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
  • A61K31/56—Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids
  • A61K31/57—Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids substituted in position 17 beta by a chain of two carbon atoms, e.g. pregnane or progesterone
• • 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
  • A61K31/56—Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P15/00—Drugs for genital or sexual disorders; Contraceptives
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P15/00—Drugs for genital or sexual disorders; Contraceptives
  • A61P15/12—Drugs for genital or sexual disorders; Contraceptives for climacteric disorders
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P19/00—Drugs for skeletal disorders
  • A61P19/08—Drugs for skeletal disorders for bone diseases, e.g. rachitism, Paget's disease
  • A61P19/10—Drugs for skeletal disorders for bone diseases, e.g. rachitism, Paget's disease for osteoporosis

Definitions

• the invention pertains to the treatment of estrogen-deficiency related complaints in females that exhibit these complaints while they are on treatment with a drug which prevents the synthesis endogenous (active) estrogens, notably estradiol.
• drugs are, e.g., anti-cancer drugs such as aromatase inhibitors, 17 ⁇ hydroxy steroid dehydrogenase inhibitors, sulfatase inhibitors.
• Estrogen-deficiency related complaints such as climacteric complaints and bone loss
• Estrogen-deficiency related complaints are well-known as symptoms in (post)menopausal women.
• various treatments exist, such as estradiol suppletion, combination of estrogens and progestagens, and other drugs.
• Another patient group comprises females which - whether before or after the natural menopause - due to some treatment or surgery exhibit complaints which are estrogen-deficiency related.
• a partial estrogen receptor antagonist such as tamoxifen, or selective estrogen receptor modulators such as raloxifene.
• raloxifene selective estrogen receptor modulators
• the problem however, with regular drugs for the treatment of estrogen- deficiency related complaints is that they cannot be used in patients which have, or have had, breast cancer or are known to have a risk for breast cancer.
• the reason is that the typical drugs used for estrogen-supplementation will increase the recurrence of, or even cause, breast tumors. In fact, it is one of known effects of estrogens and estrogen-like therapies that they stimulate breast.
• a special population of female patients having the above-indicated symptoms comprises those that are subject to treatment with drugs which act on the metabolic pathway which leads to the synthesis of endogenous estrogens rather than at the level of the estrogen receptors.
• drugs include aromatase inhibitors and 17 ⁇ hydroxy steroid dehydrogenase inhibitors, sulfatase inhibitors.
• one drug has been found which presents a solution to the above dilemma, viz. tibolone.
• This is an unexpected finding, not only because of the inherent difficulty in finding any treatment at all in the above special population, but also because tibolone itself hardly has an estrogenic activity, and is metabolized to compounds which have an approximately fifty-fold lower estrogenic receptor activity than estradiol. That particularly this drug works in the treatment of complaints related to a (near) total lack of circulating estrogen, is unprecedented.
• the compound tibolone, (7 ⁇ ,17 ⁇ )-17-hydroxy-7-methyl-19-nor-17-pregn-5(10)-en- 20-yn-3-one is known as a tissue-specific and effective agent that can be used in hormone replacement therapy (HRT) in (post)menopausal women, for the treatment of menopausal and postmenopausal disorders, including climacteric complaints, vasomotor symptoms, osteoporosis, and vaginal atrophy. See, int.al., US 5,037,817 and WO 98/47517
• Tibolone is a synthetic compound, which shows weak estrogenic, androgenic and progestagenic activities to estrogen, progesterone, and androgen receptors.
• Previous studies have shown favorable effects on bone, the vagina, the cardiovascular system, climacteric symptoms, mood, and libido without detrimental estrogen-like stimulation of the breast and endometrium (Kloosterboer, 2001; Kloosterboer et al., 2000; Pain Research and Nuffield Department of Anaesthetics, 1999; Tang et al., 1993).
• Studies have indicated that tibolone increases BMD relative to baseline or placebo over periods ranging from six months to three years (Pain Research and Nuffield Department of Anaesthetics, 1999).
• Tibolone at any rate prior to this invention, is subject to a warning for use in cancer- endangered patients.
• Tibolone is known from EP 613687 in the prevention or treatment of tumors. It should be noted that this relates to a different medical indication than that according to the invention.
• the compound of the invention may be administered enterally or parenterally, and for humans in a daily dosage of 0.003-3.0 mg per kg body weight; preferably a daily dosage of 0.03-0.4 mg per kg body weight is administered. More preferably, the invention can be carried out by providing tibolone in daily dosage amounts of from 0.2 to 5 mg, preferably 0.4 to 2.5 mg and more preferably fixed dosages of 1.25 or 2.5 mg.
• the compound may be compressed into solid dosage units, such as pills, tablets, or be processed into capsules or suppositories.
• solid dosage units such as pills, tablets, or be processed into capsules or suppositories.
• the compound can also be applied as an injection preparation in the form of a solution, suspension, emulsion, or as a spray, e.g. a nasal spray.
• a spray e.g. a nasal spray.
• dosage units e.g. tablets
• any pharmaceutically acceptable additive which does not interfere with the function of the active compound can be used.
• Suitable carriers with which the compositions can be administered include lactose, starch, cellulose derivatives and the like, or mixtures thereof, used in suitable amounts.
• an Example of a tablet of tibolone has the following composition: tibolone 2.5 mg starch 10 mg ascorbyl palmitate 0.2 mg magnesium stearate 0.5 mg lactose to make up to 100 mg
• base granules prepared by mixing the lactose with a portion of the starch. The remainder of the starch was mixed to a slurry with water and added to the mixture. The whole was granulated and dried. These base granules were mixed with ascorbyl palmitate and compound I, sieved, finely mixed with magnesium stearate and then tabletted.
• the patient population to which the present invention applies will generally be on treatment with one or more of the following drugs aminogluthethimide, anastrozole, letrozole, exemestane, formestane or other inhibitors or inactivators of aromatase, or of other enzymes which affect estradiol synthesis such as of sulfatase of 17 ⁇ - hydroxysteroid dehydrogenase.
• These drugs will generally be used in their regular therapeutically effective doses.
• anastrozole will typically be used in 1 or 10 mg/day, letrozole in 2.5 mg/day, formestane e.g. 250 or 500 mg i.m. fortnightly.
• the invention is not limited to the above compounds and dosages, the essence being in the type of treatment: the prevention of the synthesis of active estrogens, notably the synthesis of estradiol.
• the invention is a method of treatment of estrogen-deficiency related complaints in females that exhibit these complaints while they are on treatment with a drug which prevents the synthesis of active estrogens.
• drugs are, e.g., anti- cancer drugs such as aromatase inhibitors and inactivators.
• the invention resides in the use of tibolone, which has an unexpectedly beneficial working in this particular patient group in that it does not stimulate breast, while preventing bone loss and relieving climacteric complaints in a patient group in which this is more difficult than in any other group due to the nature of the concomittant cancer treatment (no circulating estrogen making for a higher severity of the complaints, the lack of effect on the estrogen receptor making for an increased risk associated with estrogenic breast stimulation once estrogen-like compounds are administered.

