CN101111266A - 含有降血糖药的用于改善或治疗糖耐量异常、临界性糖尿病、胰岛素抵抗性和高胰岛素血症的药物组合物 - Google Patents
含有降血糖药的用于改善或治疗糖耐量异常、临界性糖尿病、胰岛素抵抗性和高胰岛素血症的药物组合物 Download PDFInfo
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Abstract
本发明提供含有降血糖药作为有效成分，用于改善或治疗糖耐量异常、临界性糖尿病、胰岛素抵抗性和高胰岛素血症的药物组合物。本发明还提供用于预防或延缓从糖耐量异常、临界性糖尿病、胰岛素抵抗性和高胰岛素血症向真性糖尿病或代谢综合征发展或者易引起大血管障碍、心血管意外和缺血性心脏病的状态发展的药物组合物。
Description
技术领域
本发明涉及用于治疗临界性糖尿病或者预防由临界性糖尿病向糖尿病或动脉硬化、心肌梗塞等大血管障碍发病及发展的治疗剂。
背景技术
据报告，根据平成14年11月由厚生劳动省实施的糖尿病情况调查，推测在日本国内强疑列似为糖尿病的人包括目前正在治疗中的有大约740万人，另外，无法否定糖尿病可能性的人有大约880万人，两者加起来则有大约1620万人(非专利文献1)。无法否定糖尿病可能性的人是指血红蛋白Alc为5.6％以上小于6.1％、未接受糖尿病治疗的人。
近年来，与非糖尿病患者相比，在糖尿病患者中由动脉硬化导致的心血管意外的发生危险显著增加，因此最近的糖尿病治疗的最终目的不仅是降低血糖，而且着眼于抑制随之而来的动脉硬化所导致的心血管意外。最近，美国糖尿病学会(ADA)、世界卫生组织(WHO)、日本糖尿病学会(JDS)发表了考虑到临床、免疫学研究成果的新型糖尿病诊断标准，关于血糖值，如果确认了空腹时血糖值≥126mg/dl、随机血糖值≥200mg/dl、75g口服葡萄糖耐量试验(OGTT)2小时的血糖值≥200mg/dl中的任何一个，则诊断为糖尿病(Diabetes Care 20：1183(1997)，Diabet Med 15：539(1998)，糖尿病42：385(1999)、非专利文献2-4)。但是，从随机血糖值的值会随着进餐时间而较大变动、实施75g口服葡萄糖耐量试验很麻烦等的简便性和经济性的观点出发，优先测定空腹时血糖值。在这种现状中，由于不能否定糖尿病可能性的人或者被称为临界性糖尿病的人的特征为即便空腹时血糖值在正常范围内，餐后也为高血糖，因此无法诊断为糖尿病、不能实施治疗的情况很多。以欧洲约25000病例为对象的跟踪平均7年的发展研究(DECODE研究)表明，餐后2小时血糖值的上升与死亡危险的增大有很大关系(Lancet 354：617(1999)、非专利文献5)。另外，在日本的山形县船形町的免疫学调查中也报告了餐后高血糖引起心肌梗塞或脑梗塞的危险是正常人的2倍(Diabetes Care 22：920(1999)、非专利文献6)。更重要的是，这些调查表明空腹时血糖为正常水平、餐后血糖为140mg/dl以上小于200mg/dl的所谓临界性的人其心血管意外的发生危险也上升，在诊断为糖尿病之前的更早阶段开始治疗非常重要。
为临界性或无法否认糖尿病可能性的人的特征在于，除了餐后血糖显示很高的值以外，血浆中的胰岛素值也显示很高的值，已知该高胰岛素血症或由其导致的胰岛素抵抗性是发展为包括动脉硬化的代谢综合征的危险因子。引起高胰岛素血症的要因认为主要是由于在健康人中可见的胰岛素在餐后早期分泌减弱的所谓迟发性分泌过剩。因此，恢复餐后早期胰岛素分泌是从临界性阶段恢复的重要治疗方法。
另外，含有米格列奈、那格列奈、瑞格列奈的格列奈系口服降血糖药作为速效型胰岛素分泌促进剂被广泛使用，该药的特征在于恢复糖尿病患者中减弱的餐后早期胰岛素分泌，抑制血糖上升。但是，临床上并未确证向处于临界区域的人给予这些药对之后病情发展是否有效。通过各种研究结果表明，作为无法否认糖尿病可能性的人而举例的约880万人虽然没有接受糖尿病治疗动脉硬化的危险也很高，因此对于这些人从早期阶段开始进行利用药物的介入治疗对于改善高胰岛素血症、胰岛素抵抗性，从而阻止代谢综合征的发展是非常重要的。
