EP3082818A1 - Verwendung von par-1-antagonisten zur prävention und/oder behandlung von pelvi-perinealen funktionellen pathologischen störungen - Google Patents

Verwendung von par-1-antagonisten zur prävention und/oder behandlung von pelvi-perinealen funktionellen pathologischen störungen

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Publication number
EP3082818A1
EP3082818A1 EP14793086.1A EP14793086A EP3082818A1 EP 3082818 A1 EP3082818 A1 EP 3082818A1 EP 14793086 A EP14793086 A EP 14793086A EP 3082818 A1 EP3082818 A1 EP 3082818A1
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EP
European Patent Office
Prior art keywords
bladder
patients
syndrome
pain
pharmaceutically acceptable
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Withdrawn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
EP14793086.1A
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English (en)
French (fr)
Inventor
Bruno Le Grand
Didier Junquero
Nicolas MONJOTIN
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Pierre Fabre Medicament SA
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Pierre Fabre Medicament SA
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Publication date
Application filed by Pierre Fabre Medicament SA filed Critical Pierre Fabre Medicament SA
Publication of EP3082818A1 publication Critical patent/EP3082818A1/de
Withdrawn legal-status Critical Current

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    • 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
    • A61K31/5375—1,4-Oxazines, e.g. morpholine
    • A61K31/5377—1,4-Oxazines, e.g. morpholine not condensed and containing further heterocyclic rings, e.g. timolol
    • 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
    • A61K31/335—Heterocyclic compounds having oxygen as the only ring hetero atom, e.g. fungichromin
    • A61K31/34—Heterocyclic compounds having oxygen as the only ring hetero atom, e.g. fungichromin having five-membered rings with one oxygen as the only ring hetero atom, e.g. isosorbide
    • A61K31/343—Heterocyclic compounds having oxygen as the only ring hetero atom, e.g. fungichromin having five-membered rings with one oxygen as the only ring hetero atom, e.g. isosorbide condensed with a carbocyclic ring, e.g. coumaran, bufuralol, befunolol, clobenfurol, amiodarone
    • 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
    • A61K31/4353—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 ortho- or peri-condensed with heterocyclic ring systems
    • A61K31/4355—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 ortho- or peri-condensed with heterocyclic ring systems the heterocyclic ring system containing a five-membered ring having oxygen as a ring hetero atom
    • 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
    • A61K31/4427—Non condensed pyridines; Hydrogenated derivatives thereof containing further heterocyclic ring systems
    • A61K31/443—Non condensed pyridines; Hydrogenated derivatives thereof containing further heterocyclic ring systems containing a five-membered ring with oxygen as a ring hetero atom
    • 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
    • A61K31/33—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
    • A61K31/496—Non-condensed piperazines containing further heterocyclic rings, e.g. rifampin, thiothixene or sparfloxacin
    • 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
    • A61K31/4965—Non-condensed pyrazines
    • A61K31/497—Non-condensed pyrazines containing further heterocyclic rings
    • 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
    • A61K31/505—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim
    • A61K31/506—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim not condensed and containing further heterocyclic rings
    • 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
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P13/00—Drugs for disorders of the urinary system
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P13/00—Drugs for disorders of the urinary system
    • A61P13/10—Drugs for disorders of the urinary system of the bladder
    • 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
    • A61P15/12—Drugs for genital or sexual disorders; Contraceptives for climacteric disorders

Definitions

  • the invention relates to PAR-1 antagonists and more particularly to vorapaxar, atopaxar and 3- (2-chlorophenyl) -1- [4- (4-fluoro-benzyl) -piperazin-1-yl] propenone or a pharmaceutically acceptable salt for use in the prevention and / or treatment of pelvic-perineal functional pathologies.
  • Pelvic-perineal functional pathologies include various pathologies affecting the pelvi-perineal region excluding cancerous lesions and all known infectious, metabolic or endocrine pathologies.
