WO1999007374A1 - Use of nk-1 receptor antagonists for treating aggressive behaviour - Google Patents

Use of nk-1 receptor antagonists for treating aggressive behaviour Download PDF

Info

Publication number
WO1999007374A1
WO1999007374A1 PCT/EP1997/006689 EP9706689W WO9907374A1 WO 1999007374 A1 WO1999007374 A1 WO 1999007374A1 EP 9706689 W EP9706689 W EP 9706689W WO 9907374 A1 WO9907374 A1 WO 9907374A1
Authority
WO
WIPO (PCT)
Prior art keywords
phenyl
group
4alkyl
hydrogen
substituted
Prior art date
Application number
PCT/EP1997/006689
Other languages
French (fr)
Inventor
Nadia Melanie Rupniak
Original Assignee
Merck Sharp & Dohme Limited
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Merck Sharp & Dohme Limited filed Critical Merck Sharp & Dohme Limited
Priority to AU57529/98A priority Critical patent/AU5752998A/en
Priority to CA002298779A priority patent/CA2298779A1/en
Priority to AU91605/98A priority patent/AU737019B2/en
Priority to PCT/EP1998/004933 priority patent/WO1999007375A1/en
Priority to EP98943866A priority patent/EP1001779A1/en
Publication of WO1999007374A1 publication Critical patent/WO1999007374A1/en

Links

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
    • A61K31/535—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with at least one nitrogen and one oxygen as the ring hetero atoms, e.g. 1,2-oxazines
    • A61K31/5375—1,4-Oxazines, e.g. morpholine
    • 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

Definitions

  • This invention relates to the treatment or prevention of aggressive behaviour by the administration of a NK-1 receptor antagonist.
  • Aggressive behaviour when uncontrolled or out of proportion to any provocation may give rise to a condition which requires medication.
  • Individuals with narcissistic, obsessive, paranoid or schizoid traits may be especially prone to outbursts of aggressive behaviour, especially when under stress. When particularly severe, aggressive behaviour may lead to job loss, difficulties with marriage and interpersonal relationships, school suspension, accidents, hospitalization or incarceration.
  • antipsychotic drugs such as haloperidol or chlorpromazine may be used to control symptoms.
  • antipsychotic drugs are typically associated with a number of side-effects, including extrapyramidal symptoms, acute dystonias, tardive dyskinesias, akathesia, tremor, tachycardia, drowsiness, confusion, postural hypotension, blurring of vision, precipitation of glaucoma, dry mouth, constipation, urinary hesitance and impaired sexual function.
  • Neurokinin 1 (NK-1; substance P) receptor antagonists are being developed for the treatment of a number of physiological disorders associated with an excess or imbalance of tachykinins, and in particular substance P.
  • Examples of conditions in which substance P has been implicated include disorders of the central nervous system such as anxiety, depression and psychosis (see, for instance, International (PCT) patent specification Nos. WO 95/16679, WO 95/18124 and WO 95/23798).
  • the present invention accordingly provides the use of a NK-1 receptor antagonist for the manufacture of a medicament for the treatment or prevention of aggressive behaviour.
  • the present invention also provides a method for the treatment or prevention of aggressive behaviour, which method comprises administration to a patient in need of such treatment of an effective amount of a NK-1 receptor antagonist.
  • a pharmaceutical composition for the treatment or prevention of aggressive behaviour comprising a NK-1 receptor antagonist, together with at least one pharmaceutically acceptable carrier or excipient.
  • a combination of a conventional antipsychotic drug with a NK-1 receptor antagonist may provide an enhanced effect in the treatment of aggressive behaviour. Such a combination would be expected to provide for a rapid onset of action to treat an aggressive outburst thereby enabling use on an "as needed basis". Furthermore, such a combination may enable a lower dose of the antispychotic agent to be used without compromising the efficacy of the antipsychotic agent, thereby minimising the risk of adverse side-effects.
  • a yet further advantage of such a combination is that, due to the action of the NK-1 receptor antagonist, adverse side-effects caused by the antipsychotic agent such as acute dystonias, dyskinesias, akathesia and tremor may be reduced or prevented.
  • a NK-1 receptor antagonist and an antipsychotic agent for the manufacture of a medicament for the treatment or prevention of aggressive behaviour.
  • the present invention also provides a method for the treatment or prevention of aggressive behaviour, which method comprises administration to a patient in need of such treatment of an amount of a NK-1 receptor antagonist and an amount of an antipsychotic agent, such that together they give effective relief.
  • a pharmaceutical composition comprising a NK-1 receptor antagonist and an antipsychotic agent, together with at least one pharmaceutically acceptable carrier or excipient.
  • NK-1 receptor antagonist and the antipsychotic agent may be present as a combined preparation for simultaneous, separate or sequential use for the treatment or prevention of aggressive behaviour.
  • Such combined preparations may be, for example, in the form of a twin pack.
  • a product comprising a NK-1 receptor antagonist and an antipsychotic agent as a combined preparation for simultaneous, separate or sequential use in the treatment or prevention of aggressive behaviour.
  • the NK-1 receptor antagonist and the antipsychotic agent may be in the same pharmaceutically acceptable carrier and therefore administered simultaneously. They may be in separate pharmaceutical carriers such as conventional oral dosage forms which are taken simultaneously.
  • the term “combination” also refers to the case where the compounds are provided in separate dosage forms and are administered sequentially. Therefore, by way of example, the antipsychotic agent may be administered as a tablet and then, within a reasonable period of time, the NK-1 receptor antagonist may be administered either as an oral dosage form such as a tablet or a fast-dissolving oral dosage form.
  • a fast-dissolving oral formulation is meant, an oral delivery form which when placed on the tongue of a patient, dissolves within about 10 seconds.
  • the term "aggressive behaviour" includes explosive personality disorder, intermittent explosive disorder, aggressive personality, aggressive nature, aggressiveness, excessive emotional instability, pathological emotionality, quarrelsomeness, dementia with behavioural disturbance, and personality change of the aggressive type due to a general medical condition. Aggressive behaviour may also be associated with substance intoxication, substance withdrawal, oppositional defiant disorder, conduct disorder, antisocial personality disorder, borderline personality disorder, a manic episode and schizophrenia.
  • NK-1 receptor antagonists of use in the present invention are described in published European Patent Specification Nos. 0 360 390, 0 394 989, 0 429 366, 0 443 132, 0 482 539, 0 512 901, 0 512 902, 0 514 273, 0 514 275, 0 517 589, 0 520 555, 0 522 808, 0 528 495, 0 532 456, 0 533 280, 0 536 817, 0 545 478, 0 577 394, 0 590 152, 0 599 538, 0 610 793, 0 634 402, 0 686 629, 0 693 489, 0 694 535, 0 699 655, 0 699 674, 0 707 006, 0 708 101, 0 714 891,
  • Suitable antipsychotic agents of use in combination with a NK-1 receptor antagonist include the phenothiazine, thioxanthene, heterocyclic dibenzazepine, butyrophenone, diphenylbutylpiperidine and indolone classes of antipsychotic agent.
  • Suitable examples of phenothiazines include chlorpromazine, mesoridazine, thioridazine, acetophenazine, fluphenazine, perphenazine and trifluoperazine.
  • Suitable examples of thioxanthenes include chlorprothixene and thiothixene.
  • An example of a dibenzazepine is clozapine.
  • An example of a butyrophenone is haloperidol.
  • An example of a diphenylbutylpiperidine is pimozide.
  • An example of an indolone is molindolone.
  • Other antipsychotic agents include loxapine, sulpiride and risperidone.
  • the antipsychotic agents when used in combination with a NK-1 receptor antagonist may be in the form of a pharmaceutically acceptable salt, for example, chlorpromazine hydrochloride, mesoridazine besylate, thioridazine hydrochloride, acetophenazine maleate, fluphenazine hydrochloride, flurphenazine enathate, fluphenazine decanoate, trifluoperazine hydrochloride, thiothixene hydrochloride, haloperidol decanoate, loxapine succinate and molindone hydrochloride.
  • a pharmaceutically acceptable salt for example, chlorpromazine hydrochloride, mesoridazine besylate, thioridazine hydrochloride, acetophenazine maleate, fluphenazine hydrochloride, flurphenazine enathate, fluphenazine decanoate, trifluoperazine hydrochloride, thi
  • NK-1 receptor antagonists are those described in European Patent Specification No. 0 577 394, i.e. compounds of formula (I):
  • R 1 is selected from the group consisting of:
  • heterocylcle is unsubstituted or substituted with one or more substituent(s) selected from: (i) Ci- ⁇ alkyl, unsubstituted or substituted with halo, -CF3,
  • R 2 and R 3 are independently selected from the group consisting of:
  • R 1 and R 2 may be joined together to form a heterocyclic ring selected from the group consisting of: (a) pyrrolidinyl,
  • R 2 and R 3 may be joined together to form a heterocyclic ring selected from the group consisting of:
  • X is selected from the group consisting of:
  • R 4 is selected from the group consisting of: (1)
  • alkyl is unsubstituted or substituted with one or more of the substituents selected from:
  • R 5 is selected from the group consisting of: (1) phenyl, unsubstituted or substituted with one or more of R 11 , R 12 and R 13 ;
  • Ci-salkyl unsubstituted or substituted with one or more of the substituent(s) selected from: (a) hydroxy, (b) oxo,
  • R 6 , R 7 and R 8 are independently selected from the group consisting of:
  • Rn, R i2 and R i3 are independently selected from the definitions of R 6 , R 7 and R 8 , or -OX;
  • Y is selected from the group consisting of:
  • R 15 and R i6 are independently selected from the group consisting of:
  • Ci- ⁇ alkyl unsubstituted or substituted with one or more of the substituents selected from: (i) hydroxy, (ii) oxo,
  • R i is selected from the group consisting of:
  • Ci- ⁇ alkyl substituted with one or more of the substituents selected from:
  • heterocycle wherein the heterocycle is selected from the group consisting of:
  • heterocycle is unsubstituted or substituted with one or more substituent(s) selected from:
  • Ci- ⁇ alkyl unsubstituted or substituted with halo, -CF3, -OCH3, or phenyl,
  • Ci-ealkoxy
  • R 9 and R 10 are as defined above, R 2 and R 3 are independently selected from the group consisting of: (1) hydrogen;
  • X is - 0-
  • R 5 is phenyl, unsubstituted or substituted with halo
  • R 6 , R 7 and R 8 are independently selected from the group consisting of:
  • Z is hydrogen or Ci. alkyl; and pharmaceutically acceptable salts thereof.
  • Particularly preferred compounds of formula (I) are: 4-(3-(l,2,4-triazolo)methyl)-2(S)-(3,5-bis(trifluoromethyl)benzyloxy)-3(S)- p he ny 1- morp holine ;
  • NK-1 receptor antagonists are those described in International (PCT) Patent Specification No. WO 95/18124, i.e. compounds of formula (II):
  • R is hydrogen, halogen, Ci- ⁇ alkyl, Ci- ⁇ alkoxy, CF3, NO2, CN, SR a ,
  • R 3 is hydrogen, halogen or CF3;
  • R 4 is hydrogen, halogen, Ci-ealkyl, Ci-ealkoxy, CF3, NO2, CN, SR a , SOR a , SO 2 R a , CO 2 R a , CONR a R b , Cu- ⁇ alkenyl, C 2 -6alkynyl or C ⁇ - alkyl substituted by where R a and R b each independently represent hydrogen or C ⁇ -4alkyl;
  • R 5 is hydrogen, halogen, Ci- ⁇ alkyl, Ci- ⁇ alkoxy substituted by C ⁇ -4alkoxy or CF3;
  • Z is Ci- ⁇ alkylene or C3-6cycloalkylene
  • R 7 is hydrogen, C ⁇ -4alkyl, C3-7cycloalkyl or C3-7cycloalkylC ⁇ -4alkyl, or C2-4alkyl substituted by Ci-4alkoxy or hydroxyl;
  • R 8 is hydrogen, C ⁇ -4alkyl, C3-7cycloalkyl or C3-7cycloalkylC ⁇ -4alkyl, or C2-4alkyl substituted by one or two substituents selected from C ⁇ -4alkoxy, hydroxyl or a 4, 5 or 6 membered heteroaliphatic ring containing one or two heteroatoms selected from N, O and S; or R 7 , R 8 and the nitrogen atom to which they are attached form a heteroaliphatic ring of 4 to 7 ring atoms, optionally substituted by a hydroxy group, and optionally containing a double bond, which ring may optionally contain an oxygen or sulphur ring atom, a group S(O) or S(O)2 or a second nitrogen atom which will be part of a NH or NR C moiety where R c is C 1- 4alkyl optionally substituted by hydroxy or or R 7 , R 8 and the nitrogen atom to which they are attached form a non-aromatic azabi
  • R 9a and R 9b are each independently hydrogen or C 1- 4alkyl, or R 9a and R 9b are joined so, together with the carbon atoms to which they are attached, there is formed a C5-7 ring;
  • X is an alkylene chain of 1 to 4 carbon atoms optionally substituted by oxo;
  • Y is a Ci-4alkyl group optionally substituted by a hydroxyl group; with the proviso that if Y is Ci. 4 alkyl, R 6 is susbstituted at least by a group of formula ZNR 7 R 8 as defined above.
  • Particularly preferred compounds of formula (II) are those of formula (Ila) and pharmaceutically acceptable salts thereof:
  • a 1 is fluorine or CF3;
  • a 2 is fluorine or CF3;
  • a 3 is fluorine or hydrogen; and
  • X, Y and R G are as defined in relation to formula (II).
  • Particularly preferred compounds of formula (II) include:
  • NK-1 receptor antagonists are those described in European Patent Specification No. WO 95/23798, i.e. compounds of formula (III):
  • R 2 and R 3 are independently selected from the group consisting of:
  • R 2 and R 3 may be joined together to form a heterocyclic ring selected from the group consisting of:
  • heterocyclic ring is unsubstituted or substituted with one or more substituent(s) selected from: (i) Ci- ⁇ al yl, (ii) oxo, (iii) Ci- ⁇ alkoxy,
  • R 6 , R 7 and R 8 are independently selected from the group consisting of: (1) hydrogen;
  • Rn, R i2 and R i3 are independently selected from the definitions of R 6 , R 7 and R 8 , or -OX;
  • A is selected from the group consisting of:
  • Ci- ⁇ alkyl unsubstituted or substituted with one or more of the substituents selected from:
  • B is a heterocycle, wherein the heterocycle is selected from the group consisting of:
  • heterocycle may be substituted in addition to -X with one or more substituent(s) selected from:
  • Ci- ⁇ alkyl unsubstituted or substituted with halo, -CF3, -OCH3, or phenyl
  • p is 0 or 1;
  • X is selected from:
  • Y is selected from the group consisting of:
  • R i5 and R i6 are independently selected from the group consisting of: (a) Ci- ⁇ alkyl, unsubstituted or substituted with one or more of the substituents selected from:
  • Z is selected from:
  • R 2 and R 3 are independently selected from the group consisting of:
  • R 6 , R 7 and R 8 are independently selected from the group consisting of:
  • Rn, R i2 and R i3 are independently selected from the group consisting of: (1) fluoro, (2) chloro,
  • A is unsubstituted l- ⁇ alkyl
  • B is selected from the group consisting of:
  • p is 0 or 1;
  • X is selected from:
  • Y is -O-
  • Z is hydrogen or Ci- ⁇ alkyl; and pharmaceutically acceptable salts thereof.
  • Particularly preferred compounds of formula (III) include:
  • NK-1 receptor antagonists are those described in European Patent Specification No. WO 96/05181, i.e. compounds of formula (IV):
  • X is a group of the formula NR 6 R 7 or a C- or N-linked imidazolyl ring;
  • Y is hydrogen or C ⁇ - 4 alkyl optionally substituted by a hydroxy group
  • R i is hydrogen, halogen, Ci-ealkyl, C ⁇ -6 alkoxy, CF 3 , NO2, CN, SR a , SOR a , SO 2 R a , CO 2 R a , CONR a R , Cjs- ⁇ alkenyl, C 2 - 6 alkynyl or C ⁇ - alkyl substituted by C 1 -4alkoxy, wherein R a and R b each independently represent hydrogen or C ⁇ -4alkyl;
  • R 2 is hydrogen, halogen, Ci- ⁇ alkyl, Ci- ⁇ alkoxy substituted by Ci-4alkoxy or CF3;
  • R 3 is hydrogen, halogen or CF3;
  • R 4 is hydrogen, halogen, Ci- ⁇ alkyl, C 1- 6alkoxy, hydroxy, CF3, NO 2 ,
  • R 5 is hydrogen, halogen, Ci- ⁇ alkyl, Ci- ⁇ alkoxy substituted by C ⁇ . alkoxy or CF 3 ;
  • R 6 is hydrogen, Ci- ⁇ alkyl, C3-7cycloalkyl, C3-7cycloalkylC ⁇ -4alkyl, phenyl, or C2-4alkyl substituted by C ⁇ -4alkoxy or hydroxy;
  • R 7 is hydrogen, Ci-ealkyl, C3-7cycloalkyl, C3-7cycloalkylC ⁇ -4alkyl, phenyl, or C2-4alkyl substituted by one or two substituents selected from C ⁇ -4alkoxy, hydroxy or a 4, 5 or 6 membered heteroaliphatic ring containing one or two heteroatoms selected from N, O and S; or R 6 and R 7 , together with the nitrogen atom to which they are attached, form a saturated or partially saturated heterocyclic ring of 4 to 7 ring atoms, which ring may optionally contain in the ring one oxygen or sulphur atom or a group selected from NR 8 , S(O) or S(O)2 and which ring may be optionally substituted by one or two groups selected from hydroxyC ⁇ -4alkyl, C 1 -4alkoxyC ⁇ -4alkyl, oxo, COR a or CO2R a where R a is as previously defined; or R 6 and R 7 together with
  • R 8 is hydrogen, C ⁇ -4alkyl, hydroxyC 1 -4alkyl or C 1 -4alkoxyC 1 -4alkyl; and R 9a and R 9b are each independently hydrogen or C ⁇ -4alkyl, or R 9a and
  • R 9b are joined so, together with the carbon atoms to which they are attached, there is formed a C5-7 ring; and pharmaceutically acceptable salts thereof.
  • Particularly preferred compounds of formula (IV) are those of formula (IVa) and pharmaceutically acceptable salts thereof:
  • a i is fluorine or CF3;
  • a 2 is fluorine or CF3;
  • a 3 is fluorine or hydrogen; and X and Y are as defined in relation to formula (I).
  • NK-1 receptor antagonists of use in the present invention is that described in European Patent Specification No.
  • Y is (CH2)n wherein n is an integer from 1 to 4, and wherein any one of the carbon-carbon single bonds in said (CH2)n may optionally be replaced by a carbon-carbon double bond, and wherein any one of the carbon atoms of said (CH2)n may optionally be substituted with R 4 , and wherein any one of the carbon atoms of said (CH2)n may optionally be substituted with R 7 ;
  • Z is (CH2) m wherein m is an integer from 0 to 6, and wherein any one of the carbon-carbon single bonds of (CH2) m may optionally be replaced by a carbon-carbon double bond or a carbon-carbon triple bond, and any one of the carbon atoms of said (CH2)m may optionally be substituted with R 8 ;
  • R i is hydrogen or Ci-salkyl optionally substituted with hydroxy, C ⁇ -4alkoxy or fluoro;
  • R 2 is a radical selected from hydrogen, d-6 straight or branched alkyl, C3-7cycloalkyl wherein one of the CH2 groups in said cycloalkyl may optionally be replaced by NH, oxygen or sulphur; aryl selected from phenyl and naphthyl; heteroaryl selected from indanyl, thienyl, furyl, pyridyl, thiazolyl, isothiazolyl, oxazolyl, isoxazolyl, triazolyl, tetrazolyl and quinolyl; phenyl-C2- ⁇ alkyl, benzhydryl and benzyl, wherein each of said aryl and heteroaryl groups and the phenyl moieties of said benzyl, phenyl - C2-6alkyl and benzhydryl may optional
  • R 5 is hydrogen, phenyl or d- ⁇ alkyl; or R 2 and R 5 together with the carbon to which they are attached, form a saturated ring having from 3 to 7 carbon atoms wherein one of the CH2 groups in said ring may optionally be replaced by oxygen, NH or sulfur;
  • R 3 is aryl selected from phenyl and naphthyl; heteroaryl selected from indanyl, thienyl, furyl, pyridyl, thiazolyl, isothiazolyl, oxazolyl, isoxazolyl, triazolyl, tetrazolyl and quinolyl; and cycloalkyl having 3 to 7 carbon atoms wherein one of the (CH2) groups in said cycloalkyl may optionally be replaced by
  • R 4 and R 7 are each independently selected from hydroxy, halogen, halo, amino, oxo, cyano, methylene, hydroxymethyl, halomethyl, d- ⁇ alkylamino, di-d- ⁇ alkylamino, Ci- ⁇ alkoxy, d- ⁇ alkyl-O-CO, Ci-ealkyl-O-CO-d- ⁇ alkyl, Ci-ealkyl-CO-O, d-ealkyl-CO-d-ealkyl-O-, Ci- ⁇ alkyl-CO-, d- ⁇ alkyl-CO-d- ⁇ alkyl, and the radicals set forth in the definition of R 2 ;
  • R 6 is -NHCOR 9 , -NHCH2R 9 , SO2R 8 or one of the radicals set forth in any of the definitions of R 2 , R 4 and R 7 ;
  • R 9 is d- ⁇ alkyl, hydrogen, phenyl or phenyld- ⁇ alkyl; with the proviso that (a) when m is 0, R 8 is absent, (b) when R 4 , R 6 , R 7 or R 8 is as defined in R 2 , it cannot form together with the carbon to which it is attached ,a ring with R 5 , and (c) when R 4 and R 7 are attached to the same carbon atom, then either each of R 4 and R 7 is independently selected from hydrogen, fluoro and Ci- ⁇ alkyl, or R 4 and R 7 , together with the carbon to which they are attached, for a C3-6 saturated carbocyclic ring that forms a spiro compound with the nitrogen-containing ring to which they are attached.
  • a particularly preferred compound of formula (V) is (2S,3S)-cis-3-(2- methoxybenzylamino)-2-phenylpiperidine; or a pharmaceutically acceptable salt thereof.
  • NK-1 receptor antagonists of use in the present invention is that described in International Patent Specification No. WO 93/21155, i.e. compounds of formula (VI):
  • radicals R are phenyl radicals optionally 2- or 3-substituted by a halogen atom or a methyl radical;
  • R i is optionally substituted phenyl, cyclohexadienyl, naphthyl, indenyl or optionally substituted heterocycle;
  • R 2 is H, halogen, OH, alkyl, aminoalkyl, alky lamino alkyl, dialkylaminoalkyl, alkyloxy, alkylthio, acyloxy, carboxy, optionally substituted alkyloxycarbonyl, benzyloxycarbonyl, amino or acylamino;
  • R 3 is optionally 2-substituted phenyl;
  • R 4 is OH or fluorine when R 5 is H; or R 4 and R 5 are OH ; or R 4 and R 5 together form a bond.
  • a particularly preferred compound of formula (VI) is (3aS, 4S, 7aS)- 7,7-diphenyl-4-(2-methoxyphenyl)-2-[(2S)-(2-methoxyphenyl)propionyl] perhydroisoindol-4-ol; or a pharmaceutically acceptable salt thereof.
  • Another class of NK-1 receptor antagonists of use in the present invention is that described in European Patent Specification No. 0 591 040, i.e. compounds of formula (VII):
  • Ar represents an optionally substituted mono-, di- or tricyclic aromatic or heteroaromatic group
  • T represents a bond, a hydroxymethylene group, a d-4alkoxymethylene group or a d-salkylene group
  • Ar' represents a phenyl group which is unsubstituted or substituted by one or more substituents selected from halogen, preferably chlorine or fluorine, trifluoromethyl, C 1 -4alkoxy, d-4alkyl where the said substituents may be the same or different; a thienyl group; a benzothienyl group; a naphthyl group; or an indolyl group;
  • R represents hydrogen, C ⁇ -4alkyl, ⁇ -d-4alkoxyd-4alkyl, or ⁇ -C2-4alkanoyloxyC2-4alkyl;
  • Q represents hydrogen; or Q and R together form a 1,2-ethylene, 1,3-propylene or 1,4- butylene group;
  • Am + represents the radical
  • a particularly preferred compound of formula (VII) is (+) l-[2-[3- (3,4-dichlorophenyl)-l-[(3-isopropoxyphenyl)acetyl]-3-piperidinyl]ethyl]-4- phenyl-l-azabicyclo[2,2,2]octane; or a pharmaceutically acceptable salt, especially the chloride, thereof.
  • Another class of NK-1 receptor antagonists of use in the present invention is that described in European Patent Specification No. 0 532 456, i.e. compounds of formula (VIII):
  • R 1 represents an optionally substituted aralkyl, aryloxyalykl, heteroaralkyl, aroyl, heteroaroyl, cycloalkylcarbonyl, aralkanoyl, heteroarylalkanoyl, aralkoxycarbonyl or arylcarbamoyl group or the acyl group of an ⁇ -amino acid optionally N-substituted by a lower alkanoyl or carbamoyl-lower alkanoyl group;
  • R 2 represents cycloalkyl or an optionally substituted aryl or heteroaryl group;
  • R 3 represents hydrogen, alkyl, carbamoyl or an alkanoyl or alkenoyl group optionally substituted by carboxy or esterified or amidated carboxy;
  • R 4 represents an optionally substituted aryl group or an optionally partially saturated heteroaryl group
  • Xi represents methylene, ethylene, a bond, an optionally ketalised carbonyl group or an optionally etherified hydroxy methylene group;
  • X 2 represents alkylene, carbonyl or a bond
  • X3 represents carbonyl, oxo-lower alkyl, oxo(aza)-lower alkyl, or an alkyl group optionally substituted by phenyl, hydroxymethyl, optionally esterified or amidated carboxy, or (in other than the ⁇ -position) hydroxy.
  • a particularly preferred compound of formula (VIII) is (2R * , 4S * )-2- benzyl-l-(3,5-dimethylbenzoyl)-N-(4-quinohnylmethyl)-4-piperidineamine; or a pharmaceutically acceptable salt thereof.
  • Another class of NK-1 receptor antagonists of use in the present invention is that described in European Patent Specification No. 0 443 132, i.e. compounds of formula (IX)
  • R i is aryl, or a group of the formula:
  • X is CH or N; and Z is O or N-R 5 , in which R 5 is hydrogen or lower alkyl;
  • R 2 is hydroxy or lower alkoxy
  • R 3 is hydrogen or optionally substituted lower alkyl
  • R 4 is optionally substituted ar(lower)alkyl
  • A is carbonyl or sulfonyl; and Y is a bond or lower alkenylene.
  • a particularly preferred compound of formula (IX) is the compound of formula (IXa)
  • NK-1 receptor antagonists of use in the present invention is that described in International Patent Specification No. WO 92/17449, i.e. compounds of the formula (X)
  • R i is aryl selected from indanyl, phenyl and naphthyl; heteroaryl selected from thienyl, furyl, pyridyl and quinolyl; and cycloalkyl having 3 to 7 carbon atoms, wherein one of said carbon atoms may optionally be replaced by nitrogen, oxygen or sulfur; wherein each of said aryl and heteroaryl groups may optionally be substituted with one or more substituents, and said C3-7cycloalkyl may optionally be substituted with one or two substituents, said substituents being independently selected from chloro, fluoro, bromo, iodo, nitro, d- 10 alkyl optionally substituted with from one to three fluoro groups, d-ioalkoxy optionally substituted with from one to three fluoro groups, amino, C ⁇ - ⁇ oalkyl-S-, C ⁇ -ioalkyl-S(O)-, d-ioalkyl-SO2-, pheny
  • R 2 is thienyl, benzhydryl, naphthyl or phenyl optionally substituted with from one to three substituents independently selected from chloro, - bromo, fluoro, iodo, cycloalkoxy having 3 to 7 carbon atoms, d-ioalkyl optionally substituted with from one to three fluoro groups and C ⁇ - 10 alkoxy optionally substituted with from one to three fluoro groups.
  • a particularly preferred compound of formula (X) is (2S,3S)-3-(2- methoxy-5-trifluoromethoxybenzyl)-amino-2-phenylpiperidine; or a pharmaceutically acceptable salt thereof.
  • Another class of NK-1 receptor antagonists of use in the present invention is that described in International Patent Specification No. WO 95/08549, i.e. compounds of formula (XI)
  • R i is a C ⁇ -4alkoxy group
  • R 2 is
  • R 3 is a hydrogen or halogen atom
  • R 4 and R 5 may each independently represent a hydrogen or halogen atom, or a d-4alkyl, d-4alkoxy or trifluoromethyl group
  • R 6 is a hydrogen atom, a d-4alkyl, (CH2)mcyclopropyl, -S(O) n d- alkyl, phenyl, NR 7 R 8 , CH 2 C(O)CF 3 or trifluoromethyl group;
  • R 7 and R 8 may each independently represent a hydrogen atom, or a C ⁇ -4alkyl or acyl group; x represents zero or 1; n represents zero, 1 or 2; and m represents zero or 1.
  • Particularly preferred compounds of formula (XI) are (2-methoxy-5- tetrazol-l-yl-benzyl)-([2S,3iS]-2-phenyl-piperidin-3-yl)-amine; and [2- methoxy-5-(5-trifluoromethyl-tetrazol-l-yl)-benzyl]-([2S,3S]-2-phenyl- piperidin-3-yl)-amine; or a pharmaceutically acceptable salt thereof.
  • Another class of tachykinin antagonists of use in the present invention is that described in International Patent Specification No. WO 95/14017, i.e. compounds of formula (XII)
  • R is phenyl, 2- or 3-indolyl, 2- or 3-indolinyl, benzothienyl, benzofuranyl, or naphthyl; which R groups may be substituted with one or two halo, C ⁇ -3alkoxy, trifluoromethyl, d-4alkyl, phenyl- d-3alkoxy, or C 1 -4alkanoyl groups; R i is trityl, phenyl, diphenylmethyl, phenoxy, phenylthio, piperazinyl, piperidinyl, pyrrolidinyl, morpholinyl, indolinyl, indolyl, benzothienyl, hexamethyleneiminyl, benzofuranyl, tetrahydropyridinyl, quin
