MXPA06007165A - Methods and compositions using thalidomide for the treatment and management of central nervous system disorders or diseases - Google Patents

Abstract

Methods of treating, preventing and/or managing central nervous system disorders, such as Amyotrophic Lateral Sclerosis (ALS or Lou Gehrig’s Disease) and related syndromes are disclosed. Specific methods encompass the administration of thalidomide, or a pharmaceutically acceptable salt, solvate, hydrate, or stereoisomer thereof, alone or in combination with a second active ingredient. Pharmaceutical compositions, single unit dosage form, and kits suitable for use in methods of the invention are also disclosed.

Description

METHODS AND COMPOSITIONS CONTAINING TALIDOMIDE FOR THE TREATMENT AND MANAGEMENT OF ALTERATIONS OR DISEASES OF THE CENTRAL NERVOUS SYSTEM 1. FIELD OF THE INVENTION This invention relates, in part, to the methods of treatment, prevention and / or management of central nervous system disorders, including, but not limited to, amyotrophic lateral sclerosis (ALS or Lou Gehrig's disease) and Related disorders, which consist of the administration of thalidomide, or the salt, solvate, hydrate or stereoisomer thereof, accepted for pharmaceutical use, alone or in combination with known therapeutics. 2. BACKGROUND OF THE INVENTION The alterations of the central nervous system affect a wide range of the population with different severity. In general, the primordial particularity of this class of disorders includes the significant deterioration of cognition or memory that represents a notable deterioration with respect to the previous level of functioning. Dementia, for example, is characterized by various cognitive impairments that include significant memory impairment and may be independent or as an underlying feature of various diseases such as Alzheimer's disease, Parkinson's disease, Huntington's disease and multiple sclerosis. , to mention just a few. Other disorders of the central nervous system can be delirium, or alterations in consciousness that happen for a short time, and amnestic alterations or small deteriorations of memory that occur in the absence of other central nervous system impairments. 2. 1 TALIDOMIDE Thalidomide is a racemic compound marketed under the brand name Thalomid® and with the chemical name a- (N-phthalimido) glutarimide or 2- (2,6-dioxo-3-piperidinyl) -lH-isoindol-1,3 ( 2H) -dione. The compound has structure I: Thalidomide was originally developed in the 1950s to treat morning sickness, but due to its teratogenic effects, it was withdrawn from use. Thalidomide has been approved in the United States for the acute treatment of cutaneous manifestations of erythema nodosum leprosum in leprosy. Physician's Desk Reference, 1153-1157 (57th edition, 2003). Because its administration to pregnant women can cause birth defects, the sale of thalidomide has been strictly controlled. Id. Thalidomide has been studied in the treatment of other diseases, such as chronic graft-versus-host disease, rheumatoid arthritis, sarcoidosis, inflammatory diseases, severe skin and inflammatory bowel disease. See, in general, Koch, H. P., Prog. Med. Chem. , 22: 165-242 (1985). See also, Moller, D. R. et al., J. Immunol. 159: 5157-5161 (1997); Vasiliauskas, E. A. et al., Gastroenterology 117: 1278-1287 (1999); Ehrenpreis, E. D. et al., Gastroenterology 117: 1271-1277 (1999). It has also been claimed that thalidomide can be combined with other medications to treat ischemia / reperfusion associated with coronary and cerebral occlusion. See US Patent No. 5,643,915, which is incorporated herein by reference.

It was found that thalidomide exerts immunomodulatory and anti-inflammatory effects in various disease states, cachexia in AIDS, and opportunistic infections in AIDS. In studies that have been conducted to define the physiological targets of thalidomide, it was found that the drug has a wide variety of biological activities exclusive of its sedative effect including neurotoxicity, teratogenicity, suppression of TNF-a production by monocytes and macrophages, and the accompanying inflammatory diseases, associated with elevated levels of TNF-α, and inhibition of angiogenesis and neovascularization.

In addition, its beneficial effects have been observed in various dermatological states, ulcerative colitis, Crohn's disease, Behcets syndrome, systemic lupus erythematosus, aphthous ulcers, cancer and lupus. Anti-angiogenic properties of thalidomide have been documented in in vivo models. D'Amato et al., Thalidomide Is An Inhibitor of Angiogenesis, 1994, PNAS, USA 91: 4082-4085. Thalidomide also has a palliative effect in different neuropathic states, such as complex regional pain syndrome and radiculopathy.

However, the broad spectrum of thalidomide activity has not been fully determined. The available data from in vitro studies and preliminary clinical trials suggest that the immunological effects of the compound can vary considerably under different conditions. They may be related to the suppression of the production of tumor necrosis factor alpha (TNF-a) and the demodulation of selected cell surface adhesion molecules that participate in the migration of leukocytes. 2. 2 AMIOTROPHIC LATERAL SCLEROSIS Amyotrophic lateral sclerosis (ALS), commonly known as Lou Gehrig's disease in the United States, is a neurodegenerative disorder that affects the upper and lower motor neurons, leading to the wearing down of muscles that have lost their innervation. Nature, 1993, 364 (6435) 362. As the motor neurons degenerate, they no longer send impulses to the muscle fibers that normally allow muscle movement. ALS normally occurs in humans between the ages of 40 and 70. The first symptoms of ALS often include progressive muscle weakness, especially the arms and legs, speech, swallowing and breathing. In the same way, ALS can cause the emission of confusing words and difficult breathing. The pathological features may be shrinkage of the anterior nerve root in addition to atrophy of the spinal cord. Brain Res. Bull. , 1993, 30 (3-4), 359-64.

ALS is classified into three parts: sporadic ALS representing 90-95% of all cases of ALS; Family ALS that occurs more than once in a family lineage and represents 5 to 10% of all cases; and family ALS that occurs more than once in a family lineage and represents 5 to 10% of all cases; and ALS Guamaniana, which represents a very high incidence of ALS observed in Guam, and territories under fiduciary administration of the Pacific in the 1950s. ALS usually causes total paralysis and respiratory failure within 5 years of onset. 50% of patients with ALS die in approximately 18 months after diagnosis.

Currently, riluzole (Rilutek ™), a glutamate inhibitor, is the only approved therapy for ALS, and no other therapy for ALS or other agents are consistently effective in preventing the progression of the disease. Most of the therapy currently used focuses on the management of ALS symptoms. However, due to the side effects and the unattractive dose requirements of these drugs, new methods and compounds that can treat ALS and its symptoms are very necessary. 2. 3 PARKINSON DISEASE Parkinson's disease (PD) is the second most common neurodegenerative disease and affects approximately 1% of the population over 50 years of age. Polymeropoulos et al., 1996, Science 274: 1197-1198. Approximately one million Americans suffer from PD, and every year 50,000 people are diagnosed with the disease. Olson, L., 2000, Science 290: 721-724. Because the first symptoms of PD may not be recognized, perhaps as many as 10% of people over 60 years of age may have the disease. Olson, L., 2000, Science 290: 721-724.

Since 1960 it has been known that the loss of dopamine from neurons in the nigrostriatal pathway of the brain leads to motor abnormalities characteristic of PD. The common onset of PD occurs in middle to late adulthood with progressive clinical features. Some of the physical manifestations of PD may be rest tremors, muscle rigidity, postural instability, and dementia. The pathological characteristics of PD can be loss of dopaminergic neurons in the substantia nigra (SN) as well as the presence of intracellular inclusions or Lewy bodies in the surviving neurons in different areas of the brain. Nussbaum, R. L. and Polymeropoulos, M. H., 1997, Hum. Molec. Genet 6: 1687-1691. It is interesting to note that many other diseases have parkinsonian motor characteristics. The motor symptoms in PD are, in general, considered as a result of the deficiency or dysfunction of the dopamine or dopaminergic neurons in the substantia nigra. Nussbaum, R. L. and Polymeropoulos, M. H., 1997, Hum. Molec. Genet 6: 1687-1691. Some evidence has also suggested that molecular chaperones, specifically heat shock proteins, HSP70 and HSP40, may play a role in PD advancement. Auluck et al., 2002, Science 295: 865-868.

