CN106456637A - (s)‑吡吲哚及其药学上可接受的盐的药学用途 - Google Patents
(s)‑吡吲哚及其药学上可接受的盐的药学用途 Download PDFInfo
- Publication number
- CN106456637A CN106456637A CN201480078727.XA CN201480078727A CN106456637A CN 106456637 A CN106456637 A CN 106456637A CN 201480078727 A CN201480078727 A CN 201480078727A CN 106456637 A CN106456637 A CN 106456637A
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- CN
- China
- Prior art keywords
- pirlindole
- pain
- pharmaceutically acceptable
- acceptable salt
- acid
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
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- 239000008194 pharmaceutical composition Substances 0.000 claims abstract description 7
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- 239000000730 antalgic agent Substances 0.000 claims description 23
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Abstract
(S)‑吡吲哚或其药学上可接受的盐以及包括其的药物组合物用于疼痛的预防和治疗处理。
Description
技术领域
本发明涉及(S)-吡吲哚对映体或其药学上可接受的盐及其组合物用于治疗和预防疼痛。
背景技术
疼痛病症的治疗在医学中是最重要的，这引起对于治疗和预防的另外疗法的世界范围的需求。
疼痛是患者寻求医疗护理的最常见的症状。虽然没有精确的定义，但它可以被定义为包括与实际或潜在损伤相关或与这种损伤有关描述的任何不愉快的感觉和情感体验(国际疼痛研究协会，IASP)。
疼痛是一种非常相关的症状，其呈现复杂的发病机制。在医学的大量的综合征和疾病中描述了疼痛。在严重的形式中，疼痛转化为多种性质的残疾、进行日常活动困难、干扰情绪、专业成绩和社会关系。
此外，疼痛的解释因个体而异，对于各个体自身，在其生命不同时间，根据变化的生理，社会文化和情感状况的变化。
关于位置分布，可以区分三种类型的疼痛：外周疼痛，中枢性疼痛和心因性疼痛。
外周疼痛是外周神经纤维中的组织疾病的结果，其在传递神经冲动时产生疼痛的感觉。外周疼痛进一步分为浅外周疼痛和深外周疼痛。第一种是急性和穿透性的，它位于起源处。深外周疼痛可分为躯体的或内脏的。躯体的深外周疼痛可以是局部的(疼痛位于疼痛刺激的起源处)或辐射的(疼痛是扩散的并且远离疼痛刺激的起源处)。最后，深的内脏外周疼痛具有难以限制的位置。
中枢性疼痛是自发性疼痛，其由诸如脊髓索、延髓，丘脑或大脑皮层等的中枢神经中枢的神经损伤引起。
心因性疼痛定义为不具有组织基质的痛苦感觉。它是专属于精神性的任何疼痛，其具有特定的解剖位置。
从病理生理学角度看，疼痛可以是伤害性或神经性的。
伤害性疼痛可以定义为由对非神经性组织的实际或威胁性的损伤引起的疼痛，并且是由伤害感受器的激活引起。伤害性疼痛可以分为躯体的或内脏的。躯体疼痛是由于躯体组织(例如骨、关节、肌肉或皮肤)中的伤害感受受体的激活引起。在内脏疼痛中，内脏伤害感受器由不同的病理机制(例如机械损伤、炎症、辐射、毒性剂)激活。内脏和躯体伤害性疼痛可以是急性或慢性的。内脏疼痛更难以表征并对常规疼痛治疗较不敏感。一些疼痛综合征(例如，癌症疼痛)包括内脏和躯体伤害性疼痛的原理。
神经性疼痛可以定义为作为影响体感系统(即外周神经、背根神经节或背根或中枢神经系统)的损伤或疾病的直接结果而产生的疼痛。
已知对神经组织产生损伤或功能障碍的几乎任何病理过程可以被认为是神经性疼痛的潜在原因：病毒、细菌、无菌性炎症、由于肿瘤或其他结构性损伤引起的压力、退行性、局部缺血、自身免疫、有毒、创伤或内分泌/代谢机制都涉及神经性疼痛的产生。
