EP2773356A1 - 18-méthyl-6,7-méthylène-3-oxo-17-prégn-4-ène-21,17 -carbolactones, préparations pharmaceutiques contenant ces composés et leur utilisation dans le traitement de l'endométriose - Google Patents

18-méthyl-6,7-méthylène-3-oxo-17-prégn-4-ène-21,17 -carbolactones, préparations pharmaceutiques contenant ces composés et leur utilisation dans le traitement de l'endométriose

Info

Publication number
EP2773356A1
EP2773356A1 EP12783197.2A EP12783197A EP2773356A1 EP 2773356 A1 EP2773356 A1 EP 2773356A1 EP 12783197 A EP12783197 A EP 12783197A EP 2773356 A1 EP2773356 A1 EP 2773356A1
Authority
EP
European Patent Office
Prior art keywords
inhibitors
endometriosis
methyl
methylene
oxo
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.)
Withdrawn
Application number
EP12783197.2A
Other languages
German (de)
English (en)
Inventor
Jan HÜBNER
Rolf Bohlmann
Isabella GASHAW
Oliver Martin Dr. FISCHER
Joachim Dr. Kuhnke
Norbert Gallus
Ildiko Dr. Terebesi
Reinhard Dr. Nubbemeyer
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Bayer Pharma AG
Bayer Intellectual Property GmbH
Original Assignee
Bayer Pharma AG
Bayer Intellectual Property GmbH
Priority date (The priority date 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 date listed.)
Filing date
Publication date
Priority claimed from PCT/EP2011/069464 external-priority patent/WO2012059594A1/fr
Application filed by Bayer Pharma AG, Bayer Intellectual Property GmbH filed Critical Bayer Pharma AG
Priority to EP12783197.2A priority Critical patent/EP2773356A1/fr
Priority claimed from PCT/EP2012/071700 external-priority patent/WO2013064620A1/fr
Publication of EP2773356A1 publication Critical patent/EP2773356A1/fr
Withdrawn legal-status Critical Current

Links

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
    • A61K31/56—Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids
    • A61K31/58—Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids containing heterocyclic rings, e.g. danazol, stanozolol, pancuronium or digitogenin
    • A61K31/585—Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids containing heterocyclic rings, e.g. danazol, stanozolol, pancuronium or digitogenin containing lactone rings, e.g. oxandrolone, bufalin

