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
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K9/00—Medicinal preparations characterised by special physical form
  • A61K9/0012—Galenical forms characterised by the site of application
  • A61K9/0034—Urogenital system, e.g. vagina, uterus, cervix, penis, scrotum, urethra, bladder; Personal lubricants
  • A61K9/0039—Devices retained in the uterus for a prolonged period, e.g. intrauterine devices for contraception
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P15/00—Drugs for genital or sexual disorders; Contraceptives
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P5/00—Drugs for disorders of the endocrine system
  • A61P5/24—Drugs for disorders of the endocrine system of the sex hormones
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P7/00—Drugs for disorders of the blood or the extracellular fluid
  • A61P7/04—Antihaemorrhagics; Procoagulants; Haemostatic agents; Antifibrinolytic agents

Definitions

• the present invention relates to the subject matter characterized in the claims, i. the use of 18-methyl-15 ⁇ , 16 ⁇ -methylene-19-nor-20-spirox-4-en-3-ones in the therapy of uterine bleeding disorders and an intrauterine system (IUS) for use in the indicated indication containing an 18 -Methyl-15 ⁇ , 16 ⁇ -methylene-19-nor-20-spirox-4-en-3-one of general formula I,
• R 6 and R 7 may be a hydrogen atom or together may be an ⁇ -methylene group.
• the invention thus relates to the use of 18-methyl-15 ⁇ , 16 ⁇ -methylene-19-nor-20-spirox-4-en-3-one (compound A) or 18-methyl-6a, 7a, 15 ⁇ , 16 ⁇ -dimethyl-19-nor-20-spirox-4-en-3-one (compound B)
• Another object of the invention relates to the intrauterine application of the substances (A) or (B) for the treatment of menorrhagia and an intrauterine system for said application.
• HMB Menstrual bleeding
• hypermenorrhoea understood.
• Bleeding disorders are known in different manifestations and names 1 2 . These manifestations also become uterine ones
• Uterine bleeding disorders also often occur due to myomas (fibroids).
• Another object of the invention thus relates to the intrauterine application of the substances (A) or (B) for the therapy of the fibroids themselves and the bleeding disorders caused by them.
• progestins can attenuate or prevent any uterine bleeding.
• Another object of the invention thus relates to the intrauterine application of the substances (A) or (B) for the attenuation or prevention of uterine bleeding.
• the inventively employable progestins 18-methyl-15ß, 16ß-methylene-19-nor-20-spirox-4-en-3-one (A) or 18-methyl-6a, 7a, 15ß, 16ß-dimethylene -19-nor-20-spirox-4-en-3-one (B), and their preparation, are described in WO 2008/000521, the first-mentioned compound (A) being disclosed there only as an intermediate.
• WO 2008/000521 find application in pharmaceutical preparations for contraception and in therapy for the treatment of premenstrual disorders, such as headache, depressive moods, water retention and mastodynia.
• premenstrual disorders such as headache, depressive moods, water retention and mastodynia.
• WO2008 / 000521 also discloses parenteral oily injection solutions.
• Menorrhagia is one of the menstrual disorders and refers to an excessively strong and long cycle bleeding. Heavy menstrual bleeding is said to be more than 80ml / cycle blood loss.
• Menorrhagia are among the most common in gynecological practice
• Hysterectomies 12% of them due to menorrhagia 3 .
• the drug treatment has the advantage that fertility is not affected or when using a contraceptive after discontinuation of the drug
• Mirena ® in the treatment of menorrhagia or HMB is an extremely effective form of therapy and is superior to conventional measures 5 . Otherwise a comparable effect can only be achieved with surgical methods such as endometrial ablation or resection.
• Mirena ® in the treatment of menorrhagia already a very high standard is reached, the profile of Mirena ® is not optimal in all cases.
• Side effects usually include transient symptoms such as mood swings, chest pain, fluid retention or skin problems (acne) 7 .
• HMB Menorrhagia
• Mirena * drugs therapies based on the induction of amenorrhea (Mirena *), hormonal control (oral contraceptives), inhibition of fibrinolysis (tranexamic acid) and inhibition of inflammation (non-steroidal anti-inflammatory drugs).
• Mena * amenorrhea
• hormonal control oral contraceptives
• fibrinolysis tranexamic acid
• inflammation non-steroidal anti-inflammatory drugs
• the compounds should show a rapid "onset", that is, the therapeutic effect should be faster than in the levonorgestrel-based Mirena * Already after a shorter period of application.
• the substances used should have no androgenic properties.
• R 6 and R 7 is a hydrogen atom or together an ⁇ -methylene group, is dissolved, wherein the intrauterine use is preferred.
• the substances used according to the invention have an at least 10-fold lower androgenic activity compared to LNG.
• This property compounded with the pronounced dissociation local vs. systemic, shows that no systemic androgenic effects (eg acne) are to be expected even with very high-dose local uterine applications compared to levonorgestrel, even if systemic concentrations comparable to levonorgestrel in Mirena * ' applications should occur.
• the compounds are thus excellent for use in the therapy of uterine bleeding disorders such as menorrhagia. Intrauterine administration by IUS is preferred.