Much controversy has arisen regarding the origin of PD, and there is evidence that genetic and environmental factors can contribute to the disease. A study of the nuclear families of 948 PD cases concluded that there is a hereditary, Mendelian, primary and rare gene that influences the age of onset. Maher et al., 2002, Am. J. Med. Genet. 109: 191-197. This study also suggests the existence of a gene that influences susceptibility. Other evidence also suggests that environmental factors may be more significant than genetic factors in contributing to PD. Calne et al., 1987, Cañad. J. Neurol. Sci. 14: 303-305. Researchers have concluded that most cases of PD are caused by environmental factors imposed in a history of slow and prolonged neuronal loss due to aging. Calne, D. B and Langston, J. W., 1993, Lancet II 1457-1459. Although the origin is still unknown, it is very likely that genetic and environmental factors contribute to PD, and that environmental factors act on the genetic susceptibility to cause the disease. Recent evidence in animal models of Parkinson's disease suggests that anti-inflammatory agents inhibit the death of dopaminergic cells. McGeer et al., 2001, B. C. Med. J. 43: 138-141.

Although a cure for Parkinson's disease is not available, traditional treatment has focused on responding to the effect of the loss of dopamine in the brain. The treatment using the dopamine precursor, levodopa, has become the treatment of choice when it was discovered that the compound could alleviate PD symptoms, thereby improving the quality of life of the affected persons. Unfortunately, it has been found that long-term administration of levodopa can have side effects. Caraceni et al., 1994 Neurology, 41: 380. A variety of therapeutic strategies have been developed for the treatment of PD. MPTP, a neurotoxin known to specifically damage dopamine neurons, is commonly used as a model for the effects of PD. In one study, researchers used lentiviral vectors to deliver the neurotrophic factor derived from the cell line (GDNF) to the striatum and SN from rhesus monkeys that had been treated a week earlier with MPTP. Kordower et al., 2000, Science 290: 767-773. It is known that GDNF has trophic effects on the degeneration of nigrostriatal neurons in non-human primate models of Parkinson's disease. The results of the study showed that GDNF increased dopaminergic function in old monkeys and reversed functional deficiencies and prevented nigrostriatal degeneration in monkeys that had been treated with MPTP. It was also observed that treatment with GDNF reversed the motor deficiencies in monkeys treated with MPTP. This study also concluded that GDNF delivery could prevent nigrostriatal degeneration and induce regeneration of neurons in primate PD models. Kordower et al., 2000, Sicence 290: 767-773.

Another study that used electrical inhibition and pharmacological concealment of the symptoms of the subthalmic nucleus (STN), showed that the alteration of the basal ganglia network activity would improve the activity of the motor network in PD, supposedly suppressing the discharge activity of the neurons in the SN. Lou et al., 2002, Science 298: 425-429. The researchers used an adeno-associated virus to transduce the excitatory glutaminergic neurons in the rat STN with glutamic acid decarboxylase (GAD) to show that the change provided neuroprotection to the dopaminergic cells against toxic insults. It is interesting to note that the rats with the transduced gene also showed significant improvement of parkinsonian phenotypes. 2. 4 ALZHEIMER'S DISEASE Alzheimer's disease (AD) is a form of neurodegeneration that increasingly prevails representing approximately 50-60% of the total cases of dementia among people over 65 years of age. It currently affects approximately 15 million people worldwide, and due to the relative increase in people of advanced age in the population it is very likely that its prevalence will increase during the next 2 to 3 decades.

Alzheimer's disease is a progressive disease with an average duration of approximately 8.5 years between the onset of clinical symptoms and death. The death of pyramidal neurons and the loss of neuronal synapses in the brain regions associated with higher mental functions results in typical symptoms, characterized by evident and progressive impairment of cognitive function (Francis et al, 1999, J. Neurol. Neurosurg, Psychiatry 66: 137-47). Alzheimer's disease is the most common form of senile and presenile dementia in the world, and is clinically recognized as the relentlessly progressive dementia that presents with increasing memory loss, intellectual function and speech disturbances (Merritt, 1979, A Texbook of Neurology, 6th edition pp. 484-489 Read &Febiger, Philadelphia). The disease itself usually has a slow and steady progress that affects both sexes worldwide equally. It begins with moderately inappropriate behavior, noncritical statements, irritability, tendency toward grandiosity, euphoria, and decreased work performance; advances through deterioration in operative judgment, loss of perception, depression and loss of recent memory; it results in severe disorientation and confusion, apraxia of gait, generalized stiffness, and incontinence (Gilroy &Meyer, 1979, Medical Neurology, pp. 175-179 MacMillan Publishing Co.).

The origin of Alzheimer's disease is unknown. Evidence of genetic contribution emerges from some important observations such as family incidence, genealogical tree analysis, monozygotic and zygotic twin studies and the association of disease with Down syndrome (for review see Baraitser, 1990, The Genetics of Neurological Disorders , 2nd edition, pp. 85-88). However, this evidence is far from definitive and it is clear that one or more other factors are also needed. Elevated concentrations of aluminum have been found in the brains of some patients who died with Alzheimer's disease (Crapper et al, 1976, Brain, 99: 67-80) and one case documented markedly elevated magnesium concentrations in the tissues of a patient with Alzheimer's disease (Banta &Markesberg, 1977, Neurology, 27: 213-216), which gave rise to the suggestion that high concentrations of these metals can be neurotoxic and lead to the development of Alzheimer's disease. It was interesting to find that aluminum ions associated mainly with nuclear chromatin in regions of the brain to most likely present neurofibrillary tangles in Alzheimer's disease. However, from the statistical point of view, the absolute differences found in the aluminum levels between normal and Alzheimer brains were far from convincing. Recently, it has been suggested that there are effects on the transcriptional splicing of the mRNA that codes for the tau complex of the microtubules associated with the proteins (for review see Kosik, 1990, Curr, Opinion Cell Biol. 2: 101-104) and / or that there is inappropriate phosphorylation of these proteins (Grundke-Igbak et al., 1986, Proc Nati, Acad Sci USA 83: 4913-4917, Wolozin &Davies, 1987, Ann Neurol 22: 521-526; Hyman et al., 1988, Ann Neurol., 23: 371-379; Bancher et al., 1989, Brain, Res. 477: 90-99). Furthermore, the reduction in the enzymes involved in the synthesis of acetylcholine has allowed Alzheimer's disease to be seen as a failure of the cholinergic system (Danish &Moloney, 1976, Lancet, ii: 1403-14). However, even if cholinergic neurons are more at risk in Alzheimer's disease, it seems very likely that these reductions in enzyme activity are secondary to the degenerative process itself rather than related to the cause.

Currently there are no proven treatments for Alzheimer's disease, and no agent is consistently effective to prevent the progression of the disease. Most of the therapy currently used focuses on the management of AD symptoms. These strategies have used anti-psychiatric drugs as well as neuroleptic agents and acetylcholinesterase inhibitors. However, due to the side effects and the unattractive dosage requirements of these drugs, new methods and compounds that can treat AD and its symptoms are very necessary. 3. SUMMARY OF THE INVENTION This invention comprises methods for the treatment or prevention of central nervous system disorders and related disorders, which consist of administering to a patient in need of such treatment or prevention, an effective therapeutic or prophylactic amount of thalidomide, or a salt, solvate, hydrate or stereoisomer thereof, accepted for pharmaceutical use. Central nervous system disorders may be, but are not limited to, amyotrophic lateral sclerosis, Alzheimer's disease, Parkinson's disease, Huntington's disease, multiple sclerosis, other neuroimmune disorders such as Tourette's syndrome, delirium or disturbances in the consciousness that they occur during brief times, and amnestic alterations, or discrete deterioration of memory that occur in the absence of other central nervous system defects. The invention also encompasses methods for managing neurodegenerative disorders of the central nervous system (e.g. prolongation of the time of remission of its symptoms) which consist of administering to a patient in need of such management an effective prophylactic amount of thalidomide, or a salt, solvate, hydrate or stereoisomer thereof, accepted for pharmaceutical use. Each of these methods includes the specific dose or dosage schedules that include the cyclic treatment.

The invention further comprises pharmaceutical compositions, individual unit dosage forms and equipment suitable for use in the treatment, prevention and / or management of disorders of the central nervous system, preferably ALS, which contain thalidomide, or a salt, solvate, hydrate or stereoisomer thereof, accepted for pharmaceutical use.