Definitions

  • the present invention relates to the subject matter characterized in the claims, i. 18-methyl-6,7-methylene-3-oxo-17-pregn-4-ene-21,17 ⁇ -carbolactones (formula I), where the methylene group in position 6,7 of the steroid skeleton ⁇ or ⁇ can be constant, pharmaceutical preparations containing at least one of said isomers and their use in the therapy of endometriosis.
  • the object of the present invention is to provide novel compounds for the treatment of endometriosis, which show a better effect or side effect profile than previously available treatment therapies.
  • the compounds of the invention should be made possible by the compounds of the invention a permanent or long-term treatment of endometriosis.
  • the new therapeutic approach is intended to produce side effects such as occur when using gestagens for the treatment of endometriosis. Men, such as disorders of bleeding behavior, be avoided.
  • Endometriosis is a dislocation of endometrial tissue outside the luminal region of the uterus. These so-called endometriotic lesions either nest in the muscular area of the uterus (endometriosis interna, adenomyosis) or at various sites of the abdomen, e.g.
  • the ligaments on the parietal peritoneum of the Douglas space (peritoneal endometriosis), the intestinal wall, on the ovary (so-called endometrioma) or rectovaginal (rectovaginal, often also deeply infiltrating, endometriosis) and retain the properties of their original tissue.
  • Endometriosis is hormone dependent in all its forms and essentially shows an inflammatory character. It affects 10-20% of women of reproductive age. The disease occurs only in exceptional cases in postmenopausal women.
  • the core symptoms of endometriosis are chronic abdominal pain, dysmenorrhea, dyspareunia, dysuria, bleeding disorders and infertility. The symptoms are mostly combined. It is assumed that the lesions pass through the fallopian tube into the peritoneal space through retrograde menstruation and then settle there.
  • endometriosis can be treated by surgical removal of the endometriotic lesions in a laparoscopic procedure.
  • Endometrial implants are removed surgically with heat (electrocautery) or by excision (extirpation).
  • adhesions that may be present can be loosened, endometrial cysts can be removed, and if the child wishes, the patency of the fallopian tubes can be checked by chromopertubation. The relapse rate after such an intervention is very high (25-30%).
  • Hysterectomy ie the complete removal of the uterus, is the final therapy option in such particularly stubborn cases. In particularly severe diseases, sometimes only the removal of both ovaries and fallopian tubes (bilateral salpingo-oophorectomy, adnexectomy) brings a definite relief of symptoms.
  • the menstrual pain and prolonged or increased bleeding, which emanate from endometriosis in the uterine musculature (adenomyosis uteri) can also be successfully treated with uterine removal.
  • EP 1257280 discloses that micronized drospirenone for the treatment of endometriosis Chapron et al. Hum Reprod. 2011 Aug; 26 (8): 2028-35 suitable is. It is described in paragraph [0045] that compositions of drospirenone with a low content of estrogen or even without any estrogen are suitable inter alia for the treatment of endometriosis. This is explained by the stagnant nature of drospirenone. In EP1257280, amounts of 0.5 to 10 mg drospirenone are described as effective. Nothing is disclosed in this document about the duration of the treatment of endometriosis with drospirenone.
  • WO2008 / 107373 A1 mineralocorticoid receptor antagonists for the preparation of a medicament for the treatment of endometriosis are described.
  • compounds having a pure antimineralocorticoid action there are also proposed compounds which moreover have an action on the progesterone receptor, on the estrogen receptor, on the glucocorticoid receptor and / or on the androgen receptor.
  • the compounds spironolactone and the aforementioned drospirenone disclosed in WO2008 / 107373 A1 also have a gestagenic action.
  • the compound Eplerenone mentioned in WO2008 / 107373 A1 as pure MR antagonist shows a relatively weak in vitro potency (see Table 1). Preference is given to MR antagonists which have at least 10-fold lower IC50 in in vitro transactivation assays compared to eplerenone.
  • progestagens are also described in the treatment of endometriosis.
  • the starting point here is, on the one hand, the suppression of the function of the ovaries and, on the other hand, the induction of endometrial differentiation, the decidualization, which ultimately leads to tissue dysfunction.
  • progestins deceive the body a pregnancy and thus create a changed hormonal situation. There is no ovulation and the lining of the uterus returns. As a rule, the endometriosis complaints then decrease within 6 to 8 weeks.
  • depot MPA medroxyprogesterone acetate
  • Visanne ® dienogest
  • MPA it may come after a period of application of 6 months to reduce bone mass due to the anti-estrogenic effect of the compound. It should therefore under no circumstances be applied over a longer period than 2 years 2 .
  • progestogens may cause frequent bleeding profile irregularities, breakthrough bleeding and chest tension 3 .
  • progestogens In addition to the hormone cycle, progestogens generally also influence the bleeding profile, with bleeding disorders being a frequent side effect of gestagen. This also applies to substances that are active on other hormone receptors and at the same time have gestagenic activity, such as spironolactone.
  • Erroneous angiogenesis neovascularization, a process that takes place cyclically in the endometrium) during the decidualization of the endometrium ruptures the vascular walls and leads to the so-called breakthrough bleeding, which occurs independently of menstrual bleeding and is characteristic of chronic treatment with progestogens 4 ,
  • progesterone resistance 5 Patients with endometriosis often have so-called relative progesterone resistance 5 . It is believed that progesterone signaling may be disturbed in the endometriotic lesions, where progesterone resistance blocks complete transformation and desquamation of the endometrium. Thus, the persistence of the lesions as well as the chronic course of the disease can be favored. Therapeutic approaches whose effect does not depend on the progesterone signaling, are necessary to treat the disease permanently.
