CN101304746A - Use of flibanserin for the treatment of pre-menopausal sexual desire disorders - Google Patents

Use of flibanserin for the treatment of pre-menopausal sexual desire disorders Download PDF

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CN101304746A
CN101304746A CNA2006800416970A CN200680041697A CN101304746A CN 101304746 A CN101304746 A CN 101304746A CN A2006800416970 A CNA2006800416970 A CN A2006800416970A CN 200680041697 A CN200680041697 A CN 200680041697A CN 101304746 A CN101304746 A CN 101304746A
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sexual desire
acid
purposes
menopausal
flibanserin
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斯蒂芬妮·波伦蒂尔
罗伯特·派克
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Boehringer Ingelheim International GmbH
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Abstract

The invention relates to the use of flibanserin for the preparation of a medicament for the treatment of pre-menopausal Sexual Desire Disorders.

Description

The purposes of flibanserin in the treatment pre-menopausal sexual desire disorders
The present invention relates to flibanserin (flibanserin) and be used for the treatment of purposes in the medicine of pre-menopausal sexual desire disorders in preparation.
Invention is described
Chemical compound 1-[2-(4-(3-trifluoromethyl-phenyl) piperazine-1-yl) ethyl]-2,3-dihydro-1H-benzimidazolyl-2 radicals-ketone (flibanserin) is disclosed among European patent application EP-A-526434 with its hydrogen chlorate's form, and has following chemical constitution:
Figure A20068004169700041
Flibanserin demonstrates 5-HT 1AAnd 5-HT 2The affinity of-receptor.Therefore, it is a kind of promising therapeutic agent that is used for the treatment of multiple disease (for example depressed, schizophrenia, and anxiety).
General term " sexual dysfunction " comprising: dysaphrodisia, sexual arousal dysfunction, orgasm disorder, sexual pain disorder, sexual dysfunction due to the general medicine situation (Sexual Dysfunction due to aGeneral Medical Condition), the sexual dysfunction that material causes (Substance-InducedSexual Dysfunction), and unspecified sexual dysfunction (Diagnostic and StatisticalManual of Mental Disorders, the 4th edition, Text Revision.Washington DC, AmericanPsychiatric Association, 2000).
Before to the menopause of suffering from sexual dysfunction, find in the research of female patient, flibanserin, optional with its free alkali, the last acceptable acid-addition salts form of pharmacology and/or optional with its hydrate and/or solvate form thereof, demonstrate libido and strengthen characteristic.Therefore, the present invention relates to flibanserin, optional with its free alkali, the last acceptable acid-addition salts form of pharmacology and/or optional, the purposes before preparation is used for the treatment of menopause in the medicine of women's dysaphrodisia with its hydrate and/or solvate form thereof.
Term among the present invention " hypothyroid dysaphrodisia before the treatment menopause " etc. has the implication of " hypothyroid dysaphrodisia among the preceding women of treatment menopause ".
No matter dysaphrodisia be that exist throughout one's life or that obtain, be " general sexual type " or " the situation type " and do not rely on the nosetiology cause (organic-two kinds of situations: on the health and drug induced-, psychology causes (being caused by psychological factor), by organic-two kinds of situations: on the health and drug induced-cause the combination of (by the blocking factor initiation) with psychology, or unknown), all can be observed the beneficial effect of flibanserin.Term " property (lifelong) throughout one's life " refers to that dysaphrodisia promptly exists since sexual function is initial always among the present invention.Term " acquired (acquired) " refer to the neutral disease of the present invention be only when one section of normal sexual function after date take place." general sexual type (generalized type) " refers to that the neutral disease of the present invention is not limited to stimulate, situation or companion's particular type." situation type (situational type) " refers to that the neutral disease of the present invention is confined to stimulate, situation or companion's particular type.The hypotype that causes by " psychological factor " be applicable to when psychological factor morbidity, the severity of property disease, worsen or keep in judgement play an important role, and general medicine situation and material are to the cause of disease and the adiaphorous situation of this property disease.The hypotype that is caused by " blocking factor " is applicable to when 1) psychological factor morbidity, the severity of this property disease, worsen or keep in judgement play an important role, and 2) general medicine situation or material use through judging and also promote but be not enough to situation (the Diagnostic and StatisticalManual of Mental Disorders of bringing out property disease, the 4th edition, Text Revision.Washington DC, AmericanPsychiatric Association, 2000).