非专利文献1：厚生劳动省健康局总务课生活习惯病对策室平成14年糖尿病实态调查、2003
非专利文献2：Diabetes Care 20：1183(1997)
非专利文献3：Diabet Med 15：539(1998)
非专利文献4：糖尿病42：385(1999)
非专利文献5：Lancet 354：617(1999)
非专利文献6：Diabetes Care 22：920(1999)
发明内容
发明所要解决的技术问题
本发明的课题在于为糖耐量异常(IGT)、临界性糖尿病的人们提供通过恢复餐后早期胰岛素分泌来改善高胰岛素血症、胰岛素抵抗性、餐后高血糖，从而阻止向以动脉硬化为首的代谢综合征的发展的药物。
用于解决技术问题的方法
本发明人鉴于上述问题进行了深入研究，结果发现通过在IGT阶段开始给予以米格列奈为代表的格列奈系药物会改善高胰岛素血症、胰岛素抵抗性，进而完成本发明。
即，本发明人着眼于格列奈系药物会恢复餐后早期胰岛素分泌，发现通过从IGT阶段开始进行给予，会改善餐后的迟发过剩型胰岛素分泌、纠正高胰岛素血症，而且全身的胰岛素感受性也会被改善，从而用很少的胰岛素量即可降低血糖。
具体地说，作为格列奈系药物，本发明人将米格列奈给予作为IGT的动物模型Zucker肥胖大鼠，研究血糖、胰岛素的日内变动和全身的胰岛素感受性。
结果发现，给予4周米格列奈会抑制餐后胰岛素的过剩分泌、改善全身的胰岛素感受性。
因此，本发明人以此发现为基础完成了临界性糖尿病发展的预防剂或治疗剂。
即，本发明提供含有降血糖药作为有效成分，用于改善或治疗糖耐量异常、临界性糖尿病、胰岛素抵抗性和高胰岛素血症的药物组合物。
本发明还提供含有降血糖药作为有效成分，用于预防或延缓从糖耐量异常、临界性糖尿病、胰岛素抵抗性和高胰岛素血症向真性糖尿病(DM)或代谢综合征发展的药物组合物。
本发明还提供含有降血糖药作为有效成分，用于预防或延缓从糖耐量异常、临界性糖尿病、胰岛素抵抗性和高胰岛素血症向易于引起大血管障碍、心血管意外和缺血性心脏病的状态发展的药物组合物。
本发明还提供用于制造为了改善或治疗糖耐量异常、临界性糖尿病、胰岛素抵抗性和高胰岛素血症的药物组合物的降血糖药的应用。
本发明还提供用于制造为了预防或延缓从糖耐量异常、临界性糖尿病、胰岛素抵抗性和高胰岛素血症向真性糖尿病或代谢综合征发展的药物组合物的降血糖药的应用。
本发明还提供用于制造为了预防或延缓从糖耐量异常、临界性糖尿病、胰岛素抵抗性和高胰岛素血症向易于引起大血管障碍、心血管意外和缺血性心脏病的状态发展的药物组合物的降血糖药的应用。
发明效果
通过本发明，可以为尽管目前有很高动脉硬化等血管并发症发病危险但却没有实施治疗的临界性糖尿病患者提供用于预防或治疗其病态发展的药物。
附图说明
图1显示研究米格列奈治疗对血糖日内变动影响的结果。
图2显示研究米格列奈治疗对胰岛素日内变动影响的结果。
图3显示胰岛素耐量试验结果。
具体实施方式
作为降血糖药优选为给药后1小时的血浆中胰岛素值与未给药本发明药物组合物的情况相比，降低了15ng/mL以上的降血糖药。优选使给药后1小时的血浆中胰岛素值降至45ng/mL以下的降血糖药。
具体地说，可以使用α-葡萄糖苷酶抑制剂(α-GI)、速效性胰岛素分泌促进剂(格列奈制剂)、磺酰脲剂(SU剂)、双胍(BG)剂等。
作为α-葡萄糖苷酶抑制剂，可以举出伏格列波糖、阿卡波糖等。
作为速效性胰岛素分泌促进剂可以举出(2S)-2-苄基-4-[(3aR，7aS)-八氢-2H-异吲哚-2-基]-4-氧代丁酸(俗名：米格列奈)、N-(反式-4-异丙基环己基羰基)-D-苯丙氨酸(俗名：那格列奈)、(S)-2-乙氧基-4-[2[[3-甲基-1-[2-(1-哌啶基)苯基]丁基]氨基]-2-氧代乙基]苯甲酸(俗名：瑞格列奈)等。
作为磺酰脲剂(SU剂)，可以举出甲苯磺丁脲、氯磺丙脲、甲磺氮卓脲、醋酸己脲、甲磺吡脲、4-氯-N-[(1-吡咯烷基氨基)羰基]-苯磺酰胺(格列吡脲)、1-丁基-3-间氨基苯磺酰脲、吡磺环己脲、格列喹酮等。
作为噻唑烷类药物，可以举出匹格列酮或罗格列酮等格列酮类药物。
作为双胍剂，可以举出二甲双胍或丁二胍等。
还可以使用上述降血糖剂的结晶型、溶剂合物、可药用盐等。其中，优选速效性胰岛素分泌促进剂、特别是米格列奈或其可药用盐。