  • R i groups may be substituted with halo, d-4alkyl, d-4alkoxy, trifluoromethyl, amino, C 1 .4alkylamino, di(d-4alkyl) amino, or C2-4alkanoy lamino ; or any one of which R i groups may be substituted with phenyl, piperazinyl, C3-scycloalkyl, benzyl, d-4alkyl, piperidinyl, pyridinyl, pyrimidinyl, C2-6alkanoylamino, pyrrolidinyl, C2-6alkanoyl, or C i- 4 alkoxycarbonyl; any one of which groups may be substituted with halo, d.4alkyl, C ⁇ -4alkoxy, trifluoromethyl, amino, C ⁇ -4alkylamino, di(C
  • R 5 is pyridyl, anilino-(d-3alkyl)-, or anilinocarbonyl
  • R 2 is hydrogen, d-4alkyl, d-4alkylsulfonyl, carboxy- (Ci-3alkyl)-, C ⁇ - 3 alkoxycarbonyl-(C 1 . 3 alkyl)-, or -CO-R 6 ;
  • R 6 is hydrogen, d shaloalkyl, phenyl, Ci- ⁇ alkoxy, Ci- ⁇ hydroxy alkyl, amino, C ⁇ -4alkylamino, di(d-4alkyl)amino, or -(CH2VR 7 ; q is zero to 3;
  • R 7 is carboxy, C 1 .4alkoxycarbonyl, Ci-4alkylcarbonyloxy, amino, Ci-4alkylamino, di(C 1 -4alkyl)amino, d-ealkoxycarbonylamino, or phenoxy, phenylthio, piperazinyl, piperidinyl, pyrrolidinyl, morpholinyl, indolinyl, indolyl, benzothienyl, benzofuranyl, quinolinyl, phenyl-(d-4alkyl)-, quinolinyl-(C ⁇ -4alkyl)-, isoquinolinyl-(C ⁇ -4alkyl)-, reduced quinolinyl- (C 1 -4alkyl)-, reduced isoquinolinyl-(d-4alkyl)-, benzoyl- Ci-3alkyl; any one of which aryl or heterocyclic R 7 groups may be substituted with halo, triflu
  • R 8 is hydrogen or Ci- ⁇ alkyl
  • R 3 is phenyl, phenyl-(d-6alkyl)-, C3-8cycloalkyl, Cs-scycloalkenyl,
  • R 4 is hydrogen or C ⁇ -3alkyl; with the proviso that if R 1 is hydrogen or halo, R 3 is phenyl, phenyl-(C ⁇ -6alkyl)-, C ⁇ -scycloalkyl, Cs-scycloalkenyl, or naphthyl.
  • a particularly preferred compound of formula (XII) is [N-(2- methoxybenzyl)acetylamino]-3-(lH-indol-3-yl)-2-[N-(2-(4-piperidin-l- yl)piperidin-l-yl)acetylamino]propane; or a pharmaceutically acceptable salt thereof.
  • NK-1 receptor antagonists which are currently under investigation.
  • this listing of compounds is not meant to be comprehensive, the use and methods of the present invention may employ any NK-1 receptor antagonist, in particular a NK-1 receptor antagonist which is orally active, long acting and CNS- penetrant. Accordingly the present invention is not strictly limited to any particular structural class of compound.
  • the preferred stereochemistry of the ⁇ -carbon is either (R) when the substituent is an alkyl (e.g. methyl) group or (S) when the substituent is a hydroxyalkyl (e.g. hydroxymethyl) group.
  • suitable alkyl groups include straight-chained and branched alkyl groups containing from 1 to 6 carbon atoms. Typical examples include methyl and ethyl groups, and straight- chained or branched propyl and butyl groups. Particular alkyl groups are methyl, ethyl, n-propyl, isopropyl, n-butyl, sec-butyl and tert-butyl.
  • suitable alkenyl groups include straight-chained and branched alkenyl groups containing from 2 to 6 carbon atoms. Typical examples include vinyl and allyl groups.
  • suitable alkynyl groups include straight-chained and branched alkynyl groups containing from 2 to 6 carbon atoms. Typical examples include ethynyl and propargyl groups.
  • suitable cycloalkyl groups include groups containing from 3 to 7 carbon atoms. Particular cycloalkyl groups are cyclopropyl and cyclohexyl.
  • suitable aryl groups include phenyl and naphthyl groups.
  • a particular aryl-C ⁇ 6 alkyl, e.g. phenyl- d ealkyl, group is benzyl.
  • suitable heteroaryl groups include pyridyl, quinolyl, isoquinolyl, pyridazinyl, pyrimidinyl, pyrazinyl, pyranyl, furyl, benzofuryl, thienyl, benzthienyl, imidazolyl, oxadiazolyl and thiadiazolyl groups.
  • halogen as used herein includes fluorine, chlorine, bromine and iodine.
  • Suitable pharmaceutically acceptable salts of the NK-1 receptor antagonists of use in the present invention include acid addition salts which may, for example, be formed by mixing a solution of the compound with a solution of a pharmaceutically acceptable non-toxic acid such as hydrochloric acid, fumaric acid, maleic acid, succinic acid, acetic acid, citric acid, tartaric acid, carbonic acid, phosphoric acid or sulphuric acid.
  • Salts of amine groups may also comprise the quaternary ammonium salts in which the amino nitrogen atom carries an alkyl, alkenyl, alkynyl or aralkyl group.
  • the present invention also contemplates salts thereof, preferably non-toxic pharmaceutically acceptable salts thereof, such as the sodium, potassium and calcium salts thereof.
  • Suitable pharmaceutically acceptable salts of the antipsychotic agents used in combination with a NK-1 receptor antagonist according to the present invention include those salts described above in relation to the salts of NK-1 receptor antagonists.
  • the present invention accordingly provides the use of a NK-1 receptor antagonist selected from the compounds of formulae (I), (II), (III), (IV), (V), (VI), (VII), (VIII), (IX), (X), (XI) and (XII) for the manufacture of a medicament for the treatment or prevention of aggressive behaviour.
  • the present invention also provides a method for the treatment or prevention of aggressive behaviour, which method comprises administration to a patient in need of such treatment of an effective amount of a NK-1 receptor antagonist selected from the compounds of formulae (I), (II), (III), (IV), (V), (VI), (VII), (VIII), (IX), (X), (XI) and (XII).
  • a pharmaceutical composition for the treatment or prevention of aggressive behaviour comprising a NK-1 receptor antagonist selected from the compounds of formulae (I), (II), (III), (IV), (V), (VI), (VII), (VIII), (IX), (X), (XI) and (XII), together with at least one pharmaceutically acceptable carrier or excipient.
  • compositions according to the present invention are in unit dosage forms such as tablets, pills, capsules, powders, granules, solutions or suspensions, or suppositories, for oral, parenteral or rectal administration ⁇ by inhalation or insufflation or administration by transdermal patches or by buccal cavity absorption wafers.
  • the principal active ingredient is mixed with a pharmaceutical carrier, e.g. conventional tableting ingredients such as corn starch, lactose, sucrose, sorbitol, talc, stearic acid, magnesium stearate, dicalcium phosphate or gums, and other pharmaceutical diluents, e.g. water, to form a solid preformulation composition containing a homogeneous mixture of a compound of the present invention, or a non-toxic pharmaceutically acceptable salt thereof.
  • a pharmaceutical carrier e.g. conventional tableting ingredients such as corn starch, lactose, sucrose, sorbitol, talc, stearic acid, magnesium stearate, dicalcium phosphate or gums, and other pharmaceutical diluents, e.g. water
  • a pharmaceutical carrier e.g. conventional tableting ingredients such as corn starch, lactose, sucrose, sorbitol, talc, stearic acid, magnesium stearate, dicalcium
  • This solid preformulation composition is then subdivided into unit dosage forms of the type described above containing from 0.1 to about 500 mg of the active ingredient of the present invention.
  • the tablets or pills of the novel composition can be coated or otherwise compounded to provide a dosage form affording the advantage of prolonged action.
  • the tablet or pill can comprise an inner dosage and an outer dosage component, the latter being in the form of an envelope over the former.
  • the two components can be separated by an enteric layer which serves to resist disintegration in the stomach and permits the inner component to pass intact into the duodenum or to be delayed in release.
  • enteric layers or coatings such materials including a number of polymeric acids and mixtures of polymeric acids with such materials as shellac, cetyl alcohol and cellulose acetate.
  • liquid forms in which the novel compositions of the present invention may be incorporated for administration orally or by injection include aqueous solutions, suitably flavoured syrups, aqueous or oil suspensions, and flavoured emulsions with edible oils such as cottonseed oil, sesame oil, coconut oil, peanut oil or soybean oil, as well as elixirs and similar pharmaceutical vehicles.
  • Suitable dispersing or suspending agents for aqueous suspensions include synthetic and natural gums such as tragacanth, acacia, alginate, dextran, sodium carboxymethylcellulose, methylcellulose, polyvinyl-pyrrolidone or gelatin.
  • compositions for administration by injection include those comprising a NK-1 receptor antagonist as the active ingredient, in association with a surface -active agent (or wetting agent or surfactant) or in the form of an emulsion (as a water-in-oil or oil-in- water emulsion).
  • a surface -active agent or wetting agent or surfactant
  • Suitable surface -active agents include, in particular, non-ionic agents, such as polyoxyethylenesorbitans (e.g. TweenTM 20, 40, 60, 80 or 85) and other sorbitans (e.g. SpanTM 20, 40, 60, 80 or 85).
  • Compositions with a surface -active agent will conveniently comprise between 0.05 and 5% surface-active agent, and preferably between 0.1 and 2.5%. It will be appreciated that other ingredients may be added, for example mannitol or other pharmaceutically acceptable vehicles, if necessary.
  • Suitable emulsions may be prepared using commercially available fat emulsions, such as IntralipidTM, LiposynTM, InfonutrolTM, LipofundinTM and LipiphysanTM.
  • the active ingredient may be either dissolved in a pre- mixed emulsion composition or alternatively it may be dissolved in an oil (e.g. soybean oil, safflower oil, cottonseed oil, sesame oil, corn oil or almond oil) and an emulsion formed upon mixing with a phospholipid (e.g. egg phospholipids, soybean phospholipids or soybean lecithin) and water.
  • an oil e.g. soybean oil, safflower oil, cottonseed oil, sesame oil, corn oil or almond oil
  • a phospholipid e.g. egg phospholipids, soybean phospholipids or soybean lecithin
  • other ingredients may be added, for example glycerol or glucose, to adjust the tonicity of the emulsion.
  • Suitable emulsions will typically contain up to 20% oil, for example, between 5 and 20%.
  • the fat emulsion will preferably comprise fat droplets between 0.1 and l.O ⁇ m, particularly 0.1 and 0.5 ⁇ m, and have a pH in the range of 5.5 to 8.0.
  • Compositions for inhalation or insufflation include solutions and suspensions in pharmaceutically acceptable, aqueous or organic solvents, or mixtures thereof, and powders.
  • the liquid or solid compositions may contain suitable pharmaceutically acceptable excipients as set out above.
  • the compositions are administered by the oral or nasal respiratory route for local or systemic effect.
  • Compositions in preferably sterile pharmaceutically acceptable solvents may be nebulised by use of inert gases.
  • Nebulised solutions may be breathed directly from the nebulising device or the nebulising device may be attached to a face mask, tent or intermittent positive pressure breathing machine.
  • Solution, suspension or powder compositions may be administered, preferably orally or nasally, from devices which deliver the formulation in an appropriate manner.
  • compositions of the present invention may also be presented for administration in the form of trans-dermal patches using conventional technology.
  • the compositions may also be administered via the buccal cavity using, for example, absorption wafers.
  • compositions in the form of tablets, pills, capsules or wafers for oral administration are particularly preferred.
  • the present invention further provides a process for the preparation of a pharmaceutical composition comprising a NK-1 receptor antagonist and an antipsychotic agent, which process comprises bringing a NK-1 receptor antagonist and an antipsychotic agent, into association with a pharmaceutically acceptable carrier or excipient.
  • the NK-1 receptor antagonist and an antipsychotic agent are presented in a ratio which is consistent with the manifestation of the desired effect.
  • the ratio by weight of the NK-1 receptor antagonist and the antipsychotic agent will suitably be between 0.001 to 1 and 1000 to 1, and especially between 0.01 to 1 and 100 to l.
  • a minimum dosage level for the NK-1 receptor antagonist is about
  • a maximum dosage level for the NK-1 receptor antagonist is about 1500mg per day, preferably about lOOOmg per day and especially about 500mg per day.
  • the compounds are administered one to three times daily, preferably once a day.
  • a minimum dosage level for the antipsychotic agent will vary depending upon the choice of agent, but is typically about 0.5mg per day for the most potent compounds or about 20mg per day for less potent compounds.
  • a maximum dosage level for the antipsychotic agent is typically 30mg per day for the most potent compounds or 200mg per day for less potent compounds.
  • the compounds are administered one to three times daily, preferably once a day.
  • the amount of the NK-1 receptor antagonist required for use in the treatment or prevention of aggressive behaviour will vary not only with the particular compounds or compositions selected but also with the route of administration, the nature of the condition being treated, and the age and condition of the patient, and will ultimately be at the discretion of the patient's physician or pharmacist.
  • the amount of the NK-1 receptor antagonist and the antipsychotic agent required for use in the treatment or prevention of aggressive behaviour will vary not only with the particular compounds or compositions selected but also with the route of administration, the nature of the condition being treated, and the age and condition of the patient, and will ultimately be at the discretion of the patient's physician or pharmacist.
  • the compounds of formulae (I), (II), (III), (IV), (V), (VI), (VII), (VIII), (IX), (X), (XI) and (XII) may be prepared by the methods described in EP-A-0 577 394 (or WO 95/16679), WO 95/18124, WO 95/23798, WO 96/05181, EP-A-0 436 334, WO 93/21155, EP-A-0 591 040, EP-A-0 532 456, EP-A-0 443 132, WO 92/17449, WO 95/08549 and WO 95/14017, respectively.
  • NK-1 receptor antagonists of the formulae (I), (II), (III), (IV), (V), (VI), (VII), (VIII), (IX), (X), (XI) and (XII) for use in the present invention are compounds which are potent NK-1 receptor antagonists, i.e. compounds with an NK-1 receptor affinity (ICso) of less than lOnM.
  • ICso NK-1 receptor affinity
  • NK-1 receptor antagonist of use in the present invention are those compounds which are orally active, long acting and CNS-penetrant. Such compounds may be identified using the pharmacological assays described hereinafter. The use of this sub-class of NK-1 antagonists in the treatment or prevention of aggressive behaviour represents a further aspect of the present invention.
  • the present invention provides the use of a CNS penetrant NK-1 receptor antagonist in an oral, once-a-day medicament for the treatment of aggressive behaviour.
  • the compounds of this class advantageously exhibit a rapid onset of action and a reduced side-effect profile when compared against conventional treatments of aggressive behaviour.
  • the present invention provides a means for the identification of NK-1 receptor antagonists which would be especially effective in an oral once-a-day medicament for the treatment of aggressive behaviour.
  • the exceptional pharmacology of the class of NK-1 receptor antagonists of use in the present invention results in a rapid onset of action.
  • the present invention accordingly provides the use of an orally active, long acting, CNS-penetrant NK-1 receptor antagonist (as hereinafter defined) for the manufacture of a medicament adapted for oral administration for the treatment or prevention of aggressive behaviour.
  • the present invention also provides a method for the treatment or prevention of aggressive behaviour, which method comprises the oral administration to a patient in need of such treatment of an effective amount of an orally active, long acting, CNS-penetrant NK-1 receptor antagonist (as hereinafter defined).
  • an oral pharmaceutical composition for the treatment of aggressive behaviour which comprises an orally active, long acting, CNS-penetrant NK-1 receptor antagonist (as hereinafter defined), together with a pharmaceutically acceptable carrier or excipient.
  • the present invention accordingly provides the use of an orally active, long acting, CNS-penetrant NK-1 receptor antagonist for the manufacture of a medicament adapted for oral administration for the treatment or prevention of aggressive behaviour in a patient who is non- responsive to antipsychotic agents or for whom antipsychotic agents are is contraindicated.
  • the present invention also provides a method for the treatment or prevention of aggressive behaviour in a patient who is non-responsive to antipsychotic agents or for whom antipsychotic agents are is contraindicated, which method comprises oral administration to a patient in need of such treatment of an effective amount of an orally active, long acting, CNS-penetrant NK-1 receptor antagonist.
  • Preferred NK-1 receptor antagonists for use in the present invention as orally active, long acting, CNS-penetrant NK-1 receptor antagonists are selected from the classes of compounds described in European Patent Specification No. 0 577 394, and International Patent Specification Nos. 95/08549, 95/18124, 95/23798 and 96/05181, and International Patent Application No. PCT/GB97/01630. The preparation of such compounds is fully described in the aforementioned publications.
  • further particularly preferred NK-1 receptor antagonists of use in the present invention include:
  • NK-1 receptor antagonists in the present invention which are described in International Patent Application No. PCT/GB97/01630 may be prepared according to the following methods:
  • the mixture was stirred at -70 °C for 20 minutes, then allowed to warm to -30°C.
  • the mixture was cooled to -50 °C and triethylamine (55.95ml, 40.45g, 400mmol) was added ⁇ lowly.
  • the mixture was allowed to warm to 0°C and diluted with ice- cooled dichloromethane (250ml).
  • the mixture was washed with ice cold aqueous citric acid solution (5%, 2x300ml) and water (300ml), dried (MgSO4), and the solvent was evaporated under reduced pressure to give the title compound as a yellow oil (42.3g), which was used immediately without further purification.
  • PREPARATION 4 (5.R,6-S l )-3-Keto-6-phenyl-l-oxa-7-( ⁇ gr ⁇ -butoxycarbonyl)aza-spiror4.51decane
  • 5#,6S 3-methylene-6-phenyl- l-oxa-7-( er£-butoxycarbonyl)aza-spiro[4.5]decane
  • the solution was stirred at -80°C for 30 minutes then at room temperature for 30 minutes before being quenched by addition of saturated ammonium chloride solution and ethyl acetate.
  • the dried (MgSO4) organic phase was purified by chromatography on a column containing silica gel (eluting with hexane containing increasing proportions of ethyl acetate between 0% to 5%). Evaporation of the fractions gave the title compound.
  • O-Trimethylsilylpropargyl alcohol 24.51ml, 20.47g, 160ml was added slowly to a cooled (-10°C) solution of ethylmagnesium bromide (IM in tetrahydrofuran, 160ml, 160mmol).
  • IM ethylmagnesium bromide
  • the mixture was stirred at 0°C for 20 minutes, then at room temperature for 2 hours.
  • the mixture was cooled to -10°C and a solution of (2 ⁇ S)-l-£er£-butoxycarbonyl-2- phenylpiperidin-3-one (Preparation 1; 42.3g) in tetrahydrofuran (200ml) was added dropwise over 30 minutes. (Internal temperature below -5°C).
  • the aqueous layer was extracted with ethyl acetate (2x300ml) and the combined organic fractions were washed with water (300ml) and brine (300ml), dried (MgSO4) and the solvent was evaporated under reduced pressure to give the crude title compound as an orange oil (45g).
  • the crude material was purified by flash column chromatography on silica gel, eluting with hexane/ethyl acetate (90:10 increasing to 25:75) to give the title compound as an amber oil (32.2g).
  • PREPARATION 11 (6R.6)S)-6-Phenyl-l-oxa-7-(ter ⁇ -butoxycarbonyl)aza-spiror4.51dec-3-ene Diethylazodicarboxylate (18.2ml, ll ⁇ mmol) in THF (100ml) was added dropwise to a solution of -(2S,3R)-l-ter£-butoxycarbonyl-3-(3- hydroxyprop-l-en-l-yl)-2-phenylpiperidin-3-ol (Preparation 10; 32g, 96mmol) and triphenylphosphine (30.2g, ll ⁇ mmol) in THF (700ml).
  • Benzyl bromide (66.17ml, 95.35g, O. ⁇ mol) was added to a mixture of 4-(trifluoromethoxy)phenol (90.26g, O. ⁇ lmol) and potassium carbonate (140.97g, 1.2mol) in dimethylformamide (160ml) and the mixture was stirred at room temperature for 72 hours. The mixture was poured into
  • PREPARATION 16 (3i?. ⁇ .R,6)S)-3-(2-Benzyloxy- ⁇ -(trifluoromethoxy)phenyl)-6-phenyl-l-oxa-7- (fer£-butoxycarbonyl)aza-spiror4. ⁇ 1decane
  • Naphthalene (120mg, 0.936mmol) was dissolved in THF (1.5ml) 5 under nitrogen and freshly cut lithium metal (7.0mg, 0.94mmol) was added. The mixture was then sonicated at room temperature for 20 minutes to produce a dark green solution of lithium naphthalenide.
  • Naphthalene 120mg, 0.936mmol was dissolved in THF (1.5ml) under nitrogen and freshly cut lithium metal (7.0mg, 0.94mmol) was added. The mixture was then sonicated at room temperature for 20 0 minutes to produce a dark green solution of lithium naphthalenide.
  • Trifluoroacetic acid (2. ⁇ ml) was added dropwise to a stirred, cooled 0°C) solution of (3iS, ⁇ R,6S)-3-[2-cyclopropoxy- ⁇ -(trifluoromethoxy)phenyl]- 6-phenyl-l-oxa-7-(teri-butoxycarbonyl)aza-spiro[4. ⁇ ]decane (Preparation
  • NK-1 receptor antagonists of use in the present invention are compounds which are potent NK-1 receptor antagonists, i.e. compounds with an NK-1 receptor affinity (IC50) of less than lOnM, favourably less than 2nM and preferably less than InM.
  • IC50 NK-1 receptor affinity
  • the class of orally active, long acting, CNS-penetrant NK-1 receptor antagonists of use in the present invention is identified using a combination of the following assays:
  • Ligand binding is performed in 0.2 ⁇ ml of ⁇ OmM Tris-HCI, pH7. ⁇ , containing ⁇ mM MnCl 2 , l ⁇ OmM NaCl, 0.02% bovine serum albumin (Sigma), ⁇ O ⁇ g/ml chymostatin (Peninsula), O.lnM phenylmethylsulphonyl fluoride, 2 ⁇ g/ml pepstatin, 2 ⁇ g/ml leupeptin and 2.8 ⁇ g/ml furoyl saccharine.
  • the incubation proceeds at room temperature
  • CNS penetrant NK-1 receptor antagonists for use in the present invention can be identified by their ability to inhibit foot tapping in gerbils induced by central infusion of NK-1 receptor agonists such as GR73632
  • ⁇ test compounds may be administered orally or by subcutaneous or intraperitoneal routes. A skin incision is then made in the midline of the scalp to expose the skull.
  • a selective NK-1 receptor agonist e.g.
  • GR73632 (d Ala[L-Pro 9 ,Me-Leu 10 ]-substance P-(7-ll)) is infused directly into the cerebral ventricles (e.g. 3pmol in ⁇ l i.e. v., depending on test substance) by
  • cisplatin (lOmg/kg) is given i.v. via a jugular vein catheter inserted under a brief period of halothane anaesthesia. The catheter is then removed, the jugular vein ligated and the skin incision closed. The ferrets recover rapidly from the anaesthetic and are mobile within 10-20 minutes. The animals are observed continuously during recovery from the
  • ASSAY 4 Separation-Induced Vocalisation 30
  • Male and female guinea-pigs pups are housed in family groups with their mothers and littermates throughout the study. Experiments are commenced after weaning when the pups are 2 weeks old. Before entering an experiment, the pups are screened to ensure that a vigorous vocalisation response is reproducibly elicited following maternal separation. The pups are placed individually in an observation cage ( ⁇ cm ⁇ x 39cm x 19cm) in a room physically isolated from the home cage for l ⁇ minutes and the duration of vocalisation during this baseline period is recorded. Only animals which vocalise for longer than ⁇ minutes are employed for drug challenge studies (approximately ⁇ 0% of available pups may fail to reach this criterion). On test days each pup receives an oral
  • CNS-penetrant refers to NK-1 receptor antagonists which are able to inhibit NK-1 receptor antagonist-induced foot-tapping in the gerbil as hereinafter defined.
  • hind foot-tapping in the gerbil induced by infusion of the NK-1 receptor agonist, GR73632 (d Ala[L-Pro 9 ,Me-Leu i °]-substance P- (7-11)), under anaesthesia, directly into the central ventricles is inhibited when a CNS-penetrant NK-1 receptor antagonist is administered intravenously immediately prior to GR73632 challenge, wherein hind foot-
  • anaesthesia is inhibited with an ID5o ⁇ 3mg/kg, and preferably with an
  • the NK-1 receptor antagonist is administered orally, 1 hour prior to GR73632 challenge, wherein the foot-
  • CNS-penetrant NK-1 receptor antagonists of use in the present ivnention are also effective in the attenuation of separation-induced vocalisations by guinea-pig pups as hereinafter defined.
  • a vocalisation response in guinea-pig pups is induced by isolation from their mothers and littermates, which response is attenuated when a CNS-penetrant NK-1 receptor antagonist is administered subcutaneously 30 minutes prior to isolation, wherein vocalisations during the first 15 minutes of isolation are attenuated with an IDso ⁇ 20mg/kg, preferably with an IDso ⁇ lOmg/kg, and especially with an ID ⁇ o ⁇ mg/kg.
  • the NK-1 receptor antagonist is administered orally, 4 hours prior to isolation, wherein vocalisations during the first l ⁇ minutes of isolation are attenuated with an ID ⁇ o ⁇ 20mg/kg, preferably with an IDso ⁇ lOmg/kg, and especially with an A suitable selection cascade for NKi antagonists of use according to the present invention is as follows:
  • Yet further preferred compounds of use in the present invention may be selected from those compounds which satisfy the NK-1 receptor binding criteria of step (i) which, in addition, have ⁇ ⁇ -fold shift in l ⁇ affinity when incubated in the presence of human serum albumin (HSA) to show non-specific protein binding.
  • HSA human serum albumin
  • a NK-1 receptor antagonist of use in the present invention is the compound 2-(R)-(l-(R)-(3, ⁇ -bis(trifluoromethyl)phenyl)- ethoxy)-3-(S)-(4-fluoro ⁇ henyl)-4-(3-( ⁇ -oxo-lH,4H-l,2,4-triazolo)methyl)- 20 morpholine, the preparation of which is described in International Patent Specification No. WO 9 ⁇ /16679. In the aforementioned assays, this compound has the following activity:
  • the active ingredient, cellulose, lactose and a portion of the corn starch are mixed and granulated with 10% corn starch paste.
  • the ⁇ resulting granulation is sieved, dried and blended with the remainder of the corn starch and the magnesium stearate.
  • the resulting granulation is then compressed into tablets containing ⁇ Omg, lOOmg and 300mg of the NK-1 receptor antagonist per tablet.
  • Citric Acid Monohydrate 0.7 ⁇ mg
  • the sodium phosphate, citric acid monohydrate and sodium chloride are dissolved in a portion of the water.
  • the active ingredient is dissolved 20 ⁇ r suspended in the solution and made up to volume.
  • compositions comprising a combination of a NK-1 receptor antagonist and an antipsychotic agent may be prepared with separate active ingredients or with a combination of active ingredients in one composition. In such combined preparations, the ratio of the NK-1 receptor antagonist and the antipsychotic agent will depend upon the choice of active ingredients.
  • NK-1 antagonist ⁇ .0 100.0 300.0 chlorpromazine hydrochloride 2 ⁇ .O 25.0 25.0
  • the active ingredients, cellulose, lactose and a portion of the corn starch are mixed and granulated with 10% corn starch paste.
  • the - resulting granulation is sieved, dried and blended with the remainder of the corn starch and the magnesium stearate.
  • the resulting granulation is then compressed into tablets containing ⁇ Omg, lOOmg and 300mg of the CNS-penetrant NK-1 receptor antagonist per tablet.

