US20080287501A1 - Therapeutic uses of an insulin secretion enhancer - Google Patents

Therapeutic uses of an insulin secretion enhancer Download PDF

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US20080287501A1
US20080287501A1 US12/180,689 US18068908A US2008287501A1 US 20080287501 A1 US20080287501 A1 US 20080287501A1 US 18068908 A US18068908 A US 18068908A US 2008287501 A1 US2008287501 A1 US 2008287501A1
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Christlane Guitard
Beate Muller
Rebecca Emmons
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/16—Amides, e.g. hydroxamic acids
    • A61K31/17—Amides, e.g. hydroxamic acids having the group >N—C(O)—N< or >N—C(S)—N<, e.g. urea, thiourea, carmustine
    • A61K31/175—Amides, e.g. hydroxamic acids having the group >N—C(O)—N< or >N—C(S)—N<, e.g. urea, thiourea, carmustine having the group, >N—C(O)—N=N— or, e.g. carbonohydrazides, carbazones, semicarbazides, semicarbazones; Thioanalogues thereof
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    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/185—Acids; Anhydrides, halides or salts thereof, e.g. sulfur acids, imidic, hydrazonic or hydroximic acids
    • A61K31/19—Carboxylic acids, e.g. valproic acid
    • A61K31/195—Carboxylic acids, e.g. valproic acid having an amino group
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/185—Acids; Anhydrides, halides or salts thereof, e.g. sulfur acids, imidic, hydrazonic or hydroximic acids
    • A61K31/19—Carboxylic acids, e.g. valproic acid
    • A61K31/195—Carboxylic acids, e.g. valproic acid having an amino group
    • A61K31/197—Carboxylic acids, e.g. valproic acid having an amino group the amino and the carboxyl groups being attached to the same acyclic carbon chain, e.g. gamma-aminobutyric acid [GABA], beta-alanine, epsilon-aminocaproic acid, pantothenic acid
    • A61K31/198—Alpha-aminoacids, e.g. alanine, edetic acids [EDTA]
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    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • 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
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/41—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
    • A61K31/425—Thiazoles
    • A61K31/426—1,3-Thiazoles
    • A—HUMAN NECESSITIES
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    • A61P13/00—Drugs for disorders of the urinary system
    • A61P13/02—Drugs for disorders of the urinary system of urine or of the urinary tract, e.g. urine acidifiers
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    • A—HUMAN NECESSITIES
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    • A—HUMAN NECESSITIES
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    • A—HUMAN NECESSITIES
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    • A—HUMAN NECESSITIES
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    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
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    • A—HUMAN NECESSITIES
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    • A—HUMAN NECESSITIES
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    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P3/00—Drugs for disorders of the metabolism
    • A61P3/06—Antihyperlipidemics
    • A—HUMAN NECESSITIES
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    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
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    • A61P3/08—Drugs for disorders of the metabolism for glucose homeostasis
    • A—HUMAN NECESSITIES
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    • A61P3/08—Drugs for disorders of the metabolism for glucose homeostasis
    • A61P3/10—Drugs for disorders of the metabolism for glucose homeostasis for hyperglycaemia, e.g. antidiabetics
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    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P5/00—Drugs for disorders of the endocrine system
    • A61P5/48—Drugs for disorders of the endocrine system of the pancreatic hormones
    • A61P5/50—Drugs for disorders of the endocrine system of the pancreatic hormones for increasing or potentiating the activity of insulin
    • A—HUMAN NECESSITIES
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    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
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    • 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
    • A—HUMAN NECESSITIES
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    • A61P9/00—Drugs for disorders of the cardiovascular system
    • A61P9/12—Antihypertensives

Definitions

  • Impaired Glucose Metabolism is defined by blood glucose levels that are above the normal range but are not high enough to meet the diagnostic criteria for type 2 diabetes mellitus. The incidence of IGM varies from country to country, but usually occurs 2-3 times more frequently than overt diabetes. Until recently, individuals with IGM were felt to be pre-diabetics, but data from several epidemiologic studies argue that subjects with IGM are heterogeneous with respect to their risk of diabetes and their risk of cardiovascular morbidity and mortality. The data suggest that subjects with IGM, in particular IGT, do not always develop diabetes, but whether they are diabetic or not, they are, nonetheless, at high risk for cardiovascular morbidity and mortality.
  • IGT Impaired Glucose Tolerance
  • IFG Impaired Fasting Glucose
  • IFG/IGT both abnormalities
  • NTT Normal Glucose Tolerance
  • IGM IGM
  • type 2 diabetes mellitus The categories of Normal Glucose Tolerance (NGT), IGM and type 2 diabetes mellitus were defined by the ADA in 1997 as follows:
  • Type 2 Diabetes NGT IGM mellitus IFG FPG level ⁇ 6.1 mmol/L 6.1-7 mmol/L >7 mmol/L ( ⁇ 110 mg/dl) (110-126 mg/dl) >126 mg/dl)
  • IGT 2 h postprandial ⁇ 7.8 mmol/l 7.8-11.1 mmol/L >11.1 mmol/L glucose level ( ⁇ 140 mg/dl) (140-220 mg/dl) (>200 mg/dl) (75 g OGTT * ) ) * )
  • OGTT oral glucose tolerance test
  • IGM Individuals with IGM, especially those with the subcategory IFG, are known to have a significantly higher rate of progression to diabetes than normoglycemic individuals and are known to be high at cardiovascular risk, especially if they develop diabetes.
  • subjects with IGM, more specifically those with the subcategory IGT have a high incidence of cancer, cardiovascular diseases and mortality even if they never develop diabetes. Therefore, IGM and more specifically, the subgroup IFG, appears to be at high cardiovascular risk, especially after patients become overtly diabetic.
  • IGT is associated with a high risk for cancer, cardiovascular disease and mortality in nondiabetics and diabetics.
  • the increased risk associated with IGT is independent of all other known cardiovascular risk factors including age, sex, hypertension, low HDL and high LDL cholesterol levels [ Lancet 1999; 354: 617-621].
  • IGM insulin-driven thrombosis
  • IGT insulin-driven thrombosis
  • Isolated postprandial hyperglycemia has been shown to reduce the natural free-radical trapping agents (TRAP) that are present in serum.
  • TRAP free-radical trapping agents
  • Decreasing the level of TRAP has been shown, under experimental conditions, to be associated with an increase in free radical formation and increased oxidative stress.
  • These free radicals have been implicated in the pathological microvascular and macrovascular changes associated with atherosclerosis, cardiovascular morbidity and mortality, and cancer [Ceriello, A, Diabetic Medicine 15: 188-193, 1998].
  • the decrease of natural antioxidants like TRAP during postprandial hyperglycemia may explain the increased cardiovascular risk in subjects with IGM, and specifically IGT, that do not develop diabetes.
  • IGT is an independent risk factor in non-diabetics as well as diabetics justifies it as a new indication, separate from diabetes, for prevention and treatment of cardiovascular morbidity and mortality as well as cancer.
  • IGM is associated with following potential diseases or conditions: 1.) progression to overt diabetes mellitus type 2 (Code 250.2 of the International Classification of Diseases 9 th version ICD-9 Code 250.2) [ Diabetes Research and Clinical Practice 1998; 40: S1-S2]; 2.) increased microvascular complications of diabetes especially retinopathy and other ophthalmic complications of diabetes (ICD-9 code 250.5), nephropathy (ICD-9 code 250.4), neuropathy (ICD-9 code 250.6) [ Diabetes Care 2000; 23: 1113-1118], and peripheral angiopathy or gangrene (ICD-9 code 250.7); 3.) increased cardiovascular morbidity (ICD-9 codes 410-414) especially myocardial infarctions (ICD-9 code 410), coronary heart disease or atherosclerosis (ICD-9 code 414) and other acute and subacute forms of coronary ischemia (ICD-9 code 411); 4.) excess cerebrovascular diseases like stroke (ICD-9 codes 430-438) [ Circulation 1998; 98: 2513-2519]
  • IGM insulin glycogen
  • ICD-9 code 272 dyslipidemia
  • ICD-9 code 790.6 hyperuricemia
  • ICD-9 codes 401-404 hypertension
  • ICD-9 code 413.9 angina pectoris
  • the restoration of early phase insulin secretion and/or reduction of postprandial hyperglycemia should also prevent or reduce the excessive cardiovascular morbidity and mortality, and prevent cancer or reduce its mortality in individuals.
  • hypoglycemic agents such as insulin secretion enhancers can be used to prevent or delay the progression to overt diabetes, to reduce microvascular complications of diabetes, to reduce vascular, especially cardiovascular, mortality and morbidity, especially cardiovascular morbidity and mortality, and to reduce increased mortality related to cancer in individuals with IGT and/or IFG.
  • Hypoglycemic agents comprise, for example, an insulin secretion enhancer or an insulin sensitivity enhancer (insulin resistance deblocker) or insulin of, if appropriate, in each case a pharmaceutically acceptable salt thereof.
  • Insulin secretion enhancers are active ingredients that have the property to promote the secretion of insulin from pancreatic ⁇ -cells.
  • An insulin secretion enhancer (also called insulin secretogogue and insulinotropic agent) is, for example, a shortacting or a long-acting hypoglycemic agent.
  • a short-acting hypoglycemic is, for example, a phenylacetic acid derivative, furthermore gliquidone.
  • a corresponding phenylalanine derivative is, for example, nateglinide [N-(trans-4-isopropylcyclohexylcarbonyl)-D-phenylalanine] (cf. EP 196222 and EP 526171) of the formula
  • nateglinide likewise comprises crystal modifications such as disclosed in EP 0526171 B1 or U.S. Pat. No. 5,488,510, respectively, the subject matter of which, especially with respect to the identification, manufacture and characterization of crystal modifications, is herewith incorporated by reference to this application, especially the subject matter of claims 8 to 10 of said U.S. patent (referring to H-form crystal modification) as well as the corresponding references to the B-type crystal modification in EP 196222 B1 the subject matter of which, especially with respect to the identification, manufacture and characterization of the B-form crystal modification.
  • the B- or H-type is used.
  • a longacting hypoglycemic is, for example, a biguanide derivative or a sulphonyl urea derivative.