本发明的组合物对于改善或治疗糖耐量异常(IGT)、临界性糖尿病、胰岛素抵抗性和高胰岛素血症有效；对于预防或延缓从这些状态向真性糖尿病或代谢综合征的发展有效；特别是对于预防或延缓从这些状态向由其中胰岛素抵抗性和高胰岛素血症所引起的心绞痛、心肌梗塞和动脉硬化这些易发生大血管障碍、心血管意外和缺血性心脏病的状态发展有效。特别是，对于改善或治疗IGT、胰岛素抵抗性和高胰岛素血症，对于预防或延缓IGT向糖尿病或代谢综合征发展有效。其中，对于改善或治疗IGT和高胰岛素血症最为有效。
需要说明的是，本说明书中，代谢综合征术语具有本领域公知的意义，具体是指在2001年由国家胆固醇教育计画的成人治疗组III提出的3项以上由于胰岛素抵抗性产生的心血管疾病危险因子(胰岛素抵抗性、肥胖、高三甘油酯值、低HDL胆固醇值、高血压)累积的状态。
本发明的组合物优选含有单次给药量小于20mg、优选10mg以下的量的降血糖药。
本发明的组合物通过口服给药或非口服给药(肌肉内、皮下、静脉内等)给药。优选口服给药。用于达成上述目的的给药量由目标治疗效果、给药方法、治疗期间、年龄、体重等决定，通过口服或非口服途径，通常成人每日的给药量在为口服给药时优选使用30～60mg、更优选使用15～30mg、进一步优选使用7.5～15mg；在为非口服给药时优选使用100μg～60mg以下。优选在每餐前给药。
将本发明组合物作为口服用制剂调制时，加入赋形剂，进而根据需要加入粘合剂、崩解剂、润滑剂、着色剂、矫味除臭剂等后，利用普通方法制成例如片剂、散剂、丸剂、颗粒剂、胶囊剂、栓剂、溶液剂、糖衣剂、长效制剂或糖浆剂等。作为赋形剂例如使用乳糖、玉米淀粉、白糖、葡萄糖、山梨糖醇、结晶纤维素等，作为粘合剂例如使用聚乙烯醇、聚乙烯醚、乙基纤维素、甲基纤维素、阿拉伯胶、黄蓍胶、明胶、虫胶、羟丙基纤维素、羟丙基淀粉、聚乙烯吡咯烷酮等，作为崩解剂例如使用淀粉、琼脂、明胶粉、结晶纤维素、碳酸钙、碳酸氢钠、柠檬酸钙、糊精、果胶等，作为润滑剂例如使用硬脂酸镁、滑石、聚乙烯醇、二氧化硅、氢化植物油等，作为着色剂使用可药用的着色剂，作为矫味除臭剂使用可可粉、薄荷脑、芳香酸、薄荷油、樟脑、桂皮末等。在这些片剂或颗粒剂上当然还可以包覆糖衣、明胶衣、其他必需的包衣。
在调制注射剂时，可以根据需要添加pH调节剂、缓冲剂、稳定剂、保存剂等，通过普通方法制成皮下、肌肉内、静脉内注射剂。
实施例
以下显示实施例进一步详细地说明本发明，但实施例是用于记载本发明的说明，并不限定本发明。
实施例1
<对Zucker肥胖大鼠的病态发展的影响>
使用具有肥胖和胰岛素抵抗性特征的Zucker肥胖(ZF)大鼠，研究米格列奈的有效性。已知ZF大鼠虽然显示高胰岛素血症、糖耐量异常，但空腹时血糖为正常范围，显示类似于人类中定义为IGT的病态(Br J Pharmacol 125、1708-14、1998)。
引进6周龄的雄性Zucker肥胖大鼠，进行每天2次、每次1小时(上午9:00～10:00、下午15:00～16:00)的限制饲养从而驯化。驯化1周后随机地将大鼠分为2组，给药4周。每天2次在每次进食前进行强行口服给药，一组给予混悬在0.5％甲基纤维素的米格列奈使得使用量达到3mg/kg；另一组则仅给予作为给药介质的0.5％甲基纤维素溶液。在开始给药和开始后的第4周测定由于每天2次的限制喂养所产生的血糖和胰岛素的日内变动。测定当天不给药，在上午给饲料前(9:00)、给饲料后1小时(10:00)、给饲料后2小时(11:00)、下午的给饲料前(15:00)、给饲料后1小时(16:00)、给饲料后2小时(17:00)由尾静脉采血，测定血糖和胰岛素。血糖和胰岛素测定根据常规方法实施。
在第4周的其他时间实施以研究全身胰岛抵抗性改善程度为目的的胰岛素耐量试验(ITT)。对断食1晚的ZF大鼠背部皮下注射用生理盐水稀释至0.5U/ml的市售胰岛素制剂(NOVORIN R、NOVO)，达到0.5U/kg，给药后15分钟、30分钟、60分钟、120分钟、180分钟由尾静脉采血，测定血糖。血糖测定根据常规方法实施。
(结果)
