Classifications

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  • A61K31/41—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with two or more ring hetero atoms, at least one of which being nitrogen, e.g. tetrazole
  • A61K31/42—Oxazoles
  • A61K31/423—Oxazoles condensed with carbocyclic rings
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  • A61K31/335—Heterocyclic compounds having oxygen as the only ring hetero atom, e.g. fungichromin
  • A61K31/34—Heterocyclic compounds having oxygen as the only ring hetero atom, e.g. fungichromin having five-membered rings with one oxygen as the only ring hetero atom, e.g. isosorbide
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  • A61K31/41—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with two or more ring hetero atoms, at least one of which being nitrogen, e.g. tetrazole
  • A61K31/415—1,2-Diazoles
  • A61K31/4152—1,2-Diazoles having oxo groups directly attached to the heterocyclic ring, e.g. antipyrine, phenylbutazone, sulfinpyrazone
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  • A61K31/425—Thiazoles
  • A61K31/427—Thiazoles not condensed and containing further heterocyclic rings
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  • A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
  • A61K31/4353—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 ortho- or peri-condensed with heterocyclic ring systems
• • A—HUMAN NECESSITIES
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  • A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
  • A61K31/4353—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 ortho- or peri-condensed with heterocyclic ring systems
  • A61K31/4365—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 ortho- or peri-condensed with heterocyclic ring systems the heterocyclic ring system having sulfur as a ring hetero atom, e.g. ticlopidine
• • A—HUMAN NECESSITIES
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  • A61K31/44—Non condensed pyridines; Hydrogenated derivatives thereof
  • A61K31/4402—Non condensed pyridines; Hydrogenated derivatives thereof only substituted in position 2, e.g. pheniramine, bisacodyl
• • A—HUMAN NECESSITIES
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  • A61K31/44—Non condensed pyridines; Hydrogenated derivatives thereof
  • A61K31/4427—Non condensed pyridines; Hydrogenated derivatives thereof containing further heterocyclic ring systems
  • A61K31/4433—Non condensed pyridines; Hydrogenated derivatives thereof containing further heterocyclic ring systems containing a six-membered ring with oxygen as a ring hetero atom
• • A—HUMAN NECESSITIES
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  • A61K31/47—Quinolines; Isoquinolines
  • A61K31/4709—Non-condensed quinolines and containing further heterocyclic rings
• • A—HUMAN NECESSITIES
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  • A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
  • A61K31/496—Non-condensed piperazines containing further heterocyclic rings, e.g. rifampin, thiothixene or sparfloxacin
• • A—HUMAN NECESSITIES
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  • A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
  • A61K31/505—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim
  • A61K31/513—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim having oxo groups directly attached to the heterocyclic ring, e.g. cytosine
• • A—HUMAN NECESSITIES
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  • A61K31/70—Carbohydrates; Sugars; Derivatives thereof
  • A61K31/7028—Compounds having saccharide radicals attached to non-saccharide compounds by glycosidic linkages
  • A61K31/7034—Compounds having saccharide radicals attached to non-saccharide compounds by glycosidic linkages attached to a carbocyclic compound, e.g. phloridzin
• • A—HUMAN NECESSITIES
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  • A61K31/7042—Compounds having saccharide radicals and heterocyclic rings
  • A61K31/7048—Compounds having saccharide radicals and heterocyclic rings having oxygen as a ring hetero atom, e.g. leucoglucosan, hesperidin, erythromycin, nystatin, digitoxin or digoxin
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• • A—HUMAN NECESSITIES
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• • A—HUMAN NECESSITIES
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  • A61K45/06—Mixtures of active ingredients without chemical characterisation, e.g. antiphlogistics and cardiaca

Definitions

• the present invention relates to a new medicament for efficient and safe use of pemafibrate, a salt thereof, or a solvate of any of these.
• Pemafibrate (Chemical name: (2R)-2-[3-( ⁇ 1,3-benzoxazol-2-yl[3-(4-methoxyphenoxy)propyl]amino ⁇ m ethyl)phenoxy]butanoic acid), a salt thereof, or a solvate of any of these are compounds having PPAR ⁇ activity and are known to be useful for the prevention and/or treatment of diseases such as dyslipidemia (Patent Literature 1).
• Rifampicin (2S, 12Z, 14E, 16S, 17S, 18R, 19R, 20R, 21S, 22R, 23S, 24E) 5,6,9,17,19-pentahydroxy-23-methoxy-2,4,12,20,22-heptamethyl-8-(4-methylpiperazin-1-yliminomethyl) 1,11-dioxo-1,2-dihydro-7-(epox ypentadeca [1,11,13] trienimino) [2,1-b] furan-21yl acetate is an organic compound represented by the following formula (1)
• Clarithromycin is a compound represented by the following formula (2)
• Cyclosporine is an immunosuppressive agent used to suppress rejection in the organ transplantation of kidneys, liver, heart or bone-marrow and to treat graft-versus-host diseases, which is listed in the WHO-Essential Drug Model List (WHO Model List of Essential Medicines, 19th List).
• Clopidogrel (Chemical Name: methyl(2S)-2-(2-chlorophenyl)-2-[6,7-dihydrothieno[3,2-c]pyridin-5 (4H)-y l]acetate), a salt thereof, or a solvate of any of these are compounds known to have platelet aggregation inhibitory and antithrombotic activities (Patent Literature 2).
• Patent Literature 1 WO 2005/023777 pamphlet
• Patent Literature 2 JP—B-Hei 6-45622
• the present invention addresses to provide a medicament for safe treatment of a patient in need of treatment with pemafibrate, a salt thereof, or a solvate of any of these (hereinafter also referred to as pemafibrate therapy).
