KR20080066948A - Diaryl ureas for treating diabetic neuropathy - Google Patents

Abstract

The present invention relates to pharmaceutical compositions for treating diabetic neuropathy comprising at least a diaryl urea compound optionally combined with at least one additional therapeutic agent. Useful combinations include e.g. BAY 43-9006 as a diaryl urea compound.

Description

Diaryl urea for treating diabetic neuropathy {DIARYL UREAS FOR TREATING DIABETIC NEUROPATHY}

The present invention relates to pharmaceutical compositions for the treatment of diabetic neuropathy, comprising one or more diaryl urea compounds, optionally in combination with one or more additional therapeutic agents. Useful combinations are, for example, BAY 43-9006 as diaryl urea compounds.

BAY 43-9006 refers to 4 {4- [3- (4-chloro-3-trifluoromethylphenyl) -ureido] -phenoxy} -pyridine-2-carboxylic acid methyl amide, comprising VEGFR, PDGFR, It is a species of diaryl urea compounds that are potent anticancer and antiangiogenic agents that possess a variety of activities including inhibitory activity against raf, p38 and / or flt-3 kinase signaling molecules. See, for example, WO 2004/113274 and WO 2005/000284.

Diabetic neuropathy, also called painful diabetic neuropathy, is a common diabetes-related phenomenon. Pain as a symptom of neuropathy can appear in one third of all patients with diabetes. Neuropathic pain is difficult to manage, and available treatment options rarely completely eliminate pain (C.F. Corbett, The Diabetes Educator, Vol. 31, 2005, 4, 523-540). The cause of this is unclear and does not respond very well to conventional pain therapies (R. A. Malik (2003) Treat. Endocrinol. 2 (6), 339-400).

Recent advances in the diagnosis of neuropathic pain include methods that can distinguish neuropathic pain from non-neuropathic pain. If left untreated, pain may decrease but nerve damage may develop. Treatments for symptom management are available and include analgesics (NSAIDs), antidepressants (eg, selective serotonin reuptake inhibitors, tricyclic antidepressants), anticonvulsants, capsaicin topical creams, neciletin, as well as physical or mechanical therapies such as electrical Stimulation, acupuncture, the use of magnetic therapy, or topical use of polyurethane films.

As has been recently demonstrated (SA Price et al. (2004) Diabetes, 53, 1851-1856), treatment of diabetic animals with SB 239063, fidaresat or insulin has shown that both motor and sensory nerve conduction rate (NCV) Does not reduce everything. Reduced neuronal conduction rate is an established feature of diabetic neuropathy.

The present invention provides pharmaceutical compositions for the treatment of diabetic neuropathy comprising at least one compound of formula (I) and optionally at least one further therapeutic agent.

The present invention not only provides a treatment method that more effectively reduces neuropathic pain in a patient compared to current therapies, but also provides a treatment method for reconstitution of nerve function. The treatment method according to the invention is superior to current therapies. Thus, the present invention can be used, for example, by administering a diaryl urea compound of formula (I) and its pharmaceutically acceptable salts and derivatives thereof, and optionally further therapeutic agents.

Compounds having the structure of formula (I), pharmaceutically acceptable salts, polymorphs, solvates, hydrates, metabolites and prodrugs thereof, and diastereomeric forms (both isolated stereoisomers and mixtures of stereoisomers) are collectively referred to herein. Referred to as "Compounds of Formula I".

Formula I is as follows:

Where

Q is -C (O) R _x ,

R _x is hydroxy, C _{1 -4} alkyl, C _{1 -4} alkoxy, or NR _a R _b,

R _a and R _b are independently

a) hydrogen;

b)-hydroxy,

- C _{1 -4} alkoxy,

-Pyrrole, furan, thiophene, imidazole, pyrazole, thiazole, oxazole, isoxazole, isothiazole, triazole, tetrazole, thiadiazole, oxadiazole, pyridine, pyrimidine, pyridazine, Heteroaryl groups selected from pyrazine, triazine, benzoxazole, isoquinoline, quinoline and imidazopyrimidine,

Tetrahydropyrans, tetrahydrofuran, 1,3-dioxolane, l, 4-dioxane, morpholine, thiomorpholine, piperazine, piperidine, piperidinone, tetrahydropyrimidone, pentamethylene sulfide , Heterocyclic group selected from tetramethylene sulfide, dihydropyran, dihydrofuran and dihydrothiophene,

- one or two C _{1 -4} alkyl group optionally substituted by amino or -NH ₂

-Phenyl

Optionally substituted C _{1 -4} alkyl by;

c)-halogen or

- one or two C _{1 -4} alkyl, optionally substituted by an amino -NH ₂

Phenyl optionally substituted with; or

d) pyrrole, furan, thiophene, imidazole, pyrazole, thiazole, oxazole, isoxazole, isothiazole, triazole, tetrazole, thiadiazole, oxadiazole, pyridine, pyrimidine, pyridazine, A heteroaryl group selected from pyrazine, triazine, benzoxazole, isoquinoline, quinoline and imidazopyrimidine,

A is optionally substituted phenyl, pyridinyl, naphthyl, benzoxazole, isoquinoline, quinoline or imidazopyrimidine,

B is optionally substituted phenyl or naphthyl,

L is a bridging group which is -S- or -O-,

m is 0, 1, 2 or 3,

Each R ² is independently a C _{1 -5} alkyl, C _{1 -5} alkyl, halo, C _{1 -3} alkoxy, N- oxo-N- or hydroxy.

For A of Formula I, the structure of the particularly substituted optionally substituted phenyl moiety includes the structure of Formula 1xx.

For A of formula (I), the structure of the particularly substituted pyridinyl moiety which is of particular interest includes the structure of formula (Ix)

For A of Formula I, the structure of the particularly substituted optionally naphthyl moiety includes the structure of Formula 1y.

Structure 1y shows that substituent R ³ may be present on any carbon atom of either ring having a valence which is otherwise complete by a hydrogen atom as a substituent. The bond to the urea group may also be via any carbon atom on either ring having a valence that is otherwise complete by a hydrogen atom as a substituent.

B is optionally substituted phenyl or naphthyl. For B of Formula I, structures of particularly important optionally substituted phenyl or naphthyl residues include the following structures 2a and 2b.

Structures 2a and 2b may be present on any carbon atom of a structure whose substituent R ¹ has a valence which is otherwise complete by a hydrogen atom as a substituent, and the bond to the urea group is also a hydrogen atom as a substituent in other cases. It can be made through any carbon atom of the structure having a valence that is complete by.

In a class of embodiments of the invention, B is substituted by one or more halogen substituents. In an embodiment of the further class, R _x is NR _a and R _b, and R _a and R _b are independently hydrogen or an optionally substituted C _{1 -4} alkyl, by hydroxy, L is -S- or -O- Phosphorus crosslinking group.

