is indicated in the treatment of urinary incontinence and irntable bowel syndrome and has the following structure:
CONHZ / O
~N
The symptoms of overactive bladder (OAB) include urinary frequency and urgency, with or without incontinence in the absence of local pathological or systemic condition.
Urgency is described in the draft ICS Terminology Report [Terminology Report of the International Continence Society; Draft 6, 15'i' August 2001 ] as the sudden compelling desire to pass urine, which is difficult to control.
Recently, the terms OAB Wet and OAB Dry have been proposed to describe OAB
patients with or without incontinence respectively. Overall prevalence of OAB
Wet and Dry is similar in men and women with a prevalence rate in the US of 16.6%
[Stewart et al, Prevalence of Overactive Bladder in the United States: Results from the NOBLE
Program; Abstract Presented at the 2°d International Consultation on Incontinence, July 2001, Paris, France]. Until recently, the cardinal symptom of OAB was believed to be incontinence. However, with the advent of the new terms this is clearly not meaningful for the large number of sufferers who are not incontinent (i.e. OAB Dry patients). Thus, a recent study from Liberman et al [Health Related Quality of Life Among Adults with Symptoms of Overactive Bladder: Results From A US Community-Based Survey;
Urology 57(6), 1044-1050, 2001] examined the impact of all OAB symptoms on the quality of life of a community-based sample of the US population. This study demonstrated that individuals suffering from OAB without any demonstrable loss of urine have an impaired quality of life when compared with controls. Additionally, individuals with urgency alone have an impaired quality of life compared with controls.
Thus, urgency is now believed to be the primary symptom of OAB, but to date it has not been evaluated in a quantified way in clinical studies.
It has now been found that darifenacin, and its pharmaceutically acceptable derivatives, is useful in the reduction of urgency in patients suffering from overactive bladder.
This finding is surprising because it could not have been predicted that a compound known to be useful in the treatment of incontinence (i.e. the unwanted and often unconscious leaking of urine) would be able to reduce the feeling of urgency (i.e. the sudden compelling desire to pass urine). It is even more surprising that darifenacin, and 1 S its pharmaceutically acceptable derivatives, is able to reduce the feeling of urgency in patients who are not incontinent (i.e. OAB Dry patients).
Thus, according to the present invention, there is provided the use of darifenacin, or a pharmaceutically acceptable derivative thereof, in the manufacture of a medicament for the reduction of urgency in patients suffering from overactive bladder (OAB).
Pharmaceutically acceptable derivatives of darifenacin include solvates and salts, particularly acid addition salts such as the hydrobromide salt.
The patients to be treated may be suffering from wet overactive bladder (OAB
Wet) or dry overactive bladder (OAB Dry).
The darifenacin, or a pharmaceutically acceptable derivative thereof, can be administered alone or in any convenient pharmaceutical presentation, including those mentioned in European Patent No 388054. Oral administration is preferred. In the present indication, a suitable dosage of darifenacin, or of the active darifenacin moiety in a pharmaceutically acceptable derivative thereof, for a 70 kg person, is in the range 3.75-40 mg daily, for
3 example 7.5-30 mg daily. The dosage may be administered in, say, 3 divided doses or in a single controlled release formulation.
However, it is preferred that the darifenacin, or a pharmaceutically acceptable derivative thereof, is administered in a dosage form that is adapted to release at least 10% of the darifenacin, or a pharmaceutically acceptable derivative thereof, in the lower gastrointestinal tract of the patient. Such formulations are described in US
Patent No 6,106,864 (the teaching of which is incorporated herein by reference). The preferred such formulation is a slow release matrix tablet (see particularly Example 3 of US
Patent No 6,106,864).
The invention further provides darifenacin, or a pharmaceutically acceptable derivative thereof, for use in the reduction of urgency in patients suffering from overactive bladder.
The invention further provides a method of reducing urgency in patients suffering from overactive bladder, which comprises administering darifenacin, or a pharmaceutically acceptable derivative thereof, to a patient in need of such treatment.
The invention is illustrated by the following examples.
Examples Clinical investigations of urgency in subjects with overactive bladder Two novel methods for the assessment of urgency were used. The first was for use in a large scale clinical trial, and the second was for use in clinical laboratory studies.
In both of these studies, darifenacin was administered as its hydrobromide salt. It was presented in slow release matrix tablets of the type described in US Patent No 6,106,864, particularly Example 3. Tablets were administered once daily (o.d.).
Clinical Study 1
4 PCT/IB02/00664 In this study, OAB Wet patients recorded each episode of urgency per day and the overall severity of urgency for each day in a diary. The severity of urgency was recorded by the use of a visual analogue scale (VAS) where the anchor points were mild and severe.
Darifenacin (as hydrobromide salt; 7.Smg, l5mg and 30mg of the active moiety, o.d.) and placebo were evaluated in subjects with a diagnosis of overactive bladder in a multicentre trial and symptoms of urgency were assessed using the VAS at baseline and at the end of the study (12 weeks of treatment).
108 patients (14 male, 94 female) received 7.5 mg; 107 patients (15 male, 92 female) received 15 mg; 114 patients (16 male, 98 female) received 30 mg; and 108 patients (18 male, 90 female) received placebo.
Results Darifenacin (7.5-30mg) produced a dose-related reduction in both the number of episodes of urgency and the overall severity of urgency experienced by the OAB subject in the clinical study. The effect was significantly greater than that produced by placebo. The data is presented below in Table 1 and 2.
Table 1 Effect of Darifenacin and Placebo on Frequency and Severity of Urgency in OAB
Subjects ei i ~,II~I g~ ~~p , s - Placebo7.5mg l5mg 30mg No o episo of~ urgenc I
..