Landscapes

  • Health & Medical Sciences (AREA)
  • Chemical & Material Sciences (AREA)
  • Medicinal Chemistry (AREA)
  • Pharmacology & Pharmacy (AREA)
  • Epidemiology (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Pharmaceuticals Containing Other Organic And Inorganic Compounds (AREA)

Abstract

The present invention provides the use of an NK-1 receptor antagonist, and optionally an antipsychotic agent, for the manufacture of a medicament for the treatment or prevention of aggressive behaviour, methods of treatment using such an NK-1 receptor antagonist and pharmaceutical compositions and products comprising it.

Description

USE OF NK-1 RECEPTOR ANTAGONISTS FOR TREATING AGGRESSIVE BEHAVIOUR
This invention relates to the treatment or prevention of aggressive behaviour by the administration of a NK-1 receptor antagonist.
Aggressive behaviour when uncontrolled or out of proportion to any provocation may give rise to a condition which requires medication. Individuals with narcissistic, obsessive, paranoid or schizoid traits may be especially prone to outbursts of aggressive behaviour, especially when under stress. When particularly severe, aggressive behaviour may lead to job loss, difficulties with marriage and interpersonal relationships, school suspension, accidents, hospitalization or incarceration.
Treatment of aggressive behaviour is with drugs and psychological management. Typically, antipsychotic drugs such as haloperidol or chlorpromazine may be used to control symptoms. However, antipsychotic drugs are typically associated with a number of side-effects, including extrapyramidal symptoms, acute dystonias, tardive dyskinesias, akathesia, tremor, tachycardia, drowsiness, confusion, postural hypotension, blurring of vision, precipitation of glaucoma, dry mouth, constipation, urinary hesitance and impaired sexual function.
Neurokinin 1 (NK-1; substance P) receptor antagonists are being developed for the treatment of a number of physiological disorders associated with an excess or imbalance of tachykinins, and in particular substance P. Examples of conditions in which substance P has been implicated include disorders of the central nervous system such as anxiety, depression and psychosis (see, for instance, International (PCT) patent specification Nos. WO 95/16679, WO 95/18124 and WO 95/23798).
More recently, International (PCT) patent specification No. WO 96/24353 (published 15th August 1996) suggests that a more efficacious and safe treatment of psychiatric disorders would be achieved using a combination of a tachykinin antagonist and a serotonin agonist or selective serotonin reuptake inhibitor (SSRI). However, such as regimen would not be free of side-effects due to the serotonin agonist or SSRI.
In view of the short-comings of existing agents for the treatment of aggressive behaviour, there is a need for new, safe and effective treatment of aggressive behaviour.
The present invention accordingly provides the use of a NK-1 receptor antagonist for the manufacture of a medicament for the treatment or prevention of aggressive behaviour.
The present invention also provides a method for the treatment or prevention of aggressive behaviour, which method comprises administration to a patient in need of such treatment of an effective amount of a NK-1 receptor antagonist.
In a further aspect of the present invention, there is provided a pharmaceutical composition for the treatment or prevention of aggressive behaviour comprising a NK-1 receptor antagonist, together with at least one pharmaceutically acceptable carrier or excipient.
It will be appreciated that a combination of a conventional antipsychotic drug with a NK-1 receptor antagonist may provide an enhanced effect in the treatment of aggressive behaviour. Such a combination would be expected to provide for a rapid onset of action to treat an aggressive outburst thereby enabling use on an "as needed basis". Furthermore, such a combination may enable a lower dose of the antispychotic agent to be used without compromising the efficacy of the antipsychotic agent, thereby minimising the risk of adverse side-effects. A yet further advantage of such a combination is that, due to the action of the NK-1 receptor antagonist, adverse side-effects caused by the antipsychotic agent such as acute dystonias, dyskinesias, akathesia and tremor may be reduced or prevented.
Thus, according to a further aspect of the present invention there is provided the use of a NK-1 receptor antagonist and an antipsychotic agent for the manufacture of a medicament for the treatment or prevention of aggressive behaviour.
The present invention also provides a method for the treatment or prevention of aggressive behaviour, which method comprises administration to a patient in need of such treatment of an amount of a NK-1 receptor antagonist and an amount of an antipsychotic agent, such that together they give effective relief.
In a further aspect of the present invention, there is provided a pharmaceutical composition comprising a NK-1 receptor antagonist and an antipsychotic agent, together with at least one pharmaceutically acceptable carrier or excipient.
It will be appreciated that the NK-1 receptor antagonist and the antipsychotic agent may be present as a combined preparation for simultaneous, separate or sequential use for the treatment or prevention of aggressive behaviour. Such combined preparations may be, for example, in the form of a twin pack.
In a further or alternative aspect of the present invention, there is therefore provided a product comprising a NK-1 receptor antagonist and an antipsychotic agent as a combined preparation for simultaneous, separate or sequential use in the treatment or prevention of aggressive behaviour.
It will be appreciated that when using a combination of the present invention, the NK-1 receptor antagonist and the antipsychotic agent may be in the same pharmaceutically acceptable carrier and therefore administered simultaneously. They may be in separate pharmaceutical carriers such as conventional oral dosage forms which are taken simultaneously. The term "combination" also refers to the case where the compounds are provided in separate dosage forms and are administered sequentially. Therefore, by way of example, the antipsychotic agent may be administered as a tablet and then, within a reasonable period of time, the NK-1 receptor antagonist may be administered either as an oral dosage form such as a tablet or a fast-dissolving oral dosage form. By a "fast-dissolving oral formulation" is meant, an oral delivery form which when placed on the tongue of a patient, dissolves within about 10 seconds. As used herein, the term "aggressive behaviour" includes explosive personality disorder, intermittent explosive disorder, aggressive personality, aggressive nature, aggressiveness, excessive emotional instability, pathological emotionality, quarrelsomeness, dementia with behavioural disturbance, and personality change of the aggressive type due to a general medical condition. Aggressive behaviour may also be associated with substance intoxication, substance withdrawal, oppositional defiant disorder, conduct disorder, antisocial personality disorder, borderline personality disorder, a manic episode and schizophrenia.
As used herein, the term "treatment" refers both to the treatment and to the prevention or prophylactic therapy of aggressive behaviour. NK-1 receptor antagonists of use in the present invention are described in published European Patent Specification Nos. 0 360 390, 0 394 989, 0 429 366, 0 443 132, 0 482 539, 0 512 901, 0 512 902, 0 514 273, 0 514 275, 0 517 589, 0 520 555, 0 522 808, 0 528 495, 0 532 456, 0 533 280, 0 536 817, 0 545 478, 0 577 394, 0 590 152, 0 599 538, 0 610 793, 0 634 402, 0 686 629, 0 693 489, 0 694 535, 0 699 655, 0 699 674, 0 707 006, 0 708 101, 0 714 891, 0 723 959, 0 733 632 and 0 776 893; and in International Patent Specification Nos. 90/05525, 90/05729, 91/09844, 91/18899, 92/01688, 92/06079, 92/12151, 92/15585, 92/17449, 92/20661, 92/20676, 92/21677, 93/00330, 93/00331, 93/01159, 93/01165, 93/01169, 93/01170, 93/06099, 93/09116, 93/10073,
93/14113, 93/18023, 93/19064, 93/21155, 9321181, 93/23380, 93/24465,
94/01402, 94/02461, 94/03429, 94/03445, 94/04494, 94/04496, 94/05625,
94/07843, 94/10165, 94/10167, 94/10168, 94/10170, 94/11368, 94/13639, 94/13663, 94/14767, 94/15903, 94/19320, 94/19323, 94/20500, 94/26735, 94/26740, 94/29309, 95/02595, 95/04040, 95/04042, 95/06645, 95/07886, 95/07908, 95/08549, 95/11880, 95/14017, 95/15311, 95/16679, 95/17382, 95/18124, 95/18129, 95/19344, 95/20575, 95/21819, 96/22525, 95/23798, 95/26338, 95/28418, 95/30674, 95/30687, 96/05193, 96/05203, 96/06094, 96/07649, 96/10562, 96/16939, 96/18643, 96/20197, 96/21661, 96/29304, 96/29317, 96/29326, 96/29328, 96/31214, 96/32385, 96/37489, 97/01553, 97/01554, 97/03066, 97/08144, 97/14671, 97/17362, 97/18206, 97/19084, 97/19942 and 97/21702; and in British Patent Specification Nos. 2 266 529, 2 268 931, 2 269 170, 2 269 590, 2 271 774, 2 292 144, 2 293 168, 2 293 169, and 2 302 689. Suitable antipsychotic agents of use in combination with a NK-1 receptor antagonist include the phenothiazine, thioxanthene, heterocyclic dibenzazepine, butyrophenone, diphenylbutylpiperidine and indolone classes of antipsychotic agent. Suitable examples of phenothiazines include chlorpromazine, mesoridazine, thioridazine, acetophenazine, fluphenazine, perphenazine and trifluoperazine. Suitable examples of thioxanthenes include chlorprothixene and thiothixene. An example of a dibenzazepine is clozapine. An example of a butyrophenone is haloperidol. An example of a diphenylbutylpiperidine is pimozide. An example of an indolone is molindolone. Other antipsychotic agents include loxapine, sulpiride and risperidone. It will be appreciated that the antipsychotic agents when used in combination with a NK-1 receptor antagonist may be in the form of a pharmaceutically acceptable salt, for example, chlorpromazine hydrochloride, mesoridazine besylate, thioridazine hydrochloride, acetophenazine maleate, fluphenazine hydrochloride, flurphenazine enathate, fluphenazine decanoate, trifluoperazine hydrochloride, thiothixene hydrochloride, haloperidol decanoate, loxapine succinate and molindone hydrochloride. Perphenazine, chlorprothixene, clozapine, haloperidol, pimozide and risperidone are commonly used in a non-salt form. Particularly preferred NK-1 receptor antagonists are those described in European Patent Specification No. 0 577 394, i.e. compounds of formula (I):
Figure imgf000008_0001
or a pharmaceutically acceptable salt thereof, wherein: R1 is selected from the group consisting of:
(1) hydrogen;
(2) Ci-βalkyl, unsubstituted or substituted with one or more of the substituents selected from:
(a) hydroxy,
(b) oxo,
(c) Ci-βalkoxy,
(d) phenyl-Cι-3alkoxy, (e) phenyl,
(f) -CN,
(g) halo,
(h) -NR9R10, wherein R9 and R10 are independently selected from: (i) hydrogen,
(ii) d-ealkyl, (iii) hydroxy- Ci-βalkyl, and (iv) phenyl, (i) -NR9COR10, wherein R9 and R10 are as defined above, (j) -NR9CO2R10, wherein R9 and R10 are as defined above,
(k) -CONR9R10, wherein R9 and R10 are as denned above, (1) -COR9, wherein R9 is as defined above, (m) -CO2R9, wherein R9 is as defined above, (n) heterocycle, wherein the heterocycle is selected from the group consisting of:
(A) benzimidazolyl,
(B) benzofuranyl,
(C) benzthiophenyl,
(D) benzoxazolyl,
(E) furanyl,
(F) imidazolyl,
(G) indolyl,
(H) isoxazolyl,
(I) isothiazolyl,
(J) oxadiazolyl,
(K) oxazolyl,
( ) pyrazinyl,
(M) pyrazolyl,
(N) pyridyl,
(0) pyrimidyl,
(P) pyrrolyl,
(Q) quinolyl,
(R) tetrazolyl,
(S) thiadiazolyl,
(T) thiazolyl,
(U) thienyl,
(V) triazolyl,
(W) azetidinyl,
- (X) 1,4-dioxanyl,
00 hexahydroazepinyl,
(Z) oxanyl,
(AA) piperazinyl,
(AB) piperidinyl,
(AC) pyrrolidinyl, (AD) tetrahydrofuranyl, and
(AE) tetrahydrothienyl, and wherein the heterocylcle is unsubstituted or substituted with one or more substituent(s) selected from: (i) Ci-βalkyl, unsubstituted or substituted with halo, -CF3,
-OCH3, or phenyl,
(ii) Ci-βalkoxy, (iii) oxo, (iv) hydroxy, (v) thioxo,
(vi) -SR9, wherein R9 is as defined above, (vii) halo, (viii) cyano, (ix) phenyl, (x) trifluoromethyl,
(xi) -(CH2)m-NR9R10, wherein m is 0, 1 or 2, and R9 and R10 are as defined above,
(xii) -NR9COR10, wherein R9 and R10 are as defined above, (xiii) -CONR9R10, wherein R9 and R10 are as defined above, (xiv) -CO2R9, wherein R9 is as defined above, and
(xv) -(CH2)m-OR9, wherein m and R9 are as defined above; (3) C2-6alkenyl, unsubstituted or substituted with one or more of the substituent(s) selected from: (a) hydroxy, (b) oxo,
(c) Ci-βalkoxy,
(d) phenyl-Cι-3alkoxy,
(e) phenyl,
(f) -CN, (g) halo,
(h) -CONR9R10, wherein R9 and R10 are as defined above, (i) -COR9, wherein R9 is as defined above, (j) -CO2R9, wherein R9 is as defined above, (k) heterocycle, wherein the heterocycle is as defined above; (4) C2-ealkynyl;
(5) phenyl, unsubstitued or substituted with one or more of the substituent(s) selected from:
(a) hydroxy,
(b) C1-6alkoxy, (c) Ci-ealkyl,
(d) C2-5alkenyl,
(e) halo,
(f) -CN,
Figure imgf000011_0001
(h) -CF3l
(i) -(CH2)m-NR9R10, wherein m, R9 and R10 are as defined above,
(j) -NR9COR10, wherein R9 and R10 are as defined above,
(k) -NR9CO2R10, wherein R9 and R10 are as defined above, (1) -CONR9R10, wherein R9 and R10 are as defined above,
(m) -CO2NR9R10, wherein R9 and R10 are as defined above,
(n) -COR9, wherein R9 is as defined above,
(o) -CO2R9, wherein R9 is as defined above;
R2 and R3 are independently selected from the group consisting of:
(1) hydrogen;
(2) Ci-ealkyl, unsubstituted or substituted with one or more of the substituents selected from:
(a) hydroxy, (b) oxo,
(c) Ci-βalkoxy, (d)
Figure imgf000012_0001
(e) phenyl,
(f) -CN,
(g) halo, (h) -NR9R10, wherein R9 and R10 are independently selected from:
(i) -NR9COR10, wherein R9 and R10 are as defined above, (j) -NR9CO2R10, wherein R9 and R10 are as defined above, (k) -CONR9R10, wherein R9 and R10 are as defined above, (1) -COR9, wherein R9 is as defined above, and
(m) -CO2R9, wherein R9 is as defined above;
(3) C2-6alkenyl, unsubstituted or substituted with one or more of the substituent(s) selected from:
(a) hydroxy, (b) oxo,
(c) Ci-βalkoxy,
(d) phenyl-Ci-3alkoxy,
(e) phenyl,
( ) -CN, (g) halo,
(h) -CONR9R10 wherein R9 and R10 are as defined above, (i) -COR9, wherein R9 is as defined above, (j) -CO2R9, wherein R9 is as defined above;
(4) C2-ealkynyl; (5) phenyl, unsubstituted or substituted with one or more of the substituent(s) selected from:
(a) hydroxy,
(b) Ci-βalkoxy,
(c) Ci-ealkyl, (d) C2-5alkenyl,
(e) halo, (f) -CN,
Figure imgf000013_0001
(h) -CF3,
(i) -(CH2)m-NR9R10, wherein m, R9 and R10 are as defined above,
(j) -NR9COR10, wherein R9 and R10 are as defined above,
(k) -NR9CO2R10, wherein R9 and R10 are as defined above,
(1) -CONR9R10, wherein R9 and R10 are as defined above,
(m) -CO2NR9R10, wherein R9 and R10 are as defined above, (n) -COR9, wherein R9 is as defined above,
(o) -CO2R9, wherein R9 is as defined above;
and the groups R1 and R2 may be joined together to form a heterocyclic ring selected from the group consisting of: (a) pyrrolidinyl,
(b) piperidinyl,
(c) pyrrolyl,
(d) pyridinyl,
(e) imidazolyl, (f) oxazolyl, and
(g) thiazolyl, and wherein the heterocyclic ring is unsubstituted or substituted with one or more substituent(s) selected from: (i) Cι.6alkyl, (ii) oxo,
(iii) Ci-βalkoxy,
(iv) -NR9R10, wherein R9 and R10 are as defined above, (v) halo, and (vi) trifluoromethyl; and the groups R2 and R3 may be joined together to form a carbocyclic ring selected from the group consisting of:
(a) cyclopentyl,
(b) cyclohexyl, (c) phenyl, and wherein the carbocyclic ring is unsubstituted or substituted with one or more substituents selected from:
(i) d-ealkyl,
(ii) Ci-βalkoxy, (iii) -NR9R10, wherein R9 and R10 are as defined above,
(iv) halo, and
(v) trifluoromethyl;
and the groups R2 and R3 may be joined together to form a heterocyclic ring selected from the group consisting of:
(a) pyrrolidinyl,
(b) piperidinyl,
(c) pyrrolyl,
(d) pyridinyl, (e) imidazolyl,
(f) furanyl,
(g) oxazolyl, (h) thienyl, and (i) thiazolyl, and wherein the heterocyclic ring is unsubstituted or substituted with one " or more substituent(s) selected from:
(i) d-ealkyl,
(ii) oxo,
(iii) Ci-βalkoxy, (iv) -NR R19, wherein R9 and R10 are as defined above,
(v) halo, and (vi) trifluoromethyl;
X is selected from the group consisting of:
(1) -o-, (2) -S-,
(3) -SO-, and
Figure imgf000015_0001
R4 is selected from the group consisting of: (1)
Figure imgf000015_0002
(2) -Y-C1-8alkyl, wherein alkyl is unsubstituted or substituted with one or more of the substituents selected from:
(a) hydroxy, (b) oxo,
(c) Ci-βalkoxy,
(d) phenyl- Ci-3alkoxy,
(e) phenyl,
(f) -CN, (g) halo,
(h) -NR9R10, wherein R9 and RIO are as defined above, (i) -NR9COR10, wherein R9 and R10 are as defined above, (j) -NR9CO2R10, wherein R9 and R10 are as defined above, (k) -CONR9R10, wherein R9 and R10 are as defined above, (1) -COR9, wherein R9 is as defined above,
(m) -CO2R9, wherein R9 is as defined above;
(3) -Y-C2-6alkenyl, wherein the alkenyl is unsubstituted or substituted with one or more of the substituent(s) selected from: (a) hydroxy,
(b) oxo,
(c) Ci-βalkoxy,
(d)
Figure imgf000016_0001
(e) phenyl,
(f) -CN,
(g) halo,
(h) -CONR9R10, wherein R9 and R10 are as defined above, (i) -COR9, wherein R9 is as defined above, (j) -CO2R9, wherein R9 is as defined above,
(4) -O(CO)-phenyl, wherein the phenyl is unsubstituted or substituted with one or more of R6, R7and R8;
R5 is selected from the group consisting of: (1) phenyl, unsubstituted or substituted with one or more of R11, R12 and R13 ;
(2) Ci-salkyl, unsubstituted or substituted with one or more of the substituent(s) selected from: (a) hydroxy, (b) oxo,
(c) Ci-βalkoxy,
(d) phenyl-Ci-salkoxy,
(e) phenyl,
(f) -CN, (g) halo,
(h) -NR9R10, wherein R9 and R10 are as defined above,
(i) -NR9COR10, wherein R9 and R10 are as defined above,
(j) -NR9CO2R10, wherein R9 and R10 are as defined above,
(k) -CONR9R10, wherein R9 and R10 are as defined above, (1) -COR9, wherein R9 is as defined above,
(m) -CO2R9, wherein R9 is as defined above; (3) C2-βalkenyl, unsubstituted or substituted with one or more of the substituent(s) selected from:
(a) hydroxy,
(b) oxo, (c) C1-6alkoxy,
(d)
Figure imgf000017_0001
(e) phenyl,
( ) -CN,
(g) halo, (h) -CONR9R10, wherein R9 and R10 are as defined above,
(i) -COR9, wherein R9 is as defined above, (j) -CO2R9, wherein R9 is as defined above;
(4) heterocycle, wherein the heterocycle is as defined above;
R6, R7 and R8 are independently selected from the group consisting of:
(1) hydrogen;
(2) C1-6alkyl, unsubstituted or substituted with one or more of the substituents selected from:
(a) hydroxy, (b) oxo,
(c) C1-6alkoxy,
(d) phenyl- Ci-salkoxy,
(e) phenyl,
(f) -CN, (g) halo,
(h) -NR9R10, wherein R9 and R10 are as defined above,
(i) -NR9COR10, wherein R9 and R10 are as defined above,
(j) -NR9CO2R10, wherein R9 and R10 are as defined above,
(k) -CONR9R10, wherein R9 and R10 are as defined above, (1) -COR9, wherein R9 is as defined above, and
(m) -CO2R9, wherein R9 is as defined above; (3) C2-ealkenyl, unsubstituted or substituted with one or more of the substituent(s) selected from:
(a) hydroxy,
(b) oxo, (c) Ci-ealkoxy,
(d) phenyl-Cι-3alkoxy,
(e) phenyl,
(f) -CN,
(g) halo, (h) -CONR9R10 wherein R9 and Ri° are as defined above,
(i) -COR9 wherein R9 is as defined above, (j) -CO2R9, wherein R9 is as defined above;
(4) C2-ealkynyl;
(5) phenyl, unsubstituted or substituted with one or more of the substituent(s) selected from:
(a) hydroxy,
(b) Ci-βalkoxy,
(c) Ci-ealkyl,
(d) C2-5alkenyl, (e) halo,
(f) -CN,
Figure imgf000018_0001
(h) -CF3,
(i) -(CH2)m-NR9Rio, wherein m, R9 and Rio are as defined above,
(j) -NR9COR °, wherein R9 and R10 are as defined above,
(k) -NR9CO2R10, wherein R9 and R10 are as defined above,
(1) -CONR9R o, wherein R9 and Ri9 are as defined above,
(m) -CO2NR9Ri°, wherein R9 and Ri° are as defined above, (n) -COR9, wherein R9 is as defined above;
(o) -CO2R9, wherein R9 is as defined above; (6) halo,
(7) -CN, .
(8) -CF3,
Figure imgf000019_0001
(10) -SR14, wherein R14 is hydrogen or Ci-salkyl,
(11) -SOR14, wherein R14 is as defined above,
(12) -SO2R14, wherein Rw is as defined above,
(13) NR9COR10, wherein R9 and R10 are as defined above,
(14) CONR9COR °, wherein R9 and Ri° are as defined above, (15) NR9R10, wherein R9 and Ri° are as defined above,
(16) NR9CO2Ri°, wherein R9 and Ri° are as defined above,
(17) hydroxy,
(18) Ci-ealkoxy,
(19) COR9, wherein R9 is as defined above, (20) CO2R9, wherein R9 is as defined above,
Rn, Ri2 and Ri3 are independently selected from the definitions of R6, R7 and R8, or -OX;
Y is selected from the group consisting of:
(1) a single bond,
(2) -O-,
(3) -S-,
(4) -CO-,
Figure imgf000019_0002
(6) -CHR15-, and
(7) -CRi5R16-, wherein R15 and Ri6 are independently selected from the group consisting of:
(a) Ci-βalkyl, unsubstituted or substituted with one or more of the substituents selected from: (i) hydroxy, (ii) oxo,
(iii) Ci-βalkoxy,
Figure imgf000020_0001
(v) phenyl, (vi) -CN,
(vii) halo,
(viii) -NR9R10, wherein R9 and R10 are as defined above,
(ix) -NR9CORi°, wherein R9 and R10 are as defined above,
(x) -NR9CO2R10, wherein R9 and R10 are as defined above, (xi) -CONR9R10, wherein R9 and Ri° are as defined above,
(xii) -COR9, wherein R9 is as defined above, and
(xiii) -CO2R9, wherein R9 is as defined above;
(b) phenyl, unsubstituted or substituted with one or more of the substituent(s) selected from: (i) hydroxy,
(ii) Ci-ealkoxy,
(iii) Ci-ealkyl,
(iv) C2-5alkenyl,
(v) halo, (vi) -CN,
Figure imgf000020_0002
(ix) -(CH2)m-NR9R10, wherein m, R9 and Ri° are as defined above, (x) -NR9CORi°, wherein R9 and R10 are as defined above,
(xi) -NR9CO2R10, wherein R9 and R10 are as defined above,
(xii) -CONR9R °, wherein R9 and R10 are as defined above,
(xiii) -CO2NR9Ri°, wherein R9 and R10 are as defined above,
(xiv) -COR9, wherein R9 is as defined above, and (xv) -CO2R9, wherein R9 is as defined above; Z is selected from:
(1) hydrogen,
(2) Cι-4alkyl, and
(3) hydroxy, with the proviso that if Y is -O-, Z is other than hydroxy, or if Y is -CHR15-, then Z and Rx5 may be joined together to form a double bond.
Particularly preferred compounds of formula (I) are those wherein: Ri is selected from the group consisting of:
(1) Ci-βalkyl, substituted with one or more of the substituents selected from:
(a) heterocycle, wherein the heterocycle is selected from the group consisting of:
(A) benzimidazolyl,
(B) imidazolyl, (C) isoxazolyl,
(D) isothiazolyl,
(E) oxadiazolyl,
(F) pyrazinyl,
(G) pyrazolyl, (H) pyridyl,
(I) pyrrolyl, (J) tetrazolyl, (K) thiadiazolyl, (L) triazolyl, and (M) piperidinyl,
" and wherein the heterocycle is unsubstituted or substituted with one or more substituent(s) selected from:
(i) Ci-βalkyl, unsubstituted or substituted with halo, -CF3, -OCH3, or phenyl, (ii) Ci-ealkoxy,
(iii) oxo, (iv) thioxo, (v) cyano, (vi) -SCH3, (vii) phenyl, (viii) hydroxy, (ix) trifluoromethyl,
(x) -(CH2)m-NR9R o, wherein m is 0, 1 or 2, and R9 and R10 areindependently selected from:
(I) hydrogen,
(II) Ci-βalkyl,
(III) hydroxyCi-βalkyl, and
(IV) phenyl,
(xi) -NR9CORi°, wherein R9 and R10 are as defined above, and
(xii) -CONR9Ri°, wherein R9 and R10 are as defined above, R2 and R3 are independently selected from the group consisting of: (1) hydrogen;
(2) Ci-ealkyl
(3) C2-6alkenyl, and
(5) phenyl;
X is - 0-;
R4 is
Figure imgf000022_0001
R5 is phenyl, unsubstituted or substituted with halo;
R6, R7 and R8 are independently selected from the group consisting of:
(1) hydrogen,
(2) Ci-ealkyl,