  • One of the pelvic-perineal functional pathologies is represented by the vesical pain syndrome, also called interstitial cystitis, which is defined as being, in the absence of proven urinary infection or other objective pathologies, a chronic pelvic pain, evolving for more than six months, sometimes felt as a sensation of pressure or perceived discomfort in relation to the bladder and accompanied by at least one urinary symptom: persistent urge to urinate or pollakiuria.
  • a nocturia very often accompanies this painful bladder syndrome.
  • Pollakiuria is defined by an abnormally high frequency of urination, beyond eight urination over a 24-hour period.
  • Nocturia is defined as a need to urinate waking the patient one or more times during the night.
  • the diagnosis of vesical pain syndrome or interstitial cystitis is based on interrogation and the achievement of a mictional schedule.
  • the clinical examination must have eliminated all other causes of bladder pain, the diagnosis of Bladder Syndrome being a diagnosis of exclusion.
  • suspicion of vesical pain syndrome the realization of a cystoscopy under General or regional anesthesia is the key examination for balance sheet and diagnosis. Classically this examination can highlight glomeruli of the bladder mucosa with or without Hunner lesions.
  • cystoscopy can sometimes be normal at the initial stage and with no Hunner lesions.
  • it makes it possible to perform bladder biopsies and bladder hydrodistension.
  • Hydrodistension consists of a dilation of the bladder with water performed under anesthesia.
  • Other complementary examinations, imaging, urodynamic assessment, biology, cytology are not essential for the diagnosis but are useful for the differential diagnosis because the syndrome of interstitial cystitis remains a diagnosis of exclusion.
  • the bladder mucosa is covered by a layer of mucin which is composed of numerous glycosaminoglycans and glycoproteins. These glycosaminoglycans have the characteristic of having a negative charge enabling them to form an impermeable hydrophobic barrier.
  • This mucinous layer thus prevents urine from entering the urothelium. In patients with vesical pain syndrome, this layer is defective and the urothelium is abnormally permeable. As a result, potentially toxic substances in the urine penetrate the muscular layer of the bladder wall and depolarize the sensory nerves resulting in the symptoms of bladder pain syndrome.
  • mast cells have been found in the bladder wall in 30 to 65% of patients with bladder syndrome. Mast cells contain cytoplasmic granules containing substances such as histamine, leukotrienes, prostaglandins and tryptases. All these substances intervene in the inflammatory reaction. In vesical pain syndrome, edema, fibrosis and neovascularization may be due to the release of these mediators carried by the mast cells. Activation of mast cells is dependent on substance P and electron microscopy studies have shown an increase in substance P-rich nerve endings in contact with mast cells. Overall, there appears to be an important role of these mast cells in bladder pain syndrome. If the exact primary or secondary role of mast cells in the etiology of bladder pain syndrome remains debated to date, much research is focused on understanding the activation of these cells and their responsibility in symptomatology.
  • the neuronal mechanism is the process by which the nerves manage to secrete local mediators of inflammation.
  • the existence of a local neurogenic inflammation could be at the origin of a cascade of chain reactions.
  • This mechanism is described in bladder pain syndrome as well as in other pain syndromes, such as fibromyalgia, irritable bowel syndrome.
  • the major component of this mechanism is substance P. This theory is based on the presence of a large concentration of substance P and a large number of nerve fibers containing substance P in the bladder wall of patients with of bladder pain syndrome. Interestingly, it has been shown that the urinary concentration of substance P is proportional to the degree of pain.
  • the symptomatology of the bladder syndrome is rich and above all marked by the painful symptomatology, the topography of the pain is suprapubic bladder with irradiation to the urethra but can also affect the vagina, perineum, rectum, pelvis, sacrum .... Pain is described as burning, tugging, pressure or discomfort. It is more or less triggered by bladder filling and sometimes calmed by urination. Patients are woken up at night with pain and need to urinate. The pains often evolve by crisis with periods of several days very painful and periods where the pain is more bearable but still present.