然而，最常研究的神经性疼痛病症包括糖尿病性神经性疼痛(糖尿病NP)、疱疹后神经痛(PHN)、三叉神经痛和中枢神经性疼痛(脊髓损伤(SCI)、中枢性中风后疼痛(CPSP)和多发性硬化相关疼痛)。
其它神经性疼痛病症包括与HIV感染(HIV神经病变)、创伤后或手术后神经性疼痛、慢性神经根病变、癌相关神经性疼痛、幻痛和多病原性神经性疼痛相关的神经病变。
神经病变是影响神经的功能的障碍或病理变化。如果其涉及单个神经干，其被称为单一神经病变，如果其相继涉及若干神经干，则其被称为多病灶性单一神经病变，如果涉及(弥漫性双侧)若干神经干，它被称为多发性神经病变。
外周神经病变可以是感觉的、机动的或自主的。最常见的机动临床表现是肌肉痉挛、阵挛、肌束震颤、肌肉萎缩和肌肉力量或灵巧性的丧失。
消极的感官临床表现包括痛觉减退和感觉减退。反过来，积极的感官临床表现(除了刺痛感、麻刺感或耳鸣之外)包括感觉异常、感觉迟钝、痛觉过敏(hyperpathia和hyperalgesia)和痛觉超敏。神经病变的实例包括外周多发性神经病变，其特征在于脚和指尖的烧灼感或针刺感，其由于行走、痛觉超敏、足部感觉减退和无跟腱反射而恶化；三叉神经痛，其特征在于严重的急性疼痛、在上唇和鼻子中具有持续数秒的电击样痛，其在咀嚼或刷牙时恶化，并且不伴随神经学检查的变化；腕管综合征，其特征在于在手的第一、第二和第三指和手掌表面的急性疼痛、麻刺感和降低的敏感性，其在夜间恶化，在拇指外展和屈腕试验(Phalen test)中肌肉力量减少；股外侧皮神经的单一神经病变，其特征在于对大腿侧面的烧灼和刺痛感以及皮肤过敏性的限定区域的存在；疱疹后神经痛，其特征在于在出现囊泡后在胸腔区域具有横幅状分布的灼痛(其在皮肤愈合后不会改善)，增色皮肤斑和痛觉超敏。
疼痛对个人和社会福利的影响在最近几十年有所增加。
为此，神经性疼痛被广泛地认为是治疗起来最困难的疼痛综合征之一，并且结果通常不令人满意。据估计，神经性疼痛折磨高达7-8％的欧洲普通人群(EuropeanFederation of Neurological Societies guidelines on the pharmacologicaltreatment of neuropathic pain，欧洲神经病学学会联合会神经病理性疼痛的药物治疗指南，2010)。
神经性疼痛的管理是复杂的尝试，并且通常对患者和医生而言都是令人沮丧的。作用机制为不旨在改变潜在的病理生理过程或以辅助治疗剂量给药的药物经常用于治疗疼痛，更不用说用于治疗神经性疼痛。
这源于对药物作用机制的相对不完全的理解以及目前可用的镇痛药功效有限。治疗方法在医生之间差异很大，顽固的慢性疼痛综合征需要跨学科方法和更有效的药物疗法。
镇痛药物的使用遵循逐步的方法。第一步对应轻度疼痛，应用非阿片类镇痛药(抗炎药和扑热息痛)治疗；第二步是中度疼痛，指示弱阿片类药物，在第三步中，对于严重疼痛，指示使用强阿片类药物。根据疼痛的强度，应当在适当剂量下在相应的水平开始治疗。如果疼痛持续或恶化，应优化药物剂量。
镇痛药可分为两大类：非阿片类镇痛药和阿片类镇痛药。
非阿片类镇痛药包括扑热息痛和非类固醇抗炎药(NSAIDs)。扑热息痛作用机制并不是公知的，尽管假设是中枢作用。急性或慢性的大剂量给药涉及与巯基消耗相关的肝毒性的风险。
非类固醇抗炎药通过抑制环氧酶(COX)而起作用，环氧酶(COX)抑制参与炎症过程和疼痛的前列腺素(PG)的合成。它们可以非选择性的抑制COX1和COX2，如乙酰水杨酸(AAS)、布洛芬或双氯芬酸，或选择性仅抑制COX2，如塞来考昔、罗非昔布或依托考昔。非类固醇抗炎药存在几种副作用，包括胃肠道(恶心、上腹痛、溃疡、出血)、肾脏(急性肾衰竭、间质性肾炎)、血液学(血小板抗聚集、出血)或过敏反应。非选择性的非类固醇抗炎药(NSAIDs)的这些副作用最为声名狼藉。COX2抑制剂的主要副作用是通过抑制前列环素而增加心血管病的风险。非类固醇抗炎药治疗与胃肠道不良反应的风险增加相关。
所称的弱阿片类药物包括曲马多、氢可酮和右丙氧芬等。由于这些药物在高剂量下不良反应的发生率增加，而具有最大剂量学。曲马多是可待因的合成衍生物，其通过结合阿片类药物μ受体并抑制血清素的神经元再摄取而起作用。曲马多在肝脏中代谢并进行肾清除，因此它可能需要对肾脏或肾衰竭患者减少剂量或延长给药之间的间隔。
氢可酮是可待因和右丙氧芬的合成衍生物，并且呈现与美沙酮类似的结构。轻度至中度疼痛的患者应使用与NSAID或对乙酰氨基酚相关的弱阿片类药物治疗。如果疼痛不能以治疗剂量控制，则不应考虑改用该组中的另一种药物，而应使用更有效的阿片类药物。