• the present inventors have found that a patient in need of treatment with pemafibrate, a salt thereof, or a solvate of any of these can be safely treated by avoiding or suspending the concomitant use of pemafibrate with an OATP1B inhibitor such as rifampicin, or by reducing the dose of pemafibrate, a salt thereof, or a solvate of any of these, and the present invention has been completed.
• the present invention also found that the combined interaction of pemafibrate with clarithromycin, cyclosporine, or clopidogrel was due to clarithromycin, cyclosporine, or clopidogrel being a drug that inhibits OATP1B and further inhibits the action of certain cytochrome P450 (CYPs).
• clarithromycin, cyclosporine, or clopidogrel being a drug that inhibits OATP1B and further inhibits the action of certain cytochrome P450 (CYPs).
• the present inventors have found that a patient in need of treatment with pemafibrate a salt thereof, or a solvate of any of these can be safely treated by avoiding or suspending the concomitant use of pemafibrate with an OATP1B inhibitor and/or a CYP inhibitor, or by reducing the dose of pemafibrate, a salt thereof, or a solvate of any of these, and the present invention has been completed.
• the present invention provides the following [1] to [58].
• a medicament comprising pemafibrate, a salt thereof, or a solvate of any of these as an active ingredient, for use in the treatment of a patient in need of pemafibrate therapy, in order to suppress an increase in plasma concentration of pemafibrate when the treatment is concomitant use of pemafibrate with a medicament comprising an OATP1B inhibitor, the medicament comprising a step of avoiding or suspending the concomitant use or a step of reducing the dose of pemafibrate, a salt thereof, or a solvate of any of these.
• the medicament according to [1], wherein the pemafibrate, a salt thereof, or a solvate of any of these is pemafibrate.
• the OATP1B inhibitor is one or more drugs selected from the group consisting of clarithromycin, rifampicin, cyclosporine, a combination agent of lopinavir and ritonavir, a combination agent of atazanavir and ritonavir, a combination agent of dalnavir and ritonavir, clopidogrel, eltronbopag, a combination agent of saquinavir and ritonavir, a combination agent of tipranavir and ritonavir, and gemfibrozil.
• the patient is a patient further in need of pemafibrate therapy during treatment with an OATP1B inhibitor.
• a pharmaceutical kit comprising (A) a medicament comprising pemafibrate, a salt thereof, or a solvate of any of these as an active ingredient; and (B) an instruction to avoid or suspend concomitant use of the (A) with a medicament comprising an OATP1B inhibitor, or to reduce the dose of pemafibrate, a salt thereof, or a solvate of any of these at the time of the concomitant use.
• the pharmaceutical kit according to [10] wherein the pemafibrate, a salt thereof, or a solvate of any of these is pemafibrate.
• the OATP1B inhibitor is one or more drugs selected from the group consisting of clarithromycin, rifampicin, cyclosporine, a combination agent of lopinavir and ritonavir, a combination agent of atazanavir and ritonavir, a combination agent of dalnavir and ritonavir, clopidogrel, ertronbopag, a combination agent of saquinavir and ritonavir, a combination agent of tipranavir and ritonavir, and gemfibrozil.
• the OATP1B inhibitor is one or more drugs selected from the group consisting of clarithromycin, rifampicin, cyclosporine, a combination agent of lopinavir and ritonavir, a combination agent of atazanavir and ritonavir, a combination agent of dalnavir and ritonavir, clopidogrel, ertronbopag
• the pharmaceutical kit according to any one of [10] to [13] instructing to reduce the dose of pemafibrate, a salt thereof, or a solvate of any of these, compared with the dose when the drug is administered alone, to 1 ⁇ 2 or less.
• a medicament comprising pemafibrate, a salt thereof, or a solvate of any of these as an active ingredient, for use in the treatment of a patient in need of pemafibrate therapy, in order to suppress an increase in plasma concentration of pemafibrate when the treatment is concomitant use of pemafibrate with a medicament comprising a CYP inhibitor, the medicament comprising a step of avoiding or suspending the concomitant use or a step of reducing the dose of pemafibrate, a salt thereof, or a solvate of any of these.
• the drug that inhibits CYP3A is one or more drugs selected from the group consisting of clarithromycin, cyclosporine, cobicistat, indinavir, itraconazole, ritonavir, telaprevir, voriconazole, nelfinavir, saquinavir, boceprevir, conivaptan, ketoconazole, a combination agent of lopinavir and ritonavir, mibefradil, nefazodone, posaconazole, telithromycin, fluconazole, amprenavir, aprepitant, atazanavir, ciprofloxacin, crizotinib, a combination agent of darnavir and ritonavir, diltiazem, erythromycin, fosamprenavir, imatinib, istradefylline, miconazole, tofisopam
• the medicament according to [24], wherein the drug that inhibits CYP2C9 is one or more drugs selected from the group consisting of a fluorouracil derivative, carmofur, sulfaphenazole, amiodarone, bucolome, cyclosporine, fluconazole, miconazole, and oxandrolone.
• the patient in need of pemafibrate therapy is a patient with one or more diseases selected from the group consisting of hyperlipemia, dyslipidemia, arteriosclerosis, diabetes mellitus, diabetic complications, inflammation, non-alcoholic steatohepatitis, primary biliary cirrhosis, and heart disease.
• a pharmaceutical kit comprising (A) a medicament comprising pemafibrate, a salt thereof, or a solvate of any of these as an active ingredient; and (B) an instruction to avoid or suspend concomitant use of the (A) with a medicament comprising a CYP inhibitor, or to reduce the dose of pemafibrate, a salt thereof, or a solvate of any of these at the time of the concomitant use.
