US20130053448A1 - Therapeutic Regimens - Google Patents

Therapeutic Regimens Download PDF

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US20130053448A1
US20130053448A1 US13/697,230 US201113697230A US2013053448A1 US 20130053448 A1 US20130053448 A1 US 20130053448A1 US 201113697230 A US201113697230 A US 201113697230A US 2013053448 A1 US2013053448 A1 US 2013053448A1
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dosage form
unit dosage
ethyl
compound
salt
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Louis O'Dea
C. Richard Lyttle
Jonathan Guerriero
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Radius Health Inc
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Individual
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Assigned to RADIUS HEALTH, INC. reassignment RADIUS HEALTH, INC. ASSIGNMENT OF ASSIGNORS INTEREST (SEE DOCUMENT FOR DETAILS). Assignors: GUERRIERO, JONATHAN, LYTTLE, C. RICHARD, O'DEA, LOUIS
Assigned to RADIUS HEALTH, INC., RADIUS PHARMACEUTICALS, INC. reassignment RADIUS HEALTH, INC. RELEASE BY SECURED PARTY (SEE DOCUMENT FOR DETAILS). Assignors: MIDCAP FINANCIAL TRUST, MIDCAP FUNDING IV TRUST
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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
    • A61K31/13—Amines
    • A61K31/135—Amines having aromatic rings, e.g. ketamine, nortriptyline
    • A61K31/137—Arylalkylamines, e.g. amphetamine, epinephrine, salbutamol, ephedrine or methadone
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00—Medicinal preparations characterised by special physical form
    • A61K9/48—Preparations in capsules, e.g. of gelatin, of chocolate
    • A61K9/4841—Filling excipients; Inactive ingredients
    • A61K9/485—Inorganic compounds
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00—Medicinal preparations characterised by special physical form
    • A61K9/48—Preparations in capsules, e.g. of gelatin, of chocolate
    • A61K9/4841—Filling excipients; Inactive ingredients
    • A61K9/4866—Organic macromolecular compounds
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P15/00—Drugs for genital or sexual disorders; Contraceptives
    • A61P15/12—Drugs for genital or sexual disorders; Contraceptives for climacteric disorders
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P25/00—Drugs for disorders of the nervous system
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P5/00—Drugs for disorders of the endocrine system
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P5/00—Drugs for disorders of the endocrine system
    • A61P5/24—Drugs for disorders of the endocrine system of the sex hormones

Definitions

  • This invention relates to clinically useful therapeutic dosing regimens for the compound of formula I ((R)-6-(2-(ethyl(4-(2-(ethylamino)ethyl)benzyl)amino)-4-methoxyphenyl)-5,6,7,8-tetrahydronaphthalen-2-ol) or its salts.
  • This invention also includes unit dosage forms containing the compound of formula I ((R)-6-(2-(ethyl(4-(2-(ethylamino)ethyl)benzyl)amino)-4-methoxyphenyl)-5,6,7,8-tetrahydronaphthalen-2-ol) or its salts.
  • this invention includes a unit dosage form suitable for administration to a human comprising 10 mg of the compound of formula I as a salt
  • the 10 mg of the compound of Formula 1 is present as its dihydrochloride salt.
  • the 10 mg of the compound of Formula 1 is present as an acid addition salt.
  • the 10 mg of the compound of Formula 1 is present as its hydrogen chloride salt.
  • this invention includes a unit dosage form suitable for administration to a human comprising 5 mg of the compound of formula I as a salt (e.g., an acid addition salt, dihydrochloride salt or hydrogen chloride salt).
  • a salt e.g., an acid addition salt, dihydrochloride salt or hydrogen chloride salt.
  • this invention includes a unit dosage form suitable for administration to a human comprising 2.5 mg of the compound of formula I as a salt (e.g., an acid addition salt, dihydrochloride salt or hydrogen chloride salt).
  • a salt e.g., an acid addition salt, dihydrochloride salt or hydrogen chloride salt.
  • this invention includes a unit dosage form suitable for administration to a human comprising 1 mg of the compound of formula I as a salt (e.g., an acid addition salt, dihydrochloride salt or hydrogen chloride salt).
  • a salt e.g., an acid addition salt, dihydrochloride salt or hydrogen chloride salt.
  • the unit dosage form comprising the compound of formula I contains 1 mg, 2.5 mg, 5 mg or 10 mg as a salt (e.g., an acid addition salt, dihydrochloride salt or hydrogen chloride salt).
  • a salt e.g., an acid addition salt, dihydrochloride salt or hydrogen chloride salt.
  • the unit dosage form comprising the compound of formula I contains 1 mg, 2.5 mg, 5 mg or 10 mg as a hydrochloride salt.