阿片类药物通过结合受体μ、κ和δ而起作用，并且根据它们内在活性可以分为激动剂(吗啡、芬太尼、羟考酮、氢吗啡酮、美沙酮、哌替啶)，部分激动/拮抗剂(丁丙诺啡)和激动/拮抗剂(喷他佐辛)。纯激动剂是对μ受体和其它受体施加作用的药物。部分激动剂/拮抗剂在受体上施加部分激动剂作用，并对至少一种受体施加拮抗剂作用，激动剂/拮抗剂对受体施加纯激动剂作用，并对至少一种受体施加拮抗剂作用。
阿片类药物诱导可预期的不良副作用，如果不使其最小化可能妨碍剂量滴定和患者的治疗依从性。副作用包括呼吸抑制、恶心、呕吐、便秘、尿滞留、欣快、镇静作用、瞳孔缩小、镇咳作用、低血压、心动过缓、认知的变化(幻觉、妄想观念)、痛觉过敏、肌阵挛、消化不良、皮肤瘙痒、耐受性和依赖性。
吗啡可以通过口服或肠胃外途径(皮下和静脉内)给药。静脉内给药需要特殊护理，其使用仅限于住院环境。使用对于皮下给药输注泵。
三环抗抑郁药(阿米替林、去甲替林和地昔帕明)与镇痛药联合使用，特别是与阿片类药物联合，主要用于治疗神经性疼痛。由于其抗胆碱能作用，不良反应包括便秘、口腔干燥、尿滞留和心动过速。
抗惊厥药(卡马西平，奥卡西平，苯妥英钠、丙戊酸钠、氯硝西泮、拉莫三嗪、加巴喷丁、普瑞巴林)也用于治疗疼痛，特别是神经性疼痛。卡马西平和苯妥英钠可引起肝毒性、白细胞减少症和血小板减少症，因此需要监测血药浓度。
皮质类固醇(其中地塞米松最常用于治疗疼痛)与胃肠道疾病、糖尿病、神经精神病和近端肌病的发作相关。
因此，在本领域中仍然需要找到用于治疗疼痛的新的治疗方法，不仅作为疾病的症状而且作为疾病本身。
本发明解决的问题是提供一种替代的、新的和有效的用于治疗疼痛的药剂，其单独或与其它镇痛剂组合提供对疼痛的有效治疗，同时减少副作用，同时保持所需的止痛活性。
发明详述
本发明基于如下发现：光活性化合物(S)-吡吲哚对映体显示出有利的镇痛活性，其可用于治疗和预防疼痛。
本发明的发明人惊讶地发现，光学活性的(S)-吡吲哚对映体在疼痛的动物模型中显示止痛活性，这又解释了(S)-吡吲哚对映体在对疼痛的预防和治疗处理中的意料不到的活性，特别是神经性疼痛。
此外显示出，当与(R)-吡吲哚对映体和(外消旋)-吡吲哚相比，(S)-吡吲哚对映体的镇痛作用意料不到的高。
当(S)-吡吲哚单独用作单一活性成分或与另外镇痛剂联合治疗时，(S)-吡吲哚显示为用于治疗和预防疼痛，特别是神经性疼痛的有效药剂，其中(S)-吡吲哚已被证明还能增强这些另外的镇痛作用。
因此，本发明的目的是提供(S)-吡吲哚或其药学上可接受的盐作为镇痛剂用于治疗疼痛。
本发明的另一个目的还涉及(S)-吡吲哚或其药学上可接受的盐可以单独提供，或作为一部分与至少一种另外的镇痛剂联合治疗而提供，用于治疗疼痛。
本发明的另一个目的还涉及提供药物组合物，其包含(S)-吡吲哚或其药学上可接受的盐以及可接受的载体、赋形剂和/或适当辅药，用于治疗疼痛。
本发明的另一个目的还涉及提供药物组合物，其包含(S)-吡吲哚或其药学上可接受的盐与至少一种另外的镇痛剂的组合，以及可接受的载体、赋形剂和/或适当辅药，用于治疗疼痛，其中(S)-吡吲哚或其药学上可接受的盐和其它镇痛剂皆以固定剂量或分开的剂量给药，例如同时或按顺序给药。
本发明的另一个目的还涉及(S)-吡吲哚或其药学上可接受的盐，用于与另外的镇痛药的联合治疗，用于增强这些另外的镇痛药在治疗疼痛中的作用。
本发明还提供了一种治疗需要治疗的受试者的疼痛的方法，其特征在于向受试者以单独或与至少一种另外的镇痛剂组合的方式给药有效量的(S)-吡吲哚或其药学上可接受的盐。
本发明还提供了通过增强另外的镇痛剂的效果来治疗有需要的受试者的疼痛的方法，其特征在于向受试者以与另外的镇痛剂组合的方式给药有效量的(S)-吡吲哚或其药学上可接受的盐。
附图说明
图1A示出在治疗的第2周(TW2)期间在如下治疗组中引起快速缩回反应的平均的最低力(g)：初始对照(阴性对照)、假手术对照、SNI+水(阳性对照)、SNI+(外消旋)-吡吲哚20mg/kg、SNI+(S)-吡吲哚20mg/kg和SNI+(R)-吡吲哚20mg/kg。
图1B示出在治疗的第3周(TW3)期间在如下治疗组中引起快速缩回反应的平均的最低力(g)：初始对照(阴性对照)、假手术对照、SNI+水(阳性对照)、SNI+(外消旋)-吡吲哚20mg/kg、SNI+(S)-吡吲哚20mg/kg和SNI+(R)-吡吲哚20mg/kg。
发明的详细描述
在本发明的上下文中，以下术语具有如下所述的含义：
本发明中使用的“疼痛”包括与实际或潜在损伤相关或与这种损伤有关描述的任何不愉快的感觉和情感体验。它包括：外周疼痛、中枢性疼痛和心因性疼痛，并且包括浅表性外周疼痛、深度外周疼痛、躯体深度外周疼痛、内脏深度外周疼痛，由中枢神经中枢(例如脊髓，延髓，丘脑或大脑皮层)的神经损伤引起的疼痛，以及不具有器官基质的心理性疼痛。