  • GnRH gonadotropin releasing hormone analogs
  • GnRH agonists induce postmenopausal symptoms such as hot flashes (80-90%), sleep disorders (60-90%), vaginal dryness (30%), headache (20-30%), mood changes (10%), and decreased bone density with concomitant increased risk of osteoporosis.
  • the normal cycle sets in after two to three months after the end of the treatment.
  • the symptoms of endometriosis also return, so that a new treatment cycle must be considered.
  • Danazol ® (d) was the first "classic" agent of endometriosis and until the 70 years of the gold standard. Danazol ® leads with prolonged use, similar to the male sex hormone testosterone, to a masculinization of women. Other side effects the effects known for androgens, such as acne, hyperandrogenism, hirsutism and (irreversible) pitch change, occur. [0026] Like the GnRH agonists, Danazol® acts on the pituitary gland, which is responsible for the production of hormones affecting the ovaries stimulate.
  • Formula I solve the tasks of the invention and are ideal for use in the treatment of endometriosis.
  • Particularly preferred is the 6ß, 7ß-methylene isomer.
  • the two isomers are mentioned for the first time in WO2012 / 059594 (FIGS. 4 and 5), which was filed on 4 November 2012 and whose priority is claimed in the present application.
  • the invention thus relates to compounds of the formula I, pharmaceutical preparations containing at least one isomer of the formula I, and their use in the Treatment of endometriosis.
  • the compounds according to the invention are distinguished by a higher potency and the absence of a gestagenic effect compared to the known mineralocorticoid receptor antagonists (eplerenone, spironolactone, drospirenone).
  • potent mineralocorticoid receptor antagonists are those compounds which have a 10-fold lower IC50 in in vitro transactivation assays compared to eplerenone.
  • Mineralocorticoid receptor antagonists without appreciable gestagenic activity are those substances which have no effect in in vitro progesterone receptor transactivation assays and / or in in vivo assays (the gestagen-sensitive pregnancy-preservation assays).
  • R -methyl with 2,2-dimethoxypropane and pyridinium p-toluenesulfonate and the spirolactone 4, for example, by the method of Sturtz 9 or alternatively established via known methods 10 .
  • the dienol ether bromination can be carried out, for example, analogously to the instructions of JA Zderic, et. al. 2 done.
  • the hydrogen bromide splitting is possible by heating the
  • 6-bromine compound with basic reagents such as lithium bromide or lithium carbonate in aprotic solvents such as dimethylformamide at temperatures of
  • the therapeutically effective dose is dependent on the body weight, application route, individual behavior, the type of preparation and the time or interval at which the application takes place.
  • a typical dose range for a woman weighing 70 kg is between 1-100 mg / day, preferably between 5 and 20 mg / day. Particularly preferred is a dose of 10 mg / day.
  • Another object of the present invention relates to pharmaceutical compositions containing at least one compound of the invention and optionally at least one or more other active ingredients, and their use for the treatment of endometriosis.
  • Suitable combination active ingredients are: selective estrogen receptor modulators (SERMs), estrogen receptor (ER) antagonists, aromatase inhibitors, 17ß-HSD1 inhibitors, steroid sulfatase (STS) inhibitors, suitable GnRH agonists (especially super agonists) and - antagonists, kisspeptin receptor (KISSR) antagonists, selective androgen receptor modulators (SARMs), 5a-reductase inhibitors, selective progesterone receptor modulators (SPRMs), progestins, antigestagens, oral contraceptives, inhibitors of mitogen-activated protein (MAP) kinases and inhibitors of the MAP kinases kinases (Mkk3 / 6, Mek1 / 2, Erk1 / 2), inhibitors of protein kinases B ( ⁇ / ⁇ / ⁇ ; Akt1 / 2/3), inhibitors of phosphoinositide-3-kinases (PI3K), inhibitors of cyclin dependent kinas
  • the compounds according to the invention can act systemically and / or locally.
  • they may be applied in a suitable manner, such as, for example, orally, parenterally, pulmonarily, nasally, sublingually, lingually, buccally, rectally, dermally, transdermally, conjunctivally topically or as an implant.
  • the compounds to be used according to the invention can be converted into suitable administration forms.
  • coated donor application forms containing the compounds of the invention in crystalline and / or amorphous and / or dissolved form such as tablets (uncoated or coated tablets, for example, with enteric or delayed dissolving or insoluble coatings, the release of the invention to be used Control compound), rapidly disintegrating tablets or films / wafers in the oral cavity, films / lyophilisates, capsules (for example hard or soft gelatin capsules), dragees, granules, pellets, powders, emulsions, suspensions, aerosols or solutions.
  • parenteral administration can be done bypassing a resorption step (eg, intravenous, intraarterial, intracardiac, intraspinal or intralumbar) or with the involvement of a resorption (eg intramuscular, subcutaneous, intracutaneous, percutaneous or intraperitoneal).
  • a resorption step eg, intravenous, intraarterial, intracardiac, intraspinal or intralumbar
  • suitable application forms include injection and infusion preparations in the form of solutions, suspensions, emulsions, lyophilisates or sterile powders.
  • Inhalation medicines including powder inhalers, nebulizers
  • nasal drops solutions or sprays
  • lingual, sublingual or buccal tablets films / wafers or capsules
  • suppositories vaginal capsules
  • aqueous suspensions such as aqueous suspensions (lotions, shake mixtures), lipophilic suspensions, ointments, Creams, transdermal therapeutic systems (eg patches), milk, pastes, foams, powdered powders or implants.
  • the compounds to be used according to the invention can be converted into the stated administration forms. This can be done in a conventional manner by mixing with inert, non-toxic, pharmaceutically suitable excipients.