  • the unit dosage form comprising the compound of formula I contains 1 mg, 2.5 mg, 5 mg or 10 mg as a dihydrochloride salt.
  • the unit dosage form comprising the compound of formula I contains 1 mg, 2.5 mg, 5 mg or 10 mg as a salt, wherein said salt is a hydrogen chloride salt wherein said hydrogen chloride is present in a stoichiometry of at least one hydrogen chloride molecule but no more than 2.1 hydrogen chloride molecules for each molecule of formula I.
  • the unit dosage form is for once daily administration. In another aspect, the unit dosage form is for oral administration. In yet another aspect the unit dosage form is suitable for once daily, oral administration.
  • the unit dosage form further comprises one or more pharmaceutically acceptable excipients.
  • the dosage form unit is a tablet or capsule suitable for oral administration.
  • the dosage unit form after administration, is essentially dissolved in the stomach prior to being released into the small intestines.
  • the dosage form unit is not coated with an acid resistant coating.
  • the intended human is a woman.
  • This invention also includes methods of treating vasomotor disturbances in a peri- or post-menopausal woman in need thereof comprising administering to the woman a unit dosage form comprising 10 mg of the compound of formula I ((R)-6-(2-(ethyl(4-(2-(ethylamino)ethyl)benzyl)amino)-4-methoxyphenyl)-5,6,7,8-tetrahydronaphthalen-2-ol) as a salt (e.g., an acid addition salt, dihydrochloride salt or hydrogen chloride salt).
  • a salt e.g., an acid addition salt, dihydrochloride salt or hydrogen chloride salt.
  • This invention also includes methods of treating vasomotor disturbances in a peri- or post-menopausal woman in need thereof comprising administering to the woman a unit dosage form comprising 10 mg of the compound of formula I ((R)-6-(2-(ethyl(4-(2-(ethylamino)ethyl)benzyl)amino)-4-methoxyphenyl)-5,6,7,8-tetrahydronaphthalen-2-ol) as its dihydrochloride salt.
  • This invention also includes methods of treating vasomotor disturbances in a post-menopausal woman in need thereof comprising administering to the woman a unit dosage form containing 10 mg of (R)-6-(2-(ethyl(4-(2-(ethylamino)ethyl)benzyl)amino)-4-methoxyphenyl)-5,6,7,8-tetrahydronaphthalen-2-ol as a salt (e.g., an acid addition salt, dihydrochloride salt or hydrogen chloride salt).
  • a salt e.g., an acid addition salt, dihydrochloride salt or hydrogen chloride salt.
  • This invention also includes methods of treating vasomotor disturbances in a post-menopausal woman in need thereof comprising administering to the woman a unit dosage form containing 10 mg of (R)-6-(2-(ethyl(4-(2-(ethylamino)ethyl)benzyl)amino)-4-methoxyphenyl)-5,6,7,8-tetrahydronaphthalen-2-ol as its dihydrochloride salt.
  • the methods of this invention comprise the once-daily, oral administration of 10 mg of (R)-6-(2-(ethyl(4-(2-(ethylamino)ethyl)benzyl)amino)-4-methoxyphenyl)-5,6,7,8-tetrahydronaphthalen-2-ol as its salt (e.g., an acid addition salt, dihydrochloride salt or hydrogen chloride salt).
  • salt e.g., an acid addition salt, dihydrochloride salt or hydrogen chloride salt.
  • the methods of this invention comprise the once-daily, oral administration of 10 mg of (R)-6-(2-(ethyl(4-(2-(ethylamino)ethyl)benzyl)amino)-4-methoxyphenyl)-5,6,7,8-tetrahydronaphthalen-2-ol as its dihydrochloride salt.
  • This invention also includes methods of treating vasomotor disturbances in a peri- or post-menopausal woman in need thereof comprising administering to the woman a unit dosage form comprising 1 mg, 2.5 mg or 5 mg of the compound of formula I ((R)-6-(2-(ethyl(4-(2-(ethylamino)ethyl)benzyl)amino)-4-methoxyphenyl)-5,6,7,8-tetrahydronaphthalen-2-ol) as a salt (e.g., an acid addition salt, dihydrochloride salt or hydrogen chloride salt).
  • a salt e.g., an acid addition salt, dihydrochloride salt or hydrogen chloride salt.
  • This invention also includes methods of treating vasomotor disturbances in a peri- or post-menopausal woman in need thereof comprising administering to the woman a unit dosage form comprising 1 mg, 2.5 mg or 5 mg of the compound of formula I ((R)-6-(2-(ethyl(4-(2-(ethylamino)ethyl)benzyl)amino)-4-methoxyphenyl)-5,6,7,8-tetrahydronaphthalen-2-ol) as its dihydrochloride salt.