In the specific embodiments of the invention, thalidomide is used with one or more secondary active ingredients to treat, prevent or manage disorders of the central nervous system, preferably ALS. Examples of the second active ingredients may be, but are not limited to, dopamine agonists, levodopa, compounds used to increase the treatment with levodopa, such as monoamine oxidase (MAO) inhibitors, catechol-o-inhibitors. methyltransferase (COMT), amantadine, cholinesterase inhibitors, glutamine inhibitors, anticholinergics, antiemetics and other normal treatments for central nervous system disorders. In another example, the second active ingredients are anti-inflammatory agents, including, but not limited to, nonsteroidal anti-inflammatory drugs (NSAIDs), PDE-4 inhibitors, Jun N-terminal kinase inhibitors, methotrexate, leflunomide, antimalarial drugs and sulfasalazine, gold salts, glucocorticoids, immunosuppressive agents and other normal treatments for Parkinson's disease and related disorders. 4. DETAILED DESCRIPTION OF THE INVENTION A first embodiment comprises methods for the treatment or prevention of disorders of the central nervous system, which comprise ALS, which consist of administering to a patient in need of treatment or prevention such as this an effective therapeutic or prophylactic amount. of thalidomide, or a salt, solvate, hydrate or stereoisomer thereof, accepted for pharmaceutical use. Central nervous system disorders may be, but are not limited to, amyotrophic lateral sclerosis (ALS), Parkinson's disease; bradykinesia); muscular stiffness; Parkinsonian tremors; parkinsonian gait; rigidity of movement; depression; dementia; sleep disturbances; postural instability; hypokinetic disorders; inflammation of the CNS and peripheral nerves; synuclein alterations; atrophies of multiple systems; striatonigral degeneration, olivopontocerebellar atrophy; Shy-Draguer syndrome; motor neuron disease with parkinsonian characteristics; dementia of Lewy bodies; alterations due to tau pathology; progressive supranuclear palsy; corticobasal degeneration; frontotemporal dementia; alterations in amyloid pathology; Alzheimer disease; Alzheimer's disease with Parkinsonism; genetic alterations that may have parkinsonian characteristics; ilson's disease; Hallervorden-Spatz disease; Chedíak-Hagashi disease; SCA-3 spinocerebellar ataxia; parkinsonism with dystonia linked to X; Huntington's disease; prion disease; hyperkinetic alterations; Korea; ballism; dystonia tremors; alterations spasms or tics, which includes, but is not limited to, Tourette's syndrome; CNS trauma and myoclonus. A specific alteration of the central nervous system is amyotrophic lateral sclerosis.

Another embodiment of the invention comprises methods for the management of a central nervous system disorder, which consists of administering to a patient in need of such management an effective prophylactic amount of thalidomide, or a salt, solvate, hydrate or stereoisomer of this, accepted for pharmaceutical use.

Another embodiment of the invention comprises a method of treatment, prevention and / or management of a disorder of the central nervous system, which consists of administering to a patient in need of treatment, prevention and / or management such as this, a therapeutic or prophylactic amount. effective thalidomide, or a salt, solvate, hydrate or stereoisomer thereof, accepted for pharmaceutical use and an effective therapeutic or prophylactic amount of a second active agent.

Another embodiment of the invention comprises a method for reversing, reducing or avoiding an adverse effect associated with the administration of traditional treatment of central nervous system disorders to a patient suffering from central nervous system disorders or a related disorder, which consists of in administering to a patient in need of such reversion, reduction or avoidance an effective therapeutic or prophylactic amount of thalidomide, or a salt, solvate, hydrate or stereoisomer thereof, accepted for pharmaceutical use.

Yet another embodiment of the invention comprises a pharmaceutical composition containing thalidomide, or a salt, solvate, hydrate or stereoisomer thereof, accepted for pharmaceutical use, and a carrier, diluent or excipient accepted for pharmaceutical use, wherein the composition is adapted for parenteral, oral or transdermal administration, and the amount is sufficient to treat or prevent a central nervous system disorder, preferably ALS or to lessen the symptoms or the progression of the disease.

Also included by the invention are individual unit dosage forms containing thalidomide, or a salt, solvate, hydrate or stereoisomer thereof, accepted for pharmaceutical use.

The second active agents can be large molecules (for example proteins) or small molecules (for example inorganic, organometallic or synthetic organic molecules). Examples of the second active agent may be, but are not limited to, cytokines, hematopoietic growth factors, anti-cancer agents such as topoisomerase inhibitors, anti-angiogenic agents, microtubule stabilizing agents, apoptosis-inducing agents, alkylation and other traditional chemotherapy described in The Physician's Desk Reference 2002; cholinesterase inhibitors; antivirals; antifungals; antibiotics; anti-inflammatory; immunomodulatory agents; immunosuppressive agents such as cyclosporins; and other known or usual agents that are used in patients with ALS or Parkinson's disease. The second specific active agents may be, but are not limited to, riluzole, for ALS, a dopamine agonist or antagonist for Parkinson's disease or a cholinesterase inhibitor for Alzheimer's disease.

The invention also comprises the equipment containing thalidomide, or a salt, solvate, hydrate or stereoisomer thereof, accepted for pharmaceutical use, a second active ingredient.

Thalidomide can be purchased from commercial sources such as Celgene Corporation (Warren, New Jersey) or can be prepared according to well-known methods. It is possible to synthesize thalidomide salts, solvates and hydrates by methods well known to the skilled practitioner. In addition, the optically pure compositions can be synthesized asymmetrically or can be resolved using known resolution agents or chiral columns, as well as other standard synthetic organic chemistry techniques. These isomers can be synthesized asymmetrically or can be resolved using standard techniques such as chiral columns or agents for chiral resolution. See, for example, Jacques, J. et al., Enantiomers, Racemates and Resolutions (Wiley-Interscience, New York, 1981); and Wilen, S. H. et al., Tetrahedron 33: 2725 (1977); Eliel, E. L., Stereochemistry of Carbon Compounds (McGraw-Hill, NY, 1962); and Wilen, S. H., Tables of Resolving Agents and Optical Resolutions p. 268 (E. L. Eliel, Ed., Univ. Of Notre Dame Press, Notre Dame, IN, 1972).

As used herein, and unless otherwise indicated, the term "salt accepted for pharmaceutical use" includes non-toxic acid and basic addition salts of the compound to which the term refers. Acceptable non-toxic acid addition salts may be those obtained from organic and inorganic acids or bases known in the art, including, for example, hydrochloric acid, hydrobromic acid, phosphoric acid, sulfuric acid, methanesulfonic acid, acetic acid, acid tartaric acid, lactic acid, succinic acid, citric acid, malic acid, maleic acid, sorbic acid, aconitic acid, salicylic acid, phthalic acid, embolic acid, enanthic acid and the like.

The compounds to acids can be formed with salts with different bases accepted for pharmaceutical use. The bases that can be used to prepare accepted basic addition salts for pharmaceutical use of such acidic compounds are those which form non-toxic base addition salts, ie, the salts containing cations accepted for pharmaceutical use as they can be, but are not they limit to, salts of alkaline metals or alkaline earth metals and the salts of calcium, magnesium, sodium, or potassium in particular. Suitable organic bases can be, but are not limited to, N, N'-dibenzylethylenediamine, chloroprocaine, choline, diethanolamine, ethylenediamine, meglumain (N-methylglucamine), lysine and procaine.

Thalidomide contains one or more chiral centers, and may exist as racemic mixtures of enantiomers or mixtures of diastereomers. This invention comprises the use of the stereomerically pure forms of thalidomide, as well as the use of mixtures of these forms. For example, it is possible to use in the methods and compositions of the invention mixtures containing equivalent or non-equivalent amounts of thalidomide enantiomers. The purified (R) or (S) enantiomers of the specific compounds described herein can be used practically free of their other enantiomer.

