Classifications

• • 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
  • A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
  • A61K31/439—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom the ring forming part of a bridged ring system, e.g. quinuclidine
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K45/00—Medicinal preparations containing active ingredients not provided for in groups A61K31/00 - A61K41/00
  • A61K45/06—Mixtures of active ingredients without chemical characterisation, e.g. antiphlogistics and cardiaca
• • 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
  • A61K9/0012—Galenical forms characterised by the site of application
  • A61K9/007—Pulmonary tract; Aromatherapy
  • A61K9/0073—Sprays or powders for inhalation; Aerolised or nebulised preparations generated by other means than thermal energy
• • 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
  • A61K9/0012—Galenical forms characterised by the site of application
  • A61K9/007—Pulmonary tract; Aromatherapy
  • A61K9/0073—Sprays or powders for inhalation; Aerolised or nebulised preparations generated by other means than thermal energy
  • A61K9/0075—Sprays or powders for inhalation; Aerolised or nebulised preparations generated by other means than thermal energy for inhalation via a dry powder inhaler [DPI], e.g. comprising micronized drug mixed with lactose carrier particles
• • 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
  • A61K9/14—Particulate form, e.g. powders, Processes for size reducing of pure drugs or the resulting products, Pure drug nanoparticles
  • A61K9/141—Intimate drug-carrier mixtures characterised by the carrier, e.g. ordered mixtures, adsorbates, solid solutions, eutectica, co-dried, co-solubilised, co-kneaded, co-milled, co-ground products, co-precipitates, co-evaporates, co-extrudates, co-melts; Drug nanoparticles with adsorbed surface modifiers
  • A61K9/145—Intimate drug-carrier mixtures characterised by the carrier, e.g. ordered mixtures, adsorbates, solid solutions, eutectica, co-dried, co-solubilised, co-kneaded, co-milled, co-ground products, co-precipitates, co-evaporates, co-extrudates, co-melts; Drug nanoparticles with adsorbed surface modifiers with organic compounds
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P11/00—Drugs for disorders of the respiratory system
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P11/00—Drugs for disorders of the respiratory system
  • A61P11/06—Antiasthmatics
• • 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
  • A61P25/00—Drugs for disorders of the nervous system
  • A61P25/20—Hypnotics; Sedatives
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P43/00—Drugs for specific purposes, not provided for in groups A61P1/00-A61P41/00

Definitions

• the invention relates to a novel use of aclidinium, which can be advantageously used to improve the quality of sleep in respiratory patients.
• Respiratory diseases such as asthma and chronic obstructive pulmonary disease (COPD)
• COPD chronic obstructive pulmonary disease
• COPD inflammation occurs primarily because of exposure to noxious particles and gases, in particular to cigarette smoke. Rather than a single pathologic condition, COPD is a term encompassing several disorders, such as chronic bronchitis or emphysema.
• Asthma and COPD are commonly associated with severe impairment of the physical functions as a consequence of pulmonary symptoms such as dyspnoea (breathlessness), fatigue, cough, wheezing, chest tightness or congestion, and sputum production. Many patients with respiratory diseases complain of the serious impact of these symptoms in the quality of their sleep.
• Bronchodilating agents like the beta-adrenergic agonists or the antagonists of cholinergic muscarinic receptors are usually prescribed for inhalation to respiratory patients suffering from obstructive airway diseases, such as asthma or COPD.
• All commercially available anticholinergics are synthetic tropane derivatives, and include ipratropium, oxitropium, and tiotropium. Tiotropium, is the only long-acting anticholinergic currently on the market.
• Aclidinium is 3(R)-(2-hydroxy-2,2-dithien-2-ylacetoxy)-1-(3-phenoxypropyl)-1-azoniabicyclo[2.2.2] octane, a long-acting muscarinic receptor antagonist in development by Almirall for administration by inhalation in the treatment of respiratory diseases, especially asthma and COPD. It was first disclosed in WO 01/04118.