将研究米格列奈治疗对血糖和胰岛素日内变动的影响的结果示于图1、图2、图3、表1、表2中。图1显示在9:00～10:00和15:00～16:00给饲料时的血糖变动。对于血糖的日内变动，两组均无变化，如表1所示，对于一天的血糖总值两组也基本相同。另一方面，图2显示了此时的血浆胰岛素值，米格列奈给药组明显降低，如表1所示，米格列奈给药组的一天胰岛素总值显著降低。这说明使用米格列奈进行长期治疗改善了胰岛素抵抗性，结果以更少的胰岛素值即可抑制血糖的上升。
因此，为了更为正确地定量全身的胰岛素感受性的改善程度，实施了ITT。其特征在于，通过注射胰岛素，血糖一过性地降低，但当胰岛素抵抗性很强时，即使注射胰岛素也不会显示明显的血糖降低。如图3所示，在为ZF大鼠的情况下，即便给予胰岛素，血糖在给予60分钟后也仅显示给予前的约70％左右。但是，通过米格列奈的治疗，给予胰岛素60分钟后，血糖降低至给予前的50％左右。比较给予胰岛素后的血糖总值，也如表2所示那样，米格列奈给药组明显显示低值，说明改善了胰岛素抵抗性。
由以上实验结果可知，从IGT阶段开始的米格列奈治疗改善了认为是动脉硬化发展促进因子的胰岛素抵抗性或高胰岛素血症，可以抑制IGT向DM或代谢综合征的发展。
表1
血糖日内变动总值 胰岛素日内变动总值
给予介质组 1061±37mg·hr/dl 285±20ng·hr/ml
米格列奈组 1050±20mg·hr/dl 224±11ng·hr/ml
表2
血糖总值
给予介质组 279±6mg·hr/dl
米格列奈组 243±7mg·hr/dl
Claims (12)
1.含有降血糖药作为有效成分，用于改善或治疗糖耐量异常、临界性糖尿病、胰岛素抵抗性和高胰岛素血症的药物组合物。
2.含有降血糖药作为有效成分，用于预防或延缓从糖耐量异常、临界性糖尿病、胰岛素抵抗性和高胰岛素血症向真性糖尿病或代谢综合征发展的药物组合物。
3.含有降血糖药作为有效成分，用于预防或延缓从糖耐量异常、临界性糖尿病、胰岛素抵抗性和高胰岛素血症向易于引起大血管障碍、心血管意外和缺血性心脏病的状态发展的药物组合物。
4.权利要求1～3任一项所述的药物组合物，其中降血糖药与未给予本发明药物组合物的情况相比，使给药后1小时的血浆中胰岛素值降低了15ng/mL以上。
5.权利要求1～3任一项所述的药物组合物，其中降血糖药将给药后1小时的血浆中胰岛素值降低至45ng/mL以下。
6.权利要求1～5任一项所述的药物组合物，其中降血糖药选择α-葡萄糖苷酶抑制剂、速效性胰岛素分泌促进剂、磺酰脲剂、噻唑烷系药剂和双胍剂。
7.权利要求6的药物组合物，其中降血糖剂为速效性胰岛素分泌促进剂。
8.权利要求7的药物组合物，其中速效性胰岛素分泌促进剂为(2S)-2-苄基-4-[(3aR，7aS)-八氢-2H-异吲哚-2-基]-4-氧代丁酸、N-(反式-4-异丙基环己基羰基)-D-苯丙氨酸、(S)-2-乙氧基-4-[2[[3-甲基-1-[2-(1-哌啶基)苯基]丁基]氨基]-2-氧代乙基]苯甲酸或它们的可药用盐。
9.权利要求8的药物组合物，其中速效性胰岛素分泌促进剂为(2S)-2-苄基-4-[(3aR，7aS)-八氢-2H-异吲哚-2-基]-4-氧代丁酸或其可药用盐。
10.为了制造用于改善或治疗糖耐量异常、临界性糖尿病、胰岛素抵抗性和高胰岛素血症的药物组合物的降血糖药的应用。
11.为了制造用于预防或延缓从糖耐量异常、临界性糖尿病、胰岛素抵抗性和高胰岛素血症向真性糖尿病或代谢综合征发展的药物组合物的降血糖药的应用。
12.为了制造用于预防或延缓从糖耐量异常、临界性糖尿病、胰岛素抵抗性和高胰岛素血症向易于引起大血管障碍、心血管意外和缺血性心脏病的状态发展的药物组合物的降血糖药的应用。
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| JPS6354321A (ja) * | 1985-03-27 | 1988-03-08 | Ajinomoto Co Inc | 血糖降下剤 |
| AU654331B2 (en) * | 1991-03-30 | 1994-11-03 | Kissei Pharmaceutical Co. Ltd. | Succinic acid compounds |
