PT1437131E - Utilização de ramipril para a prevenção de diabetes num doente sem insuficiência cardíaca congestiva pré-existente - Google Patents
Utilização de ramipril para a prevenção de diabetes num doente sem insuficiência cardíaca congestiva pré-existente Download PDFInfo
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- A61K31/505—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim
- A61K31/519—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim ortho- or peri-condensed with heterocyclic rings
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- A61K31/40—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
- A61K31/403—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 condensed with carbocyclic rings, e.g. carbazole
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- A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
- A61K31/41—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with two or more ring hetero atoms, at least one of which being nitrogen, e.g. tetrazole
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- A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
- A61K31/41—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with two or more ring hetero atoms, at least one of which being nitrogen, e.g. tetrazole
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- A61K31/41—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with two or more ring hetero atoms, at least one of which being nitrogen, e.g. tetrazole
- A61K31/4164—1,3-Diazoles
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- A61P9/00—Drugs for disorders of the cardiovascular system
- A61P9/10—Drugs for disorders of the cardiovascular system for treating ischaemic or atherosclerotic diseases, e.g. antianginal drugs, coronary vasodilators, drugs for myocardial infarction, retinopathy, cerebrovascula insufficiency, renal arteriosclerosis
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- A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
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- A61P9/14—Vasoprotectives; Antihaemorrhoidals; Drugs for varicose therapy; Capillary stabilisers
Description
DESCRIÇÃO "UTILIZAÇÃO DE RAMIPRIL PARA A PREVENÇÃO DE DIABETES NUM DOENTE SEM INSUFICIÊNCIA CARDÍACA CONGESTIVA PRÉ-EXISTENTE"
CAMPO DA INVENÇÃO A presente invenção refere-se à utilização de ramipril ou um seu sal f armaceuticamente aceitável, na preparação de um medicamento para a prevenção ou redução do início da diabetes num doente sem insuficiência cardíaca congestiva (CHF) pré-existente e em que o doente está em elevado risco de vir a sofrer um evento cardiovascular, devido a um historial anterior de doença cardíaca isquémica, acidente vascular cerebral ou doença arterial periférica.
ANTECEDENTES DA INVENÇÃO
Os compostos que interferem com o RAS são bem conhecidos na técnica e são utilizados para tratar doenças cardiovasculares, em particular, hipertensão arterial e insuficiência cardíaca. Principalmente, pode-se interferir no RAS pela inibição das enzimas sintetizadoras das angiotensinas ou pelo bloqueio dos receptores correspondentes nos locais efectores. Estão actualmente disponíveis inibidores da enzima de conversão da angiotensina (ACE) e antagonistas do receptor tipo 1 da angiotensina II (AT II). 1
Os inibidores da ACE são compostos que inibem a conversão da angiotensina I na angiotensina II activa, bem como a degradação do vasodilatador activo bradicinina. Ambos estes mecanismos conduzem à vasodilatação. Tais compostos têm sido descritos, por exemplo, nos documentos EP 158927, EP 317878, US 4743450 e US 4857520. O ramipril (divulgado no documento EP-A-079022) é um inibidor da ACE de acção prolongada. O seu metabolito activo é o diácido livre ramiprilato, que é obtido in vivo após administração de ramipril. Em doentes hipertensos, sabe-se que a administração de ramipril provoca uma redução na resistência arterial periférica e, assim, uma redução da pressão sanguínea sem um aumento compensatório na taxa cardíaca. Está a ser utilizado actualmente no tratamento da hipertensão e CHF. Além disso, o ramipril tem demonstrado reduzir a mortalidade em doentes com sinais clínicos de insuficiência cardíaca congestiva após terem sobrevivido a um enfarte do miocárdio agudo. Tem sido sugerido que o ramipril tem uma vantagem adicional sobre muitos outros inibidores da ACE, devido à sua pronunciada inibição da ACE em tecidos, resultando em efeitos protectores nos órgãos e. g., coração, rim e vasos sanguíneos.