  • the constant urinary symptom is the persistent and strong urge to urinate. It can be associated with diurnal and nocturnal pollakiuria. Urodynamic imperfections or urgencies may be present, but they mostly meet and it is a diagnosis that must be eliminated during overactive bladder in which the urgencies are not painful. Often, patients with vesical pain syndrome do not complain of a real urgency but rather of a permanent urge of desire ranging from simple discomfort to a real pain that is relieved by urination. This relief by urination explains the willingness of these patients to empty their bladder which leads to confusion with urge. If the need can not be relieved, discomfort or pain generally increases without urinary leakage, which may be the case for urge. This is true for the majority of patients with bladder syndrome, but it is possible to have a bladder syndrome and associated urge, which complicates the diagnosis.
  • the clinical syndrome of overactive bladder can have several origins: a neurological origin (spinal cord injury, Parkinson's disease, multiple sclerosis ...), a psycho-behavioral origin or be idiopathic and enter into the nosological framework of pelvic functional pathologies. perineal.
  • the clinical syndrome of overactive bladder may or may not be accompanied by uninhibited contractions of the detrusor muscle, which is the bladder muscle.
  • contraction of the detrusor is not necessarily accompanied by involuntary urinary leakage.
  • the bladder hyperactivity syndrome of variable expression includes urges with or without incontinence and / or night and daytime pollakiuria. There is not one symptom that is pathognomonic of overactive bladder, but rather a set of symptoms that may be suggestive of this pathology: the presence of a triad of symptoms may reasonably suggest hyperactivity.
  • Urgencies or urges correspond to an urgent need to urinate accompanied by a fear of flight. They are followed or not by imperious urination, which can not be controlled and delayed by the patient, and thus cause leakage by urgency.
  • Urinary incontinence is defined as an accidental or involuntary loss of urine through the urethra. This condition affects both men and women and the origin is often multifactorial. The prevalence of this disorder represents about 3 million people in France. It is particularly common in the elderly. Urinary continence requires a properly functioning pelvic floor for the integrity of the sphincters and nerve controls acting on them and the detrusor. Any alteration of any of these structures can lead to incontinence. Several forms of incontinence are classically distinguished:
  • urinary incontinence characterized by urine leakage accompanied or immediately preceded by urgent and irrepressible urination leading to urination that can not be deferred and retained.
  • urinary incontinence can have psychological (anxiety, depression) and social (withdrawal) implications.
  • Urinary incontinence may be promoted by age, stress, obesity, neurological disorders, infection, prolapse or sphincter relaxation or pelvic floor muscles following abdominal surgery or childbirth for example.
  • Anal incontinence corresponds to the involuntary emission of gas and / or liquid and / or solid stools, while faecal incontinence excludes the emission of gas.
  • Anal incontinence does not only concern the elderly, but also people of all ages, with women being more often affected than men. Indeed, childbirth and the occurrence of menopause are factors promoting this incontinence. Other risk factors include certain traumatic or surgical procedures in the anal sphincter. But incontinence can also result from certain neurological pathologies (cerebrovascular accidents, diabetes, multiple sclerosis ...) of certain anal surgeries or congenital malformations. Fecal incontinence can also accompany prolapse of the rectum or be a symptom of another disease such as cancer for example.
  • the chronic pelvic-perineal pain is pain characterized also by their chronicity (more than six months), the absence of malignant pathology and their topography: the pelvis on the one hand, and the perineum on the other. go.
  • Half of patients complain of isolated pelvic pain, a quarter of patients also suffer from irritable bowel syndrome, 10% of patients have a clinical syndrome of overactive bladder, the remaining 15% accumulate all 3 syndromes.
  • the associations are very frequent between all the painful pathologies: vesical pain syndrome, vestibulodynia, irritable bowel syndrome, pelvic pain, fibromyalgia, and myofascial pain.
  • Bladder pain syndrome makes sense here because it can cover true diseases of the bladder wall with an intolerance to bladder filling but it can also cover bladder hypersensitivity whose origin is not necessarily in the bladder.
  • bladder pain syndrome As for many diseases whose exact causes are not known, there is no cure for bladder pain syndrome. However, several treatment options can relieve patients by reducing symptoms. As a first step, behavioral changes and self-care practice can improve symptoms and should be implemented as much as possible. Similarly, stress management practices should be encouraged to manage the exacerbation of stress-induced symptoms. Physical therapies by appropriate manual techniques may also be provided.