The variable p is 0, 1, 2, 3 or 4, typically 0 or 1. The variable n is 0, 1, 2, 3, 4, 5 or 6, typically 0, 1, 2, 3 or 4. The variable m is 0, 1, 2 or 3, usually 0.

Each R ¹ is independently halogen, C _{1 -5} alkyl, _{halo, NO 2, C (O)} NR 4 R 5, C 1 -6 alkyl, C _{1 -6} dialkyl amine, C _{1 -3} alkyl amines, CN is amino, hydroxy or C _{1 -3} alkoxy. When present, R ¹ is more generally halogen, of which halogen is usually chlorine or fluorine, more generally fluorine.

Each R ² is independently a C _{1 -5} alkyl, C _{1 -5} alkyl, halo, C _{1 -3} alkoxy, N- oxo-N- or hydroxy. When present, R ² is usually methyl or trifluoromethyl.

Each R ³ is independently selected from halogen, R ⁴ , OR ⁴ , S (O) R ⁴ , C (O) R ⁴ , C (O) NR ⁴ R ⁵ , oxo, cyano or nitro (NO ₂ ) do.

R ⁴ and R ⁵ is hydrogen, C _{1 -6} alkyl and per-is independently selected from C _{1 -6} alkyl halide to.

Other examples of A include 3-tert-butyl phenyl, 5-tert-butyl-2-methoxyphenyl, 5- (trifluoromethyl) -2-phenyl, 3- (trifluoromethyl) -4-chlorophenyl , 3- (trifluoromethyl) -4-bromophenyl and 5- (trifluoromethyl) -4-chloro-2-methoxyphenyl.

Another example of B is

이 포함된다.

This includes.

Preferably, the urea group —NH—C (O) —NH— and the bridging group L are not bonded to adjacent ring carbons of B, but are separated and bonded by one or two ring carbons.

Examples of R ¹ groups include fluorine, chlorine, bromine, methyl, NO ₂ , C (O) NH ₂ , methoxy, SCH ₃ , trifluoromethyl and methanesulfonyl.

Examples of R ² groups include methyl, ethyl, propyl, oxygen and cyano.

Examples of R ³ groups include trifluoromethyl, methyl, ethyl, propyl, butyl, isopropyl, tert-butyl, chlorine, fluorine, bromine, cyano, methoxy, acetyl, trifluoromethanesulfonyl, trifluorome Methoxy and trifluoromethylthio.

Formula II is as follows:

Where

Ra and Rb are independently hydrogen and C ₁ -C ₄ alkyl,

B is

이고,

ego,

Wherein the urea group —NH—C (O) —NH— and the oxygen bridging group are not bonded to adjacent ring carbons of B, but are separated and bonded by one or two ring carbons,

또는

이고,A is

or

ego,

Where variable n is 0, 1, 2, 3 or 4, and R ³ is trifluoromethyl, methyl, ethyl, propyl, butyl, isopropyl, tert-butyl, chlorine, fluorine, bromine, cyano, methoxy , Acetyl, trifluoromethanesulfonyl, trifluoromethoxy or trifluoromethylthio.

In a subgroup of such compounds, each of the R ³ substituents in A of Formula II is selected from chlorine, trifluoromethyl, tert-butyl or methoxy.

이고, 화학식 II의 B는 페닐렌, 플루오로-치환된 페닐렌 또는 디플루오로-치환된 페닐렌이다.In another subgroup of such compounds, A of Formula II is

And B of Formula II is phenylene, fluoro-substituted phenylene or difluoro-substituted phenylene.

Another class of important compounds includes those compounds having the structure of Formula X wherein the phenyl ring “B” optionally has one halogen substituent.

For compounds of formula X, R ² , m and A are as defined for formula I above. The variable “m” is preferably zero, such that only C (O) NHCH ₃ remains on the pyridinyl moiety as a substituent. Preferred group for A is substituted phenyl with one or more substituents R ³ . R ³ is preferably halogen, preferably Cl or F, trifluoromethyl and / or methoxy.

Important compounds in the subgroups include those having the structures of the formulas Z1 and Z2.

Preferred as compounds of formula (I) according to the invention are the 4 {4- [3- (4-chloro-3-trifluoromethylphenyl) -ureido] -phenoxy} -pyridine-2-carboxylic acid methyl Amide (BAY 43-9006) or p-toluenesulfonic acid of 4 {4- [3- (4-chloro-3-trifluoromethylphenyl) -ureido] -phenoxy} -pyridine-2-carboxylic acid methyl amide Salt (tosylate salt of compound (I)). More preferably, p-toluenesulfonic acid salt of 4 {4- [3- (4-chloro-3-trifluoromethylphenyl) -ureido] -phenoxy} -pyridine-2-carboxylic acid methyl amide At least 80% is present as stable polymorph I. Most preferably, the p-toluenesulfonic acid salt of 4 {4- [3- (4-chloro-3-trifluoromethylphenyl) -ureido] -phenoxy} -pyridine-2-carboxylic acid methyl amide is at least 80% is present in stable polymorph I and in micronized form.

Micronization can be achieved by standard grinding methods known to those skilled in the art, preferably by air chat grinding. The micronized form may have an average particle size of 0.5 to 10 μm, preferably 1 to 6 μm, more preferably 1 to 3 μm. The particle sizes shown are the average of the particle size distributions measured by laser diffraction known to those skilled in the art (measuring device: HELOS, Sympatec).

P-toluenesulfonic acid salt of 4 {4- [3- (4-chloro-3-trifluoromethylphenyl) -ureido] -phenoxy} -pyridine-2-carboxylic acid methyl amide and its stable polymorph I The method of preparation is described in patent applications EP 04023131.8 and EP 04023130.0.

If any moiety is "substituted" it may have up to the indicated number of substituents, each substituent may be present at any available position on the residue and may be attached via any available atom on the substituent. “Any available position” is any position on a residue that can be chemically achieved through a method known in the art or taught herein, for example, that does not produce unstable molecules that cannot be administered to humans. it means. When two or more substituents are present on any moiety, each substituent is independently defined among the other substituents and thus may be the same or different.

The term "optionally substituted" means that the residue so modified may be unsubstituted or substituted with the identified substituent (s).

As pyridine substituents the term “hydroxy” includes 2-, 3- and 4-hydroxypyridine and is also referred to in the art as 1-oxo-pyridine, 1-hydroxy-pyridine or pyridine-N-oxide. It is understood to include.

When the words compound, salt, etc. are used herein in the plural, it is also taken to mean a single compound, salt, and the like.

The term C _{1 -6} alkyl, unless indicated otherwise, cyclic, or linear, or one or more branched straight-chain, branched or cyclic having from 1 to 6 carbon atoms, which may be branched as a (branching) It means an alkyl group. Such groups include, for example, methyl, ethyl, n-propyl, isopropyl, n-butyl, isobutyl, sec-butyl, tert-butyl, cyclopropyl, cyclobutyl and the like.