此外，“疼痛”包括伤害性或神经性疼痛。伤害性疼痛是由于伤害感受器的激活，由非神经组织的实际或威胁性损伤引起的疼痛，并且伤害性疼痛被分类为躯体的或内脏的。躯体疼痛是由于躯体组织(例如骨、关节、肌肉或皮肤)中的伤害感受性受体的激活。在内脏疼痛中，内脏伤害感受器由不同的病理机制(例如机械损伤、炎症、辐射、毒性剂)活化。内脏和躯体伤害性疼痛可以是急性或慢性的，并且包括癌症疼痛。
根据本发明的“神经性疼痛”可以定义为作为影响躯体感觉系统(即外周神经、背根神经节或背根，或中枢神经系统)的损伤或疾病的直接结果而产生的疼痛，并且包括关联到以下的疼痛：
-神经病变，其是影响神经的功能性病症或病理变化，例如单神经病变(如果其涉及单个神经干)，多个单神经病变(如果其连续涉及若干神经干)和多发性神经病变(如果涉及弥漫性双侧的若干神经干)。
-外周神经病变，其可以是感觉、运动或自主神经的病变。最常见的运动临床表现包括肌肉痉挛、阵挛、肌束震颤、肌肉萎缩和肌肉力量或灵巧性的丧失。
-消极感知临床表现，诸如痛觉减退和感觉减退。
-积极感知临床表现，除了刺痛感，麻刺感或耳鸣的感觉之外，例如感觉异常、感觉减退、痛觉过度、痛觉过敏和异常性疼痛。
其中神经性疼痛的实例包括：糖尿病性神经性疼痛(糖尿病性NP)、疱疹后神经痛(PHN)、三叉神经痛和中枢神经性疼痛(脊髓损伤(SCI)、中枢性中风后疼痛(CPSP)相关的疼痛，HIV感染(HIV神经病变)相关的神经病变，创伤后或手术后神经性疼痛、慢性神经根病变、癌相关神经性疼痛、幻觉痛和多病原性神经性疼痛，外周多发性神经病、其特征在于脚和指尖的灼烧和针刺感，其通过行走、痛觉超敏、足部感觉减退而恶化，并且不存在跟腱反射；三叉神经痛，其特征在于严重急性疼痛、中毒性神经病变、压迫性神经病变和创伤，其特征在于自发性刺痛、灼烧痛和电击痛，以及疼痛超敏症——包括触摸痛、针刺痛觉超敏和痛觉过敏，在上唇和鼻子中持续几秒钟的电击痛，其在咀嚼或刷牙时恶化，并且不伴随着神经学检查的变化；腕管综合征，其特征在于在手的第一、第二和第三指和手掌表面的急性疼痛、麻刺感和降低的敏感性，其在夜间恶化，在拇指外展和屈腕试验(Phalen test)中肌肉力量减少；股外侧皮神经的单一神经病变，其特征在于对大腿侧面的烧灼和刺痛感以及皮肤过敏性的限定区域的存在；疱疹后神经痛，其特征在于在出现囊泡后在胸腔区域具有横幅状分布的灼痛，囊泡在皮肤愈合后不会改善，增色皮肤斑点。
术语“另外的镇痛剂的效果的增强作用”是指以固定剂量或分开剂量，例如以同时或按顺序形式，联合给药(S)-吡吲哚和至少一种另外的镇痛剂——包括阿片类药物和麻醉剂，增强另外的镇痛剂的镇痛作用，其允许给药更低剂量的活性剂，并降低不良反应、依赖性和耐受性发生的风险。
对于本发明的目的，当通过手性色谱法或比旋光度计算的对映体纯度等于或大于97％时，其被认为是对映体纯的。
术语“药学上可接受的盐”是指在适当的药物评价范围内的那些盐，其适合用于与人组织和器官和低等动物的组织和器官接触，没有过度的毒性、刺激、过敏反应或类似的，并且与合理的利益/风险比是一致的。药学上可接受的盐在技术上是众所周知的。在本说明书中提及了在本发明的上下文中优选的盐的列表。
本文所用的术语“药学上可接受的载体、赋形剂和辅药”是指本领域技术人员已知的任何类型的固体、半固体或惰性流体赋形剂、填充剂、包封或制剂辅助材料。
吡吲哚，2,3,3a,4,5,6-六氢-8-甲基-1H-吡嗪并[3,2,1-j,k]咔唑是具有下式的四环化合物：
吡哚吲哚是一种单胺氧化酶A(MAO-A)的可逆抑制剂，迄今为止用作治疗抑郁症的药物。
吡吲哚具有不对称碳原子，但迄今为止只有外消旋物，(外消旋)-吡吲哚(对应于等量的两种对映体(R)和(S)的混合物)用于药物中。
(S)-吡吲哚对映体具有下式：
对于本发明的目的，(S)-吡吲哚对映体可以例如根据P.Chiap等人在以下文章描述的方法获得“Automated determination of pirlindole enantiomers in plasma byon-line coupling of a pre-column packed with restricted access material to achiral liquid chromatographic column”，药学和生物学期刊，27(2002)447-455。
根据该方法，可以通过R-异氰酸苯乙酯和外消旋吡吲哚衍生，制备LC分离相应的非对映体，水解和重结晶来合成(S)-吡吲哚。
本发明中提供的(S)-吡吲哚是对映体纯的。
本发明基于如下发现：光学活性的(S)-吡吲哚对映体在疼痛的动物模型中显示止痛活性，这进而解释了(S)-吡吲哚对映体在治疗和预防疼痛，特别是神经性疼痛中的意料不到的活性。