  • An approriate biguanide is, for example, metformin or, if appropriate, a pharmaceutically acceptable salt thereof, especially the hydrochloride thereof.
  • sulfonylurea derivatives are, especially those which promote the secretion of insulin from pancreatic ⁇ -cells by transmitting signals of insulin secretion via SU receptors in the cell membrane, including (but are not limited to) tolbutamide; chlorpropamide; tolazamide; acetohexamide; 4-chloro-N-[(1-pyrrolidinylamino)carbonyl]-benzensulfonamide (glycopyramide); glibenclamide (glyburide); gliclazide; 1-butyl-3-metanilylurea; carbutamide; glibonuride; glipizide; gliquidone; glisoxepid; glybuthiazole; glibuzole; glyhexamide; glymidine; glypinamide; phenbutamide; and tolylcyclamide, or, if appropriate, in each case a pharmaceutically acceptable salt thereof.
  • tolbutamide chlorpropamide
  • Insulin secretion enhancers furthermore include the representatives of the new generation of SUs such as calcium (2S)-2-benzyl-3-(cis-hexahydro-2-isoindolinlycarbonyl)-propionate dihydrate (KAD-1229) and glimepiride (Hoe 490); and in free or pharmaceutically acceptable salt form.
  • SUs such as calcium (2S)-2-benzyl-3-(cis-hexahydro-2-isoindolinlycarbonyl)-propionate dihydrate (KAD-1229) and glimepiride (Hoe 490); and in free or pharmaceutically acceptable salt form.
  • Insulin secretion enhancers likewise include DPP-IV inhibitors, GLP1 and GLP1 agonists.
  • DPP-IV is a serine protease and catalyses cleavage of N-terminal Xaa-Pro or XaaAla dipeptide residues omcluding glucagon-like protein-1 (GLP-1).
  • GLP-1 glucagon-like protein-1
  • Corresponding inhibitors of DPP-IV increase circulating concentrations of GLP-1 and therefore increasing insulin secretion.
  • DPP-IV inhibitors are described in WO98/19998 and WO00/34241.
  • Preferred is 1- ⁇ 2-[(5-cyanopyridin-2-yl)amino]ethylamino ⁇ acetyl-2(S)-cyano-pyrrolidine dihydrochloride (cf. example 3 of WO98/19998) and (S)1-[(3-hydroxy-1-adamantyl)amino]-acetyl-2-cyano-pyrrolidine (cf. example 1 of WOO/34241).
  • GLP-1 and GLP-1 agonists likewise enhance insulin secretion.
  • a preferred insulin secretion enhancer is repaglinide and metformin, most preferred is nateglinide.
  • An insulin sensitivity enhancer restores impaired insulin receptor function to reduce insulin resistance and consequently enhance the insulin sensitivity.
  • An appropriate insulin sensitivity enhancer is, for example, an appropriate hypoglycemic thiazolidinedione derivative (glitazone).
  • An appropriate glitazone is, for example, (S)-((3,4-dihydro-2-(phenyl-methyl)-2H-1-benzopyran-6-yl)methyl-thiazolidine-2,4-dione (englitazone), 5- ⁇ [4-(3-(5-methyl-2-phenyl-4-oxazolyl)-1-oxopropyl)-phenyl]-methyl ⁇ thiazolidine-2,4-dione (darglitazone), 5-[4-(1-methyl-cyclohexyl)methoxy)-phenyl]methyl)thiazolidine-2,4-dione (ciglitazone), 5- ⁇ [4-(2-(1-indolyl)ethoxy)phenyl]methyl ⁇ -thiazolidine-2,4-dione (DRF2189), 5- ⁇ 4-[2-(5-methyl-2-phenyl-4-oxazolyl)-ethoxy)]benzyl ⁇ -thiazolidine
  • the structure of the active agents identified by generic or tradenames may be taken from the actual edition of the standard compendium “The Merck Index” or from databases, e.g. Patents International (e.g. IMS World Publications). The corresponding content thereof is hereby incorporated by reference. Any person skilled in the art is fully enabled to identify the active agents and, based on these references, likewise enabled to manufacture and test the pharmaceutical indications and properties in standard test models, both in vitro and in vivo.
  • hypoglycemic agents such as insulin enhancers can restore early phase insulin secretion and reduce post-prandial glucose levels in subjects with IGM.
  • a multi-center, double-blind, parallel group, randomized study can be conducted in subjects with IGM in order to evaluate the incidence of confirmed hypoglycemia and the effects on prandial glucose associated with the administration of nateglinide 30 mg, 60 mg or 120 mg or placebo before each main meal during 8 weeks of treatment.
  • Subjects are selected on the basis of a 2-hour plasma glucose value after a 75 g oral glucose tolerance test (OGTT) and patients essentially meeting the following additional inclusion criteria are included in the study:
  • OGTT oral glucose tolerance test
  • BMI body mass index
  • Corresponding dosages of e.g. nateglinide are administered with a large glass of water 2 (BID), 3 (TID) or 4 (QID) times daily depending on the number of main meals (breakfast, lunch, snack, dinner).
  • the first dose is to be given with the first main meal (standardized meal i.e. 55% carbohydrates, 25% fat and 20% protein).
  • Visits are scheduled to be performed at weeks 0, 2, 4 and 8 and the patients are to be fasted for at least 7 hours. All blood samples for laboratory evaluations are drawn between 07.00 and 10.00 a.m. HbAlc is to be measured at baseline and after 8 weeks of treatment (fasting glucose and fructosamine).
  • Samples of blood are to be drawn at 10, 20, 20, 60, 120, and 180 minutes after drug administration (time 0) and the glucose and insulin levels to be measured.
  • time 0 the time after drug administration
  • samples of blood are to be drawn at 10, 20, 20, 60, 120, and 180 minutes after drug administration (time 0) and the glucose and insulin levels to be measured.
  • time 0 the time after drug administration
  • glucose and insulin levels to be measured.
  • weeks 0 and 8 visits patients complete a standard meal challenge containing approximately 500 kcal and measurements of insulin and glucose will be performed.
  • hypoglycemic agents as well as a combination of hypoglycemic agents can be used in subjects with IGM, especially IFG and/or IGT, for the prevention or delay of progression to overt diabetes mellitus type 2; for the prevention, reduction or delay in onset of a condition selected from the group consisting of increased microvascular complications; increased cardiovascular morbidity; excess cerebrovascular diseases; increased cardiovascular mortality and sudden death; higher incidences and mortality rates of malignant neoplasms; and other metabolic disturbances that are associated with IGM.
  • hypoglycemic agents as well as a combination of hypoglycemic agents can be used in subjects with IGM, especially IFG and/or IGT, for the prevention, reduction or delay in onset of a condition selected from the group e.g. consisting of retinopathy, other ophthalmic complications of diabetes, nephropathy, neuropathy, peripheral angiopathy, peripheral angiopathy, gangrene, myocardial infarctions, coronary heart disease, atherosclerosis, other acute and subacute forms of coronary ischemia, stroke, dyslipidemia, hyperuricemia, hypertension, angina pectoris, microangiopathic changes that result in amputation, cancer, cancer deaths, obesity, uricemia, insulin resistance, arterial occlusive disease, and atherosclerosis.
  • retinopathy other ophthalmic complications of diabetes
  • nephropathy neuropathy
  • peripheral angiopathy peripheral angiopathy
  • gangrene myocardial infarctions
  • coronary heart disease atheros
  • hypoglycemic agents can be used in subjects with IGM, especially with IFG and/or IGT, to prevent or delay the progression to overt diabetes, to reduce microvascular complications of diabetes, to reduce vascular, especially cardiovascular, mortality and morbidity, especially cardiovascular morbidity and mortality, and to reduce increased mortality related to cancer in individuals with IGT.
  • the present invention relates to a method in subjects with IGM, especially IFG and/or IGT, for the prevention or delay of progression to overt diabetes mellitus type 2; for the prevention, reduction or delay in onset of a condition selected from the group consisting of increased microvascular complications; increased cardiovascular morbidity; excess cerebrovascular diseases; increased cardiovascular mortality and sudden death; higher incidences and mortality rates of malignant neoplasms; and other metabolic disturbances that are associated with IGM.
  • the present invention relates to a method used in subjects with IGM, especially IFG and/or IGT, for the prevention, reduction or delay in onset of a condition selected from the group e.g. consisting of retinopathy, other ophthalmic complications of diabetes, nephropathy, neuropathy, peripheral angiopathy, peripheral angiopathy gangrene, myocardial infarctions, coronary heart disease, atherosclerosis, other acute and subacute forms of coronary ischemia, stroke, dyslipidemia, hyperuricemia, hypertension, angina pectoris, microangiopathic changes that result in amputation, cancer, cancer deaths, obesity, uricemia, insulin resistance, arterial occlusive disease, and atherosclerosis.
  • retinopathy other ophthalmic complications of diabetes
  • nephropathy neuropathy
  • peripheral angiopathy peripheral angiopathy gangrene
  • myocardial infarctions myocardial infarctions
  • coronary heart disease atherosclerosis
  • the present invention relates to a method of prevention or delay of the progression to overt diabetes, especially type 2 (ICD-9 Code 250.2), prevention or reduction of microvascular complications like retinopathy (ICD-9 code 250.5), neurophathy (ICD-9 code 250.6), nephropathy (ICD-9 code 250.4) and peripheral angiopathy or gangrene (ICD-9 code 250.7), later termed “microvascular complications” in subjects with IGM, especially IFG IGT. Further the present invention relates to a method to prevent or reduce conditions of excessive cardiovascular morbidity (ICD-9 codes 410-414), e.g.
  • ICD-9 codes 410-414 e.g.
  • ICD-9 code 410 myocardial infarction
  • ICD-9 code 411-414 arterial occlusive disease, atherosclerosis and other acute and subacute forms of coronary ischemia
  • ICD-9 code 411-414 later termed “cardiovascular morbidity”; to prevent, reduce, or delay the onset of excess cerebrovascular diseases like stroke (ICD-9 codes 430-438); to reduce increased cardiovascular mortality (ICD-9 codes 390459) and sudden death (ICD-9 code 798. 1); to prevent the development of cancer (ICD-9 codes 140-208) and to reduce cancer deaths, in each case, in subjects with IGM, especially IFG and IGT.