  • This invention also includes methods of treating vasomotor disturbances in a post-menopausal woman in need thereof comprising administering to the woman a unit dosage form containing 1 mg, 2.5 mg or 5 mg of (R)-6-(2-(ethyl(4-(2-(ethylamino)ethyl)benzyl)amino)-4-methoxyphenyl)-5,6,7,8 -tetrahydronaphthalen-2-ol as its salt (e.g., an acid addition salt, dihydrochloride salt or hydrogen chloride salt).
  • a unit dosage form containing 1 mg, 2.5 mg or 5 mg of (R)-6-(2-(ethyl(4-(2-(ethylamino)ethyl)benzyl)amino)-4-methoxyphenyl)-5,6,7,8 -tetrahydronaphthalen-2-ol as its salt (e.g., an acid addition salt, dihydrochloride salt or hydrogen chloride salt).
  • This invention also includes methods of treating vasomotor disturbances in a post-menopausal woman in need thereof comprising administering to the woman a unit dosage form containing 1 mg, 2.5 mg or 5 mg of (R)-6-(2-(ethyl(4-(2-(ethylamino)ethyl)benzyl)amino)-4-methoxyphenyl)-5,6,7,8-tetrahydronaphthalen-2-ol as its dihydrochloride salt.
  • the methods of this invention comprise the once-daily, oral administration of 1 mg, 2.5 mg or 5 mg of (R)-6-(2-(ethyl(4-(2-(ethylamino)ethyl)benzyl)amino)-4-methoxyphenyl)-5,6,7,8-tetrahydronaphthalen-2-ol as its salt (e.g., an acid addition salt, dihydrochloride salt or hydrogen chloride salt).
  • salt e.g., an acid addition salt, dihydrochloride salt or hydrogen chloride salt.
  • the methods of this invention comprise the once-daily, oral administration of 1 mg, 2.5 mg or 5 mg of (R)-6-(2-(ethyl(4-(2-(ethylamino)ethyl)benzyl)amino)-4-methoxyphenyl)-5,6,7,8 -tetrahydronaphthalen-2-ol as its dihydrochloride salt.
  • the dosage form unit is a tablet or capsule suitable for oral administration.
  • the methods of this invention administer a unit dosage form that, after administration, is essentially dissolved in the stomach prior to being released into the small intestines.
  • the methods of this invention administer a unit dosage form that is not coated with an acid resistant coating.
  • This invention also includes methods of treating vasomotor disturbances in a peri- or post-menopausal woman comprising administering to the woman a compound of formula I ((R)-6-(2-(ethyl(4-(2-(ethylamino)ethyl)benzyl)amino)-4-methoxyphenyl)-5,6,7,8-tetrahydronaphthalen-2-ol) or a salt thereof wherein said administration results in a steady state plasma C max of from 0.40 ng/mL to 1.44, such as from 0.40 ng/mL to 1.43 ng/mL.
  • said administration results in a steady state C max of from 0.22 ng/mL to 1.61 ng/mL.
  • the compound of formula I is in the form of a salt (e.g., an acid addition salt, dihydrochloride salt or hydrogen chloride salt).
  • the compound of formula is orally administered, once-daily.
  • the compound that is administered orally, once-daily is in a unit dosage form.
  • the unit dosage form is a tablet or a capsule.
  • This invention also includes methods of treating vasomotor disturbances in a post-menopausal woman comprising administering to the woman a compound of formula I ((R)-6-(2-(ethyl(4-(2-(ethylamino)ethyl)benzyl)amino)-4-methoxyphenyl)-5,6,7,8-tetrahydronaphthalen-2-ol) wherein said administration results in a steady state plasma C max of from 0.40 ng/mL to 1.44 ng/mL, such as from 0.40 ng/mL to1.43 ng/mL. In certain related embodiments, said administration results in a steady state C max of from 0.22 ng/mL to 1.61 ng/mL.
  • the compound is administered once-daily. In another aspect, the compound is administered orally, once-daily.
  • (R)-6-(2-(ethyl(4-(2-(ethylamino)ethyl)benzyl)amino)-4-methoxyphenyl)-5,6,7,8-tetrahydronaphthalen-2-ol is administered as its dihydrochloride salt.
  • This invention also includes methods of treating vasomotor disturbances in a peri- or post-menopausal woman comprising the administering of (R)-6-(2-(ethyl(4-(2-(ethylamino)ethyl)benzyl)amino)-4-methoxyphenyl)-5,6,7,8-tetrahydronaphthalen-2-ol wherein said daily administration results in a steady state trough level of from 0.11 ng/mL to 0.79 ng/mL or from 0.12 ng/mL to 0.86 ng/mL.