因此本发明提供了(S)-吡吲哚对映体及其药学上可接受的盐，作为替代和新的药剂用于疼痛的预防和治疗处理，更具体地是神经性疼痛，其包括与任何类型的外周神经病变相关的疼痛。
本申请的发明人已经发现，(S)-吡吲哚对映体或其药学上可接受的盐可以单独用作单独的活性成分，或作为一部分与至少一种另外的镇痛剂的联合治疗，用于治疗和预防疼痛。
(S)-吡吲哚对映体提供对疼痛的预防和治疗效果的改进，更具体地是对神经性疼痛。此外，(S)-吡吲哚与其他镇痛剂相比表现出更安全的特性。(S)-吡吲哚不呈现阿片类药物的副作用，其中尤其是相关的尿滞留、恶心和呕吐，呼吸效果(呼吸抑制)和耐受性。此外，使用(S)-吡吲哚将克服与非类固醇抗炎药(NSAID)相关的副作用，其包括肾损伤、胃肠道出血、血小板抑制、高血压和充血性心力衰竭。高龄是与NSAID给药相关的不良胃肠事件的主要风险因素。对于NSAID-诱发的上消化道出血的住院患者的死亡率约为5-10％。
事实上，当(S)-吡吲哚对映体或其药学上可接受的盐用于与另外的镇痛剂联合治疗时，这些另外的镇痛剂的镇痛效果被加强，使得需要较低剂量的活性成分以实现期望的治疗效果，从而降低对这些镇痛剂的不良反应、依赖性和耐受性发生的风险。
(S)-吡吲哚对映体或其药学上可接受的盐与至少一种另外的镇痛剂的共同给药，允许将镇痛剂的剂量与非联合治疗中所采用的剂量相比减少25-50％。
共同给药或在(S)-吡吲哚与另外的镇痛剂的联合治疗中的使用包括：(S)-吡吲哚或其药学上可接受的盐与至少一种(两种、三种、四种等)另外的镇痛剂的共同给药，其中活性成分的制剂是固定剂量(单一产品)或分开剂量的产品，其中每种活性成分被配制成以同时或按顺序形式给药的合适形式。
本发明考虑将所述产品以组合包用于联合治疗与使用说明书一起呈现。
根据本发明的在与(S)-吡吲哚或其药学上可接受的盐联合治疗中使用的另外的镇痛剂或药物包含至少一种来自以下列的化合物或药物：降低神经元兴奋性的化合物(例如卡马西平、奥卡西平、艾斯利卡西平、苯妥英钠、丙戊酸)、钙通道拮抗剂(普瑞巴林)、离子型和代谢型谷氨酸受体拮抗剂、γ-氨基丁酸活性增强剂(加巴喷丁)或μ、κ和δ阿片类药物受体激动剂、部分激动剂/拮抗剂和拮抗剂。
此外，患有疼痛或未来可能患有疼痛的患者，更具体的是与任何类型的外周神经病病相关的神经性疼痛、根据本发明可以由以固定的或分开的联合治疗的方式使用(S)-吡吲哚或其药学上可接受的盐和选自以下的至少一种化合物或药物：具有除了降低神经元过度兴奋之外的其他任何作用机制的化合物，例如对乙酰氨基酚、非类固醇消炎药(乙酰水杨酸、双氯芬酸、萘丁酮、尼美舒利、萘丁美酮、依托度酸、吡罗昔康、赖氨酸氯尼辛、二氟尼柳、阿西美辛、葡糖美辛、吲哚美辛、丙谷美辛、奥沙美辛、舒林酸、醋氯芬酸、芬替酸、酮咯酸、佐美酸、美洛昔康、替诺昔康、氯诺昔康、非诺洛芬，芬布芬(fenbufeno)、氟比洛芬、苯恶洛芬、布洛芬、酮洛芬、右酮洛芬、吡洛芬、吲哚洛芬、萘普生、奥沙普秦、噻洛芬(tiaprofen)、右旋布洛芬、甲氯芬那酸、甲芬那酸、氟芬那酸、托芬那酸、尼氟酸、依托芬那酯、阿扎丙宗、肝蛋白、非普拉宗、莫尼氟酯、替尼达普、糖胺聚糖、多硫酸、塞来昔布、罗非昔布、帕瑞昔布、伐地昔布和依托昔布)、葡萄糖胺或双醋瑞因。
本发明预期可以提供包含有效量的(S)-吡吲哚化合物或其药学上可接受的盐的组合物，其根据用于制备药学上有用的组合物的已知方法与一种或多种药学上可接受的载体组合配制成药物组合物。
这样的制剂在本领域技术人员熟知和容易获得的许多来源中详细描述。例如，由Allen、Loyd V.，Jr等人所编，第22版，Remington's The Science and Practice ofPharmacy描述了可以与本发明组合使用的制剂的制备。
本发明的药物组合物可以配制成直肠、胃肠外、脑池内、阴道内、腹膜内、局部(以粉末、软膏或滴剂的形式)、口服(以液体或固体形式)向人和其它哺乳动物给药，或以口服或鼻喷雾的形式给药。本文所用的术语“肠胃外”是指给药方式，其包括静脉内、肌内、腹膜内、胸骨内、皮下、关节内注射和输注。
用于胃肠外注射的药物组合物包括药学上可接受的无菌或非灭菌的水性或非水性溶液、分散液、悬浮液或乳液，以及用于在无菌可注射溶液或分散液中重构的粉剂。
如果需要并为了更有效的分布，本发明的化合物可以包埋在延长控制释放或定向给药系统中，例如聚合物基质、脂质体和微球体。
向个体给药的(S)-吡吲哚化合物或其药学上可接受的盐的剂量将取决于所需反应，并且可取决于待治疗的受试者、其年龄、健康、体重、治疗频率等。例如根据本发明考虑的剂量水平对于口服给药而言为0.1至10mg/kg，对于静脉内给药为0.01至10mg/kg。
(S)-吡吲哚分子具有仲胺基，其具有碱性特征，从而容易形成酸式盐，在本发明的上下文中其可以是药学上可接受的酸式盐。