• Aclidinium is rapidly hydrolysed in human plasma to two inactive metabolites, and hence has a reduced potential for systemic side effects and a wider safety margin than currently available inhaled anticholinergic treatments. Its additional effect in improving quality of sleep is an unexpected finding of this invention.
• the present invention provides aclidinium, or any of its steroisomers or mixture of stereoisomers, or a pharmaceutically acceptable salt or solvate thereof, for use in improving the quality of sleep in respiratory patients.
• aclidinium is in the form of a salt with an anion X ⁇ .
• the anion X ⁇ is bromide.
• the respiratory patient suffers from a disease selected from acute or chronic bronchitis, emphysema, asthma and chronic obstructive pulmonary disease, preferably asthma and chronic obstructive pulmonary disease, most preferably chronic obstructive pulmonary disease.
• aclidinium is administered as a pharmaceutical composition suitable for inhalation, preferably in the form of a dry powder.
• the composition can be administered by means of any inhaler device, more preferably the Genuair®.
• a dry powder formulation comprises a pharmaceutically acceptable carrier selected from mono-, di- or polysaccharides and sugar alcohols.
• the carrier is lactose.
• Aclidinium is administered at least once a day, preferably in the morning or in the evening. More preferably aclidinium is administered twice daily. In a most preferred embodiment aclidinium is administered twice daily, one in the morning and another one in the evening.
• the effective dose of aclidinium to be used per inhalation is the equivalent to a metered nominal dose from 100 to 1000 micrograms of aclidinium bromide in a dry powder for inhalation, more preferably 200 or 400 micrograms of aclidinium bromide.
• aclidinium is co-administered with an additional medication suitable for the treatment of respiratory diseases, selected for example from one or more of the following: corticosteroids, beta-adrenergic agonists, PDE4 inhibitors, antihistamines, anti-IgE antibodies, leukotriene D4 inhibitors, inhibitors of egfr-kinase, p38 kinase inhibitors and/or NK1-receptor antagonists.
• the additional medications can be present in the same pharmaceutical composition as aclidinium or in separate pharmaceutical compositions.
• the additional medication is selected from corticosteroids, beta-adrenergic agonists and/or PDE4 inhibitors.
• the improvement by aclidinium of the quality of sleep of the respiratory patient can be measured by observing the reduction of one or more of the following:
• the invention further provides a pharmaceutical composition comprising aclidinium for improving the quality of sleep in respiratory patients.
• the invention further provides the use of aclidinium in the manufacture of a medicament for improving the quality of sleep in respiratory patients.
• the invention further provides a method of improving the quality of sleep in respiratory patients, which method comprises administering to said patient an effective amount of aclidinium, as defined above.
• the aclidinium is administered in the form of a salt with an anion X ⁇ , wherein X ⁇ is a pharmaceutically acceptable anion of a mono or polyvalent acid. More typically, X ⁇ is an anion derived from an inorganic acid, such as hydrochloric acid, hydrobromic acid, sulphuric acid and phosphoric acid, or an organic acid such as methanesulphonic acid, acetic acid, fumaric acid, succinic acid, lactic acid, citric acid or maleic acid. Most preferably the aclidinium is in the form of aclidinium bromide.
• the compound of the invention may exist in both unsolvated and solvated forms.
• solvate is used herein to describe a molecular complex comprising a compound of the invention and an amount of one or more pharmaceutically acceptable solvent molecules.
• hydrate is employed when said solvent is water.
• solvate forms include, but are not limited to, compounds of the invention in association with water, acetone, dichloromethane, 2-propanol, ethanol, methanol, dimethylsulfoxide (DMSO), ethyl acetate, acetic acid, ethanolamine, or mixtures thereof. It is specifically contemplated that in the present invention one solvent molecule can be associated with one molecule of the compounds of the present invention, such as a hydrate.