Os compostos que interferem com o RAS, incluindo os inibidores da ACE e antagonistas da AT II, são utilizados correntemente no tratamento de vários distúrbios cardiovasculares, especialmente em doentes que apresentam uma elevada pressão sanguínea. A utilização dos referidos compostos na prevenção de distúrbios cardiovasculares é muito menos comum e a utilização dos referidos compostos na prevenção de acidente vascular cerebral, diabetes e/ou CHF é, até aqui, desconhecida. 2
SUMARIO DA INVENÇÃO A presente invenção refere-se à utilização de ramipril ou um seu sal f armaceut icamente aceitável, na preparação de um medicamento para a prevenção ou redução do início da diabetes num doente sem insuficiência cardíaca congestiva (CHF) pré-existente e em que o doente está em elevado risco de vir a sofrer um evento cardiovascular, devido a um historial anterior de doença cardíaca isquémica, acidente vascular cerebral ou doença arterial periférica, especialmente em doentes que apresentam uma pressão sanguínea normal ou baixa.
DESCRIÇÃO DETALHADA DA INVENÇÃO
Verificou-se, de forma surpreendente, que a diabetes pode ser prevenida pela utilização de ramipril. A presente invenção é especialmente surpreendente no facto de que, especialmente os doentes com uma função cardíaca essencialmente normal e/ou que apresentam uma pressão sanguínea normal ou baixa, beneficiam acentuadamente da acção preventiva do ramipril.
Os doentes que apresentam uma pressão sanguínea normal ou baixa são conhecidos como doentes normotensos. Exemplos de directrizes que definem os valores de pressão sanguínea, para grupos diferentes de doentes, incluindo diferentes idades, incluem as directrizes publicadas pela OMS e JNC (USA) . Na presente invenção, pode ser encontrada uma definição adequada de uma pressão sanguínea normal ou baixa em JNC VI.
Na presente invenção, "diabetes" refere-se a diabetes de tipo II, também conhecida como diabetes mellitus não dependente 3 de insulina (NIDDM).
Formulações farmacêuticas São descritas formulações farmacêuticas compreendendo ramipril ou um sal farmaceuticamente aceitável como ingrediente activo, incluindo metabolitos, para utilização na prevenção ou redução do início da diabetes.
Para utilização clínica, o ramipril é formulado numa formulação farmacêutica para administração oral, intravenosa, subcutânea, traqueal, brônquica, intranasal, pulmonar, transdérmica, bocal, rectal, parentérica ou qualquer outro modo de administração. A formulação farmacêutica pode conter o inibidor em mistura com um adjuvante, diluente e/ou veículo farmaceuticamente aceitável.
Na preparação das formulações farmacêuticas, o ingrediente activo pode ser misturado com ingredientes sólidos em pó, tais como lactose, sacarose, sorbitol, manitol, amido, amilopectina, derivados da celulose, gelatina ou outro ingrediente adequado, bem como com agentes de desintegração e agentes lubrificantes, tais como estearato de magnésio, estearato de cálcio, estearilfumarato de sódio e ceras de polietilenoglicol. A mistura pode depois ser processada em grânulos ou prensada em comprimidos. 0 ingrediente activo pode ser pré-misturado separadamente com os outros ingredientes não-activos, antes de ser misturado para formar uma formulação. 4
As cápsulas de gelatina mole podem ser preparadas com cápsulas contendo uma mistura do ingrediente activo da invenção, óleo vegetal, gordura ou outro veiculo adequado para cápsulas de gelatina mole. As cápsulas de gelatina dura podem conter grânulos dos ingredientes activos. As cápsulas de gelatina dura podem também conter os ingredientes activos em combinação com ingredientes sólidos em pó, tais como lactose, sacarose, sorbitol, manitol, amido de batata, amido de milho, amilopectina, derivados de celulose ou gelatina.
As unidades de dosagem para administração rectal podem ser preparadas (i) na forma de supositórios que contêm a substância activa misturada com uma base gorda neutra; (ii) na forma de uma cápsula rectal de gelatina que contém a substância activa numa mistura com um óleo vegetal, óleo de parafina ou outro veículo adequado para cápsulas de gelatina rectais; (iii) na forma de uma microenema pronto a utilizar; ou (iv) na forma de uma formulação em microenema seca para ser reconstituída num solvente adequado, mesmo antes da administração.