代表性的药学上可接受的酸式盐包括但不限于：乙酸盐、己二酸盐、藻酸盐、柠檬酸盐、天冬氨酸盐、苯甲酸盐、苯磺酸盐、硫酸氢盐、丁酸盐、樟脑酸盐、樟脑磺酸盐、双葡糖酸盐、延胡索酸盐、甘油磷酸盐、半硫酸盐、硬脂酸庚酸盐、己酸盐、盐酸盐、氢溴酸盐、碘化氢、2-羟基乙磺酸盐(羟乙基磺酸盐)、乳酸盐、马来酸盐、甲磺酸盐、烟酸盐、2-萘磺酸盐、草酸盐、双羟基萘酸盐、果胶酸盐、过硫酸盐、3-苯基丙酸盐、苦味酸盐、新戊酸盐、丙酸盐、琥珀酸盐、酒石酸盐、硫氰酸盐、磷酸盐、谷氨酸盐、碳酸氢盐、对甲苯磺酸盐、十一酸盐和扁桃酸盐。
可以与本发明的(S)-吡吲哚化合物形成优选的药学上可接受的酸式盐的实例包括无机酸，诸如盐酸、氢溴酸、硫酸和磷酸，以及有机酸，诸如甲磺酸、柠檬酸、扁桃酸、琥珀酸和柠檬酸。
优选的药学上可接受的盐是：(S)-吡吲哚-(R)扁桃酸盐、(S)-吡吲哚甲磺酸盐和(S)-吡吲哚柠檬酸盐。
以下实施例旨在说明本发明，并且不应理解为限制本发明的范围。
实施例
实施例1：
S-吡吲哚盐酸盐的片剂
制造片剂通过直接压缩进行，并且包括混合所有组分，使它们过筛并在所需的相对大气湿度下以合适的压缩力压制而成。
定性和定量组成(所述量以总组合物的重量百分比％给出)。
S-吡吲哚盐酸盐的片剂
制备片剂通过湿法制粒随后压制进行，其包括用适当溶液将活性成分制粒、干燥并过筛，加入必要的辅药，并在所需的相对大气湿度下用合适的压制力进行压制。
定性和定量组成(量以总组合物的重量百分比％给出)。
| (S)-吡吲哚盐酸盐 | 25.00 |
| 微晶纤维素 | 15.00 |
| 乳糖一水合物 | 50.00 |
| HPMC | 4.00 |
| 粗晶交联羧甲基纤维素钠 | 5.00 |
| 硬脂酸钙 | 1.00 |
实施例2：
上述体内测定显示(S)-吡吲哚对映体在治疗疼痛中的有益效果。
为此目的，发明人选择了由Decosterd和Woolf(Pain，2000)设计的动物模型，其开发了部分去神经模型，技术上容易执行并且在所产生的损伤程度方面具有最小差异性。最重要的是，这个模型将使得在损伤的初级感觉神经元和相邻完整的感觉神经元中的变化能够直接测量，由此可以调查它们对病理生理学疼痛的相对贡献。
该模型的基本特征是看如果坐骨神经的三个末端的远端分支中的两个被轴突切断(胫骨和腓总神经)免去一个(腓肠神经)，将会发生什么；因此，该模型称为保留性神经损伤(SNI)模型。
保留性神经损伤模型已被证明是强大的，具有密切模仿临床神经性疼痛的许多特征的机械敏感性和热反应性的显着和长期的变化。
所有程序在成年(200-250g)雄性SD大鼠(Sprague-Dawley Rat)上进行。在氟烷(2％)麻醉下，切开大腿外侧表面上的皮肤，并且直接通过股二头肌暴露坐骨神经及其三个末端分支的部分：腓肠、腓总神经和胫神经。保留性神经损伤程序包括轴突切除术、胫骨结扎和留下完整腓肠神经的腓总神经。将普通的腓总神经和胫神经用5.0的丝紧绑，并在结扎处远端切除，除去2+4mm的远端神经残端。小心以避免与完整腓肠神经的任何接触或伸展。肌肉和皮肤在两层中封闭。假手术对照涉及坐骨神经及其分支的暴露，没有任何损伤。
Von Frey试验是机械敏感性试验，其由称为“Von Frey纤毛”的薄的校准的塑料细丝组成，其应用于受试动物的后爪的足底表面。细丝呈现不同硬度，用于确定引起后爪缩回的硬度。将每根细丝施用于每只大鼠两个后爪的足底表面，从硬度较小开始。用具有增加的刚度的Von Frey纤毛重复该过程，直到引起反射性和持续性的后爪缩回的那一个。这被定义为缩回阈值，以克为单位测量，并且是机械性痛觉超敏的指标。
在本实施例中，将动物分成6组(每组n＝7)：初始对照(阴性对照)、假手术对照、SNI+水(阳性对照)、SNI+(外消旋)-吡吲哚20mg/kg、SNI+(S)-吡吲哚20mg/kg、SNI+(R)-吡吲哚20mg/kg和SNI+(外消旋)-吡吲哚20mg/kg。
对各个组(假手术对照组、SNI+水(阳性对照)组、SNI+(外消旋)-吡吲哚组、SNI+(S)-吡吲哚组和SNI+(R)-吡吲哚组)施用外科手术后，将动物限制为期7周时间，目的是充分诱导机械性痛觉超敏。在接下来的3周，开始治疗，并且每天通过腹膜内(ip)途径施用水或测试物之一(外消旋-吡吲哚、S-吡吲哚和R-吡吲哚)。
用于本试验的制剂如下：
S-吡吲哚盐酸盐的腹膜内溶液
R-吡吲哚盐酸盐的腹膜内溶液
吡吲哚盐酸盐的腹膜内溶液
通过将活性成分溶于水直至完全溶解来制备(S)-吡吲哚盐酸盐、(R)-吡吲哚盐酸盐和(外消旋)-吡吲哚盐酸盐。