  • drugs that will act on pain and inflammation primarily, as well as directly on the altered bladder wall, may be used to protect or reconstitute the bladder.
  • Anti-inflammatory drugs Steroids can relieve pain and inflammation but they are rarely sufficient and their effect is not durable over time. They are generally well tolerated but can cause unwanted side effects. In general, all painkillers can be tried. Paracetamol and opioid analgesics, morphine derivatives may be effective, alone or in combination with other painkillers. Tricyclic antidepressants administered at doses lower than those used to treat depression, also have an effect on pain. The administration of antihistamines may be effective, as local histamine secretion by mast cells may play a local role in inflammation. Pentosan polysulfate can also be administered; it is a polysaccharide whose structure is similar to that of glycosaminoglycans which is eliminated in the urine and would allow to reconstitute the altered layer.
  • Hydrodistension may relieve patients for a few weeks but the effects fade as interventions occur and repeating them increases the risk of developing a compliance disorder.
  • Instillations of different products can be proposed; the local treatment having the advantage of allowing direct application of the product in contact with the mucosa and reducing the systemic exposure.
  • Instillation is a therapeutic method consisting of introducing a solution into a natural duct or cavity of the body, to wash, disinfect and treat the duct or cavity. The solution in the bladder is administered by means of a probe.
  • efficacy is heparin which has anti-inflammatory and protective properties and which contributes to temporarily strengthen the altered layer of glycoproteins. In the absence of sufficiently robust studies, it is difficult to properly assess the benefits and risks of this treatment.
  • the instillation of the products in the bladder can relieve and can be proposed despite the inconvenience of having to make urinary polls with their septic and traumatic risks.
  • PAR receptors prote-activated receptors
  • PARIs are heptaheloid receptors, coupled to trimeric G proteins, there are PARIs composed of 425 amino acids, PAR2 with 397 amino acids, PAR3 consisting of 374 amino acids and PAR4 with 385 acids. amines.
  • Thrombin activates PAR1, PAR3 and PAR4 by cleaving their extracellular N-terminus between arginine 41 and serine 42.
  • the cleaved peptide has no particular activity, the new N-terminus of the receptor plays the role agonist by folding to the cell surface and interacting with the extracellular domains.
  • PARI plays a key role in platelet activation at low thrombin concentrations while PAR4 responds to high concentrations.
  • IRAP has been established in the field of vascular biology and atherothrombosis.
  • PARI antagonists have emerged as promising novel and orally active antithrombotics.
  • vorapaxar and atopaxar have provided promising clinical data (Capodanno et al., 2012).
  • Vorapaxar has also been granted FDA registration in 2014 for "reduction of thrombotic events in patients with a history of myocardial infarction or peripheral arterial disease". Atopaxar is not currently being developed as an antiaggregant.
  • IRAP and PAR2 are expressed on both urothelial cells and detrusor cells (Saban et al., 2007).
  • a selective IRAP antagonist is an innovative therapeutic approach to treat inflammation and associated pain in pelvic-perineal functional pathologies and in particular in bladder pain syndrome.
  • vorapaxar, atopaxar and 3- (2-chloro-phenyl) -1- [4- (4-fluoro-benzyl) -piperazin-1-yl] -propenone, or one of their pharmaceutically acceptable salts, is capable of protecting the bladder by effectively decreasing its myogenic contractile responses.
  • Vorapaxar is described in patent application WO 03089428, it is ethyl N- [(3R, 3aS, 4S, 4aR, 7R, 8aR, 9aR) -4- [(E) -2- [5 - (3-fluorophenyl) -2-pyridyl] vinyl] -3-methyl-1-oxo-3 ⁇ , 4,4a, 5,6,7,8,8a, 9,9a-decahydro-3H-benzo [f] isobenzofuran-7-yl] carbamate.
  • Atopaxar is [(1- (3-tert-butyl-4-methoxy-5-morpholinophenyl) -2- (5,6-diethoxy-fluoro-1-imino-1,3-dihydro-2H-isoindole) 2yl) ethanone hydrobromide.