• the pharmaceutical kit according to [33] wherein the pemafibrate, a salt thereof, or a solvate of any of these is pemafibrate.
• CYP inhibitor is a drug that inhibits CYP3A.
• drug that inhibits CYP3A is one or more drugs selected from the group consisting of clarithromycin, cyclosporine, cobicistat, indinavir, itraconazole, ritonavir, telaprevir, voriconazole, nelfinavir, saquinavir, boceprevir, conivaptan, ketoconazole, a combination agent of lopinavir and ritonavir, mibefradil, nefazodone, posaconazole, telithromycin, fluconazole, amprenavir, aprepitant, atazanavir, ciprofloxacin, crizotinib, a combination agent of darnavir and ritonavir, diltiazem,
• CYP inhibitor is a drug that inhibits CYP2C8.
• drug that inhibits CYP2C8 is one or more drugs selected from the group consisting of gemfibrozil, clopidogrel, cyclosporine, deferasirox, and teriflunomide.
• the CYP inhibitor is a drug that inhibits CYP2C9.
• the pharmaceutical kit according to [39], wherein the drug that inhibits CYP2C9 is one or more drugs selected from the group consisting of a fluorouracil derivative, carmofur, sulfaphenazole, amiodarone, bucolome, cyclosporine, fluconazole, miconazole, and oxandrolone.
• the pharmaceutical kit according to any one of [33] to [41] instructing to reduce the dose of pemafibrate, a salt thereof, or a solvate of any of these, compared with the dose when the drug is administered alone, to 1 ⁇ 2 or less.
• a medicament comprising pemafibrate, a salt thereof, or a solvate of any of these as an active ingredient, for use in the treatment of a patient in need of pemafibrate therapy, in order to suppress an increase in plasma concentration of pemafibrate when the treatment is concomitant use of pemafibrate with a medicament comprising an OATP1B inhibitor, comprising an optional step of avoiding or suspending the concomitant use or reducing the dose of pemafibrate, a salt thereof, or a solvate of any of these.
• a pharmaceutical kit comprising (A) a medicament comprising pemafibrate, a salt thereof, or a solvate of any of these as an active ingredient; and (B) an instruction optionally to avoid or suspend concomitant use of the (A) with a medicament comprising an OATP1B inhibitor, or to reduce the dose of pemafibrate, a salt thereof, or a solvate of any of these at the time of the concomitant use.
• a medicament comprising pemafibrate, a salt thereof, or a solvate of any of these as an active ingredient, for use in the treatment of a patient in need of pemafibrate therapy, in order to suppress an increase in plasma concentration of pemafibrate when the treatment is concomitant use of pemafibrate with a medicament comprising a CYP inhibitor, comprising an optional step of avoiding or suspending the concomitant use or reducing the dose of pemafibrate, a salt thereof, or a solvate of any of these.
• a pharmaceutical kit comprising (A) a medicament comprising pemafibrate, a salt thereof, or a solvate of any of these as an active ingredient; and (B) an instruction optionally to avoid or suspend concomitant use of the (A) with a CYP inhibitor, or to reduce the dose of pemafibrate, a salt thereof, or a solvate of any of these at the time of the concomitant use.
• a method of treating a patient in need of pemafibrate therapy comprising a step of avoiding or suspending concomitant use of pemafibrate, a salt thereof, or a solvate of any of these with an OATP1B inhibitor or reducing the dose of pemafibrate, a salt thereof, or a solvate of any of these, in order to suppress an increase in plasma concentration of pemafibrate in the concomitant use.
• a method of treating a patient in need of pemafibrate therapy comprising an optional step of avoiding or suspending concomitant use of pemafibrate, a salt thereof, or a solvate of any of these with an OATP1B inhibitor or reducing the dose of pemafibrate, a salt thereof, or a solvate of any of these, in order to suppress an increase in plasma concentration of pemafibrate in the concomitant use.
• pemafibrate, a salt thereof, or a solvate of any of these for treating a patient in need of pemafibrate therapy, comprising a step of avoiding or suspending concomitant use of pemafibrate, a salt thereof, or a solvate of any of these with an OATP1B inhibitor or reducing the dose of pemafibrate, a salt thereof, or a solvate of any of these, in order to suppress an increase in plasma concentration of pemafibrate in the concomitant use.
• pemafibrate, a salt thereof, or a solvate of any of these for treating a patient in need of pemafibrate therapy, comprising an optional step of avoiding or suspending concomitant use of pemafibrate, a salt thereof, or a solvate of any of these with an OATP1B inhibitor or reducing the dose of pemafibrate, a salt thereof, or a solvate of any of these, in order to suppress an increase in plasma concentration of pemafibrate in the concomitant use.
• a method of treating a patient in need of pemafibrate therapy comprising a step of avoiding or suspending concomitant use of pemafibrate, a salt thereof, or a solvate of any of these with a CYP inhibitor or reducing the dose of pemafibrate, a salt thereof, or a solvate of any of these, in order to suppress an increase in plasma concentration of pemafibrate in the concomitant use.
• a method of treating a patient in need of pemafibrate therapy comprising an optional step of avoiding or suspending concomitant use of pemafibrate, a salt thereof, or a solvate of any of these with a CYP inhibitor or reducing the dose of pemafibrate, a salt thereof, or a solvate of any of these, in order to suppress an increase in plasma concentration of pemafibrate in the concomitant use.
• pemafibrate, a salt thereof, or a solvate of any of these for treating a patient in need of pemafibrate therapy, comprising a step of avoiding or suspending concomitant use of pemafibrate, a salt thereof, or a solvate of any of these with a CYP inhibitor or reducing the dose of pemafibrate, a salt thereof, or a solvate of any of these, in order to suppress an increase in plasma concentration of pemafibrate in the concomitant use.