在治疗的第2周和第3周，测试机械性痛觉超敏。将动物置于高架线网上，用一组上升力Von Frey纤毛刺激爪的足底表面。阈值被认为是引起针对重复刺激之一的快速缩回反应的最低力量(Tal和Bennett，1994)。测试爪的脚外侧和脚内侧足底表面以及脚背表面。
引起快速缩回反应的平均的最低力(g)，对于阳性组(阳性对照组)，在第二周(wk2)结束时为0.41g，在第三周(wk3)结束时为0.14g。这些值显著低于从首次接受试验的组(阴性对照组)和假手术组获得的那些值，二者在wk2和wk3结束时，平均最低力是15g。见图1A和图1B所示。
与SNI+(R)-吡吲哚20mg/kg的活性治疗组中(腹膜内注射，在wk2和wk3时的平均最低力分别是3.08g和1.39g)相比，在SNI+(S)-吡吲哚20mg/kg的活性治疗组中(腹膜内注射)的平均最低力显著提高(在wk2和wk3时分别为4.51g和7.43g)，并且对于SNI+(外消旋)-吡吲哚20mg/kg的活性治疗组中，在wk2和wk3时的平均最低力分别是3.50g和2.08g)。参见图1A和图1B。
这些意想不到的效果支持了(S)-吡吲哚对于治疗疼痛，特别是神经性疼痛综合征的益处，此外，与(外消旋)-和(R)-吡吲哚化合物相比，(S)-吡吲哚在所述治疗中显示出意料不到的优异效果。
Claims (12)
1.(S)-吡吲哚对映体或其药学上可接受的盐用于治疗处理或预防疼痛的用途。
2.根据权利要求1所述的(S)-吡吲哚对映体或其药学上可接受的盐的用途，其特征在于所述(S)-吡吲哚是对映体纯的。
3.根据权利要求1和2所述的(S)-吡吲哚对映体或其药学上可接受的盐的用途，其用于与至少一种另外的镇痛剂的联合治疗。
4.根据权利要求3所述的(S)-吡吲哚对映体或其药学上可接受的盐的用途，其中所述联合治疗包括固定剂量的联合治疗或选自将活性剂按顺序给药或同时给药的分开的联合治疗。
5.根据权利要求3和4所述的(S)-吡吲哚对映体或其药学上可接受的盐的用途，用于增强所述至少一种另外的镇痛剂在治疗疼痛中的效果。
6.根据权利要求1至5中任一项所述的(S)-吡吲哚对映体或其药学上可接受的盐的用途，其是(S)-吡吲哚(R)-扁桃酸盐的形式。
7.根据权利要求1至5中任一项所述的(S)-吡吲哚对映体或其药学上可接受的盐的用途，其是(S)-吡吲哚甲磺酸盐的形式。
8.根据权利要求1至5中任一项所述的(S)-吡吲哚对映体或其药学上可接受的盐的用途，其是(S)-吡吲哚柠檬酸盐的形式。
9.根据权利要求3至8中任一项所述的(S)-吡吲哚对映体或其药学上可接受的盐的用途，其特征在于，所述至少一种另外的镇痛剂是降低神经元兴奋性的化合物，其选自：钠通道抑制剂(酰胺咪嗪、奥卡西平、艾司利卡西平、苯妥英、丙戊酸)、钙通道拮抗剂(普瑞巴林)、离子型和代谢型谷氨酸受体拮抗剂、γ-氨基丁酸活性增强剂(加巴喷丁)或μ、κ和δ阿片类药物受体激动剂、部分激动剂/拮抗剂或拮抗剂。
10.根据权利要求3至8所述的(S)-吡吲哚对映体或其药学上可接受的盐的用途，其特征在于，所述至少一种另外的镇痛剂选自以下的化合物：扑热息痛、非类固醇抗炎药(乙酰水杨酸、双氯芬酸、萘丁酮、尼美舒利、萘丁美酮、依托度酸、吡罗昔康、赖氨酸氯尼辛、二氟尼柳、阿西美辛、葡糖美辛、吲哚美辛、丙谷美辛、奥沙美辛、舒林酸、醋氯芬酸、芬替酸、酮咯酸、佐美酸、美洛昔康、替诺昔康、氯诺昔康、非诺洛芬，芬布芬、氟比洛芬、苯恶洛芬、布洛芬、酮洛芬、右酮洛芬、吡洛芬、吲哚洛芬、萘普生、奥沙普秦、噻洛芬、右旋布洛芬、甲氯芬那酸、甲芬那酸、氟芬那酸、托芬那酸、尼氟酸、依托芬那酯、阿扎丙宗、肝蛋白、非普拉宗、莫尼氟酯、替尼达普、糖胺聚糖、多硫酸、塞来昔布、罗非昔布、帕瑞昔布、伐地昔布和依托昔布)、葡萄糖胺或双醋瑞因。
11.根据前述权利要求中任一项所述的(S)-吡吲哚对映体或其药学上可接受的盐的用途，其中疼痛是神经性疼痛。
12.用于治疗疼痛的药物组合物，其包含根据前述权利要求中任一项所述的(S)-吡吲哚对映体或其药学上可接受的盐以及药学上可接受的载体、赋形剂或辅药。
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| PCT/PT2014/000029 WO2015171005A1 (en) | 2014-05-09 | 2014-05-09 | (s)-pirlindole or its pharmaceutically acceptable salts for use in medicine |
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| CA2948595C (en) * | 2014-05-09 | 2021-07-13 | Tecnimede Sociedade Tecnico-Medicinal S.A. | Pharmaceutically acceptable salts of pirlindole enantiomers for use in medicine |