| NO179246C (no) * | 1991-11-20 | 1996-09-04 | Sankyo Co | Aromatiske amino-alkoholderivater og mellomprodukter til fremstilling derav |
| CN1103590C (zh) * | 1993-09-15 | 2003-03-26 | 三共株式会社 | 使用噻唑烷二酮防止或延缓非胰岛素依赖性糖尿病(niddm)的发作 |
| US5478852C1 (en) * | 1993-09-15 | 2001-03-13 | Sankyo Co | Use of thiazolidinedione derivatives and related antihyperglycemic agents in the treatment of impaired glucose tolerance in order to prevent or delay the onset of noninsulin-dependent diabetes mellitus |
| IL113313A (en) * | 1994-04-11 | 1999-09-22 | Sankyo Co | Heterocyclic compounds and pharmaceutical compositions containing the same |
| US6006753A (en) * | 1996-08-30 | 1999-12-28 | Eli Lilly And Company | Use of GLP-1 or analogs to abolish catabolic changes after surgery |
| CN1245158C (zh) * | 1996-11-15 | 2006-03-15 | 味之素株式会社 | 片剂组合物 |
| ID21411A (id) * | 1997-12-10 | 1999-06-10 | Takeda Chemical Industries Ltd | Agen untuk mengobati daya tahan glukosa yang berisiko tinggi rusak |
| JPH11236337A (ja) * | 1997-12-10 | 1999-08-31 | Takeda Chem Ind Ltd | 耐糖能異常改善剤 |
| US6100300A (en) * | 1998-04-28 | 2000-08-08 | Bristol-Myers Squibb Company | Metformin formulations and method for treating intermittent claudication employing same |
| US6559188B1 (en) * | 1999-09-17 | 2003-05-06 | Novartis Ag | Method of treating metabolic disorders especially diabetes, or a disease or condition associated with diabetes |
| ES2211454T3 (es) * | 1999-09-30 | 2004-07-16 | Pfizer Products Inc. | Pirrolilamidas como inhibidores de la colageno fosforilasa. |
| US6586438B2 (en) * | 1999-11-03 | 2003-07-01 | Bristol-Myers Squibb Co. | Antidiabetic formulation and method |
| SG149676A1 (en) * | 1999-12-23 | 2009-02-27 | Novartis Ag | Use of hypoglycemic agent for treating impaired glucose metabolism |