The term C _{1 -6} haloalkyl, unless indicated otherwise, means a saturated hydrocarbon radical having carbon atoms of up to 6 substituted by one or more halogen atoms or less to perhalo. The radicals may be cyclic, linear or branched into one or multiple branches. Halo substituent (s) include fluoro, chloro, bromo or iodo. Fluoro, chloro and bromo are preferred, and fluoro and chloro are more preferred. Halogen substituent (s) may be located on any available carbon. If more than one halogen substituent is present on this moiety, they may be the same or different. Examples of such halogenated alkyl substituents include chloromethyl, dichloromethyl, trichloromethyl, fluoromethyl, difluoromethyl, trifluoromethyl, 2,2,2-trifluoroethyl and 1,1,2,2- Tetrafluoroethyl, and the like.

The term C _{1 -6} alkoxy, unless indicated otherwise, cyclic, or linear, or one or a plurality of which may be branched furnace branched, cyclic having from 1 to 6 carbon atoms, a saturated, straight-chain or branched-chain alkoxycarbonyl group And groups such as methoxy, ethoxy, n-propoxy, isopropoxy, butoxy, pentoxy and the like. It also includes halogenated groups such as 2,2-dichloroethoxy, trifluoromethoxy and the like.

Halo or halogen means fluoro, chloro, bromo or iodo. Fluoro, chloro and bromo are preferred, and fluoro and chloro are more preferred.

C _{1 -3} alkyl amines are unless indicated otherwise, it means methylamino, ethylamino, propylamino or isopropylamino.

Examples of the C _{1 -6-di-alkyl} amines are diethylamino, ethyl-isopropylamino, methyl-iso-butylamino, and di-hexyl-amino, but contain not limited to this.

The term heteroaryl means both monocyclic and bicyclic heteroaryl rings. Monocyclic heteroaryl means an aromatic monocyclic ring having 5 to 6 ring atoms and 1 to 4 heteroatoms selected from N, O and S and the remaining atoms are carbon. If more than one heteroatom is present in the residue, they may be the same or different since they are independently selected from the other (s). Monocyclic heteroaryl rings include pyrrole, furan, thiophene, imidazole, pyrazole, thiazole, oxazole, isoxazole, isothiazole, triazole, tetrazole, thiadiazole, oxadiazole, pyridine, Pyrimidine, pyridazine, pyrazine and triazine.

Bicyclic heteroaryl means a fused bicyclic moiety wherein one of the rings is selected from the monocyclic heteroaryl rings described above and the second ring is benzene or another monocyclic heteroaryl ring described above. If the two rings of the bicyclic moiety are heteroaryl rings, they may be the same or different as long as they can be chemically achieved by means known in the art. Bicyclic heteroaryl rings include, but are not limited to, for example, benzoxazole (fused phenyl and oxazole), quinoline (fused phenyl and pyridine), imidazopyrimidine (fused imidazole and pyrimidine), and the like. Synthetically achievable 5-5, 5-6 or 6-6 fused bicyclic aromatic structures are also included.

Bicyclic heteroaryl moieties may be partially saturated. When partially saturated, the monocyclic heteroaryl ring as described above is fully or partially saturated, the second ring as described above is fully or partially saturated, or both rings are partially saturated.

The term “5- or 6-membered heterocyclic ring containing one or more atoms selected from oxygen, nitrogen and sulfur, saturated, partially saturated or aromatic” includes tetrahydropyran, tetrahydrofuran, 1,3-diox Solan, 1,4-dioxane, morpholine, thiomorpholine, piperazine, piperidine, piperidinone, tetrahydropyrimidone, pentamethylene sulfide, tetramethylene sulfide, dihydropyran, dihydrofuran, Dihydrothiophene, pyrrole, furan, thiophene, imidazole, pyrazole, thiazole, oxazole, isoxazole, isothiazole, triazole, pyridine, pyrimidine, pyridazine, pyrazine, triazine, etc. This is not restrictive.

The term - roneun "C _{1 -3} alkyl, phenyl", for example, include the 2-methylphenyl, isopropylphenyl, 3-phenylpropyl or 2-phenyl-1-methylethyl. Substituted examples include 2- [2-chlorophenyl] ethyl, 3,4-dimethylphenylmethyl and the like.

Unless stated or indicated otherwise, the term “aryl” refers to a 6-12 membered mono- or bicyclic aromatic hydrocarbon group having 0, 1, 2, 3, 4, 5 or 6 substituents (eg, phenyl, naphthalene, Azulene, indene).

The compounds of formula (I) may contain one or more asymmetric centers, depending on the position and nature of the various substituents of interest. Asymmetric carbon atoms may be present in the (R) or (S) configuration or the (R, S) configuration. In certain cases, asymmetry may also occur due to limited rotation of a given bond, eg, a bond in the center connecting two substituted aromatic rings of a particular compound. Substituents on the ring may also exist in cis or trans form. All such configurations (including enantiomers and diastereomers) are intended to be included within the scope of this invention. Preferred compounds are those which have an absolute configuration of the compound of formula I which provides more desirable biological activity. Individual, pure or partially purified isomers of the compounds of the invention, or racemic mixtures thereof, are also included within the scope of the invention. Purification of such isomers and separation of the isomer mixtures can be accomplished by standard techniques known in the art.

Optical isomers can be obtained by dividing the racemic mixture according to conventional methods, for example by forming diastereomeric salts with optically active acids or bases, or by forming covalent diastereomers. have. Examples of suitable acids are tartaric acid, diacetyltartaric acid, ditoluoyltartaric acid and camphorsulfonic acid. Mixtures of diastereomers can be separated into their respective diastereomers on the basis of their physical and / or chemical differences by methods known in the art, for example by chromatography or fractional crystallization. The optically active base or acid is then liberated from the separated diastereomeric salts. Several methods for the separation of optical isomers involve the use of chiral chromatography (eg, chiral HPLC columns) optimally selected to maximize separation of enantiomers, with or without conventional derivatization. Suitable chiral HPLC columns are Chiracel OD and Chilacel OJ, for example, manufactured by Daicel, among many other commonly available choices. Enzymatic separations with or without derivatization are also useful. Optically active compounds of formula (I) can also be obtained by chiral synthesis with optically active starting materials.

The invention also relates to useful forms of the compounds disclosed herein, such as pharmaceutically acceptable salts, metabolites and prodrugs. The term "pharmaceutically acceptable salts" refers to relatively nontoxic inorganic or organic acid addition salts of the compounds of the present invention. See, eg, S.M. Berge, et al. "Pharmaceutical Salts," J. Pharm. Sci. 1977, 66, 1-19. Pharmaceutically acceptable salts include salts, such as hydrochloric acid, sulfuric acid, phosphoric acid, methanesulfonic acid, camphorsulfonic acid, oxalic acid, maleic acid, succinic acid and citric acid, by reacting a major compound serving as a base with an inorganic or organic acid. Salts obtained by forming are included. Pharmaceutically acceptable salts also include salts in which the main compound acts as an acid and is reacted with a suitable base, such as sodium, potassium, calcium, magnesium, ammonium and choline salts. Those skilled in the art will also recognize that acid addition salts of the claimed compounds can be prepared by reacting the compound with the appropriate inorganic or organic acid via any of a number of known methods. Alternatively, alkali and alkaline earth metal salts are prepared by reacting the compounds of the present invention with the appropriate base through various known methods.