• pemafibrate, a salt thereof, or a solvate of any of these for treating a patient in need of pemafibrate therapy, comprising an optional step of avoiding or suspending concomitant use of pemafibrate, a salt thereof, or a solvate of any of these with a CYP inhibitor or reducing the dose of pemafibrate, a salt thereof, or a solvate of any of these, in order to suppress an increase in plasma concentration of pemafibrate in the concomitant use.
• a medicament for effective and safe use since an increase in plasma concentration of pemafibrate, a salt thereof, or a solvate of any of these is suppressed, a medicament for effective and safe use can be provided.
• pemafibrate is a compound represented by the following formula (3)
• pemafibrate, a salt thereof, or a solvate of any of these includes, in addition to pemafibrate itself, a pharmaceutically acceptable salt of pemafibrate, and a solvate of pemafibrate or a pharmaceutically acceptable salt of pemafibrate with water and the like.
• the pemafibrate, a salt thereof, or a solvate of any of these is pemafibrate.
• Pemafibrate, a salt thereof, or a solvate of any of these can be produced according to the method described in, for example, WO 2005/023777.
• the compounds may also be formulated according to the methods described in literatures in order to provide them as a medicament.
• the medicament containing pemafibrate, a salt thereof, or a solvate of any of these are preferably those for oral administration, and include a tablet, a capsule, a granule and the like.
• an “OATP1B inhibitor” is a drug that inhibits the action of organic anion-transporting polypeptides (OATP) 1B1 and/or OATP1B3 in the body, examples of which include clarithromycin, rifampicin, cyclosporine, a combination agent of lopinavir and ritonavir, a combination agent of atazanavir and ritonavir, a combination agent of dalnavir and ritonavir, clopidogrel, eltrombopag, a combination agent of saquinavir and ritonavir, a combination agent of tipranavir and ritonavir, and gemfibrozil.
• OATP organic anion-transporting polypeptides
• the OATP1B inhibitor may also be an OATP1B inhibitor as described in the “Drug Interaction Guidelines for Drug Development and Proper Information” (Final Draft), Evaluation and Licensing Division, Pharmaceutical and Food Safety Bureau, MHLW, Jul. 8, 2014, the Guidelines (Guidance for Industry Drug Interaction Studies-Study Design, Data Analysis, Implications for Dosing, and Labeling Recommendations Draft Guidance (February 2012)) of the U.S. Food and Drug Administration, or the Guidelines (Guideline on the investigation of drug interactions (21 Jun. 2012)) of the European Medicines Agency.
• the OATP1B inhibitor is clarithromycin.
• the OATP1B inhibitor is rifampicin.
• the OATP1B inhibitor is cyclosporine.
• the OATP1B inhibitor is clopidogrel.
• a drug that inhibits OATP1B1 examples include cyclosporine, rifampicin, clarithromycin, a combination agent of lopinavir and ritonavir, combination of atazanavir and ritonavir, a combination agent of dalnavir and ritonavir, a combination agent of saquinavir and ritonavir, gemfibrozil, eltrombopag, a combination agent of tipranavir and ritonavir, and clopidogrel.
• Examples of “a drug that inhibits OATP1B3” include cyclosporine, rifampicin, clarithromycin, a combination agent of lopinavir and ritonavir, a combination agent of atazanavir and ritonavir, a combination agent of darnavir and ritonavir, a combination agent of saquinavir and ritonavir, and gemfibrozil.
• Examples of “a drug that inhibit OATP1B1 and OATP1B3” include cyclosporine, rifampicin, clarithromycin, a combination agent of lopinavir and ritonavir, a combination agent of atazanavir and ritonavir, a combination agent of darnavir and ritonavir, a combination agent of saquinavir and ritonavir, and gemfibrozil.
• a medicament containing an OATP1B inhibitor those for oral administration are preferable, and examples of which include a tablet, a capsule and a granule.
• cytochrome P450 or “CYP” are enzymes involved in metabolizing drugs in the liver, and “a CYP inhibitor” refers to a drug that inhibits the action of CYP in the body by ingestion.
• a CYP inhibitor include, but are not limited to, “a CYP3A inhibitor”, “a CYP2C8 inhibitor”, and “a CYP2C9 inhibitor.”
• Examples of a drug that inhibits CYP3A include clarithromycin, cyclosporine, cobicystat, indinavir, itraconazole, ritonavir, telaprevir, voriconazole, nelfinavir, saquinavir, boceprevir, conibaptan, ketoconazole, a combination agent of lopinavir and ritonavir, mibefradil, nefazodone, posaconazole, telithromycin, fluconazole, amprenavir, apre
• Examples of “a drug that inhibits CYP2C8” include gemfibrozil, clopidogrel, cyclosporine, deferasirox, and teriflunomide.
• Examples of “a drug that inhibits CYP2C9” include fluorouracil derivatives, carmofur, sulfaphenazole, amiodarone, bucolome, cyclosporine, fluconazole, miconazole, and oxandrolone.
• the “CYP inhibitor” may be a “drug that inhibits CYP3A”, “a drug that inhibits CYP2C8”, or “a drug that inhibits CYP2C9” as described in the “Drug Interaction Guideline for Drug Development and Proper Information (Final Draft) (Evaluation and Licensing Division, Pharmaceutical and Food Safety Bureau, MHLW, Jul. 8, 2014), the guideline (Guidance for Industry Drug Interaction Studies-Study Design, Data Analysis, Implications for Dosing, and Labeling Recommendations Draft Guidance (February 2012)) of the U.S. Food and Drug Administration, or the guideline (Guideline on the investigation of drug interactions (21 Jun. 2012)) of the European Medicines Agency.