  • excipients e.g., microcrystalline cellulose, lactose, mannitol
  • solvents e.g, liquid polyethylene glycols
  • emulsifiers and dispersing or wetting agents e.g., sodium dodecyl sulfate, polyoxysorbitanoleate
  • binders e.g., polyvinylpyrrolidone
  • synthetic and natural polymers e.g., albumin.
  • Stabilizers eg antioxidants such as ascorbic acid) binklare
  • dyes eg inorganic pigments such as iron oxides
  • flavor and / or odoriferous e.g., inorganic pigments such as iron oxides
  • a suspension of 22 g of 3-methoxy-18-methyl-17-pregna-3,5-diene-21,17 ⁇ -carbolactone in 220 ml of dimethylformamide was added successively at 0 ° C with 22 ml of a 10% sodium acetate solution and at this temperature with 8.84 g of 1, 3-dibromo-5,5-dimethylhydantoin added in portions, stirred for 0.5 hours at 0 ° C (ice bath), mixed with 8.25 g of lithium bromide and 7.24 g of lithium carbonate, and stirred for 5 hours at 80 ° C bath temperature.
  • the ovariectomized SCID mice were hormonally substituted with estradiol and progesterone capsules to provide an optimal hormone milieu for the primate endometrium.
  • Donor monkeys were treated with estradiol and progesterone for 7 days.
  • the endometrium of the animals was chopped and cut into 2x2x4 mm pieces.
  • the endometrium was transplanted into the abdominal cavity of the mice or implanted subcutaneously by means of a laparotomy.
  • the lesions were allowed to grow for 14 days with estradiol and progesterone treatment, followed by 14 days of estradiol treatment (corresponding to one menstrual cycle). Treatment started with daily administration of the compound of the invention over a period of 28 days.
  • Endometriosis is experimentally induced by transplantation of murine uterine fragments from a donor mouse of the same strain into the peritoneal cavity of the recipient mouse.
  • Female animals of the balb / c strain were used.
  • the mouse cycle was determined by vaginal swab. Only donor animals were used which are in the estrus. The donor animals were killed and the uterine horns were removed and then cut longitudinally. From the uteri, 2 mm biopsies were punched out with a punch, which were then sutured into the recipient animal.
  • the recipient animals were anesthetized and subjected to laparotomy. During the procedure, 6 uterine doses of a donor mouse were sutured to the parietal peritoneum of the recipient mouse. The day after this procedure, the 4-week treatment with the substances to be tested started (vehicle: Tween80 / Captex 200P). After 28 days, the animals were opened in a final laparotomy and lesion sizes determined. The lesions were photographically recorded and the area was measured using AxioVision software. 14 animals were used per treatment group.
  • test substance 6 was tested in 3 different dosing schemes and the lesion size was evaluated in comparison with the vehicle-treated animals (group A).
  • the following doses were tested: 3, 10 and 30 mg / kg / day (Groups B, C, D).
  • Figure 2/2 shows the mean lesion sizes (in mm 2 ) per animal (y-axis).
  • Example 5 In vitro / in vivo action on MR and PR
  • Table 1 shows the in vivo data on the gestagenicity of the substances.
  • the genotoxicity in vivo can be determined by means of two different assays, one using the pregnancy maintenance test in the rat and the other using the McPhails test in the rabbit (endometrial transformation).
  • the progestagens drospirenone and levonorgestrel are listed, to which data from both assays are known.
  • norethisterone is cited to illustrate, with levonorgestrel, the effect of an 18-methyl group on gestated potency.
  • MR mineralocorticoid receptor
  • the GAL4 DNA binding domain (amino acids 1-147) from the vector pFC2-dbd (Stratagene) is amplified with the PCR amplified ligand-binding domains of the mineralocorticoid receptor (MR, amino acids 734-985 ) and the progesterone receptor (PR, amino acids 680-933) in the vector plRES2 (Clontech) cloned.
  • MR mineralocorticoid receptor
  • PR progesterone receptor
  • the reporter construct containing five copies of the GAL4 binding site upstream of a thymidine kinase promoter, expresses the firefly luciferase (Photinus pyralis) after activation and binding of the GAL4 steroid hormone receptor chimeras by the specific agonists aldosterone (MR) and Progesterone (PR).
  • MR aldosterone
  • PR Progesterone
  • the MR and PR cells are plated in medium (Optimem, 2.5% FCS, 2 mM glutamine, 10 mM HEPES) in 96- (or 384- or 1536-) well microtiter plates the day before the test and in a cell incubator (96% humidity, 5% v / v CO 2 , 37 ° C).
  • medium Optimem, 2.5% FCS, 2 mM glutamine, 10 mM HEPES
  • 96- (or 384- or 1536-) well microtiter plates the day before the test and in a cell incubator (96% humidity, 5% v / v CO 2 , 37 ° C).
  • the substances to be tested are taken up in the above-mentioned medium and added to the cells.
  • the respective specific agonists of steroid hormone receptors are added.
  • the luciferase activity is measured by means of a video camera.
  • the measured relative light units result in a sigmoidal stimulation curve as a function of the substance concentration.
  • the ICso values are calculated using the computer program GraphPad PRISM (version 3.02).
  • Test for gestagenic activity in vivo pregnancy maintenance in the rat The pregnancy maintenance test represents a model in which the sensitivity of the endometrium to a progestin is very sensitively examined. Pregnancy is only continued in the presence of an effective gestagen. Pregnant rats are castrated and treated with test substance or positive control for a period of 7 days. At the end of the treatment, the number of live and dead fetuses is determined as a measure of the gestagenic, ie pregnancy-preserving, effect of the test substance. 3. Test for gestagenic activity in vivo: McPhail assay in rabbit
  • Female rabbits are ovariectomized. 7 days after ovariectomy animals receive estradiol for 6 days. The animals are treated with the test substance for 5 days, and then the uterus is dissected out and worked up histologically. As a measure of the gestagenic effect, the secretory transformation of the endometrium is evaluated (threshold dose above which a secretory transformation begins).

