NO328340B1 - Synergistisk kombinasjonsmedikament av roflumilast og salmeterol samt anvendelse derav. - Google Patents
Synergistisk kombinasjonsmedikament av roflumilast og salmeterol samt anvendelse derav. Download PDFInfo
- Publication number
- NO328340B1 NO328340B1 NO20020815A NO20020815A NO328340B1 NO 328340 B1 NO328340 B1 NO 328340B1 NO 20020815 A NO20020815 A NO 20020815A NO 20020815 A NO20020815 A NO 20020815A NO 328340 B1 NO328340 B1 NO 328340B1
- Authority
- NO
- Norway
- Prior art keywords
- roflumilast
- salmeterol
- acid
- adrenoceptor agonist
- combination
- Prior art date
Links
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- 229960002586 roflumilast Drugs 0.000 title claims description 20
- GIIZNNXWQWCKIB-UHFFFAOYSA-N Serevent Chemical compound C1=C(O)C(CO)=CC(C(O)CNCCCCCCOCCCCC=2C=CC=CC=2)=C1 GIIZNNXWQWCKIB-UHFFFAOYSA-N 0.000 title claims description 18
- 229960004017 salmeterol Drugs 0.000 title claims description 18
- 229940000425 combination drug Drugs 0.000 title description 2
- 239000011885 synergistic combination Substances 0.000 title 1
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Classifications
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- A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
- A61K31/505—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim
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- A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
- A61K31/44—Non condensed pyridines; Hydrogenated derivatives thereof
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- A61K31/4015—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with one nitrogen as the only ring hetero atom, e.g. sulpiride, succinimide, tolmetin, buflomedil having oxo groups directly attached to the heterocyclic ring, e.g. piracetam, ethosuximide
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- A61K31/00—Medicinal preparations containing organic active ingredients
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- A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
- A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
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- A61K31/52—Purines, e.g. adenine
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- A—HUMAN NECESSITIES
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- A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
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- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
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Description
Foreliggende oppfinnelse omhandler kombinasjonen av visse kjente aktive forbindelser for terapeutiske formål. Mer spesielt vedrører foreliggende oppfinnelse et medikament omfattende en PDE-inhibitor kombinert med en <p>2 adrenoceptoragonist som angitt i krav 1 samt anvendelsen av disse for fremstilling av et medikament for behandling av luftveisforstyrrelser som angitt i krav 4.
Substansene roflumilast og salmeterol anvendt i kombinasjonen ifølge oppfinnelsen er kjente aktive forbindelser fra henholdsvis PDE4-inhibitorklassen og fø adrenoceptor-agonistklassen. Deres kombinerte anvendelse i betydningen ifølge oppfinnelsen for terapeutiske formål har enda ikke blitt beskrevet i den tidligere teknikk.
I det følgende gis en kort omtale av tidligere teknikk:
I US 3840537 omhandles imidazo[5,1-f]triazinoner hvilke beskrives å virke som spasmolytika og fosfodiesterase-inhibitorer. Den spesifikke forbindelsen 2-amino-5-metyl-7-propyl-imidazo[5,1-f]-as-triazin-4(3H)-on angis å virke på en synergistisk måte i kombinasjon med salbutamol.
I FR 2390164 beskrives kombinasjoner av teofyllin eller aminofyllin med beta-sympatomimetika slik som salbutamol eller terbutalin som viste antiastmatisk virkning.
I US 3941785 beskrives imidazo[5,1-f]-as-triaziner og derivater derav å være spasmolytika og fosfodiesterase-inhibitorer. Det er videre beskrevet at triazinene kan formuleres i kombinasjon med forbindelser slik som salbutamol og isoprenalin som har stimulerende aktivitet på
(3-adrenoreseptorer.
Raeburn D. et. al i British Jorunal of Pharmacolgy, Vol. 113, nr. 4, 1994, s. 1423-1431, beskriver at RP73401 økte styrke og varighet av bronkodilatasjon frembrakt av salbutamol i en modell for histamininduserte bronkospasmer i bedøvede marsvin.
Blease K. et al. i British Jorunal of Pharmacolgy, Vol. 124, nr. 1, 1998, s. 229-237 beskriver at rolipram i kombinasjon med salbutamol, men ingen av midlene alene, hemmet TNF-a-indusert E-selektinekspresjon, mens ICAM-1- og VCAM-l-ekspresjon ikke ble påvirket.
Beskrivelse av oppfinnelsen
Det er formålet med foreliggende oppfinnelse å gjøre luftveisterapeutika tilgjengelige som tilfredsstiller de følgende betingelser:
God antiinflammatorisk virkning
Markert bronkorelaksasjon og -dilatasjon
God oral tilgjengelighet, i det minste med hensyn til PDE-inhibitoren
Mindre alvorlige bivirkninger
God anvendbarhet for langtidsterapi
Gunstig påvirkning på bronkial hyperreaktivitet.