When used herein, and unless otherwise indicated, the term "stereo-purely pure" means a composition that comprises a stereoisomer of a compound and is substantially free of the other stereoisomer of that compound. For example, a stereoimically pure composition of a compound having a chiral center will be substantially free of the opposite enantiomer of the compound. A stereomerically pure composition of the compound having two chiral centers will be practically free of other diastereomers of the compound. A common stereomerically pure compound comprises more than about 80% of a stereoisomer of the compound and less than about 20% by weight of the other stereoisomer of the compound, more preferably more than about 90% of a stereoisomer of the compound and less than about 10 % by weight of the other stereoisomer of the compound, even more preferably, more than about 95% of a stereoisomer of the compound and less than about 5% by weight of the other stereoisomer of the compound, and more preferably, more than about 97% of a stereoisomer of the compound and less than about 3% by weight of the other stereoisomer of the compound.

When used herein, and unless otherwise indicated, the term "enantiomerically pure" means a composition of enantiomeric purity of a compound having a chiral center.

It should be noted that if there is a difference between a structure represented and a name given to this structure, the structure represented must be taken more into account. Furthermore, if the stoichiometry of a structure or a part of a structure is not indicated with, for example, bold or dashed lines, the structure or part of the structure must be construed as comprising all stereoisomers thereof. 4. 1 SECONDS ACTIVE INGREDIENTS As already mentioned, it is possible to use a second ingredient or active agent in the methods and compositions of the invention together with thalidomide, particularly the traditional agents or therapies that are used to treat or manage disorders of the central nervous system. The second specific active agents also stimulate the division and differentiation of erythroid progenitors committed in cells in vitro or in vivo.

In one embodiment, it is possible to administer a second active ingredient with thalidomide, or a salt, solvate, hydrate or stereoisomer thereof, accepted for pharmaceutical use. In a specific embodiment, the second active ingredient is riluzole. In one embodiment, the second active ingredient is a dopamine agonist or antagonist, for example, but not limited to, Levodopa, L-DOPA, cocaine, a-methyltyrosine, reserpine, tetrabenazine, benzotropin, pargyline, fenodolpam mesylate, cabergoline , pramipexole dihydrochloride, ropinorol, amantadim hydrochloride, selegiline hydrochloride, carbidopa, pergolide mesylate, Sinemet CR or Symmetrel.

In another embodiment, the second active ingredient that is administered with thalidomide, or a salt, solvate, hydrate or stereoisomer thereof, accepted for pharmaceutical use, is an MAO inhibitor, for example, but not limited to, iproniazid, clorgyline, phenelzine and isocarboxazide.

In another embodiment, a second active ingredient that is administered with thalidomide, or a salt, solvate, hydrate or stereoisomer thereof, accepted for pharmaceutical use, is a COMT inhibitor, for example, but is not limited to tolcapone and entacapone.

In another embodiment, the second active ingredient that is administered with thalidomide, or a salt, solvate, hydrate or stereoisomer thereof, accepted for pharmaceutical use, is a cholinesterase inhibitor, for example, but not limited to, salicylate [sic] of physostigmine, physostigmine sulfate, physostigmine bromide, meostigmine bromide, neostigmine methylisulfate, ambenonim chloride, edrophonium chloride, tacrine, pralidoxime chloride, obidoxime chloride, trimedoxime bromide, diacetyl monoxime, endophonium, pyridostigmine and demecarium.

In still another embodiment, the second active ingredient that is administered with thalidomide, or a salt, solvate, hydrate or stereoisomer thereof, accepted for pharmaceutical use, is an anti-inflammatory agent that can be, but is not limited to, naproxen sodium , diclofenac sodium, diclofenac potassium, celecoxib, sulindaco, oxaprozin, diflunisal, etodolaco, meloxicam, ibuprofen, ketoprofen, nabumetone, refecoxib, methotrexate, leflunomide, sulfasalazine, gold salts, immunoglobulin RH0-D, mycophenolate mofetil, cyclosporine, azathioprine, tacrolimus, basiliximab, daclizumab, salicylic acid, acetylsalicylic acid, methyl salicylate, diflunisal, salsalate, olsalazine, sulfasalazine, acetaminophen, indomethacin, sulindaco, mefenamic acid, meclofenamate sodium, tolmetin, guetorolaco, diclofenac, flurbinprofen, oxaprozin, piroxicam, meloxicam, ampiroxicam, droxicam, pivoxicam, tenoxicam, phenylbutazone, oxyphenbutazone, antipyrine, aminopyrine, apazone, zileuton , aurothioglucose, gold sodium thiomalate, auranofin, methotrexate colchicine, allopurinol, probenecid, sulfinpyrazone and benzbromarone or betamethasone and other glucocorticoids.

In yet another embodiment, the second active ingredient that is administered with thalidomide, or a salt, solvate, hydrate or stereoisomer thereof, accepted for pharmaceutical use, is an antiemetic agent, for example, but not limited to, metoclopromide, domperidone, prochlorperazine, promethazine, chlorpromazine, trimethobenzamide, ondansetron, granisetron, hydroxyzine, acetylleucine monoethanolamine, alizapride, azasetron, benzquinamide, bietanautine, bromopride, bluclizine, clebopride, cyclizine, dimenhydrinate, diphenidol, dolasetron, meclizine, metalatal, metopimazine, nabilon, oxyperdyl, pipamazine , scopolamine, sulpiride, tetrahydrocannabinol, thiethylperazine, thioproperazine, tropisetron and mixtures thereof. 4. 2. METHOD OF TREATMENT AND HANDLING The methods of this invention comprise methods for the prevention, treatment and / or management of central nervous system disorders, preferably ALS, Parkinson's disease, neuroimmune disorders such as Tourette's syndrome or the disease of Alzheimer's When used herein, unless otherwise indicated, the term "prevention" includes but is not limited to, the inhibition or avoidance of symptoms associated with neurodegenerative disorders of the central nervous system. Central nervous system disorders can be, but are not limited to, amyotrophic lateral sclerosis (ALS); CNS trauma with progressive motor deterioration; kinetic type disorders, bradykinesia, movement promotion; difficulty of movement; deteriorate of dexterity; hypophonia; monotonic voice; muscle stiffness, facial expression inexpressive; decreased flicker; stooped posture; decreased swing of the arms when walking; micrography; Parkinsonian tremor; parkinsonian gait; postural instability; hurried march; rigidity of movement; cognitive disorders, mood, sensation, sleep or autonomic function; dementia; depression and sleep disturbances. When used herein, unless otherwise indicated, the term "treatment" refers to the administration of a composition after the onset of the symptoms of central nervous system disorders, preferably Parkinson's disease or a related disorder, while "prevention" refers to administration before the onset of symptoms, particularly in patients at risk for central nervous system disorders, preferably Parkinson's disease or a related disorder. When used herein, and unless otherwise indicated, the term "management" includes the prevention of the reappearance of the symptoms of central nervous system disorders in a patient who has suffered disorders of the central nervous system, the prolongation of the time in which the symptoms remain in remission in a patient who has suffered central nervous system disorders or the prevention of the incidence of central nervous system disorders in patients at risk of suffering central nervous system disorders.

In a specific modality, the central nervous system disorder that could be prevented, treated and / or managed is not Parkinson's disease, but Alzheimer's disease, dementia, depression, amyotrophic lateral sclerosis (ALS), neuroimmunological disorders or trauma. of the SNC.

The invention comprises methods for the treatment or prevention of disorders of the central nervous system, preferably ALS, Parkinson's disease or Alzheimer's disease. In one embodiment, the methods of the invention are used to treat or prevent movement-related disorders, including but not limited to, progressive motor impairment, slow performance or bradykinesia, lack of movement or akinesia, movement disorders that impair movement. fine motor control and fingerprinting, and other manifestations of bradykinesia such as, but not limited to, hypophonia and monotonic speech. In another embodiment, the methods of the invention are used to treat or prevent disorders related to muscle rigidity, including but not limited to, uniform increase in resistance to passive movement, interruptions to passive movement, and combinations of stiffness and dystonia. In a specific embodiment, the methods of the invention are used to treat inflammation associated with Parkinson's or related disease. In still another embodiment of the invention, disorders resembling parkinsonian tremors are treated or prevented by the methods of the invention, including, but not limited to, tremors of the face, jaw, tongue, posture and other tremors. that are present at rest and that decrease during movement. In another embodiment, the methods of the invention are used to treat or prevent gait disorders including, but not limited to, those that resemble parkinsonian gait, shuffle walking, short steps, tendency to turn en bloc and hurried march. In another embodiment of the invention, non-motor symptoms are treated or prevented using the methods of the invention which include, but are not limited to, alterations in mood, cognition, sensation, sleep, dementia and depression. In another embodiment of the invention, secondary forms of parkinsonism are treated or prevented by the methods of the invention including, but not limited to, drug-induced parkinsonism, vascular parkinsonism, multiple system atrophy, progressive supranuclear palsy, disorders with primary tau pathology, degeneration of cortical basal ganglia, parkinsonism with dementia, hyperkinetic disorders, chorea, Huntington's disease, dystonia, Wilson's disease, Tourette's syndrome, essential tremor, myoclonus and slow-moving disorders. In another embodiment of the invention, other disorders of the central nervous system are treated or prevented by the methods of the invention including, but not limited to, Alzheimer's disease, amyotrophic lateral sclerosis (ALS) and CNS trauma.