Therefore, for example, term " hypothyroid dysaphrodisia before the property menopause throughout one's life " refers to the hypothyroid dysaphrodisia of women before the initial menopause that always exists of sexual function, and term " hypothyroid dysaphrodisia before the acquired menopause " refers to the hypothyroid dysaphrodisia of women before the menopause that normal sexual function took place after the regular period.
Therefore, in a preferred embodiment, the present invention relates to flibanserin, optional with its free alkali, the last acceptable acid-addition salts form of pharmacology and/or optional with its hydrate and/or solvate form thereof, be used for the treatment of purposes in the medicine that is selected from following disease in preparation: hypothyroid dysaphrodisia (HSDD) before the menopause, sexual aversion disorder before the menopause, pre-menopausal sexual desire disappearance (pre-menopausal loss ofsexual desire), pre-menopausal sexual desire lacks (pre-menopausal lack of sexual desire), pre-menopausal sexual desire reduces (pre-menopausal decreased sexual desire), pre-menopausal sexual desire suppresses (pre-menopausal inhibited sexual desire), libido disappearance (pre-menopausalloss of libido) before the menopause, libido disorder (pre-menopausal libido disturbance) before the menopause, and hyposexuality (pre-menopausal frigidity) before the menopause.
The present invention particularly preferably is flibanserin, optional with its free alkali, the last acceptable acid-addition salts form of pharmacology and/or optional with its hydrate and/or solvate form thereof, be used for the treatment of purposes in the medicine that is selected from following disease in preparation: sexual aversion disorder, pre-menopausal sexual desire disappearance, pre-menopausal sexual desire lack before hypothyroid dysaphrodisia, the menopause before the menopause, pre-menopausal sexual desire reduces, and pre-menopausal sexual desire suppresses.
In preferred embodiments, the present invention relates to flibanserin, optional with its free alkali, the last acceptable acid-addition salts form of pharmacology and/or optional with its hydrate and/or solvate form thereof, be used for the treatment of purposes in the medicine that is selected from following disease in preparation: hypothyroid dysaphrodisia, pre-menopausal sexual desire disappearance, pre-menopausal sexual desire reduce before the menopause, and pre-menopausal sexual desire suppresses.
In another preferred embodiment, the present invention relates to flibanserin, optional with its free alkali, the last acceptable acid-addition salts form of pharmacology and/or optional with its hydrate and/or solvate form thereof, be used for the treatment of purposes in the medicine that is selected from following disease in preparation: hypothyroid dysaphrodisia before the property menopause throughout one's life, sexual aversion disorder before the property menopause throughout one's life, the property pre-menopausal sexual desire lacks throughout one's life, the property pre-menopausal sexual desire lacks throughout one's life, the property pre-menopausal sexual desire reduces throughout one's life, the property pre-menopausal sexual desire suppresses throughout one's life, libido disappearance before the property menopause throughout one's life, libido disorder before the property menopause throughout one's life, and hyposexuality before the property menopause throughout one's life.
The present invention particularly preferably is flibanserin, optional with its free alkali, the last acceptable acid-addition salts form of pharmacology and/or optional with its hydrate and/or solvate form thereof, be used for the treatment of purposes in the medicine that is selected from following disease in preparation: sexual aversion disorder before hypothyroid dysaphrodisia, the property menopause throughout one's life before the property menopause throughout one's life, throughout one's life property pre-menopausal sexual desire disappearance, the property pre-menopausal sexual desire lacks throughout one's life, the property pre-menopausal sexual desire reduces throughout one's life, and the property pre-menopausal sexual desire suppresses throughout one's life.
In particularly preferred embodiments, the present invention relates to flibanserin, optional with its free alkali, the last acceptable acid-addition salts form of pharmacology and/or optional with its hydrate and/or solvate form thereof, be used for the treatment of purposes in the medicine that is selected from following disease in preparation: hypothyroid dysaphrodisia before the property menopause throughout one's life, throughout one's life property pre-menopausal sexual desire disappearance, the property pre-menopausal sexual desire reduces throughout one's life, and the property pre-menopausal sexual desire suppresses throughout one's life.