  • (R)-6-(2-(ethyl(4-(2-(ethylamino)ethyl)benzyl)amino)-4-methoxyphenyl)-5,6,7,8-tetrahydronaphthalen-2-ol is administered as its salt (e.g., an acid addition salt, dihydrochloride salt or hydrogen chloride salt).
  • its salt e.g., an acid addition salt, dihydrochloride salt or hydrogen chloride salt.
  • this invention also includes methods of treating vasomotor disturbances in post-menopausal women comprising the daily administration of (R)-6-(2-(ethyl(4-(2-(ethylamino)ethyl)benzyl)amino)-4-methoxyphenyl)-5,6,7,8-tetrahydronaphthalen-2-ol wherein said administration results in a steady state plasma C max of from 0.40 ng/mL to 1.43 ng/mL or a steady state plasma C max of from 0.22 ng/mL to 1.61 ng/mL and a steady state trough plasma level of from 0.11 ng/mL to 0.79 ng/mL or from 0.12 ng/mL to 0.86 ng/mL In some embodiments, (R)-6-(2-(ethyl(4-(2-(ethylamino)ethyl)benzyl)amino)-4-methoxyphenyl)-5,6,7,8
  • the one or more delineated pharmacokinetic parameters are achieved by the administration of (R)-6-(2-(ethyl(4-(2-(ethylamino)ethyl)benzyl)amino)-4-methoxyphenyl)-5,6,7,8-tetrahydronaphthalen-2-ol as a once-daily, oral administration of a unit dosage form.
  • the unit dosage form is a capsule or tablet.
  • the capsule or tablet is essentially dissolved in the stomach prior to being released into the small intestines.
  • the dosage form unit is not coated with an acid resistant coating.
  • the one or more delineated pharmacokinetic parameters are achieved by the administration of (R)-6-(2-(ethyl(4-(2-(ethylamino)ethyl)benzyl)amino)-4-methoxyphenyl)-5,6,7,8-tetrahydronaphthalen-2-ol as a once-daily, oral administration of a dosage form unit comprising 10 mg of the compound as its salt (e.g., an acid addition salt, dihydrochloride salt or hydrogen chloride salt).
  • a dosage form unit comprising 10 mg of the compound as its salt (e.g., an acid addition salt, dihydrochloride salt or hydrogen chloride salt).
  • the dosage form unit is a capsule or tablet. In certain embodiments, the capsule or tablet is essentially dissolved in the stomach prior to being released into the small intestines. In some embodiments, the dosage form unit is not coated with an acid resistant coating.
  • the one or more delineated pharmacokinetic parameters are achieved by the administration of (R)-6-(2-(ethyl(4-(2-(ethylamino)ethyl)benzyl)amino)-4-methoxyphenyl)-5,6,7,8-tetrahydronaphthalen-2-ol as a once-daily, oral administration of a dosage form unit comprising 1 mg, 2.5 mg or 5mg of the compound as its salt (e.g., an acid addition salt, dihydrochloride salt or hydrogen chloride salt).
  • a dosage form unit comprising 1 mg, 2.5 mg or 5mg of the compound as its salt (e.g., an acid addition salt, dihydrochloride salt or hydrogen chloride salt).
  • the dosage form unit is a capsule or tablet. In certain embodiments, the capsule or tablet is essentially dissolved in the stomach prior to being released into the small intestines. In some embodiments, the dosage form unit is not coated with an acid resistant coating.
  • FIG. 1 is a graph showing the reduction in mean weekly frequency of moderate and severe hot flashes (Safety/Intent-to-treat population (ITT)).
  • FIG. 2 is a graph showing the reduction in mean weekly frequency of all hot flashes (ITT).
  • FIG. 3 is a graph showing reduction in mean severity of all hot flashes (ITT).
  • FIG. 4 is a graph showing the reduction in weekly composite scores.
  • CNS central nervous system
  • hormone levels ie estrogens and progestins
  • the side effects are variously described but most prominently include an uncomfortable heating of the skin, usually on the upper body and most often in the face and neck.
  • the sensations are transitory in nature, typically less than 30 minutes in duration.
  • the sensation of heat can be accompanied by sweating, accelerated heart rate and a significant amount of physical discomfort.
  • These sensations are typically referred to as hot flashes or hot flushes and may occur not only in the day but at night as well.
