WO2004098595A1 - COMPOSITION COMPRISING ROFLUMILAST AND A TNFα ANTAGONIST - Google Patents

COMPOSITION COMPRISING ROFLUMILAST AND A TNFα ANTAGONIST Download PDF

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Publication number
WO2004098595A1
WO2004098595A1 PCT/EP2004/050742 EP2004050742W WO2004098595A1 WO 2004098595 A1 WO2004098595 A1 WO 2004098595A1 EP 2004050742 W EP2004050742 W EP 2004050742W WO 2004098595 A1 WO2004098595 A1 WO 2004098595A1
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Prior art keywords
tnfα
disease
roflumilast
necrosis factor
tumor necrosis
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PCT/EP2004/050742
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French (fr)
Inventor
Johannes Barsig
Christian Weimar
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Altana Pharma Ag
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—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
    • A61K31/44—Non condensed pyridines; Hydrogenated derivatives thereof
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K38/00—Medicinal preparations containing peptides
    • A61K38/16—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
    • A61K38/17—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans
    • A61K38/177—Receptors; Cell surface antigens; Cell surface determinants
    • A61K38/1793—Receptors; Cell surface antigens; Cell surface determinants for cytokines; for lymphokines; for interferons
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P43/00—Drugs for specific purposes, not provided for in groups A61P1/00-A61P41/00
    • Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
    • Y02—TECHNOLOGIES OR APPLICATIONS FOR MITIGATION OR ADAPTATION AGAINST CLIMATE CHANGE
    • Y02A—TECHNOLOGIES FOR ADAPTATION TO CLIMATE CHANGE
    • Y02A50/00—TECHNOLOGIES FOR ADAPTATION TO CLIMATE CHANGE in human health protection, e.g. against extreme weather
    • Y02A50/30—Against vector-borne diseases, e.g. mosquito-borne, fly-borne, tick-borne or waterborne diseases whose impact is exacerbated by climate change

Definitions

  • Composition comprising Roflumilast and a TNF ⁇ antagonist
  • the invention relates to the combination of certain known active compounds for therapeutic purposes.
  • the substances used in the combination according to the invention are known active compounds from the phosphodiesterase 4 (PDE4) inhibitor class and known active compounds from the tumor necrosis factor alpha (TNF ⁇ ) antagonist class. Their combined use in the sense according to the invention for therapeutic purposes has not yet been described in the prior art.
  • 5,605,690 describes a method for treating TNF- dependent inflammatory diseases in a mammal by administering a tumor necrosis factor antagonist, and particularly pointing to a TNF-receptor.
  • WO document WO91/03553 describes treating TNF- dependent inflammatory diseases, such as arthritis, by administering tumor necrosis factor receptor protein with an i ⁇ terleukin-1 receptor and/or an interleukin-2 receptor.
  • the invention relates to pharmaceutical compositions and methods for preventing or reducing the onset of symptoms of a disease in which phosphodiesterase 4 (PDE4) and/or tumor necrosis factor alpha (TNF ⁇ ) activity is detrimental, or treating or reducing the severity of a disease in which phosphodiesterase A (PDE4) and/or tumor necrosis factor alpha (TNF ⁇ ) activity is detrimental.
  • PDE4 phosphodiesterase 4
  • TNF ⁇ tumor necrosis factor alpha
  • compositions and methods for treating a disease mediated by phosphodiesterase 4 (PDE4) and/or tumor necrosis factor alpha (TNF ⁇ ) activity by administering a PDE4 inhibitor in combination with a TNF ⁇ antagonist.
  • PDE4 phosphodiesterase 4
  • TNF ⁇ tumor necrosis factor alpha
  • the invention relates in a first aspect to a method for preventing or reducing the onset of symptoms of a disease in which phosphodiesterase 4 (PDE4) and/or tumor necrosis factor alpha (TNFc ) activity is detrimental, or treating or reducing the severity of a disease in which phosphodiesterase 4 (PDE4) and/or tumor necrosis factor alpha (TNF ⁇ ) activity is detrimental by administering to a patient in need thereof simultaneously an effective amount of (1 ) roflumilast and (2) a TNF ⁇ antagonist selected from the group of etanercept, onercept and pegsunercept.