In another embodiment preferred, the present invention relates to flibanserin, optional with its free alkali, the last acceptable acid-addition salts form of pharmacology and/or optional with its hydrate and/or solvate form thereof, be used for the treatment of purposes in the medicine that is selected from following disease in preparation: hypothyroid dysaphrodisia before the acquired menopause, sexual aversion disorder before the acquired menopause, acquired pre-menopausal sexual desire disappearance, acquired pre-menopausal sexual desire lacks, acquired pre-menopausal sexual desire reduces, acquired pre-menopausal sexual desire suppresses, libido disappearance before the acquired menopause, libido disorder before the acquired menopause, and hyposexuality before the acquired menopause.
The present invention particularly preferably is flibanserin, optional with its free alkali, the last acceptable acid-addition salts form of pharmacology and/or optional with its hydrate and/or solvate form thereof, be used for the treatment of purposes in the medicine that is selected from following disease in preparation: sexual aversion disorder, acquired pre-menopausal sexual desire disappearance, acquired pre-menopausal sexual desire lack before hypothyroid dysaphrodisia, the acquired menopause before the acquired menopause, acquired pre-menopausal sexual desire reduces, the inhibition of acquired pre-menopausal sexual desire.
In particularly preferred embodiments, the present invention relates to flibanserin, optional with its free alkali, the last acceptable acid-addition salts form of pharmacology and/or optional with its hydrate and/or solvate form thereof, be used for the purposes of the medicine of following disease in preparation: hypothyroid dysaphrodisia, acquired pre-menopausal sexual desire disappearance, acquired pre-menopausal sexual desire reduce before the acquired menopause, and acquired pre-menopausal sexual desire suppresses.
In addition, the present invention relates to the hypotype general property or situation of any disease mentioned above and/or relate to this type of disease that causes or cause by blocking factor by device quality factor, psychological factor.
Flibanserin can be chosen wantonly with its free alkali form, with its pharmaceutically useful acid-addition salts form and/or optional with its hydrate and/or solvate form thereof use.Suitable acid-addition salts comprises the acid-addition salts that for example is selected from following acid formation: succinic acid, hydrobromic acid, acetic acid, fumaric acid, maleic acid, methanesulfonic acid, lactic acid, phosphoric acid, hydrochloric acid, sulphuric acid, tartaric acid and citric acid.Also can use the mixture of acid-addition salts mentioned above.In the acid-addition salts of mentioning in front, preferred hydrogen chlorate (hydrochloride) and hydrobromate (hydrobromide), preferred especially hydrogen chlorate.If flibanserin uses with free alkali form, preferably use with the form of disclosed flibanserin polymorph A among the WO 03/014079.
Choose wantonly with its free alkali form, the last acceptable acid-addition salts form of pharmacology and/or the optional flibanserin that uses with its hydrate and/or solvate form thereof and can sneak in the conventional pharmaceutical preparation with solid, liquid or spray form.For example, said composition can be oral to be suitable for, rectum, parenteral or be suitable for the form that snuffing goes into and exist: preferred form comprises for example capsule, tablet, coated tablet, ampulla, suppository and nasal mist.
This active ingredient can be sneaked in the excipient or carrier of conventional use in the pharmaceutical composition, for example: Pulvis Talci, arabic gum, lactose, gelatin, magnesium stearate, corn starch, aqueous or non-aqueous solvent (vehicle), polyvinylpyrrolidone, semi-synthetic fatty acid glyceride, benzalkonium chloride, sodium phosphate, EDTA, polysorbate80.Said composition can be prepared with dosage device easily, and each dosage device is through adjusting to supply the active component of single dosage.The dosage range that be suitable for every day is between 0.1 to 400 milligram, preferably between 1.0 to 300 milligrams, more preferably between 2 to 200 milligrams.Each dosage device can eligibly comprise 0.01 milligram to 100 milligrams, preferred 0.1 to 50 milligram.
To 1,2,3 or 4 these dosage devices of administration patient's every day.The compounds of this invention preferably in a period of time continuously or still less time with every day three times, more preferably administration once or twice.
Preferably, this dosage in a period of time continuously in the morning with administration in evening patient, be more preferably in the morning and be administered once (25 or 50 milligrams of flibanserins) and be administered once evening (25 or 50 milligrams of flibanserins), (50 or 100 milligrams of flibanserins) at night most preferably only is administered once.