• a polymer system can be used, as used for example in Mirena ® .
• the active ingredient (A) or (B) is first processed with a polymeric carrier material to a central rod (core).
• the active ingredient in any Ratio with the polymeric carrier material, such as polydimethylsiloxane (POMS) mixed.
• POMS polydimethylsiloxane
• Vulcanization is usually surrounded in a second step by a membrane based on a polymer that ensures a uniform dosage over a long period of time.
• the desired release rate (“release rate”) can be controlled by selecting the polymer and the thickness of the membrane.
• the polymer used for the membrane are in principle the same polymers as for the core (the central rod) in question. To mention here are e.g.
• Polydimethylsiloxane which may optionally be fluorinated or mixtures of different polymers.
• the membrane thickness is preferably in the range of 0.5 mm.
• the membrane is applied by a tube made of the desired polymer (membrane) is first brought to swell in a solvent and then pressed into the still swollen tube of drug-containing core.
• a tube made of the desired polymer membrane
• the tube ends are then still closed with a plug, which preferably consists of the same material as the tube / membrane, in order to counteract "bleeding" of the active substance at the tube ends, which can lead to a "burst effect" in the application ,
• the tube can also be glued with silicone.
• According to the invention can be used rods that release a daily dose in the range of 1-500 pg of the respective active ingredient (A) or (B).
• the release rate of active ingredient (A) can be chosen half as high as that of active ingredient (B) due to its higher effectiveness.
• Active ingredient (A) thus results in a preferred dose range of 1 - 200pg / day, more preferably is the range of 1-100pg and in particular the range of 2-50pg / day.
• Active substance (B) is preferably metered in the range between 2 and 500 ⁇ g / day, more preferably the range between 2 and 200 ⁇ g and in particular the range of 5 to 100 ⁇ g / day.
• the rat experiment described below was carried out analogously to the preparation of the drug reservoirs, as described, for example, for a human-suitable IUS (see, for example, EP 0 652 738 B1).
• polysiloxanes and modified polysiloxane polymers can be used (for example, see EP 0652738 B1, WO 00/29464 and WO 00/00550).
• an active agent loaded core was first prepared by using a mixture of polyethylene oxide block polydimethylsiloxane copolymer (PEO -b-PDMS), polydimethylsiloxane and 10% by weight of the active ingredient (here the respective progestin A or B) using of a Pt (O) -divinyltetramethyldisiloxane
• Catalyst was vulcanized.
• PEO-b-PDMS and polydimethylsiloxane (POMS) can be used, in which case was used as the catalyst for the vulcanization bis (2.4-dichlorobenzoyl) peroxide.
• a vertical piston unit with a corresponding nozzle head was used to produce the active substance-containing core.
• the nozzle head was dimensioned so that the active substance-containing core has an outer diameter of about 1 mm.
• the active ingredient-containing core thus prepared is then coated with a membrane consisting of POMS, polytrifluoropropylmethylsiloxane (PTFPMS) or a PTFPMS / PDMS elastomeric mixture (75% of PTFMPS, 25% POMS).
• PTFPMS polytrifluoropropylmethylsiloxane
• PDMS elastomeric mixture 75% of PTFMPS, 25% POMS.
• the sheathing was carried out by cutting the core and the membrane to the length of 0-5 mm, the membrane being slightly longer (about 1 mm at each end) than the core, thus following the ends of the membrane the insertion of the core can be closed with a small stopper.
• the core In order to allow the introduction of the core into the membrane, it was first swelled in a cyclohexane or acetone-hexane mixture. In the swollen membrane then the active substance-containing core was inserted.
• the ends of the tubes are either glued with silicone or closed with a small stopper made of PTFPMS.
• Serum levels of luteinizing hormone (LH) serve to detect systemic effects of locally applied progestin.
• Basal serum LH levels of ovariectomized rats are elevated compared to LH levels in intact control animals.
• Unwanted systemic efficacy of uterine-administered progestin can be demonstrated by lowering the LH level.
• the uterine tissue was homogenized in 800 ⁇ L RLT lysis buffer (Qiagen, Hilden, Germany, # 79216) using the Precellys24 homogenizer (Peqlab, Er Weg, Germany; 2.8mm ceramic beads; # 91-PCS-CK28, 2x 6000rpm). 400 ⁇ of the homogenate obtained were used for the isolation of the total RNA. For this, the QIAsymphony RNA kit (Qiagen, # 931636) was used
• progestins can be dosed with local activity so without the side effects described for levonorgestrel occur in women.
• PC3 human prostate carcinoma
• Culture medium was RPMI medium (without L-glutamine; without phenol red) #E 15-49 PAA L-glutamine 200mM # 25030-024 Gibco BRL 100U / 100pg / ml penicillin / Streptomycin Gibco # 15140-122 used with 10% fetal calf serum (FCS).
• FCS fetal calf serum
• the cultivation of the cells was carried out at 37 ° C and 5% CO 2 .
• the test medium was the same as the culture medium except that the 10% FCS was replaced by 5% activated charcoal-treated FCS (CCS).
• Drug levels should occur as they are observed for levonorgestrel in Mirena ® applications.
• the amount of active ingredient (A) or (B) released was determined by reversed-phase liquid chromatography with UV detection in a 1% 2-hydroxypropyl- ⁇ -cyclodextn (2-HPBCD) solution.