  • women might experience additional CNS disturbances. For example, some women experience depression, irritability, mood swings and other emotional or mood disorders as a consequence of the declining and/or fluctuating hormone levels associated with the menopause period. It has been known for some time that if women supplement their declining and/or fluctuating hormone levels with estrogens and/or progestins, these side effects can be largely, if not completely, eliminated. However, depending on the particular treatment modality being employed, the use of these hormones in postmenopausal women can be associated with certain side effects including the possibility of increased risk for breast cancer, uterine bleeding, uterine cancer, stroke, blood clots and even heart disease. Not surprisingly, researchers have for some time been trying to find therapies that will treat the hormone-associated CNS effects of the menopausal period while avoiding some, and preferably all of the side effects.
  • a dihydrochloride salt means that the base compound (R)-6-(2-(ethyl(4-(2-(ethylamino)ethyl)benzyl)amino)-4-methoxyphenyl)-5,6,7,8-tetrahydronaphthalen-2-ol has from 1.6 to 2 HCl's associated with the molecule.
  • a dihydrochloride salt refers to the base compound (R)-6-(2-(ethyl(4-(2-(ethylamino)ethyl)benzyl)amino)-4-methoxyphenyl)-5,6,7,8-tetrahydronaphthalen-2-ol wherein that base compound has from 1.8 to 2 HCl's associated with it.
  • the term dihydrochloride refers to the base compound with approximately 2HCl's associated with it.
  • a “unit dosage form” is a dosage form that is a discrete dosage formulation meaning that the entire drug content to be administered at a single time is contained in a single dosage form unit.
  • pills, tablets, lozenges, capsules are all dosage form units for purposes of this invention.
  • the drug or some component of the drug formulation is not a single dosage form but only that the dose to be administered as a whole is a discrete unit.
  • a capsule may contain granules of the drug within the capsule but it is a single capsule that is to be administered.
  • a lozenge may contain the drug substance dissolved in a matrix but the drug form is the lozenge itself and thus is a unit dosage formulation.
  • the “unit dosage form” can be administered to a patient or preferably self-administered by a patient in a form that is generally acceptable in the pharmaceutical venue.
  • the unit dosage form is pharmaceutically useful.
  • pharmaceutically useful dosage forms are suitable for oral delivery and include pills, tablets, buccal tablets, orally-disintegrating tablets, thin films, chewable tablets, lozenges, sublingual tablets or pills, liquid solutions, suspensions, syrups, powder or granules suitable for sprinkling in food or beverages capsules, food or candy with the drug contained within.
  • Excipients include those excipients that are generally regarded as safe for administration to humans.
  • Excipients especially suitable for formulations suitable for oral delivery include diluents (monosaccharides, disaccharides and polyhydric alcohols including starch, mannitol, dextrose, sucrose, microcrystalline cellulose, maltodextrin, sorbitol, xylitol, fructose and the like), binders (starch, gelatin, natural sugars, gums, waxes and the like), disintegrants (alginic acid, carboxymethylcellulose (calcium or sodium), cellulose, crocarmellose, crospovidone, microcrystalline cellulose, sodium starch glycolate, agar and the like), acidic or basic buffering agents (citrates, phoshphates, gluconates, acetates, carbonates, bicarbonates and the like), chelating agents (edetic acid, edetate calcium, edetate disodium and
  • the unit dosage formulations or unit dosage forms of this invention can be prepared in different forms including most commonly, tablets and capsules.
  • the tablets can be formulated by a wide variety of methods known to one of skill in the art including, for example, preparing a dry powder mixture of the drug substance in combination with one or more of the excipients granulating the mixture and pressing to together into a tablet and optionally coating the tablet with an enteric or non-enteric coating.
  • the final coat typically includes a light protective pigment such as titanium oxide and a shellac or wax to keep the tablet dry and stable. While not intending to be limited by theory or example, in some instances it might be preferred to prepare the tablets by wet granulating the drug with one or more of the excipients and then extruding the granulated material.
  • the unit dosage formulations or unit dosage forms of this invention also include capsules wherein the drug is enclosed inside the capsule either as a powder together with optional excipients or as granules containing usually including one or more excipients together with the drug and wherein the granule in turn can be optionally coated, for example, enterically or non-enterically.
  • the formulations of this invention may be solids and when present as solids, they maybe of defined particle size. It maybe sometimes preferable to administer the compound with a certain particle size—a particle size with a preferred range where the average mean particle size diameter is under 100 microns, or 75 microns, or 50 microns, or 35 microns, or 10 microns or 5 microns.
  • a dose description of 10 mg when referring to (R)-6-(2-(ethyl(4-(2-(ethylamino)ethyl)benzyl)amino)-4-methoxyphenyl)-5,6,7,8-tetrahydronaphthalen-2-ol dihydrochloride means about 10 mg of the entire weight of the compound as its salt (e.g., an acid addition salt, dihydrochloride salt or hydrogen chloride salt) such as its dihydrochloride salt. Small variations about the 10 mg should be considered to fall within the 10 mg description of this invention. For example, differences in weighing, humidity, small impurities of the synthesis, etc means that a dose range from 9 mg to 11 mg will be considered equal to 10 mg for purpose of the description in this invention.
