Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/13—Amines
  • A61K31/135—Amines having aromatic rings, e.g. ketamine, nortriptyline
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
  • A61K31/44—Non condensed pyridines; Hydrogenated derivatives thereof
  • A61K31/445—Non condensed piperidines, e.g. piperocaine
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/535—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with at least one nitrogen and one oxygen as the ring hetero atoms, e.g. 1,2-oxazines
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/557—Eicosanoids, e.g. leukotrienes or prostaglandins
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P27/00—Drugs for disorders of the senses
  • A61P27/02—Ophthalmic agents
  • A61P27/06—Antiglaucoma agents or miotics

Definitions

• the present invention relates generally to the field of ophthalmology.
• the invention relates to the treatment of glaucoma using a combination of a glutamate antagonist to preserve visual field and an intraocular pressure lowering compound.
• IOP intraocular pressure
• glaucoma has historically been treated by medically and /or surgically lowering elevated IOP, for example, by the administration of IOP-lowering agents such as miotics, ⁇ and ⁇ / ⁇ adrenergic agonists, beta-blockers, and carbonic anhydrase inhibitors.
• IOP-lowering agents such as miotics, ⁇ and ⁇ / ⁇ adrenergic agonists, beta-blockers, and carbonic anhydrase inhibitors.
• factors other than IOP may play a role in the occurrence of visual field loss.
• Degeneration of retinal ganglion cells may be related to ischemia or mechanical distortion of the nerve fibers as they exit through the optic nerve head or from pathological perturbations of the retina.
• Retinal dysfunction may be related to ischemia or excitotoxicity.
• Excitotoxicity is neuronal injury due to excessive excitatory amino acid
• EAA EAA stimulation.
• glutamate is the major EAA that permits the bipolar and amacrine cells to communicate with the ganglion cell.
• excitotoxicity results from hypoxia, ischemia, hypoglycemia or trauma. (See, for example, Beal, M.F., “Mechanisms of excitotoxicity in neurologic diseases,” FASEB J.. 6:3338-3344 (1992); and Choi, D.W., "Excitotoxic cell death,” J. Neurobiol.. 23: 1261-1276 (1992).)
• Toxicity to the inner retina has been observed following intravitreal injection of EAAs following application of EAAs to the isolated animal retina or from exogenously applied glutamate to retinal ganglion cells in culture. See generally, Sattayasai, et al., "Morphology of quisqualate-induced neurotoxicity in the chicken retina," Invest. Ophthalmol. Vis. Sci.. 28:106-117 (1987); Tung et al., "A quantitative analysis of the effects of excitatory neurotoxins on retinal ganglion cells in the chick, Visual Neurosci..
• EAA receptors have been characterized as metabotropic or ionotropic. Activation of a metabotropic receptor affects cellular processes via G-proteins; whereas ionotropic receptors affect the translocation of mono- and divalent cations across the cell membrane. There are at least three ionotropic receptors that have been named for the agonist that preferentially stimulates the receptor. These receptors have been classified as: N-methyl-D-aspartate (NMDA); kainate; and AMPA (2-amino-3-(3-hydroxy-5-methylisoxazol-4-yl) propanoic acid). These EAA receptors are differentially distributed to specific cells in the retina.
• NMDA N-methyl-D-aspartate
• AMPA 2-amino-3-(3-hydroxy-5-methylisoxazol-4-yl) propanoic acid
• antagonists of the NMDA receptor are neuroprotective; however, not all antagonists of the diversely distributed EAA receptors are neuroprotective to the inner retina through antagonism of the NMDA receptor, Zeevalk et al., "Action of the anti-ischemic agent ifenprodil on N-methyl-D-aspartate and kainate-mediated excitotoxicity," Brain Res., 522:135-139 (1990)), and many of these EAA antagonists have significant CNS side-effects and are therefore not suitable for treating these degenerative diseases of the eye.
• the present invention is directed to the use of a glutamate antagonist and an IOP controlling agent, dosed separately or in combination for the treatment of persons suffering from glaucoma or ocular hypertension.
• the present invention involves the use of two types of agents to treat glaucoma and ocular hypertension.
• One agent is an IOP-lowering agent directed at preventing the damage to retinal ganglion cells brought on by mechanical, circulatory, and other poorly understood factors related to elevated IOP.
• the second agent is a glutamate antagonist used to prevent further damage to ganglion cells and optic nerve fibers from excitotoxicity.
• glutamate antagonist means an antagonist of the NMDA receptor channel complex.
• NMDA receptor antagonists include channel blockers (agents that operate uncompetitively to block the NMDA receptor channel); receptor antagonists (agents that compete with NMDA or glutamate at the NMDA binding site); and agents acting at the glycine coagonist site or any of several modulation sites (e.g., zinc, magnesium, redox, or polyamine sites).