Representative salts of the compounds of the present invention include, for example, conventional non-toxic salts and quaternary ammonium salts formed from inorganic or organic acids or bases in a manner well known in the art. For example, such acid addition salts include acetate, adipate, alginate, ascorbate, aspartate, benzoate, benzenesulfonate, bisulfate, butyrate, citrate, camphorlate, camphorsulfonate, cinna Mate, cyclopentanepropionate, digluconate, dodecyl sulfate, ethanesulfonate, fumarate, glucoheptanoate, glycerophosphate, hemisulfate, heptanoate, hexanoate, hydrochloride, hydrobromide, Hydroiodide, 2-hydroxyethanesulfonate, itaconate, lactate, maleate, mandelate, methanesulfonate, 2-naphthalenesulfonate, nicotinate, nitrate, oxalate, pamoate, Pectinate, persulfate, 3-phenylpropionate, picrate, pivalate, propionate, succinate, sulfonane , Tartrate, thiocyanate, tosylate, include trifluoromethanesulfonate, and undecanoate.

Base salts include alkali metal salts such as potassium and sodium salts, alkaline earth metal salts such as calcium and magnesium salts, and ammonium salts with organic bases such as dicyclohexylamine and N-methyl-D-glucamine. In addition, basic nitrogen-containing groups include lower alkyl halides such as methyl, ethyl, propyl and butyl chloride, bromide and iodide; Dialkyl sulfates such as dimethyl, diethyl and dibutyl sulfate; And diamyl sulfates, long chain halides such as decyl, lauryl, myristyl and stearyl chloride, bromide and iodide, aryl or aralkyl halides such as benzyl and phenethyl bromide, and other monosubstituted aralkyl halides or Quaternized with a reagent such as a polysubstituted aralkyl halide.

Solvates for the purposes of the present invention are in the form of compounds in which the solvent molecules form complexes in the solid state, including but not limited to, for example, ethanol and methanol. Hydrates are a specific form of solvates in which the solvent molecule is water.

Certain pharmacologically active agents can be further modified with unstable functional groups that degrade after in vivo administration to provide the parent active and pharmacologically inactive derivatizing groups. Such derivatives, commonly referred to as prodrugs, for example, alter the physicochemical properties of the active agent, target the active agent to specific tissues, alter the pharmacokinetic and pharmacodynamic properties of the active agent, and reduce unwanted side effects. It can be used to make. Prodrugs of the present invention include, for example, esters of suitable compounds of the present invention that are good pharmaceutically acceptable esters, such as alkyl esters including methyl, ethyl, propyl, isopropyl, butyl, isobutyl or pentyl esters. Included. Although methyl esters are preferred, additional esters may be used, such as phenyl-C ₁ -C ₅ alkyl.

Methods that can be used to synthesize other prodrugs are described in the following documents on this subject, which are incorporated herein by reference for the description of their synthesis methods:

Metabolites of the compounds of the present invention include oxidized derivatives of compounds of formula (I), (II), (X), (Z1) and (Z2) in which at least one of the nitrogens is substituted with a hydroxy group; Included are derivatives in which the nitrogen atom of the pyridine group is in oxide form (referred to as 1-oxo-pyridine in the art), or has hydroxy substituents (referred to as 1-hydroxy-pyridine in the art).

General manufacturing method

The particular method to be used in the preparation of the compounds used in this embodiment of the invention depends on the particular compound desired. Factors such as the selection of specific substituents play a role in the pathways taken in the preparation of certain compounds of the invention. Such factors are readily recognized by those skilled in the art.

The compounds of the present invention are described in known chemical reactions and in published international applications WO 00/42012, WO 03/047579, WO 2005/009961, WO 2004/078747 and WO 05/000284 and European patent applications EP 04023131.8 and EP 04023130.0. It can be prepared using a procedure as described.

The compounds of the present invention can be prepared according to conventional chemical methods and / or as disclosed below from starting materials that are commercially available or can be produced according to routine conventional chemical methods. General methods for the preparation of the compounds of the present invention are provided below.

The preparation of the urea of formula I is carried out in a solvent which does not react with any starting material in the presence of phosgene, di-phosgene, tri-phosgen, carbonyldiimidazole or equivalents, as described in one or more of the published documents. From the condensation of two arylamine fragments. Alternatively, the compounds of formula (I) may be synthesized by reaction of amino compounds with isocyanate compounds, as described in one or more of the published international applications described above.

Isocyanates are commercially available or can be synthesized from heterocyclic amines according to methods commonly known to those skilled in the art [eg, amines may be phosgene or phosgene equivalents such as trichloromethyl chloroformate (diphosgene) , Bis (trichloromethyl) carbonate (triphosgene), or N, N'-carbonyldiimidazole (CDI); Or alternatively, by Curtius-type rearrangement of amides, carboxylic acid derivatives (such as esters), acid halides or acid anhydrides.

Aryl amines are commercially available or can be synthesized according to methods commonly known to those skilled in the art. Aryl amines are typically synthesized by reducing nitroaryl using a metal catalyst such as Ni, Pd or Pt and a hydride transfer agent such as H ₂ , or formate, cyclohexadiene or borohydride (Rylander Hydrogenation Methods; Academic Press: London, UK (1985)]. Nitroaryl can also be used with strong hydride sources such as LiAlH ₄ (Seyden-Penne. Reductions by the Alumino- and borohydrides in Organic Synthesis; VCH Publishers: New York (1991)), or often in acidic media. It can be directly reduced using a zero-valent metal such as Fe, Sn or Ca. Numerous methods exist for the synthesis of nitroaryl (March. Advanced Organic Chemistry, 3 ^rd Ed .; John Wiley: New York (1985)), Larock. Comprehensive Organic Transformations; VCH Publishers: New York (1989 )]). Nitro radicals typically are formed by electrophilic aromatic nitration using HNO _3, or another NO ₂ ⁺ source.