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• Health & Medical Sciences (AREA)
• Pharmacology & Pharmacy (AREA)
• Veterinary Medicine (AREA)
• Life Sciences & Earth Sciences (AREA)
• Public Health (AREA)
• Chemical & Material Sciences (AREA)
• General Health & Medical Sciences (AREA)
• Animal Behavior & Ethology (AREA)
• Medicinal Chemistry (AREA)
• Epidemiology (AREA)
• Chemical Kinetics & Catalysis (AREA)
• Engineering & Computer Science (AREA)
• Organic Chemistry (AREA)
• Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
• General Chemical & Material Sciences (AREA)
• Physical Education & Sports Medicine (AREA)
• Bioinformatics & Cheminformatics (AREA)
• Orthopedic Medicine & Surgery (AREA)
• Endocrinology (AREA)
• Reproductive Health (AREA)
• Rheumatology (AREA)
• Pharmaceuticals Containing Other Organic And Inorganic Compounds (AREA)
• Acyclic And Carbocyclic Compounds In Medicinal Compositions (AREA)
• Medicines That Contain Protein Lipid Enzymes And Other Medicines (AREA)
• Steroid Compounds (AREA)

Priority Applications (11)

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Publications (1)

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• 2003
  • 2003-01-16 KR KR10-2004-7011160A patent/KR20040073572A/ko not_active Withdrawn
  • 2003-01-16 IL IL16276903A patent/IL162769A0/xx unknown
  • 2003-01-16 PL PL03371181A patent/PL371181A1/xx not_active Application Discontinuation
  • 2003-01-16 JP JP2003561609A patent/JP2005518412A/ja active Pending
  • 2003-01-16 EP EP20030731620 patent/EP1469861A1/en not_active Withdrawn
  • 2003-01-16 HR HR20040635A patent/HRP20040635A2/hr not_active Application Discontinuation
  • 2003-01-16 MX MXPA04007071A patent/MXPA04007071A/es not_active Application Discontinuation
  • 2003-01-16 CA CA002472240A patent/CA2472240A1/en not_active Abandoned
  • 2003-01-16 RU RU2004125594/14A patent/RU2004125594A/ru not_active Application Discontinuation
  • 2003-01-16 CN CNA038025108A patent/CN1620298A/zh active Pending
  • 2003-01-16 BR BR0306789-0A patent/BR0306789A/pt not_active IP Right Cessation
  • 2003-01-16 US US10/502,444 patent/US20050124592A1/en not_active Abandoned
  • 2003-01-16 WO PCT/EP2003/000373 patent/WO2003061665A1/en not_active Ceased
• 2004
  • 2004-06-28 IS IS7338A patent/IS7338A/is unknown
  • 2004-07-01 ZA ZA2004/05262A patent/ZA200405262B/en unknown
  • 2004-07-06 EC EC2004005179A patent/ECSP045179A/es unknown

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