  • the term “pharmaceutically acceptable” refers to molecular entities and compositions that produce no adverse, allergic or other adverse reactions when administered to a human.
  • pharmaceutically acceptable excipient includes any diluent, adjuvant or excipient, such as preservatives, fillers, disintegrating, wetting, emulsifying, dispersing, antibacterial or antifungal agents, or else agents which delay absorption and intestinal and digestive resorption. The use of these media or vectors is well known to those skilled in the art.
  • salts for the therapeutic use of a compound of the present invention include conventional non-toxic salts of the compound of the invention such as those formed from organic or inorganic acids.
  • inorganic acids such as hydrochloric, hydrobromic, phosphoric and sulfuric acids
  • organic acids such as acetic, trifluoroacetic, propionic, succinic, fumaric, malic or tartaric acids.
  • solvates acceptable for the therapeutic use of a compound of the present invention include conventional solvates such as those formed in the last step of preparing a compound of the invention due to the presence of solvents.
  • solvates due to the presence of water or ethanol mention may be made of solvates due to the presence of water or ethanol.
  • Vorapaxar, atopaxar and 3- (2-chloro-phenyl) -1- [4- (4-fluoro-benzyl) -piperazin-1-yl] -propenone are selective PARI antagonists.
  • the PARI antagonists known to date are N3-cyclopropyl-7- ([4- (1-methylethyl) phenyl] methyl) -7H-pyrrolo [3,2-f] quinazolin-1,3-diamine (SCH-79797). ), vorapaxar (SCH-530348), atopaxar (E5555) and SCH-602539.
  • the subject of the invention is the use of a PARI antagonist as a medicament for the prevention and / or treatment of pelvic-perineal functional pathologies.
  • the subject of the invention is the use of vorapaxar as a medicament for the prevention and / or treatment of pelvic-perineal functional pathologies.
  • the subject of the invention is the use of atopaxar as a medicament for the prevention and / or treatment of pelvic-perineal functional pathologies.
  • the subject of the invention is the use of 3- (2-chlorophenyl) -1- [4- (4-fluoro-benzyl) -piperazin-1-yl] -propenone as a medicament in the prevention and / or the treatment of pelvic-perineal functional pathologies.
  • the subject of the invention is the use of a PARI antagonist as a medicament for the prevention and / or treatment of bladder pain syndrome.
  • the subject of the invention is the use of vorapaxar as a medicament for the prevention and / or treatment of bladder pain syndrome.
  • the subject of the invention is the use of atopaxar as a medicament for the prevention and / or treatment of bladder pain syndrome.
  • the subject of the invention is the use of 3- (2-chlorophenyl) -1- [4- (4-fluoro-benzyl) -piperazin-1-yl] propenone as the drug in the prevention and / or treatment of bladder pain syndrome.
  • the invention relates to the use of a PARI antagonist as a medicament for the prevention and / or treatment of bladder hyperactivity syndrome.
  • the subject of the invention is the use of vorapaxar as a medicament for the prevention and / or treatment of bladder hyperactivity syndrome.
  • the subject of the invention is the use of atopaxar as a medicament for the prevention and / or treatment of bladder hyperactivity syndrome.
  • the subject of the invention is the use of 3- (2-chlorophenyl) -1- [4- (4-fluoro-benzyl) -piperazin-1-yl] -propenone as a medicament in the prevention and / or the treatment of overactive bladder syndrome.
  • Another object of the invention is the use of a PARI antagonist in patients with urinary incontinence and / or anal or faecal incontinence.
  • Another object of the invention relates to the use of vorapaxar in patients with urinary incontinence and / or anal or fecal incontinence.
  • Another subject of the invention relates to the use of atopaxar in patients with urinary incontinence and / or anal or fecal incontinence.
  • Another subject of the invention relates to the use of 3- (2-chloro-phenyl) -1- [4- (4-fluoro-benzyl) -piperazin-1-yl] -propenone in patients with incontinence. urinary and / or anal or faecal incontinence.