The pyridine ring has a hydroxy substituent on its nitrogen atom and the pyridine-1-oxides of formula (I) in which A, B and L are broadly defined as above, use the corresponding pyridine using oxidation conditions known in the art. It can be prepared from. Some examples are:

Peracids such as metachloroperbenzoic acid in chlorinated solvents such as dichloromethane, dichloroethane or chloroform (Markgraf et al., Tetrahedron 1991, 47 , 183);

(Me ₃ SiO) ₂ (Coperet et al., Tetrahedron Lett. 1998, 39 , 761) in the presence of a catalytic amount of perenic acid in a chlorinated solvent such as dichloromethane;

Perfluoro-cis-2-butyl-3-propyloxaziridine in several combinations of halogenated solvents (Amone et al., Tetrahedron 1998, 54 , 7831);

Hypofluoric acid-acetonitrile complexes in chloroform (Dayan et al., Synthesis 1999, 1427);

Oxone in the presence of a base such as KOH in water (Robker et al., J. Chem. Res., Synop. 1993, 10 , 412);

Magnesium monoperoxyphthalate in the presence of glacial acetic acid (Klemm et al., J. Heterocyclic Chem. 1990, 6, 1537);

Hydrogen peroxide in the presence of water and acetic acid (Lin AJ, Org. Prep. Proced. Int. 1991, 23 (1), 114);

Dimethyldioxirane in acetone (Boyd et al., J. Chem. Soc., Perkin Trans. 1991, 9 , 2189).

In addition, certain methods for preparing diaryl urea and intermediate compounds are already described elsewhere in the patent literature and can be applied to the compounds of the present invention. For example, Miller, S. et al., "Inhibition of p38 Kinase using Symmetrical and Unsymmetrical Diphenyl Ureas" PCT International Application WO 99 32463, Miller, S. et al., "Inhibition of raf Kinase using Symmetrical and Unsymmetrical Substituted Diphenyl Ureas "PCT International Application WO 99 32436, Dumas, J. et al.," Inhibition of p38 Kinase Activity using Substituted Heterocyclic Ureas "PCT International Application WO 99 32111, Dumas, J. et al.," Method for the Treatment of Neoplasm by Inhibition of raf Kinase using N-Hereroaryl-N '-(hetero) arylureas "PCT International Application WO 99 32106, Dumas, J. et al.," Inhibition of p38 Kinase Activity using Aryl- and Heteroaryl-Substituted Heterocyclic Ureas "PCT International Application WO 99 32110, Dumas, J. et al., "Inhibition of raf Kinase using Aryl- and Heteroaryl-Substituted Heterocyclic Ureas" PCT International Application WO 99 32455, Riedl, B. et al., "O-Carboxy Aryl Substituted Diphenyl Ureas as raf Kinase Inhibitors "PCT International Application WO 00 42012, Riedl, B. et al.," O-Carboxy Aryl Substitut ed Diphenyl Ureas as p38 Kinase Inhibitors "PCT International Application WO 00 41698, Dumas, J. et al.," Heteroaryl ureas containing nitrogen hetero-atoms as p38 kinase inhibitors "US Patent Application US 20020065296, Dumas, J. et al. , "Preparation of N-aryl-N '-[(acylphenoxy) phenyl] ureas as raf kinase inhibitors" PCT International Application WO 02 62763, Dumas, J. et al., "Inhibition of raf kinase using quinolyl, isoquinolyl or pyridyl ureas "PCT International Application WO 02 85857, Dumas, J. et al.," Preparation of quinolyl, isoquinolyl or pyridyl-ureas as inhibitors of raf kinase for the treatment of tumors and / or cancerous cell growth "US Patent Application Publication US 20020165394 See. All such patent applications are incorporated herein by reference.

Synthetic modifications that can be used in the synthesis of compounds of formula (I) and in the synthesis of intermediates involved in the synthesis of compounds of formula (I) are known to or can be achieved by those skilled in the art. Synopsis of synthetic transformations can be found in the following compilation:

In addition, repeated reviews of synthetic methodologies and related topics are described in Organic Reactions; John Wiley: New York; Organic Syntheses; John Wiley: New York; Reagents for Organic Synthesis: John Wiley: New York; The Total Synthesis of Natural Products; John Wiley: New York; The Organic Chemistry of Drug Synthesis; John Wiley: New York; Annual Reports in Organic Synthesis; Academic Press: San Diego CA; And Methoden der Organischen Chemie (Houben-Weyl); Thieme: Stuttgart, Germany]. In addition, databases of synthetic modifications can be searched using Chemical Abstracts (can be retrieved using CAS Online or SciFinder), Handbuch der Organischen Chemie (Beilstein) (which can be retrieved using SpotFire and REACCS).

Additional Remedies

The compounds of formula (I) according to the invention can be combined with further therapeutic agents such as analgesics, antidepressants, antidiabetic agents, glucose control agents, neuroprotective agents, anticonvulsants, anesthetics, anti-inflammatory agents or capsaicin.

Examples of analgesics include, but are not limited to, NSAIDs (nonsteroidal anti-inflammatory drugs), COX-1- or COX-2-inhibitors.

Examples of NSAIDs are, for example, aceclofenac, acetaminophen, o-acetylsalicylic acid, alclofenac, alminpropene, amphenac, ampyroxoxycam, amtolmethinguacyl, anirolact, anthracenine, azapropazone, benoryl Lat, Vermoprofen, Vindarit, Bromfenac, Bucloxae saure, Bucolom, Bupexamac, Bumadzon, Butybufen, Butycirat, Carbasalat Calcium, Carpropene, Synmethasin, Cynoxine Calm, Clidanac, Clovuzart, Devoxmet, Dexibuprofen, Dexketoprofen, Diclofenac, Diflunisal, Eltenac, Enfenam Saeure, Ethersalat, Etodolac, Etofenatmat, Peclo Buzon, felbinac, pentiazac, pepradinol, flobufen, flocfenin, flufenamic acid, fluoxapropene, flurbiprofen, flurbiprofen axetyl, purfenac, furpropene, Glucametacin, Ibufenac, Ibuprofen, Indian Buffen, Indomethacin, Indometh Gin pranesil, indopropene, ketoprofen, ketorolac, lobenzarit, rhoazolak, lornoxicam, roxofene, mefenamic acid, meloxycamp, mesalazine, mofezolac, nabumetone, naproxen, Niflumic, olsalazine, oxaprozin, felubiprofen, phenylbutazone, pimepropene, pyrazolac, pyroxicam, pirpropene, pranopropene, prefelone, prinomid, proglumeta Sin, Proquazone, Proticinic Acid, Romanisat, Salicyamide, Salicylic Acid, Salmsteine, Salnasdine, Salsalat, Sulindac, Suprofen, Talniflumat, Tenipap, Tennosal, Tenoxycam, Tepoc Saline, thiapropenesauree, tiaramid, tilnopropene arbamel, thimegadine, tinoridine, tolfenamic acid, tolmetin, ufenamat, chymoprofen, zaltoprofen and zolipropene This is not restrictive.

Preference is given to NSAIDs selected from the group consisting of acetaminophen, o-acetylsalicylic acid, clidanac, diclofenac, flurbiprofen, ibuprofen, ketoprofen and sulindac. More preferably, o-acetylsalicylic acid is used as the NSAID.