  • the method further relates to a method of prevention or reduction of other metabolic disturbances that are associated with IGM including hyperglycemia (including isolated postprandial hyperglycemia), dyslipidemia (ICD-9 code 272), hyperuricemia (ICD-9 code 790.6) as well as hypertension (ICD-9 codes 401-404) and angina pectoris (ICD-9 code 413.9), in each case, in subjects with IGM, especially IFG and IGT.
  • hyperglycemia including isolated postprandial hyperglycemia
  • dyslipidemia ICD-9 code 272
  • hyperuricemia ICD-9 code 790.6
  • hypertension ICD-9 codes 401-404
  • angina pectoris ICD-9 code 413.9
  • hypoglycemic agents in particular of early phase secretion, is rapidly reversible and the reduction of postprandial glucose levels is favorable for prevention or treatment in this indication.
  • the method comprises administering to a subject in need thereof an effective amount of hypoglycemic agents such as an insulin secretion enhancer or a pharmaceutically acceptable salt thereof.
  • a subject in need of such method is a warm-blooded animal including man.
  • the present invention also relates to a method to be used in subjects with IGM, and especially IFG and/or IGT, and associated diseases and conditions such as isolated prandial hyperglycemia, prevention or delay of the progression to overt diabetes, especially type 2, prevention reduction, or delay the onset of microvascular complications, prevention or reduction of gangrene or microangiopathic changes that result in amputation, prevention or reduction of excessive cardiovascular morbidity and cardiovascular mortality, prevention of cancer and reduction of cancer deaths.
  • diseases and conditions such as isolated prandial hyperglycemia, prevention or delay of the progression to overt diabetes, especially type 2, prevention reduction, or delay the onset of microvascular complications, prevention or reduction of gangrene or microangiopathic changes that result in amputation, prevention or reduction of excessive cardiovascular morbidity and cardiovascular mortality, prevention of cancer and reduction of cancer deaths.
  • the present invention likewise relates to a method of treatment of conditions and diseases associated with IGM and especially IFG and/or IGT (including isolated prandial hyperglycemia) including obesity, increased age, diabetes during pregnancy, dyslipidemia, high blood pressure, uricemia, insulin resistance, arterial occlusive disease, atherosclerosis, retinopathy, nephropathy, angina pectoris, myocardial infarction, and stroke.
  • IGM especially IFG and/or IGT (including isolated prandial hyperglycemia) including obesity, increased age, diabetes during pregnancy, dyslipidemia, high blood pressure, uricemia, insulin resistance, arterial occlusive disease, atherosclerosis, retinopathy, nephropathy, angina pectoris, myocardial infarction, and stroke.
  • IGT isolated prandial hyperglycemia
  • said preventions should be effected in individuals with glucose levels in the ranges that have been proven in large epidemiologic studies to confer increased cardiovascular, microvascular and cancer risk. These levels include levels of plasma glucose ⁇ 7.8 mmol/L mmol/L after an OGTT or casual glucose evaluation and/or fasting plasma glucose in the IFG range (fasting plasma glucose between 6.1 and 7 mmol/l).
  • levels of plasma glucose ⁇ 7.8 mmol/L mmol/L after an OGTT or casual glucose evaluation and/or fasting plasma glucose in the IFG range fasting plasma glucose between 6.1 and 7 mmol/l.
  • the present invention also relates to a method to be used in subjects with IFG comprising administering to a subject in need thereof a therapeutically effective amount of a DPP-IV inhibitor.
  • the present invention relates to the use of a hypoglycemic agent or a pharmaceutically acceptable salt thereof for the manufacture of a medicament in subjects with IGM, especially IFG and/or IGT, for the prevention or delay of progression to overt diabetes mellitus type 2; for the prevention, reduction or delay in onset of a condition selected from the group consisting of increased microvascular complications; increased cardiovascular morbidity; excess cerebrovascular diseases; increased cardiovascular mortality and sudden death; higher incidences and mortality rates of malignant neoplasms; and other metabolic disturbances that are associated with IGM.
  • the present invention relates to the use of an insulin secretion enhancer or a pharmaceutically acceptable salt thereof for the manufacture of a medicament for the prevention or delay of the progression to overt diabetes, especially type 2, prevention or reduction of microvascular complications, prevention or reduction of excessive cardiovascular morbidity and cardiovascular mortality, prevention of cancer and reduction of cancer deaths.
  • the present invention relates to the use of an insulin secretion enhancer or a pharmaceutically acceptable salt for the manufacture of a medicament in subjects with IGM, and especially IFG and/or IGT, and associated diseases and conditions such as isolated prandial hyperglycemia for the following: prevention or delay of the progression to overt diabetes, especially type 2, prevention or reduction of microvascular complications, prevention or reduction of excessive cardiovascular morbidity and cardiovascular mortality, prevention of cancer and reduction of cancer deaths.
  • the present invention relates to a pharmaceutical composition in subjects with IGM, especially IFG and/or IGT, for the prevention or delay of progression to overt diabetes mellitus type 2; for the prevention, reduction or delay in onset of a condition selected from the group consisting of increased microvascular complications; increased cardiovascular morbidity; excess cerebrovascular diseases; increased cardiovascular mortality and sudden death; higher incidences and mortality rates of malignant neoplasms; and other metabolic disturbances that are associated with IGM; comprising a hypoglycemic agent or a pharmaceutically acceptable salt thereof and a pharmaceutically acceptable carrier.
  • the present invention relates to a pharmaceutical composition for the prevention or delay of the progression to overt diabetes, especially type 2, prevention or reduction of microvascular complications, prevention or reduction of excessive cardiovascular morbidity and cardiovascular mortality, prevention of cancer and reduction of cancer deaths, comprising an insulin secretion enhancers or a pharmaceutically acceptable salt thereof and a pharmaceutically acceptable carrier.
  • the present invention relates to a pharmaceutical composition in subjects with IGM, and especially IFG and/or IGT and associated diseases and conditions such as isolated prandial hyperglycemia for the following: prevention or delay of the progression to overt diabetes, especially type 2, prevention or reduction of microvascular complications, prevention or reduction of excessive cardiovascular morbidity and cardiovascular mortality, prevention of cancer and reduction of cancer deaths.
  • the corresponding active ingredient or a pharmaceutically acceptable salt thereof may also be used in form of a hydrate or include other solvents used for crystallization.
  • the present invention relates to the combination such as a combined preparation or pharmaceutical composition, respectively, comprising at least one insulin secretion enhancer and alt least one insulin sensitiser; or at least two insulin secretion enhancers; or at least two insulin sensitisers; to be used in subjects with IGM, especially IFG and/or IGT, for the prevention or delay of progression to overt diabetes mellitus type 2; for the prevention, reduction or delay in onset of a condition selected from the group consisting of increased microvascular complications; increased cardiovascular morbidity; excess cerebrovascular diseases; increased cardiovascular mortality and sudden death; higher incidences and mortality rates of malignant neoplasms; and other metabolic disturbances that are associated with IGM.
  • the jointly therapeutically effective amounts of the active agents according to the combination of the present invention can be administered simultaneously or sequentially in any order, separately or in a fixed combination.
  • terapéuticaally effective amount shall mean that amount of a drug or combination that will elicit the biological or medical response needed to achieve the therapeutic effect as specified according to the present invention in the warm-blooded animal, including man.
  • a “therapeutically effective amount” can be administered when administering a single hypoglycemic agent and also in both a fixed or free combination of hypoglycemic agents.
  • a “jointly effective amount” in a combination according to the present invention shall also include a non-effective amount of at least one of the agents to be combined, if the overall effect can be achieved by the combined administration of the (fixed or free) combination.
  • the pharmaceutical composition according to the present invention as described hereinbefore and hereinafter may be used for simultaneous use or sequential use in any order, for separate use or as a fixed combination.
  • Preferred components for a combination according to the present invention preferably those that are designated as preferred hypoglycemic agents, that are most preferably selected from nateglinide, repaglinide, metformin, pioglitazone, rosiglitazone, troglitazone, 12-[(5-cyanopyridin-2-yl)amino]ethylamino)acetyl-2(S)-cyano-pyrrolidine, and (S)1-[(3-hydroxy-1-adamantyl)amino]-acetyl-2-cyano-pyrrolidine, or, if appropriate, in each case, a pharmaceutically acceptable salt thereof.
  • preferred hypoglycemic agents that are most preferably selected from nateglinide, repaglinide, metformin, pioglitazone, rosiglitazone, troglitazone, 12-[(5-cyanopyridin-2-yl)amino]ethylamino)acetyl-2
  • the present invention likewise relates to a “kit-of-parts”, for example, in the sense that the components to be combined according to the present invention can be dosed independently or by use of different fixed combinations with distinguished amounts of the components, i.e. simultaneously or at different time points.
  • the parts of the kit of parts can then e.g. be administered simultaneously or chronologically staggered, that is at different time points and with equal or different time intervals for any part of the kit of parts.
  • the time intervals are chosen such that the effect on the treated disease or condition in the combined use of the parts is larger than the effect that would be obtained by use of only any one of the components.
  • the invention furthermore relates to a commercial package comprising the combination according to the present invention together with instructions for simultaneous, separate or sequential use.
  • the compounds to be combined can be present as pharmaceutically acceptable salts. If these compounds have, for example, at least one basic center, they can form acid addition salts. Corresponding acid addition salts can also be formed having, if desired, an additionally present basic center.
  • the compounds having an acid group for example COOH can also form salts with bases.
  • salts e.g. of nateglinide are, for example, salts formed with bases, namely cationic salts such as alkali and alkaline earth metal salts, as well as ammonium salts.
  • compositions according to the invention can be prepared in a manner known per se and are those suitable for enteral, such as oral or rectal, and parenteral administration to mammals (warm-blooded animals), including man, comprising a therapeutically effective amount of the pharmacologically active compound, alone or in combination with one or more pharmaceutically acceptable carries, especially suitable for enteral or parenteral application.
  • novel pharmaceutical preparations contain, for example, from about 10% to about 100%, preferably 80%, preferably from about 20% to about 60%, of the active ingredient.