As preparações líquidas podem ser preparadas na forma de xaropes ou suspensões, e. g., soluções ou suspensões contendo os ingredientes activos e o restante consistindo, por exemplo, de açúcar ou álcoois de açúcares e uma mistura de etanol, água, glicerol, propilenoglicol e polietilenoglicol. Se desejado, tais preparações liquidas podem conter agentes corantes, agentes aromatizantes, conservantes, sacarina e carboximetilcelulose ou outros agentes espessantes. As preparações líquidas podem também ser preparadas na forma de um pó seco para ser reconstituído, antes da utilização, com um solvente adequado. 5
As soluções para administração parentérica podem ser preparadas como uma solução de uma formulação da invenção num solvente farmaceuticamente aceitável. Estas soluções podem conter também ingredientes de estabilização, conservantes e/ou ingredientes tamponantes. As soluções para administração parentérica podem também ser preparadas como uma preparação seca para ser reconstituída, antes da utilização, com um solvente adequado. A quantidade total de ingrediente activo está, de um modo adequado, dentro na gama de cerca de 0,1% (p/p) a cerca de 95% (p/p) da formulação, de um modo adequado, de 0,5% a 50% (p/p) e, de um modo preferido, de 1% a 25% (p/p).
As formulações farmacêuticas podem conter entre cerca de 0,1 mg e cerca de 1000 mg do ingrediente activo, de um modo preferido, entre 1 mg e 100 mg do ingrediente activo. A dose do ingrediente activo a ser administrada irá depender da indicação relevante, da idade, peso e sexo do doente e pode ser determinada por um médico. A dosagem irá, de um modo adequado, estar na gama de cerca de 0,01 mg/kg a cerca de 20 mg/kg, de um modo preferido, entre 0,1 mg/kg e 10 mg/kg. A dose diária típica do ingrediente activo varia dentro de uma vasta gama e irá depender de vários factores, tais como a indicação relevante, a via de administração, a idade, peso e sexo do doente e pode ser determinada por um médico. Em geral, dosagens e, especialmente, dosagens orais e parentéricas, irão estar na gama de cerca de 0,1 a cerca de 100 mg por dia do ingrediente activo, de um modo preferido, entre 1 e 50 mg por dia do ingrediente activo. 6 0 Exemplo seguinte tem como intenção ilustrar a invenção.
EXEMPLO
Foi concebido um ensaio clinico de larga escala para examinar o efeito do inibidor da ACE ramipril versus placebo na redução de eventos cardiovasculares. 0 estudo foi realizado em 267 centros em 19 países durante um período de seis anos e incluiu 9541 participantes gue estavam em elevado risco de eventos cardiovasculares devido a um historial de anterior doença cardíaca isguémica, acidente vascular cerebral, doença arterial periférica ou indivíduos com diabetes. A pressão sanguínea sistólica no momento da inclusão dos doentes foi, em média, de 13 8 mm Hg e, assim, os doentes eram normotensos no início do estudo. Após um mês de terapia com ramipril ou placebo, a pressão sanguínea sistólica diminuiu em 5,48 mm Hg e 1,59 mm Hg, respectivamente. 0 ponto final primário do estudo foi enfarte do miocárdio (MI), acidente vascular cerebral e morte cardiovascular (CV) (mortalidade). 0 estudo foi interrompido mais cedo devido a uma nítida redução no ponto final combinado de mortes cardiovasculares, atagues cardíacos e acidentes vasculares cerebrais em doentes a tomar o ramipril. Além dos benefícios acima, verificou-se também uma redução de entre um guarto e um guinto na necessidade de procedimentos de revascularização (tais como cirurgia de bypass 7 da artéria coronária por enxerto, angioplastia de balão, etc.) e complicações relacionadas com a diabetes.
Verificou-se uma redução nítida em 32% no grupo do ramipril no número de doentes que desenvolveram acidente vascular cerebral e isto é surpreendente uma vez que os doentes eram normotensos quando recrutados para o estudo. 0 número de doentes que desenvolveram CHF foi reduzido significativamente em 21% no grupo do ramipril, o que foi inesperado uma vez que os doentes não evidenciavam sinais ou sintomas de CHF no início do estudo.