  • PDE4 phosphodiesterase 4
  • TNFc tumor necrosis factor alpha
  • TNF ⁇ tumor necrosis factor alpha
  • the invention in a second aspect relates to a method for preventing or reducing the onset of symptoms of a disease in which phosphodiesterase 4 (PDE4) and/or tumor necrosis factor alpha (TNF ⁇ ) activity is detrimental, or treating or reducing the severity of a disease in which phosphodiesterase 4 (PDE4) and/or tumor necrosis factor alpha (TNF ⁇ ) activity is detrimental by administering to a patient in need thereof in succession, close in time or remote in time, in any order whatever an effective amount of (1) roflumilast and (2) a TNF ⁇ antagonist selected from the group of etanercept, onercept and pegsunercept.
  • PDE4 phosphodiesterase 4
  • TNF ⁇ tumor necrosis factor alpha
  • the invention also relates to a pharmaceutical composition for preventing or reducing the onset of symptoms of a disease in which phosphodiesterase 4 (PDE4) and/or tumor necrosis factor alpha (TNF ⁇ ) activity is detrimental, or treating or reducing the severity of a disease in which phosphodiesterase 4 (PDE4) and/or tumor necrosis factor alpha (TNF ⁇ ) activity is detrimental, comprising as a fixed combination an effective amount of (a) roflumilast and
  • TNF ⁇ antagonist selected from the group of etanercept, onercept and pegsunercept and optionally
  • the invention further relates to a pharmaceutical composition for preventing or reducing the onset of symptoms of a disease in which phosphodiesterase 4 (PDE4) and/or tumor necrosis factor alpha (TNF ⁇ ) activity is detrimental, or treating or reducing the severity of a disease in which phosphodiesterase 4 (PDE4) and/or tumor necrosis factor alpha (TNF ⁇ ) activity is detrimental, comprising as a free combination an effective amount of
  • TNF ⁇ antagonist selected from the group of etanercept, onercept and pegsunercept and optionally a pharmaceutically acceptable carrier.
  • the invention additionally relates to a method for preparing a pharmaceutical composition which is effective for preventing or reducing the onset of symptoms of a disease in which phosphodiesterase 4 (PDE4) and/or tumor necrosis factor alpha (TNF ⁇ ) activity is detrimental, or treating or educing the severity of a disease in which phosphodiesterase 4 (PDE4) and/or tumor necrosis factor alpha (TNF ⁇ ) activity is detrimental, which method comprises mixing an effective amount of roflumilast and a TNF ⁇ antagonist selected from the group of etanercept, onercept and pegsunercept with a pharmaceutically acceptable carrier.
  • PDE4 phosphodiesterase 4
  • TNF ⁇ tumor necrosis factor alpha
  • the invention furthermore relates to the use of a combination of roflumilast and a TNF ⁇ antagonist selected from the group of etanercept, onercept and pegsunercept for the preparation of a pharmaceutical composition for reducing the onset of symptoms of a disease in which phosphodiesterase 4 (PDE4) and/or tumor necrosis factor alpha (TNF ⁇ ) activity is detrimental, or treating or reducing the severity of a disease in which phosphodiesterase 4 (PDE4) and/or tumor necrosis factor alpha (TNF ⁇ ) activity is detrimental.
  • PDE4 phosphodiesterase 4
  • TNF ⁇ tumor necrosis factor alpha
  • the combination therapy which is the subject matter of this invention comprises administering roflumilast with a TNF ⁇ antagonist selected from the group of etanercept, onercept and pegsunercept to prevent onset of a disease in which phosphodiesterase 4 (PDE4) and/or tumor necrosis factor alpha (TNF ⁇ ) activity is detrimental or to treat such an existing condition.