  • Pharmaceutical preparations according to the invention for enteral or parenteral administration are, for example, those in unit dose forms, such as sugar-coated tablets, tablets, capsules or suppositories, and furthermore ampoules. These are prepared in a manner known per se, for example by means of conventional mixing, granulating, sugar-coating, dissolving or lyophilizing processes.
  • compositions for oral use can be obtained by combining the active ingredient with solid carriers, if desired granulating a mixture obtained, and processing the mixture or granules, if desired or necessary, after addition of suitable excipients to give tablets or sugar-coated tablet cores.
  • the doses for hypoglycemic agents for use according to the present invention may, for example, be those that are being used for agents that have already been launched.
  • tablets of repaglinide in doses of 0.5 mg, 1 mg or 2 mg of the active ingredient or tablets of metformin in doses of 500 mg or 850 mg of the active ingredient may be taken Likewise these doses may also be used for the agents to be combined combination according to the present invention.
  • a person skilled in the art is fully enabled, based on his knowledge, to determine the specific doses for the specific hypolipidemic agents whether taken alone or in combination.
  • Nateglinide (I) is preferably administered to the warm-blooded animal in a dosage in the range of about 5 to 1200, more preferably 25 to 800, mg/day, when the warm-blooded animal is a human of about 70 kg body weight.
  • Preferred dosages contain 30 mg, 60 mg or 120 mg of nateglinide to be administered preferably before the main meals.
  • the dose regimen are two times a day (BID) or three times a day (TID) or four times a day (QID).
  • composition Composition: nateglinide (I) 12.960 kg lactose, NF 30.564 kg microcrystalline cellulose, NF 15.336 kg povidone, USP 2.592 kg croscarmellose sodium, NF 3.974 kg colloidal silicon dioxide, NF 1.382 kg magnesium stearate, NF 1.231 kg coating: opadry yellow 1.944 kg purified water, USP* Q.S. *removed during process
  • Preparation process The microcrystalline cellulose, povidone, part of the croscarmellose sodium, nateglinide (I) and lactose are mixed in a high shear mixer and afterwards granulated using purified water.
  • the wet granules are dried in a fluid bed dryer and passed through a screen.
  • the colloidal silicon dioxide and the rest of the croscarmellose sodium are mixed, passed through a screen and blended with the dried granules in a V-blender.
  • the magnesium stearate is passed through a screen, blended with the blend from the V-blender and afterwards the total mixture is compressed to tablets.
  • the opadry yellow is suspended in purified water and the tablets are coated with the coating suspension.
  • composition nateglinide 12.960 kg lactose, NF 30.564 kg microcrystalline cellulose, NF 15.336 kg povidone, USP 2.592 kg croscarmellose sodium, NF 3.974 kg colloidal silicon dioxide, NF 1.382 kg magnesium stearate, NF 1.231 kg coating: opadry yellow 1.944 kg purified water, USP* Q.S. *removed during process
  • Preparation process The microcrystalline cellulose, povidone, a portion of the croscarmellose sodium, nateglinide and lactose are granulated in a collette gral granulator with the addition of purified water.
  • the wet granules are dried in a fluid bed dryer and passed through a screen.
  • the colloidal silicon dioxide and the rest of the croscarmellose sodium are mixed, passed through a screen and blended with the dried granules in a V-blender.
  • the magnesium stearate is passed through a screen, blended with the blend from the V-blender and afterwards the total mixture is compressed to tablets.
  • the opadry yellow is suspended in purified water and the tablets are coated with the coating suspension.
  • Variants of this process include adding the colloidal silica and the remaining croscarmellose sodium to the second granulator load after drying, then screening together; and combining as many as 3 granulator/drier loads per batch.

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Abstract

The invention relates to the use of a hypolipidemic agent or a pharmaceutically acceptable salt thereof for the manufacture of a medicament for the prevention or delay of the progression to overt diabetes, especially type 2, prevention or reduction of microvascular complications (eg, retinopathy, neurophathy, nephropathy), prevention or reduction of excessive cardiovascular morbidity (eg, myocardial infarction, arterial occlusive disease, atherosclerosis and stroke) and cardiovascular mortality, prevention of cancer and reduction of cancer deaths. Additionally, the invention relates to the use of a treatment for diseases and conditions that are associated with IGM, IGT or IFG.

Description

  • Impaired Glucose Metabolism (IGM) is defined by blood glucose levels that are above the normal range but are not high enough to meet the diagnostic criteria for type 2 diabetes mellitus. The incidence of IGM varies from country to country, but usually occurs 2-3 times more frequently than overt diabetes. Until recently, individuals with IGM were felt to be pre-diabetics, but data from several epidemiologic studies argue that subjects with IGM are heterogeneous with respect to their risk of diabetes and their risk of cardiovascular morbidity and mortality. The data suggest that subjects with IGM, in particular IGT, do not always develop diabetes, but whether they are diabetic or not, they are, nonetheless, at high risk for cardiovascular morbidity and mortality.
  • Among subjects with IGM, about 58% have Impaired Glucose Tolerance (IGT), another 29% have Impaired Fasting Glucose (IFG), and 13% have both abnormalities (IFG/IGT). IGT is characterized by elevated postprandial (post-meal) hyperglycemia while IFG has been defined by the ADA (see Table below) on the basis of fasting glycemic values.
  • The categories of Normal Glucose Tolerance (NGT), IGM and type 2 diabetes mellitus were defined by the ADA in 1997 as follows:
  • Type 2 Diabetes
    NGT IGM mellitus
    IFG
    FPG level <6.1 mmol/L 6.1-7 mmol/L   >7 mmol/L
    (<110 mg/dl) (110-126 mg/dl)  >126 mg/dl)
    And and/or or
    IGT
    2 h postprandial <7.8 mmol/l 7.8-11.1 mmol/L   >11.1 mmol/L
    glucose level (<140 mg/dl) (140-220 mg/dl) (>200 mg/dl)
    (75 g OGTT *))
    *) These criteria were defined using the WHO recommended conditions for administration of an oral glucose tolerance test (OGTT), i.e., the oral administration of a glucose load containing the equivalent of 75 g of anhydrous glucose dissolved in water with a blood sample taken 2 hours later to analyze the post-prandial glucose. Other OGTT test conditions have confirmed the associated risks of the IGT and IFG categories including: 1) using 50 g glucose instead of 75 g, 2) using a casual (non-fasting) glucose sample as the analyte, and 3) analyzing the post-prandial glucose at 1 hour rather than 2 hours post-glucose load. Under all of these conditions, the glycemic categories defined above have been linked to the increased risks described below, but the standardized OGTT is preferred in order to minimize variations in test results.
  • Individuals with IGM, especially those with the subcategory IFG, are known to have a significantly higher rate of progression to diabetes than normoglycemic individuals and are known to be high at cardiovascular risk, especially if they develop diabetes. Interestingly, subjects with IGM, more specifically those with the subcategory IGT, have a high incidence of cancer, cardiovascular diseases and mortality even if they never develop diabetes. Therefore, IGM and more specifically, the subgroup IFG, appears to be at high cardiovascular risk, especially after patients become overtly diabetic. IGT, on the other hand, is associated with a high risk for cancer, cardiovascular disease and mortality in nondiabetics and diabetics. The increased risk associated with IGT is independent of all other known cardiovascular risk factors including age, sex, hypertension, low HDL and high LDL cholesterol levels [Lancet 1999; 354: 617-621].
  • One mechanism through which IGM, and more specifically, IGT, has been linked to micro- and macroangiopathic complications in the absence of the abnormal FPG characteristic of diabetics, is postprandial hyperglycemia. Isolated postprandial hyperglycemia, even in nondiabetics, has been shown to reduce the natural free-radical trapping agents (TRAP) that are present in serum. Decreasing the level of TRAP has been shown, under experimental conditions, to be associated with an increase in free radical formation and increased oxidative stress. These free radicals have been implicated in the pathological microvascular and macrovascular changes associated with atherosclerosis, cardiovascular morbidity and mortality, and cancer [Ceriello, A, Diabetic Medicine 15: 188-193, 1998]. The decrease of natural antioxidants like TRAP during postprandial hyperglycemia may explain the increased cardiovascular risk in subjects with IGM, and specifically IGT, that do not develop diabetes. The fact that IGT is an independent risk factor in non-diabetics as well as diabetics justifies it as a new indication, separate from diabetes, for prevention and treatment of cardiovascular morbidity and mortality as well as cancer.
  • IGM is associated with following potential diseases or conditions: 1.) progression to overt diabetes mellitus type 2 (Code 250.2 of the International Classification of Diseases 9th version ICD-9 Code 250.2) [Diabetes Research and Clinical Practice 1998; 40: S1-S2]; 2.) increased microvascular complications of diabetes especially retinopathy and other ophthalmic complications of diabetes (ICD-9 code 250.5), nephropathy (ICD-9 code 250.4), neuropathy (ICD-9 code 250.6) [Diabetes Care 2000; 23: 1113-1118], and peripheral angiopathy or gangrene (ICD-9 code 250.7); 3.) increased cardiovascular morbidity (ICD-9 codes 410-414) especially myocardial infarctions (ICD-9 code 410), coronary heart disease or atherosclerosis (ICD-9 code 414) and other acute and subacute forms of coronary ischemia (ICD-9 code 411); 4.) excess cerebrovascular diseases like stroke (ICD-9 codes 430-438) [Circulation 1998; 98: 2513-2519]); 5.) increased cardiovascular mortality (ICD-9 codes 390459) [Lancet 1999; 354: 617-621], and sudden death (ICD-9 code 798.1); 6.) higher incidences and mortality rates of malignant neoplasms (ICD-9 codes 140-208) [Am J Epidemiol. 1990; 131: 254-262, Diabetologia 1999; 42: 1050-1054]. Other metabolic disturbances that are associated with IGM include dyslipidemia (ICD-9 code 272), hyperuricemia (ICD-9 code 790.6) as well as hypertension (ICD-9 codes 401-404) and angina pectoris (ICD-9 code 413.9) [Ann Int Med 1998; 128: 524-533].