Igualmente surpreendente foi a redução acentuada de 36% no número de doentes que desenvolveram diabetes no grupo do ramipril.
Abreviaturas ACE = enzima de conversão da angiotensina
AT II = receptor tipo 1 da angiotensina II CHF = insuficiência cardíaca congestiva IDMM = diabetes mellitus dependente de insulina JNC = Joint National Committee
MI enfarte do miocárdio
NIDDM = diabetes mellitus nao dependente de insulina OMS =
Organizaçao Mundial de Saúde
Lisboa, 4 de Julho de 2012 9
Claims (2)
- REIVINDICAÇÕES 1. Utilização de ramipril ou um seu sal farmaceuticamente aceitável, na preparação de um medicamento para a prevenção ou redução do início da diabetes num doente sem insuficiência cardíaca congestiva (CHF) pré-existente e em que o doente está em elevado risco de vir a sofrer um evento cardiovascular, devido a um historial anterior de doença cardíaca isquémica, acidente vascular cerebral ou doença arterial periférica.
- 2. Utilização de acordo com a reivindicação 1, em que o doente apresenta pressão sanguínea normal ou baixa. Lisboa, 4 de Julho de 2012 1
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Application Number | Priority Date | Filing Date | Title |
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SE9903028A SE9903028D0 (sv) | 1999-08-27 | 1999-08-27 | New use |
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PT1437131E true PT1437131E (pt) | 2012-07-12 |
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PT80042658T PT1925303E (pt) | 1999-08-27 | 2000-08-25 | Utilização de antagonistas do receptor tipo 1 da angiotensina ii para a prevenção de diabetes |
PT04006330T PT1437131E (pt) | 1999-08-27 | 2000-08-25 | Utilização de ramipril para a prevenção de diabetes num doente sem insuficiência cardíaca congestiva pré-existente |
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PT80042658T PT1925303E (pt) | 1999-08-27 | 2000-08-25 | Utilização de antagonistas do receptor tipo 1 da angiotensina ii para a prevenção de diabetes |
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EP (4) | EP1212081B2 (pt) |
JP (1) | JP4843172B2 (pt) |
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AU (3) | AU7648400A (pt) |
BG (2) | BG66115B1 (pt) |
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PT (2) | PT1925303E (pt) |
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SE (1) | SE9903028D0 (pt) |
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Families Citing this family (30)
Publication number | Priority date | Publication date | Assignee | Title |
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PL353199A1 (en) * | 1999-08-30 | 2003-11-03 | Aventis Pharma Deutschland Gmbh | Use of inhibitors of the renin-angiotensin system in the prevention of cardiovascular events |
EP1375500A1 (en) * | 2001-03-26 | 2004-01-02 | Kotobuki Pharmaceutical Co., Ltd. | Isoquinuclidine derivative, process for producing the same, and medicinal composition containing the same |
WO2003032965A2 (en) * | 2001-10-17 | 2003-04-24 | King Pharmaceuticals Research And Development, Inc | Use of ace inhibitors for reducing type 2 diabetes in high risk patients |
US6844361B2 (en) | 2002-02-04 | 2005-01-18 | Aventis Pharma Deutschland Gmbh | Pharmaceutical composition comprising a sodium hydrogen exchange inhibitor and an angiotensin converting enzyme inhibitor |
DE10230272A1 (de) * | 2002-07-05 | 2004-01-22 | Solvay Pharmaceuticals Gmbh | AT1-Rezeptorantagonisten zur Prävention von Folgeschlaganfällen |
EP1382334A1 (en) * | 2002-07-11 | 2004-01-21 | Université de Picardie Jules Verne | Use of angiotensin II AT1-receptor blockers (ARB), alone or combined with thiazide or angiotensin II for the treatment of stroke |
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2012
- 2012-07-24 CY CY20121100657T patent/CY1112987T1/el unknown
- 2012-11-09 US US13/673,852 patent/US20130317047A1/en not_active Abandoned
-
2014
- 2014-12-23 CY CY20141101082T patent/CY1115869T1/el unknown
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