The methods encompassed by this invention consist of administering thalidomide, or a salt, solvate, hydrate or stereoisomer thereof, accepted for pharmaceutical use, to a patient (may be a human) suffering, or possibly suffering, disorders of the central nervous system.

Another method is to administer: 1) thalidomide, or a salt, solvate, hydrate or stereoisomer thereof, accepted for pharmaceutical use, and 2) a second active agent or active ingredient. Examples of the second active agents are also described herein (see section 4.2).

The administration of thalidomide and the second active agent to a patient can occur at the same time or in succession by the same or different administration route. The suitability of a specific route of administration employed for a particular active agent will depend on the active agent itself (for example, if it can be administered orally without decomposing before entering the circulation) and the disease being treated. A preferred route of administration for thalidomide is the oral route. Preferred routes of administration for the second active agents or active ingredients of the invention are known to those skilled in the art. See for example Physcician's Desk Reference, 1775-1760 (56th edition) 2002).

In one embodiment of the invention, the range of the recommended daily dose of an immunomodulatory compound for the conditions described herein is within the range of from about 1 mg to about 10,000 mg per day, administered as a single dose once a day or preferably in divided doses throughout the day. More specifically, the daily dose is administered twice a day in evenly divided doses. Specifically, a daily dose range should be from about 1 mg to about 5,000 mg per day, more specifically, between about 10 mg and about 2500 mg per day, between about 1000 mg and about 800 mg per day, between about 100 mg and approximately 1200 mg per day or between around 25 mg and around 2500 mg per day. To manage a patient, treatment should be started at a lower dose, perhaps around 1 mg to about 2500 mg, and should be increased if necessary to approximately 200 mg to about 5000 mg per day as a single dose or in divided doses. , depending on the patient's general response. In a particular embodiment, thalidomide can preferably be administered in an amount of about 400, 800, 1200, 2500, 5000 or 10,000 mg per day in two divided doses.

In another embodiment, thalidomide is administered together with a second active agent. The second active agent is administered orally, intravenously or subcutaneously and once or twice a day in an amount of from about 1 to about 1000 mg, from about 5 to about 500 mg, from about 10 to about of 350 mg or from about 50 to about 200 mg. The specific amount of the second active agent will depend on the specific agent being used, the disorder being treated or handled, the severity and stage of the central nervous system disorder and the amount or quantities of thalidomide and the additional, optional active agents that they are administered concomitantly to the patient.

In some embodiments, the prophylactic or therapeutic agents of the invention are administered in a cyclic fashion to a patient. The cyclic treatment consists in the administration of a first agent for a time, followed by the administration of the agent and / or the second agent for a time and repeating this successive administration. Cyclic treatment can reduce the development of resistance to one or more of the therapies, avoid or reduce side effects of one of the therapies and / or improve the efficacy of the treatment.

In a preferred embodiment, the prophylactic or therapeutic agents are administered in a cycle of approximately 24 hours, approximately once or twice a day. A cycle may consist of the administration of a therapeutic or prophylactic agent and at least one (1) or three (3) weeks of rest. The number of cycles that are administered will be from about 1 to about 12 cycles, most commonly from about 2 to about 10 cycles and more commonly from about 2 to about 8 cycles. 4. 3. PHARMACEUTICAL COMPOSITIONS AND INDIVIDUAL UNITARY DOSAGE FORMS Pharmaceutical compositions can be used in the preparation of individual unit dosage forms. The pharmaceutical compositions and dosage forms of the invention contain thalidomide, or a salt, solvate, hydrate or stereoisomer thereof, accepted for pharmaceutical use. The pharmaceutical compositions and dosage forms of the invention may also contain one or more excipients.

The pharmaceutical compositions and dosage forms of the invention may also contain one or more additional active ingredients. Accordingly, the pharmaceutical compositions and dosage forms of the invention contain the active ingredients described herein (for example thalidomide, or a salt, solvate, hydrate or stereoisomer thereof, accepted for pharmaceutical use, and a second active ingredient) . Examples of additional, optional active ingredients are described herein (see for example section 4.2).

The individual unit dosage forms of the invention are suitable for oral, mucosal (eg nasal, sublingual, vaginal, buccal or rectal), or parenteral (eg, subcutaneous, intravenous, bolus, intramuscular or intraarterial), transdermal or transcutaneous to a patient. Examples of the dosage forms may be, but are not limited to: tablets, caplets, capsules such as soft gelatin capsules; cachets, troches, pills, dispersions, suppositories, powders, aerosols (for example, nasal injections or inhalers); gels, liquid dosage forms suitable for oral or mucosal administration to a patient such as suspensions (for example, aqueous or non-aqueous liquid suspensions, oil-in-water emulsions or water-in-oil liquid emulsions), solutions and elixirs; liquid dosage forms suitable for parenteral administration to a patient and sterile solids (eg, crystalline or amorphous solids) that can be resuspended or reconstituted to obtain liquid dosage forms suitable for parenteral administration to a patient.

The composition, configuration and type of dosage forms of the invention will vary depending on the use. For example, a dosage form that is used in the acute treatment of a disease may contain larger amounts of one or more of the active ingredients contained therein compared to a dosage form used in the chronic treatment thereof. disease. Likewise, a parenteral dosage form may contain smaller amounts of one or more active ingredients that it contains compared to an oral dosage form that is used to treat the same disease. These and other forms in which the specific dosage forms encompassed by this invention will vary will be apparent to those skilled in the art. See for example Remington's Pharmaceutical Sciences, 18th edition, Mack Publishing, Easton PA (1990).

The pharmaceutical compositions and the common dosage forms contain one or more excipients. Suitable excipients are well known to those skilled in the art and non-limiting examples of suitable excipients are provided herein. Whether a specific excipient is suitable for incorporation into a pharmaceutical composition or dosage form depends on various factors well known in the art including, but not limited to, the manner in which the dosage form is administered to the patient. For example, oral dosage forms as tablets may contain excipients not suitable for use in parenteral dosage forms. The suitability of a specific excipient will also depend on the specific active ingredients in the dosage form. For example, the decomposition of some active ingredients can be accelerated by some excipients such as lactose, or when exposed to water. Active ingredients containing primary or secondary amines are particularly susceptible to this accelerated decomposition. Accordingly, this invention comprises pharmaceutical compositions and dosage forms that contain little, if any, lactose other mono- or disaccharides [sic]. When used herein, the term "lactose free" means that the amount of lactose present, if any, is insufficient to significantly increase the rate of degradation of an active ingredient.

The lactose-free compositions of the invention may contain excipients well known in the art and are listed, for example, in the US Pharmacopeia (USP) 25-NF20 (2002). In general, the lactose-free compositions contain active ingredients, a binder / diluent, and a lubricant in compatible and accepted amounts for pharmaceutical use. Preferred lactose-free dosage forms contain active ingredients, microcrystalline cellulose, pregelatinized starch and magnesium stearate.