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• Health & Medical Sciences (AREA)
• Pharmacology & Pharmacy (AREA)
• Veterinary Medicine (AREA)
• Public Health (AREA)
• Chemical & Material Sciences (AREA)
• General Health & Medical Sciences (AREA)
• Animal Behavior & Ethology (AREA)
• Medicinal Chemistry (AREA)
• Life Sciences & Earth Sciences (AREA)
• Reproductive Health (AREA)
• Epidemiology (AREA)
• Engineering & Computer Science (AREA)
• Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
• General Chemical & Material Sciences (AREA)
• Chemical Kinetics & Catalysis (AREA)
• Organic Chemistry (AREA)
• Bioinformatics & Cheminformatics (AREA)
• Gynecology & Obstetrics (AREA)
• Urology & Nephrology (AREA)
• Diabetes (AREA)
• Endocrinology (AREA)
• Hematology (AREA)
• Pharmaceuticals Containing Other Organic And Inorganic Compounds (AREA)
• Steroid Compounds (AREA)
• Acyclic And Carbocyclic Compounds In Medicinal Compositions (AREA)
• Indole Compounds (AREA)
• Medicinal Preparation (AREA)
• Plural Heterocyclic Compounds (AREA)

Applications Claiming Priority (2)

Publications (1)

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• 2013
  • 2013-04-19 SG SG11201406583QA patent/SG11201406583QA/en unknown
  • 2013-04-19 EP EP13717280.5A patent/EP2841073A1/de not_active Withdrawn
  • 2013-04-19 KR KR20147029290A patent/KR20150005548A/ko not_active Application Discontinuation
  • 2013-04-19 MA MA37443A patent/MA37443A1/fr unknown
  • 2013-04-19 CN CN201380021631.5A patent/CN104379149A/zh active Pending
  • 2013-04-19 AU AU2013251842A patent/AU2013251842A1/en not_active Abandoned
  • 2013-04-19 US US14/396,742 patent/US20150119372A1/en not_active Abandoned
  • 2013-04-19 CA CA 2871001 patent/CA2871001A1/en not_active Abandoned
  • 2013-04-19 WO PCT/EP2013/058152 patent/WO2013160200A1/de active Application Filing
  • 2013-04-19 BR BR112014026086A patent/BR112014026086A2/pt not_active IP Right Cessation
  • 2013-04-19 EA EA201491917A patent/EA201491917A1/ru unknown
  • 2013-04-19 PE PE2014001785A patent/PE20142437A1/es not_active Application Discontinuation
  • 2013-04-19 MX MX2014012848A patent/MX2014012848A/es unknown
  • 2013-04-19 JP JP2015507478A patent/JP2015514789A/ja active Pending
  • 2013-04-23 AR ARP130101342 patent/AR090800A1/es unknown
  • 2013-04-23 TW TW102114450A patent/TW201345530A/zh unknown
  • 2013-04-23 UY UY34759A patent/UY34759A/es not_active Application Discontinuation
• 2014
  • 2014-10-19 IL IL235096A patent/IL235096A0/en unknown
  • 2014-10-22 PH PH12014502371A patent/PH12014502371A1/en unknown
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• 2015
  • 2015-07-22 HK HK15106972.2A patent/HK1206271A1/zh unknown

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