CN100376245C - 结合有泰妥拉唑与消炎剂的药物组合物 - Google Patents

结合有泰妥拉唑与消炎剂的药物组合物 Download PDF

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CN100376245C
CN100376245C CNB2003801072011A CN200380107201A CN100376245C CN 100376245 C CN100376245 C CN 100376245C CN B2003801072011 A CNB2003801072011 A CN B2003801072011A CN 200380107201 A CN200380107201 A CN 200380107201A CN 100376245 C CN100376245 C CN 100376245C
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tenatoprazole
antiinflammatory
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弗朗索瓦·舒策
苏济·沙尔比
埃尔韦·菲舍
米歇尔·霍默林
阿兰·塔库恩
稻叶良生
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Sidem Pharma SA
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Abstract

本发明涉及新颖药物组合。本发明的药物组合物包含泰妥拉唑与一种或多种消炎剂的组合，所述消炎剂选自非类固醇消炎剂和环加氧酶-2抑制剂。本发明适于疼痛和炎症性表现的治疗。

Description

结合有泰妥拉唑与消炎剂的药物组合物
本发明涉及用作治疗目的的新型组合物，更特别地是结合有消炎剂与泰妥拉唑(tenatoprazole)的药物组合物，用以治疗疼痛和炎症性疾病的症状，同时避免标准消炎剂的副作用。
消炎剂是一类已广泛使用多年的药品。最初的治疗用消炎剂之一是阿斯匹林，其解热、止痛和抗血小板聚集性也是公知的并已证明可将其用于众多适应症。如此，估计全世界每年消耗数百万阿斯匹林药片。
非类固醇性消炎剂(NSAIDS)是治疗疼痛和急性炎症最广泛使用的药品。可将它们主要分为标准NSAID和环加氧酶同功酶-2(COX-2)抑制剂。
例如，阿斯匹林、双氯芬酸、依托度酸、吲哚美辛、萘普生、布洛芬和吡罗昔康(piroxicam)是通常用于治疗炎症性风湿病和关节病的标准NSAIDs。
然而，标准NSAIDs产生了某些副作用，尤其是易于诱发胃和肠溃疡(Goodman and Gilman，The Pharmacological Basis of Therapeutics；9th Edition，McGraw Hill)。上述副作用与组成异构体环加氧酶-1(COX-1)的抑制有关。特别是在治疗慢性疾病时，上述药物由于需要长期服用而特别成问题。
发炎时诱发的环加氧酶-1的另一异构体环加氧酶-2存在的发现使开发潜在的更特效和更安全的药物成为可能。当前可利用的上述NSAIDs具有选择性抑制COX-2作用的效力，从而作用于发炎处而在胃肠道的上部很少发生副作用。如此，开发了COX-2抑制剂如塞来考昔(celecoxib)和罗非考昔(rofecoxib)，并构成了一类治疗发炎疾病症状的新型药物。