  • a dose description of 1 mg, 2.5 mg or 5 mg when referring to (R)-6-(2-(ethyl(4-(2-(ethylamino)ethyl)benzyl)amino)-4-methoxyphenyl)-5,6,7,8-tetrahydronaphthalen-2-ol dihydrochloride means about 1 mg, 2.5 mg or 5 mg of the entire weight of the compound as its salt (e.g., an acid addition salt, dihydrochloride salt or hydrogen chloride salt), such as its dihydrochloride salt. Small variations about the 1 mg, 2.5 mg or 5 mg should be considered to fall within the weight description of this invention.
  • differences in weighing, humidity, small impurities of the synthesis, etc means that a dose range from 0.9 mg to 1.1 mg will be considered equal to 1 mg for purpose of the description in this invention or 2.2 mg to 2.8 mg will be considered equal to 2.5 mg for purpose of the description in this invention, or 4.4 mg to 5.6 mg will be considered equal to 5 mg for purpose of the description in this invention.
  • the compound (R)-6-(2-(ethyl(4-(2-(ethylamino)ethyl)benzyl)amino)-4-methoxyphenyl)-5,6,7,8-tetrahydronaphthalen-2-ol dihydrochloride may vary to a certain degree with regard to the amount of the (S)-enantiomer that may be present in the drug product.
  • the phrase “essentially dissolved in the stomach” means that after oral administration of a dosage form of this invention or a method of this invention, the compound (R)-6-(2-(ethyl(4-(2-(ethylamino)ethyl)benzyl)amino)-4-methoxyphenyl)-5,6,7,8-tetrahydronaphthalen-2-ol is more than 50% dissolved in the stomach prior to being released into the duodenum.
  • the phrase “essentially dissolved in the stomach” means that after oral administration of a dosage form of this invention or a method of this invention, the compound (R)-6-(2-(ethyl(4-(2-(ethylamino)ethyl)benzyl)amino)-4-methoxyphenyl)-5,6,7,8-tetrahydronaphthalen-2-ol is more than 70% dissolved in the stomach prior to being released into the duodenum.
  • the phrase “essentially dissolved in the stomach” means that after oral administration of a dosage form of this invention or a method of this invention, the compound (R)-6-(2-(ethyl(4-(2-(ethylamino)ethyl)benzyl)amino)-4-methoxyphenyl)-5,6,7,8-tetrahydronaphthalen-2-ol is more than 90% dissolved in the stomach prior to being released into the duodenum.
  • the dissolution of (R)-6-(2-(ethyl(4-(2-(ethylamino)ethyl)benzyl)amino)-4-methoxyphenyl)-5,6,7,8-tetrahydronaphthalen-2-ol in the stomach can be affected by different parameters, particularly those related to the excipients that the compound is co-formulated with and especially to whether the dosage formulation form is coated with a material that prevents dissolution of the coating material in the acid environment of the stomach.
  • the dosage form is not coated with an acid resistant coating.
  • an acid resistant coating refers to a coating on a tablet, granule, tablet, capsule or any other particle that contains (R)-6-(2-(ethyl(4-(2-(ethylamino)ethyl)benzyl)amino)-4-methoxyphenyl)-5,6,7,8-tetrahydronaphthalen-2-ol within it.
  • An acid resistant material means that the coating is resistant to pH's of up to about 5.5.
  • Acid resistant coating materials are well known by those of ordinary skill in the art and include materials such as polymeric acids such as methacrylic acid polymers, and the like. Acid resistant materials also include such materials as waxes, shellacs, fatty acids, polymeric acids, plant fibers and the like.
  • the drug in a form that avoids or largely avoids exposure of the drug substance in the person's stomach being treated.
  • a patient suffering from gastritis or some other form of irritation in the stomach may prefer to take a dosage formulation that largely or completely bypasses the direct exposure of the drug to the stomach lining.
  • a coating may be added to the drug dosage form such as an enteric coating that is stable in the acidic pH in the stomach but is more readily dissolved in the less acidic environment of the small intestine.
  • Acid resistant materials also include such materials as waxes, shellacs, fatty acids, polymeric acids, plant fibers and the like.
  • vasomotor disturbances refers to the constellation of central nervous system disturbances associated with the peri- and postmenopausal period.
  • vasomotor disturbances includes hot flashes and/or hot flushes that are severe, moderate or mild.