This invention also comprises anhydrous pharmaceutical compositions and dosage forms containing active ingredients, since water can facilitate the degradation of some compounds. For example, the addition of water (for example 5%) is widely accepted in pharmaceutical techniques as a means to simulate long-term storage to determine the characteristics of a shelf life or the stability of the formulations over time. See, for example, Jens T. Carstensen, Drug Stability: Principies & Practice, 2nd edition, Marcel Dekker, NY, NY, 1995, pp. 379-80. In effect, water and heat accelerate the decomposition of some compounds. Thus, the effect of water in a formulation can be of great importance since moisture is commonly encountered during the manufacture, handling, packaging, storage, shipping and use of the formulations.

The anhydrous pharmaceutical compositions and dosage forms of the invention can be prepared using anhydrous or low moisture content ingredients and low humidity conditions. Pharmaceutical compositions and dosage forms containing lactose and at least one active ingredient containing a primary or secondary amine are preferably anhydrous if considerable contact with moisture is expected during manufacture, packaging and storage.

An anhydrous pharmaceutical composition must be prepared and stored so that its anhydrous nature is maintained. Accordingly, the anhydrous compositions are preferably packaged using known materials to avoid exposure to water so that they can be included in convenient kits or formulation equipment. Examples of suitable packaging can be, but are not limited to, hermetically sealed aluminum sheets, plastics, unit dose packs (eg vials), blister packs and strip packs.

The invention further comprises pharmaceutical compositions and dosage forms containing one or more compounds that reduce the rate at which the active ingredient decomposes. These compounds, which are known herein as "stabilizers", can be, but are not limited to, antioxidants such as ascorbic acid, pH buffers or saline buffers [sic].

Like the amounts and types of excipients, the specific amounts and types of active ingredients in a dosage form may differ depending on factors such as, but not limited to, the route by which they are administered to patients. However, the common dosage forms of the invention contain thalidomide, or a salt, solvate, hydrate or stereoisomer thereof, accepted for pharmaceutical use in an amount from about 1 to about 1200 mg. The common dosage forms contain thalidomide, or a salt, solvate, hydrate or stereoisomer thereof, accepted for pharmaceutical use in an amount of about 1, 2, 5, 10, 25, 50, 100, 200400, 800, 1,200, 2,500 , 5,000 or 10,000 mg. In a particular embodiment, a preferred dosage form contains thalidomide in an amount of about 400, 800 or 1,200 mg. Common dosage forms contain the second active ingredient in an amount of 1 to about 1000 mg, from about 5 to about 500 mg, from about 10 to about 350 mg or from about 50 to about 200 mg. Of course, the specific amount of the second active ingredient will depend on the specific agent being used, the disorder being treated or handled, and the amount and amounts of thalidomide and any additional, optional active agents that are administered concomitantly to the patient. . 4. 3.1 ORAL DOSAGE FORMS The pharmaceutical compositions of the invention which are suitable for oral administration may be presented as small dosage forms, such as, but not limited to, tablets (eg chewable tablets), caplets, capsules, and liquids. (like syrups flavored). These dosage forms contain predetermined amounts of active ingredients and can be prepared by pharmacy methods well known to those skilled in the art. See, in general, Remington's, Pharmaceuticals Sciences, 18th edition Mack Publishing, Easton PA (1990).

The common oral dosage forms of the invention are prepared by combining the active ingredients in an intimate mixture with at least one excipient according to the traditional pharmaceutical composition techniques. The excipients can take a wide variety of forms depending on the form of preparation desired for administration. For example, suitable excipients for use in the liquid dosage form or oral aerosol include, but are not limited to, water, glycols, oils, alcohols, flavoring agents, preservatives and coloring agents. Examples of excipients suitable for use in solid oral dosage forms (eg powders, tablets, capsules or caplets) can be, but are not limited to, starches, sugars, microcrystalline cellulose, diluents, granulating agents, lubricants, binders. and disintegrating agents.

Because of their ease of administration, tablets and capsules represent the most advantageous oral dosage unit forms, in which case solid excipients are employed. If desired, the tablets can be coated by the normal aqueous or non-aqueous techniques. These dosage forms can be prepared by any pharmacy method. In general, pharmaceutical compositions and dosage forms are prepared by uniformly and intimately admixing the active ingredients with liquid carriers, finely divided solid carriers, or both, and then molding the product into the desired presentation, if necessary.

For example, a tablet can be prepared by compression or molding. Compressed tablets can be prepared by compressing in a convenient machine the active ingredients in a free-flowing form such as powders or granules, optionally mixed with an excipient. The molded tablets can be prepared by molding in a suitable machine a mixture of the powdered compound moistened with an inert liquid diluent.

Examples of the excipients that may be used in the oral dosage forms of the invention may be, but are not limited to, binders, diluents, disintegrants and lubricants. Suitable binders for use in pharmaceutical compositions and dosage forms include, but are not limited to, corn starch, potato starch or other starches, gelatin, natural and synthetic gums such as acacia, sodium alginate, alginic acid, other alginates, powdered tragacanth, guar gum, cellulose and their derivatives (for example ethylcellulose, cellulose acetate, calcium carboxymethylcellulose, sodium carboxymethylcellulose), polyvinyl pyrrolidone, methylcellulose, pregelatinized starch, hydroxypropylmethylcellulose (for example the numbers 2208, 2906, 2910), microcrystalline cellulose and mixtures thereof.

Suitable forms of microcrystalline cellulose may be, but are not limited to, materials marketed as AVICEL-PH-101, AVICEL-PH-103, AVICEL-RC-581, AVICEL-PH-105, (available from FMC Corporation), American Viseóse Division, sales Avicel, Marcus Hook, PA), and mixtures of these. A specific binder is a mixture of microcrystalline cellulose and sodium carboxymethylcellulose marketed as AVICEL-RC-581. The suitable and low moisture anhydrous additives or additives can be AVICEL-PH-103 ™ and Starch 1500 LM.

Examples of suitable diluents for use in the pharmaceutical compositions and dosage forms described herein include, but are not limited to, talc, calcium carbonate (eg, granules or powder), microcrystalline cellulose, powdered cellulose, dextrates, kaolin, mannitol, silicic acid, sorbitol, starch, pregelatinized starch and mixtures thereof. The binder or diluent in the pharmaceutical compositions of the invention will usually be present in amounts of from about 50 to about 99% by weight of the pharmaceutical composition or dosage form.

The disintegrants are used in the compositions of the invention to allow the tablets to disintegrate if exposed to an aqueous environment. Tablets that contain too much disintegrant can disintegrate in storage, while those that contain too little can not disintegrate at the desired rate or in the desired conditions. Thus, a sufficient amount of disintegrant that is not too much or too little to detrimentally alter the release of the active ingredients should be used to form the solid oral dosage forms of the invention. The amount of disintegrant used varies based on the type of formulation, and can be readily ascertained by those skilled in the art. Common pharmaceutical compositions contain from about 0.5 to about 15% by weight of disintegrant, preferably from about 1 to about 5% by weight of the disintegrant.

Disintegrants that can be used in the pharmaceutical compositions and dosage forms of the invention can be, but are not limited to, agar agar, alginic acid, calcium carbonate, microcrystalline cellulose, croscarmellose sodium, crospovidone, polacrilin potassium, glycolate starch of sodium, potato or tapioca starch, other starches, pregelatinized starch, other starches, clays, other algin, other celluloses gums and mixtures thereof.

Lubricants that may be used in the pharmaceutical compositions and dosage forms of the invention may be, but are not limited to, calcium stearate, magnesium stearate, mineral oil, light mineral oil, glycerin, sorbitol, mannitol, polyethylene glycol, other glycols , stearic acid, sodium lauryl sulfate, talcum, hydrogenated vegetable oil (such as peanut oil, cottonseed oil, sunflower oil, cessation oil, olive oil, corn oil and soybean oil), zinc stearate, ethyl oleate, ethyl laureate agar and mixtures thereof. Other lubricants may be, for example, a siloid silica gel (AEROSIL200, manufactured by WR Grace Co. of Baltimore, MD), a synthetic silica coagulated aerosol (marketed by Degusta Co. of Plano, TX), CAB-0- SIL (a pyrogenic silicon dioxide product marketed by Cabot Co. of Boston, MA) and mixtures thereof. If used, lubricants are normally used in an amount of less than about 1% by weight of the pharmaceutical compositions or dosage forms in which they are incorporated.