然而，尽管COX-2抑制剂能明显减少诸如与服用标准NSAIDs相关的胃或出血性(haemorrhagic)溃疡的主要病症，但它们不能明显改善诸如胃痛和消化不良的次要问题，而且不能预防全部的主要病症。最近的研究表明，在服用塞来考昔的患者中观察到轻微病症的百分数分别为4.8％(胃痛)、4.8％(消化不良症状)和2.4％(恶心)，而用标准NSAIDs治疗的情况下，上述百分数分别为6.2％、5.9％和3.4％。用另一COX-2抑制剂罗非考昔与标准NSAIDs治疗相比较得到相似的结果。
泰妥拉唑或称5-甲氧基-2-[[(4-甲氧基-3，5-二甲基-2-吡啶基)甲基]亚磺酰基]咪唑并[4，5-b]吡啶描述在欧洲专利号254.588中。该化合物属于治疗胃溃疡用的被认为是质子泵抑制剂的药物族。
该系列中的第一个已知衍生物是在欧洲专利号005.129中所述的奥美拉唑，该化合物具有抑制胃酸分泌的性能，并被广泛用作人体治疗中的抗溃疡剂。
其它质子泵抑制剂包括雷贝拉唑(rabeprazole)、喷妥拉唑(pantoprazole)和兰索拉唑(lansoprazole)，这些化合物结构相似且均属于吡啶基-甲基-亚磺酰基-苯并咪唑族。泰妥拉唑具有类似的结构，但属于咪唑并吡啶类型。上述化合物是在硫原子级别上具有不对称性的亚砜，因此通常为两种对映体的外消旋混合物形式。
也有设想将奥美拉唑用于治疗胃食管反流性疾病，但其对此适应症的作用并不完全令人满意。研究由此表明，奥美拉唑与其它质子泵抑制剂相似，其持效期并不足以确保夜发性反流的有效治疗。
泰妥拉唑和其抑制腺苷三磷酸酶(H++K+)及胃酸分泌的能力详细描述在欧洲专利号254.588中。
已有建议将诸如奥美拉唑的质子泵抑制剂处方用于以消炎药治疗的患者以限制其副作用，尤其是与胃损伤和溃疡相关的并发症，但是消炎药的副作用可非常严重而且不可预料，尤其是诸如老人的高危人群，并且标准质子泵抑制剂的伴随服用并不能完全满足预防性治疗的需要。
专利申请WO No.01.66088涉及一种无释放基(group-releasing)NSAID的口服自乳化药物形态，该药物与胃液接触时原位形成乳液。该申请也考虑到了诸如消炎剂与诸如奥美拉唑的常规质子泵抑制剂的可能组合。专利申请WO No.01.56573公开了一种可增强胃肠活动性的COX-2抑制剂系列消炎剂，而且该申请也考虑到了与质子泵抑制剂的可能组合。然而，以上引用的两专利申请并没有描述上述组合的任何实施例，而且没有暗示消炎剂与泰妥拉唑的特定组合。
也有建议将E1前列腺素类似物如米索前列醇与消炎剂如双氯芬酸的组合用以治疗作为消炎剂副作用产生的胃溃疡，但米索前列醇的排除半衰期太短以至于不能得到长期效果。
因此，仍需要具有消炎活性的药物，该药物可用于长期治疗而不会产生有害影响，尤其是对老年患者或存在胃或十二指肠溃疡风险的患者，从而能预防上述副作用。
实际上，本发明的目的就是通过对引起胃-十二指肠损伤和消化性溃疡的副作用施加预防性效果，使医生可获得治疗疼痛和发炎症状的药物，尤其用于治疗发炎性疾病如发炎性风湿病、关节炎和骨关节炎的症状。
本申请人进行的研究表明，与其它质子泵抑制剂和尤其是NSAIDs的消炎药的单独或组合使用相比，泰妥拉唑与消炎药的结合取得了预料不到的效果。更特别地，研究表明泰妥拉唑与一种或多种消炎药的组合能够控制胃酸过多，而且消炎活性的效力改进、使用更安全，并能有效治疗疼痛和发炎疾病患者，尤其是风湿性发炎如关节炎、类风湿性关节炎和关节病患者，同时预防由消炎药引起的消化失调。
因此，本发明的目的是结合有特定质子泵抑制剂泰妥拉唑与一种或多种消炎药的药物组合物。
本发明的目的还在于制造适于治疗疼痛和发炎疾病症状的口服或肠胃外途径给药的药物制剂，所述药物制剂包括泰妥拉唑与一种或多种消炎药。
本发明的另一目的是泰妥拉唑与至少一种消炎药组合应用于治疗疼痛和发炎症状，以及泰妥拉唑与至少一种消炎药组合应用于制造治疗疼痛和发炎疾病症状的药物。
根据本发明，泰妥拉唑可以游离或盐的形式使用；例如，钾、镁、钠或钙盐。