Det har nå blitt funnet at den kombinerte anvendelse av PDE4-inhibitoren roflumilast som kan anvendes som et luftveisterapeutikum og |32 adrenoceptoragonisten salmeterol på fremragende måte oppfyller betingelsene nevnt over.
Oppfinnelsen omhandler derfor den kombinerte anvendelsen av PDE4-inhibitoren roflumilast som kan anvendes som et luf tveisterapeutikum og |32 adrenoceptoragonisten salmeterol i behandlingen av luftveisforstyrrelser.
PDE4-inhibitoren roflumilast som kan anvendes som et luftveisterapeutikum i betydningen av foreliggende oppfinnelse er en forbindelse som bremser nedbrytningen av cyklisk AMP (cAMP) eller cyklisk GMP (cGMP) ved inhibering av fosfodiesterasene, hvilket kan føre til en relativ økning i den intracellulære konsentrasjon av cAMP eller cGMP.
PDE4-inhibitoren roflumilast er vist ved hjelp av dens formel:
Ingen hydrogenatomer er indikert i formlene over.
p2 adrenoceptoragonisten salmeterol er en selektivt virkende substans som kun har en mild kardial virkning og blir derfor også anvendt i terapi, spesielt i den orale terapi av luftveisforstyrrelser. Salmeterol er en såkalt langtidsvirkende p2 adrenoceptoragonist.
PDE4-inhibitoren roflumilast og p2 adrenoceptoragonisten salmeterol kan være tilstede som sådan eller i kjemisk bundet form. Det forstås herved at de nevnte aktive forbindelser også kan være tilstede, for eksempel, i form av deres farmakologisk tolererbare salter og/eller som solvater (f.eks. hydrater), og/ eller i form av deres N-oksider etc. Passende farmakologisk tolererbare salter her er spesielt vannløselige og vannuløselige syreaddisjons-salter med syrer slik som, for eksempel, saltsyre, hydro-bromsyre, fosforsyre, salpetersyre, svovelsyre, eddiksyre, sitronsyre, D-glukonsyre, benzosyre, 2-(4-hydroksybenzoyl)-benzosyre, smørsyre, sulfosalisylsyre, maleinsyre, laurinsyre, eplesyre, fumarsyre, ravsyre, oksalsyre, vinsyre, embonsyre, stearinsyre, toluensulfonsyre, metan-sulfonsyre eller l-hydroksy-2-naftonsyre, syrene blir anvendt i saltfremstilling - avhengig av om det er en mono-eller polybasisk syre og avhengig av hvilket salt som er ønsket - i et ekvimolart kvantitativt forhold eller et som avviker derfra. Videre, kan de nevnte aktive forbindelser også være tilstede som rene enantiomerer eller som enantiomerblandinger i ethvert blandeforhold.
Luftveisforstyrrelser som kan nevnes er spesielt allergen-og inflammasjonsinduserte bronkiale forstyrrelser (bronkitt, obstruktiv bronkitt, spastisk bronkitt, allergisk bronkitt, allergisk astma, bronkial astma, KOLS), som kan behandles ved kombinasjonen ifølge oppfinnelsen også i betydningen av en langtidsterapi (hvis ønsket med passende justering av dosen av de individuelle komponenter til beho-vene ved det tidspunkt, for eksempel behov utsatt for se-songrelaterte variasjoner).
"Kombinert anvendelse" eller "kombinasjon" innen betydningen av foreliggende oppfinnelse skal forstås som å bety at de individuelle komponenter kan administreres samtidig (i form av et kombinasjonsmedikament), mer eller mindre samtidig (fra separate pakkeenheter) eller etter hverandre (direkte etter hverandre eller ellers alternativt ved et relativt stort tidsintervall) på en måte som er kjent per se og vanlig.
Innen betydningen av foreliggende oppfinnelse, blir "anvendelse" foretrukket forstått som å bety den orale administrasjon av begge aktive forbindelser. Hvis kun PDE4-inhibitoren roflumilast blir administrert oralt, blir "anvendelse" med hensyn til p2 adrenoceptoragonisten salmeterol spesielt forstått som å bety topisk anvendelse i inhalatorisk form. For dette blir |32 adrenoceptoragonisten salmeterol foretrukket administrert ved inhalasjon i form av en aerosol, aerosolpartiklene med fast, flytende eller blandet sammensetning har en diameter på 0,5 til 10 ym, fordelaktig på 2 til 6 ym.