  • PDE4 phosphodiesterase 4
  • TNF ⁇ tumor necrosis factor alpha
  • the invention thus relates to the combined use of roflumilast and a TNF ⁇ antagonist selected from the group of etanercept, onercept and pegsunercept in preventing the symptoms of, or treating a a disease in which phosphodiesterase 4 (PDE4) and/or tumor necrosis factor alpha (TNF ⁇ ) activity is detrimental.
  • roflumilast is understood to include the pharmaceutically acceptable salts and the N-oxide of ROFLUMILAST, which can likewise be used according to the invention.
  • ROFLUMILAST is the international non proprietary name (INN) for 3-cyclopropylmethoxy-4-difluoro- methoxy-N-(3,5-dichloropyrid-4-yl)benzamide [structure of formula (1 .1 )].
  • Suitable pharmaceutically acceptable salts of ROFLUMILAST are in particular water-soluble and water-insoluble acid addition salts with acids such as, for example, hydrochloric acid, hydrobromic acid, phosphoric acid, nitric acid, sulfuric acid, acetic acid, citric acid, D-gluconic acid, benzoic acid, 2-(4-hydroxybenzoyl)-benzoic acid, butyric acid, sulfosalicylic acid, maleic acid, lauric acid, malic acid, fumaric acid, succinic acid, oxalic acid, tartaric acid, embonic acid, stearic acid, toluenesulfonic acid, methanesulfonic acid or 1-hydroxy-2-naphthoic acid, the acids being employed in salt preparation - depending on whether it is a mono- or polybasic acid and depending on which salt is desired - in an equimolar quantitative ratio or one differing therefrom.
  • acids such as, for example, hydrochloric
  • the active compounds and their pharmaceutically acceptable salts mentioned can also be present, for example, in the form of their pharmaceutically acceptable solvates, in particular in the form of their hydrates.
  • the term "etanercept” is understood to include the recombinant version of the soluble p75 Tumor Necrosis Factor Receptor (TNFR) linked to the Fc portion of the human lgG1 known under the INN ETANERCEPT, or its biologically active equivalents.
  • TNFR Tumor Necrosis Factor Receptor
  • Etanercept inhibits tumor necrosis factor biological activity by acting as a competitive inhibitor to the binding of tumor necrosis factor to its cell receptors.
  • ETANERCEPT is described in U.S. Patent No. 5,605,690.
  • onercept is understood to include the recombinant soluble monomeric human Tumor Necrosis Factor-1 Receptor Type 1 (r-hTBP-1) known under the INN ONERCEPT, or its biologically active equivalents. ONERCEPT is described in the EP patent application EP0433900.
  • pegsunercept is understood to include the recombinant pegylated soluble tumor necrosis factor receptor type 1 (PEG sTNFRI ) known under the INN PEGSUNERCEPT, or its biologically active equivalents. PEGSUNERCEPT is described in the international patent application WO98/01555.
  • Bioly active as used throughout the specification as a characteristic of tumor necrosis factor antagonists, means, for example, that a particular molecule shares sufficient amino acid sequence similarity with the embodiments of the present invention disclosed herein to be capable of binding detectable quantities of tumor necrosis factor receptor, transmitting a tumor necrosis factor stimulus to a cell, for example, as a component of a hybrid receptor construct, or cross-reacting with anti-tumor necrosis factor receptor antibodies raised against tumor necrosis factor receptor from natural (i.e., nonrecombinant) sources.
  • the biologically active tumor necrosis factor antagonists within the scope of the present invention are capable of binding greater than O.l nmoles tumor necrosis factor per nmole receptor, and in another embodiment, are capable of binding greater than 0.5 nmole tumor necrosis factor per nmole receptor in standard binding assays (see U.S. Patent No. 5,605,690).