• treatment and “treating” are to be understood as embracing amelioration of symptoms of a disease or condition and/or elimination or reduction of the cause of the disease or condition and/or prevention of the appearance of the disease or its symptoms.
• terapéuticaally effective amount refers to an amount sufficient to effect treatment when administered to a patient in need of treatment.
• Aclidinium can also be used in combination with other drugs known to be effective in the treatment of the diseases or the disorders indicated above.
• aclidinium can be combined with corticosteroids or glucocorticoids, beta-adrenergic agonists, PDE4 inhibitors, antihistamines, anti-IGE antibodies, leukotriene D4 antagonists, inhibitors of egfr kinase, p38 kinase inhibitors and/or NK-1 receptor agonists.
• Corticosteroids that can be combined with aclidinium in the present invention particularly include those suitable for administration by inhalation in the treatment of respiratory diseases or conditions, e.g., prednisolone, methylprednisolone, dexamethasone, naflocort, deflazacort, halopredone acetate, budesonide, beclomethasone dipropionate, hydrocortisone, triamcinolone acetonide, fluocinolone acetonide, fluocinonide, clocortolone pivalate, methylprednisolone aceponate, dexamethasone palmitoate, tipredane, hydrocortisone aceponate, prednicarbate, alclometasone dipropionate, halometasone, methylprednisolone suleptanate, mometasone furoate, rimexolone, prednisolone far
• Beta-adrenergic agonists that can be combined with aclidinium in the present invention particularly include (32 adrenergic agonists useful for treatment of respiratory diseases or conditions, for example, selected from the group consisting of arformoterol, bambuterol, bitolterol, broxaterol, carbuterol, clenbuterol, dopexamine, fenoterol, formoterol, hexoprenaline, ibuterol, isoprenaline, mabuterol, meluadrine, nolomirole, orciprenaline, pirbuterol, procaterol, reproterol, ritodrine, rimoterol, salbutamol, salmeterol, sibenadet, sulfonterol, terbutaline, tulobuterol, vilanterol, olodaterol, KUL-1248, LAS-100977, carmoterol and indacaterol,
• the (32 adrenergic agonist is a long-acting (32 adrenergic agonist, e.g., selected from the group consisting of formoterol, salmeterol, carmoterol , vilanterol, olodaterol, LAS-100977 and indacaterol in free or pharmaceutically acceptable salt form.
• a long-acting (32 adrenergic agonist e.g., selected from the group consisting of formoterol, salmeterol, carmoterol , vilanterol, olodaterol, LAS-100977 and indacaterol in free or pharmaceutically acceptable salt form.
• Aclidinium for use in the present invention may be administered by any suitable route to provide local antimuscarinic action. It is preferably administered by inhalation, e.g., as a powder, spray, or aerosol, preferably as a dry powder.
• Pharmaceutical compositions comprising aclidinium may be prepared using conventional diluents or excipients and techniques known in the galenic art.
• Medicaments for administration in a dry powder for inhalation desirably have a controlled particle size.
• the optimum particle size for inhalation into the bronchial system is usually 1-10 nm, preferably 2-5 nm. Particles having a size above 20 nm are generally too large when inhaled to reach the small airways.
• the particles of the active ingredient as produced may be size reduced by conventional means, e.g. by micronisation or supercritical fluid techniques.
• the desired fraction may be separated out by air classification or sieving.
• the particles will be crystalline.
• an excipient for example a mono-, di- or polysaccharide or sugar alcohol, such as lactose, mannitol or glucose is generally employed.
• the particle size of the excipient will usually be much greater than the inhaled medicament within the present invention.
• lactose particles When the excipient is lactose it will typically be present as lactose particles, preferably crystalline alpha lactose monohydrate, e.g., having an average particle size range of 20-1000 ⁇ m, preferably in the range of 90-150 ⁇ m.