• the U.S. Food and Drug Administration generally defines a “potent inhibitor” as an inhibitor that, in clinical evaluation, caused a >5-fold increase in plasma AUC values or a >80% decrease in clearance of CYP substrates (not limited to sensitive CYP substrates).
• the U.S. Food and Drug Administration generally defines a “moderate inhibitor” as an inhibitor that, in clinical evaluation, caused a >2-fold increase in AUC values, but a ⁇ 5-fold increase in clearance of sensitive CYP substrates or a 50% to 80% decrease in clearance of sensitive CYP substrates when the inhibitor was given at the highest approved dose and at the shortest dosing interval.
• potent CYP3A inhibitors include boceprevir, clarithromycin, conivaptan, indinavir, itraconazole, ketoconazole, a combination agent of lopinavir and ritonavir, mibefradil, nefazodone, nelfinavir, posaconazole, ritonavir, saquinavir, telaprevir, voriconazole; moderate CYP3A inhibitors include amprenavir, aprepitant, atazanavir, ciprofloxacin, crizotinib, a combination agent of darnavir and ritonavir, diltiazem, erythromycin, fluconazole, fosamprenavir, imatinib and verapamil.
• rifampicin includes, not only rifampicin itself, but also a pharmaceutically acceptable salt thereof, and a solvate of rifampicin or its pharmaceutically acceptable salt with water and the like.
• rifampicin is rifampicin as listed in the Japanese Pharmacopoeia, Seventeenth Edition.
• clarithromycin includes not only clarithromycin itself, but also a pharmaceutically acceptable salt thereof, a solvate of clarithromycin or its pharmaceutically acceptable salt with water and the like.
• clarithromycin is clarithromycin as listed in the Japanese Pharmacopoeia, Seventeenth Edition.
• cyclosporine includes not only cyclosporine A represented by the following formula (4); but also cyclosporine B, cyclosporine C, cyclosporine D, cyclosporine E, cyclosporine F, cyclosporine G, and cyclosporine H, which are analogs of cyclosporine A; a pharmaceutically acceptable salt of cyclosporine; and a solvate of cyclosporine or its pharmaceutically acceptable salt with water and the like.
• cyclosporine is cyclosporine A, preferably cyclosporine listed in the Japanese Pharmacopeia, Seventeenth Edition (cyclosporine A).
• clopidogrel includes, not only clopidogrel itself, but also a pharmaceutically acceptable salt thereof, and a solvate of clopidogrel or its pharmaceutically acceptable salt with water and the like.
• salt of clopidogrel include, but are not limited to, a hydrochloride, a sulfate, a bisulfate, a hydrobromide, and a taurocholate.
• clopidogrel is clopidogrel sulfate, preferably clopidogrel sulfate as listed in the Japanese Pharmacopoeia, Seventeenth Edition.
• a patient in need of pemafibrate therapy or “a patient in need of treatment with pemafibrate, a salt thereof, or a solvate of any of these” includes, but not limited to, a patient expressing one or more diseases selected from the group consisting of, for example, hyperlipidemia, dyslipidemia, arteriosclerosis, diabetes mellitus, diabetic complications, inflammation, non-alcoholic steatohepatitis, primary biliary cirrhosis, and heart disease.
• diseases selected from the group consisting of, for example, hyperlipidemia, dyslipidemia, arteriosclerosis, diabetes mellitus, diabetic complications, inflammation, non-alcoholic steatohepatitis, primary biliary cirrhosis, and heart disease.
• treatment with an OATP1B inhibitor refers to administration of an OATP1B inhibitor for the treatment of a disease, and the OATP1B inhibitor used can differ depending on the disease to be treated.
• OATP1B inhibitor used can differ depending on the disease to be treated.
• rifampicin is used in the treatment of pulmonary tuberculosis and other tuberculosis, non-tuberculous mycobacteriosis, including Mycobacterium avium complex (MAC) disease, and leprosy.
• MAC Mycobacterium avium complex
• Clarithromycin is used for the treatment of general infectious diseases (superficial skin infections, deep skin infections, lymphangitis, lymphadenitis, chronic pyoderma, secondary infections caused by trauma, burns and surgical wounds, perianal abscess, pharyngeal/laryngitis, tonsillitis, acute bronchitis, pneumonia, lung abscess, secondary infection of chronic respiratory lesions, urethritis, cervicitis, infectious enteritis, otitis media, sinusitis, periodontitis, pericoronitis, or jaw inflammation by one or more bacteria selected from the group consisting of Staphylococcus, Streptococcus, Streptococcus pneumoniae, Moraxella (Branhamera) catarrhalis, Haemophilus influenzae, Legionella, Campylobacter, Peptostreptococcus, Chlamydia, and Mycoplasma), nontuberculous mycobacterial disease including Mycobacterium avium complex (MAC)
• Cyclosporine reduces rejection in organ transplantation (kidney, liver, heart, lung, pancreas, small intestine), rejection in bone marrow transplantation and graft-versus-host disease, Behcet's disease (if ocular symptoms are present) and other noninfectious uveitis (limited to active intermediate or posterior noninfectious uveitis that may be ineffective with existing therapy), psoriasis (psoriasis vulgaris (if skin rash is more than 30% of the whole body or refractory), pustular psoriasis, erythrodermic psoriasis, arthritic psoriasis), anemia (aplastic anemia (severe), pure red cell aplasia), nephrotic syndrome (frequent relapsing, or with resistance in steroid), myasthenia gravis (in the treatment after thymectomy, when the effect of steroids is insufficient or when it is difficult to administer steroids due to adverse reactions).