Baseline 8.1 8.5 8.6 8.4 Median change from -1.2 -1.8 -2.3* -3***
baseline Median % Change -15.7 -29.2 -26.9 -33.1 from baseline _-H Placebo7.5mg 15mg 30mg ..
sate ..,ty - f a : cylday , Baseline 53.5 53.2 56.2 53.5 Median change from -3.9 -7 -7* -9.4*
baseline Median % Change -8.0 -14.2 -11.6 -19.9 from baseline * P<0.05, * * P<0.01, * * * P<0.001 Table 2 S Effect of Darifenacin on Frequency & Severity of Urgency in OAB subjects corrected for placebo 3~~'.~ E ~ M4 ~tt ~is i f t'~I 7.5mg l5mg 30mg F

la ~.
s o ~r e~ ' ~~~
.

Baseline 8.5 8.6 8.4 Median difference -0.5 -1.1* -1.4***
from placebo S rity o wrge~n 7.5mg 15mg 30mg ~liiay Baseline 53.2 56.2 53.5 Median difference -2.5 -3.8* -5.5*
from placebo * P<0.05, * * P<0.01, * * * P<0.001 Clinical Study 2 This study used a novel method for measuring the time between the first onset of the urgency and the need to micturate, which is known as the 'warning time'. A
modified stop-watch was used which required the subject to press a button at the onset of urge and a second button when they felt they needed to micturate.
Darifenacin (as the hydrobromide salt; 30mg o.d.) and placebo were evaluated in subjects with symptoms of urgency. The subjects were a mixture of OAB Wet and OAB Dry sufferers. The 'warning time' was assessed at baseline and following 2 weeks of treatment using the modified stop watch.
36 patients (29 female, 7 male) received darifenacin; and 36 patients (22 female, 14 male) received placebo.
Results Treatment with darifenacin of subjects with urgency produced a significant increase in the' warning time when compared with subjects treated with placebo. The data are displayed in Table 3.
It should be noted that both OAB Wet and OAB Dry subjects responded to treatment.
Table 3 Effect of Darifenacin and Placebo on Warning Time in Subjects with Urgency and Frequency ~ ~i~~~,~l~~i~ ~~' ~~s ~ ~~~~ i~~,Darifenacin Placebo ' ~ ~ ~ ~ ~ ~ V
g ' '~ ~ a r Baseline (Median) 4.7 9.4 Week 2 (Median) 8.4** 4.1 *P<0.05, * * P<0.01, * * * P<0.001 Median difference from placebo 4.3 minutes Conclusions The results show darifenacin produced a clinically significant attenuation of the symptom of urgency in subjects with overactive bladder.

Claims (9)

Claims:
1. The use of darifenacin, or a pharmaceutically acceptable derivative thereof, in the manufacture of a medicament for the reduction of urgency in patients suffering from overactive bladder.
2. The use as claimed in claim l, wherein the darifenacin is in the form of a pharmaceutically acceptable acid addition salt.
3. The use as claimed in claim 1, wherein the darifenacin is in the form of its hydrobromide salt.
4. The use as claimed in any one of the preceding claims, wherein the patients to be treated are suffering from wet overactive bladder.
5. The use as claimed in any one of claims 1 to 3, wherein the patients to be treated are suffering from dry overactive bladder.
6. The use as claimed in any one of the preceding claims, wherein the darifenacin, or a pharmaceutically acceptable derivative thereof, is administered in a dosage form that is adapted to release at least 10% of the darifenacin, or a pharmaceutically acceptable derivative thereof, in the lower gastrointestinal tract of the patient.
7. The use as claimed in claim 6, wherein the dosage form is a slow release matrix tablet.
8. Darifenacin, or a pharmaceutically acceptable derivative thereof, for use in the reduction of urgency in patients suffering from overactive bladder.
9. A method of reducing urgency in patients suffering from overactive bladder, which comprises administering darifenacin, or a pharmaceutically acceptable derivative thereof, to a patient in need of such treatment.
CA2469702A 2001-12-14 2002-03-05 Darifenacin for use in the treatment of urgency induced by overactive bladder Expired - Lifetime CA2469702C (en)