  • Clearly, the broad spectrum of diseases and conditions that are linked to IGM, and especially IGT, represents an area of tremendous medical need. Many of the same diseases and conditions have been associated with both IGM and diabetes, but only recently has it been possible to identify that that the nondiabetic population that has IGM, and especially IGT, should be an indication for prevention and treatment. Accordingly, in subjects with IGM and especially IGT and/or IFG, the restoration of early phase insulin secretion and/or the reduction of prandial hyperglycemia should help to prevent or delay the progression to overt diabetes and to prevent or reduce microvascular complications associated with diabetes by preventing the development of the overt diabetes. In addition, in individuals with IGM and especially those with IGT and/or IFG, the restoration of early phase insulin secretion and/or reduction of postprandial hyperglycemia should also prevent or reduce the excessive cardiovascular morbidity and mortality, and prevent cancer or reduce its mortality in individuals.
  • Thus the stage between normoglycemia and type 2 diabetes mellitus, especially the glycemic stage, is becoming of major interest and there is a strong need for a method to inhibit or delay the progression to type 2 diabetes mellitus, and also the variety of cardiovascular and microvascular conditions and diseases as well as cancer that have been associated with IGM and especially IFG and/or IGT.
  • It has unexpectedly been found that hypoglycemic agents such as insulin secretion enhancers can be used to prevent or delay the progression to overt diabetes, to reduce microvascular complications of diabetes, to reduce vascular, especially cardiovascular, mortality and morbidity, especially cardiovascular morbidity and mortality, and to reduce increased mortality related to cancer in individuals with IGT and/or IFG.
  • Hypoglycemic agents comprise, for example, an insulin secretion enhancer or an insulin sensitivity enhancer (insulin resistance deblocker) or insulin of, if appropriate, in each case a pharmaceutically acceptable salt thereof.
  • Insulin secretion enhancers are active ingredients that have the property to promote the secretion of insulin from pancreatic β-cells.
  • An insulin secretion enhancer (also called insulin secretogogue and insulinotropic agent) is, for example, a shortacting or a long-acting hypoglycemic agent. A short-acting hypoglycemic is, for example, a phenylacetic acid derivative, furthermore gliquidone.
  • A corresponding phenylalanine derivative is, for example, nateglinide [N-(trans-4-isopropylcyclohexylcarbonyl)-D-phenylalanine] (cf. EP 196222 and EP 526171) of the formula
  • Figure US20080287501A1-20081120-C00001
  • and repaglinide [(S)-2-ethoxy-4-{2-[[3-methyl-1-[2-(1-piperidinyl)phenyl]butyl]amino]-2-oxoethyl}benzoic acid]; and in free form or, if appropriate, in each case a pharmaceutically acceptable salt thereof.
  • The term nateglinide likewise comprises crystal modifications such as disclosed in EP 0526171 B1 or U.S. Pat. No. 5,488,510, respectively, the subject matter of which, especially with respect to the identification, manufacture and characterization of crystal modifications, is herewith incorporated by reference to this application, especially the subject matter of claims 8 to 10 of said U.S. patent (referring to H-form crystal modification) as well as the corresponding references to the B-type crystal modification in EP 196222 B1 the subject matter of which, especially with respect to the identification, manufacture and characterization of the B-form crystal modification. Preferably, in the present invention, the B- or H-type, more preferably the H-type, is used.
  • A longacting hypoglycemic is, for example, a biguanide derivative or a sulphonyl urea derivative.
  • An approriate biguanide is, for example, metformin or, if appropriate, a pharmaceutically acceptable salt thereof, especially the hydrochloride thereof.
  • Examples of sulfonylurea derivatives (SU) are, especially those which promote the secretion of insulin from pancreatic β-cells by transmitting signals of insulin secretion via SU receptors in the cell membrane, including (but are not limited to) tolbutamide; chlorpropamide; tolazamide; acetohexamide; 4-chloro-N-[(1-pyrrolidinylamino)carbonyl]-benzensulfonamide (glycopyramide); glibenclamide (glyburide); gliclazide; 1-butyl-3-metanilylurea; carbutamide; glibonuride; glipizide; gliquidone; glisoxepid; glybuthiazole; glibuzole; glyhexamide; glymidine; glypinamide; phenbutamide; and tolylcyclamide, or, if appropriate, in each case a pharmaceutically acceptable salt thereof.
  • Insulin secretion enhancers furthermore include the representatives of the new generation of SUs such as calcium (2S)-2-benzyl-3-(cis-hexahydro-2-isoindolinlycarbonyl)-propionate dihydrate (KAD-1229) and glimepiride (Hoe 490); and in free or pharmaceutically acceptable salt form.
  • Insulin secretion enhancers likewise include DPP-IV inhibitors, GLP1 and GLP1 agonists.
  • DPP-IV is a serine protease and catalyses cleavage of N-terminal Xaa-Pro or XaaAla dipeptide residues omcluding glucagon-like protein-1 (GLP-1). Corresponding inhibitors of DPP-IV increase circulating concentrations of GLP-1 and therefore increasing insulin secretion.
  • Representatives of DPP-IV inhibitors are described in WO98/19998 and WO00/34241. Preferred is 1-{2-[(5-cyanopyridin-2-yl)amino]ethylamino}acetyl-2(S)-cyano-pyrrolidine dihydrochloride (cf. example 3 of WO98/19998) and (S)1-[(3-hydroxy-1-adamantyl)amino]-acetyl-2-cyano-pyrrolidine (cf. example 1 of WOO/34241).
  • GLP-1 and GLP-1 agonists likewise enhance insulin secretion.
  • A preferred insulin secretion enhancer is repaglinide and metformin, most preferred is nateglinide.
  • An insulin sensitivity enhancer restores impaired insulin receptor function to reduce insulin resistance and consequently enhance the insulin sensitivity.
  • An appropriate insulin sensitivity enhancer is, for example, an appropriate hypoglycemic thiazolidinedione derivative (glitazone).
  • An appropriate glitazone is, for example, (S)-((3,4-dihydro-2-(phenyl-methyl)-2H-1-benzopyran-6-yl)methyl-thiazolidine-2,4-dione (englitazone), 5-{[4-(3-(5-methyl-2-phenyl-4-oxazolyl)-1-oxopropyl)-phenyl]-methyl}thiazolidine-2,4-dione (darglitazone), 5-[4-(1-methyl-cyclohexyl)methoxy)-phenyl]methyl)thiazolidine-2,4-dione (ciglitazone), 5-{[4-(2-(1-indolyl)ethoxy)phenyl]methyl}-thiazolidine-2,4-dione (DRF2189), 5-{4-[2-(5-methyl-2-phenyl-4-oxazolyl)-ethoxy)]benzyl}-thiazolidine-2,4-dione (BM-13.1246), 5-(2-naphthylsulfonyl)-thiazolidine-2,4-dione (AY-31637), bis{4-[(2,4-dioxo-5-thiazolidinyl)methyl]phenyl}methane (YM268), 5-[(4-[2-(5-methyl-2-phenyl-4-oxazolyl)-2-hydroxyethoxy]benzyl]-thiazolidine-2,4-dione (AD-5075), 5-[4-1-phenyl-1-cyclopropanecarbonylamino)-benzyl]-thiazolidine-2,4-dione (DN-108) 5-{[4-(2-(2,3-dihydroindol-1-yl)ethoxy)phenyl]methyl}-thiazolidine-2,4-dione, 5-[3-(4-chloro-phenyl])-2-propynyl]-5-phenylsulfonyl)thiazolidine-2,4-dione, 5-[3-(4-chlorophenyl])-2-propynyl]-5-(4-fluorophenyl-sulfonyl)thiazolidine-2,4-dione, 5-{[4-(2-(methyl-2-pyridinyl-amino)-ethoxy)phenyl]methyl}-thiazolidine-2,4-dione (rosiglitazone), 5-{[4-(2-(5-ethyl-2-pyridyl)ethoxy)phenyl]-methyl}thiazolidine-2,4-dione (pioglitazone), 5-[4-((3,4-dihydro-6-hydroxy-2,5,7,8-tetramethyl-2H-1-benzopyran-2-yl)methoxy)-phenyl]-methyl)-thiazolidine-2,4-dione (troglitazone), 5-[6-(2-fluoro-benzyloxy)naphthalen-2-ylmethyl]-thiazolidine-2,4-dione (MCC555), 5-{[2-(2-naphthyl)-benzoxazol-5-yl]-methyl}thiazolidine-2,4-dione (T-174) and 5-(2,4-dioxothiazolidin-5-ylmethyl)-2-methoxy-N-(4-trifluoromethyl-benzyl)benzamide (KRP297). Preferred are pioglitazone, rosiglitazone and troglitazone.
  • The structure of the active agents identified by generic or tradenames may be taken from the actual edition of the standard compendium “The Merck Index” or from databases, e.g. Patents International (e.g. IMS World Publications). The corresponding content thereof is hereby incorporated by reference. Any person skilled in the art is fully enabled to identify the active agents and, based on these references, likewise enabled to manufacture and test the pharmaceutical indications and properties in standard test models, both in vitro and in vivo.
  • Favorable effects can be verified that confirm that hypoglycemic agents such as insulin enhancers can restore early phase insulin secretion and reduce post-prandial glucose levels in subjects with IGM. A multi-center, double-blind, parallel group, randomized study can be conducted in subjects with IGM in order to evaluate the incidence of confirmed hypoglycemia and the effects on prandial glucose associated with the administration of nateglinide 30 mg, 60 mg or 120 mg or placebo before each main meal during 8 weeks of treatment. Subjects are selected on the basis of a 2-hour plasma glucose value after a 75 g oral glucose tolerance test (OGTT) and patients essentially meeting the following additional inclusion criteria are included in the study:
  • two-hour glycemia post-OGTT between 7.8 to 11.1 mmol/L (one OGTT to be performed during the year before entering the study, the second to be performed within two weeks prior entering the study);
  • FPG<7 mmol/L;
  • patients are to have a body mass index (BMI) between 20-32 kg/m2;
  • patients are to maintain prior diet during the full course of study;
  • males, non-fertile females, females of child-bearing potential using a medically approved birth control method are included;
  • the use of other antidiabetics during the trial is not permitted.