Abstract

La présente invention concerne des 18-méthyl-6,7-méthylène-3-oxo- 17-prégn-4-ène-21,17β-carbolactones de formule générale (I), où le groupe 6,7-méthylène peut se trouver en position α ou β, des préparations pharmaceutiques contenant au moins un isomère de formule (I), ainsi que leur utilisation dans le traitement de l'endométriose.
EP12783197.2A 2011-11-04 2012-11-02 18-méthyl-6,7-méthylène-3-oxo-17-prégn-4-ène-21,17 -carbolactones, préparations pharmaceutiques contenant ces composés et leur utilisation dans le traitement de l'endométriose Withdrawn EP2773356A1 (fr)

Priority Applications (1)

Application Number Priority Date Filing Date Title
EP12783197.2A EP2773356A1 (fr) 2011-11-04 2012-11-02 18-méthyl-6,7-méthylène-3-oxo-17-prégn-4-ène-21,17 -carbolactones, préparations pharmaceutiques contenant ces composés et leur utilisation dans le traitement de l'endométriose

Applications Claiming Priority (4)

Application Number Priority Date Filing Date Title
PCT/EP2011/069464 WO2012059594A1 (fr) 2010-11-04 2011-11-04 Antagonistes de récepteur de minéralocorticoïde pour le traitement de l'obésité induite par corticoïde
DE102012212838 2012-07-23
PCT/EP2012/071700 WO2013064620A1 (fr) 2011-11-04 2012-11-02 18-méthyl-6,7-méthylène-3-oxo-17-prégn-4-ène-21,17β-carbolactones, préparations pharmaceutiques contenant ces composés et leur utilisation dans le traitement de l'endométriose
EP12783197.2A EP2773356A1 (fr) 2011-11-04 2012-11-02 18-méthyl-6,7-méthylène-3-oxo-17-prégn-4-ène-21,17 -carbolactones, préparations pharmaceutiques contenant ces composés et leur utilisation dans le traitement de l'endométriose

Publications (1)

Publication Number Publication Date
EP2773356A1 true EP2773356A1 (fr) 2014-09-10

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Family Applications (1)

Application Number Title Priority Date Filing Date
EP12783197.2A Withdrawn EP2773356A1 (fr) 2011-11-04 2012-11-02 18-méthyl-6,7-méthylène-3-oxo-17-prégn-4-ène-21,17 -carbolactones, préparations pharmaceutiques contenant ces composés et leur utilisation dans le traitement de l'endométriose

Country Status (1)

Country Link
EP (1) EP2773356A1 (fr)

Non-Patent Citations (1)

* Cited by examiner, † Cited by third party
Title
See references of WO2013064620A1 *

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