Applications Claiming Priority (3)

Application Number Priority Date Filing Date Title
GB0129962.7 2001-12-14
GBGB0129962.7A GB0129962D0 (en) 2001-12-14 2001-12-14 Method of treatment
PCT/IB2002/000664 WO2003051354A1 (en) 2001-12-14 2002-03-05 Method of treatment

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CA2469702A1 CA2469702A1 (en) 2003-06-26
CA2469702C true CA2469702C (en) 2010-07-06

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US (3) US20030130338A1 (en)
EP (1) EP1458376B1 (en)
JP (3) JP2005516925A (en)
KR (1) KR100889086B1 (en)
CN (1) CN100488505C (en)
AT (1) ATE341323T1 (en)
AU (1) AU2002236141B2 (en)
BR (1) BR0214925A (en)
CA (1) CA2469702C (en)
CY (1) CY1105814T1 (en)
CZ (1) CZ301283B6 (en)
DE (1) DE60215219T2 (en)
DK (1) DK1458376T3 (en)
ES (1) ES2276910T3 (en)
GB (1) GB0129962D0 (en)
HK (1) HK1073779A1 (en)
HU (1) HU229908B1 (en)
IL (2) IL162391A0 (en)
MX (1) MXPA04005760A (en)
NO (1) NO20042586L (en)
NZ (1) NZ533421A (en)
PL (1) PL206034B1 (en)
PT (1) PT1458376E (en)
RU (1) RU2321398C2 (en)
SI (1) SI1458376T1 (en)
SK (1) SK287510B6 (en)
WO (1) WO2003051354A1 (en)
ZA (1) ZA200404289B (en)

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* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2007109142A2 (en) * 2006-03-17 2007-09-27 Oregon Health & Science University M3 muscarinic receptor antagonists for treating tumors
CN101084891A (en) * 2007-06-29 2007-12-12 北京本草天源药物研究院 Darifenacin or its pharmaceutical salt pharmaceutical preparation for oral
CZ200845A3 (en) * 2008-01-28 2009-09-02 Zentiva, A. S. Process for preparing darifenacin
SI2394648T1 (en) * 2009-02-04 2017-02-28 Astellas Pharma Inc. Pharmaceutical composition for oral administration
CN102048706B (en) * 2011-01-12 2012-02-22 山东创新药物研发有限公司 Darifenacin hydrobromide sustained-release tablet and preparation method

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* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
GB8906166D0 (en) * 1989-03-17 1989-05-04 Pfizer Ltd Therapeutic agents
GB9518953D0 (en) * 1995-09-15 1995-11-15 Pfizer Ltd Pharmaceutical formulations

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Publication number Publication date
US20030130338A1 (en) 2003-07-10
KR20040066892A (en) 2004-07-27
CN1604777A (en) 2005-04-06
EP1458376B1 (en) 2006-10-04
KR100889086B1 (en) 2009-03-16
IL162391A (en) 2012-04-30
AU2002236141A1 (en) 2003-06-30
US8748476B2 (en) 2014-06-10
HUP0402625A2 (en) 2005-04-28
SK287510B6 (en) 2010-12-07
CA2469702A1 (en) 2003-06-26
US20090162433A1 (en) 2009-06-25
EP1458376A1 (en) 2004-09-22
CN100488505C (en) 2009-05-20
CY1105814T1 (en) 2011-02-02
MXPA04005760A (en) 2005-03-31
RU2321398C2 (en) 2008-04-10
HU229908B1 (en) 2014-12-29
SK2502004A3 (en) 2004-10-05
NZ533421A (en) 2007-02-23
GB0129962D0 (en) 2002-02-06
DE60215219D1 (en) 2006-11-16
NO20042586L (en) 2004-06-18
ZA200404289B (en) 2005-09-28
DE60215219T2 (en) 2007-10-18
HK1073779A1 (en) 2005-10-21
PT1458376E (en) 2007-01-31
PL206034B1 (en) 2010-06-30
WO2003051354A1 (en) 2003-06-26
IL162391A0 (en) 2005-11-20
JP2005516925A (en) 2005-06-09
CZ2004719A3 (en) 2005-01-12
DK1458376T3 (en) 2007-02-12
CZ301283B6 (en) 2009-12-30
SI1458376T1 (en) 2007-06-30
JP2013199506A (en) 2013-10-03
ATE341323T1 (en) 2006-10-15
US20070264333A1 (en) 2007-11-15
AU2002236141B2 (en) 2007-02-01
RU2004121780A (en) 2005-08-10
PL369426A1 (en) 2005-04-18
ES2276910T3 (en) 2007-07-01
BR0214925A (en) 2004-12-21
JP2010024244A (en) 2010-02-04

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