(3) halo, and (4) -CF3; Y is -O-; and
Z is hydrogen or Ci. alkyl; and pharmaceutically acceptable salts thereof.
Particularly preferred compounds of formula (I) are: 4-(3-(l,2,4-triazolo)methyl)-2(S)-(3,5-bis(trifluoromethyl)benzyloxy)-3(S)- p he ny 1- morp holine ;
4-(3-(l,2,4-triazolo)methyl)-2(S)-(3,5-bis(trifluoromethyl)benzyloxy)-3(R)- phenyl-morp holine;
4-(3-(5-oxo-lH,4H-l,2,4-triazolo)methyl)-2(S)-(3,5- bis(trifluoromethyl)benzyloxy)-3(S)-phenyl-morpholine; and 2-(R)-(l-(R)-(3,5-bis(trifluoromethyl)phenyl)ethoxy)-3-(S)-(4-fluorophenyl)- 4-(3-(5-oxo-lH,4H-l,2,4-triazolo)methyl)morpholine; or a pharmaceutically acceptable salt thereof.
Further preferred NK-1 receptor antagonists are those described in International (PCT) Patent Specification No. WO 95/18124, i.e. compounds of formula (II):
Figure imgf000023_0001
or a pharmaceutically acceptable salt or prodrug thereof, wherein
R is hydrogen, halogen, Ci-βalkyl, Ci-βalkoxy, CF3, NO2, CN, SRa,
SOR SO2Ra, CO2Ra, CONRaRb, C2-6alkenyl, C2-6alkynyl or Cι- alkyl substituted by C1-4alkoxy, where Ra and Rb each independently represent hydrogen or C1-4alkyl; R2 is hydrogen, halogen, Ci-βalkyl, Ci-βalkoxy substituted by
C1.4alkoxy or CF3; R3 is hydrogen, halogen or CF3;
R4 is hydrogen, halogen, Ci-ealkyl, Ci-ealkoxy, CF3, NO2, CN, SRa, SORa, SO2Ra, CO2Ra, CONRaRb, Cu-βalkenyl, C2-6alkynyl or Cι- alkyl substituted by
Figure imgf000024_0001
where Ra and Rb each independently represent hydrogen or Cι-4alkyl;
R5 is hydrogen, halogen, Ci-βalkyl, Ci-βalkoxy substituted by Cι-4alkoxy or CF3;
R6 is a 5-membered or 6-membered heterocyclic ring containing 2 or 3 nitrogen atoms optionally substituted by =O, =S or a C1-4alkyl group, and optionally substituted by a group of the formula ZNR7R8 where
Z is Ci-βalkylene or C3-6cycloalkylene;
R7 is hydrogen, Cι-4alkyl, C3-7cycloalkyl or C3-7cycloalkylCι-4alkyl, or C2-4alkyl substituted by Ci-4alkoxy or hydroxyl;
R8 is hydrogen, Cι-4alkyl, C3-7cycloalkyl or C3-7cycloalkylCι-4alkyl, or C2-4alkyl substituted by one or two substituents selected from Cι-4alkoxy, hydroxyl or a 4, 5 or 6 membered heteroaliphatic ring containing one or two heteroatoms selected from N, O and S; or R7, R8 and the nitrogen atom to which they are attached form a heteroaliphatic ring of 4 to 7 ring atoms, optionally substituted by a hydroxy group, and optionally containing a double bond, which ring may optionally contain an oxygen or sulphur ring atom, a group S(O) or S(O)2 or a second nitrogen atom which will be part of a NH or NRC moiety where Rc is C1-4alkyl optionally substituted by hydroxy or
Figure imgf000024_0002
or R7, R8 and the nitrogen atom to which they are attached form a non-aromatic azabicyclic ring system of 6 to 12 ring atoms; or Z, R7 and the nitrogen atom to which they are attached form a heteroaliphatic ring of 4 to 7 ring atoms which may optionally contain an oxygen ring atom;
R9a and R9b are each independently hydrogen or C1-4alkyl, or R9a and R9b are joined so, together with the carbon atoms to which they are attached, there is formed a C5-7 ring; X is an alkylene chain of 1 to 4 carbon atoms optionally substituted by oxo; and
Y is a Ci-4alkyl group optionally substituted by a hydroxyl group; with the proviso that if Y is Ci.4alkyl, R6 is susbstituted at least by a group of formula ZNR7R8 as defined above.
Particularly preferred compounds of formula (II) are those of formula (Ila) and pharmaceutically acceptable salts thereof:
Figure imgf000025_0001
(Ila) wherein:
A1 is fluorine or CF3; A2 is fluorine or CF3; A3 is fluorine or hydrogen; and X, Y and RG are as defined in relation to formula (II). Particularly preferred compounds of formula (II) include:
2-(R)-(l-(R)-(3,5-bis(trifluoromethyl)phenyl)ethoxy)-4-(5-(dimethylamino) methyl- 1,2, 3-triazol-4-yl)methyl-3-(S)-phenylmorp holine; 2 - (R) - ( 1 - (R) - (3 , 5 -bis (trifluoromethyl)pheny l)ethoxy ) - 4- (5 - (dimethy lamino) " methyl-l,2,3-triazol-4-yl)methyl-3-(S)-(4-fluorophenyl)morphohne; and pharmaceutically acceptable salts thereof.
Further preferred NK-1 receptor antagonists are those described in European Patent Specification No. WO 95/23798, i.e. compounds of formula (III):
Figure imgf000026_0001
or a pharmaceutically acceptable salt thereof, wherein:
R2 and R3 are independently selected from the group consisting of:
(1) hydrogen,
(2) Ci-βalkyl, unsubstituted or substituted with one or more of the substituents selected from:
(a) hydroxy,
(b) oxo,
(c) Ci-βalkoxy,
(d) phenyl-Ci-3alkoxy,
(e) phenyl,
(f) -CN,
(g) halo,
(h) -NR9Ri°, wherein R9 and R10 are independently selected from:
(i) hydrogen,
(ii) Ci-βalkyl,
(iii) hydroxy- Ci-βalkyl, and
(iv) phenyl, (i) -NR9CORi°, wherein R9 and Ri° are as defined above, (j) -NR9CO2R10, wherein R9 and R10 are as defined above, (k) -CONR9R10, wherein R9 and R"> are as defined above, (1) -COR9, wherein R9 is as defined above, and (m) -CO2R9, wherein R9 is as defined above; (3) C2-6alkenyl, unsubstituted or substituted with one or more of the substituent(s) selected from:
( )' hydroxy,
(b) oxo,
(c) Ci-βalkoxy,
(d) phenyl-Ci-3alkoxy,
(e) phenyl,
Φ -CN,
(g) halo,
(h) -CONR9Ri° wherein R9 and Ri° are as defined above,
(i) -COR9 wherein R9 is as defined above,
G) -CO2R9, wherein R9 is as defined above;
(4) C2-ealkynyl;
(5) phenyl, unsubstituted or substituted with one or more of the substituent(s) selected from:
(a) hydroxy,
(b) Ci-βalkoxy,
(c) Ci-ealkyl,
(d) C2-5alkenyl,
(e) halo,
( ) -CN,
Figure imgf000027_0001
(h) -CF3,
(i) -(CH2)m-NR9R10, wherein m, R9 and Ri° are as defined above,
(j) -NR9CORi°, wherein R9 and R10 are as defined above,
(k) -NR9CO2Ri°, wherein R9 and R10 are as defined above,
(1) -CONR9R °, wherein R9 and R10 are as defined above,
(m) -Cθ2NR9Ri°, wherein R9 and R10 are as defined above,
(n) -COR9, wherein R9 is as defined above,
(o) -CO2R9, wherein R9 is as defined above; and the groups R2 and R3 may be joined together to form a carbocyclic ring selected from the group consisting of: (a) cyclop entyl, (b) cyclohexyl,
(c) phenyl, and wherein the carbocyclic ring is unsubstituted or substituted with one or more substituents selected from: (i) Ci-βalkyl, (ii) Ci-ealkoxy,
(iii) -NR9Ri°, wherein R9 and R10 are as defined above,
(iv) halo, and
(v) trifluoromethyl;
and the groups R2 and R3 may be joined together to form a heterocyclic ring selected from the group consisting of:
(a) pyrrolidinyl,
(b) piperidinyl,
(c) pyrrolyl, (d) pyridinyl,
(e) imidazolyl,
(f) furanyl,
(g) oxazolyl, (h) thienyl, and (i) thiazolyl,
- and wherein the heterocyclic ring is unsubstituted or substituted with one or more substituent(s) selected from: (i) Ci-βal yl, (ii) oxo, (iii) Ci-βalkoxy,
(iv) -NR9Ri°, wherein R9 and R10 are as defined above, (v) halo, and
(vi) trifluoromethyl;
R6, R7 and R8 are independently selected from the group consisting of: (1) hydrogen;
(2) Ci-βalkyl, unsubstituted or substituted with one or more of the substituents selected from:
(a) hydroxy,
(b) oxo, (c) Ci-βalkoxy,
(d) phenyl-Cι-3alkoxy,
(e) phenyl,
(f) -CN,
(g) halo, (h) -NR9Ri°, wherein R9 and Ri° are as defined above,
(i) -NR9CORi°, wherein R9 and Ri° are as defined above, (j) -NR9CO2Rio, wherein R9 and Ri° are as defined above, (k) -CONR9R °, wherein R9 and Ri° are as defined above, (1) -COR9, wherein R9 is as defined above, and (m) -CO2R9, wherein R9 is as defined above;
(3) C2-6alkenyl, unsubstituted or substituted with one or more of the substituent(s) selected from:
(a) hydroxy,
(b) oxo, (c) Ci-βalkoxy,
(d) phenyl-Cι-3alkoxy,
(e) phenyl,
(f) -CN,
(g) halo, (h) -CONR9R ° wherein R9 and Ri° are as defined above,
(i) -COR9 wherein R9 is as defined above, (j) -CO2R9, wherein R9 is as defined above;
(4) C2-6alkynyl;
(5) phenyl, unsubstituted or substituted with one or more of the substituent(s) selected from:
(a) hydroxy,
(b) Ci-βalkoxy,
(c) Ci-βalkyl,
(d) C2-5alkenyl,
(e) halo,
(f) -CN,
(g) -NO2,
( ) -CF3,
(i) -(CH2)m-NR9R °, wherein m, R9 and Ri° are as defined above, (j) -NR9CORi°, wherein R9 and Ri° are as defined above,
(k) -NR9CO2R10, wherein R9 and Ri° are as defined above, (1) -CONR9Ri°, wherein R9 and Ri° are as defined above, (m) -Cθ2NR9Ri°, wherein R9 and R10 are as defined above, (n) -COR9, wherein R9 is as defined above, (o) -CO2R9, wherein R9 is as defined above;
(6) halo,
(7) -CN,
(8) -CF3,
Figure imgf000030_0001
(10) -SR , wherein R14 is hydrogen or d-δalkyi,
(11) -SOR14, wherein Ri4 is as defined above,
(12) -SO2R14, wherein R14 is as defined above,
(13) NR9CORi°, wherein R9 and R ° are as defined above,
(14) CONR9CORi°, wherein R9 and Ri° are as defined above, (15) NR9Ri°, wherein R9 and Ri° are as defined above,
(16) NR9CO2Ri°, wherein R9 and Ri° are as defined above, (17) hydroxy,
(18) Ci-ealkoxy,
(19) COR9, wherein R9 is as defined above,
(20) CO2R9, wherein R9 is as defined above, (21) 2-pyridyl,
(22) 3-pyridyl,
(23) 4-pyridyl,
(24) 5-tetrazolyl,
(25) 2-oxazolyl, and (26) 2-thiazolyl;
Rn, Ri2 and Ri3 are independently selected from the definitions of R6, R7 and R8, or -OX;
A is selected from the group consisting of:
(1) Ci-βalkyl, unsubstituted or substituted with one or more of the substituents selected from:
(a) hydroxy,
(b) oxo, (c) Ci-ealkoxy,
(d) phenyl- d-βalkoxy,
(e) phenyl,
(f) -CN,
(g) halo, wherein halo is fluoro, chloro, bromo or iodo, (h) -NR9Ri°, wherein R9 and Ri° are as defined above,
(i) -NR9CORi°, wherein R9 and Ri° are as defined above,
(j) -NR9CO2R10, wherein R9 and Ri° are as defined above,
(k) -CONR9Ri°, wherein R9 and Ri° are as defined above,
(1) -COR9, wherein R9 is as defined above, and (m) -CO2R9, wherein R9 is as defined above; (2) C2 Galkenyl, unsubstituted or substituted with one or more of the substituent(s) selected from:
(a) hydroxy,
(b) oxo,
(c) Ci-βalkoxy,
(d) phenyl-d^alkoxy,
(e) phenyl, ω -CN,
(g) halo,
( ) -CONR9Ri° wherein R9 and R10 are as defined above,
(i) -COR9 wherein R9 is as defined above, and
(j) -CO2R9, wherein R9 is as defined above; and
(3) C2-6alkynyl;
B is a heterocycle, wherein the heterocycle is selected from the group consisting of:
Figure imgf000032_0001
N-N H X
N-N N-N N-N
N s X X 1 N S N Ό
X H N
Figure imgf000032_0002
Figure imgf000033_0001
Figure imgf000033_0002
and wherein the heterocycle may be substituted in addition to -X with one or more substituent(s) selected from:
(i) Ci-βalkyl, unsubstituted or substituted with halo, -CF3, -OCH3, or phenyl,
(ii) Ci-βalkoxy, (iii) oxo, (iv) hydroxy, (v) thioxo, (vi) -SR9, wherein R9 is as defined above,
(vii) halo, (viii) cyano, (ix) phenyl, (x) trifluoromethyl, (xi) -(CH2)m-NR9Rio, wherein m is 0, 1 or 2, and R9 and Ri° are as defined above, (xii) -NR9CORi°, wherein R9 and R10 are as defined above,
(xiii) -CONR9Ri°, wherein R9 and R10 are as defined above,
(xiv) -CO2R9, wherein R9 is as defined above, and
(xv) -(CH2)m-OR9, wherein m and R9 are as defined above;
p is 0 or 1;
X is selected from:
(a) -PO(OH)O" • M+, wherein M+ is a pharmaceutically acceptable monovalent counterion,
(b) -PO(O-)2 • 2M+,
(c) -PO(O 2 • D2+, wherein D2+ is a pharmaceutically acceptable divalent counterion,
(d) -CH(R )-PO(OH)O" • M+, wherein R4 is hydrogen or Ci-salkyl, (e) -CH(R )-PO(O-)2 • 2M+,
(f) -CH(R )-PO(O-)2 • D2+,
Figure imgf000034_0001
(h) -CH(R4)-SO - • M+,
(i) -CO-CH2CH2-CO2- • M+, (j) -CH(CH3)-O-CO-R5, wherein R5 is selected from the group consisting of:
(i) .NH3 M"
O'
H2 M"
(ϋ) -N; 9
0' R9
(iii) O C0o "M+
Figure imgf000035_0001
Figure imgf000035_0002
(k) hydrogen, with the proviso that if p is 0 and none of R11, Ri2 or Ri3 are -OX, then X is other than hydrogen;
Y is selected from the group consisting of:
(1) a single bond,
(2) -O-,
(3) -S-,
(4) -CO-, (5) -CH2-,
(6) -CHR15-, and
(7) -CR15Ri6-, wherein Ri5 and Ri6 are independently selected from the group consisting of: (a) Ci-βalkyl, unsubstituted or substituted with one or more of the substituents selected from:
(i) hydroxy,
(ii) oxo,
(iii) Ci-βalkoxy,
Figure imgf000036_0001
(v) phenyl,
(vi) -CN,
(vii) halo,
(viii) -NR9R10, wherein R9 and R10 are as defined above, (ix) -NR9CORi°, wherein R9 and Ri° are as defined above,
(x) -NR9CO2R10, wherein R9 and R10 are as defined above,
(xi) -CONR9Ri°, wherein R9 and R10 are as defined above,
(xii) -COR9, wherein R9 is as defined above, and
(xiii) -CO2R9, wherein R9 is as defined above; (b) phenyl, unsubstituted or substituted with one or more of the substituent(s) selected from:
(i) hydroxy,
(ii) Ci-βalkoxy,
(iii) Ci-βalkyl, (iv) C2-5alkenyl,
(v) halo,
(vi) -CN,
Figure imgf000036_0002
(viii) -CF3, (ix) -(CH2)m-NR9Rio, wherein m, R9 and Ri° are as defined above, (x) -NR9COR10, wherein R9 and Ri° are as defined above,
(xi) -NR9CO2Ri°, wherein R9 and Ri° are as defined above,
(xii) -CONR9Ri°, wherein R9 and Ri° are as defined above,
(xiii) -Cθ2NR9Ri°, wherein R9 and Ri° are as defined above, (xiv) -COR9, wherein R9 is as defined above, and
(xv) -CO2R9, wherein R9 is as defined above;
Z is selected from:
(1) hydrogen, (2) Ci-ealkyl, and
(3) hydroxy, with the proviso that if Y is -O-, Z is other than hydroxy, or if Y is -CHR15-, then Z and Ri5 may be joined together to form a double bond.
Particularly preferred compounds of formula (III) are those wherein: R2 and R3 are independently selected from the group consisting of:
(1) hydrogen,
(2) d-ealkyl,
(3) C2-6alkenyl, and
(4) phenyl; R6, R7 and R8 are independently selected from the group consisting of:
(1) hydrogen,
(2) d-ealkyl,
(3) fluoro,
(4) chloro, (5) bromo,
(6) iodo, and
(7) -CF3;
Rn, Ri2 and Ri3 are independently selected from the group consisting of: (1) fluoro, (2) chloro,
(3) bromo, and (4) iodo; A is unsubstituted l-βalkyl; B is selected from the group consisting of:
Figure imgf000038_0001
H X
// \ N-N N-N N_N' i N S N υ ^ ^S
X H
Figure imgf000038_0002
p is 0 or 1;
X is selected from:
(a) -PO(OH)O" • M+, wherein M+ is a pharmaceutically acceptable monovalent counterion, (b) -PO(O-)2 • 2M+,
(c) -PO(O")2 * D2+, wherein D2+ is a pharmaceutically acceptable divalent counterion,
(d) -CH(R )-PO(OH)O" • M+, wherein R4 is hydrogen or Ci-salkyl, (e) -CH(R4)-PO(O-)2 • 2M+,
(f) -GH(R4)-PO(O-)2 • D2+,
(i) -CO-CH2CH2-CO2- • M+,
(j) -CH(CH3)-O-CO-R5, wherein R5 is selected from the group consisting of:
(i) .NH3 M"
0'
H2 M"
(ϋ) ~0' 'OH
(iϋ) 0 C02 " M
C02 " M'
(iv)
0 C02 " M
C0
(v) ~0
NH,
Figure imgf000039_0001
Y is -O-;
Z is hydrogen or Ci-βalkyl; and pharmaceutically acceptable salts thereof. Particularly preferred compounds of formula (III) include:
(1) 2-(S)-(3,5rbis(trifluoromethyl)benzyloxy)-3-(S)-phenyl-4-(3-(5-oxo- lH,4H-l,2,4-triazolo)methyl)morpholine N-oxide;
(2) 2-(S)-(3,5-bis(trifluoromethyl)benzyloxy)-3-(S)-phenyl-4-(3-(4- (ethoxycarbonyloxy-l-ethyl)-5-oxo-lH-l,2,4- triazolo)methyl)morpholine;
(3) 2-(R)-(l-(R)-(3,5-bis(trifluoromethyl)phenyl)ethoxy)-3-(S)-(4- fluorophenyl)-4-(3-(4-monophosphoryl-5-oxo-lH-l,2,4- triazolo)methyl)morp holine ; (4) 2-(R)-(l-(R)-(3,5-bis(trifluoromethyl)phenyl)ethoxy)-3-(S)-(4- fluorophenyl)-4-(3-(l-monophosphoryl-5-oxo-lH-l,2,4- triazolo)methyl)morp holine ;
(5) 2-(R)-(l-(R)-(3,5-bis(trifluoromethyl)phenyl)ethoxy)-3-(S)-(4- fluorophenyl)-4-(3-(2-monophosphoryl-5-oxo-lH- 1,2,4- triazolo)methy l)morp holine;
(6) 2-(R)-(l-(R)-(3,5-bis(trifiuoromethyl)phenyl)ethoxy)-3-(S)-(4- fluorophenyl)-4-(3-(5-oxyphosphoryl-lH-l,2,4- triazolo)me thy l)morp holine ;
(7) 2-(S)-(l-(R)-(3,5-bis(trifluoromethyl)phenyl)ethoxy)-3-(S)-(4- fluorophenyl)-4-(3-(l-monophosphoryl-5-oxo-4H-l,2,4- triazolo)methyl)morpholine; and pharmaceutically acceptable salts thereof.
Further preferred NK-1 receptor antagonists are those described in European Patent Specification No. WO 96/05181, i.e. compounds of formula (IV):
Figure imgf000041_0001
wherein
X is a group of the formula NR6R7 or a C- or N-linked imidazolyl ring;
Y is hydrogen or Cι-4alkyl optionally substituted by a hydroxy group;
Ri is hydrogen, halogen, Ci-ealkyl, Cι-6alkoxy, CF3, NO2, CN, SRa, SORa, SO2Ra, CO2Ra, CONRaR , Cjs-βalkenyl, C2-6alkynyl or Cι- alkyl substituted by C1-4alkoxy, wherein Ra and Rb each independently represent hydrogen or Cι-4alkyl;
R2 is hydrogen, halogen, Ci-βalkyl, Ci-βalkoxy substituted by Ci-4alkoxy or CF3;
R3 is hydrogen, halogen or CF3; R4 is hydrogen, halogen, Ci-βalkyl, C1-6alkoxy, hydroxy, CF3, NO2,
CN, SRa, SORa, SO2Ra, CO2Ra, CONRaR , C^ealkenyl, C2-6alkynyl or Ci-4alkyl substituted by Cι-4alkoxy, wherein Ra and Rb are as previously defined;
R5 is hydrogen, halogen, Ci-βalkyl, Ci-βalkoxy substituted by Cι. alkoxy or CF3;
R6 is hydrogen, Ci-βalkyl, C3-7cycloalkyl, C3-7cycloalkylCι-4alkyl, phenyl, or C2-4alkyl substituted by Cι-4alkoxy or hydroxy;
R7 is hydrogen, Ci-ealkyl, C3-7cycloalkyl, C3-7cycloalkylCι-4alkyl, phenyl, or C2-4alkyl substituted by one or two substituents selected from Cι-4alkoxy, hydroxy or a 4, 5 or 6 membered heteroaliphatic ring containing one or two heteroatoms selected from N, O and S; or R6 and R7, together with the nitrogen atom to which they are attached, form a saturated or partially saturated heterocyclic ring of 4 to 7 ring atoms, which ring may optionally contain in the ring one oxygen or sulphur atom or a group selected from NR8, S(O) or S(O)2 and which ring may be optionally substituted by one or two groups selected from hydroxyCι-4alkyl, C1-4alkoxyCι-4alkyl, oxo, CORa or CO2Ra where Ra is as previously defined; or R6 and R7 together with the nitrogen atom to which they are attached, form a non-aromatic azabicyclic ring system of 6 to 12 ring atoms;
R8 is hydrogen, Cι-4alkyl, hydroxyC1-4alkyl or C1-4alkoxyC1-4alkyl; and R9a and R9b are each independently hydrogen or Cι-4alkyl, or R9a and
R9b are joined so, together with the carbon atoms to which they are attached, there is formed a C5-7 ring; and pharmaceutically acceptable salts thereof.
Particularly preferred compounds of formula (IV) are those of formula (IVa) and pharmaceutically acceptable salts thereof:
Figure imgf000042_0001
wherein
Ai is fluorine or CF3; A2 is fluorine or CF3;
A3 is fluorine or hydrogen; and X and Y are as defined in relation to formula (I).
Specific compounds of formula (IV) of use in the present invention include:
2-(R)-(l-(R)-(3,5-bis(trifluoromethyl)phenyl)ethoxy)-3-(S)-(4-fluorophenyl)-
4-(4-morpholinobut-2-yn-yl)morpholine;
2-(R)-(l-(R)-(3,5-bis(trifluoromethyl)phenyl)ethoxy)-4-(4-N,N- dimethylaminobut-2-yn-yl)-3-(S)-(4-fluorophenyl)morpholine; 4-(4-azetidinylbut-2-yn-yl)-2-(R)-(l-(R)-(3,5-bis(trifluoromethyl)phenyl) ethoxy)-3-(S)-(4-fluorophenyl)morpholine;
2-(R)-(l-(R)-(3,5-bis(trifluoromethyl)phenyl)ethoxy)-3-(S)-(4-fluorophenyl)-
4-(4-imidazolylbut-2-yn-yl)morpholine;
2-(R)-(l-(R)-(3,5-bis(trifluoromethyl)phenyl)ethoxy)-3-(S)-(4-fluorophenyl)- 4-(4-(N-methylpiperazinyl)but-2-yn-yl)morpholine;
4-(4-bis(2-methoxyethyl)aminobut-2-yn-yl)-2-(R)-(l-(R)-(3,5- bis(trifluoromethyl)phenyl)ethoxy)-3-(S)-(4-fluorophenyl)morphohne;
2-(R)-(l-(R)-(3,5-bis(trifluoromethyl)phenyl)ethoxy)-3-(S)-(4-fluorophenyl)-
4-(4-pyrrolidinobut-2-yn-yl)morpholine; 3-(S)-(4-fluorophenyl)-2-(R)-(l-(R)-(3-fluoro-5-(trifluoromethyl)phenyl) ethoxy)-4-(4-morpholinobut-2-yn-yl)morpholine;
3-(S)-(4-fluorophenyl)-4-(4-morpholinobut-2-yn-yl)-2-(R)-(l-(R)-(3-
(trifluoromethyl)phenyl)ethoxy)morpholine;
4-(4-azetidinylbut-2-yn-yl)-3-(S)-(4-fluorophenyl)-2-(R)-(l-(R)-(3- (trifluoromethyl)phenyl)ethoxy)morpholine; 2-(R)-(l-(R)-(3,5-bis(trifluoromethyl)phenyl)ethoxy)-4-(4-(N-(2- methoxyethyl)-N-methyl)aminobut-2-yn-yl)-3-(S)-phenylmorphohne;
2-(R)-(l-(R)-(3,5-bis(trifluoromethyl)phenyl)ethoxy)-4-(4-(N-cyclopropyl-N-
(2-methoxyethyl)amino)but-2-yn-yl)-3-(S)-phenylmorpholine; 2-(R)-(l-(R)-(3,5-bis(trifluoromethyl)phenyl)ethoxy)-4-(4-(N-isopropyl-N-(2- methoxyethyl)amino)but-2-yn-yl)-3-(S)-phenylmorpholine; 4-(4-(N,N-dimethylamino)but-2-yn-yl)-3-(S)-(4-fluorophenyl)-2-(R)-(l-(S)-
(3-fluoro-5-(trifluoromethyl)phenyl-2-hydroxyethoxy)morpholine;
4-(4-azetidinylbut-2yn-yl)-3-(S)-(4-fluorophenyl)-2-(R)-(l-(S)-(3-fluoro-5-
(trifluoromethyl)phenyl)-2-hydroxyethoxy)morpholine; 2-(R)-(l-(S)-(3,5-bis(trifluoromethyl)phenyl)-2-hydroxyethoxy)-4-(4-(N,N- dimethylamino)but-2-yn-yl)-3-(S)-(4-fluorophenyl)morpholine;
4-(4-azetidinylbut-2-yn-yl)-2-(R)-(l-(S)-(3,5-bis(trifluoromethyl)phenyl-2- hydroxyethoxy)-3-(S)-(4-fluorophenyl)morpholine;
4-(4-N-bis(2-methoxy)ethyl-N-methylamino)but-2-yn-yl)-2-(R)-(l-(R)-(3,5- bis(trifluoromethyl)phenyl)ethoxy)-3-(S)-(4-fluorophenyl)morpholine;
2-(R)-(l-(R)-(3,5-bis(trifluoromethyl)phenyl)ethoxy)-3-(S)-(4-fluorophenyl)-
4-(4-(2-(S)-(methoxymethyl)pyrrolidino)but-2-yn-yl)morpholine;
4-(4-(7-azabicyclo[2.2.1]heptano)but-2-yn-yl)-2-(R)-(l-(R)-(3,5- bis(trifluoromethyl)phenyl)ethoxy)-3-(S)-(4-fluorophenyl)morpholine; 2-(R)-(l-(R)-(3,5-bis(trifluoromethyl)phenyl)ethoxy)-4-(4- diisopropylaminobut-2-yn-yl)-3-(S)-(4-fluorophenyl)morpholine;
2-(R)-(l-(R)-(3-fluoro-5-(trifluoromethyl)phenyl)ethoxy)-4-(4-(2-(S)-
(methoxymethyl)pyrrolidino)but-2-yn-yl)-3-(S)-phenylmorpholine;
2-(R)-(l-(R)-(3,5-bis(trifluoromethyl)phenyl)ethoxy)-3-(S)-(4-fluorophenyl)- 4-(4-(2-(S)-(hydroxymethyl)pyrrolidino)but-2-yn-yl)morpholine; and pharmaceutically acceptable salts thereof.
Another class of NK-1 receptor antagonists of use in the present invention is that described in European Patent Specification No.
0 436 334, i.e. compounds of formula (V):
Figure imgf000044_0001
or a pharmaceutically acceptable salt thereof, wherein
Y is (CH2)n wherein n is an integer from 1 to 4, and wherein any one of the carbon-carbon single bonds in said (CH2)n may optionally be replaced by a carbon-carbon double bond, and wherein any one of the carbon atoms of said (CH2)n may optionally be substituted with R4, and wherein any one of the carbon atoms of said (CH2)n may optionally be substituted with R7;
Z is (CH2)m wherein m is an integer from 0 to 6, and wherein any one of the carbon-carbon single bonds of (CH2)m may optionally be replaced by a carbon-carbon double bond or a carbon-carbon triple bond, and any one of the carbon atoms of said (CH2)m may optionally be substituted with R8;
Ri is hydrogen or Ci-salkyl optionally substituted with hydroxy, Cι-4alkoxy or fluoro; R2 is a radical selected from hydrogen, d-6 straight or branched alkyl, C3-7cycloalkyl wherein one of the CH2 groups in said cycloalkyl may optionally be replaced by NH, oxygen or sulphur; aryl selected from phenyl and naphthyl; heteroaryl selected from indanyl, thienyl, furyl, pyridyl, thiazolyl, isothiazolyl, oxazolyl, isoxazolyl, triazolyl, tetrazolyl and quinolyl; phenyl-C2-βalkyl, benzhydryl and benzyl, wherein each of said aryl and heteroaryl groups and the phenyl moieties of said benzyl, phenyl - C2-6alkyl and benzhydryl may optionally be substituted with one or more substituents independently selected from halo, nitro, d-β alkyl, d-βalkoxy, trifluoromethyl, amino, d-βalkylamino, d-βalkyl-O-CO, Ci-βalkyl-O-CO- Ci-ealkyl, d-6alkyl-CO-O, Ci-ealkyl-CO-d-ealkyl-O-, d-6alkyl-CO, - d-βalkyl-CO-Ci-ealkyl-, di-d-ealkylamino, -CONH-Cι-6alkyl, Ci-ealkyl-CO-NH-Ci-ealkyl, -NHCOH and -NHCO-d.6alkyl; and wherein one of the phenyl moieties of said benzhydryl may optionally be replaced by naphthyl, thienyl, furyl or pyridyl; R5 is hydrogen, phenyl or d-βalkyl; or R2 and R5 together with the carbon to which they are attached, form a saturated ring having from 3 to 7 carbon atoms wherein one of the CH2 groups in said ring may optionally be replaced by oxygen, NH or sulfur; R3 is aryl selected from phenyl and naphthyl; heteroaryl selected from indanyl, thienyl, furyl, pyridyl, thiazolyl, isothiazolyl, oxazolyl, isoxazolyl, triazolyl, tetrazolyl and quinolyl; and cycloalkyl having 3 to 7 carbon atoms wherein one of the (CH2) groups in said cycloalkyl may optionally be replaced by NH, oxygen or sulphur; wherein each of said aryl and heteroaryl groups may optionally be substituted with one or more substituents, and said C3-7cycloalkyl may optionally be substituted with one or two substituents, each of said substituents being independently selected from halo, nitro, Ci-βalkyl, Ci-βalkoxy, trifluoromethyl, amino, d-βalkylamino, -CO-NH- Ci-ealkyl, Ci-ealkyl-CO-NH-d-ealkyl, -NHCOH and -NHCO-Cι-6alkyl;