  • Corresponding dosages of e.g. nateglinide are administered with a large glass of water 2 (BID), 3 (TID) or 4 (QID) times daily depending on the number of main meals (breakfast, lunch, snack, dinner). The first dose is to be given with the first main meal (standardized meal i.e. 55% carbohydrates, 25% fat and 20% protein). Visits are scheduled to be performed at weeks 0, 2, 4 and 8 and the patients are to be fasted for at least 7 hours. All blood samples for laboratory evaluations are drawn between 07.00 and 10.00 a.m. HbAlc is to be measured at baseline and after 8 weeks of treatment (fasting glucose and fructosamine). Samples of blood are to be drawn at 10, 20, 20, 60, 120, and 180 minutes after drug administration (time 0) and the glucose and insulin levels to be measured. At weeks 0 and 8 visits, patients complete a standard meal challenge containing approximately 500 kcal and measurements of insulin and glucose will be performed.
  • The findings from analyses of all obtained data in such a study clearly revealed that 2 hour prandial glucose levels, HBA1c and fructosamine levels were surprisingly and significantly reduced, that early phase insulin secretion was restored, and that nateglinide could prevent or delay the progression to type 2 diabetes mellitus. With longer treatment and follow-up, conditions and diseases associated with IGM could be prevented or reduced.
  • This type of study in individuals with IGM and particularly IFG and IGT differs from those in diabetics since the subjects have normal FPG and are nondiabetics or pre-diabetics.
  • Surprisingly, hypoglycemic agents as well as a combination of hypoglycemic agents can be used in subjects with IGM, especially IFG and/or IGT, for the prevention or delay of progression to overt diabetes mellitus type 2; for the prevention, reduction or delay in onset of a condition selected from the group consisting of increased microvascular complications; increased cardiovascular morbidity; excess cerebrovascular diseases; increased cardiovascular mortality and sudden death; higher incidences and mortality rates of malignant neoplasms; and other metabolic disturbances that are associated with IGM.
  • Furthermore, hypoglycemic agents as well as a combination of hypoglycemic agents can be used in subjects with IGM, especially IFG and/or IGT, for the prevention, reduction or delay in onset of a condition selected from the group e.g. consisting of retinopathy, other ophthalmic complications of diabetes, nephropathy, neuropathy, peripheral angiopathy, peripheral angiopathy, gangrene, myocardial infarctions, coronary heart disease, atherosclerosis, other acute and subacute forms of coronary ischemia, stroke, dyslipidemia, hyperuricemia, hypertension, angina pectoris, microangiopathic changes that result in amputation, cancer, cancer deaths, obesity, uricemia, insulin resistance, arterial occlusive disease, and atherosclerosis.
  • According to the present invention, hypoglycemic agents can be used in subjects with IGM, especially with IFG and/or IGT, to prevent or delay the progression to overt diabetes, to reduce microvascular complications of diabetes, to reduce vascular, especially cardiovascular, mortality and morbidity, especially cardiovascular morbidity and mortality, and to reduce increased mortality related to cancer in individuals with IGT.
  • Accordingly, the present invention relates to a method in subjects with IGM, especially IFG and/or IGT, for the prevention or delay of progression to overt diabetes mellitus type 2; for the prevention, reduction or delay in onset of a condition selected from the group consisting of increased microvascular complications; increased cardiovascular morbidity; excess cerebrovascular diseases; increased cardiovascular mortality and sudden death; higher incidences and mortality rates of malignant neoplasms; and other metabolic disturbances that are associated with IGM.
  • Especially, the present invention relates to a method used in subjects with IGM, especially IFG and/or IGT, for the prevention, reduction or delay in onset of a condition selected from the group e.g. consisting of retinopathy, other ophthalmic complications of diabetes, nephropathy, neuropathy, peripheral angiopathy, peripheral angiopathy gangrene, myocardial infarctions, coronary heart disease, atherosclerosis, other acute and subacute forms of coronary ischemia, stroke, dyslipidemia, hyperuricemia, hypertension, angina pectoris, microangiopathic changes that result in amputation, cancer, cancer deaths, obesity, uricemia, insulin resistance, arterial occlusive disease, and atherosclerosis.
  • Accordingly, the present invention relates to a method of prevention or delay of the progression to overt diabetes, especially type 2 (ICD-9 Code 250.2), prevention or reduction of microvascular complications like retinopathy (ICD-9 code 250.5), neurophathy (ICD-9 code 250.6), nephropathy (ICD-9 code 250.4) and peripheral angiopathy or gangrene (ICD-9 code 250.7), later termed “microvascular complications” in subjects with IGM, especially IFG IGT. Further the present invention relates to a method to prevent or reduce conditions of excessive cardiovascular morbidity (ICD-9 codes 410-414), e.g. myocardial infarction (ICD-9 code 410), arterial occlusive disease, atherosclerosis and other acute and subacute forms of coronary ischemia (ICD-9 code 411-414), later termed “cardiovascular morbidity”; to prevent, reduce, or delay the onset of excess cerebrovascular diseases like stroke (ICD-9 codes 430-438); to reduce increased cardiovascular mortality (ICD-9 codes 390459) and sudden death (ICD-9 code 798. 1); to prevent the development of cancer (ICD-9 codes 140-208) and to reduce cancer deaths, in each case, in subjects with IGM, especially IFG and IGT. The method further relates to a method of prevention or reduction of other metabolic disturbances that are associated with IGM including hyperglycemia (including isolated postprandial hyperglycemia), dyslipidemia (ICD-9 code 272), hyperuricemia (ICD-9 code 790.6) as well as hypertension (ICD-9 codes 401-404) and angina pectoris (ICD-9 code 413.9), in each case, in subjects with IGM, especially IFG and IGT.
  • The codes identified hereinbefore and hereafter according to the International Classification of Diseases 9th version and the corresponding definitions allocated thereto are herewith incorporated by reference and likewise form part of the present invention.
  • The induction by hypoglycemic agents, in particular of early phase secretion, is rapidly reversible and the reduction of postprandial glucose levels is favorable for prevention or treatment in this indication.
  • The method comprises administering to a subject in need thereof an effective amount of hypoglycemic agents such as an insulin secretion enhancer or a pharmaceutically acceptable salt thereof. A subject in need of such method is a warm-blooded animal including man.
  • The present invention also relates to a method to be used in subjects with IGM, and especially IFG and/or IGT, and associated diseases and conditions such as isolated prandial hyperglycemia, prevention or delay of the progression to overt diabetes, especially type 2, prevention reduction, or delay the onset of microvascular complications, prevention or reduction of gangrene or microangiopathic changes that result in amputation, prevention or reduction of excessive cardiovascular morbidity and cardiovascular mortality, prevention of cancer and reduction of cancer deaths.
  • The present invention likewise relates to a method of treatment of conditions and diseases associated with IGM and especially IFG and/or IGT (including isolated prandial hyperglycemia) including obesity, increased age, diabetes during pregnancy, dyslipidemia, high blood pressure, uricemia, insulin resistance, arterial occlusive disease, atherosclerosis, retinopathy, nephropathy, angina pectoris, myocardial infarction, and stroke.
  • Preferably, said preventions should be effected in individuals with glucose levels in the ranges that have been proven in large epidemiologic studies to confer increased cardiovascular, microvascular and cancer risk. These levels include levels of plasma glucose ≧7.8 mmol/L mmol/L after an OGTT or casual glucose evaluation and/or fasting plasma glucose in the IFG range (fasting plasma glucose between 6.1 and 7 mmol/l). As new epidemiologic data become available to lower the glycemic levels that are incontrovertibly linked to the above-mentioned risks, or as the international standards for defining the IGT and IFG risk groups are changed, the use of the invention is also warranted for treatment of the groups at risk.
  • The present invention also relates to a method to be used in subjects with IFG comprising administering to a subject in need thereof a therapeutically effective amount of a DPP-IV inhibitor.
  • The present invention relates to the use of a hypoglycemic agent or a pharmaceutically acceptable salt thereof for the manufacture of a medicament in subjects with IGM, especially IFG and/or IGT, for the prevention or delay of progression to overt diabetes mellitus type 2; for the prevention, reduction or delay in onset of a condition selected from the group consisting of increased microvascular complications; increased cardiovascular morbidity; excess cerebrovascular diseases; increased cardiovascular mortality and sudden death; higher incidences and mortality rates of malignant neoplasms; and other metabolic disturbances that are associated with IGM.
  • The present invention relates to the use of an insulin secretion enhancer or a pharmaceutically acceptable salt thereof for the manufacture of a medicament for the prevention or delay of the progression to overt diabetes, especially type 2, prevention or reduction of microvascular complications, prevention or reduction of excessive cardiovascular morbidity and cardiovascular mortality, prevention of cancer and reduction of cancer deaths.
  • The present invention relates to the use of an insulin secretion enhancer or a pharmaceutically acceptable salt for the manufacture of a medicament in subjects with IGM, and especially IFG and/or IGT, and associated diseases and conditions such as isolated prandial hyperglycemia for the following: prevention or delay of the progression to overt diabetes, especially type 2, prevention or reduction of microvascular complications, prevention or reduction of excessive cardiovascular morbidity and cardiovascular mortality, prevention of cancer and reduction of cancer deaths.
  • The present invention relates to a pharmaceutical composition in subjects with IGM, especially IFG and/or IGT, for the prevention or delay of progression to overt diabetes mellitus type 2; for the prevention, reduction or delay in onset of a condition selected from the group consisting of increased microvascular complications; increased cardiovascular morbidity; excess cerebrovascular diseases; increased cardiovascular mortality and sudden death; higher incidences and mortality rates of malignant neoplasms; and other metabolic disturbances that are associated with IGM; comprising a hypoglycemic agent or a pharmaceutically acceptable salt thereof and a pharmaceutically acceptable carrier.
  • The present invention relates to a pharmaceutical composition for the prevention or delay of the progression to overt diabetes, especially type 2, prevention or reduction of microvascular complications, prevention or reduction of excessive cardiovascular morbidity and cardiovascular mortality, prevention of cancer and reduction of cancer deaths, comprising an insulin secretion enhancers or a pharmaceutically acceptable salt thereof and a pharmaceutically acceptable carrier.
  • The present invention relates to a pharmaceutical composition in subjects with IGM, and especially IFG and/or IGT and associated diseases and conditions such as isolated prandial hyperglycemia for the following: prevention or delay of the progression to overt diabetes, especially type 2, prevention or reduction of microvascular complications, prevention or reduction of excessive cardiovascular morbidity and cardiovascular mortality, prevention of cancer and reduction of cancer deaths.