A preferred oral, solid dosage form of the invention contains thalidomide, anhydrous lactose, microcrystalline cellulose, polyvinylpyrrolidone, stearic acid, colloidal anhydrous silica and gelatin. 4. 3.2 DOSAGE FORMS FOR DELAYED DELIVERY The active ingredients of the invention can be administered by controlled release means or by delivery devices that are well known to those skilled in the art. Examples may be, but are not limited to, those described in US Patent Nos. 3,845,770; 3,916,899; 3,536,809; 3,598,123; and 4,008,719; 5,674,533; 5,059,595, 5,591,767; 5,120,548; 5,073,543; 5,639,476; 5,354,556 and 5,733,566, each of which is incorporated herein by reference. These dosage forms can be used to provide the slow or controlled release of one or more active ingredients using, for example, hydropropylmethyl cellulose, other polymer matrices, gels, permeable membranes, osmotic systems, multilayer coatings, microparticles, liposomes, microspheres or a combination of these to obtain the release profile that is desired in different proportions. Suitable controlled release formulations, known to those skilled in the art include those described herein, and can be readily selected for use with the active ingredients of the invention. The invention thus comprises individual unit dosage forms suitable for oral administration such as, but not limited to, tablets, capsules, gelcaps and caplets that are adapted for controlled release.

All controlled release pharmaceutical products have a common goal of better medicinal therapy over that obtained by their uncontrolled counterparts. In theory, the use of a controlled release preparation optimally designed in medical treatments is characterized by a minimum of the active substance used to cure or control the condition in a minimum amount of time. The advantages of controlled release formulations can be prolonged drug activity, reduced dosing frequency and increased compliance or patient compliance. In addition, controlled release formulations can be used to affect the time of onset of action or other characteristics such as concentrations of the drug in blood, and thus can modify the incidence of side effects (eg adverse).

Most controlled-release formulations are designed to initially release a quantity of drug (active ingredient) that soon produces the desired therapeutic effect, and little by little and continuously release the other amounts of medication to maintain this level of effect therapeutic or prophylactic for a long time. To maintain this constant level of medication in the body, the drug must be released from the dosage form at a rate that replaces the amount of drug that is being metabolized and excreted from the body. The controlled release of the active ingredient can be stimulated by some states such as, but not limited to, pH, temperature, enzymes, water or other conditions or physiological compounds. 4. 3.3 PARENTERAL DOSAGE FORMS Parenteral dosage forms can be administered to patients by different routes including, but not limited to, subcutaneous, intravenous (including plunger injection), intramuscular, or intraarterial. Because their administration normally derives the patients' natural defenses against contaminants, the parenteral dosage forms are preferably sterile or can be sterilized before being administered to a patient. Examples of parenteral dosage forms can be, but are not limited to, ready-to-inject solutions, anhydrous powders ready to be dissolved or suspended in a pharmaceutically acceptable vehicle for injection, ready-for-injection suspensions and emulsions.

Suitable vehicles that can be used to obtain the parenteral dosage forms of the invention are well known to those skilled in the art. Examples may be, but are not limited to: water for injection USP; aqueous vehicles such as, but not limited to, sodium chloride injection, Ringer's injection, dextrose injection, dextrose and sodium chloride injection, lactose-free Ringer's injection; miscible vehicles in water such as, but not limited to, ethyl alcohol, polyethylene glycol and polypropylene glycol; and non-aqueous vehicles such as, but not limited to, corn oil, cottonseed oil, peanut oil, sesame oil, ethyl oleate, isopropyl myristate and benzyl benzoate.

Compounds that increase the solubility of one or more of the active ingredients described herein may also be incorporated into the parenteral dosage forms of the invention. For example, it is possible to use cyclodextrin and its derivatives to increase the solubility of thalidomide. See, for example, US Patent No. 5,134,127, which is incorporated herein by reference. 4. 3.4. TOPICAL AND MUCOUS DOSAGE FORMS The topical and mucosal dosage forms of the invention may be, but are not limited to, sprays, aerosols, emulsion solutions, suspensions or other forms known to those skilled in the art. See, for example, Remington's Pharmaceuticals Sciences, 16th and 18th edition, Mack Publishing, Easton PA (1980 &1990); and Introduction to Pharmaceuticals Dosage Forms, 4th Edition, Lea & Febiger, Philadelphia (1985). Suitable dosage forms for treating mucosal tissues within the oral cavity can be formulated as mouth rinses or as oral gels.

Suitable excipients (e.g. carriers and diluents) and other materials that can be used to provide topical and mucosal dosage forms comprised by this invention are well known to those skilled in the pharmaceutical art and depend on the specific tissue to which a a certain composition or pharmaceutical dosage form. Taking this into account, common excipients may be, but are not limited to, water, acetone, ethanol, ethylene glycol, propylene glycol, butan-1,3-diol, isopropyl myristate, isopropyl palmitate, mineral oil and mixtures thereof. Form solutions, emulsions or gels, which are non-toxic and accepted for pharmaceutical use. Moisturizers may also be added to pharmaceutical compositions and dosage forms if desired. Examples of these additional ingredients are well known in the art. See, for example, Remington's Pharmaceuticals Sciences, 16th and 18th edition, Mack Publishing, Easton PA (1980 &1990).

The pH of a pharmaceutical composition or dosage form can also be adjusted to improve the delivery of one or more active ingredients. In the same way, the polarity of a solvent carrier, its ionic concentration or tonicity can be adjusted to improve the supply. Compounds such as stearates can also be added to pharmaceutical compositions or dosage forms to advantageously modify the hydrophilicity or lipophilicity of one or more active ingredients to improve delivery. In this regard, stearates can contribute as a lipid vehicle for the formulation, as an emulsifying or surfactant agent and as a feed improver or penetration enhancing agent. It is possible to use different salts, hydrates or solvates of the active solvents to further adjust the properties of the resulting composition. 4. 3.5 EQUIPMENT In general, the active ingredients of the invention are preferably not administered to a patient at the same time and by the same route of administration. This invention, therefore, comprises the equipment that, when used by the physician, can simplify the administration of adequate amounts of active ingredients to a patient.

A common kit of the invention comprises a dosage form of thalidomide, or a salt, solvate, hydrate or stereoisomer thereof, accepted for pharmaceutical use. The equipment comprised by this invention may also contain other active ingredients. Examples of the other active ingredients may be, but are not limited to, those described herein (see for example section 4.2).

The kits of the invention may further comprise devices that are used to administer the active ingredients. Examples of these devices may be, but are not limited to, syringes, drip bags, patches and inhalers.

The kits of the invention may further contain vehicles accepted for pharmaceutical use which may be used to administer one or more active ingredients. For example, if an active ingredient is provided in a solid form that must be reconstituted for parenteral administration, the equipment may contain a sealed container with a convenient vehicle in which the active ingredient can be dissolved to form a sterile, particle-free solution. , which is suitable for parenteral administration. Examples of vehicles accepted for pharmaceutical use may be, but are not limited to: water for injection USP; aqueous vehicles such as, but not limited to, sodium chloride injection, Ringer's injection, dextrose injection, dextrose and sodium chloride injection, and lactose-free Ringer's injection; miscible vehicles in water such as, but not limited to, ethyl alcohol, polyethylene glycol and polypropylene glycol; and non-aqueous vehicles such as, but not limited to, corn oil, cottonseed oil, peanut oil, sesame oil, ethyl oleate, isopropyl myristate and benzyl benzoate. 4. 4 CYCLICAL THERAPY IN DISORDERS OF THE CENTRAL NERVOUS SYSTEM In a specific modality, thalidomide is administered cyclically to patients with central nervous system disorders. The cyclic therapy consists in the administration of a first agent for a time, followed by the administration of the agent and / or the second agent for a time and repeating this successive administration. Cyclic therapy can reduce the presence of resistance to one or more therapies, avoid or reduce the side effects of one or more of the therapies and / or improve the effectiveness of the treatment.

In a specific embodiment, the prophylactic to therapeutic agents, in an amount of about 400, 800 or 1200 mg, are administered in a cycle of about 24 weeks, about once or twice a day. A cycle may consist of administering a therapeutic over the prophylactic agent and at least one (1), two (2) or three (3) weeks of rest. The number of cycles that will be administered will be from about 1 to about 12 cycles, most commonly from about 2 to about 10 cycles and more commonly from about 2 to about 8 cycles.