本发明组合物中所用消炎药可选自标准非类固醇消炎药(NSAIDs)和环加氧酶-2抑制剂。如此就可以使泰妥拉唑与阿斯匹林或选自双氯芬酸、依托度酸、吲哚美辛、萘普生、布洛芬和吡罗昔康的标准NSAID组合。本发明组合物所用环加氧酶-2抑制剂可以是诸如塞来考昔或罗非考昔。
如上所示，本发明的组合物可有利地用于治疗任意的疼痛和发炎症状，特别是老年患者，具有溃疡史的患者，或接受阿斯匹林或抗凝血剂治疗的患者，等等。它们尤其适用于治疗发炎性风湿病，特别是关节炎andosteoarthritis、牙龈疼痛等，而且可避免与使用已知消炎剂相关联的主要和次要消化性并发症。
本申请人进行的研究表明，用本发明结合有泰妥拉唑和消炎药的组合物可有效治疗上述症状，而且其低的副作用风险，尤其是低的胃-十二指肠损伤和消化性溃疡的风险确保了它的优点，所述优点由泰妥拉唑活性的特定类型与消炎药活性的特定类型相互补充而产生。
事实上，泰妥拉唑可与其它的质子泵抑制剂区分开来，这是由于其令人吃惊的更长排除半衰期，以及如本申请人实验过程中所证明的相当大的组织暴露程度。
在口服单剂量和持续7天日剂量的情况下，在高加索人个体(n＝8/组)中的I期研究可以证明泰妥拉唑的不同剂量对药物代谢动力学参数的影响。
测试剂量是10、20、40和80mg的泰妥拉唑。
所得结果列在下表1中。
表1
  单剂量     重复剂量(7天)
  10mg     20mg     40mg     80mg     10mg    20mg     40mg     80mg
 Cmax(μg/ml) 0.9 2.4 5.3 8.3 1.6 3 5.5 11.8
 Tmax(h)   4     4     3     3     3    2     3     2
 T1/2(h)   5     6     6     7     5    8     9     9.2
 AUC0-t   8     24     43     97     13    36     75     218
在上表中，所用缩略语具有如下含义：
Cmax  最大浓度
Tmax达到最大浓度所需时间
T1/2排除半衰期
AUC0-t零时至最后测量浓度之间曲线下的面积
上表1所示结果证明，依赖于剂量，平均排除半衰期在服用单剂后为5-6小时，而服用7天后为5-9.2小时。泰妥拉唑还表现出高AUC值(曲线下面积)，这提供了经由口服途径的低代谢速率和/或高生物可利用率的证据。而且，无论何种服药情况，是单剂量还是重复剂量，Cmax、AUC0-t和AUC0-inf值均以线性方式增加。通过外推法计算AUC0-inf值。
Tolman等人比较了两种质子泵抑制剂兰索拉唑和奥美拉唑的AUC值(J.Clin.Gastroenterol.，24(2)，65-70，1997)，但这并不能判断一种产品优于另一产品。事实上，必须把不同标准考虑在内，即泵再生所需时间和抑制质子泵所需最小浓度以上的时间段。对于泵再生时间，观察到泵通常具有30-48小时的半衰期，因此每72-96小时就会全部更新。
本申请人进行的药物代谢动力学研究表明，由于上述预料不到的药物代谢动力学性质，泰妥拉唑能够通过保持抑制浓度并持续足够长时间来满足前述的两个标准而对抗质子泵再生现象。
如此，由所得AUC值证明的与泰妥拉唑的长半衰期相关的长时暴露使其在活性位点上的存在时间延长，并因此产生时间延长的药效作用。因此该试验表明，泰妥拉唑具有明显高于其它质子泵抑制剂的血浆半衰期/泵再生时间比，从而可将其用于治疗目前可用药物几无疗效的症状，尤其是用于胃食管反流和胃-十二指肠溃疡的夜发性症状的治疗。