  • The corresponding active ingredient or a pharmaceutically acceptable salt thereof may also be used in form of a hydrate or include other solvents used for crystallization.
  • Furthermore, the present invention relates to the combination such as a combined preparation or pharmaceutical composition, respectively, comprising at least one insulin secretion enhancer and alt least one insulin sensitiser; or at least two insulin secretion enhancers; or at least two insulin sensitisers; to be used in subjects with IGM, especially IFG and/or IGT, for the prevention or delay of progression to overt diabetes mellitus type 2; for the prevention, reduction or delay in onset of a condition selected from the group consisting of increased microvascular complications; increased cardiovascular morbidity; excess cerebrovascular diseases; increased cardiovascular mortality and sudden death; higher incidences and mortality rates of malignant neoplasms; and other metabolic disturbances that are associated with IGM.
  • Further benefits when applying the combination of the present invention are that lower doses of the individual drugs to be combined according to the present invention can be used to reduce the dosage, for example, that the dosages need not only often be smaller but are also applied less frequently, or can be used in order to diminish the incidence of side effects. This is in accordance with the desires and requirements of the patients to be treated.
  • Preferably, the jointly therapeutically effective amounts of the active agents according to the combination of the present invention can be administered simultaneously or sequentially in any order, separately or in a fixed combination.
  • The term “therapeutically effective amount” shall mean that amount of a drug or combination that will elicit the biological or medical response needed to achieve the therapeutic effect as specified according to the present invention in the warm-blooded animal, including man. A “therapeutically effective amount” can be administered when administering a single hypoglycemic agent and also in both a fixed or free combination of hypoglycemic agents. A “jointly effective amount” in a combination according to the present invention shall also include a non-effective amount of at least one of the agents to be combined, if the overall effect can be achieved by the combined administration of the (fixed or free) combination. The pharmaceutical composition according to the present invention as described hereinbefore and hereinafter may be used for simultaneous use or sequential use in any order, for separate use or as a fixed combination.
  • Preferred components for a combination according to the present invention preferably those that are designated as preferred hypoglycemic agents, that are most preferably selected from nateglinide, repaglinide, metformin, pioglitazone, rosiglitazone, troglitazone, 12-[(5-cyanopyridin-2-yl)amino]ethylamino)acetyl-2(S)-cyano-pyrrolidine, and (S)1-[(3-hydroxy-1-adamantyl)amino]-acetyl-2-cyano-pyrrolidine, or, if appropriate, in each case, a pharmaceutically acceptable salt thereof.
  • In a variation thereof, the present invention likewise relates to a “kit-of-parts”, for example, in the sense that the components to be combined according to the present invention can be dosed independently or by use of different fixed combinations with distinguished amounts of the components, i.e. simultaneously or at different time points. The parts of the kit of parts can then e.g. be administered simultaneously or chronologically staggered, that is at different time points and with equal or different time intervals for any part of the kit of parts. Preferably, the time intervals are chosen such that the effect on the treated disease or condition in the combined use of the parts is larger than the effect that would be obtained by use of only any one of the components.
  • The invention furthermore relates to a commercial package comprising the combination according to the present invention together with instructions for simultaneous, separate or sequential use.
  • The compounds to be combined can be present as pharmaceutically acceptable salts. If these compounds have, for example, at least one basic center, they can form acid addition salts. Corresponding acid addition salts can also be formed having, if desired, an additionally present basic center. The compounds having an acid group (for example COOH) can also form salts with bases.
  • Pharmaceutically acceptable salts e.g. of nateglinide are, for example, salts formed with bases, namely cationic salts such as alkali and alkaline earth metal salts, as well as ammonium salts.
  • The pharmaceutical compositions according to the invention can be prepared in a manner known per se and are those suitable for enteral, such as oral or rectal, and parenteral administration to mammals (warm-blooded animals), including man, comprising a therapeutically effective amount of the pharmacologically active compound, alone or in combination with one or more pharmaceutically acceptable carries, especially suitable for enteral or parenteral application.
  • The novel pharmaceutical preparations contain, for example, from about 10% to about 100%, preferably 80%, preferably from about 20% to about 60%, of the active ingredient. Pharmaceutical preparations according to the invention for enteral or parenteral administration are, for example, those in unit dose forms, such as sugar-coated tablets, tablets, capsules or suppositories, and furthermore ampoules. These are prepared in a manner known per se, for example by means of conventional mixing, granulating, sugar-coating, dissolving or lyophilizing processes. Thus, pharmaceutical preparations for oral use can be obtained by combining the active ingredient with solid carriers, if desired granulating a mixture obtained, and processing the mixture or granules, if desired or necessary, after addition of suitable excipients to give tablets or sugar-coated tablet cores.
  • The doses for hypoglycemic agents for use according to the present invention may, for example, be those that are being used for agents that have already been launched. For example, tablets of repaglinide in doses of 0.5 mg, 1 mg or 2 mg of the active ingredient or tablets of metformin in doses of 500 mg or 850 mg of the active ingredient may be taken Likewise these doses may also be used for the agents to be combined combination according to the present invention. A person skilled in the art is fully enabled, based on his knowledge, to determine the specific doses for the specific hypolipidemic agents whether taken alone or in combination.
  • Nateglinide (I) is preferably administered to the warm-blooded animal in a dosage in the range of about 5 to 1200, more preferably 25 to 800, mg/day, when the warm-blooded animal is a human of about 70 kg body weight. Preferred dosages contain 30 mg, 60 mg or 120 mg of nateglinide to be administered preferably before the main meals. Depending on the number of main meals the dose regimen are two times a day (BID) or three times a day (TID) or four times a day (QID).
  • The following Examples illustrate the invention described above; they are not, however, intended to limit the scope of the invention in any way.
    • EXAMPLE 1 Tablets of Nateglinide (I)
  • 216,000 tablets, each which contain 120 mg of nateglinide (I) are prepared as follows:
  • Composition:
    nateglinide (I) 12.960 kg
    lactose, NF 30.564 kg
    microcrystalline cellulose, NF 15.336 kg
    povidone, USP 2.592 kg
    croscarmellose sodium, NF 3.974 kg
    colloidal silicon dioxide, NF 1.382 kg
    magnesium stearate, NF 1.231 kg
    coating: opadry yellow 1.944 kg
    purified water, USP* Q.S.
    *removed during process
  • Preparation process: The microcrystalline cellulose, povidone, part of the croscarmellose sodium, nateglinide (I) and lactose are mixed in a high shear mixer and afterwards granulated using purified water. The wet granules are dried in a fluid bed dryer and passed through a screen. The colloidal silicon dioxide and the rest of the croscarmellose sodium are mixed, passed through a screen and blended with the dried granules in a V-blender. The magnesium stearate is passed through a screen, blended with the blend from the V-blender and afterwards the total mixture is compressed to tablets. The opadry yellow is suspended in purified water and the tablets are coated with the coating suspension.
    • EXAMPLE 2 Galenic Formulation of Nateglinide (I) No. 1
  • intra-granular:
    nateglinide (I) 120 mg
    lactose monohydrate 283 mg
    micro-crystalline cellulose 142 mg
    povidone 24 mg
    croscarmellose sodium 24 mg
    extra-granular:
    magnesium stearate 7 mg
    opadry white 20 mg
    • EXAMPLE 3 Galenic Formulation of Nateglinide (I) No. 2
  • intra-granular:
    nateglinide (I) 120 mg
    lactose monohydrate 283 mg
    microcrystalline cellulose 142 mg
    povidone 24 mg
    croscarmellose sodium 24 mg
    extra-granular:
    croscarmellose sodium 12.8 mg
    magnesium stearate 11.4 mg
    opadry yellow 18.0 mg
    colloidal silicon dioxide 12.8 mg
    • EXAMPLE 4 Tablets of Natealinide
  • 108,000 tablets, each which contain 120 mg of nateglinide are prepared as follows:
  • Composition:
    nateglinide 12.960 kg
    lactose, NF 30.564 kg
    microcrystalline cellulose, NF 15.336 kg
    povidone, USP 2.592 kg
    croscarmellose sodium, NF 3.974 kg
    colloidal silicon dioxide, NF 1.382 kg
    magnesium stearate, NF 1.231 kg
    coating: opadry yellow 1.944 kg
    purified water, USP* Q.S.
    *removed during process
  • Preparation process: The microcrystalline cellulose, povidone, a portion of the croscarmellose sodium, nateglinide and lactose are granulated in a collette gral granulator with the addition of purified water. The wet granules are dried in a fluid bed dryer and passed through a screen. The colloidal silicon dioxide and the rest of the croscarmellose sodium are mixed, passed through a screen and blended with the dried granules in a V-blender. The magnesium stearate is passed through a screen, blended with the blend from the V-blender and afterwards the total mixture is compressed to tablets. The opadry yellow is suspended in purified water and the tablets are coated with the coating suspension. Variants of this process include adding the colloidal silica and the remaining croscarmellose sodium to the second granulator load after drying, then screening together; and combining as many as 3 granulator/drier loads per batch.
    • EXAMPLE 5 Pharmaceutical composition of Nateglinide (120 mg)
  • nateglinide 120 mg
    lactose monohydrate 283 mg
    microcrystalline cellulose 142 mg
    Povidone 24 mg
    croscarmellose sodium 36.8 mg
    magnesium stearate 11.4 mg
    opadry yellow 18.0 mg
    colloidal silicon dioxide 12.8 mg

Claims (5)

1. A method for suppressing hyperglycemia in a non-diabetic subject with IGT and/or IFG comprising administering repaglinide (S)1-[(3-hydroxy-1-adamantyl)amino]-acetyl-2-cyano-pyrrolidine or a pharmaceutically acceptable salt thereof to the subject in need thereof.
2-7. (canceled)
8. A method of inhibiting or delaying progression to type 2 diabetes in a non-diabetic subject with IGT and/or IFG comprising administering repaglinide (S)1-[(3-hydroxy-1-adamantyl)amino]-acetyl-2-cyano-pyrrolidine or a pharmaceutically acceptable salt thereof to the subject in need thereof.