. EXAMPLES The following studies are intended to further illustrate the invention without limiting its scope. . 1 STUDIES IN AMIOTROPHIC LATERAL SCLEROSIS The effects of thalidomide in a model of amyotrophic lateral sclerosis were investigated in mice. Thalidomide was administered to male transgenic mice overexpressing the mutated human form (G93A) of Cu, Zn-superoxide dismutase (mSODl) (Sciences, 302, 113-117, 2003) once or twice a day for 14 days. The anti-ALS activity of thalidomide was evaluated by measuring the rescue of motor neurons or the prolongation of survival compared to the reference compound, riluzole. . 2 STUDIES ON PARKINSON'S DISEASE The effects of thalidomide on a model of Parkinson's disease were investigated in mice. Male C57 / BL6 mice were injected once a day for 7 days with MPTP (30 mg / kg, i.p.). Thalidomide was administered once or twice a day for 14 days. On day 28, the striatum was removed, homogenized in perchloric acid and centrifuged. The supernatant was separated and analyzed for dopamine and other monoamines such as serotonin by reverse phase HPLC and electrochemical detection. The antiparkinson activity of thalidomide was evaluated in comparison with the reference compound, selegiline. . 3 STUDIES ON ALZHEIMER'S DISEASE The effects of thalidomide in a model of Alzheimer's disease were investigated in rat PC12 pheochromocytoma cells. PC12 cells were cultured in the presence of dopamine, dopamine receptor agonist DI, adenosine, adenosine A2a receptor, nicotine or acetylcholine receptor agonist alpha 7 nicotinic and thalidomide. After 24 hours, the cell supernatants were harvested and analyzed for the activity of acetylcholinesterase by the Ellman method (Hawkins and Knittle, Anal Chem. 44: 416-

Claims (19)

417, 1972). The suppression of acetylcholinesterase activity levels by thalidomide was evaluated in comparison to the tacrine reference compound. 5. 4 CYCLICAL THERAPEUTICS IN DISORDERS OF THE CENTRAL NERVOUS SYSTEM On day 1 of a 24-week cycle, the transfusion of a blood product was administered to patients with ALS. On day 10, administration of 800 mg / d of thalidomide was started. During day 30, transfusion of a blood product was administered. On day 34, administration of 800 mg / d of thalidomide was stopped. On day 59 the administration of 400 mg / d of thalidomide was started. The embodiments of the invention described herein are only a sampling of the scope of the invention. The full scope of the invention is better understood with reference to the appended claims. CLAIMS

1. A method for treating or preventing disorders of the central nervous system, which consists of administering to a patient in need of such treatment or prevention an effective therapeutic or prophylactic amount of thalidomide, or a salt, solvate, hydrate or stereoisomer thereof, accepted for pharmaceutical use.

2. A method for managing a central nervous system disorder, which is to administer to a patient in need of such management an effective prophylactic amount of thalidomide, or a salt, solvate, hydrate or stereoisomer thereof, accepted for pharmaceutical use.

3. The method of claim 1, which comprises administering to a patient in need of such treatment an effective therapeutic or prophylactic amount of thalidomide.

4. The method of claim 2, which comprises administering to a patient in need of such management, an effective therapeutic or prophylactic amount of thalidomide.

5. The method of claim 1, characterized in that the disorder of the central nervous system is: Parkinson's disease; Alzheimer disease; Amyotrophic lateral sclerosis, progressive motor weakness; neuroimmunological disorders; CNS trauma; Alzheimer's disease with Parkinsonism; bradykinesia; alkinesia; movement disorders that impair fine motor control and fingerprinting; hypophonia; monotonic voice; rigidity; dystonia; inflammation associated with Parkinson's disease; tremors of the face, jaw, tongue, posture; parkinsonian gait; walk by shuffling; short steps; hurried march; alterations in mood, cognition, sensation, sleep; dementia; depression; medication-induced parkinsonism; vascular parkinsonism; atrophy of multiple systems; progressive supranuclear palsy; alterations due to tau pathology; degeneration of cortical basal ganglia; parkinsonism with dementia; hyperkinetic alterations; Korea; Huntington's disease; dystonia; Wilson's disease; Tourette syndrome; essential tremor, myoclonus; or a delayed movement disorder.

6. The method of claim 2, characterized in that the disorder of the central nervous system is: Parkinson's disease; Alzheimer disease; Amyotrophic lateral sclerosis, progressive motor weakness; neuroimmunological disorders; CNS trauma; Alzheimer's disease with Parkinsonism; bradykinesia; alkinesia; movement disorders that impair fine motor control and fingerprinting; hypophonia; monotonic voice; rigidity; dystonia; inflammation associated with Parkinson's disease; tremors of the face, jaw, tongue, posture; parkinsonian gait; walk by shuffling; short steps; hurried march; alterations in mood, cognition, sensation, sleep; dementia; depression; medication-induced parkinsonism; vascular parkinsonism; atrophy of multiple systems; progressive supranuclear palsy; alterations due to tau pathology; degeneration of cortical basal ganglia; parkinsonism with dementia; hyperkinetic alterations; Korea; Huntington's disease; dystonia; Wilson's disease; Tourette syndrome; essential tremor, myoclonus; or a delayed movement disorder.

7. The method of claim 5, characterized in that the disorder of the central nervous system is amyotrophic lateral sclerosis.

8. The method of claim 6, characterized in that the central nervous system disorder is amyotrophic lateral sclerosis.

9. A method for the treatment or prevention of a central nervous system disorder, which consists of administering to a patient in need of such treatment or prevention an effective therapeutic or prophylactic amount of thalidomide, or a salt, solvate, hydrate or stereoisomer thereof , accepted for pharmaceutical use, and an effective therapeutic or prophylactic amount of at least one second active ingredient.

10. A method for managing a central nervous system disorder, which consists of administering to a patient in need of such management a prophylactic amount of thalidomide, or a salt, solvate, hydrate or stereoisomer thereof, accepted for pharmaceutical use, and a effective therapeutic or prophylactic amount of at least one second active ingredient.

11. The method of claim 9, characterized in that the central nervous system disorder is Parkinson's disease.

12. The method of claim 10, characterized in that the central nervous system disorder is Parkinson's disease.

13. The method of claim 9, characterized in that the second active ingredient is riluzole, a dopamine agonist, an inhibitor of monoamine oxidase (MAO), a catechol-O-methyltransferase inhibitor. (COMT), amantadine, a cholinesterase inhibitor, an antiemetic or an anti-inflammatory agent.

14. The method of claim 10, characterized in that the second active ingredient is riluzole, a dopamine agonist, an inhibitor of monoamine oxidase (MAO), a catechol-O-methyltransferase (COMT) inhibitor, amantadite, a cholinesterase inhibitor, an antiemetic or an anti-inflammatory agent.

15. The method of any of claims 1, 2, 9 or 10, characterized in that the stereoisomer of thalidomide is the R or S enantiomer of thalidomide.

16. A method for reducing or avoiding an adverse effect associated with the administration of a second active ingredient to a patient suffering from a disorder of the central nervous system, which consists of administering to a patient in need of such reduction or avoidance a quantity of the second active ingredient and an effective therapeutic or prophylactic amount of thalidomide, or a salt, solvate, hydrate or stereoisomer thereof, accepted for pharmaceutical use.

17. A pharmaceutical composition containing thalidomide, or a salt, solvate, hydrate or stereoisomer thereof, accepted for pharmaceutical use in an amount effective to treat, prevent or manage a disorder the central nervous system and a carrier.

18. A pharmaceutical composition containing thalidomide, or a salt, solvate, hydrate or stereoisomer thereof, accepted for pharmaceutical use, in an amount effective to treat, prevent or manage a central nervous system disorder, and a second active ingredient.

19. The pharmaceutical composition of claim 18, characterized in that the second active ingredient is riluzole, a dopamine agonist, a monoamine oxidase (MAO) inhibitor, a catechol-O-methyltransferase (COMT) inhibitor, amantadite, an anticholinergic, an antiemetic or anti-inflammatory agent.