• R 5 H, halogen, trifluoromethyl, Cl-4 alkyl, OH, Cl-4 alkoxy, benzyloxy, Cl-16 alkanoyloxy, benzoyloxy.
• WAY- 126251 (see Drug News Perspect 11(9), November 1998), memantine, and other compounds disclosed in WO 94/13275 to the extent they are suitable for chronic administration.
• At least one of the compounds of this invention are administered orally with daily dosage of these compounds ranging between 0.01 and 500 milligrams.
• the preferred total daily dose ranges between 1 and 100 milligrams.
• Non-oral administration such as, intravitreal, topical ocular, transdermal patch, parenteral, intraocular injection, or subconjunctival routes may require an adjustment of the total daily dose necessary to provide a therapeutically effect amount of the compound.
• the compounds can be inco ⁇ orated into various types of ophthalmic formulations for topical delivery to the eye. They may be combined with ophthalmologically acceptable preservatives, surfactants, viscosity enhancers, penetration enhancers, buffers, sodium chloride, and water to form aqueous, sterile ophthalmic suspensions or solutions.
• Ophthalmic solution formulations may be prepared by dissolving the compound in a physiologically acceptable isotonic aqueous buffer. Further, the ophthalmic solution may include an ophthalmologically acceptable surfactant to assist in dissolving the compound.
• the ophthalmic solutions may contain a thickener, such as, hydroxymethylcellulose, hydroxyethylcellulose, hydroxypropylmethylcellulose, methylcellulose, polyvinyl- pyrrolidone, or the like, to improve the retention of the formulation in the conjunctival sac.
• a thickener such as, hydroxymethylcellulose, hydroxyethylcellulose, hydroxypropylmethylcellulose, methylcellulose, polyvinyl- pyrrolidone, or the like, to improve the retention of the formulation in the conjunctival sac.
• the active ingredient is combined with a preservative in an appropriate vehicle, such as, mineral oil, liquid lanolin, or white petrolatum.
• Sterile ophthalmic gel formulations may be prepared by suspending the active ingredient in a hydrophilic base prepared from the combination of, for example, carbopol-940, or the like, according to the published formulations for analogous ophthalmic preparations; preservatives and tonicity agents can be inco ⁇ orated.
• the compounds are preferably formulated as topical ophthalmic suspensions or solutions, with a pH of about 4 to 8.
• the compounds will normally be contained in these formulations in an amount .001% to 5% by weight, but preferably in an amount of .01% to 2% by weight.
• 1 to 2 drops of these formulations would be delivered to the surface of the eye 1 to 4 times per day according to the routine discretion of a skilled clinician.
• the preferred compound, eliprodil is orally bioavailable, demonstrates a low incidence of adverse effects upon administration, and effectively crosses the blood-brain barrier (Drugs of the Future, 1994, 19, 905-909) indicating that effective concentrations are expected in the target tissue, the retina.
• the compound is described in U.S. Patent No. 4,690,931 , the contents of which are inco ⁇ orated herein by reference.
• the IOP-lowering agents useful in the present invention include all presently known IOP-lowering pharmaceuticals, including, but not limited to, miotics (e.g., piloca ⁇ ine, carbachol, and acetylcholinesterase inhibitors); ⁇ and ⁇ / ⁇ adrenergic agonists (e.g., epinephrine, dipivalylepinephrine, para-amino clonidine and brimonidine); beta-blockers (e.g., betaxolol, S-betaxolol, levobunolol, carteolol, and timolol); prostaglandins and their analogues and derivatives, such as, compounds disclosed in U.S.
• miotics e.g., piloca ⁇ ine, carbachol, and acetylcholinesterase inhibitors
• ⁇ and ⁇ / ⁇ adrenergic agonists e.g., epinephrine
• carbonic anhydrase inhibitors e.g., acetazolamide, methazolamide, and ethoxzolamide, and compounds disclosed in U.S. Patent Nos. 5,153,192; 5,240,923; 5,378,703; and 4,797,41
• the preferred IOP-lowering agents are: timolol, betaxolol, S-betaxolol levobunolol, carteolol, piloca ⁇ ine, carbachol, epinephrine, dipivalyl epinephrine- ⁇ methyl dipivalylepinephrine, brinzolamide, dorzolamide, unoprostone, latanoprost, travoprost, apraclonidine, and brimonidine.
• IOP-lowering agents will be administered systemically, or if in a topical formulation, at a concentration of between 0.001 and 5.0 wt%, preferably, 0.01 to 2.5 wt%, but preferably 0.001 - 0.005 for prostaglandins.
• the IOP-lowering compositions of the present invention may additionally include components to provide sustained release and/or comfort.
• Such components include high molecular weight, anionic mucomimetic polymers, gelling polysaccharides and finely-divided drug carrier substrates. These components are discussed in greater detail in U.S. Patent Nos. 4,911,920; 5,403,841; 5,212,162; and 4,861,760. The entire contents of these patents are inco ⁇ orated herein by reference.