  • ⁇ phosphodiesterase 4
  • TNF ⁇ tumor necrosis factor alpha
  • bronchitis acute and chronic airway disorders of varying origin
  • bronchitis allergic bronchitis, chronic bronchitis, bronchial asthma, severe chronic asthma, emphysema, COPD, pulmonary sarcoidosis, pulmonary fibro- sis, siliciosis
  • dermatoses especially of proliferative, inflammatory and allergic type
  • psoriasis vulgaris
  • toxic and allergic contact eczema atopic eczema
  • seborrhoeic eczema Lichen simplex, sunburn, pruritus in the anogenitai area
  • alopecia areata, hypertrophic scars, discoid lupus erythematosus, follicular and widespread py
  • the pharmaceutical compositions according to the invention can furthermore be used in the treatment of conditions associated with cerebral metabolic inhibition, such as cerebral senility, senile dementia (Alzheimer's disease), memory impairment associated with Parkinson's disease or multiinfarct dementia; in the treatment of malignancies to inhibit tumor growth, or metastasis, and/or to alleviate cachexia secondary to malignancy; in the treatment of infectious diseases like bacterial meningitis, cachexia or cerebral malaria; and in the treatment of diseases like sciatica, inflammatory bone disease, bone resorption disease, hepatitis, viral hepatitis, reperfusion injury, scar tissue formation, pyrexia, perio- dontal disease and radiation toxicity.
  • the pharmaceutical compositions according to the invention can as well be used in the treatment of chronic fever syndromes, metabolic syndrome and sequalae, e.g. type 2 diabetes.
  • combined use (or “combination”) embraces the administration of roflumilast and a TNF ⁇ antagonist selected from the group etanercept, onercept and pegsunercept as part of a specific treatment regimen intended to provide a beneficial effect from the co-action of these therapeutic agents.
  • Administration of these therapeutic agents in combination typically is carried out over a defined time period (usually, minutes, hours, days or weeks depending upon the combination selected).
  • Combined use generally is not intended to encompass the administration of two of these therapeutic agents as part of separate monotherapy regimens that incidentally and arbitrarily result in the combinations of the present invention.
  • Combined use or “combination” within the meaning of the present invention is to be understood as meaning that the individual components can be administered simultaneously (in the form of a combination medicament - fixed combination) or more or less simultaneously, respectively in succession (from separate pack units -free combination; directly in succession or else alternatively at a relatively large time interval).
  • one therapeutic agent could be taken in the morning and one later in the day.
  • one therapeutic agent could be taken once daily and the other twice weekly.
  • Simultaneous administration preferably is accomplished, for example, by administering to the subject in need thereof a single capsule or subcutaneous injection having a fixed ratio of each therapeutic agent.
  • More or less simultaneous administration or administration in succession of each therapeutic agent can be effected by any appropriate route, including, but not limited to, oral routes, intravenous routes, intramuscular routes, and direct absorption through mucous membrane tissues.
  • the therapeutic agents can be administered by the same route or by different routes.
  • a first therapeutic agent of the combination selected may be administered by intravenous or subcutaneous injection while the other therapeutic agent of the combination may be administered orally.
  • the sequence in which the therapeutic agents are administered is not narrowly critical.
  • the TNF ⁇ antagonist compositions according to the invention are preferably administered via par- enteral administration, for example, intravenous injection, subcutaneous injection, intramuscular injection, or intramedullary injection.
  • Other routes of administration for the TNF ⁇ antagonists include, for example, intra-articular, intraperitoneal or subcutaneous routes by bolus injection, continuous infusion, sustained release from implants, or other suitable techniques.
  • the TNF ⁇ antagonists according to the invention will be administered in the form of a composition comprising purified protein in conjunction with physiologically acceptable carriers, excipients or diluents. Such carriers will be non- toxic to recipients at the dosages and concentrations employed.
  • compositions entails combining the TNF ⁇ antagonists with buffers, antioxidants such as ascorbic acid, low molecular weight (less than about 10 residues) polypeptides, proteins, amino acids, carbohydrates including glucose, sucrose or dextrins, chelating agents such as EDTA, glutathione and other stabilizers and excipients.
  • antioxidants such as ascorbic acid
  • chelating agents such as EDTA, glutathione and other stabilizers and excipients.
  • Neutral buffered saline or saline mixed with conspecific serum albumin are exemplary appropriate diluents.