  • Another object of the invention is the use of a PARI antagonist in patients with chronic pelvic-perineal pain.
  • Another object of the invention is the use of vorapaxar in patients with chronic pelvic-perineal pain.
  • Another object of the invention is the use of atopaxar in patients with chronic pelvic-perineal pain.
  • Another subject of the invention relates to the use of 3- (2-chloro-phenyl) -1- [4- (4-fluoro-benzyl) -piperazin-1-yl] -propenone in patients suffering from pain. pelvic perineal chronic.
  • the present invention further relates to a pharmaceutical composition comprising a PARI antagonist as active ingredient and at least one pharmaceutically acceptable excipient, for its use as a medicament for the prevention and / or treatment of pelvic-perineal functional pathologies, in particular of bladder pain syndrome, overactive bladder syndrome, chronic pelvic-peritoneal pain.
  • the present invention also relates to a pharmaceutical composition comprising a PARI antagonist as active ingredient and at least one pharmaceutically acceptable excipient, for use as a medicament in patients with urinary incontinence and / or incial or fecal incontinence.
  • compositions according to the present invention can be formulated for administration to humans.
  • the compositions according to the invention can be administered orally, sublingually, subcutaneously, intramuscularly, intravenously, transdermally, locally or rectally.
  • the active ingredient can be administered in unit dosage forms, in admixture with conventional pharmaceutical carriers, to humans.
  • Suitable unit dosage forms include oral forms such as tablets, capsules, powders, granules and oral solutions or suspensions, sublingual and oral forms of administration, subcutaneous forms of administration or transdermal, topical, intramuscular, intravenous, intravenous, nasal or intraocular, intravesical, intramural or rectal forms of administration.
  • the main active ingredient is mixed with a pharmaceutical vehicle such as gelatin, starch, lactose, magnesium stearate, talc, gum arabic, silica or the like.
  • a pharmaceutical vehicle such as gelatin, starch, lactose, magnesium stearate, talc, gum arabic, silica or the like.
  • the tablets can be coated with sucrose or other suitable materials or they can be treated so that they have prolonged or delayed activity and continuously release a predetermined amount of active ingredient.
  • a preparation in capsules is obtained by mixing the active ingredient with a diluent and pouring the resulting mixture into soft or hard gelatin capsules.
  • a syrup or elixir preparation may contain the active ingredient together with a sweetener, an antiseptic, as well as a flavoring agent and a suitable colorant.
  • the water-dispersible powders or granules may contain the active ingredient in admixture with dispersing agents or wetting agents, or suspending agents, as well as with taste correctors or sweeteners.
  • gels, creams, powders, suspensions, solutions, foams or suppositories are used which are prepared with binders melting at the rectal temperature, for example cocoa butter or polyethylene glycols.
  • parenteral intravenous, intramuscular, intradermal, subcutaneous
  • intranasal intraocular
  • intravesical intramural administration
  • aqueous suspensions containing isotonic saline solutions or sterile and injectable solutions containing dispersion and / or pharmacologically compatible wetting agents.
  • the active ingredient may also be formulated in the form of microcapsules, optionally with one or more additive carriers.
  • Formulations suitable for the chosen form of administration are known in the art and described for example in Remington, The Science and Practice of Pharmacy, 19th edition, 1995, Mack Publishing Company.
  • the pharmaceutical composition according to the present invention is intended for a local administration, it is called endovésical treatment, the pharmaceutical composition according to the present invention is intended to be used in an endovesical administration form.
  • endovesical treatments bladder instillation and / or intramural injection, that is to say administration in the thickness of the bladder wall, will be preferred.
  • PARI antagonist assays in the compositions of the invention may be adjusted to provide an amount of substance that is effective in achieving the desired therapeutic response for a particular composition of the method of administration.
  • the effective dose of the compound of the invention varies according to many parameters such as, for example, the chosen route of administration, weight, age, sex, the nature of the pathology, the type of treatment (s). administered and the sensitivity of the individual to treat. Consequently, the optimal dosage should be determined by the specialist in the field according to the parameters that he considers relevant.