| ATE399000T1 (de) * | 1999-12-28 | 2008-07-15 | Ajinomoto Kk | Antidiabetes-zubereitung zur oralen verabreichung |
| RU2281764C2 (ru) * | 2000-03-17 | 2006-08-20 | Адзиномото Ко., Инк. | Лекарственные средства для лечения осложнений, связанных с диабетом, и невропатии и их применения |
| AU2001294265A1 (en) * | 2000-10-18 | 2002-04-29 | Ajinomoto Co., Inc. | Process for producing nateglinide crystal |
| WO2002032853A1 (fr) * | 2000-10-18 | 2002-04-25 | Ajinomoto Co.,Inc. | Procede de preparation d'acylphenylalanines |
| AU2001295999A1 (en) * | 2000-10-24 | 2002-05-06 | Ajinomoto Co., Inc. | Nateglinide-containing preparations |
| ES2288997T3 (es) * | 2000-10-24 | 2008-02-01 | Ajinomoto Co., Inc. | Procedimiento para producir cristales de nateglinida de tipo b. |
| JP2004513935A (ja) * | 2000-11-17 | 2004-05-13 | ノボ ノルディスク アクティーゼルスカブ | グルカゴンアンタゴニスト／逆アゴニスト |
| US6652838B2 (en) * | 2001-04-05 | 2003-11-25 | Robert E. Weinstein | Method for treating diabetes mellitus |
| FR2834214B1 (fr) * | 2001-12-28 | 2004-09-24 | Lipha | Composition pharmaceutique comprenant un inhibiteur d'alpha-glucosidase et un acide 4-oxo-butanoique et son utilisation pour traiter le diabete |
| US6830759B2 (en) * | 2002-06-28 | 2004-12-14 | Ajinomoto Co., Inc. | Antidiabetic preparation for oral administration |
| US7071341B2 (en) * | 2003-02-28 | 2006-07-04 | Council Of Scientific And Industrial Research | α-Glucosidase inhibitors and their synthesis from a natural source |
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| US20070275999A1 (en) | 2007-11-29 |
| EP1891971A1 (en) | 2008-02-27 |
| KR20070102694A (ko) | 2007-10-19 |
| WO2006080524A1 (ja) | 2006-08-03 |
| JP4974057B2 (ja) | 2012-07-11 |
| EP1891971A4 (en) | 2010-02-03 |
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