Therefore, more not remarkable such as side effect such as calmness.
Suitable tablet can mix active substance by (for example) and obtains with known excipients, this excipient is for example inert diluent, for example calcium carbonate, calcium phosphate or lactose; Disintegrating agent, for example corn starch or alginic acid; Binding agent, for example starch or gelatin; Lubricant, for example magnesium stearate or Pulvis Talci; And/or delay releasing agent, for example carboxymethyl cellulose, cellulose acetate phthalate or polyvinyl acetate.Tablet also can comprise several layers.
Coated tablet also can correspondingly be generally used for the material of tablet coating by use, but for example power ketone or Lac, arabic gum, Pulvis Talci, titanium dioxide or sugar carry out coating and prepare kernel with what the mode that is similar to tablet was produced.Postpone to discharge or prevent incompatibility for reaching, kernel also can be made up of many layers.Similarly, this tablet coating can be made up of to reach many layers and postpone to discharge, and it can use the above-mentioned excipient that is used for tablet.
The syrup or the elixir that comprise active substance of the present invention or its combination can comprise sweetener in addition, for example glucide, sucdrol, glycerol or sucrose and taste modifying agent, and flavoring agent for example is as vanillin or orange extract.It also can comprise suspension adjuvants or thickening agent, for example sodium carboxymethyl cellulose; Wetting agent, for example condensation product of aliphatic alcohol and oxirane; Or antiseptic, for example p-Hydroxybenzoate.
Injection solution prepares in a usual manner, for example, adds antiseptic such as p-Hydroxybenzoate, or the alkali metal salt of stabilizing agent such as ethylenediaminetetraacetic acid, and is transferred in injection vials or the ampoule.
Contain one or more active substances or active substance combination capsule can by as this active substance and inert carrier such as lactose or sorbitol mixed, and it be packaged in the gelatine capsule and make.
The suppository that is fit to can make by for example mixing with the carrier that is provided for this purpose such as neutral fat or Polyethylene Glycol or derivatives thereof.
Embodiment
The present invention will be described and unrestricted its scope for following embodiment:
The embodiment of pharmaceutical preparation
A) Tablet Each tablet
100 milligrams of flibanserins
240 milligrams of lactose
340 milligrams of corn starchs
45 milligrams of polyvinylpyrrolidones
Magnesium stearate 15 milligrams
740 milligrams
Active substance, lactose and some corn starchs of fine gtinding are mixed.Mixture is sieved, then with the water-soluble solution-wet of polyvinylpyrrolidone, knead, wet granulation and dry.This granule, remaining corn starch and magnesium stearate are sieved and mixed.To this mixture being suppressed tablet with preparation suitable shape and size.
B) Tablet Each tablet
80 milligrams of flibanserins
190 milligrams of corn starchs
55 milligrams of lactose
35 milligrams of microcrystalline Cellulose
15 milligrams of polyvinylpyrrolidones
23 milligrams of carboxymethyl starch sodium
Magnesium stearate 2 milligrams
400 milligrams
Active substance, some corn starchs, lactose, microcrystalline Cellulose and the polyvinylpyrrolidone of fine gtinding are mixed, this mixture is sieved, and handle to form granule with remaining corn starch and water, it is through super-dry and screening.Add carboxymethyl starch sodium and magnesium stearate, and it is mixed, this mixture is suppressed to form the tablet of suitable size.
C) Coated tablet Each coated tablet
5 milligrams of flibanserins
41.5 milligrams of corn starchs
30 milligrams of lactose
3 milligrams of polyvinylpyrrolidones
Magnesium stearate 0.5 milligram
80 milligrams
Active substance, corn starch, lactose and polyvinylpyrrolidone mixed fully and use water-wet.This wet agglomerate is passed the sieve of 1 millimeter mesh size, dry under about 45 ℃, then this granule is passed identical sieve.After the magnesium stearate mixing, in the tablet maker, suppress the convex surface tablet core of 6 millimeters of diameters.With the coating of forming by sugar and Pulvis Talci basically the tablet core of making is thus carried out coating with known method.With wax purified sugar coated tablet is polished.