Aerosoldannelse kan utføres, for eksempel, av trykkdrevne jetforstøvere eller ultrasoniske forstøvere, men fordelaktig av drivgassdrevne doserte aerosoler eller drivgassfri administrasjon av mikroniserte aktive forbindelser fra inhalasj onskapsler.
De aktive forbindelsene blir dosert i en størrelsesorden som er vanlig for den individuelle dose, det er mer sann-synlig mulig, på grunn av de individuelle virkninger, som gjensidig positivt påvirker og forsterker, å redusere de respektive doser ved den kombinerte administrasjon av de aktive forbindelser sammenlignet med normen. Tradisjonelt, blir p2 adrenoceptoragonisten (avhengig av styrke) administrert i en dose på, for eksempel, 0,002 til 2,0 mg per dag ved administrasjon ved inhalasjon.
Avhengig av det anvendte inhalatorsystemet, i tillegg til de aktive forbindelser inneholder administrasjonsformene i tillegg de krevde eksipienser, slik som, for eksempel, drivgasser (f.eks. Frigen i tilfellet med doserte aerosoler) , overflateaktive substanser, emulgatorer, stabilise-ringsmidler, konserveringsmidler, smaksstoffer, fyllstoffer (f.eks. laktose i tilfellet med pulverinhalatorer) eller, hvis passende, ytterligere aktive forbindelser.
For inhalasjonsformål, er et stort antall apparaturer tilgjengelige med hvilke aerosoler med optimal partikkelstør-relse kan dannes og administreres, ved anvendelse av en inhalasjonsteknikk som er så riktig som mulig for pasien-ten. I tillegg til anvendelsen av adaptere (avstandsstyk-ker, ekspandere) og pæreformede beholdere (f.eks. Nebula-tor®, Volumatic®), og automatiske anordninger som emitterer en pufferspray (Autohaler®) , for doserte aerosoler, spesielt i tilfellet med pulverinhalatorer, er mange tekniske løsninger tilgjengelige (f.eks. Diskhaler®, Rotadisk®, Turbohaler® eller inhalatoren beskrevet i europeisk pa-tentsøknad EP 0 505 321), ved anvendelse av disse kan en optimal administrasjon av aktiv forbindelse oppnås.
I tilfellet med den orale administrasjon av p2 adrenoceptoragonisten salmeterol sammen med PDE4-inhibitoren roflumilast, som er den foretrukne administrasjonsform, blir p2 adrenoceptoragonisten salmeterol administrert i en daglig dose på, for eksempel, 0,05 til 60 mg. For PDE-inhibitoren, er det mulig i tilfellet med oral administrasjon å variere dosene - avhengig av den aktive forbindelsen - innenfor et vidt område, det er mulig, som grenser, å starte fra en dose på 1 - 2000 ug/kg kroppsvekt. I tilfellet med administrasjonen av PDE-inhibitoren roflumilast, er dosen i området fra 2-20 ug/kg kroppsvekt .
PDE4-inhibitoren roflumilast som skal administreres oralt blir formulert - hvis passende sammen med p2 adrenoceptoragonisten salmeterol - for å gi medikamenter ifølge prosesser kjent per se og velkjent for fagmannen. De farmakologisk aktive forbindelser anvendes som medikamenter, foretrukket i kombinasjon med passende farmasøytiske eksipienser eller vehikler, i form av tabletter, belagte tabletter, kapsler, emulsjoner, suspensjoner eller oppløsninger, innholdet av den aktive forbindelsen er fordelaktig mellom 0,1 og 95 % og, ved det passende valg av eksipiensene og vehiklene, er det mulig å oppnå en farmasøytisk administrasjonsform nøyaktig tilpasset til de(n) aktive forbindelsen(e) og/eller til den ønskede virkningsinntreden (f.eks. en forlenget frigivelsesform eller en enterisk form). Spesielt verdt å nevne innen betydningen av den kombinerte, orale administrasjon av begge aktive forbindelser ifølge oppfinnelsen er orale administrasjonsformer, f.eks. tabletter eller kapsler, i hvilke en del av p2 adrenoceptoragonisten og PDE-inhibitoren er til stede i ikke-forlenget frigivelsesform og en ytterligere, foretrukket større del, av p2 adrenoceptoragonisten er til stede i forlenget frigivelsesform.
Fagmannen er på grunnlag av hans/hennes ekspertkunnskap kjent med hvilke eksipienser eller vehikler som er passende for de ønskede farmasøytiske formuleringer. I tillegg til løsningsmidler, geldannende midler, tabletteksipienser og andre aktiv forbindelsesbærere, er det mulig å anvende, for eksempel, antioksidanter, dispergeringsmidler, emulgatorer, skumdempingsmidler, smakskorrigerende midler, konserveringsmidler, løselighetsformidlere, fargestoffer eller per-meeringsfremmere og komplekseringsmidler (f.eks. cyklodek-striner).