R4 and R7 are each independently selected from hydroxy, halogen, halo, amino, oxo, cyano, methylene, hydroxymethyl, halomethyl, d-βalkylamino, di-d-βalkylamino, Ci-βalkoxy, d-βalkyl-O-CO, Ci-ealkyl-O-CO-d-βalkyl, Ci-ealkyl-CO-O, d-ealkyl-CO-d-ealkyl-O-, Ci-εalkyl-CO-, d-βalkyl-CO-d-βalkyl, and the radicals set forth in the definition of R2;
R6 is -NHCOR9, -NHCH2R9, SO2R8 or one of the radicals set forth in any of the definitions of R2, R4 and R7;
R8 is oximino (=NOH) or one of the radicals set forth in any of the definitions of R2, R4 and R7;
R9 is d-βalkyl, hydrogen, phenyl or phenyld-βalkyl; with the proviso that (a) when m is 0, R8 is absent, (b) when R4, R6, R7 or R8 is as defined in R2, it cannot form together with the carbon to which it is attached ,a ring with R5, and (c) when R4 and R7 are attached to the same carbon atom, then either each of R4 and R7 is independently selected from hydrogen, fluoro and Ci-βalkyl, or R4 and R7, together with the carbon to which they are attached, for a C3-6 saturated carbocyclic ring that forms a spiro compound with the nitrogen-containing ring to which they are attached.
A particularly preferred compound of formula (V) is (2S,3S)-cis-3-(2- methoxybenzylamino)-2-phenylpiperidine; or a pharmaceutically acceptable salt thereof.
Another class of NK-1 receptor antagonists of use in the present invention is that described in International Patent Specification No. WO 93/21155, i.e. compounds of formula (VI):
Figure imgf000047_0001
or a pharmaceutically acceptable salt thereof, wherein radicals R are phenyl radicals optionally 2- or 3-substituted by a halogen atom or a methyl radical; Ri is optionally substituted phenyl, cyclohexadienyl, naphthyl, indenyl or optionally substituted heterocycle;
R2 is H, halogen, OH, alkyl, aminoalkyl, alky lamino alkyl, dialkylaminoalkyl, alkyloxy, alkylthio, acyloxy, carboxy, optionally substituted alkyloxycarbonyl, benzyloxycarbonyl, amino or acylamino; R3 is optionally 2-substituted phenyl;
R4 is OH or fluorine when R5 is H; or R4 and R5 are OH ; or R4 and R5 together form a bond.
A particularly preferred compound of formula (VI) is (3aS, 4S, 7aS)- 7,7-diphenyl-4-(2-methoxyphenyl)-2-[(2S)-(2-methoxyphenyl)propionyl] perhydroisoindol-4-ol; or a pharmaceutically acceptable salt thereof. Another class of NK-1 receptor antagonists of use in the present invention is that described in European Patent Specification No. 0 591 040, i.e. compounds of formula (VII):
R Q
Ar-T- CO-N-CH2 -C-CH2 -CH2 -Am + , A " (VII)
Ar ' wherein
Ar represents an optionally substituted mono-, di- or tricyclic aromatic or heteroaromatic group;
T represents a bond, a hydroxymethylene group, a d-4alkoxymethylene group or a d-salkylene group; Ar' represents a phenyl group which is unsubstituted or substituted by one or more substituents selected from halogen, preferably chlorine or fluorine, trifluoromethyl, C1-4alkoxy, d-4alkyl where the said substituents may be the same or different; a thienyl group; a benzothienyl group; a naphthyl group; or an indolyl group; R represents hydrogen, Cι-4alkyl, ω-d-4alkoxyd-4alkyl, or ω-C2-4alkanoyloxyC2-4alkyl;
Q represents hydrogen; or Q and R together form a 1,2-ethylene, 1,3-propylene or 1,4- butylene group; Am+ represents the radical
Figure imgf000048_0001
in which Xi, X2 and X3, together with the nitrogen atom to which they are attached, form an azabicyclic or azatricyclic ring system optionally substituted by a phenyl or benzyl group; and A- represents a pharmaceutically acceptable anion. A particularly preferred compound of formula (VII) is (+) l-[2-[3- (3,4-dichlorophenyl)-l-[(3-isopropoxyphenyl)acetyl]-3-piperidinyl]ethyl]-4- phenyl-l-azabicyclo[2,2,2]octane; or a pharmaceutically acceptable salt, especially the chloride, thereof. Another class of NK-1 receptor antagonists of use in the present invention is that described in European Patent Specification No. 0 532 456, i.e. compounds of formula (VIII):
Figure imgf000049_0001
or a pharmaceutically acceptable salt thereof, wherein R1 represents an optionally substituted aralkyl, aryloxyalykl, heteroaralkyl, aroyl, heteroaroyl, cycloalkylcarbonyl, aralkanoyl, heteroarylalkanoyl, aralkoxycarbonyl or arylcarbamoyl group or the acyl group of an α-amino acid optionally N-substituted by a lower alkanoyl or carbamoyl-lower alkanoyl group; R2 represents cycloalkyl or an optionally substituted aryl or heteroaryl group;
R3 represents hydrogen, alkyl, carbamoyl or an alkanoyl or alkenoyl group optionally substituted by carboxy or esterified or amidated carboxy;
R4 represents an optionally substituted aryl group or an optionally partially saturated heteroaryl group;
Xi represents methylene, ethylene, a bond, an optionally ketalised carbonyl group or an optionally etherified hydroxy methylene group;
X2 represents alkylene, carbonyl or a bond; and
X3 represents carbonyl, oxo-lower alkyl, oxo(aza)-lower alkyl, or an alkyl group optionally substituted by phenyl, hydroxymethyl, optionally esterified or amidated carboxy, or (in other than the α-position) hydroxy.
A particularly preferred compound of formula (VIII) is (2R*, 4S*)-2- benzyl-l-(3,5-dimethylbenzoyl)-N-(4-quinohnylmethyl)-4-piperidineamine; or a pharmaceutically acceptable salt thereof. Another class of NK-1 receptor antagonists of use in the present invention is that described in European Patent Specification No. 0 443 132, i.e. compounds of formula (IX)
Figure imgf000050_0001
or a pharmaceutically acceptable salt thereof, wherein Ri is aryl, or a group of the formula:
Figure imgf000050_0002
X is CH or N; and Z is O or N-R5, in which R5 is hydrogen or lower alkyl;
R2 is hydroxy or lower alkoxy;
R3 is hydrogen or optionally substituted lower alkyl;
R4 is optionally substituted ar(lower)alkyl;
A is carbonyl or sulfonyl; and Y is a bond or lower alkenylene.
A particularly preferred compound of formula (IX) is the compound of formula (IXa)
Figure imgf000050_0003
or a pharmaceutically acceptable salt thereof.
Another class of NK-1 receptor antagonists of use in the present invention is that described in International Patent Specification No. WO 92/17449, i.e. compounds of the formula (X)
Figure imgf000051_0001
or a pharmaceutically acceptable salt thereof, wherein
Ri is aryl selected from indanyl, phenyl and naphthyl; heteroaryl selected from thienyl, furyl, pyridyl and quinolyl; and cycloalkyl having 3 to 7 carbon atoms, wherein one of said carbon atoms may optionally be replaced by nitrogen, oxygen or sulfur; wherein each of said aryl and heteroaryl groups may optionally be substituted with one or more substituents, and said C3-7cycloalkyl may optionally be substituted with one or two substituents, said substituents being independently selected from chloro, fluoro, bromo, iodo, nitro, d-10alkyl optionally substituted with from one to three fluoro groups, d-ioalkoxy optionally substituted with from one to three fluoro groups, amino, Cι-ιoalkyl-S-, Cι-ioalkyl-S(O)-, d-ioalkyl-SO2-, phenyl, phenoxy, C1.1oalkyl-SO2NH-, C1.1oalkyl-SO2NH-C1.1oakyl-, d-ιoalkylamino-did-ιoalkyl-, cyano, hydroxy, cycloalkoxy having 3 to 7 carbon atoms, d-βalkylamino, Ci-βdialkylamino, HC(O)NH- and Cι-10alkyl-C(O)NH-; and
R2 is thienyl, benzhydryl, naphthyl or phenyl optionally substituted with from one to three substituents independently selected from chloro, - bromo, fluoro, iodo, cycloalkoxy having 3 to 7 carbon atoms, d-ioalkyl optionally substituted with from one to three fluoro groups and Cι-10alkoxy optionally substituted with from one to three fluoro groups.
A particularly preferred compound of formula (X) is (2S,3S)-3-(2- methoxy-5-trifluoromethoxybenzyl)-amino-2-phenylpiperidine; or a pharmaceutically acceptable salt thereof. Another class of NK-1 receptor antagonists of use in the present invention is that described in International Patent Specification No. WO 95/08549, i.e. compounds of formula (XI)
R'
Figure imgf000052_0001
or a pharmaceutically acceptable salt thereof, wherein Ri is a Cι-4alkoxy group; R2 is
Figure imgf000052_0002
R3 is a hydrogen or halogen atom; R4 and R5 may each independently represent a hydrogen or halogen atom, or a d-4alkyl, d-4alkoxy or trifluoromethyl group;
R6 is a hydrogen atom, a d-4alkyl, (CH2)mcyclopropyl, -S(O)nd- alkyl, phenyl, NR7R8, CH2C(O)CF3 or trifluoromethyl group;
R7 and R8 may each independently represent a hydrogen atom, or a Cι-4alkyl or acyl group; x represents zero or 1; n represents zero, 1 or 2; and m represents zero or 1.
Particularly preferred compounds of formula (XI) are (2-methoxy-5- tetrazol-l-yl-benzyl)-([2S,3iS]-2-phenyl-piperidin-3-yl)-amine; and [2- methoxy-5-(5-trifluoromethyl-tetrazol-l-yl)-benzyl]-([2S,3S]-2-phenyl- piperidin-3-yl)-amine; or a pharmaceutically acceptable salt thereof. Another class of tachykinin antagonists of use in the present invention is that described in International Patent Specification No. WO 95/14017, i.e. compounds of formula (XII)
R8 R4
R— (CH2)n— C- CH— N— (CH2)0— R
NH R
(CO)
Figure imgf000053_0001
or a pharmaceutically acceptable salt thereof, wherein m is zero, 1, 2 or 3; n is zero or 1; o is zero, 1 or 2; p is zero or 1; R is phenyl, 2- or 3-indolyl, 2- or 3-indolinyl, benzothienyl, benzofuranyl, or naphthyl; which R groups may be substituted with one or two halo, Cι-3alkoxy, trifluoromethyl, d-4alkyl, phenyl- d-3alkoxy, or C1-4alkanoyl groups; Ri is trityl, phenyl, diphenylmethyl, phenoxy, phenylthio, piperazinyl, piperidinyl, pyrrolidinyl, morpholinyl, indolinyl, indolyl, benzothienyl, hexamethyleneiminyl, benzofuranyl, tetrahydropyridinyl, quinolinyl, isoquinolinyl, reduced quinolinyl, reduced isoquinolinyl, phenyl-(d-4alkyl)-, phenyl-(Cι-4alkoxy)-, quinohnyl-(Cι-4alkyl)-, isoquinolinyl-(d-4alkyl)-, reduced quniolinyl-(Cι-4alkyl)-, reduced isoquinolinyl-(d-4alkyl)-, benzoyl-(Cι.3alkyl)-, C1. alkyl, or -NH-CH2-R5; any one of which Ri groups may be substituted with halo, d-4alkyl, d-4alkoxy, trifluoromethyl, amino, C1.4alkylamino, di(d-4alkyl) amino, or C2-4alkanoy lamino ; or any one of which Ri groups may be substituted with phenyl, piperazinyl, C3-scycloalkyl, benzyl, d-4alkyl, piperidinyl, pyridinyl, pyrimidinyl, C2-6alkanoylamino, pyrrolidinyl, C2-6alkanoyl, or C i-4alkoxycarbonyl; any one of which groups may be substituted with halo, d.4alkyl, Cι-4alkoxy, trifluoromethyl, amino, Cι-4alkylamino, di(Cι-4alkyl)amino, or C2-4alkanoylamino; or Ri is amino, a leaving group, hydrogen, Cι-4alkylamino, or di(C i .4alkyl) amino ;
R5 is pyridyl, anilino-(d-3alkyl)-, or anilinocarbonyl;
R2 is hydrogen, d-4alkyl, d-4alkylsulfonyl, carboxy- (Ci-3alkyl)-, Cι-3alkoxycarbonyl-(C1.3alkyl)-, or -CO-R6;
R6 is hydrogen,
Figure imgf000054_0001
d shaloalkyl, phenyl, Ci-βalkoxy, Ci-βhydroxy alkyl, amino, Cι-4alkylamino, di(d-4alkyl)amino, or -(CH2VR7; q is zero to 3;
R7 is carboxy, C1.4alkoxycarbonyl, Ci-4alkylcarbonyloxy, amino, Ci-4alkylamino, di(C1-4alkyl)amino, d-ealkoxycarbonylamino, or phenoxy, phenylthio, piperazinyl, piperidinyl, pyrrolidinyl, morpholinyl, indolinyl, indolyl, benzothienyl, benzofuranyl, quinolinyl, phenyl-(d-4alkyl)-, quinolinyl-(Cι-4alkyl)-, isoquinolinyl-(Cι-4alkyl)-, reduced quinolinyl- (C1-4alkyl)-, reduced isoquinolinyl-(d-4alkyl)-, benzoyl- Ci-3alkyl; any one of which aryl or heterocyclic R7 groups may be substituted with halo, trifluoromethyl, Cι-4alkoxy, d-4alkyl, amino,
Figure imgf000054_0002
di(d-4alkyl)amino, or C2-4alkanoy lamino; or any one of which R7 groups may be substituted with phenyl, piperazinyl, C3-βcycloalkyl, benzyl, piperidinyl, pyridinyl, pyrimidinyl, pyrrolidinyl, d-βalkanoyl, or Cι-4alkoxycarbonyl; any of which groups may be substituted with halo, trifluoromethyl, amino, Cι-4alkoxy, Cι-4alkyl, d-4alky lamino, di(C1-4alkyl)amino, or C2-4alkanoy lamino ;
R8 is hydrogen or Ci-βalkyl; R3 is phenyl, phenyl-(d-6alkyl)-, C3-8cycloalkyl, Cs-scycloalkenyl,
Ci-βalkyl, naphthyl, d-salkenyl, or hydrogen; any one or which groups except hydrogen may be substituted with one or two halo, Cι-3alkoxy, d-3alkylthio, nitro, trifluoromethyl, or Cι-3alkyl groups; and
R4 is hydrogen or Cι-3alkyl; with the proviso that if R1 is hydrogen or halo, R3 is phenyl, phenyl-(Cι-6alkyl)-, Cβ-scycloalkyl, Cs-scycloalkenyl, or naphthyl.
A particularly preferred compound of formula (XII) is [N-(2- methoxybenzyl)acetylamino]-3-(lH-indol-3-yl)-2-[N-(2-(4-piperidin-l- yl)piperidin-l-yl)acetylamino]propane; or a pharmaceutically acceptable salt thereof.
The above compounds are only illustrative of NK-1 receptor antagonists which are currently under investigation. As this listing of compounds is not meant to be comprehensive, the use and methods of the present invention may employ any NK-1 receptor antagonist, in particular a NK-1 receptor antagonist which is orally active, long acting and CNS- penetrant. Accordingly the present invention is not strictly limited to any particular structural class of compound.
The preferred compounds of formulae (I), (II), (III) and (IV) will have the 2- and 3-substituents on the morpholine ring in the cis arrangement, the preferred stereochemistry being as shown in the following general formula:
Figure imgf000055_0001
Where the benzyloxy moiety is α-substituted, the preferred stereochemistry of the α-carbon is either (R) when the substituent is an alkyl (e.g. methyl) group or (S) when the substituent is a hydroxyalkyl (e.g. hydroxymethyl) group.
Unless otherwise defined herein, suitable alkyl groups include straight-chained and branched alkyl groups containing from 1 to 6 carbon atoms. Typical examples include methyl and ethyl groups, and straight- chained or branched propyl and butyl groups. Particular alkyl groups are methyl, ethyl, n-propyl, isopropyl, n-butyl, sec-butyl and tert-butyl.
Unless otherwise defined herein, suitable alkenyl groups include straight-chained and branched alkenyl groups containing from 2 to 6 carbon atoms. Typical examples include vinyl and allyl groups.
Unless otherwise defined herein, suitable alkynyl groups include straight-chained and branched alkynyl groups containing from 2 to 6 carbon atoms. Typical examples include ethynyl and propargyl groups.
Unless otherwise defined herein, suitable cycloalkyl groups include groups containing from 3 to 7 carbon atoms. Particular cycloalkyl groups are cyclopropyl and cyclohexyl.
Unless otherwise defined herein, suitable aryl groups include phenyl and naphthyl groups.
A particular aryl-Cχ 6alkyl, e.g. phenyl- d ealkyl, group is benzyl. Unless otherwise defined herein, suitable heteroaryl groups include pyridyl, quinolyl, isoquinolyl, pyridazinyl, pyrimidinyl, pyrazinyl, pyranyl, furyl, benzofuryl, thienyl, benzthienyl, imidazolyl, oxadiazolyl and thiadiazolyl groups.
The term "halogen" as used herein includes fluorine, chlorine, bromine and iodine.
The compounds of use in this invention may have one or more asymmetric centres and can therefore exist as enantiomers and possibly as diastereoisomers. It is to be understood that the present invention relates to the use of all such isomers and mixtures thereof. Suitable pharmaceutically acceptable salts of the NK-1 receptor antagonists of use in the present invention include acid addition salts which may, for example, be formed by mixing a solution of the compound with a solution of a pharmaceutically acceptable non-toxic acid such as hydrochloric acid, fumaric acid, maleic acid, succinic acid, acetic acid, citric acid, tartaric acid, carbonic acid, phosphoric acid or sulphuric acid. Salts of amine groups may also comprise the quaternary ammonium salts in which the amino nitrogen atom carries an alkyl, alkenyl, alkynyl or aralkyl group. Where the compound carries an acidic group, for example a carboxylic acid group, the present invention also contemplates salts thereof, preferably non-toxic pharmaceutically acceptable salts thereof, such as the sodium, potassium and calcium salts thereof.
Suitable pharmaceutically acceptable salts of the antipsychotic agents used in combination with a NK-1 receptor antagonist according to the present invention include those salts described above in relation to the salts of NK-1 receptor antagonists. The present invention accordingly provides the use of a NK-1 receptor antagonist selected from the compounds of formulae (I), (II), (III), (IV), (V), (VI), (VII), (VIII), (IX), (X), (XI) and (XII) for the manufacture of a medicament for the treatment or prevention of aggressive behaviour.
The present invention also provides a method for the treatment or prevention of aggressive behaviour, which method comprises administration to a patient in need of such treatment of an effective amount of a NK-1 receptor antagonist selected from the compounds of formulae (I), (II), (III), (IV), (V), (VI), (VII), (VIII), (IX), (X), (XI) and (XII). In a further aspect of the present invention, there is provided a pharmaceutical composition for the treatment or prevention of aggressive behaviour comprising a NK-1 receptor antagonist selected from the compounds of formulae (I), (II), (III), (IV), (V), (VI), (VII), (VIII), (IX), (X), (XI) and (XII), together with at least one pharmaceutically acceptable carrier or excipient. Preferably the compositions according to the present invention are in unit dosage forms such as tablets, pills, capsules, powders, granules, solutions or suspensions, or suppositories, for oral, parenteral or rectal administration^ by inhalation or insufflation or administration by transdermal patches or by buccal cavity absorption wafers.
For preparing solid compositions such as tablets, the principal active ingredient is mixed with a pharmaceutical carrier, e.g. conventional tableting ingredients such as corn starch, lactose, sucrose, sorbitol, talc, stearic acid, magnesium stearate, dicalcium phosphate or gums, and other pharmaceutical diluents, e.g. water, to form a solid preformulation composition containing a homogeneous mixture of a compound of the present invention, or a non-toxic pharmaceutically acceptable salt thereof. When referring to these preformulation compositions as homogeneous, it is meant that the active ingredient is dispersed evenly throughout the composition so that the composition may be readily subdivided into equally effective unit dosage forms such as tablets, pills and capsules. This solid preformulation composition is then subdivided into unit dosage forms of the type described above containing from 0.1 to about 500 mg of the active ingredient of the present invention. The tablets or pills of the novel composition can be coated or otherwise compounded to provide a dosage form affording the advantage of prolonged action. For example, the tablet or pill can comprise an inner dosage and an outer dosage component, the latter being in the form of an envelope over the former. The two components can be separated by an enteric layer which serves to resist disintegration in the stomach and permits the inner component to pass intact into the duodenum or to be delayed in release. A variety of materials can be used for such enteric layers or coatings, such materials including a number of polymeric acids and mixtures of polymeric acids with such materials as shellac, cetyl alcohol and cellulose acetate.
The liquid forms in which the novel compositions of the present invention may be incorporated for administration orally or by injection include aqueous solutions, suitably flavoured syrups, aqueous or oil suspensions, and flavoured emulsions with edible oils such as cottonseed oil, sesame oil, coconut oil, peanut oil or soybean oil, as well as elixirs and similar pharmaceutical vehicles. Suitable dispersing or suspending agents for aqueous suspensions include synthetic and natural gums such as tragacanth, acacia, alginate, dextran, sodium carboxymethylcellulose, methylcellulose, polyvinyl-pyrrolidone or gelatin.
Preferred compositions for administration by injection include those comprising a NK-1 receptor antagonist as the active ingredient, in association with a surface -active agent (or wetting agent or surfactant) or in the form of an emulsion (as a water-in-oil or oil-in- water emulsion). Suitable surface -active agents include, in particular, non-ionic agents, such as polyoxyethylenesorbitans (e.g. Tween™ 20, 40, 60, 80 or 85) and other sorbitans (e.g. Span™ 20, 40, 60, 80 or 85). Compositions with a surface -active agent will conveniently comprise between 0.05 and 5% surface-active agent, and preferably between 0.1 and 2.5%. It will be appreciated that other ingredients may be added, for example mannitol or other pharmaceutically acceptable vehicles, if necessary.
Suitable emulsions may be prepared using commercially available fat emulsions, such as Intralipid™, Liposyn™, Infonutrol™, Lipofundin™ and Lipiphysan™. The active ingredient may be either dissolved in a pre- mixed emulsion composition or alternatively it may be dissolved in an oil (e.g. soybean oil, safflower oil, cottonseed oil, sesame oil, corn oil or almond oil) and an emulsion formed upon mixing with a phospholipid (e.g. egg phospholipids, soybean phospholipids or soybean lecithin) and water. It will be appreciated that other ingredients may be added, for example glycerol or glucose, to adjust the tonicity of the emulsion. Suitable emulsions will typically contain up to 20% oil, for example, between 5 and 20%. The fat emulsion will preferably comprise fat droplets between 0.1 and l.Oμm, particularly 0.1 and 0.5μm, and have a pH in the range of 5.5 to 8.0. Compositions for inhalation or insufflation include solutions and suspensions in pharmaceutically acceptable, aqueous or organic solvents, or mixtures thereof, and powders. The liquid or solid compositions may contain suitable pharmaceutically acceptable excipients as set out above. Preferably the compositions are administered by the oral or nasal respiratory route for local or systemic effect. Compositions in preferably sterile pharmaceutically acceptable solvents may be nebulised by use of inert gases. Nebulised solutions may be breathed directly from the nebulising device or the nebulising device may be attached to a face mask, tent or intermittent positive pressure breathing machine. Solution, suspension or powder compositions may be administered, preferably orally or nasally, from devices which deliver the formulation in an appropriate manner.
Compositions of the present invention may also be presented for administration in the form of trans-dermal patches using conventional technology. The compositions may also be administered via the buccal cavity using, for example, absorption wafers.
Compositions in the form of tablets, pills, capsules or wafers for oral administration are particularly preferred.
The present invention further provides a process for the preparation of a pharmaceutical composition comprising a NK-1 receptor antagonist and an antipsychotic agent, which process comprises bringing a NK-1 receptor antagonist and an antipsychotic agent, into association with a pharmaceutically acceptable carrier or excipient.
When administered in combination, either as a single or as separate pharmaceutical composition(s), the NK-1 receptor antagonist and an antipsychotic agent are presented in a ratio which is consistent with the manifestation of the desired effect. In particular, the ratio by weight of the NK-1 receptor antagonist and the antipsychotic agent will suitably be between 0.001 to 1 and 1000 to 1, and especially between 0.01 to 1 and 100 to l. A minimum dosage level for the NK-1 receptor antagonist is about