• the IOP-lowering compositions of the present invention may further comprise various formulatory ingredients, such as antimicrobial preservatives and tonicity agents.
• antimicrobial preservatives include: benzalkonium chloride, thimerosal, chlorobutanol, methyl paraben, propyl paraben, phenylethyl alcohol, edetate disodium, sorbic acid, Polyquad ® and other agents equally well-known to those skilled in the art.
• Such preservatives, if utilized, will typically be employed in an amount between about 0.001 and about 1.0 wt%.
• agents which may be used to adjust the tonicity or osmolality of the formulations include: sodium chloride, potassium chloride, mannitol, dextrose, glycerin, and propylene glycol. Such agents, if utilized, will typically be employed in an amount between about 0.1 and about 10.0 wt%.
• compositions may be formulated in various dosage forms suitable for topical ophthalmic delivery, including solutions, suspensions, emulsions, gels, and erodible solid ocular inserts.
• the compositions are preferably aqueous suspensions or solutions.
• compositions of the present invention may also comprise non-aqueous formulations such as: substantially non-aqueous liquids substantially non-aqueous semi-solid compositions and solid compositions or devices.
• the first class, substantially non-aqueous liquids comprise an IOP-lowering agent and a second agent ("drug combination") dissolved or suspended in one or more of the following: vegetable and mineral oils, such as, liquid petrolatum, corn oil, castor oil, sesame oil, and peanut oil; triglycerides, such as the capric/caprylic triglycerides commonly used in foods and cosmetics; liquid lanolin and lanolin derivatives; and perfluorohydrocarbons.
• vegetable and mineral oils such as, liquid petrolatum, corn oil, castor oil, sesame oil, and peanut oil
• triglycerides such as the capric/caprylic triglycerides commonly used in foods and cosmetics
• liquid lanolin and lanolin derivatives such as the capric/caprylic triglycerides commonly used in foods and cosmetics
• perfluorohydrocarbons such as the capric/caprylic triglycerides commonly used in foods and cosmetics.
• the second class, semi-solid compositions comprise an IOP-lowering agent dissolved or suspended in one or more of the following: various types of petrolatum, such as white, yellow, red and so on; lanolin and lanolin derivatives; gelled mineral oil having a hydrocarbon base, such as Plastibase®; petrolatum and ethylene carbonate mixtures; petrolatum in combination with surfactants and polyglycol, such as polyoxyl 40 stearate and polyethylene glycol.
• various types of petrolatum such as white, yellow, red and so on
• lanolin and lanolin derivatives such as gelled mineral oil having a hydrocarbon base, such as Plastibase®
• petrolatum and ethylene carbonate mixtures such as polyoxyl 40 stearate and polyethylene glycol.
• the third class, solid compositions or devices include non-erodible devices which are inserted into the conjunctival sac of the eye and later removed, such as the Alza-type diffusion or osmotic pressure controlled polymer membranes; and bioerodible polymers which do not have to be removed from the conjunctival sac, such as essentially anhydrous but water soluble polymers and resins (e.g., celluloses, polycarboxylic acids, and so on).
• non-erodible devices which are inserted into the conjunctival sac of the eye and later removed, such as the Alza-type diffusion or osmotic pressure controlled polymer membranes; and bioerodible polymers which do not have to be removed from the conjunctival sac, such as essentially anhydrous but water soluble polymers and resins (e.g., celluloses, polycarboxylic acids, and so on).
• bioerodible inserts described and detailed in US 4,540,408 (Lloyd) and US 4,730,013 (Bondi et al.), wherein drug combinations of the present invention would be entrained in a non-aqueous matrix consisting essentially of polyvinyl alcohol.
• US 4,540,408 Lioyd
• US 4,730,013 Bodi et al.
• the present invention is also directed to methods of treating persons with glaucoma or ocular hypertension.
• At least one glutamate antagonist will be administered systemically and at least one IOP-lowering composition described above is applied topically to the affected eye(s) of the patient.
• the frequency and amount of dosage will be determined by the clinician based on various clinical factors.
• the methods will typically comprise topical application of one or two drops (or an equivalent amount of a solid or semi-solid dosage form) to the affected eye one to four times per day.

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• 1999
  • 1999-03-12 EP EP99912458A patent/EP1169061A1/en not_active Withdrawn
  • 1999-03-12 AU AU30829/99A patent/AU3082999A/en not_active Abandoned
  • 1999-03-12 WO PCT/US1999/005423 patent/WO2000054810A1/en active Application Filing
  • 1999-03-12 CA CA002368242A patent/CA2368242A1/en not_active Abandoned
• 2002
  • 2002-02-19 HK HK02101195.9A patent/HK1040184A1/zh unknown

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