• Clopidogrel is used to suppress recurrence after ischemic cerebrovascular disorder (excluding cardiogenic cerebrovascular embolism), to treat ischemic heart disease to which percutaneous coronary intervention (PCI) is applied (acute coronary syndrome (unstable angina pectoris, non-ST-elevation myocardial infarction, ST-elevation myocardial infarction), stable angina pectoris, old myocardial infarction), and to suppress thrombus and embolus formation in peripheral arterial disease.
• PCI percutaneous coronary intervention
• treatment with an OATP1B inhibitor is not limited to the treatment of these diseases.
• the patient in need of pemafibrate therapy is a patient in need of further treatment with an OATP1B inhibitor.
• Such patients include, a patient in need of additional pemafibrate therapy during treatment with an OATP1B inhibitor, a patient in need of additional therapy with an OATP1B inhibitor during pemafibrate therapy, and a patient in need of simultaneous start of pemafibrate therapy and treatment with an OATP1B inhibitor.
• treatment with a CYP inhibitor refers to administration of a CYP inhibitor for the treatment of a disease, and the CYP inhibitor to be used depends on the disease to be treated.
• clarithromycin is used for the treatment of general infectious diseases (superficial skin infections, deep skin infections, lymphangitis, lymphadenitis, chronic pyoderma, secondary infections caused by trauma, burns and surgical wounds, perianal abscess, pharyngeal/laryngitis, tonsillitis, acute bronchitis, pneumonia, lung abscess, secondary infection of chronic respiratory lesions, urethritis, cervicitis, infectious enteritis, otitis media, sinusitis, periodontitis, pericoronitis, or jaw inflammation by one or more bacteria selected from the group consisting of Staphylococcus, Streptococcus, Streptococcus pneumoniae, Moraxella (Branhamera) catarrhalis, Haemophilus influenzae,
• Cyclosporine reduces rejection in organ transplantation (kidney, liver, heart, lung, pancreas, small intestine), rejection in bone marrow transplantation and graft-versus-host disease, Behcet's disease (if ocular symptoms are present) and other noninfectious uveitis (limited to active intermediate or posterior noninfectious uveitis that may be ineffective with existing therapy), psoriasis (psoriasis vulgaris (if skin rash is more than 30% of the whole body or refractory), pustular psoriasis, erythrodermic psoriasis, arthritic psoriasis), anemia (if erythroderma, arthritic psoriasis), (aplastic anemia (severe), pure red cell aplasia), nephrotic syndrome (frequent relapsing, or with resistance in steroid), myasthenia gravis (in the treatment after thymectomy, when the
• Clopidogrel is used to suppress recurrence after ischemic cerebrovascular disorder (excluding cardiogenic cerebrovascular embolism), to treat ischemic heart disease to which percutaneous coronary angioplasty (PCI) is applied (acute coronary syndrome (unstable angina pectoris, non-ST-elevation myocardial infarction, ST-elevation myocardial infarction), stable angina pectoris, old myocardial infarction), and to suppress thrombus and embolus formation in peripheral arterial diseases.
• PCI percutaneous coronary angioplasty
• treatment with a CYP inhibitor is not limited to the treatment of these diseases.
• the patient in need of pemafibrate therapy is a patient in need of further treatment with a CYP inhibitor.
• a patient in need of further pemafibrate therapy during treatment with a CYP inhibitor include, for example, a patient in need of further pemafibrate therapy during treatment with a CYP inhibitor, a patient in need of additional treatment with a CYP inhibitor during pemafibrate therapy, and a patient in need of simultaneous start of pemafibrate therapy and treatment with a CYP inhibitor.
• a “concomitant use” refers to a patient's taking two or more medicaments or to let a patient take two or more medicaments.
• the patient may take two medications simultaneously or one by one at an interval.
• Rifampicin is a drug known to act as an inhibitor of OATP1B1 and OATP1B3 by a single administration, and it is conceivable that its inhibitory effect is involved in increasing plasma concentration of pemafibrate. That is, concomitant use of an OATP1B inhibitor with pemafibrate, a salt thereof, or a solvate of any of these may increase plasma concentration of pemafibrate. Therefore, in order to suppress the increase in the plasma concentration of pemafibrate, the concomitant use was avoided or suspended, or the dose of pemafibrate, a salt thereof, or a solvate of any of these was reduced.
• Clarithromycin is known to inhibit CYP3A, OATP1B1, and OATP1B3, thereby causing drug interactions, and may be involved in increasing plasma concentration of pemafibrate. That is, if the drug inhibits CYP3A, OATP1B1, and OATP1B3, the plasma concentration of pemafibrate may be increased by concomitant use of pemafibrate, a salt thereof, or a solvate of any of these. Therefore, in order to suppress the increase in the plasma concentration of pemafibrate, the concomitant use was avoided or suspended, or the dose of pemafibrate, a salt thereof, or a solvate of any of these was reduced.
• examples of “a drug that inhibits CYP3A, OATP1B1, and OATP1B3” include clarithromycin, cyclosporine, and HIV-protease inhibitors.
• HIV protease inhibitors include atazanavir, a salt thereof, or a solvate of any of these (atazanavir sulfate etc.), indinavir, a salt thereof, or a solvate of any of these (indinavir sulfate ethanol adduct etc.), saquinavir, a salt thereof, or a solvate of any of these (saquinavir mesylate etc.), darnavir, a salt thereof, or a solvate of any of these (darnavir ethanol adduct etc.), nelfinavir, a salt thereof, or a solvate of any of these (nelfinavir mesylate etc.), phosamprenavir, a salt thereof, or
• a medicament comprising a drug that inhibits CYP3A, OATP1B1, and OATP1B3 includes a concomitant drug that exhibits other pharmacological action than a medicament that includes either clarithromycin, cyclosporine, or an HIV-protease inhibitor as the sole pharmacological action compound.