  • Vasomotor disturbances may also include inappropriate sweating and/or sweating at night.
  • Vasomotor disturbances is sometimes referred to in the art as “vasomotor symptoms” associated with the peri- or postmenopause periods.
  • a “perimenopausal woman” is a woman who is transitioning into menopause.
  • the perimenopausal period is not strictly defined but rather is understood by one of skill in the medical arts to include women whose estrogen levels have begun to fluctuate unevenly often leading to irregular menstrual cycles.
  • the perimenopausal period typically begins several years before true menopause and includes up to one year after the woman's final menstrual period. From a functional perspective with regard to treating a perimenopausal woman with the compositions and methods of this invention, the perimenopausal period is most easily identified by the symptoms associated with it.
  • postmenopausal woman refers to any woman who has is at least 40 years of age and is naturally amenorrheic for a period of at least one year or has elevated FSH levels (>25 mIU in some embodiments, >30 mIU in some embodiments and >50 mIU in other embodiments).
  • postmenopausal woman refers to women who are amenorrheic through surgical removal of the ovaries.
  • the term “postmenopausal woman” refers to women who are amenorrheic through treatment with an agent that causes suppression of ovarian function such as leutinizing hormone agonists (eg leuprolide), antagonists or gonadotropin hormone releasing hormone antagonists such (eg ganirelix).
  • an agent that causes suppression of ovarian function such as leutinizing hormone agonists (eg leuprolide), antagonists or gonadotropin hormone releasing hormone antagonists such (eg ganirelix).
  • Postmenopausal women from 40 to 75 years of age (inclusive) who meet the study entry criteria and have provided written informed consent will be eligible for the study.
  • the women will be established to be postmenopausal on the basis of menstrual history (one year of amenorrhea) and/or serum FSH levels. Women with documented surgical menopause who meet the study entry criteria will also be eligible 6 months after surgery.
  • the principal entry criterion is a documented history of moderate to severe hot flashes with an event frequency of 7 per day or 50 per week. All patients are to be in good general health as determined by medical history, physical examination (including pelvic examination and Pap test) and clinical laboratory testing. Pelvic ultrasound should also demonstrate no clinically significant abnormality.
  • BMI Body Mass Index
  • a total of 100 patients are planned to be enrolled in the study.
  • Study Diary entries of hot flash frequency and severity and associated symptoms will be reviewed at each study visit. Serum markers of estrogen effect will be measured at specific study visits while on treatment.
  • Safety evaluations include physical examinations, vital signs, 12-lead ECG, clinical laboratory tests, and adverse events. Study specific algorithms for management of vaginal bleeding and clinically significant breast tenderness have been included.
  • Safety laboratory assessments will be performed at specific study visits during the treatment period and the final visit. All patients will be monitored for cardiac safety (QTc interval assessment) at specific study visits using a standardized 12-lead ECG.
  • the safety data includes the incidence and severity of adverse events by dose and cumulative dose, and the pathological changes in hematology, chemistry and urinalysis data. Changes in physical examination, vital signs, ECG and clinical laboratory tests will be summarized using descriptive statistics. Shift frequencies will be summarized for clinical laboratory tests.
  • Treatment groups will be assessed for uniformity at baseline (baseline characteristics, medical history, physical examination, vital signs, and ECG).
  • Placebo contained the same excipients as active medication, but without (R)-6-(2-(ethyl(4-(2-(ethylamino)ethyl)benzyl)amino)-4-methoxyphenyl)-5,6,7,8-tetrahydronaphthalen-2-ol dihydrochloride. The patients were instructed to take the capsules orally in the fasted state (morning).
  • the capsules containing (R)-6-(2-(ethyl(4-(2-(ethylamino)ethyl)benzyl)amino)-4-methoxyphenyl)-5,6,7,8-tetrahydronaphthalen-2-ol dihydrochloride were prepared in dosage strengths of 0 mg, 10 mg, 25 mg and 50 mg.
  • the composition of the capsules is shown in Table 3.
  • Capsules containing 1, 2.5 and 5 mg of drug can be similarly prepared.
  • the maximum duration of study participation for an individual patient is approximately 10-weeks (72 days) from the initial Screening visit to the completion of final study evaluations. Patients will complete screening procedures during the Screening Period within 14 days prior to the first dose of study medication. After completion of the Screening Period, patients will be randomized if they meet the entrance criteria and will receive the first dose of study medication on Day 1 of the Treatment Period.
  • the Treatment Period will be 28 days in duration and will involve daily oral self-administration of (R)-6-(2-(ethyl(4-(2-(ethylamino)ethyl)benzyl)amino)-4-methoxyphenyl)-5,6,7,8-tetrahydronaphthalen-2-ol dihydrochloride or its Placebo and documentation of hot flashes/symptoms using a Study Diary.