Examples of anesthetics include, but are not limited to, for example, melixetine, lidocaine, and benzocaine. Melixetine is preferred.

Examples of antidepressants include, but are not limited to, selective serotonin reuptake inhibitors or tricyclic antidepressants, such as duloxetine, trazodone and venlafaxine.

Examples of anticonvulsants include, but are not limited to, gabapentin, lamotrigine, amitriptyline, and pregabalin.

Examples of antidiabetic agents include, for example, insulin, CB-1 antagonists such as limonabant or SLV-319, 5HT absorption inhibitors such as sibutramine, lipolytic inhibitors such as orlistat or ALT-962, CNTF agonists such as evil Sokin, DGAT inhibitors such as BAY 74-4113, DPP IV inhibitors such as bildagliptin, cytagliptin, saxagliptin, LAF-237, MK-0431 or BMS-477118, GLP-1 analogs such as exenatide, Betatropin, BIM-51077, CJC-1131 or Liraglutide, PPAR αγ agonists such as BAY 62-9069, BAY 68-2959, Tesaglitasar, Muraglitasar, ONO-5129, LY-510929, LY-519818, GW-677954, TAK-559, nabeglitazar or AVE-0847, PPAR γ agonists such as pioglitazone, rosiglitazone, R-483, balaglitazone, riboglitazone or TAK-654 But is not limited thereto. Preference is given to BAY 74-4113, BAY 62-9069, BAY 68-2959, Rimonabant, SLV-319, pioglitazone, rosiglitazone, orlistat, tesaglitazar, muraglitasar and exenatide.

Indication

The compounds and combinations according to the invention can be used to prepare medicaments for the treatment of diabetic neuropathy. The invention also provides a method of treating diabetic neuropathy comprising administering an effective amount of at least one compound of formula (I) and optionally at least one additional therapeutic agent according to the invention. An “effective amount” is an amount of a compound useful to achieve the desired result, eg, to treat a disease or condition. Diabetic neuropathy is also known as painful diabetic neuropathy.

administration

Compounds or drug combinations of the invention can be, for example, oral, parenteral, intestinal, intravenous, intraperitoneal, topical, transdermal (eg using certain standard patches), intraocular, intranasal, topical, non-oral And may be administered in any form by any effective route, including, for example, spraying, inhaling, subcutaneous, intramuscular, buccal, sublingual, rectal, vaginal, intraarterial, and intradural. They may be administered alone or in combination with any ingredient (s) that are active or inactive.

Preferably, it is administered by oral administration.

The compounds or drug combinations of the invention may be prepared in conventional formulations, which may be liquid or solid, including but not limited to general and enteric coated tablets, capsules, pills, powders, granules, elixirs, tinctures. , Solutions, suspensions, syrups, solid and liquid aerosols and emulsions can be converted in a known manner.

Combinations of the invention can be administered at any time and in any effective form. For example, the compounds may be administered simultaneously, eg in a single composition or dosage unit (eg, pills or liquids containing all of the compositions), or they may be administered simultaneously in separate compositions (eg, in one The drug may be administered intravenously, while the other is administered orally or intramuscularly). The drugs may also be administered sequentially at different time points. Agents may be conventionally formulated to achieve the desired release rate over an extended period of time, eg, 12-hours, 24-hours. This can be achieved by using agents with suitable metabolic half-lives and / or derivatives thereof and / or by using controlled-release preparations.

Drug combinations can act synergistically, for example, when drugs work together to cause the combinational effect to be greater than the algebraic sum of their respective effects. Thus, administration of a reduced amount of drug may reduce, for example, toxicity or other harmful or unwanted effects, and / or use the same amount as that used when the agent is administered alone, providing greater efficacy. Can be achieved.

The compound or drug combination of the present invention may be further combined with any other suitable additive or pharmaceutically acceptable carrier. Such additives include any materials already mentioned, as well as Remington : The Science and Practice of Pharmacy (Gennaro and Gennaro, eds, 20th edition, Lippincott Williams & Wilkins, 2000); Theory and Practice of Industrial Pharmacy (Lachman et al., Eds., 3rd edition, Lippincott Williams & Wilkins, 1986); Encyclopedia of Pharmaceutical And any commonly used materials such as those described in Technology (Swarbrick and Boylan, eds., 2nd edition, Marcel Dekker, 2002).

In addition, the compounds or drug combinations of the present invention may be administered in conjunction with other active agents or other therapies used to treat any of the aforementioned diseases and / or symptoms.

Other therapies according to the present invention include, but are not limited to, physical or mechanical therapies such as electrical stimulation, acupuncture, magnet therapy, or topical use of polyurethane films.

The invention also provides combinations of one or more compounds of formula (I) and one or more of the other therapeutic agents mentioned above useful for the treatment of diseases or disorders. For the purposes of the present invention "combination"

A single composition or dosage form containing at least one compound of formula (I) and at least one other therapeutic agent mentioned above;

A combination pack containing at least one compound of formula (I) and at least one other therapeutic agent mentioned above, administered simultaneously or sequentially;

A kit comprising one or more compounds of formula (I) and one or more other therapeutic agents mentioned above, packaged separately from each other in unit dosage form or in independent unit dosage forms, with or without instructions that they are administered simultaneously or sequentially; And

-Separate, independent dosage forms of one or more compounds of formula (I) and one or more other therapeutic agents mentioned above, cooperating to achieve a therapeutic effect, for example the treatment of the disease, when administered simultaneously or sequentially.

The dosage of each agent in the combination can be selected with reference to the type of disease and / or disease condition and / or others in order to provide the desired therapeutic activity. For example, the active agents in the combination can be provided and administered in a fixed combination. By "fixed combination" is meant herein the pharmaceutical form in which the components are present in a fixed ratio that provides the desired efficacy. These amounts can be routinely determined for a particular patient, where various indicators are used (eg, type of disease, age of the patient, disease state, patient health, weight, etc.) to select an appropriate dosage or administration. The amount can be relatively standard.

The amount of active ingredient to be administered depends on the specific compound and dosage unit to be used, the mode and time of administration, the duration of treatment, the age, sex and general condition of the patient to be treated, the nature and extent of the symptoms to be treated, the rate of drug metabolism and excretion, possible drug combinations, and It may vary widely depending on considerations such as drug-drug interactions and the like.

Preferably, the amount of compound of formula (I) is 20 to 2000 mg, preferably 40 to 800 mg, more preferably 50 to 600 mg.

More preferably, p-toluenesulfonic acid of 4 {4- [3- (4-chloro-3-trifluoromethylphenyl) -ureido] -phenoxy} -pyridine-2-carboxylic acid methyl amide in the pharmaceutical composition The amount of salt is 27 to 2740 mg, preferably 54 to 1096 mg, more preferably 68 to 822 mg.

In another embodiment of the invention, the compound of formula I is administered in combination with one or more additional therapeutic agents in an amount that can be determined by one of ordinary skill in the art by their professional judgment.

