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
  • A61P15/00—Drugs for genital or sexual disorders; Contraceptives
  • A61P15/08—Drugs for genital or sexual disorders; Contraceptives for gonadal disorders or for enhancing fertility, e.g. inducers of ovulation or of spermatogenesis
• • 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
  • A61P15/18—Feminine 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

Definitions

• R 6 and R 7 may be a hydrogen atom or together may be an ⁇ -methylene group.
• the invention thus relates to the intrauterine application of 18-methyl-15 ⁇ , 16 ⁇ -methylene-19-nor-20-spirox-4-en-3-one (compound A) or 18-methyl-6a, 7a, 15 ⁇ , 16 ⁇ -dimethylene-19-nor-20-spirox-4-en-3-one (compound B)
• Another object of the invention relates to the use of an IUS containing the substance (A) or (B) in contraception and in gynecological therapy.
• gynecological therapy e.g. the treatment of endometriosis, endometrial hyperplasia, inflammation of the endometrium (endometritis), uterine pain and dysmenorrhea, the use being excluded in the treatment of menorrhagia [also known as hypermenorrhea or heavy enstrual bleeding (HMB)] and other forms of uterine bleeding disorders ,
• Another object of the invention relates to the use of 18-ethyl-15ß, 16ß-methylene-19-nor-20-spirox-4-en-3-one (compound A) in contraception and gynecological therapy.
• 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.
• Compound B and other substances described in WO 2008/000521 are used in pharmaceutical preparations for contraception and in therapy for the treatment of premenstrual disorders, such as headache, depressive moods, water retention and astodynia.
• WO2008 / 000521 also discloses parenteral oily injection solutions.
• intrauterine use and the use of the compounds in an intrauterine system (IUS) are not described in WO 2008/000521.
• oral contraceptives are the most widely used contraceptive method in many countries. Nevertheless, hormone-containing, in particular estrogen-containing contraceptives in the public and the literature due to potential risks (such as a slightly increased risk of thrombosis,
• the basis for the contraceptive effect of Mirena ® is essentially the thickening of the cervical mucus and the local effect of Levonorgestrels, which leads to a strong antiproliferative effect on the endometrium.
• levonorgestrel alters the utero-tubal milieu and impairs sperm motility and function.
• Plasma drug levels of on average by 206 pg / ml 2 Although this value is below that of orally administered levonorgestrel-containing contraceptives, it is still so high that it inhibits ovulation in about 20% of users in the first year of application and the known systemic side effects such as acne, depressive moods, May result in chest pain or decreased libido 3 .
• Contraceptive methods e.g., hormone level measurement or temperature method
• mechanical methods e.g., condom or diaphragm
• chemical methods e.g., spermicides
• the object of the present invention is therefore to provide a contraceptive method which, with comparable high contraceptive safety, as achieved by the known hormone-based contraceptive methods, has even better tolerability.
• R 6 and R 7 is a hydrogen atom or together an ⁇ -methylene group, namely by the intrauterine application of 18-methyl-15 ⁇ , 16 ⁇ -methylene-19-nor-20-spirox-4-ene-3 or 18-methyl-6a, 7a, 15 ⁇ , 16 ⁇ -dimethylene-19-nor-20-spirox-4-en-3-one.
• 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 substances A and B are excellent for intrauterine use in gynecological therapy but especially in contraception.
• 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 may be in any proportion with the polymeric carrier material, e.g. 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 other mixtures of polymers.
• the membrane thickness is preferably in the range of 0.5 mm.
• the membrane is applied by a made of the desired polymer tube (membrane) is first brought to swell in a solvent and then pressed into the still swollen tube of drug-containing core.
• 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.
• Systems which can be used according to the invention are those which release a daily dose in the range from 1 to 500 ⁇ g of the respective active ingredient (A) or (B).
• the release rate of active ingredient (A) may be chosen half as high as that of active ingredient (B) due to its higher efficacy.
• Active ingredient (A) thus results in a preferred dose range of 1- 200 g / day, more preferably 1-100 g / day, in particular from 2-50 g / day.
• Active ingredient (B) is preferably in the range between 2-500pg / day, more preferably from 2-200pg / day, in particular from 5-100 g / day, dosed.
• Another object of the invention thus relates to an intrauterine system containing the active ingredient (A) or (B), as well as the application of the intrauterine system in the contraception.
• 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).
• a drug-loaded core was first prepared by using a mixture of polyethylene oxide block polydimethylsiloxane copolymer (PEO -b-PDMS), polydimethylsiloxane and 10 weight percent of the active ingredient (here the respective progestin A or B) using a Pt (O) -divinyltetramethyldisiloxane catalyst was vulcanized.
• PEO -b-PDMS polyethylene oxide block polydimethylsiloxane copolymer
• Pt (O) -divinyltetramethyldisiloxane catalyst was vulcanized.
• PEO-b-PDMS polydimethylsiloxane (PDMS) can be used, was used as the catalyst for vulcanization bis (2,4-dichlorobenzoyl) peroxide.
• PDMS polydimethylsiloxane
• a vertical piston unit was used with a corresponding nozzle head.
• 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 prepared in this way is subsequently treated with a membrane which consists of PDMS, polytrifluoropropylmethylsiloxanes (PTFPMS) or a PTFPMS / PDMS elastomeric mixture (75% of PTFPMS, 25% PDMS), jacketed.
• the membrane material had an inner diameter of ⁇ 1 mm and a
• the sheathing was carried out by cutting the core and the membrane to the length of 10-15 mm, the membrane being slightly longer (about 1 mm at each end) than the core, so that the ends of the membrane after 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 levels of intact control animals.
• Unwanted systemic efficacy of uterine-administered progestin can be demonstrated by a decrease in LH levels.
• the E2 applications were continued at a daily dose of 0.1 g / animal to increase the responsiveness of the uterus (preservation of progesterone). Receptor expression) to ensure progestins. On days 4, 10 and 17, blood was drawn for LH level determinations.
• progestins can be dosed with local activity so without the side effects described for levonorgestrel occur in women.
• very rapid degradation rates were also found in vitro (liver). Rapid in vitro degradation in the liver can also be implicated in rapid in vivo degradation, resulting in a very low systemic exposure of 18-methyl-15 ⁇ , 16 ⁇ -methylene-19-nor-20-spirox-4-ene 3-one and 18-methyl-6a, 7a, 15 ⁇ , 16 ⁇ -dimethylene-19-nor-20-spirox-4-en-3-one is calculated after application by an IUS.
• PC3 human prostate carcinoma
• Culture medium was RPMI medium (without L-glutamine; without phenol red) # E15-49 PAA L-glutamine 200mM # 25030-024 Gibco BRL 100U / 100g / ml penicillin
• FCS fetal calf serum
• the cultivation of the cells was carried out at 37 ° C and 5% C0 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).
• CCS activated charcoal-treated FCS
• Cells were seeded in wells of a 96 well plate ("CulturPlate" from Packard # 6005180) with 2x104 cells / well / 200 ⁇ assay medium The cells were incubated with different concentrations of the test substances and 80 ⁇ substrate with the "steadylite HTS Reporter Gene Assay System" of Measure Perkin Elmer. Results:
• 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- ⁇ -cyclodextrin (2-HPBCD) solution.