D) Capsule Each capsule
150 milligrams of flibanserins
268.5 milligrams of corn starchs
Magnesium stearate 1.5 milligram
420 milligrams
Material and corn starch are mixed and water is got wet.Wet agglomerate is sieved and drying.Dried particles is sieved and mixes with magnesium stearate.Purified mixture is packaged in No. 1 hard gelatin capsule.
E) Ampoule solution
50 milligrams of flibanserins
50 milligrams in sodium chloride
5 milliliters of waters for injection
PH value or the optional pH value with 5.5 to 6.5 of this active substance with himself is dissolved in the water, and add sodium chloride make its etc. ooze.Gained solution filtered make it not contain pyrogen, and under aseptic condition, filtrate is transferred in the ampoule, then ampoule is implemented sterilization and sealed by fusion method.
F) Suppository
50 milligrams of flibanserins
Hard fat 1650 milligrams
1700 milligrams
Hard butter is melted.Under 40 ℃, make through grinding active substance and disperse equably.It is cooled to 38 ℃ and be poured onto in the slight refrigerated suppository mold.
Clinical test results
Hereinafter, the witness experimental data of flibanserin clinical trial of the effect in women's property disease before treatment menopause.
Be the effect of flibanserin (maximum TDD: 100 milligrams a day 2 times) and placebo relatively among the women HSDD patient before menopause, with this EXPERIMENTAL DESIGN be perspective, multicenter, 12 weeks, at random, double blinding, placebo, Proof of Concept (proof of concept), parallel group test.For each treatment group, 75 patients of random assortment.
Whether the flibanserin treatment in 12 weeks produces significant clinically treatment response (as being determined by the DSM-IV standard) to be used for estimating in health female HSDD patient to design the test of this Proof of Concept.Compare with parallel placebo group, estimate the effectiveness of flibanserin.
After about 28 days screening phase (do not have treatment), to the part of 12 weeks of this test, double blinding, at this duration of test, it takes the research medicine in the morning with in about 12 hours evening of being separated by with qualified patient's random division.
Figure A20068004169700111
According to the DSM-IV standard, the patient must be women and be the HSDD that suffers from the acquisition type through tentative diagnosis before 18 to 45 years old the menopause.By the end of baseline visit, outbreak recently must continue at least 24 weeks.
Baseline severity standard is from Arizona sex experience scale (Arizona Sexual ExperiencesScale), needs 5 or 6 scoring (very weak or do not have libido) on the libido project.(people such as McGahueyCA., Psychiatric Annals 1999; 29 (1): 39-45; People such as McGahuey CA., J.SexMarital Therapy 2000; 26:25-44).
Dose distribution is simple random assortment, extraordinarily measures administration (one-timeup titration) can implementing one the 8th week.Starting dose be morning a slice tablet and evening a slice tablet.
Instruct the patient to approach once to take in per 12 hours unwitting research medicine as much as possible.Suggestion is not to take medicine less than ten hours interval.If missed dose, then take next prescribed dose according to schedule.Do not take doubling dosage.The suggestion patient takes each Research on dose medicine with 150 milliliters of (five ounces) water.
If the patient is not showing that researcher thinks significant progress and do not have serious or insupportable negative event the 56th day (the 8th week), then with every day the tablet number from morning and evening each a slice tablet double, with the dosage of flibanserin from 50 milligrams increase to for one day 2 times 100 milligrams one day 2 times, or the placebo tablets number of patient in the placebo group is doubled to four of every days from two of every days.
Efficacy variable as proof flibanserin effectiveness among the women HSDD before treatment menopause, (interactive Voice Response-FemaleSexual Behavior Question IVR-FSBQ) is designed to use simple from filling out questionnaire to measure libido relevant emotion and incident that phone finishes with interactive voice response-women's sexual behaviour questionnaire.For promoting its application flexibility, in this test in basic upward by the use FSBQ of IVR system weekly by exploitation of Healthcare Technology Systems company and management.
Show IVR-FSBQ (libido is relevant) below.
Last week your frequency of sinking into property thought (for example considering making love or sex fantasy) how?
If a bit all do not have, please by 0
If there is one day, please by 1
If there are two days, please by 2
If have three days but be not every day, please by 3
If have every day, please by 4
If every day is greater than 1 time, please by 5
On FAS (analytical data collection fully), carry out end point analysis.Except as otherwise noted, otherwise use the LOCF method (last is observed and is included into forward) of data evaluation.