Farmakologi
Modell
Sen inflammatorisk luftveisreaksjon i den ovalbumin-sensibiliserte/-utfordrede brune norske rotte
Antiinflammatorisk aktivitet av roflumilast, pumafentrin (BYK-33043) og salmeterol ble bestemt i ovalbumin (OVA)-sensibiliserte og OVA-utfordrede brune norske rotter. Sensibilisering ble gjort ved samtidig injeksjon av Bordetella pertussis-suspensjon i.p. og OVA/AHG-suspensjon s.c. på dag 1, 14 og 21. 28 dager etter sensibiliserings-start ble bevisste brune norske rotter utfordret ved inhalasjon av den aerosoliserte OVA-oppløsning i 1 h (~20 ml/h). Ikke-utfordrede, kun sensibiliserte dyr ble anvendt som grunnlinjekontroll. Legemidlene (grundig blandet med laktose) eller placebokontrollen (laktose) ble administrert intratrakealt (i.t.) som tørre pulvere 1 h før OVA-utfordringer. 48h senere, ble OVA-utfordrede eller ikke-utfordrede dyr bedøvet og bronkoalveolar skylling (BAL) ble utført ved anvendelse av 3x4 ml BAL-buffer per dyr. Antallet totale celler og eosinofiler i BAL-fluidet, og proteinkonsentrasjonen i det cellefrie BAL-fluid ble bestemt. Legemiddelinduserte relative endringer ble beregnet og statistisk analysert ved Jonckheere Terpstra-testen.
Oppsummering
PDE-inhibitorene roflumilast (PDE4-inhibitor) og pumafentrin (PDE3>4-inhibitor) administrert ved doser på henholdsvis 0,3 umol/kg og 3 umol/kg i.t., viste ikke noen signifi-kante virkninger på celleinfiltrering og proteinakkumule-ring. De negative verdiene oppnådd (trend: økning i inflam-masjon) faller inn i området av biologisk variabilitet i modellen og derfor, må ingen signifikans tilknyttes disse data.
I motsetning, utviste den lengevirkende P2-adrenerge resep-toragonisten salmeterol gitt ved en dose på 3 umol/kg i.t inhiberende effekter på total celle og eosinofil influks inn i alveolært rom og proteinnivåer i BAL-fluid. Imidler-tid mislyktes dataene i å nå signifikans.
Ko- administrasjon av PDE- inhibitoren roflumilast eller pumafentrin med salmeterol resulterte i synergistiske effekter sammenlignet med administrasjon av hver forbindelse alene, dvs. begge PDE-inhibitorer kombinert med £2 agonis-ten viste en signifikant inhibering av eosinofili og reduk-sjon av proteinkonsentrasjon i BAL-fluidet. Kombinasjonen av PDE3/4-inhibitoren pumafentrin og salmeterol var mer virkningsfull på alle målte parametre (forskjellen var ikke signifikant), og viste i tillegg, en signifikant effekt på inhibering av total celleinfluks inn i det alveolære rom.
Claims (6)
1. Medikament omfattende en PDE-inhibitor, som skal administreres oralt, fra PDE4-inhibitorgruppen kombinert med en P2 adrenoceptoragonist i fast eller fri kombinasjon, hvori PDE-inhibitoren er roflumilast, et farmakologisk tolererbart salt av roflumilast og/eller N-oksidet av roflumilast og p2 adrenoceptoragonisten er salmeterol eller et farmakologisk tolererbart salt derav.
2. Medikament ifølge krav 1, som er en fast oral kombinasjon .
3. Medikament ifølge krav 1 eller 2 for anvendelse i den terapeutiske behandling av luftveisforstyrrelser.
4. Medikament ifølge krav 3, hvori luftveisforstyrrelsen er brokitt, obstruktiv bronkitt, allergisk bronkitt, allergisk astma, bronkial astma eller KOLS.
5. Anvendelse av roflumilast, et farmakologisk tolererbart salt av roflumilast og/eller N-oksidet av roflumilast, som skal administreres oralt, i kombinasjon med salmeterol eller et farmakologisk tolererbart salt derav for fremstilling av et medikament for den terapeutiske behandlingen av luftveisforstyrrelser.
6. Anvendelse ifølge krav 5, hvori luftveisforstyrrelsen er brokitt, obstruktiv bronkitt, allergisk bronkitt, allergisk astma, bronkial astma eller KOLS.
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PCT/EP2000/007852 WO2001013953A2 (en) | 1999-08-21 | 2000-08-11 | Synergistic combination of pde inhibitors and beta 2 adrenoceptor agonist |
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