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• Health & Medical Sciences (AREA)
• Life Sciences & Earth Sciences (AREA)
• Reproductive Health (AREA)
• Veterinary Medicine (AREA)
• Chemical & Material Sciences (AREA)
• Public Health (AREA)
• Medicinal Chemistry (AREA)
• General Health & Medical Sciences (AREA)
• Animal Behavior & Ethology (AREA)
• Pharmacology & Pharmacy (AREA)
• Epidemiology (AREA)
• Gynecology & Obstetrics (AREA)
• Chemical Kinetics & Catalysis (AREA)
• Organic Chemistry (AREA)
• Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
• General Chemical & Material Sciences (AREA)
• Endocrinology (AREA)
• Bioinformatics & Cheminformatics (AREA)
• Engineering & Computer Science (AREA)
• Urology & Nephrology (AREA)
• Diabetes (AREA)
• Pregnancy & Childbirth (AREA)
• Pharmaceuticals Containing Other Organic And Inorganic Compounds (AREA)
• Steroid Compounds (AREA)
• Medicines That Contain Protein Lipid Enzymes And Other Medicines (AREA)

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• 2013
  • 2013-04-11 TW TW102112904A patent/TW201350122A/zh unknown
  • 2013-04-19 BR BR112014026193A patent/BR112014026193A2/pt not_active Application Discontinuation
  • 2013-04-19 EA EA201491922A patent/EA201491922A1/ru unknown
  • 2013-04-19 JP JP2015507482A patent/JP2015514791A/ja active Pending
  • 2013-04-19 KR KR1020147029292A patent/KR20150004807A/ko not_active Application Discontinuation
  • 2013-04-19 MX MX2014012849A patent/MX2014012849A/es unknown
  • 2013-04-19 CN CN201380021453.6A patent/CN104254333A/zh active Pending
  • 2013-04-19 SG SG11201406582XA patent/SG11201406582XA/en unknown
  • 2013-04-19 CA CA2871003A patent/CA2871003A1/en not_active Abandoned
  • 2013-04-19 US US14/396,736 patent/US20150065472A1/en not_active Abandoned
  • 2013-04-19 WO PCT/EP2013/058220 patent/WO2013160213A1/de active Application Filing
  • 2013-04-19 PE PE2014001786A patent/PE20142438A1/es not_active Application Discontinuation
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  • 2013-04-19 AU AU2013254840A patent/AU2013254840A1/en not_active Abandoned
  • 2013-04-19 EP EP13717289.6A patent/EP2841074A1/de not_active Withdrawn
  • 2013-04-23 UY UY0001034758A patent/UY34758A/es not_active Application Discontinuation
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• 2014
  • 2014-10-19 IL IL235095A patent/IL235095A0/en unknown
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• 2015
  • 2015-06-24 HK HK15105985.9A patent/HK1205000A1/xx unknown

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