For meeting the DSM-IV standard of hypothyroid dysaphrodisia, the severity of hyposexuality requires to be " permanent or repeatability lacks (or lacking) sex fantasy and sexual activity desire ".Therefore, IVR-FSBQ problem 1 " last week, your frequency of sinking into property thought (for example considering making love or sex fantasy) how? " whether treatability is desired obstacle for the proof flibanserin is indispensable.A main result of this clinical trial is between the difference on this problem (that is, the every monthly average to baseline changes) with flibanserin and between with the patient of placebo treatment.What show among Fig. 1 is for property thought frequency, changes with respect to the every monthly average of the IVR-FSBQ of baseline scores, and this figure has clearly proved flibanserin effectiveness in women's dysaphrodisia before treatment menopause.

Claims (17)

1. flibanserin, optional with its free alkali, the last acceptable acid-addition salts form of pharmacology and/or choose purposes in the medicine of dysaphrodisia before preparation is used for the treatment of postmenopausal women wantonly with its hydrate and/or solvate form thereof.
2. purposes as claimed in claim 1, it is characterized in that described pre-menopausal sexual desire disorders is selected from the preceding hypothyroid dysaphrodisia of menopause, the preceding sexual aversion disorder of menopause, pre-menopausal sexual desire disappearance, pre-menopausal sexual desire shortage, pre-menopausal sexual desire reduction, pre-menopausal sexual desire inhibition, the preceding libido disappearance of menopause, the preceding libido disorder of menopause, and the preceding hyposexuality of menopause.
3. as the purposes of claim 1 or 2, it is characterized in that described pre-menopausal sexual desire disorders is selected from the preceding hypothyroid dysaphrodisia of menopause, the preceding sexual aversion disorder of menopause, pre-menopausal sexual desire disappearance, pre-menopausal sexual desire shortage, pre-menopausal sexual desire reduction, pre-menopausal sexual desire inhibition.
4. as claim 1,2 or 3 purposes, it is characterized in that described pre-menopausal sexual desire disorders is lifelong sexual type.
5. as claim 1,2 or 3 purposes, it is characterized in that described pre-menopausal sexual desire disorders is for obtaining sexual type.
6. one or multinomial purposes in the claim as described above is characterized in that described pre-menopausal sexual desire disorders is a general property hypotype.
7. one or multinomial purposes in the claim as described above is characterized in that described pre-menopausal sexual desire disorders is the situation hypotype.
8. one or multinomial purposes in the claim as described above is characterized in that described pre-menopausal sexual desire disorders is to be caused by psychological factor.
9. one or multinomial purposes in the claim as described above is characterized in that described pre-menopausal sexual desire disorders is to be caused by the device quality factor.
10. one or multinomial purposes in the claim as described above is characterized in that described pre-menopausal sexual desire disorders is to be caused by blocking factor.
11. one or multinomial purposes in the claim as described above, it is characterized in that flibanserin is to use with the form that is selected from the pharmaceutically useful acid-addition salts that is formed by following acid: succinic acid, hydrobromic acid, acetic acid, fumaric acid, maleic acid, methanesulfonic acid, lactic acid, phosphoric acid, hydrochloric acid, sulphuric acid, tartaric acid, citric acid, and composition thereof.
12. one or multinomial purposes in the claim is characterized in that flibanserin is to use with its free alkali form as described above.
13. as the purposes of claim 12, it is characterized in that flibanserin is to use with free alkali polymorph A form, it has about 161 ℃ fusing point when using dsc measurement.
14. one or multinomial purposes in the claim is characterized in that flibanserin is to use with the dosage range between 0.1 to 400 mg/day as described above.
15. one or multinomial purposes in the claim as described above, it is characterized in that flibanserin in a period of time continuously once a day or administered twice.
16. one or multinomial purposes in the claim is characterized in that flibanserin is to reach in the morning to use evening as described above, are more preferably morning once (25 or 50 milligrams of flibanserins) and evening once (25 or 50 milligrams of flibanserins).
17. one or multinomial purposes in the claim as described above is characterized in that flibanserin only uses once (50 or 100 milligrams of flibanserins) continuously at night in a period of time.
CNA2006800416970A 2005-11-08 2006-11-06 Use of flibanserin for the treatment of pre-menopausal sexual desire disorders Pending CN101304746A (en)

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