The pharmaceutical composition according to the invention is administered at least once a day, preferably at most three times, more preferably at most two times. Administration via the oral route is preferred. For each administration, the number of tablets or capsules taken simultaneously should not exceed two.

Nevertheless, in some cases, it may be advantageous to deviate from the specified amounts depending on the body weight, the individual's behavior with respect to the active ingredient, the type of agent, and the time or interval of administration. For example, in some cases, less than the minimum amount mentioned above may be sufficient, while in other cases the upper limit specified must be exceeded. If relatively high doses are administered, it may be feasible to divide them into multiple individual doses throughout the day.

Combinations of the invention can achieve greater therapeutic efficacy than when the compounds are used alone, including an effective amount of one or more compounds of Formula I and one or more other therapeutic agents mentioned above. The combinations of the present invention may be useful for treating diabetic neuropathy and no therapeutic effect is observed when the agent is used alone or enhanced effects are observed when the combination is administered.

The relative ratios of each compound in the combinations of the present invention may also be selected based on their respective mechanism of action and disease biology. The relative ratios of each of the compounds can vary widely, and the present invention provides a combination for treating diabetic neuropathy, in which the amounts of the compounds of formula I and other therapeutic agents can be conventionally adjusted such that one of the two is present in higher amounts. Include.

The release of one or more agents in the combination may also be controlled to provide the desired therapeutic activity when appropriate in a single dosage form, combination pack, kit, or individual independent dosage form.

Preferred are combinations comprising at least one compound of formula (I) and at least one NSAID. More preferably, 4 {4- [3- (4-chloro-3-trifluoromethylphenyl) -ureido] -phenoxy} -pyridine-2-carboxylic acid methyl amide (BAY 43-9006) or 4 P-toluenesulfonic acid salt of {4- [3- (4-chloro-3-trifluoromethylphenyl) -ureido] -phenoxy} -pyridine-2-carboxylic acid methyl amide, and at least one NSAID Combinations are used. Most preferably, 4 {4- [3- (4-chloro-3-trifluoromethylphenyl) -ureido] -phenoxy} -pyridine-2-carboxylic acid methyl amide (BAY 43-9006) or 4 P-toluenesulfonic acid salt of {4- [3- (4-chloro-3-trifluoromethylphenyl) -ureido] -phenoxy} -pyridine-2-carboxylic acid methyl amide, and o-acetylsalicylic acid Combinations are used.

Claims (17)

Use of a compound of formula (I), or a pharmaceutically acceptable salt, polymorph, solvate, hydrate, metabolite, prodrug or diastereomeric form thereof, in the manufacture of a medicament for the treatment of diabetic neuropathy: <Formula I>

Where Q is -C (O) R _x , R _x is hydroxy, C _{1 -4} alkyl, C _{1 -4} alkoxy, or NR _a R _b, R _a and R _b are independently a) hydrogen; b)-hydroxy, - C _{1 -4} alkoxy, -Pyrrole, furan, thiophene, imidazole, pyrazole, thiazole, oxazole, isoxazole, isothiazole, triazole, tetrazole, thiadiazole, oxadiazole, pyridine, pyrimidine, pyridazine, pyrazine , Heteroaryl group selected from triazine, benzoxazole, isoquinoline, quinoline and imidazopyrimidine, Tetrahydropyrans, tetrahydrofuran, 1,3-dioxolane, l, 4-dioxane, morpholine, thiomorpholine, piperazine, piperidine, piperidinone, tetrahydropyrimidone, pentamethylene sulfide , Heterocyclic group selected from tetramethylene sulfide, dihydropyran, dihydrofuran and dihydrothiophene, - one or two C _{1 -4} alkyl group optionally substituted by amino or -NH ₂ -Phenyl Optionally substituted C _{1 -4} alkyl by; c)-halogen or - one or two C _{1 -4} alkyl, optionally substituted by an amino -NH ₂ Phenyl optionally substituted with; or d) pyrrole, furan, thiophene, imidazole, pyrazole, thiazole, oxazole, isoxazole, isothiazole, triazole, tetrazole, thiadiazole, oxadiazole, pyridine, pyrimidine, pyridazine, A heteroaryl group selected from pyrazine, triazine, benzoxazole, isoquinoline, quinoline and imidazopyrimidine, A is an optionally substituted phenyl group of formula 1xx, an optionally substituted pyridinyl group of formula 1x, or an optionally substituted naphthyl residue of formula 1y: <Formula 1xx>

<Formula 1x>

<Formula 1y>

, B is optionally substituted phenyl or naphthyl of formulas 2a and 2b: <Formula 2a>

<Formula 2b>

, L is a bridging group which is -S- or -O-, p is 0, 1, 2, 3 or 4, n is 0, 1, 2, 3, 4, 5 or 6, m is 0, 1, 2 or 3, Each R ¹ is independently halogen, C _{1 -5} alkyl, _{halo, NO 2, C (O)} NR 4 R 5, C 1 -6 alkyl, C _{1 -6} dialkyl amine, C _{1 -3} alkyl amines, CN , an amino, hydroxy or C _{1 -3} alkoxy, Each R ² is independently a C _{1 -5} alkyl, hydroxy, C _{1 -5} alkyl, halo, C _{1 -3} alkoxy, N- oxo-N- or dihydroxydiphenyl, Each R ³ is independently halogen, R ⁴ , OR ⁴ , S (O) R ⁴ , C (O) R ⁴ , C (O) NR ⁴ R ⁵ , oxo, cyano or nitro (NO ₂ ), R ⁴ and R ⁵ are independently hydrogen, C _{1 -6} alkyl or fur-a C _{1 -6} alkyl halide to. The method of claim 1, A is 3-tert-butyl phenyl, 5-tert-butyl-2-methoxyphenyl, 5- (trifluoromethyl) -2-phenyl, 3- (trifluoromethyl) -4-chlorophenyl, 3- (Trifluoromethyl) -4-bromophenyl or 5- (trifluoromethyl) -4-chloro-2-methoxyphenyl; B is

ego; R ¹ is fluorine, chlorine, bromine, methyl, NO ₂ , C (O) NH ₂ , methoxy, SCH ₃ , trifluoromethyl or methanesulfonyl; R ² is methyl, ethyl, propyl, oxygen or cyano; R ³ is trifluoromethyl, methyl, ethyl, propyl, butyl, isopropyl, tert-butyl, chlorine, fluorine, bromine, cyano, methoxy, acetyl, trifluoromethanesulfonyl, trifluoromethoxy or tri Fluoromethylthioin. Use according to claim 1 or 2, wherein the compound of formula (I) is also in the form of a compound of formula (II) or a salt, polymorph, solvate, hydrate, metabolite, prodrug or diastereoisomer thereof. <Formula II>