• the above combination agents include a combination agent of ritonavir and lopinavir (e.g., Kaletra), a combination agent of ritonavir and ombitavir hydrate and palitaprevir hydrate (VIEKIRAX), a combination agent of ritonavir and darnavir ethanol adduct, and a combination agent of darnavir ethanol adduct and cobicistat (Prezcobix).
• a combination agent of ritonavir and lopinavir e.g., Kaletra
• VIEKIRAX combination agent of ritonavir and ombitavir hydrate and palitaprevir hydrate
• Prezcobix a combination agent of darnavir ethanol adduct and cobicistat
• Concomitant use of “a drug that inhibits CYP3A” and “a drug that inhibits OATP1B1 and OATP1B3” may inhibit CYP3A, OATP1B1, and OATP1B3, and may increase plasma concentration of pemafibrate by administering pemafibrate, a salt thereof, or a solvate of any of these to the same patients.
• pemafibrate, a salt thereof, or a solvate of any of these is used concomitant with “a drug that inhibits CYP3A” or “a drug that inhibits OATP1B1 and OATP1B3,” and avoiding or suspending the concomitant use, or reducing the dose of pemafibrate, a salt thereof, or a solvate of any of these can suppress the increase in plasma concentration of pemafibrate.
• Cyclosporine is also known to inhibit CYP3A, CYP2C8, CYP2C9, OATP1B1, and OATP1B3, and to cause drug interactions, and it is considered that cyclosporine is involved in increasing plasma concentration of pemafibrate. That is, if a drug inhibits CYP3A, CYP2C8, CYP2C9, OATP1B1, and OATP1B3, plasma concentration of pemafibrate may be increased by concomitant use of pemafibrate, a salt thereof, or a solvate of any of these with such a drug.
• the present inventors determined to avoid or suspend the concomitant use, or reduce the dose of pemafibrate, a salt thereof, or a solvate of any of these.
• a drug that inhibits CYP3A may inhibit CYP3A, CYP2C8, CYP2C9, OATP1B1 and OATP1B3, and may increase the plasma concentration of pemafibrate by administering pemafibrate, a salt thereof, or a solvate of any of these to the same subject.
• pemafibrate, a salt thereof, or a solvate of any of these is concomitantly used with one or more drugs selected from the group consisting of “a drug that inhibits CYP3A”, “a drug that inhibits CYP2C8”, “a drug that inhibits CYP2C9” and “a drug that inhibits OATP1B1 and OATP1B3”.
• Increase in the plasma concentration of pemafibrate can be suppressed by avoiding or suspending the concomitant use or by reducing the dose of pemafibrate, a salt thereof, or a solvate of any of these.
• Clopidogrel is also known to inhibit CYP2C8 and OATP1B1 and cause drug interactions, and may be involved in increasing plasma concentration of pemafibrate. That is, if the drug inhibits CYP2C8 and OATP1B1, the plasma concentration of pemafibrate may be increased by concomitant use with pemafibrate, a salt thereof, or a solvate of any of these or solvates thereof. Therefore, in order to suppress an increase in the plasma concentration of pemafibrate, the present inventors determined to avoid or suspend the concomitant use, or to reduce the dose of pemafibrate, a salt thereof, or a solvate of any of these.
• concomitant use of “a drug that inhibits CYP2C8” with “a drug that inhibits OATP1B1” may inhibit CYP2C8 and OATP1B1, and if pemafibrate, a salt thereof, or a solvate of any of these is further administered to the same patients, the plasma concentration of pemafibrate may be increased.
• pemafibrate, a salt thereof, or a solvate of any of these concomitant with “a drug that inhibits CYP2C8” or “a drug that inhibits OATP1B1”, and avoidance or suspension of such concomitant use or reduction of pemafibrate, a salt thereof, or a solvate of any of these can suppress an increase in plasma concentration of pemafibrate.
• the “step of avoiding or suspending the concomitant use with the pharmaceutical containing the OATP1B inhibitor” is not particularly limited, and includes, for example, any one of the following steps (i) to (vii).
• the above (i) to (vii) can replace the “OATP1B inhibitor” with any drug, and can be read as a step for an arbitrary drug.
• the arbitrary drug is one or more drugs selected from the group consisting of, for example, but not limited to, a CYP inhibitor, a drug that inhibits CYP3A, a drug that inhibits CYP2C8, a drug that inhibits CYP2C9, a drug that inhibits OATP1B1 and OATP1B3, and a drug that inhibits OATP1B1.
• dose means an amount of active ingredient used per day and is expressed in units of g/day or mg/day.
• the dose of pemafibrate, a salt thereof, or a solvate of any of these to a patient in need of pemafibrate therapy is preferably 0.1 to 0.4 mg/day. If the patient further requires treatment with an OATP1B inhibitor, less than 0.4 mg/day is preferable, and 0.1 to 0.2 mg/day is more preferable.
• the daily dose of pemafibrate when pemafibrate is used concomitantly with clarithromycin or clopidogrel, it is preferable that the daily dose of pemafibrate be 0.1 mg and the maximal dose be up to 0.2 mg per day, but the dose is not limited thereto. It is also preferable that pemafibrate, a salt thereof, or a solvate of any of these be administered in a manner that the above daily dose is divided into twice.