  • patients will return to the clinic for the End-of-Treatment Visit (Day 29) and enter the Follow-up Period of 30 days.
  • the end of patient participation will be at the End-of-Study Visit, scheduled at the end of the Follow-up Period.
  • the treatment period duration was 4 weeks.
  • the maximum duration of study participation for an individual patient was approximately 10 weeks (72 days) from the initial Screening visit to the completion of final study evaluations.
  • Safety population (Safety/Intent-to-treat [ITT]), defined as all patients who received one or more doses of study drug
  • Per-Protocol Population defined as all patients of the ITT Population who met all entrance criteria or had a waiver of unmet criterion, had not used any prohibited concomitant medications, met study drug compliance of 90%, provided acceptably complete (25 days of full data) diary information, and met assessment and visit compliance at baseline and End-of-Treatment Visits. All efficacy endpoints were to be analyzed for the ITT and PP populations, with the exception of the drug levels (analyzed for the ITT population only). Safety endpoints were to be analyzed for the Safety/ITT population.
  • Continuous, quantitative variable summaries included the number of patients (N) (with non missing values), mean, standard deviation, median, minimum, maximum, and 95% confidence interval.
  • Categorical, qualitative variable summaries included the frequency and percentage of patients who were in the particular category. In general, the denominator for the percentage calculation was to be based upon the total number of patients in the study population for the treatment groups at the specific timepoint, unless otherwise specified. Descriptive summaries were to be presented for the number and percentage of patients in each study population (overall and by center), disposition of patients (including number of patients screened, screen failure patients, and patients randomized, completed and withdrawn), and study withdrawals by reason of withdrawal.
  • Summaries of demographics and baseline characteristics were to include the following: age, race, height, weight, BMI, medical history (time since last menses and number of months of hot flash history), hot flash history (moderate, severe, and moderate and severe), and concomitant medication at baseline, Baseline physical examination (abnormal and normal), vital signs (systolic and diastolic blood pressure, pulse rate, temperature, respiratory rate), and 12-lead ECG (abnormal and normal).
  • Summaries of AEs clinical laboratory investigations (chemistries, hematology, coagulation, serum estradiol, and urinalysis), vital signs (blood pressure, pulse rate, respiratory rate, and body temperature), physical examinations, ECG investigations, and pelvic ultrasound were to be provided. Adverse events of vaginal bleeding and breast tenderness (and related breast events) were to be tabulated separately.
  • Pair-wise comparisons of change from baseline were to be tested between the placebo group and each drug dose group for each timepoint; the mean difference together with a 95% confidence interval of the difference was to be presented for placebo compared with each active treatment group. Nominal p-values at Week 4 were to be presented. In addition, graphical presentations of mean ( ⁇ standard error of the mean) and percent group responses over time together with repeated measures ANOVA to assess potential trend in responses over time in each dose group wereto be presented. For the associated vasomotor symptoms (palpitations, insomnia, joint aches, and headaches collected in the patient diaries), patient and event frequencies were to be summarized by treatment week and treatment group.
  • the ranges were derived from the mean number listed in the table plus or minus one standard deviation (the number in parenthesis after each mean value). For example a steady state trough level ranging from 0.11 ng/mL to 0.79 ng/mL is derived from Table 4 by taking the trough level for 10 mg, 0.45 ng/mL, adding 0.34 to get the upper value of 0.79 and subtracting 0.34 to get the lover value of 0.11. Other ranges for steady state trough levels and ranges for Cmax can be similarly derived from the data in Tables 4 and 5.
  • the graphical representation of the data from table 6 is shown in FIG. 1 .
  • the 10 mg group demonstrated the greatest reduction in hot flashes at each weekly time point.
  • the graphical representation of the data from Table 7 is shown in FIG. 2 .
  • Hot flashes were also scored according to their severity with a mild hot flash scored a “1”, a moderate hot flash scored a “2” and a severe hot flash scored a “3”.
  • a mean hot flash severity can be derived by taking the sum of the total obtained by multiplying the total frequency of hot flashes in each group (mild, moderate or severe) by the severity assigned to that type of hot flash (1, 2 or 3, respectively) and then dividing the total by the frequency of all hot flashes. This gives the mean severity and is averaged over a week period and presented in Table 8. A graph of the data from Table 8 is shown in FIG. 3 . The 10 mg dose had the greatest reduction in severity of hot flashes at all time points.
  • FIG. 4 is a graphical representation of the data in Table 9.
  • the composite score indicates that the 10 mg group had the greatest composite score reduction at each weekly timepoint.

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