Where Ra and Rb are independently hydrogen and C ₁ -C ₄ alkyl, B is

ego, Wherein the urea group —NH—C (O) —NH— and the oxygen bridging group are not bonded to adjacent ring carbons of B, but are separated and bonded by one or two ring carbons, A is of the general formula 1x or 1xx: <Formula 1x>

<Formula 1xx>

, Where variable n is 0, 1, 2, 3 or 4, and R ³ is trifluoromethyl, methyl, ethyl, propyl, butyl, isopropyl, tert-butyl, chlorine, fluorine, bromine, cyano, methoxy , Acetyl, trifluoromethanesulfonyl, trifluoromethoxy or trifluoromethylthio. The method according to any one of claims 1 to 3, Each of the R ³ substituents is chlorine, trifluoromethyl, tert-butyl or methoxy, A in formula (II)

ego, B of Formula (II) is phenylene, fluoro-substituted phenylene or difluoro-substituted phenylene. The use according to any one of claims 1 to 4, wherein the compound of formula (I) is also in the form of a compound of formula (X) or a salt, polymorph, solvate, hydrate, metabolite, prodrug or diastereomeric form thereof. : <Formula X>

Where The phenyl ring “B” optionally has one halogen substituent, A is an optionally substituted phenyl group of formula 1xx, an optionally substituted pyridinyl group of formula 1x, or an optionally substituted naphthyl residue of formula 1y: <Formula 1xx>

<Formula 1x>

<Formula 1y>

, n is 0, 1, 2, 3, 4, 5 or 6, m is 0, 1, 2 or 3, Each R ² is independently a C _{1 -5} alkyl, hydroxy, C _{1 -5} alkyl, halo, C _{1 -3} alkoxy, N- oxo-N- or dihydroxydiphenyl, Each R ³ is independently halogen, R ⁴ , OR ⁴ , S (O) R ⁴ , C (O) R ⁴ , C (O) NR ⁴ R ⁵ , oxo, cyano or nitro (NO ₂ ), R ⁴ and R ⁵ are independently hydrogen, C _{1 -6} alkyl or fur-a C _{1 -6} alkyl halide to. 6. Use according to claim 5, wherein m is 0 and A is phenyl substituted with one or more substituents R ³ . 7. Use according to claim 6, wherein R ³ is halogen, trifluoromethyl and / or methoxy. The use according to claim 1, wherein the compound of formula (I) is also in the form of a compound having the structure of one of formulas Z1 or Z2, or salts, polymorphs, solvates, hydrates, metabolites, prodrugs or diastereomers thereof. <Formula Z1>

<Formula Z2>

9. Use according to claim 8, wherein the compound of formula I is the tosylate salt of the compound of formula Z1. From at least one compound of formula (I) as defined in any one of claims 1 to 9 and an analgesic, antidepressant, antidiabetic, glucose modulator, neuroprotective, anticonvulsant, anesthetic, anti-inflammatory and capsaicin Combination comprising one or more therapeutic agents selected. The combination of claim 10, wherein the additional therapeutic agent is an NSAID or an antidiabetic agent. The combination of claim 10, wherein the additional therapeutic agent is o-acetylsalicylic acid. Use of the combination of any one of claims 10 to 12 in the manufacture of a medicament for the treatment of diabetic neuropathy. A pharmaceutical composition comprising a combination as defined in any one of claims 10-12. The pharmaceutical composition of claim 14 for the treatment of diabetic neuropathy. Administering to a subject in need thereof an effective amount of at least one compound of formula (I), or a pharmaceutically acceptable salt, polymorph, solvate, hydrate, metabolite, prodrug, or diastereomeric form thereof A method of treating diabetic neuropathy in said subject, comprising: <Formula I>

Where Q is -C (O) R _x , R _x is hydroxy, C _{1 -4} alkyl, C _{1 -4} alkoxy, or NR _a R _b, R _a and R _b are independently a) hydrogen; b)-hydroxy, - C _{1 -4} alkoxy, -Pyrrole, furan, thiophene, imidazole, pyrazole, thiazole, oxazole, isoxazole, isothiazole, triazole, tetrazole, thiadiazole, oxadiazole, pyridine, pyrimidine, pyridazine, pyrazine , Heteroaryl group selected from triazine, benzoxazole, isoquinoline, quinoline and imidazopyrimidine, Tetrahydropyrans, tetrahydrofuran, 1,3-dioxolane, l, 4-dioxane, morpholine, thiomorpholine, piperazine, piperidine, piperidinone, tetrahydropyrimidone, pentamethylene sulfide , Heterocyclic group selected from tetramethylene sulfide, dihydropyran, dihydrofuran and dihydrothiophene, - one or two C _{1 -4} alkyl group optionally substituted by amino or -NH ₂ -Phenyl Optionally substituted C _{1 -4} alkyl by; c)-halogen or - one or two C _{1 -4} alkyl, optionally substituted by an amino -NH ₂ Phenyl optionally substituted with; or d) pyrrole, furan, thiophene, imidazole, pyrazole, thiazole, oxazole, isoxazole, isothiazole, triazole, tetrazole, thiadiazole, oxadiazole, pyridine, pyrimidine, pyridazine Is a heteroaryl group selected from pyrazine, triazine, benzoxazole, isoquinoline, quinoline and imidazopyrimidine, A is an optionally substituted phenyl group of formula 1xx, an optionally substituted pyridinyl group of formula 1x, or an optionally substituted naphthyl residue of formula 1y: <Formula 1xx>

<Formula 1x>

<Formula 1y>

, B is optionally substituted phenyl or naphthyl of formulas 2a and 2b: <Formula 2a>

<Formula 2b>

, L is a bridging group which is -S- or -O-, p is 0, 1, 2, 3 or 4, n is 0, 1, 2, 3, 4, 5 or 6, m is 0, 1, 2 or 3, Each R ¹ is independently halogen, C _{1 -5} alkyl, _{halo, NO 2, C (O)} NR 4 R 5, C 1 -6 alkyl, C _{1 -6} dialkyl amine, C _{1 -3} alkyl amines, CN , an amino, hydroxy or C _{1 -3} alkoxy, Each R ² is independently a C _{1 -5} alkyl, hydroxy, C _{1 -5} alkyl, halo, C _{1 -3} alkoxy, N- oxo-N- or dihydroxydiphenyl, Each R ³ is independently halogen, R ⁴ , OR ⁴ , S (O) R ⁴ , C (O) R ⁴ , C (O) NR ⁴ R ⁵ , oxo, cyano or nitro (NO ₂ ), R ⁴ and R ⁵ are independently hydrogen, C _{1 -6} alkyl or fur-a C _{1 -6} alkyl halide to. The compound of claim 16, wherein the compound of formula I is combined with one or more therapeutic agents selected from the group consisting of analgesics, antidepressants, antidiabetics, glucose modulators, neuroprotective agents, anticonvulsants, anesthetics, anti-inflammatory agents and capsaicin Way.