• the lactose particles for use in formulations of the invention have a d10 of 90-160 ⁇ m, a d50 of 170-270 ⁇ m, and d90 of 290-400 ⁇ m.
• Suitable lactose materials for use in the present invention are commercially available, e.g., from DMW Internacional (Respitose GR-001, Respitose SV-001, Respitose SV-003); Meggle (Capsulac 60, Inhalac 70, Capsulac 60 INH); and Borculo Domo (Lactohale 100-200, Lactohale 200-300, and Lactohale 100-300).
• the ratio between the lactose particles and the aclidinium by weight will depend on the inhaler device used, but is typically, e.g., 5:1 to 200:1, for example 50:1 to 150:1, e.g., 60-70:1.
• the aclidinium is administered in the form of a dry powder formulation of aclidinium bromide in admixture with lactose, in a ratio by weight of aclidinium to lactose of 1:50 to 1:150, suitable for administration via a dry powder inhaler, wherein the aclidinium particles have an average particle size of from 2 to 5 ⁇ m in diameter, e.g., less than 3 ⁇ m in diameter, and the lactose particles have a d10 of 90-160 ⁇ m, a d50 of 170-270 ⁇ m, and d90 of 290-400 ⁇ m.
• Dry powder compositions for topical delivery to the lung by inhalation may, for example, be presented in capsules and cartridges of for example gelatine or blisters of for example laminated aluminium foil, for use in an inhaler or insufflator.
• Each capsule or cartridge may generally contain between 0.001-50 mg, more preferably 0.01-5 mg of active ingredient or the equivalent amount of a pharmaceutically acceptable salt thereof.
• the active ingredient (s) may be presented without excipients.
• Packaging of the formulation may be suitable for unit dose or multi-dose delivery.
• the formulation can be pre-metered or metered in use. Dry powder inhalers are thus classified into three groups: (a) single dose, (b) multiple unit dose and (c) multi dose devices.
• Aclidinium is preferably administered with a multi-dose inhaler, more preferably with the Genuair® (formerly known as Novolizer SD2FL), which is described the following patent applications Nos: WO97/000703, WO03/000325 and WO2006/008027.
• Genuair® formerly known as Novolizer SD2FL
• Dosages will vary depending on, e.g., the individual, the mode and frequency of administration, and the nature and severity of the condition to be treated.
• Daily dosages for a 70 kg adult human may typically for example be on the order of 100-1000 micrograms of active agent in the form of dry powder for inhalation.
• COPD received aclidinium 400 micrograms twice-daily (in the morning, 9 am, and in the evening, 9 pm) and placebo for 15 days, with a 9-15 day washout between treatment periods.
• COPD patients with FEV1/FVC ⁇ 70% were randomised (1:1:1) to aclidinium 200 micrograms, 400 micrograms, or placebo.
• the quality of sleep was reported daily using electronic diaries and a questionnaire, which assessed symptom frequency and severity and its effect on morning activities. Rescue medication use was also assessed.
• aclidinium significantly improved the quality of sleep compared to placebo.
• Example 2 The incidence of sleep difficulties was recorded daily on a patient diary card. As in Example 1, the scores ranged from 0 for none to 1-4 for increasing severity of the sleep difficulties. The change in the score produced by each treatment with respect to the baseline was then measured.
• the average score ( ⁇ SEM) of the patients treated with tiotropium was ⁇ 0.011 (0.091), which is practically identical to the baseline and very similar to the score of 0.061 (0.088), observed in the patients treated with placebo. There is no statistically significant difference between these two scores (p>0.05). In contrast, the score of the patients treated with aclidinium was ⁇ 0.123 (0.089). In this case there is a statistically significant difference with placebo (p ⁇ 0.05).
• phase Ha results demonstrate that the remarkable improvement of sleep quality produced by aclidinium is not observed when the patients are treated with tiotropium, the reference anticholinergic drug currently in the market. This unexpected effect of aclidinium is therefore not obvious and involves an inventive step.

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