| EP3392250A1 (en) | 2017-04-21 | 2018-10-24 | Tecnimede-Sociedade Tecnico-Medicinal, S.A. | Process for the preparation of piperazine ring for the synthesis of pyrazinocarbazole derivatives |
| EP3392251A1 (en) | 2017-04-21 | 2018-10-24 | Tecnimede-Sociedade Tecnico-Medicinal, S.A. | Process for the preparation of pirlindole enantiomers and its salts |
| MX2018011142A (es) | 2018-09-13 | 2019-10-10 | Federico Amezcua Amezcua | Combinacion farmaceutica sinergica de un inhibidor selectivo de la ciclooxigenasa 2 y un derivado de antraquinona. |
| EP3900716A1 (en) * | 2020-04-21 | 2021-10-27 | Dompe' Farmaceutici S.P.A. | Co-crystal of gabapentin, ketoprofen and lysine, pharmaceutical compositions and their medical use |
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| US20040106681A1 (en) * | 2002-10-03 | 2004-06-03 | Cypress Bioscience, Inc. | Dosage escalation and divided daily dose of anti-depressants to treat neurological disorders |
| EP1688161A1 (en) * | 2004-11-02 | 2006-08-09 | Switch Biotech Aktiengesellschaft | Use of pirlindole for the treatment of diseases which are characterized by proliferation of t-lymphocytes and/or hyperproliferation of keratinocytes in particular atopic dermatitis and psoriasis |
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| US20070043030A1 (en) * | 2003-09-15 | 2007-02-22 | Vectura Limited | Pharmaceutical compositions for treating premature ejaculation by pulmonary inhalation |
| CA2948595C (en) * | 2014-05-09 | 2021-07-13 | Tecnimede Sociedade Tecnico-Medicinal S.A. | Pharmaceutically acceptable salts of pirlindole enantiomers for use in medicine |
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| US20040106681A1 (en) * | 2002-10-03 | 2004-06-03 | Cypress Bioscience, Inc. | Dosage escalation and divided daily dose of anti-depressants to treat neurological disorders |
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