• a step of reducing the dose of pemafibrate, a salt thereof, or a solvate of any of these means changing the dose of pemafibrate, a salt thereof, or a solvate of any of these selected from the group consisting of from 0.4 mg/day to 0.35 mg/day, from 0.4 mg/day to 0.3 mg/day, from 0.4 mg/day to 0.25 mg/day, from 0.4 mg/day to 0.2 mg/day, from 0.4 mg/day to 0.15 mg/day, from 0.4 mg/day to 0.1 mg/day, from 0.4 mg/day to 0.05 mg/day, from 0.35 mg/day to 0.3 mg/day, from 0.35 mg/day to 0.25 mg/day, and from 0.35 mg/day to 0.2 mg/day, and from 0.35 mg/day to 0.15 mg/day, from 0.35 mg/day to 0.1 mg/day, from 0.35 mg/day to 0.05 mg/day, from 0.3 mg/day to 0.25 mg/day, and from 0.
• reducing the dose of pemafibrate, a salt thereof, or a solvate of any of these can be expressed, for example, as “reducing the amount of pemafibrate, a salt thereof, or a solvate of any of these to be administered”, “reducing the amount of pemafibrate, a salt thereof, or a solvate of any of these” or “lowering the dose of pemafibrate, a salt thereof, or a solvate of any of these.”
• the “step of avoiding or suspending concomitant use” and the “step of reducing the dose of pemafibrate, a salt thereof, or a solvate of any of these” for suppressing an increase in plasma concentration of pemafibrate can be performed as required, and embodiments thereof include, for example, the medicaments recited in [47] and [49], the pharmaceutical kits recited in [48] and [50], the methods for treatment recited in [52] and [56], and the use for treatment recited in [54] and [58], and the like.
• the dose of clarithromycin to a patient in need of treatment with clarithromycin is preferably from 200 to 1,600 mg/day, preferably 200 to 800 mg/day for the treatment of general infectious diseases, 400 to 1,600 mg/day for the treatment of non-tuberculous mycobacteriosis, and 200 to 800 mg/day for the treatment of Helicobacter pylori infections.
• the dose of clopidogrel, a salt thereof, or a solvate of any of these to a patient in need of treatment with clopidogrel, a salt thereof, or a solvate of any of these is 75 to 400 mg/day, preferably 75 to 300 mg/day as clopidogrel, more preferably 391.5 mg/day of clopidogrel sulfate (equivalent to 300 mg/day of clopidogrel) on day 1 and 97.875 mg/day of clopidogrel sulfate (equivalent to 75 mg/day of clopidogrel) on and after day 2 of administration.
• One embodiment of the present invention includes a pharmaceutical kit comprising (A) a medicament comprising pemafibrate, a salt thereof, or a solvate of any of these or solvate thereof as an active ingredient; and (B) an instruction to avoid or suspend concomitant use of the (A) and a medicament comprising an OATP1B inhibitor or to reduce the dose of pemafibrate, a salt thereof, or a solvate of any of these.
• an instruction to avoid or suspend concomitant use is an instruction describing a situation in which concomitant use of two specific medicaments should be avoided or suspended.
• the “instruction to avoid or suspend concomitant use of Medicament A and Medicament B” is not particularly limited, but includes, for example, an instruction for instructing (a) to (h) below.
• Medicament A should not be administered to a patient receiving Medicament B, but should be administered with care when particularly necessary.
• instruction include a package insert, a package label, or a user manual, and include, but are not limited to, a package insert, an interview form, a prescribing information, a patient information leaflet, for example.
• Subjects were orally administered on the following schedule.
• the administration of 0.4 mg of pemafibrate on Days 1 and 4 was carried out under fasting for at least 8 hours, and the fasting was maintained for 4 hours after the administration.
• Plasma concentration of pemafibrate was measured on blood samples from patients taken prior to and at 0.25, 0.5, 1, 1.5, 2, 3, 4, 6, 8, 10, 12, 14, 16, 24, 36, 48, 72 hours after administration of the drug on Days 1 and 4.
• Subjects were orally administered on the following schedule.
• the administration of 0.4 mg of pemafibrate on Days 1 and 9 was carried out under fasting for at least 8 hours, and the fasting was maintained for 4 hours after the administration.
• Plasma concentration of pemafibrate was measured on blood samples from patients collected prior to and at 0.25, 0.5, 1, 1.5, 2, 3, 4, 6, 8, 10, 12, 14, 16, 24, 36, 48, 72 hours after administration of 0.4 mg of pemafibrate on Days 1 and 9.
• Subjects were orally administered on the following schedule. Drug administration was carried out under fasting for at least 8 hours, and fasting was maintained for 4 hours after administration.
• Plasma concentration of pemafibrate was measured on blood samples from patients taken prior to and at 0.25, 0.5, 1, 1.5, 2, 3, 4, 6, 8, 10, 12, 14, 16, 24, 36, 48, 72 hours after administration of the drug on Days 1 and 4.
• Subjects were orally administered on the following schedule.
• Pemafibrate administration on Days 1, 4, and 7 was carried out under fasting for at least 8 hours and maintained fasting for 4 hours after administration.
• Plasma concentration of pemafibrate was measured on blood samples from patients taken prior to and at 0.25, 0.5, 1, 1.5, 2, 3, 4, 6, 8, 10, 12, 14, 16, 24, 36, 48, 72 hours after administration of the drug on Days 1, 4, and 7.
• the present invention can avoid an increase in plasma concentration of pemafibrate, a salt thereof, or a solvate of any of these.
• a medicament can be provided for the effective and safe use of pemafibrate, a salt thereof, or a solvate of any of these.

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