5mg per day, preferably about lOmg per day and especially about 20mg per day. A maximum dosage level for the NK-1 receptor antagonist is about 1500mg per day, preferably about lOOOmg per day and especially about 500mg per day. The compounds are administered one to three times daily, preferably once a day. A minimum dosage level for the antipsychotic agent will vary depending upon the choice of agent, but is typically about 0.5mg per day for the most potent compounds or about 20mg per day for less potent compounds. A maximum dosage level for the antipsychotic agent is typically 30mg per day for the most potent compounds or 200mg per day for less potent compounds. The compounds are administered one to three times daily, preferably once a day.
It will be appreciated that the amount of the NK-1 receptor antagonist required for use in the treatment or prevention of aggressive behaviour will vary not only with the particular compounds or compositions selected but also with the route of administration, the nature of the condition being treated, and the age and condition of the patient, and will ultimately be at the discretion of the patient's physician or pharmacist.
When used in combination, it will be appreciated that the amount of the NK-1 receptor antagonist and the antipsychotic agent required for use in the treatment or prevention of aggressive behaviour will vary not only with the particular compounds or compositions selected but also with the route of administration, the nature of the condition being treated, and the age and condition of the patient, and will ultimately be at the discretion of the patient's physician or pharmacist.
The compounds of formulae (I), (II), (III), (IV), (V), (VI), (VII), (VIII), (IX), (X), (XI) and (XII) may be prepared by the methods described in EP-A-0 577 394 (or WO 95/16679), WO 95/18124, WO 95/23798, WO 96/05181, EP-A-0 436 334, WO 93/21155, EP-A-0 591 040, EP-A-0 532 456, EP-A-0 443 132, WO 92/17449, WO 95/08549 and WO 95/14017, respectively. Particularly preferred NK-1 receptor antagonists of the formulae (I), (II), (III), (IV), (V), (VI), (VII), (VIII), (IX), (X), (XI) and (XII) for use in the present invention are compounds which are potent NK-1 receptor antagonists, i.e. compounds with an NK-1 receptor affinity (ICso) of less than lOnM.
A particularly preferred class of NK-1 receptor antagonist of use in the present invention are those compounds which are orally active, long acting and CNS-penetrant. Such compounds may be identified using the pharmacological assays described hereinafter. The use of this sub-class of NK-1 antagonists in the treatment or prevention of aggressive behaviour represents a further aspect of the present invention.
Thus, the present invention provides the use of a CNS penetrant NK-1 receptor antagonist in an oral, once-a-day medicament for the treatment of aggressive behaviour. The compounds of this class advantageously exhibit a rapid onset of action and a reduced side-effect profile when compared against conventional treatments of aggressive behaviour.
In particular, the present invention provides a means for the identification of NK-1 receptor antagonists which would be especially effective in an oral once-a-day medicament for the treatment of aggressive behaviour.
The exceptional pharmacology of the class of orally active, long acting, CNS-penetrant NK-1 receptor antagonists (as hereinafter defined) of use in the present invention enables the treatment of aggressive behaviour, without the need for concomitant therapy and in particular, - without the need for concomitant use of antipsychotic agents.
Furthermore, the exceptional pharmacology of the class of NK-1 receptor antagonists of use in the present invention results in a rapid onset of action. The present invention accordingly provides the use of an orally active, long acting, CNS-penetrant NK-1 receptor antagonist (as hereinafter defined) for the manufacture of a medicament adapted for oral administration for the treatment or prevention of aggressive behaviour.
The present invention also provides a method for the treatment or prevention of aggressive behaviour, which method comprises the oral administration to a patient in need of such treatment of an effective amount of an orally active, long acting, CNS-penetrant NK-1 receptor antagonist (as hereinafter defined).
In a further aspect of the present invention, there is provided an oral pharmaceutical composition for the treatment of aggressive behaviour which comprises an orally active, long acting, CNS-penetrant NK-1 receptor antagonist (as hereinafter defined), together with a pharmaceutically acceptable carrier or excipient.
There exists a patient population in whom aggressive behaviour is inadequately treated with antipsychotic agents. Furthermore, some patients may be adversely affected by the side-effects of antipsychotic agents such that the use of an antipsychotic agent, alone or in combination with a NK-1 receptor antagonist, would be undesirable.
The present invention accordingly provides the use of an orally active, long acting, CNS-penetrant NK-1 receptor antagonist for the manufacture of a medicament adapted for oral administration for the treatment or prevention of aggressive behaviour in a patient who is non- responsive to antipsychotic agents or for whom antipsychotic agents are is contraindicated.
The present invention also provides a method for the treatment or prevention of aggressive behaviour in a patient who is non-responsive to antipsychotic agents or for whom antipsychotic agents are is contraindicated, which method comprises oral administration to a patient in need of such treatment of an effective amount of an orally active, long acting, CNS-penetrant NK-1 receptor antagonist. Preferred NK-1 receptor antagonists for use in the present invention as orally active, long acting, CNS-penetrant NK-1 receptor antagonists are selected from the classes of compounds described in European Patent Specification No. 0 577 394, and International Patent Specification Nos. 95/08549, 95/18124, 95/23798 and 96/05181, and International Patent Application No. PCT/GB97/01630. The preparation of such compounds is fully described in the aforementioned publications. Thus, further particularly preferred NK-1 receptor antagonists of use in the present invention include:
2-(S)-(3,5-bis(trifluoromethyl)benzyloxy)-3(S)-(4-fluorophenyl)-4-(3-(5-oxo- lH,4H-l,2,4-triazolo)methyl)morpholine; 2-(R)-(l-(R)-(3,5-bis(trifluoromethyl)phenyl)ethoxy)-4-(3-(5-oxo-lH,4H- l,2,4-triazolo)methyl)-3-(S)-phenyl-morpholine; 2-(S)-(3,5-bis(trifluoromethyl)benzyloxy)-4-(3-(5-oxo-lH,4H- 1,2,4- triazolo)methyl)-3-(S)-phenyl-morpholine; 2-(R)-(l-(R)-(3,5-bis(trifluoromethyl)phenyl)ethoxy)-3-(S)-(4-fluorophenyl)- 4-(3-(5-oxo-lH,4H-l,2,4-triazolo)methyl)morpholine;
2-(R)-(l-(R)-(3,5-bis(trifluoromethyl)phenyl)ethoxy)-4-(5-(N,N- dimethylamino)methyl-l,2,3-triazol-4-yl)methyl-3-(S)-phenylmorpholine; 2-(R)-(l-(R)-(3,5-bis(trifluoromethyl)phenyl)ethoxy)-4-(5-(N,N- dimethylamino)methyl-l,2,3-triazol-4-yl)methyl-3-(S)-(4- fluorophenyl)morpholine;
2-(R)-(l-(R)-(3,5-bis(trifluoromethyl)phenyl)ethoxy)-3-(S)-(4-fluorophenyl)- 4-(3-(4-monophosphoryl-5-oxo-lH-l,2,4-triazolo)methyl)morpholine; 2-(R)-(l-(R)-(3,5-bis(trifluoromethyl)phenyl)ethoxy)-3-(S)-(4-fluorophenyl)- 4-(3-(l-monophosphoryl-5-oxo-lH-l,2,4-triazolo)methyl)morphohne; 2-(R)-(l-(R)-(3,5-bis(trifluoromethyl)phenyl)ethoxy)-3-(S)-(4-fluorophenyl)- - 4-(3-(2-monophosphoryl-5-oxo-lH-l,2,4-triazolo)methyl)morpholine; 2-(R)-(l-(R)-(3,5-bis(trifluoromethyl)phenyl)ethoxy)-3-(S)-(4-fluorophenyl)- 4-(3-(5-oxyphosphoryl-lH-l,2,4-triazolo)methyl)morp holine; 2-(S)-(l-(R)-(3,5-bis(trifluoromethyl)phenyl)ethoxy)-3-(S)-(4-fluorophenyl)- 4-(3-(l-monophosphoryl-5-oxo-4H-l,2,4-triazolo)methyl)morpholine; 2-(R)-(l-(R)-(3,5-bis(trifluoromethyl)phenyl)ethoxy)-4-(4-N,N- dimethylaminobut-2-yn-yl)-3-(S)-(4-fluorophenyl)morpholine; (3S,5R,6S)-3-[2-cyclopropoxy-5-(trifluoromethoxy)phenyl-l-oxa-7-aza- spiro[4.5]decane; (3R,5R,6S)-3-[2-cyclopropoxy-5-(trifluoromethoxy)phenyl-l-oxa-7-aza- spiro[4.5]decane; or a pharmaceutically acceptable salt thereof.
Full descriptions of the preparation of the NK-1 receptor antagonists may be found in the references cited herein. Two compounds of use as orally active, long acting, CNS penetrant
NK-1 receptor antagonists in the present invention which are described in International Patent Application No. PCT/GB97/01630 may be prepared according to the following methods:
PREPARATION 1
(2<S)-l-^βrt-Butoxycarbonyl-2-phenylpiperidin-3-one
Dimethyl sulfoxide (20.80ml, 22.90g, 29.3mmol) in dichloromethane (75ml) was added dropwise to a cooled (-70°C) solution of oxalyl chloride (13.95ml, 20.30g, 160mmol) in dichloromethane (350ml). The mixture was stirred at -70°C for 15 minutes, then (2S,3S -l-ter£-butoxycarbonyl-3- hydroxy-2-phenylpiperidine (prepared by the method described in European Patent Specification number 0 528 495-A; 36.91g, 133mmol) in dichloromethane (150ml) was added dropwise. The mixture was stirred at -70 °C for 20 minutes, then allowed to warm to -30°C. The mixture was cooled to -50 °C and triethylamine (55.95ml, 40.45g, 400mmol) was added βlowly. The mixture was allowed to warm to 0°C and diluted with ice- cooled dichloromethane (250ml). The mixture was washed with ice cold aqueous citric acid solution (5%, 2x300ml) and water (300ml), dried (MgSO4), and the solvent was evaporated under reduced pressure to give the title compound as a yellow oil (42.3g), which was used immediately without further purification. Η NMR (250MHz, CDC13) δ 7.5-7.3 (5H, m), 5.8 (IH, br s), 4.2 (IH, br s), 3.4 (IH, m), 2.6 (2H, m), 2.0 (2H, ), and 1.54 (9H, s).
PREPARATION 2 (2S,3i?)-l-ter^Butoxycarbonyl-3-hvdroxy-3-(2-methylene-3- phenoχypropyl)-2-phenylpiperidine
A solution of 3-(chloromagnesio)-2-(phenoxymethyl)-l-propene in THF (0.91M, 3ml) (Louw et. al, Tetrahedron, 48, 6087-6104, 1992, prepared from 2.74mmol of 3-chloro-2-(phenoxymethyl)-l-propene) was slowly added to a solution of (2<S)-l-ter£-butoxycarbonyl-2-phenylpiperidin- 3-one (Preparation 1) in THF (3ml). The mixture was stirred at room temperature for 1 hours, then saturated aqueous ammonium chloride (20ml) was added and the mixture was extracted with ethyl acetate (20ml). The organic phase was washed with brine, dried (MgSO4) and the solvent was evaporated under reduced pressure . The residue was purified by column chromatography on silica gel, eluting with hexane/ethyl acetate (100:0 increasing to 80:20) to give the title compound. Η NMR (360MHz, CDC13) δ 7.48 (2H, d, =6.9 Hz), 7.35-7.2 (6H, m), 6.9-6.88 (3H, m), 5.4 (IH, s), 5.15 (2H, d, =13.7 Hz), 4.61 (2H, s), 4.11 (2H, m), 3.17 (IH, m), 2.66 and 2.59 (2H, AB d, =14.0 Hz), 1.95 (2H, m), 1.79 (2H, m), and 1.36 (9H, s). m/z (ES+) 424 (M+l).
PREPARATION 3
(5i?,6)S)-3-Methylene-6-phenyl-l-oxa-7-(^βrf-butoxycarbonyl)aza- spiro[4.5]decane
To a cooled(-80 °C) solution of (2S,3R)-l-ter£-butoxycarbonyl-3- hydroxy-3-(2-methylene-3-phenoxypropyl)-2-phenylpiperidine (Preparation 2, 1.53g, 3.62mmol) in THF (20ml) was added n-butyl lithium (2.5M in hexanes, 1.45ml, 3.62mmol) followed by a solution of zinc chloride (0.5M in THF, 7.24ml, 3.62mmol). The solution was allowed to warm to room temperature and tetrakis(triphenylphosphine)palladium (0) (0.23g, 0.2mmol) was added. The mixture was degassed with bubbling nitrogen and heated under reflux for 16 hours. The mixture was cooled and the solvent was evaporated under reduced pressure. The residue was partitioned between ethyl acetate and 2M sodium hydroxide. The organic phase was washed with saturated brine, dried (MgSO4) and purified by chromatography on a column containing silica gel (eluting with hexane containing increasing proportions of ethyl acetate between 0% to 5%). Evaporation of the fractions gave (6S,5R)-3-methylene-6-phenyl-l-oxa-7- (tert-butoxycarbonyl)aza-spiro[4.5]decane. Η NMR (360MHz, CDC13) δ 7.58 (2H, d, =8.4 Hz), 7.32-7.21 (3H, m), 5.23 (IH, s), 5.06 (IH, m), 4.97 (IH, m), 4.39 (2H, AB d, =13.3 Hz), 3.99 (IH, dd, =13.3, 4.48 Hz), 2. 83 (IH, ABd =15.5 Hz), 2.7 (lH,td =12.5, 3.93 Hz), 2.5 (IH, ABd, =15.4 Hz), 2.15 (2H, td, =12., .4 Hz), 1.69 (2H, m), and 1.46 (9H,s). m/z (ES+) 329 (M+2H-tBuOCO).
PREPARATION 4 (5.R,6-Sl)-3-Keto-6-phenyl-l-oxa-7-(^gr^-butoxycarbonyl)aza-spiror4.51decane Through a cooled (-80 °C) solution of (5#,6S)-3-methylene-6-phenyl- l-oxa-7-( er£-butoxycarbonyl)aza-spiro[4.5]decane (Preparation 3; 0.665g) in dichloromethane (5ml) and methanol (5ml) was bubbled a mixture of ozone and oxygen for 45 minutes. After the solution had been purged with nitrogen, dimethyl sulphide (0.5ml) was added and then stirred under nitrogen at room temperature for 16 hours. The solvent was removed in υacuo and the residue partitioned between ethyl acetate and water. The organic phase was dried (MgSO4), evaporated and the residue purified by " chromatography on a column containing silica gel (eluting with hexane containing increasing proportions of ethyl acetate between 0% to 10%). Evaporation of the fractions gave the title compound. Η NMR (250MHz, CDCI3) δ 7.58 (2H, d, =6.2 Hz), 7.37-7.26 (3H, m), 5.3 (IH, s), 4.15 and 4.09 (2H, AB d, =17.4 Hz), 3.97 (IH, m), 2.80 (IH, td, =12.9, 4.0 Hz), 2.74 and 2.48 (2H, ABd, =7=18.1 Hz), 2.29 (2H, m), 1.88-1.63 (2H, m), and 1.44 (9H, s). m/z (ES+) 332 (M+l).
PREPARATION 5 (5.R.6S)-3-Trifluoromethylsulfonyloxy-6-phenyl-l-oxa-7-(ter^- butoxycarbonvDaza-spiro[4.51dec-3-ene
To a cooled (-80 °C) solution of 1M sodium hexamethyldisilazide (0.38ml, 0.38mmol) in THF was added a solution of (5i?,6S)-3-keto-6- phenyl-l-oxa-7-(terf-butoxycarbonyl)aza-spiro[4.5]decane (Preparation 4; O.lOδmg, 0.319mmol) in THF (3ml). The solution was stirred for 1 hours at -80°C then a solution of 2-[N,N-bis(trifluoromethylsulfonyl)amino]-5- chloropyridine (0.163g, 0.415mmol) in THF (3ml) was added. The solution was stirred at -80°C for 30 minutes then at room temperature for 30 minutes before being quenched by addition of saturated ammonium chloride solution and ethyl acetate. The dried (MgSO4) organic phase was purified by chromatography on a column containing silica gel (eluting with hexane containing increasing proportions of ethyl acetate between 0% to 5%). Evaporation of the fractions gave the title compound. Η NMR (360MHz, CDCls) δ 7.4 (2H, d, J=1.3 Hz), 7.3-7.22 (3H, m), 6.01 (IH, t, =2.13 Hz), 5.13 (IH, s), 4.56 and 4.26 (2H, ABdd, =12.4, 1.97 Hz),4.10 (IH, dt, =12.6, 4.22 Hz), 3.00 (IH, m), 2.28-2.04 (2H, m), 1.88-1.76 (2H, m), and 1.37 (9H, s). m/z (ES+) 464 (M+l).
PREPARATION 6 (5R,6<g)-3-Trimethylstannyl-6-phenyl-l-oxa-7-(ter^-butoxycarbonyl)aza- spiro|"4.5]dec-3-ene
To a degassed solution of (5i?,6<S)-3-trifluoromethylsulfonyloxy-6- phenyl-l-oxa-7-(terf-butoxycarbonyl)aza-spiro[4.5]dec-3-ene (Preparation
5; 0.482g, 1.04mmol), lithium chloride (0.264g, 6.25mmol), lithium carbonate (0.076g) and hexamethyl distannane(0.96g, 2.9mmol) in THF
(10ml) was added triphenylphosphine palladium (0) (0.06g). The solution was degassed and then heated at 60°C for 5 hours under nitrogen. Water (20ml) and ethyl acetate (20ml) were added and the dried organic phase was purified by chromatography on a column containing silica gel (eluting with hexane containing increasing proportions of ethyl acetate between 0% to 5%). Evaporation of the fractions gave the title compound as a crystalline solid. Η NMR (360MHz, CDC13) δ 7.25 (2H, d, =7.3 Hz), 7.1- 7.0 (3H, m), 5.83 (IH, t, =2.5 Hz), 4.78 (IH, s), 4.48 and4.02 (2H, dd, =12.9, 2.3 Hz), 3.96 (IH, dd, =6.16, 13.4 Hz), 2.95 (IH, td, =13.3, 4.5 Hz), 1.84 (IH, m), 1.68 (IH, m), 1.60 (2H, m), 1.19 (9H, s), and 0.0 (6H, s).
PREPARATION 7 (2S.3jR)-l-ter^-Butoxycarbonyl-3-(3-hydroxypropyn-l-yl)-2-phenylpiperidin- 3-ol
O-Trimethylsilylpropargyl alcohol (24.51ml, 20.47g, 160ml) was added slowly to a cooled (-10°C) solution of ethylmagnesium bromide (IM in tetrahydrofuran, 160ml, 160mmol). The mixture was stirred at 0°C for 20 minutes, then at room temperature for 2 hours. The mixture was cooled to -10°C and a solution of (2<S)-l-£er£-butoxycarbonyl-2- phenylpiperidin-3-one (Preparation 1; 42.3g) in tetrahydrofuran (200ml) was added dropwise over 30 minutes. (Internal temperature below -5°C). The mixture was stirred at room temperature for 14 hours, poured into water (300ml) and saturated aqueous ammonium chloride (300ml) and extracted with ethyl acetate (2x300ml). The combined organic fractions were washed with brine (300ml), dried (MgSO4) and the solvent was evaporated under reduced pressure. The residue was dissolved in ethyl acetate (500ml) and a solution of tetrabutylammonium fluoride (IM in THF, 160ml, 160mmol) was added dropwise. The mixture was stirred at room temperature for 30 minutes, water (300ml) was added, and the layers were separated. The aqueous layer was extracted with ethyl acetate (2x300ml) and the combined organic fractions were washed with water (300ml) and brine (300ml), dried (MgSO4) and the solvent was evaporated under reduced pressure to give the crude title compound as an orange oil (45g). The crude material was purified by flash column chromatography on silica gel, eluting with hexane/ethyl acetate (90:10 increasing to 25:75) to give the title compound as an amber oil (32.2g). *H NMR (CDCI3) δ 7.53-7.55 (2H, m), 7.19-7.35 (3H, m), 5.56 (IH, s), 4.27 (2H, s), 3.99-4.03 (IH, m), 3.25 (IH, br s), 2.77-2.81 (IH, m), 2.77 (IH, br s), 2.12-2.20 (IH, m), 1.91-1.99 (2H, m), 1.77-1.83 (IH, m), and 1.39 (9H, s).
PREPARATION 8 2-Bromo-4-(trifluoromethoxy)phenol
To a cooled (0 °C) solution of 4-trifluoromethoxyphenol (35.6g, 0.2mol) in chloroform (280ml) was added dropwise a solution of bromine (32g, 0.2mol) in chloroform (50ml). The solution was stirred at 0°C for 1 hour and at room temperature for 2 hours. Dichloromethane (200ml) and water (400ml) ware added and the organic phase was washed further with water(400ml), brine (200ml) and dried (MgSO4). The solvent was removed and the residue was purified by distillation at reduced pressure to give the title compound. Η NMR (250MHz, CDCI3) δ 7.38 (IH, d, =2.1 Hz), 7.13 (IH, dd, J=9.1, 2.1 Hz), 7.03 (IH, d, =9.1 Hz), and 5.53 (IH, s).
PREPARATION 9 2-Benzyloxy-5-(trifluoromethoxy)bromobenzene
2-Bromo-4-(trifluoromethoxy)phenol (Preparation 8; 5g, 20mmol) was dissolved in N,N-dimethylformamide (60ml), and potassium carbonate (5.4g, 40mmol) was added, followed by benzyl bromide (3.5ml, 30mmol), and the reaction was stirred at ambient temperature for 15 hours. The reaction was diluted with water (150ml) and extracted into ethyl acetate (3x60ml). The combined organic fractions were washed with water (100ml), brine (100ml), dried (MgSO4) and evaporated in vacuo. Purification on silica, eluting with 2% and 5% ethyl acetate in hexane gave the title compound as a clear oil (6.7g, 96%). Η NMR (250MHz, CDCI3) δ 5.47 (2H, s), 7.23 (IH, d, =9 Hz), 7.43 (IH, dd J=8.2, 2.9 Hz), and 7.75 (6H, m).
PREPARATION 10 -(25'.3ig)-l-tert,-Butoxycarbonyl-3-(3-hvdroxyprop-l-en-l-ylV2- phenylpiperidin-3-ol
Palladium on calcium carbonate, poisoned with lead (Lindlar catalyst, 2g) was added to a solution of (2S,3R)-l-£er£-butoxycarbonyl-3-(3- hydroxypropyn-lyι)-2-phenylpiperidin-3-ol (Preparation 7; 32g, 96.6mmol) in ethyl acetate (300ml) and the mixture was stirred under hydrogen (1 atmosphere) for 4 hours. The mixture was filtered and the solvent was evaporated under reduced pressure to give the title compound as an oil (32g, 100%). Ή NMR (360MHz, CDC13) δ 7.42 (2H, d, =7.6 Hz), 7.35-7.25 (3H, m), 5.83 (IH, d, 12.3 Hz), 5.68 (IH, dt, =12.3, 6.0 Hz), 5.06 (IH, s), 4.27 (IH, m), 4.12 (2H, m), 3.32 (IH, m), 3.13 (IH, s), 2.28 (IH, t, J=5.9 Hz), 2.02 (IH, m), 1.92-1.78 (3H, m), and 1.32 (9H, s). m/z (ES+) 334 (M+l).
PREPARATION 11 (5R.6)S)-6-Phenyl-l-oxa-7-(ter^-butoxycarbonyl)aza-spiror4.51dec-3-ene Diethylazodicarboxylate (18.2ml, llδmmol) in THF (100ml) was added dropwise to a solution of -(2S,3R)-l-ter£-butoxycarbonyl-3-(3- hydroxyprop-l-en-l-yl)-2-phenylpiperidin-3-ol (Preparation 10; 32g, 96mmol) and triphenylphosphine (30.2g, llδmmol) in THF (700ml). The mixture was stirred at 0°C for 30 minutes then at room temperature for 1.5 hours. The solvent was evaporated under reduced pressure and the residue was purified by flash column chromatography on silica gel, eluting with hexane/ethyl acetate (95:δ increasing to 80:20) to give the title compound as a colorless solid (23.4g, 77%). Η NMR (CDCls) δ 7.4δ (2H, d, =7.4 Hz), 7.27 (2H, t, =7.4 Hz), 7.20 (IH, t, =7.4 Hz), 6.03 (IH, dt, =6.1, 2.0 Hz), δ.68 (IH, dt, =6.1, 2.0 Hz), δ.06 (IH, s), 4.61 (IH, dt, =13.1, 2.0 Hz), 4.32 (IH, dt, =13.1, 2.0 Hz), 4.08 (IH, m), 3.05 (IH, m), 2.0δ (IH, m), 1.75 (3H, m), and 1.37 (9H, s). m/z (ES+) 316 (M+l).
PREPARATION 12
5 2-Benzyloxy-δ-(trifluoromethoxy)benzene
Benzyl bromide (66.17ml, 95.35g, O.δβmol) was added to a mixture of 4-(trifluoromethoxy)phenol (90.26g, O.δlmol) and potassium carbonate (140.97g, 1.2mol) in dimethylformamide (160ml) and the mixture was stirred at room temperature for 72 hours. The mixture was poured into
10 water (l.δ 1) and extracted with ethyl acetate (3xδ00ml). The combined organic fractions were washed with aqueous sodium carbonate (saturated, 500ml), dried (MgSO4) and the solvent was evaporated under reduced pressure to give the title compound as a colorless solid (133. δg, 99%). XH NMR (360MHz, CDC13) δ 7.39 (δH, m), 7.14 (2H, d, =7=9.0 Hz), 6.9δ (2H, d, lδ =9.0 Hz), and δ.Oδ (2H, s).
PREPARATION 13
2-Benzyloxy-δ-(trifluoromethoxy)iodobenzene
Iodine (71.96g, 0.28mol) in chloroform was added dropwise to a
20 mixture of 2-benzyloxy-δ-(trifluoromethoxy)benzene (Preparation 12, 73.06g, 0.27mol) and silver trifluoroacetate (71.δ7g, 0.32mol) in dichloromethane and the mixture was stirred at room temperature for 18 hours. The mixture was filtered through celite, washed with aqueous sodium thiosulfate (δ%, 2x2 1), dried (MgSO4) and the solvent was
2δ evaporated under reduced pressure. The residue was purified by flash " column chromatography on silica gel, eluting with hexane/ethyl acetate, to give the title compound as a colorless oil (108.03g), containing 11% unreacted 2-benzyloxy-δ-(trifluoromethoxy)iodobenzene. Η NMR (360MHz, CDCI3) δ 7.67 (IH, d, =2.8 Hz), 7.40 (δH, m), 7.16 (IH, dd,
30 J=8.9, 2.8 Hz), 6.82 (IH, d, =8.9 Hz), and 5.14 (2H, s). PREPARATION 14
(δR.6<S)-3-(2-Benzyloxy-5-(trifluoromethoxy)phenyl)-6-phenyl-l-oxa-7-(ter^- butoxycarbonyl)aza-spiro|"4.δldec-3-ene
(δΛ,6S)-3-Trimethylstannyl-6-phenyl-l-oxa-7-(ter£- δ butoxycarbonyl)aza-spiro[4.δ]dec-3-ene (Preparation 6; 6.43mmol), lithium chloride (0.163g), benzyloxy-5-(trifluoromethoxy)phenol (Preparation 9; 7.7mmol) in toluene (25ml) was degassed before addition of triphenylphosphine palladium (0) (0.37g). The solution was degassed thoroughly before heating to 110°C for 14 hours. The solution was 0 partitioned between water and ethyl acetate and the dried organic phase was purified by chromatography on a column containing silica gel (eluting with hexane containing increasing proportions of ethyl acetate between 0% to 4%) to give the title compound. Η NMR (360MHz, CDC13) δ 1.33 (9H, s), 1.65 (IH, m), 1.76 (2H, m), 2.08 (IH, m), 3.11 (IH, m), 4.08 (IH, m), 5 4.60 (IH, dd, =12.2 Hz, J=2 Hz), 4.92 (IH, dd, =12.1 Hz, J=1.8 Hz), 5.08 (IH, s), 5.1 (2H, q, =11.5 Hz), 6.6δ (IH, s), 6.94 (2H, d, =8.9 Hz), 7.08 (IH, d, J=9 Hz), 7.18 (2H, t, =8.1 Hz), 7.2δ (3H, m), 7.38 (δH, m).
PREPARATION 15 0 (3S.δ.R.6g -3-(2-Hvdroxy-δ-(trifluoromethoxy)phenyl)-6-phenyl-l-oxa-7- (fer£-butoxycarbonyl)aza-spiro[4.δ1decane