因此，当使泰妥拉唑与消炎药如双氯芬酸、塞来考昔、吲哚美辛、萘普生、布洛芬或罗非考昔结合并优选晚上睡觉前服用时，与其它质子泵抑制剂相比，泰妥拉唑在抑制胃酸度方面具有明显的优势，因此能有效作用于胃酸的夜发性高峰以及胃食管反流患者的夜发性症状，其中该药能明显缓解上述即使用标准质子泵抑制剂如奥美拉唑进行典型治疗仍难以治愈的患者。
本发明组合物可以与所选服药方式相适应的标准形态服用，例如经由口服或肠胃外途径，但优选为口服或静脉途径。例如，可以使用含泰妥拉唑和消炎药作活性物质的片剂或胶囊制剂，或使用含泰妥拉唑盐与一种或多种消炎剂及可作药用的标准基质的供肠胃外使用的乳液或溶液。
单位剂量可含有10-60mg泰妥拉唑和10-500mg消炎剂，优选双氯芬酸、萘普生、布洛芬、塞来考昔或罗非考昔。
如下作为实施例给出了结合有泰妥拉唑和标准非类固醇消炎剂的胶囊的合适配方：
泰妥拉唑       20mg
双氯芬酸       100mg
赋形剂   qs    300mg
下面给出了结合有泰妥拉唑和环加氧酶抑制剂的配方实施例：
泰妥拉唑       20mg
塞来考昔       200mg
赋形剂   qs    300mg
剂量作为患者状态和疾病严重程度的函数由医生确定。通常每天10-120mg，优选20-40mg泰妥拉唑和20-1600mg消炎药。
例如，在初期或维持治疗的情况下，老年人膝关节炎的发炎部位的治疗可以是每天晚上服用1-2片药片，每片含20mg泰妥拉唑和100mg双氯芬酸，持续4-10周的时间段。
在患严重疾病的患者中，可通过初期经由静脉途径，而后通过口服途径而有效给药。
本发明还具有可通过每周服用1片含20或40mg泰妥拉唑和100-200mg消炎药如双氯芬酸、塞来考昔或罗非考昔的单剂量进行有效的连续治疗的优点。
下述临床病例研究证明了本发明所述组合的效力。
表2  消化性疾病的预防
年龄/性别   NSAID/泰妥拉唑组合 重量比 疗程 严重的消化性疾病 轻的消化性疾病 安全性
45/女   萘普生/T  500/20   8周 0 0 +++
39/女   双氯芬酸/T  100/20   12周 0 0 +++
41/男   布洛芬/T  600/20   8周 0 0 +++
34/男   双氯芬酸/T  100/20   8周 0 0 +++
52/男   塞来考昔/T  200/20   8周 0 0 +++
39/男   塞来考昔/T  200/20   10周 0 0 +++
T＝泰妥拉唑
NSAID和泰妥拉唑的重量比以mg表示的。如此，“萘普生/T”“500/20”是指含500mg萘普生和20mg泰妥拉唑的胶囊。在上述疗程内每天服用1个胶囊进行治疗。在布洛芬与泰妥拉唑结合的情况下，每个胶囊含400mg布洛芬和5mg泰妥拉唑，每天服用4个胶囊。
上表2所示结果表明，服用本发明结合有泰妥拉唑与非类固醇消炎剂的组合物不会产生任何严重或轻微的消化性问题，而且该治疗具有很好的耐受性。

Claims (6)

1.用于治疗疼痛和炎性疾病的药物组合物，其特征在于该组合物包含泰妥拉唑与一种或多种消炎剂的组合，所述消炎剂选自
-选自阿斯匹林、双氯芬酸、依托度酸、吲哚美辛、萘普生、布洛芬和吡罗昔康的非类固醇消炎剂，和
-选自罗非考昔和塞来考昔的环加氧酶-2抑制剂。
2.根据权利要求1的组合物，其中泰妥拉唑与消炎剂的重量比为1∶2至1∶40。
3.根据权利要求1的组合物，其中组合物包含各自含有10-60mg泰妥拉唑与10-500mg消炎剂的单位剂量。
4.根据权利要求1的组合物，其中泰妥拉唑是钾、镁、钠或钙盐的形式。
5.根据前述任一项权利要求的组合物，其中组合物经由口服或肠胃外途径给药。
6.泰妥拉唑与一种或多种消炎剂在制造用于治疗疼痛和炎性疾病的药物中的组合应用。
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