  • the effective doses may vary widely, daily doses may range between 0.1 mg and 1000 mg per 24 hours, and preferably between 1 and 200 mg, for an adult with an average weight of 70 kg , in one or more takes. The following examples make it possible to better understand the invention without limiting its scope.
  • Example 1 Effect of 3- (2-Chloro-phenyl) -1- [4- (4-fluoro-benzyl) -piperazin-1-yl] -propenone on an isolated rat bladder model (Shimizu et al. Biol Pharm, Bull, 34 (7): 1122-1125, 2011).
  • cyclophophamide is injected bilaterally into rats (female Wistar Han, weighing 250 to 275 g on the day of the experiment, from Charles River laboratory France) intraperitoneally at a dose of 150 mg. / kg in a final volume of 5 mL / kg.
  • a pain assessment is performed 2 hours after administration of cyclophosphamide.
  • naive animals In naive animals (without administration of cyclophosphamide) or 24 hours after administration of cyclophosphamide, the animals are anesthetized with pentobarbital (60 mg / kg) and euthanized.
  • the bladder is rapidly removed and placed in a modified oxygenated Krebs-Henseleit solution of the following composition (mM): NaCl 114; KCl 4.7; CaCl 2 2.5; MgSO 4 1.2; KH 2 P0 4 1.2; NaHCO 3 and glucose 11.7 (pH 7.4 with 95% O 2 and 5% CO 2 ).
  • the bladder is cleansed of connective tissue, weighed, the distal and proximal portions are removed, and the bladder is cut longitudinally into two equal "strips".
  • the inflammation increases by a factor of 2.5 the bladder contractility due to PAR activation.
  • the contraction amplitude was 0.99 ⁇ 0.20 g for the naive vehicle group versus 2.73 ⁇ 0.34 g for the cyclophosphamide treated vehicle group.
  • the compound of the invention antagonizes trypsin-only contraction at high concentrations in na ⁇ ve animals as shown in Figure 1.
  • the bladder contraction amplitude is halved with the compound of the invention at 30 ⁇ versus vehicle ( 0.55 ⁇ 0.24g versus 0.99 ⁇ 0.20g) and nothing is observed at the other concentrations of the compound of the invention.
  • the compound of the invention antagonizes in a concentration-dependent manner the vesical contraction with trypsin in an inflamed condition (FIG. 2). Up to 3 ⁇ the compound of the invention seems inactive, at ⁇ the compound of the invention reduces by 35% the bladder contraction (1.76 ⁇ 0.30g versus 2.73 ⁇ 0.34g). At 30 ⁇ the compound of the invention reduces about 70% vesical contraction (0.92 ⁇ 0.17g versus 2.73 ⁇ 0.34g).
  • the reference product (SCH203099) antagonizes trypsin contraction only at high concentrations in na ⁇ ve animals (Figure 3).
  • the amplitude of bladder contraction was halved in the presence of 10 ⁇ of SCH203099 versus vehicle (0.48 ⁇ 0.11g versus 0.99 ⁇ 0.20g) and nothing was observed at the other concentrations of SCH203099.
  • the compound SCH203099 antagonizes in a concentration-dependent manner the bladder contraction with trypsin in an inflamed condition (FIG. 4).
  • a reduction of 25% is observed with 3 ⁇ of SCH203099 (2.05 ⁇ 053g versus 2.73 ⁇ 0.34g), a decrease of 35% is noted in the presence of 10 ⁇ of SCH203099 (1.77 ⁇ 0.38g versus 2, 73 ⁇ 0.34g) and SCH203099 at 30 ⁇ reduced bladder contraction by 60% (1.04 ⁇ 0.16g versus 2.73 ⁇ 0.34g).
  • the compound of the invention antagonizes in a concentration-dependent manner the TFLLR bladder contraction in naive animals.
  • the compound of the invention appears inactive, at 3 ⁇ a decrease of 45% of the bladder contraction is observed (0.33 ⁇ 0.05g versus 0.59 ⁇ 0.14g).
  • the compound of the invention reduces by 70% the bladder contraction (0.18 ⁇ 0.04g versus 0.59 ⁇ 0.14 g).