(δi?,6S)-3-(2-Benzyloxy-δ-(trifluoromethoxy)phenyl)-6-phenyl-l-oxa- 7-(ter£-butoxycarbonyl)aza-spiro[4.δ]dec-3-ene (Preparation 14) (3.88g) was dissolved in ethyl acetate (lδml) and methanol (lδml). Palladium δ hydroxide on carbon (l.OOg) was added and the suspension was shaken under a hydrogen atmosphere (δO psi) for 72 hours. The mixture was filtered and the solvent was evaporated under reduced pressure. The residue was purified by medium pressure chromatography on silica gel, eluting with hexane/ethyl acetate (7δ:2δ) to give (3R,5R,6S)-3-(2-hydroxy- 0 5-(trifluoromethoxy)phenyl)-6-phenyl-l-oxa-7-(tert-butoxycarbonyl)aza- spiro[4.5]decane (191mg), Η NMR (2δOMHz, CDCI3) δ 7.70 (2H, d, =7.3 Hz), 7.33 (2H, t, =7.3 Hz), 7.26 (IH, d, =7.3 Hz), 7.0δ (IH, br s), 6.96 (2H, m), 6.82 (IH, d, =9.4 Hz), δ.43 (IH, s), 4.27 (IH, m), 4.01 (IH, m), 3.9δ (IH, m), 3.73 (IH, m), 2.73 (2H, m), 2.33 (IH, m), 1.87-l.δ8 (4H, m); and l.δO (9H, s).and (3S,5R,6S)-3-(2-hydroxy-5-(triβuoromethoxy)phenyl)- δ 6-phenyl-l-oxa-7-(tert-butoxycarbonyl)aza-spiro[4.5]decane (2.3g), Η NMR (360MHz, CDC13) δ 1.38 (9H, s), 1.73 (2H, m), 1.81 (IH, m), 2.18 (2H, m), 2.δ0 (IH, m), 2.81 (IH, m), 3.62 (IH, t, =7.2 Hz), 3.92 (IH, m), 3.98 (IH, d, =13.2 Hz), 4.23 (IH, m), δ.33 (IH, s), 6.7δ (IH, d, =8.δ Hz), 6.94 (2H, m), 7.2δ (IH, m), 7.31 (2H, m), and 7.δδ (2H, d, =7.8 Hz).
10
PREPARATION 16 (3i?.δ.R,6)S)-3-(2-Benzyloxy-δ-(trifluoromethoxy)phenyl)-6-phenyl-l-oxa-7- (fer£-butoxycarbonyl)aza-spiror4.δ1decane
A mixture of 2-benzyloxy-δ-(trifluoromethoxy)iodobenzene lδ (Preparation 13, 21.8g, δδ.2mmol), (δi?,6S)-6-phenyl-l-oxa-7-(ierf- butoxycarbonyl)aza-spiro[4.δ]dec-3-ene (Preparation 11, 7.0g, 22.1mmol), tetra-n-butylammonium chloride (6.18g, 22.2mmol), lithium chloride (9.3δg, 0.22mol) and potassium formate (δ.64g, 67.0mmol) in dimethylformamide (100ml) was degassed with a firestone valve (δ x).
20 Palladium acetate (491mg, 2.2mmol) was added and the mixture was degassed with a firestone valve (δ x). The mixture was stirred at 60°C for lδ hours, then further 2-benzyloxy-δ-(trifluoromethoxy)iodobenzene (Preparation 13, 4.32g, ll.Ommol), potassium formate (2.78g, 33.δmmol) and palladium acetate (260mg, l.lmmol) were added. The mixture was
2δ stirred at 60°C for 22 hours, cooled and filtered. The solvent was evaporated under reduced pressure, water (600ml) was added and the mixture was extracted with ethyl acetate (2x300ml). The combined organic fractions were washed with brine (300ml), dried (MgSO4) and the solvent was evaporated under reduced pressure. The residue was purified
30 by flash column chromatography on silica gel, eluting with hexane/dichloromethane (7δ:2δ increasing to 0:100) then dichloromethane/ethyl acetate (9δ:δ), to give the title compound (9.42g, 73%). iH NMR (360MHz, CDC13) δ 7.δ6 (2H, d, =7=7.7 Hz), 7.40-7.20 (8H, m), 7.14 (IH, d, =7=2.0 Hz), 7.00 (IH, dd, =7=8.9, 2.0 Hz), 6.88 (IH, d, =7=8.9 Hz), δ.30 (IH, s), δ.08 (2H, s), 4.27 (IH, m), 3.97 (IH, m), 3.87 (2H, m), δ 2.78 (IH, m), 2.δ6 (IH, m), 2.1δ (IH, m), 1.96 (IH, m), 1.67 (3H, m), and 1.42 (9H, s).
PREPARATION 17
(3 .δ7g.6Sj-3-(2-Hvdroxy-δ-(trifluoromethoxy)phenyl)-6-phenyl-l-oxa-7-
10 (fer -butoxycarbonyl)aza-spiro|~4.5]decane
Palladium on carbon (10%, 0.59g) was added to a solution of (3i2,572,6jS)-3-(2-benzyloxy-5-(trifluoromethoxy)phenyl)-6-phenyl-l-oxa-7- (teri-butoxycarbonyl)aza-spiro[4.δ]decane (Preparation 16, 6.10g, lO.δmmol) in methanol-water (99:1, 200ml) and the mixture was stirred lδ under hydrogen (δO psi.) for 72 hours. The mixture was filtered, washing with ethanol, and the solvent was evaporated under reduced pressure. The residue was purified by flash column chromatography on silica gel, eluting with dichloromethane/ethyl acetate (99:1 increasing to 90:10) to give the title compound. Η NMR (360MHz, CDCI3) δ 7.70 (2H, d, =7=7.3
20 Hz), 7.33 (2H, t, =7=7.3 Hz), 7.26 (IH, d, =7=7.3 Hz), 7.0δ (IH, br s), 6.96 (2H, m), 6.82 (IH, d, =7=9.4 Hz), δ.43 (IH, s), 4.27 (IH, m), 4.01 (IH, m), 3.9δ (IH, m), 3.73 (IH, m), 2.73 (2H, m), 2.33 (IH, m), 1.87-1.58 (4H, m), and 1.50 (9H, s).
25 PREPARATION 18
" (3S.5-R.6g)-3-r2-(l-Phenylthiocvcloprop-l-yl)oxy-δ- (trifluoromethoxy)phenyll-6-phenyl-l-oxa-7-(ter^-butoxycarbonyl)aza- spiro["4.δ"|decane
(3S,δi?,6S)-3-(2-Hydroxy-δ-(trifluoromethoxy)phenyl)-6-phenyl-l- 30 oxa-7-(£er£-butoxycarbonyl)aza-spiro[4.δ]decane (Preparation lδ) (290mg, O.δ9mmol) was dissolved in toluene (δml) and silver carbonate (179mg, O.βδmmol) was added in one portion. (l-Iodocycloprop-l-yl)phenylsulfide (Cohen T. and Mate J. R., J. Am. Chem. Soc. 1980, 102, 6902) (180mg, O.βδmmol) was then added over one minute at room temperature. The mixture was stirred at δδ°C for 4 hours, then further portions of silver δ carbonate (179mg, 0.6δmmol) and (l-iodocycloprop-l-yl)phenylsulfide (180mg, O.βδmmol) were added. The mixture was stirred at δδ°C for a further 3 hours, cooled, filtered and the solvent was evaporated under reduced pressure. The residue was purified by column chromatography on silica gel, eluting with hexane/ethyl acetate (90:10 increasing to 80:20) to 0 give the title compound as a colourless oil (120mg, 32%). XH NMR
(2δOMHz, CDCI3) δ 7.δδ-7.44 (4H, m), 7.36-7.23 (7H, m), 7.13-7.02 (2H, m), 5.16 (IH, br s), 4.09 (IH, t, =7=6 Hz), 4.03-3.92 (IH, m), 3.67-3.49 (2H, m), 2.94-2.79 (IH, m), 2.26 (IH, dd, =7=7.9, 12.9 Hz), 2.15-2.01 (2H, m), 1.76- 1.59 (3H, m), 1.53-1.45 (4H, m), and 1.36 (9H, s). m/z (ES+) 642 (M+l). 5
PREPARATION 19
(3-R.5-R.6S -3-r2-(l-Phenylthiocvcloprop-l-v oxy-δ-
(trifluoromethoxy)phenyll-6-phenyl-l-oxa-7-(^βrt-butoxycarbonyl)aza- spiro|"4.δ]decane 0 Prepared from (3R,δi2,6S)-3-(2-hydroxy-δ-
(trifluoromethoxy)phenyl)-6-phenyl-l-oxa-7-(terf-butoxycarbonyl)aza- spiro[4.δ]decane (Preparation 17) according to the method of Preparation 18. iH NMR (360MHz, CDCI3) δ 7.δ7 (2H, app. d, =7=7.6 Hz), 7.45 (2H, app. d, =7=7.7 Hz), 7.36-7.19 (7H, m), 7.16-7.06 (2H, m), 5.28 (IH, br s), δ 4.13 (IH, app. t, =7=7.8 Hz), 3.96 (IH, br. d, =7=13 Hz), 3.80-3.60 (2H, m), 2.79 (IH, br. t, =7=13 Hz), 2.δ0 (IH, dd, =7=13, 7.9 Hz), 2.17 (IH, dt, =7=13, 4.6 Hz), 1.80 (IH, dd, =7=12, 9.8 Hz), 1.75-1.38 (7H, m), and 1.44 (9H, s). m/z (ES+) 642 (M+l). PREPARATION 20
('3S'.5i?.6)g)-3-[2-Cyclopropoxy-δ-(trifluoromethoxy)phenyll-6-phenyl-l-oxa- 7-(ter^-butoxycarbonyl)aza-spiro 4.δldecane
Naphthalene (120mg, 0.936mmol) was dissolved in THF (1.5ml) 5 under nitrogen and freshly cut lithium metal (7.0mg, 0.94mmol) was added. The mixture was then sonicated at room temperature for 20 minutes to produce a dark green solution of lithium naphthalenide. This solution was cooled to -78 °C, then (3S,δR,6S)-3-[2-(l-phenylthiocycloprop- 1 -yl)oxy- δ- (trifluoromethoxy)phenyl] -6-phenyl- 1 -oxa- 7- (tert- butoxycarbonyl)aza-spiro[4.δ]decane (Preparation 18) (120mg, 0.187mmol) in THF (O.δml) was added over 1 minute. The reaction mixture was stirred for 30 minutes, then water (δml) and ether (10ml) were added. The layers were separated and the aqueous layer was extracted with ether (10ml). The combined organic fractions were dried (MgSO4) and the δ solvent was evaporated under reduced pressure. The residue was purified by column chromatography on silica gel, eluting with hexane/ethyl acetate (90:10 increasing to 80:20) to give the title compound as a colourless oil (δ8.6mg, 59%). Η NMR (250MHz, CDC13) δ 7.δ8-7.δ2 (2H, m), 7.36-7.17 (4H, m), 7.10-7.01 (2H, m), 5.18 (IH, br s), 4.20 (IH, t, =7=6.7 Hz), 4.0δ-3.9δ 0 (IH, m), 3.76-3.δδ (3H, m), 2.92-2.79 (IH, m), 2.37 (IH, dd, =7=12.9, 7.8 Hz), 2.18-2.06 (2H, m), 1.80-1.67 (3H, m), 1.38 (9H, s), and 0.86-0.73 (4H, m). m/z (ES+) δ34 (M+l).
PREPARATION 21 δ (3i?,δi^,6S)-3-[2-Cvclopropoxy-δ-(trifluoromethoxy)phenyll-6-phenyl-l-oxa-
7-( βr -butoxycarbonyl)aza-spiro[4.δ1decane
Naphthalene (120mg, 0.936mmol) was dissolved in THF (1.5ml) under nitrogen and freshly cut lithium metal (7.0mg, 0.94mmol) was added. The mixture was then sonicated at room temperature for 20 0 minutes to produce a dark green solution of lithium naphthalenide. A solution of (3R,δi?,6S)-3-[2-(l-phenylthiocycloprop-l-yl)oxy-δ- (trifluoromethoxy)phenyl]-6-phenyl-l-oxa-7-(ieri-butoxycarbonyl)aza- spiro[4.δ]decane (Preparation 19, 13δmg, 0.21mmol) in THF (2ml) under nitrogen was cooled to -78°C and the solution of lithium naphthalenide in THF was added dropwise until the intense green colour persisted. The δ reaction was then stirred for one minute, water (δml) was added and the mixture was warmed to room temperature. Ether (10ml) was added and the layers were separated. The aqueous phase was extracted with a further portion of ether (10ml) and the combined organic phases were dried (MgSO4) and the solvent was evaporated under reduced pressure.
10 The residue was purified by column chromatography on silica gel, eluting with hexane/ethyl acetate (δ0:δ0) to give the title compound as a colourless oil (87mg, 78%). Η NMR (360MHz, CDC13) δ 7.δ9 (2H, app. d, =7=7.6 Hz), 7.32 (2H, app. t, =7=7.6 Hz), 7.27-7.18 (2H, m), 7.11-7.03 (2H, m), δ.32 (IH, br s), 4.29-4.21 (IH, m), 3.97 (IH, br. d, =7=13 Hz), 3.83-3.68 (3H, m), 2.76 lδ (IH, dt, =7=13, 4.1 Hz), 2.55 (IH, dd, =7=13, 7.2 Hz), 2.22 (IH, dt, =7=12, 5.2 Hz), 1.85 (IH, dd, =7=13, 9.9 Hz), 1.80-1.63 (3H, m), 1.46 (9H, s), and 0.82- 0.76 (4H, m). m/z (ES+) 534 (M+l).
COMPOUND A
20 (3S,δ7g.65')-3-r2-Cvclopropoxy-δ-(trifluoromethoxy)phenyll-6-phenyl-l-oxa- 7 - aza- spiro [4. δ] decane Hydrochloride
Trifluoroacetic acid (2. δml) was added dropwise to a stirred, cooled 0°C) solution of (3iS,δR,6S)-3-[2-cyclopropoxy-δ-(trifluoromethoxy)phenyl]- 6-phenyl-l-oxa-7-(teri-butoxycarbonyl)aza-spiro[4.δ]decane (Preparation
2δ 20; 492mg, 0.92mmol) in dichloromethane (25ml) and the mixture was stirred at room temperature for 3 hours. The mixture was poured into water (50ml), the pH was adjusted to 10.0 with aqueous sodium hydroxide (4M) and the mixture was extracted with dichloromethane (3x50ml). The combined organic fractions were dried (MgSO4) and the solvent was
30 evaporated under reduced pressure. The residue was purified by flash column chromatography on silica gel, eluting with dichloromethane/methanol/ammonia (aq.) (96:4:0.4 increasing to 94:6:0.6). The residue was dissolved in ethanol (20ml), cooled in ice and ethereal hydrogen chloride (IM, 1.8ml, l.δmmol) was added dropwise. The mixture was stirred at 0°C for δ minutes, then the solvent was evaporated under δ reduced pressure. The residue was crystallized from ether (20ml)/ethanol (O.δml) and the solid was collected and dried in vacuo to give the title compound as a colorless solid (354mg, 89%). m.p. 214-216 °C, Η NMR (500MHz, CD3OD) δ 7.59 (2H, m), 7.52 (3H, m), 7.26 (IH, d, =7=8.9 Hz), 7.03 (IH, dd, =7=8.9, 2.2 Hz), 6.20 (IH, d, =7=2.2 Hz), 4.85 (2H, br s), 4.43 10 (IH, s), 4.19 (IH, t, =7=8.0 Hz), 3.87 (IH, quin, =7=8.0 Hz), 3.76 (IH, m), 3.44 (IH, m), 3.25 (2H, m) 2.29-1.78 (6H, m), 0.80 (2H, m), and 0.66 (2H, m). m/z (ES+) 434 (M+l). Found: C, 61.41; H, 5.51; N, 3.08. C24H26F3NO3.HCI requires: C, 61.34; H, δ.79; N, 2.98%.
lδ COMPOUND B
(3R.δJR.6.S)-3- 2-Cvclopropoxy-δ-(trifluoromethoxy)phenyll-6-phenyl-l-oxa- 7-aza-spiro|~4.δldecane
Prepared from the compound of Preparation 21 according to the method used for Compound A. Η NMR (360MHz, CDCI3) δ 7.δ0-7.42 (2H, 20 m), 7.36-7.26 (3H, m), 7.03 (IH, d, =7=8.9 Hz), 6.9δ (IH, br. d, =7=8.9 Hz), 6.81 (IH, br s), 3.92 (IH, t, =7=7.4 Hz), 3.62-3.δ3 (2H, m), 3.δ0 (IH, s), 3.20 (IH, dd, =7=12, 4.2 Hz), 2.77 (IH, dt, =7=12, 2.8 Hz), 2.30-1.93 (4H, m), 1.87 (IH, br s), 1.71-1.49 (3H, m), 0.76-0.6δ (2H, m), and 0.6δ-0.54 (2H, m). m/z (ES+) 434 (M+l).
25
Particularly preferred NK-1 receptor antagonists of use in the present invention are compounds which are potent NK-1 receptor antagonists, i.e. compounds with an NK-1 receptor affinity (IC50) of less than lOnM, favourably less than 2nM and preferably less than InM. The class of orally active, long acting, CNS-penetrant NK-1 receptor antagonists of use in the present invention is identified using a combination of the following assays:
δ ASSAY 1: NK-1 Receptor binding
NK-1 receptor binding assays are performed in intact Chinese hamster ovary (CHO) cells expressing the human NK-1 receptor using a modification of the assay conditions described by Cascieri et al, =7. Pharmacol. Exp. Ther., 1992, 42, 4δ8. The receptor is expressed at a level
10 of 3xl05 receptors per cell. Cells are grown in monolayer culture, detached from the plate with enzyme-free dissociation solution (Speciality Media Inc.), and washed prior to use in the assay. i25I-Tyr8-substance P (O.lnM, 2000Ci/mmol; New England Nuclear) is incubated in the presence or absence of test compounds (dissolved in δμl dimethylsulphoxide, DMSO) lδ with δxlO4 CHO cells. Ligand binding is performed in 0.2δml of δOmM Tris-HCI, pH7.δ, containing δmM MnCl2, lδOmM NaCl, 0.02% bovine serum albumin (Sigma), δOμg/ml chymostatin (Peninsula), O.lnM phenylmethylsulphonyl fluoride, 2μg/ml pepstatin, 2μg/ml leupeptin and 2.8μg/ml furoyl saccharine. The incubation proceeds at room temperature
20 until equilibrium is achieved (>40 minutes) and the receptor-ligand complex is harvested by filtration over GF/C filters pre-soaked in 0.1% polyethylenimine using a Tomtek 96-well harvester. Non-specific binding is determined using excess substance P (lμM) and represents <10% of total binding.
2δ
ASSAY 2: Gerbil Foot-Tapping
CNS penetrant NK-1 receptor antagonists for use in the present invention can be identified by their ability to inhibit foot tapping in gerbils induced by central infusion of NK-1 receptor agonists such as GR73632
30 based on the method of Rupniak & Williams, Eur. =7. Pharmacol, 1994, 265, 179. Briefly, male or female Mongolian gerbils (3δ-70g) are anaesthetised by inhalation of an isoflurane/oxygen mixture to permit exposure of the jugular vein in order to permit administration of test compounds or vehicle in an injection volume of δml/kg i.v. Alternatively, δ test compounds may be administered orally or by subcutaneous or intraperitoneal routes. A skin incision is then made in the midline of the scalp to expose the skull. A selective NK-1 receptor agonist (e.g. GR73632 (d Ala[L-Pro9,Me-Leu10]-substance P-(7-ll)) is infused directly into the cerebral ventricles (e.g. 3pmol in δμl i.e. v., depending on test substance) by
10 vertical insertion of a cuffed 27 gauge needle to a depth of 4.5mm below bregma. The scalp incision is closed and the animal allowed to recover from anaesthesia in a clear perspex observation box (25cm x 20cm x 20cm). The duration of hind foot tapping is then recorded continuously for approximately δ minutes. lδ
ASSAY 3: Ferret Emesis
Individually housed male ferrets (1.0 -2.δ kg) are dosed orally by gavage with test compound. Ten minutes later they are fed with approximately lOOg of tinned cat food. At 60 minutes following oral
20 dosing, cisplatin (lOmg/kg) is given i.v. via a jugular vein catheter inserted under a brief period of halothane anaesthesia. The catheter is then removed, the jugular vein ligated and the skin incision closed. The ferrets recover rapidly from the anaesthetic and are mobile within 10-20 minutes. The animals are observed continuously during recovery from the
2δ anaesthetic and for 4 hours following the cisplatin injection. The numbers of retches and vomits occurring during the 4 hours after cisplatin administration are recorded by trained observers.
ASSAY 4: Separation-Induced Vocalisation 30 Male and female guinea-pigs pups are housed in family groups with their mothers and littermates throughout the study. Experiments are commenced after weaning when the pups are 2 weeks old. Before entering an experiment, the pups are screened to ensure that a vigorous vocalisation response is reproducibly elicited following maternal separation. The pups are placed individually in an observation cage (δδcm δ x 39cm x 19cm) in a room physically isolated from the home cage for lδ minutes and the duration of vocalisation during this baseline period is recorded. Only animals which vocalise for longer than δ minutes are employed for drug challenge studies (approximately δ0% of available pups may fail to reach this criterion). On test days each pup receives an oral
10 dose or an s.c. or i.p. injection of test compound or vehicle and is then immediately returned to the home cage with its mother and siblings for 30 to 60 minutes before social isolation for lδ minutes as described above. The duration of vocalisation on drug treatment days is expressed as a percentage of the pre-treatment baseline value for each animal. The same lδ subjects are retested once weekly for up to 6 weeks. Between 6 and 8 animals receive each test compound.
As used herein, the term "CNS-penetrant" refers to NK-1 receptor antagonists which are able to inhibit NK-1 receptor antagonist-induced foot-tapping in the gerbil as hereinafter defined.
20 Essentially, hind foot-tapping in the gerbil induced by infusion of the NK-1 receptor agonist, GR73632 (d Ala[L-Pro9,Me-Leui°]-substance P- (7-11)), under anaesthesia, directly into the central ventricles is inhibited when a CNS-penetrant NK-1 receptor antagonist is administered intravenously immediately prior to GR73632 challenge, wherein hind foot-
2δ tapping over a period of five minutes following recovery from the
" anaesthesia is inhibited with an ID5o≤3mg/kg, and preferably with an
Figure imgf000082_0001
In an alternative method, the NK-1 receptor antagonist is administered orally, 1 hour prior to GR73632 challenge, wherein the foot-
30 tapping over a period of five minutes following recovery from anaesthesia is inhibited with an ID5o≤30mg/kg, and preferably with an IDso≤lOmg/kg. CNS-penetrant NK-1 receptor antagonists of use in the present ivnention are also effective in the attenuation of separation-induced vocalisations by guinea-pig pups as hereinafter defined.
Essentially, a vocalisation response in guinea-pig pups is induced by isolation from their mothers and littermates, which response is attenuated when a CNS-penetrant NK-1 receptor antagonist is administered subcutaneously 30 minutes prior to isolation, wherein vocalisations during the first 15 minutes of isolation are attenuated with an IDso≤20mg/kg, preferably with an IDso≤lOmg/kg, and especially with an IDδo≤δmg/kg. In an alternative method, the NK-1 receptor antagonist is administered orally, 4 hours prior to isolation, wherein vocalisations during the first lδ minutes of isolation are attenuated with an IDδo≤20mg/kg, preferably with an IDso≤lOmg/kg, and especially with an
Figure imgf000083_0001
A suitable selection cascade for NKi antagonists of use according to the present invention is as follows:
(i) Determine affinity for human NKi receptor in radioligand binding studies (Assay 1); select compounds with ICso < lOnM, preferably IC5o < 2nM, especially IC5o < InM. 0 (ii) Determine ability of compounds to penetrate CNS by their ability to inhibit foot tapping in gerbils induced by central injection of an NKi agonist (Assay 2); select compounds that inhibit foot tapping with ID50 ≤ 3mg/kg i.v., and preferably ID50 ≤ lmg/kg i.v. when administered immediately prior to central NK1 agonist challenge, or ID50 ≤ 30mg/kg p.o., δ and preferably ID50 ≤ lOmg/kg p.o. 1 hour prior to challenge.
(iii) Determine central duration of action of compounds in gerbil foot tapping assay following intravenous administration 24 hours prior to central NKi agonist challenge; select compounds showing < 25-fold loss of potency compared with ID50 determined in step (ii) above with the proviso 0 that ID50 ≤ lOmg/kg i.v., and preferably < 5mg/kg i.v. after 24 hour pre-treatment. (iv) Determine oral bioavailability of compounds by pharmacokinetic analysis, activity in gerbil foot tapping assay following oral administration and/or by ability to inhibit cisp latin-induced emesis in ferrets (Assay 3); select compounds with ID90 < 3mg/kg p.o., and preferably
Figure imgf000084_0001
Particularly preferred compounds of use in the present invention are identified using steps (i) to (iv) followed by step (v):
(v) Determine activity of compounds in assays sensitive to conventional antipsychotic drugs (inhibition of distress vocalisations in 10 guinea-pig pups (Assay 4)). Select compounds with ID50 ≤ 20mg/kg, and preferably ID50 ≤ lOmg/kg.
Yet further preferred compounds of use in the present invention may be selected from those compounds which satisfy the NK-1 receptor binding criteria of step (i) which, in addition, have < δ-fold shift in lδ affinity when incubated in the presence of human serum albumin (HSA) to show non-specific protein binding.
One example of a NK-1 receptor antagonist of use in the present invention is the compound 2-(R)-(l-(R)-(3,δ-bis(trifluoromethyl)phenyl)- ethoxy)-3-(S)-(4-fluoroρhenyl)-4-(3-(δ-oxo-lH,4H-l,2,4-triazolo)methyl)- 20 morpholine, the preparation of which is described in International Patent Specification No. WO 9δ/16679. In the aforementioned assays, this compound has the following activity:
human NK-1 receptor binding: ICso=0.1nM gerbil foot-tapping (δ mins.): IDso=0.36mg/kg i.v. gerbil foot-tapping (24 hrs.): IDso=0.33mg/kg i.v. ferret emesis: ID9o<3mg/kg p.o.
2δ The following example illustrates pharmaceutical compositions according to the invention. EXAMPLE 1 Tablets containing δ0-300mg of NK-1 antagonist
Amount mg NK-1 antagonist δθ.0 100.0 300.0
Microcrystalline cellulose 80.0 80.0 80.0
Modified food corn starch 80.0 80.0 80.0
Lactose 189.5 139.5 139.5
Magnesium Stearate O.δ O.δ O.δ
The active ingredient, cellulose, lactose and a portion of the corn starch are mixed and granulated with 10% corn starch paste. The δ resulting granulation is sieved, dried and blended with the remainder of the corn starch and the magnesium stearate. The resulting granulation is then compressed into tablets containing δOmg, lOOmg and 300mg of the NK-1 receptor antagonist per tablet.
10 EXAMPLE 2 Parenteral injection
Amount
Active Ingredient 10 to 300mg
Citric Acid Monohydrate 0.7δmg
Sodium Phosphate 4.δmg lδ Sodium Chloride 9mg
Water for injection to 10ml
The sodium phosphate, citric acid monohydrate and sodium chloride are dissolved in a portion of the water. The active ingredient is dissolved 20 υr suspended in the solution and made up to volume.
Pharmaceutical compositions comprising a combination of a NK-1 receptor antagonist and an antipsychotic agent may be prepared with separate active ingredients or with a combination of active ingredients in one composition. In such combined preparations, the ratio of the NK-1 receptor antagonist and the antipsychotic agent will depend upon the choice of active ingredients.
EXAMPLE 3 Tablets containing 50-300mg of NK-1 antagonist and δ-lOmg of haloperidol
Amount mg
NK-1 antagonist 50.0 δθ.0 100.0 100.0 300.0 300.0 haloperidol δ.O 10.0 δ.O 10.0 δ.O 10.0
Microcrystalline cellulose 80.0 80.0 80.0 80.0 80.0 80.0 Modified food corn starch 80.0 80.0 80.0 80.0 80.0 80.0
Lactose 184.5 179.δ 134.5 129.5 134.5 129.5
Magnesium Stearate O.δ 0.5 0.5 0.5 0.5 0.5
EXAMPLE 4 Tablets containing δ0-300mg of NK-1 antagonist and 2δmg of chlorpromazine hydrochloride
Amount mg
NK-1 antagonist δθ.0 100.0 300.0 chlorpromazine hydrochloride 2δ.O 25.0 25.0
Microcrystalline cellulose 80.0 80.0 80.0
Modified food corn starch 80.0 80.0 80.0
Lactose 164.5 114.5 114.5
Magnesium Stearate 0.5 0.5 O.δ
The active ingredients, cellulose, lactose and a portion of the corn starch are mixed and granulated with 10% corn starch paste. The - resulting granulation is sieved, dried and blended with the remainder of the corn starch and the magnesium stearate. The resulting granulation is then compressed into tablets containing δOmg, lOOmg and 300mg of the CNS-penetrant NK-1 receptor antagonist per tablet.