9. A method of reducing risk or onset of cardiovascular conditions in a non-diabetic subject with IGT and/or IFG comprising administering repaglinide (S)1-[(3-hydroxy-1-adamantyl)amino]-acetyl-2-cyano-pyrrolidine or a pharmaceutically acceptable salt thereof to the subject in need thereof.
10. The method according to claim 1, or 8, or 9, wherein the subject with IGT and/or IFG has prandial glucose excursions having 2 hour plasma glucose values between 7.8 to 11.1 mmol/L after an OGTT or casual glucose test.
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Families Citing this family (47)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6878749B2 (en) * 1999-09-17 2005-04-12 Novartis Ag Method of treating metabolic disorders, especially diabetes, or a disease or condition associated with diabetes
SG149676A1 (en) * 1999-12-23 2009-02-27 Novartis Ag Use of hypoglycemic agent for treating impaired glucose metabolism
CA2403442A1 (en) * 2000-03-17 2002-09-17 Ajinomoto Co., Inc. Use of nateglinide alone or in combination for the treatment or prevention of diabetic complications
GB0014969D0 (en) * 2000-06-19 2000-08-09 Smithkline Beecham Plc Novel method of treatment
TWI249519B (en) 2000-08-29 2006-02-21 Nobex Corp Immunoregulatory compounds and derivatives and methods of treating diseases therewith
US8048924B2 (en) 2001-08-29 2011-11-01 Biocon Limited Methods and compositions employing 4-aminophenylacetic acid compounds
JP2005519949A (en) * 2002-03-11 2005-07-07 ノバルティス アクチエンゲゼルシャフト Nateglinide salt
US8980952B2 (en) * 2002-03-20 2015-03-17 University Of Maryland, Baltimore Methods for treating brain swelling with a compound that blocks a non-selective cation channel
US20030215889A1 (en) * 2002-03-20 2003-11-20 Simard J. Marc Non-selective cation channel in neural cells and methods for treating brain swelling
US7407955B2 (en) 2002-08-21 2008-08-05 Boehringer Ingelheim Pharma Gmbh & Co., Kg 8-[3-amino-piperidin-1-yl]-xanthines, the preparation thereof and their use as pharmaceutical compositions
US20040209803A1 (en) * 2002-12-19 2004-10-21 Alain Baron Compositions for the treatment and prevention of nephropathy
US7790681B2 (en) * 2002-12-17 2010-09-07 Amylin Pharmaceuticals, Inc. Treatment of cardiac arrhythmias with GLP-1 receptor ligands
KR100882156B1 (en) 2003-08-08 2009-02-06 아지노모토 가부시키가이샤 Pharmaceutical preparation containing nateglinide
KR20140089408A (en) * 2003-11-17 2014-07-14 노파르티스 아게 Use of dipeptidyl peptidase iv inhibitors
EP1841414A1 (en) * 2003-12-31 2007-10-10 Alpharma, Inc. Rosiglitazone and metformin formulations
WO2005065654A2 (en) * 2003-12-31 2005-07-21 Alpharma, Inc. Rosiglitazone formulations
KR20120064735A (en) * 2004-04-01 2012-06-19 아지노모토 가부시키가이샤 Nateglinide-containing preparation
HUE028158T2 (en) 2004-07-07 2016-12-28 Biocon Ltd Synthesis of azo bonded immunoregulatory compounds
AU2005290238A1 (en) * 2004-09-18 2006-04-06 Department Of Veterans Affairs Therapeutic agents trageting the NCCa-ATP channel and methods of use thereof
AU2005287090A1 (en) 2004-09-18 2006-03-30 Department Of Veterans Affairs Therapeutic agents targeting the NCca-ATP channel and methods of use thereof
DE102004054054A1 (en) 2004-11-05 2006-05-11 Boehringer Ingelheim Pharma Gmbh & Co. Kg Process for preparing chiral 8- (3-amino-piperidin-1-yl) -xanthines
CN101111266A (en) * 2005-01-31 2008-01-23 味之素株式会社 Medicinal composition for ameliorating or treating glucose intolerance, borderline diabetes, insulin resistance and hyperinsulinemia containing hypoglycemic agent
JP4822204B2 (en) * 2005-07-06 2011-11-24 国立大学法人神戸大学 Antihyperglycemic action prediction system
RU2008108984A (en) * 2005-08-10 2009-09-20 Такеда Фармасьютикал Компани Лимитед (Jp) THERAPEUTIC AGENT FROM DIABETES
WO2007101179A2 (en) * 2006-02-28 2007-09-07 Board Of Supervisors Of Louisiana State University And Agricultural And Mechanical College Enterostatin as therapeutic agent for hypoglycemia
EP1852108A1 (en) 2006-05-04 2007-11-07 Boehringer Ingelheim Pharma GmbH & Co.KG DPP IV inhibitor formulations
MX2008014024A (en) 2006-05-04 2008-11-14 Boehringer Ingelheim Int Polymorphs.
PE20080251A1 (en) 2006-05-04 2008-04-25 Boehringer Ingelheim Int USES OF DPP IV INHIBITORS
US8217025B2 (en) * 2006-11-17 2012-07-10 Harbor Therapeutics, Inc. Drug screening and treatment methods
WO2008089103A2 (en) 2007-01-12 2008-07-24 University Of Maryland, Baltimore Targeting ncca-atp channel for organ protection following ischemic episode
WO2008098160A1 (en) * 2007-02-09 2008-08-14 University Of Maryland, Baltimore Antagonists of a non-selective cation channel in neural cells
CA3065983C (en) 2007-06-22 2022-07-26 The United States Of America As Represented By The Department Of Veterans Affairs Inhibitors of ncca-atp channels for therapy
PE20091730A1 (en) 2008-04-03 2009-12-10 Boehringer Ingelheim Int FORMULATIONS INVOLVING A DPP4 INHIBITOR
CN101548972B (en) * 2008-04-03 2012-10-17 万特制药(海南)有限公司 Solid pharmaceutical composition containing repaglinide
EP2294053B1 (en) 2008-05-16 2016-01-06 Takeda California, Inc. Glucokinase activators
BRPI0916997A2 (en) 2008-08-06 2020-12-15 Boehringer Ingelheim International Gmbh DPP-4 INHIBITOR AND ITS USE
US20200155558A1 (en) 2018-11-20 2020-05-21 Boehringer Ingelheim International Gmbh Treatment for diabetes in patients with insufficient glycemic control despite therapy with an oral antidiabetic drug
EP3646859A1 (en) 2009-11-27 2020-05-06 Boehringer Ingelheim International GmbH Treatment of genotyped diabetic patients with dpp-iv inhibitors such as linagliptin
AU2011249722B2 (en) 2010-05-05 2015-09-17 Boehringer Ingelheim International Gmbh Combination therapy
US9034883B2 (en) 2010-11-15 2015-05-19 Boehringer Ingelheim International Gmbh Vasoprotective and cardioprotective antidiabetic therapy
US9555001B2 (en) 2012-03-07 2017-01-31 Boehringer Ingelheim International Gmbh Pharmaceutical composition and uses thereof
EP3685839A1 (en) 2012-05-14 2020-07-29 Boehringer Ingelheim International GmbH Linagliptin for use in the treatment of albuminuria and kidney related diseases
WO2013174767A1 (en) 2012-05-24 2013-11-28 Boehringer Ingelheim International Gmbh A xanthine derivative as dpp -4 inhibitor for use in modifying food intake and regulating food preference
ES2950384T3 (en) 2014-02-28 2023-10-09 Boehringer Ingelheim Int Medical use of a DPP-4 inhibitor
CN104127424A (en) * 2014-07-30 2014-11-05 沈阳药科大学 Glibenclamide derivative, preparation method and application thereof
CN104127423A (en) * 2014-07-30 2014-11-05 沈阳药科大学 Gliquidone derivative, preparation method and application thereof
BR112018072401A2 (en) 2016-06-10 2019-02-19 Boehringer Ingelheim International Gmbh combinations of linagliptin and metformin

Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6166063A (en) * 1998-12-10 2000-12-26 Novartis Ag N-(substituted glycyl)-2-cyanopyrrolidines, pharmaceutical compositions containing them and their use in inhibiting dipeptidyl peptidase-IV
US6303661B1 (en) * 1996-04-25 2001-10-16 Probiodrug Use of dipeptidyl peptidase IV effectors for lowering the blood glucose level in mammals
US6559188B1 (en) * 1999-09-17 2003-05-06 Novartis Ag Method of treating metabolic disorders especially diabetes, or a disease or condition associated with diabetes
US6878749B2 (en) * 1999-09-17 2005-04-12 Novartis Ag Method of treating metabolic disorders, especially diabetes, or a disease or condition associated with diabetes

Family Cites Families (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
TW492957B (en) * 1996-11-07 2002-07-01 Novartis Ag N-substituted 2-cyanopyrrolidnes
ES2159184T3 (en) * 1997-06-13 2001-09-16 Novo Nordisk As NEW POSOLOGY FOR DMNI.
IL143004A0 (en) * 1998-11-11 2002-04-21 Smithkline Beecham Plc Combinations comprising a beta-agonist and a further antidiabetic agent
SI1131070T1 (en) * 1998-11-12 2008-12-31 Smithkline Beecham Plc Pharmaceutical composition for modified release of an insulin sensitiser and metformin
SG149676A1 (en) * 1999-12-23 2009-02-27 Novartis Ag Use of hypoglycemic agent for treating impaired glucose metabolism

Patent Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6303661B1 (en) * 1996-04-25 2001-10-16 Probiodrug Use of dipeptidyl peptidase IV effectors for lowering the blood glucose level in mammals
US6166063A (en) * 1998-12-10 2000-12-26 Novartis Ag N-(substituted glycyl)-2-cyanopyrrolidines, pharmaceutical compositions containing them and their use in inhibiting dipeptidyl peptidase-IV
US6559188B1 (en) * 1999-09-17 2003-05-06 Novartis Ag Method of treating metabolic disorders especially diabetes, or a disease or condition associated with diabetes
US6878749B2 (en) * 1999-09-17 2005-04-12 Novartis Ag Method of treating metabolic disorders, especially diabetes, or a disease or condition associated with diabetes

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