  • the compound of the invention completely abolishes the bladder contraction (0.00 ⁇ 0.04g versus 0.59 ⁇ 0.14g) with even relaxation of the tissue during the experiment (Figure 5).
  • the compound of the invention also antagonizes in a concentration-dependent manner the bladder contraction with TFLLR in an inflamed condition (FIG.
  • the reference product (SCH203099) antagonizes TFLLR bladder contraction only at high concentrations in na ⁇ ve animals (Figure 7).
  • the amplitude of bladder contraction was halved in the presence of 10 ⁇ of SCH203099 versus vehicle (0.26 ⁇ 0.07g versus 0.59 ⁇ 0.14g) and nothing was observed at other concentrations of SCH203099.
  • the compound SCH203099 antagonizes the SFLLR bladder contraction in an inflammatory condition in a concentration-dependent manner (FIG. 8). At 3 ⁇ of SCH203099, little evidence is observed (10% reduction). A decrease of 35% is noted in the presence of 10 ⁇ of SCH203099 (0.73 ⁇ 0.10g versus 1.10 ⁇ 0.18g) and the SCH203099 at 30 ⁇ reduces by 55% the bladder contraction (0.49 ⁇ 0.08g versus 1.10 ⁇ 0.18 g).
  • trypsin-induced bladder contractions are similarly antagonized by the reference product (SCH203099) and the compound of the invention.
  • the compound of the invention is more powerful on the inflamed bladders.
  • Example 2 Effects of vorapaxar and atopaxar on an isolated rat bladder model.
  • the aim of this study is to evaluate the effects of vorapaxar and atopaxar on bladder contraction amplitude with trypsin and TFLLR.
  • Atopaxar is a concentration-dependent antagonist of trypsin bladder contraction in na ⁇ ve animals as shown in Figure 11.
  • a l ⁇ atopaxar induced a slight decrease in bladder contraction (1.02 ⁇ 0.20g versus 1.17 ⁇ 0.10g).
  • atopaxar reduced bladder contraction by 38% (0.74 ⁇ 0.19g versus 1.17 ⁇ 0.10g).
  • atopaxar reduced bladder contraction by 70% (0.36 ⁇ 0.15 g versus 1.17 ⁇ 0.10 g) and completely abolished it at 30 ⁇ ( Figure 11).
  • Atopaxar has a concentration-dependent antagonism of TFLLR bladder contraction in na ⁇ ve animals from 10 nM ( Figure 12). At 10 nM atopaxar induced a decrease of more than 50% in the bladder contraction (0.21 ⁇ 0.03g versus 0.50 ⁇ 0.09g). At 1 ⁇ atopaxar virtually abolishes bladder contraction with a reduction of more than 80% (0.08 ⁇ 0.03g versus 0.50 ⁇ 0.09g), as shown in Figure 12.

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EP14793086.1A 2013-12-16 2014-10-31 Verwendung von par-1-antagonisten zur prävention und/oder behandlung von pelvi-perinealen funktionellen pathologischen störungen Withdrawn EP3082818A1 (de)

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FR1362682A FR3014693B1 (fr) 2013-12-16 2013-12-16 Utilisation de la 3-(2-chloro-phenyl)-1-[4-(4-fluoro-benzyl)-piperazin-1-yl]-propenone pour la prevention et/ou le traitement des pathologies fonctionnelles pelvi-perineales
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US20160287603A1 (en) 2016-10-06
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US9980970B2 (en) 2018-05-29
JP2016540799A (ja) 2016-12-28
MX370061B (es) 2019-11-29
AU2014365665B2 (en) 2019-08-29
IL246216A0 (en) 2016-07-31
WO2015090705A1 (fr) 2015-06-25
MX2016007795A (es) 2016-09-07
RU2678309C1 (ru) 2019-01-25
KR20160089518A (ko) 2016-07-27
MA39072A1 (fr) 2017-05-31
US10265322B2 (en) 2019-04-23
FR3014693B1 (fr) 2016-01-08
CN105813642B (zh) 2019-05-03

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