Claims

1. Use of a NK-1 receptor antagonist for the manufacture of a medicament for the treatment or prevention of aggressive behaviour. δ
2. Use of a NK-1 receptor antagonist and an antipsychotic agent for the manufacture of a medicament for the treatment or prevention of aggressive behaviour.
10 3. A pharmaceutical composition for the treatment or prevention of aggressive behaviour comprising a NK-1 receptor antagonist, together with at least one pharmaceutically acceptable carrier or excipient.
lδ 4. A composition according to claim 3 which further comprises an antipsychotic agent.
δ. A product comprising a NK-1 receptor antagonist and an antipsychotic agent as a combined preparation for simultaneous, separate 20 or sequential use in the treatment or prevention of aggressive behaviour.
6. A method for the treatment or prevention of aggressive behaviour, which method comprises administration to a patient in need of such treatment of an effective amount of a NK-1 receptor antagonist.
2δ
7. A method for the treatment or prevention of aggressive behaviour, which method comprises administration to a patient in need of such treatment of an amount of a NK-1 receptor antagonist and an amount of an antipsychotic agent, such that together they give effective
30 relief.
8. A use according to claim 1 or 2, a composition according to claim 3 or 4, a product according to claim δ or a method according to claim 6 or 7 wherein the NK-1 receptor antagonist is a compound of formula I:
Figure imgf000088_0001
δ wherein
Ri is selected from the group consisting of:
(1) Ci-βalkyl, substituted with one or more of the substituents selected from:
(a) heterocycle, wherein the heterocycle is selected from 10 the group consisting of:
(A) benzimidazolyl,
(B) imidazolyl,
(C) isoxazolyl,
(D) isothiazolyl, lδ (E) oxadiazolyl,
(F) pyrazinyl,
(G) pyrazolyl, (H) pyridyl, (I) pyrrolyl,
20 (J) tetrazolyl,
(K) thiadiazolyl, (L) triazolyl, and (M) piperidinyl, and wherein the heterocycle is unsubstituted or substituted with one or 2δ more substituent(s) selected from:
(i) Ci-βalkyl, unsubstituted or substituted with halo, -CF3, -OCH3, or phenyl, (ii) Ci-βalkoxy, (iii) oxo, (iv) thioxo, (v) cyano, δ (vi) -SCHs,
(vii) phenyl, (viii) hydroxy, (ix) trifluoromethyl,
(x) -(CH2)m-NR9Rio, wherein m is 0, 1 or 2, and R9 and Ri° 10 areindependently selected from:
(I) hydrogen,
(II) d-ealkyl,
(III) hydroxyd-βalkyl, and
(IV) phenyl, lδ (xi) -NR9CORi°, wherein R9 and Ri° are as defined above, and
(xii) -CONR9R10, wherein R9 and R10 are as defined above, R2 and R3 are independently selected from the group consisting of: (1) hydrogen; 20 (2) Ci-ealkyl
(3) d-βalkenyl, and (δ) phenyl; X is -O-; R is
Figure imgf000089_0001
R5 is phenyl, unsubstituted or substituted with halo; R6, R7 and R8 are independently selected from the group consisting of: (1) hydrogen, (2) d-ealkyl,
(3) halo, and
(4) -CF3; Y is -O-; and δ Z is hydrogen or d-4alkyl; or a pharmaceutically acceptable salt thereof.
9. A use according to claim 1 or 2, a composition according to claim 3 or 4, a product according to claim δ or a method according to claim 10 6 or 7 wherein the NK-1 receptor antagonist is a compound of formula Ila:
Figure imgf000090_0001
(Ila) wherein:
A1 is fluorine or CF3; lδ A2 is fluorine or CF3;
A3 is fluorine or hydrogen;
R6 is a δ-membered or 6-membered heterocyclic ring containing 2 or 3 nitrogen atoms optionally substituted by
=O, =S or a d-4alkyl group, and optionally substituted by a
20 group of the formula ZNR7R8 where
Z is d-βalkylene or d-βcycloalkylene;
R7 is hydrogen, C1.4alkyl, C3-7cycloalkyl or C3-7cycloalkyld-
4alkyl, or C2-4alkyl substituted by Cι-4alkoxy or hydroxyl; R8 is hydrogen, Cι-4alkyl, C3-7cycloalkyl or C3-7cycloalkylCι- 4alkyl, or U2-4alkyl substituted by one or two substituents selected from d^alkoxy, hydroxyl or a 4, δ or 6 membered heteroaliphatic ring containing one or two heteroatoms δ selected from N, O and S; or R7, R8 and the nitrogen atom to which they are attached form a heteroaliphatic ring of 4 to 7 ring atoms, optionally substituted by a hydroxy group, and optionally containing a double bond, which ring may optionally contain an oxygen or 10 sulphur ring atom, a group S(O) or S(O)2 or a second nitrogen atom which will be part of a NH or NRC moiety where Rc is d- 4alkyl optionally substituted by hydroxy or d-4alkoxy; or R7, R8 and the nitrogen atom to which they are attached form a non-aromatic azabicyclic ring system of 6 to 12 ring lδ atoms; or Z, R7 and the nitrogen atom to which they are attached form a heteroaliphatic ring of 4 to 7 ring atoms which may optionally contain an oxygen ring atom; or a pharmaceutically acceptable salt thereof. 20
10. A use according to claim 1 or 2, a composition according to claim 3 or 4, a product according to claim δ or a method according to claim 6 or 7 wherein the NK-1 receptor antagonist is a compound kof formula III: 2δ
Figure imgf000092_0001
wherein:
R2 and R3 are independently selected from the group consisting of: δ (1) hydrogen,
(2) d-ealkyl,
(3) C2-βalkenyl, and
(4) phenyl;
R6, R7 and R8 are independently selected from the group consisting of: 10 (1) hydrogen,
(2) Ci-ealkyl,
(3) fluoro,
(4) chloro, (δ) bromo, lδ (6) iodo, and
(7) -CF3; Rn, Ri2 and Ri3 are independently selected from the group consisting of:
(1) fluoro,
(2) chloro,
20 (3) bromo, and
(4) iodo; A is unsubstituted l-βalkyl; B is selected from the group consisting of:
Figure imgf000093_0001
Figure imgf000093_0002
Figure imgf000093_0003
p is 0 or 1;
X is selected from: (a) -PO(OH)O" • M+, wherein M+ is a pharmaceutically acceptable monovalent counterion,
(b) -PO(O")2 • 2M+,
(c) -PO(O 2 * D2+, wherein D2+ is a pharmaceutically acceptable divalent counterion, (d) -CH(R )-PO(OH)O" • M\ wherein R4 is hydrogen or Ci-salkyl,
(e) -CH(R4)-PO(O-)2 • 2M+,
(f) -CH(R4)-PO(O-)2 • D2+, (i) -CO-CH2CH2-CO2- • M+,
(j) -CH(CH3)-O-CO-R5, wherein R5 is selected from the group consisting of:
(i) . NH3 M"
0
H. Ϊ
(ϋ) -N?
~0 'OH
(ϋi) 0 C02 " M
Figure imgf000094_0001
CO,
(v) 0
NH0
Figure imgf000094_0002
δ Y is -O-;
Z is hydrogen or Ci-βalkyl; or a pharmaceutically acceptable salt thereof.
11. A use according to claim 1 or 2, a composition according to claim 3 or 4, a product according to claim δ or a method according to claim 6 or 7 wherein the NK-1 receptor antagonist is a compound of formula IVa:
Figure imgf000095_0001
wherein
A1 is fluorine or CF3; A2 is fluorine or CF3; 10 A3 is fluorine or hydrogen;
X is a group of the formula NR6R7 or a C- or N-linked imidazolyl ring;
Y is hydrogen or Cι-4alkyl optionally substituted by a hydroxy group; lδ or a pharmaceutically acceptable salt thereof.
12. A use according to claim 1 or 2, a composition according to claim 3 or 4, a product according to claim δ or a method according to claim 6 or 7 wherein the NK-1 receptor antagonist is a compound of formula V: 20
Figure imgf000096_0001
wherein:
Y is (CH2)n wherein n is an integer from 1 to 4, and wherein any one of the carbon-carbon single bonds in said (CH2)n may optionally be δ replaced by a carbon-carbon double bond, and wherein any one of the carbon atoms of said (CH2)n may optionally be substituted with R4, and wherein any one of the carbon atoms of said (CH2)n may optionally be substituted with R7;
Z is (CH2)m wherein m is an integer from 0 to 6, and wherein any
10 one of the carbon-carbon single bonds of (CH2)m may optionally be replaced by a carbon-carbon double bond or a carbon-carbon triple bond, and any one of the carbon atoms of said (CH2)m may optionally be substituted with R8;
Ri is hydrogen or Ci-salkyl optionally substituted with hydroxy, lδ d-4alkoxy or fluoro;
R2 is a radical selected from hydrogen, d-6 straight or branched alkyl, C3-7cycloalkyl wherein one of the CH2 groups in said cycloalkyl may optionally be replaced by NH, oxygen or sulphur; aryl selected from phenyl and naphthyl; heteroaryl selected from indanyl, thienyl, furyl, pyridyl,
20 thiazolyl, isothiazolyl, oxazolyl, isoxazolyl, triazolyl, tetrazolyl and quinolyl; phenyl-C2-6alkyl, benzhydryl and benzyl, wherein each of said aryl and heteroaryl groups and the phenyl moieties of said benzyl, phenyl - C2-6alkyl and benzhydryl may optionally be substituted with one or more substituents independently selected from halo, nitro, d-6 alkyl, Ci-ealkoxy,
2δ trifluoromethyl, amino, d-βalky lamino, Ci-ealkyl-O-CO, d-βalkyl-O-CO- Ci-ealkyl, d-ealkyl-CO-O, d-ealkyl-CO-Ci-ealkyl-O-, d-ealkyl-CO, Ci-ealkyl-CO-d-ealkyl-, di-d-ealkylamino, -CONH-d-ealkyl, Ci-ealkyl-CO-NH-Ci-ealkyl, -NHCOH and -NHCO-d-ealkyl; and wherein one of the phenyl moieties of said benzhydryl may optionally be replaced by naphthyl, thienyl, furyl or pyridyl; δ R5 is hydrogen, phenyl or d ealkyl; or R2 and R5 together with the carbon to which they are attached, form a saturated ring having from 3 to 7 carbon atoms wherein one of the CH2 groups in said ring may optionally be replaced by oxygen, NH or sulfur;
10 R3 is aryl selected from phenyl and naphthyl; heteroaryl selected from indanyl, thienyl, furyl, pyridyl, thiazolyl, isothiazolyl, oxazolyl, isoxazolyl, triazolyl, tetrazolyl and quinolyl; and cycloalkyl having 3 to 7 carbon atoms wherein one of the (CH2) groups in said cycloalkyl may optionally be replaced by NH, oxygen or sulphur; lδ wherein each of said aryl and heteroaryl groups may optionally be substituted with one or more substituents, and said C3-7cycloalkyl may optionally be substituted with one or two substituents, each of said substituents being independently selected from halo, nitro, Ci-βalkyl, d-βalkoxy, trifluoromethyl, amino, d-6alkylamino, -CO-NH- Ci-ealkyl,
20 Ci-ealkyl-CO-NH-Ci-ealkyl, -NHCOH and -NHCO-Ci-ealkyl;
R4 and R7 are each independently selected from hydroxy, halogen, halo, amino, oxo, cyano, methylene, hydroxymethyl, halomethyl, d-βalkylamino, di-Ci-6alkylamino, d ealkoxy, d-βalkyl-O-CO, Ci-ealkyl-O-CO-d-ealkyl, Ci-ealkyl-CO-O, Ci-ealkyl-CO-Ci-ealkyl-O-,
2δ d-βalkyl-CO-, Ci-ealkyl-CO-d-βalkyl, and the radicals set forth in the definition of R2;
R6 is -NHCOR9, -NHCH2R9, SO2R8 or one of the radicals set forth in any of the definitions of R2, R4 and R7;
R8 is oximino (=NOH) or one of the radicals set forth in any of the
30 definitions of R2, R4 and R7;
R9 is d-βalkyl, hydrogen, phenyl or phenyld-ealkyl; with the proviso that (a) when m is 0, R8 is absent, (b) when R4, R6, R7 or R8 is as defined in R2, it cannot form together with the carbon to which it is attached ,a ring with R5, and (c) when R4 and R7 are attached to the same carbon atom, then either each of R4 and R7 is independently selected δ from hydrogen, fluoro and Ci-βalkyl, or R4 and R7, together with the carbon to which they are attached, for a C3-6 saturated carbocyclic ring that forms a spiro compound with the nitrogen-containing ring to which they are attached; or a pharmaceutically acceptable salt thereof.
10
13. A use according to claim 1 or 2, a composition according to claim 3 or 4, a product according to claim δ or a method according to claim 6 or 7 wherein the NK-1 receptor antagonist is a compound of formula VI:
Figure imgf000098_0001
wherein: radicals R are phenyl radicals optionally 2- or 3-substituted by a halogen atom or a methyl radical;
R1 is optionally substituted phenyl, cyclohexadienyl, naphthyl, 20 indenyl or optionally substituted heterocycle;
R2 is H, halogen, OH, alkyl, aminoalkyl, alkylaminoalkyl, dialkylaminoalkyl, alkyloxy, alkylthio, acyloxy, carboxy, optionally substituted alkyloxycarbonyl, benzyloxycarbonyl, amino or acylamino;
R3 is optionally 2-substituted phenyl; 2δ R4 is OH or fluorine when R5 is H; or R4 and R5 are OH ; or R4 and R5 together form a bond; or a pharmaceutically acceptable salt thereof.
14. A use according to claim 1 or 2, a composition according to claim 3 or 4, a product according to claim δ or a method according to claim 6 or 7 wherein the NK-1 receptor antagonist is a compound of formula VII: δ
R Q
Ar-T-CO-N- CH2 -C- CH2 - CH2 -Am + , A " (VII)
!
Ar ' wherein:
Ar represents an optionally substituted mono-, di- or tricyclic 10 aromatic or heteroaromatic group;
T represents a bond, a hydroxymethylene group, a Cι-4alkoxymethylene group or a Ci-salkylene group;
Ar' represents a phenyl group which is unsubstituted or substituted by one or more substituents selected from halogen, preferably chlorine or lδ fluorine, trifluoromethyl, d-4alkoxy, Cι-4alkyl where the said substituents may be the same or different; a thienyl group; a benzothienyl group; a naphthyl group; or an indolyl group;
R represents hydrogen,
Figure imgf000099_0001
ω-Cι-4alkoxyCι-4alkyl, or co - C2-4alkanoyloxy C2-4alkyl; 20 Q represents hydrogen; or Q and R together form a 1,2-ethylene, 1,3-propylene or 1,4- butylene group;
Am+ represents the radical
Figure imgf000099_0002
in which Xi, X2 and X3, together with the nitrogen atom to which they are attached, form an azabicyclic or azatricyclic ring system optionally substituted by a phenyl or benzyl group; and
A- represents a pharmaceutically acceptable anion. δ lδ. A use according to claim 1 or 2, a composition according to claim 3 or 4, a product according to claim δ or a method according to claim 6 or 7 wherein the NK-1 receptor antagonist is a compound of formula VII
Figure imgf000100_0001
10 wherein:
Ri represents an optionally substituted aralkyl, aryloxyalykl, heteroaralkyl, aroyl, heteroaroyl, cycloalkylcarbonyl, aralkanoyl, heteroarylalkanoyl, aralkoxycarbonyl or arylcarbamoyl group or the acyl group of an α-amino acid optionally N-substituted by a lower alkanoyl or lδ carbamoyl-lower alkanoyl group;
R2 represents cycloalkyl or an optionally substituted aryl or heteroaryl group;
R3 represents hydrogen, alkyl, carbamoyl or an alkanoyl or alkenoyl group optionally substituted by carboxy or esterified or amidated carboxy; 20 R4 represents an optionally substituted aryl group or an optionally partially saturated heteroaryl group;
Xi represents methylene, ethylene, a bond, an optionally ketalised carbonyl group or an optionally etherified hydroxymethylene group; X2 represents alkylene, carbonyl or a bond; and 2δ X3 represents carbonyl, oxo-lower alkyl, oxo(aza)-lower alkyl, or an alkyl group optionally substituted by phenyl, hydroxymethyl, optionally esterified or amidated carboxy, or (in other than the α-position) hydroxy; or a pharmaceutically acceptable salt thereof.
16. A use according to claim 1 or 2, a composition according to claim 3 or 4, a product according to claim δ or a method according to claim 6 or 7 wherein the NK-1 receptor antagonist is a compound of formula IX:
Figure imgf000101_0001
wherein:
R1 is aryl, or a group of the formula:
Figure imgf000101_0002
X is CH or N; and
Z is O or N-R5, in which R5 is hydrogen or lower alkyl;
R2 is hydroxy or lower alkoxy;
R3 is hydrogen or optionally substituted lower alkyl; lδ R4 is optionally substituted ar(lower)alkyl;
A is carbonyl or sulfonyl; and
Y is a bond or lower alkenylene; or a pharmaceutically acceptable salt thereof.
20 17. A use according to claim 1 or 2, a composition according to claim 3 or 4, a product according to claim δ or a method according to claim 6 or 7 wherein the NK-1 receptor antagonist is a compound of formula X:
Figure imgf000102_0001
wherein:
Ri is aryl selected from indanyl, phenyl and naphthyl; heteroaryl selected from thienyl, furyl, pyridyl and quinolyl; and cycloalkyl having 3 δ to 7 carbon atoms, wherein one of said carbon atoms may optionally be replaced by nitrogen, oxygen or sulfur; wherein each of said aryl and heteroaryl groups may optionally be substituted with one or more substituents, and said C3-7cycloalkyl may optionally be substituted with one or two substituents, said substituents being independently selected
10 from chloro, fluoro, bromo, iodo, nitro, Ci-ioalkyl optionally substituted with from one to three fluoro groups, Ci-ioalkoxy optionally substituted with from one to three fluoro groups, amino, d-ioalkyl-S-, d-ιoalkyl-S(O)-, d-ioalkyl-SO2-, phenyl, phenoxy, d.ioalkyl-SO2NH-, Ci-ioalkyl-SO2NH-Ci-ioakyl-, d-ioalkylamino-did-ioalkyl-, cyano, hydroxy, lδ cycloalkoxy having 3 to 7 carbon atoms, d-βalky lamino, Ci-βdialkylamino, HC(O)NH- and d.ioalkyl-C(O)NH-; and
R2 is thienyl, benzhydryl, naphthyl or phenyl optionally substituted with from one to three substituents independently selected from chloro, bromo, fluoro, iodo, cycloalkoxy having 3 to 7 carbon atoms, Cι-10alkyl
20 optionally substituted with from one to three fluoro groups and Ci-ioalkoxy optionally substituted with from one to three fluoro groups; or a pharmaceutically acceptable salt thereof.
18. A use according to claim 1 or 2, a composition according to 2δ claim 3 or 4, a product according to claim δ or a method according to claim 6 or 7 wherein the NK-1 receptor antagonist is a compound of formula XI:
Figure imgf000103_0001
wherein:
Ri is a Cι-4alkoxy group; R2 is
Figure imgf000103_0002
R3 is a hydrogen or halogen atom;
R4 and R5 may each independently represent a hydrogen or halogen atom, or a Cι-4alkyl, d-4alkoxy or trifluoromethyl group;
R6 is a hydrogen atom, a d.4alkyl, (CH2)mcyclopropyl, -S(O)nCι- 10 4alkyl, phenyl, NR7R8, CH2C(O)CF3 or trifluoromethyl group;
R7 and R8 may each independently represent a hydrogen atom, or a Cι-4alkyl or acyl group; x represents zero or 1; n represents zero, 1 or 2; and lδ m represents zero or 1; or a pharmaceutically acceptable salt thereof.
19. A use according to claim 1 or 2, a composition according to claim 3 or 4, a product according to claim δ or a method according to claim 20 6 or 7 wherein the NK-1 receptor antagonist is a compound of formula XII: R8 R4
I
R— (CH2)n- -C-CH— N— (CH2)o- -R3 NH R2
1
(CO)p (CH2)m
1 ! (Xii)
R1 wherei LnI1:. m is zero, 1, 2 or 3; n is zero or 1; o is zero, 1 or 2; p is zero or 1;
R is phenyl, 2- or 3-indolyl, 2- or 3-indolinyl, benzothienyl, benzofuranyl, or naphthyl; which R groups may be substituted with one or two halo, Cι-3alkoxy, trifluoromethyl, d-4alkyl, phenyl-Cι-3alkoxy, or Cι-4alkanoyl groups;
Ri is trityl, phenyl, diphenylmethyl, phenoxy, phenylthio, piperazinyl, piperidinyl, pyrrolidinyl, morpholinyl, indolinyl, indolyl, benzothienyl, hexamethyleneiminyl, benzofuranyl, tetrahydropyridinyl, quinolinyl, isoquinolinyl, reduced quinolinyl, reduced isoquinolinyl, phenyl-(Cι-4alkyl)-, phenyl-(Cι-4alkoxy)-, quinolinyl-(d-4alkyl)-, isoquinolinyl-(d-4alkyl)-, reduced quniolinyl-(Ci-4alkyl)-, reduced isoquinolinyl-(Cι.4alkyl)-, benzoyl-(d-3alkyl)-,
Figure imgf000104_0001
or -NH-CH2-R5; any one of which R1 groups may be substituted with halo, Cι.4alkyl, Cι-4alkoxy, trifluoromethyl, amino, d-4alkylamino, di(Ci-4alkyl)amino, or C2-4alkanoy lamino; or any one of which Ri groups may be substituted with phenyl, piperazinyl, d-scycloalkyl, benzyl,
Figure imgf000104_0002
piperidinyl, pyridinyl, pyrimidinyl, C2-6alkanoylamino, pyrrolidinyl, C2-6alkanoyl, or Cι-4alkoxycarbonyl; any one of which groups may be substituted with halo, Cι-4alkyl, d-4alkoxy, trifluoromethyl, amino, Ci-4alkylamino, di(Cι-4alkyl)amino, or C2-4alkanoy lamino ; or R1 is amino, a leaving group, hydrogen, Cι-4alkylamino, or δ di(Cι-4alkyl)amino;
R5 is pyridyl, anilino-(Cι-3alkyl)-, or anilinocarbonyl;
R2 is hydrogen, Cι-4alkyl, d-4alkylsulfonyl, carboxy-(Ci-3alkyl)-, Cι-3alkoxycarbonyl-(Cι-3alkyl)-, or -CO-R6;
R6 is hydrogen, Cι-4alkyl, Cι-3haloalkyl, phenyl, Cι-3alkoxy, 10 d-3hydroxy alkyl, amino, d-4alky lamino, di(Cι-4alkyl)amino, or -(CH2)q-R7; q is zero to 3;
R7 is carboxy, Cι-4alkoxycarbonyl, Cι-4alkylcarbonyloxy, amino, d-4alkylamino, di(Cι-4alkyl)amino, d-6alkoxycarbonylamino, or phenoxy, phenylthio, piperazinyl, piperidinyl, pyrrolidinyl, morpholinyl, indolinyl, lδ indolyl, benzothienyl, benzofuranyl, quinolinyl, phenyl-(d-4alkyl)-, quinolinyl-(Ci-4alkyl)-, isoquinohnyl-(d-4alkyl)-, reduced quinolinyl- (d-4alkyl)-, reduced isoquinolinyl-(Ci-4alkyl)-, benzoyl-d-3alkyl; any one of which aryl or heterocyclic R7 groups may be substituted with halo, trifluoromethyl, Ci-4alkoxy, d.4alkyl, amino, d-4alkylamino, 20 di(d-4alkyl)amino, or C2-4alkano lamino; or any one of which R7 groups may be substituted with phenyl, piperazinyl, C3-scycloalkyl, benzyl, piperidinyl, pyridinyl, pyrimidinyl, pyrrolidinyl, d-βalkanoyl, or Cι-4alkoxycarbonyl; any of which groups may be substituted with halo, trifluoromethyl, 2δ amino, Cι-4alkoxy, d-4alkyl, Cι-4alkylamino, di(d-4alkyl)amino, or C2-4alkanoy lamino ;
R8 is hydrogen or Ci-βalkyl;
R3 is phenyl, phenyl- (d-βalkyl)-, Cβ-scycloalkyl, Cs-βcycloalkenyl, Ci-salkyl, naphthyl, C2-βalkenyl, or hydrogen; any one or which groups except hydrogen may be substituted with one or two halo, Cι-3alkoxy, d-3alkylthio, nitro, trifluoromethyl, or Cι-3alkyl groups; and
R4 is hydrogen or d salkyl; δ with the proviso that if Ri is hydrogen or halo, R3 is phenyl, phenyl-(d-6alkyl)-, C3-8cycloalkyl, Cs-scycloalkenyl, or naphthyl; or a pharmaceutically acceptable salt thereof.
20. A use, composition, product or method according to any one of 10 the preceding claims wherein the NK-1 receptor antagonist is orally active, long acting, CNS-penetrant.
21. A use according to claim 1 or 2, a composition according to claim 3 or 4, a product according to claim δ or a method according to claim lδ 6 or 7 wherein the NK-1 receptor antagonist is selected from the classes of compounds described in EP-A-0δ77394, WO-A-9δ08δ49, WO-A-9δl8124, WO-A-9623798, WO-A-960δl81 and International Patent Application No. PCT/GB97/01630.
20 22. A use according to claim 1 or 2, a composition according to claim 3 or 4, a product according to claim δ or a method according to claim 6 or 7 wherein the NK-1 receptor antagonist is selected from: 2-(S)-(3,δ-bis(trifluoromethyl)benzyloxy)-3(S)-(4-fluorophenyl)-4-(3-(δ-oxo- lH,4H-l,2,4-triazolo)methyl)morpholine;
2δ 2-(R)-(l-(R)-(3,5-bis(trifluoromethyl)phenyl)ethoxy)-4-(3-(5-oxo-lH,4H- l,2,4-triazolo)methyl)-3-(S)-phenyl-morpholine; 2-(S)-(3,δ-bis(trifluoromethyl)benzyloxy)-4-(3-(δ-oxo-lH,4H-l,2,4- triazolo)methyl)-3-(S)-phenyl-morpholine; 2-(R)-(l-(R)-(3,δ-bis(trifluoromethyl)phenyl)ethoxy)-3-(S)-(4-fluorophenyl)-
30 4-(3-(δ-oxo-lH,4H-l,2,4-triazolo)methyl)morpholine; - 10δ -
2-(R)-(l-(R)-(3,δ-bis(trifluoromethyl)phenyl)ethoxy)-4-(δ-(N,N- dimethylamino)methyl-l,2,3-triazol-4-yl)methyl-3-(S)-phenylmorpholine; 2-(R)-(l-(R)-(3,δ-bis(trifluoromethyl)phenyl)ethoxy)-4-(δ-(N,N- dimethylamino)methyl-l,2,3-triazol-4-yl)methyl-3-(S)-(4- δ fluorophenyl)morpholine;
2-(R)-(l-(R)-(3,δ-bis(trifluoromethyl)phenyl)ethoxy)-3-(S)-(4-fluorophenyl)- 4-(3-(4-monophosphoryl-δ-oxo-lH-l,2,4-triazolo)methyl)morphohne; 2-(R)-(l-(R)-(3,δ-bis(trifluoromethyl)phenyl)ethoxy)-3-(S)-(4-fluorophenyl)- 4-(3-(l-monophosphoryl-δ-oxo-lH-l,2,4-triazolo)methyl)morphohne;
10 2-(R)-(l-(R)-(3,δ-bis(trifluoromethyl)phenyl)ethoxy)-3-(S)-(4-fluorophenyl)- 4-(3-(2-monophosphoryl-δ-oxo-lH-l,2,4-triazolo)methyl)morpholine; 2-(R)-(l-(R)-(3,5-bis(trifluoromethyl)phenyl)ethoxy)-3-(S)-(4-fluorophenyl)- 4- (3- (δ-oxyphosphoryl- IH- 1 , 2, 4-triazolo)me thy l)morp holine ; 2-(S)-(l-(R)-(3,δ-bis(trifluoromethyl)phenyl)ethoxy)-3-(S)-(4-fluorophenyl)- lδ 4-(3-(l-monophosphoryl-δ-oxo-4H-l,2,4-triazolo)methyl)morphoHne; 2-(R)-(l-(R)-(3,δ-bis(trifluoromethyl)phenyl)ethoxy)-4-(4-N,N- dimethylaminobut-2-yn-yl)-3-(S)-(4-fluorophenyl)morpholine; (3S,δR,6S)-3-[2-cyclopropoxy-δ-(trifluoromethoxy)phenyl-l-oxa-7-aza- spiro [4. δ] decane ;
20 (3R,δR,6S)-3-[2-cyclopropoxy-δ-(trifluoromethoxy)phenyl-l-oxa-7-aza- spiro [4. δ] decane ; and the pharmaceutically acceptable salts thereof.
23. A use according to claim 1 or 2, a composition according to 2δ claim 3 or 4, a product according to claim δ or a method according to claim 6 or 7 wherein the aggressive behaviour is explosive personality disorder, intermittent explosive disorder, aggressive personality, aggressive nature, aggressiveness, excessive emotional instability, pathological emotionality, quarrelsomeness, dementia with behavioural disturbances, and 30 personality change of the aggressive type due to a general medical condition.
PCT/EP1997/006689 1997-08-04 1997-11-25 Use of nk-1 receptor antagonists for treating aggressive behaviour WO1999007374A1 (en)

Priority Applications (5)

Application Number Priority Date Filing Date Title
AU57529/98A AU5752998A (en) 1997-08-04 1997-11-25 Use of nk-1 receptor antagonists for treating aggressive behaviour
CA002298779A CA2298779A1 (en) 1997-08-04 1998-07-31 Use of nk-1 receptor antagonists for treating aggressive behaviour disorders
AU91605/98A AU737019B2 (en) 1997-08-04 1998-07-31 Use of NK-1 receptor antagonists for treating aggressive behaviour disorders
PCT/EP1998/004933 WO1999007375A1 (en) 1997-08-04 1998-07-31 Use of nk-1 receptor antagonists for treating aggressive behaviour disorders
EP98943866A EP1001779A1 (en) 1997-08-04 1998-07-31 Use of nk-1 receptor antagonists for treating aggressive behaviour disorders

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
GB9716457.8 1997-08-04
GBGB9716457.8A GB9716457D0 (en) 1997-08-04 1997-08-04 Therapeutic agents

Publications (1)

Publication Number Publication Date
WO1999007374A1 true WO1999007374A1 (en) 1999-02-18

Family

ID=10816946

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/EP1997/006689 WO1999007374A1 (en) 1997-08-04 1997-11-25 Use of nk-1 receptor antagonists for treating aggressive behaviour

Country Status (3)

Country Link
AU (1) AU5752998A (en)
GB (1) GB9716457D0 (en)
WO (1) WO1999007374A1 (en)

Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
GB2394417A (en) * 2002-10-24 2004-04-28 Novartis Ag Solid dispersion comprising a piperidine substance P antagonist and a carrier

Citations (13)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP0436334A2 (en) * 1990-01-04 1991-07-10 Pfizer Inc. 3-Aminopiperidine derivatives and related nitrogen containing heterocycles
EP0443132A1 (en) * 1989-12-22 1991-08-28 Fujisawa Pharmaceutical Co., Ltd. Peptides having tachykinin antagonist activity, a process for preparation thereof and pharmaceutical compositions comprising the same
WO1992017449A1 (en) * 1991-03-26 1992-10-15 Pfizer Inc. Stereoselective preparation of substituted piperidines
EP0532456A1 (en) * 1991-08-12 1993-03-17 Ciba-Geigy Ag 1-Acylpiperidine derivatives and their use as substance P antagonists
WO1993021155A1 (en) * 1992-04-10 1993-10-28 Rhone-Poulenc Rorer S.A. Perhydroisoindole derivatives as p substance antagonists
EP0577394A1 (en) * 1992-06-29 1994-01-05 Merck & Co. Inc. Morpholine and thiomorpholine tachykinin receptor antagonists
EP0591040A1 (en) * 1992-09-30 1994-04-06 Sanofi Quaternary basic amides as tachykinines antagonists
WO1995008549A1 (en) * 1993-09-22 1995-03-30 Glaxo Group Limited 3-(5-tetrazolyl-benzyl)amino-piperidine derivatives and antagonists of tachykinins
WO1995014017A1 (en) * 1993-11-17 1995-05-26 Eli Lilly And Company Non-peptide tachykinin receptor antagonists
WO1995018124A1 (en) * 1993-12-29 1995-07-06 Merck Sharp & Dohme Limited Substituted morpholine derivatives and their use as therapeutic agents
WO1995023798A1 (en) * 1994-03-04 1995-09-08 Merck & Co., Inc. Prodrugs of morpholine tachykinin receptor antagonists
WO1996005181A1 (en) * 1994-08-15 1996-02-22 Merck Sharp & Dohme Limited Morpholine derivatives and their use as therapeutic agents
WO1996024353A1 (en) * 1995-02-10 1996-08-15 Eli Lilly And Company Methods of treating or preventing psychiatric disorders

Patent Citations (13)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP0443132A1 (en) * 1989-12-22 1991-08-28 Fujisawa Pharmaceutical Co., Ltd. Peptides having tachykinin antagonist activity, a process for preparation thereof and pharmaceutical compositions comprising the same
EP0436334A2 (en) * 1990-01-04 1991-07-10 Pfizer Inc. 3-Aminopiperidine derivatives and related nitrogen containing heterocycles
WO1992017449A1 (en) * 1991-03-26 1992-10-15 Pfizer Inc. Stereoselective preparation of substituted piperidines
EP0532456A1 (en) * 1991-08-12 1993-03-17 Ciba-Geigy Ag 1-Acylpiperidine derivatives and their use as substance P antagonists
WO1993021155A1 (en) * 1992-04-10 1993-10-28 Rhone-Poulenc Rorer S.A. Perhydroisoindole derivatives as p substance antagonists
EP0577394A1 (en) * 1992-06-29 1994-01-05 Merck & Co. Inc. Morpholine and thiomorpholine tachykinin receptor antagonists
EP0591040A1 (en) * 1992-09-30 1994-04-06 Sanofi Quaternary basic amides as tachykinines antagonists
WO1995008549A1 (en) * 1993-09-22 1995-03-30 Glaxo Group Limited 3-(5-tetrazolyl-benzyl)amino-piperidine derivatives and antagonists of tachykinins
WO1995014017A1 (en) * 1993-11-17 1995-05-26 Eli Lilly And Company Non-peptide tachykinin receptor antagonists
WO1995018124A1 (en) * 1993-12-29 1995-07-06 Merck Sharp & Dohme Limited Substituted morpholine derivatives and their use as therapeutic agents
WO1995023798A1 (en) * 1994-03-04 1995-09-08 Merck & Co., Inc. Prodrugs of morpholine tachykinin receptor antagonists
WO1996005181A1 (en) * 1994-08-15 1996-02-22 Merck Sharp & Dohme Limited Morpholine derivatives and their use as therapeutic agents
WO1996024353A1 (en) * 1995-02-10 1996-08-15 Eli Lilly And Company Methods of treating or preventing psychiatric disorders

Non-Patent Citations (2)

* Cited by examiner, † Cited by third party
Title
A. SIEGEL ET AL.: "NEUROCHEMICAL MECHANISMS UNDERLYING AMYGDALOID MODULATION OF AGGRESIVE BEHAVIOR IN THE CAT", AGGRESSIVE BEHAVIOR, vol. 21, no. 1, 1995, pages 49 - 62, XP002065995 *
WILSON J D: "AINTPSYCHOTIC OR NEUROLEPTIC MEDICATIONS", 1993, HARRISON'S PRINCIPLES OF INTERNAL MEDICINE, VOL. VOL. 2, PAGE(S) 2144/2145, WILSON J D, XP002060259 *

Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
GB2394417A (en) * 2002-10-24 2004-04-28 Novartis Ag Solid dispersion comprising a piperidine substance P antagonist and a carrier

Also Published As

Publication number Publication date
AU5752998A (en) 1999-03-01
GB9716457D0 (en) 1997-10-08

Similar Documents

Publication Publication Date Title
WO1998047514A1 (en) Use of an nk-1 receptor antagonist and an ssri for treating obesity
AU5485898A (en) Use of NK-1 receptor antagonists for treating sexual dysfunctions
AU5559298A (en) Use of nk-1 receptor antagonists for treating bipolar disorders
EP0942732B1 (en) Use of nk-1 receptor antagonists for treating movement disorders
AU732633B2 (en) Use of NK-1 receptor antagonists for treating schizophrenic disorders
EP0941092B1 (en) Use of nk-1 receptor antagonists for treating major depressive disorders
EP0942731A1 (en) Use of nk-1 receptor antagonists for treating substance use disorders
WO1999007373A1 (en) Use of nk-1 receptor antagonists for treating mania
WO1999007374A1 (en) Use of nk-1 receptor antagonists for treating aggressive behaviour
AU737019B2 (en) Use of NK-1 receptor antagonists for treating aggressive behaviour disorders
EP0942733B1 (en) Use of nk-1 receptor antagonists for treating cognitive disorders
EP1001779A1 (en) Use of nk-1 receptor antagonists for treating aggressive behaviour disorders
WO1999007376A1 (en) Use of nk-1 receptor antagonists for treating mania
EP1001780A1 (en) Use of nk-1 receptor antagonists for treating mania
AU5752798A (en) Use of nk-1 receptor antagonists for treating severe anxiety disorders
EP0977572A1 (en) Use of nk-1 receptor antagonists for treating eating disorders
AU5559098A (en) Use of nk-1 receptor antagonists for treating stress disorders

Legal Events

Date Code Title Description
AK Designated states

Kind code of ref document: A1

Designated state(s): AL AM AT AU AZ BA BB BG BR BY CA CH CN CU CZ DE DK EE ES FI GB GE GH HU ID IL IS JP KE KG KP KR KZ LC LK LR LS LT LU LV MD MG MK MN MW MX NO NZ PL PT RO RU SD SE SG SI SK SL TJ TM TR TT UA UG US UZ VN YU ZW

AL Designated countries for regional patents

Kind code of ref document: A1

Designated state(s): GH KE LS MW SD SZ UG ZW AM AZ BY KG KZ MD RU TJ TM AT BE CH DE DK ES FI FR GB GR IE IT LU MC NL PT SE BF BJ CF CG CI CM GA GN ML MR NE SN TD TG

DFPE Request for preliminary examination filed prior to expiration of 19th month from priority date (pct application filed before 20040101)
121 Ep: the epo has been informed by wipo that ep was designated in this application
NENP Non-entry into the national phase

Ref country code: KR

REG Reference to national code

Ref country code: DE

Ref legal event code: 8642

122 Ep: pct application non-entry in european phase
NENP Non-entry into the national phase

Ref country code: CA