  • product is formulated as a lyophilizate using appropriate excipi- ent solutions (e.g. sucrose) as diluents. Appropriate dosages can be determined in trials.
  • preservatives may also be added, such as benzyl alcohol.
  • amount and frequency of administration will depend, of course, on such factors as the nature and severity of the indication being treated, the desired response, the condition of the patient, and so forth.
  • roflumilast is oral.
  • roflumilast is administered by intravenous infusion or injection.
  • roflumilast is administered by intramuscular or subcutaneous injection.
  • Other routes of administration are also contemplated, including intranasal and transdermal routes, and by inhalation.
  • the therapeutic agent(s) are formulated to give medicaments according to processes known per se and familiar to the person skilled in the art.
  • the therapeutic agents are employed as medicament, preferably in combination with suitable pharmaceutical carrier, in the form of tablets, coated tablets, capsules, caplets, emulsions, suspensions or solutions, the therapeutic agent content advantageously being between 0.1 and 95% and, by the appropriate choice of the carrier, it being possible to achieve a pharmaceutical administration form precisely tailored to the therapeutic agent(s) and/or to the desired onset of action (e.g. a sustained- release form or an enteric form).
  • sterile injectable preparations for example, sterile injectable aqueous or oleaginous solutions/suspensions can be formulated according to the known art using suitable dispersing or wetting agents and suspending agents.
  • the sterile injectable preparation can also be a sterile injectable solution or suspension in a nontoxic parenteraly acceptable diluent or solvent, for example, as a solution in 1 ,3-butane- diol.
  • acceptable vehicles and solvents that can be employed are water, Ringer's solution, and isotonic sodium chloride solution.
  • sterile, fixed oils are conventionally employed as a solvent or suspending medium.
  • any bland fixed oil can be employed including synthetic mono-or diglycerides.
  • fatty acids such as oleic acid find use in the preparation of injectables.
  • formulations for parenteral administration can be in the form of aqueous or non-aqueous isotonic sterile injection solutions or suspensions. These solutions can be prepared fromsterile powders or granules having one or more of the carriers or diluents mentioned for use in the formulations for oral administration.
  • parenteral as used herein includes subcutaneous, intravenous or intramuscular injections, or infusion techniques.
  • the therapeutic agent(s) of the present invention can be administered by a variety of methods known in the art, although for many therapeutic applications, the preferred route of administration for a fixed combination of roflumilast and a TNF ⁇ antagonist according to the invention is subcutaneous injection.
  • the therapeutic agent(s) are dosed in an order of magnitude customary for the individual dose, it more likely being possible, on account of the individual actions, which are mutually positively influencing and reinforcing, to reduce the respective doses on the combined administration of the therapeutic agent(s) with the norm.
  • the adult daily dose is in the range from 50 - 1000 ⁇ g, preferably in the range from 250 - 500 ⁇ g, preferably by once daily administration.
  • the adult daily dose is in the range from 50 - 1000 ⁇ g, preferably in the range from 250 - 500 ⁇ g.
  • the adult daily dose is in the range from 50 - 600 ⁇ g, preferably in the range from 150 - 300 ⁇ g.
  • the TNF ⁇ antagonist is administered in systemic amounts ranging from about 0.1 mg/kg/week to about 100 mg/kg/week. In preferred embodiments of the present invention, the TNF ⁇ antagonist is administered in amounts ranging from about 0.5 mg/kg/week to about 50 mg/kg/week. For local intra -articular administration, dosages preferably range from about 0.01 mg/kg to about 1.0 mg/kg per injection.
  • the adult dose of ETANERCEPT is 25 mg twice a week, as a subcutaneous injection. In another embodiment of the present invention the adult dose of ETANERCEPT is 50 mg once a week, as a subcutaneous injection.

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Abstract

The invention relates to the combined administration of roflumilast and a TNFα antagonist selected from the group consisting of etanercept, onercept and pegsunercept for the treatment of a disease in which phosphodiesterase 4 (PDE4) and/or tumor necrosis factor alpha (TNFα) activity is detrimental.

Description

Composition comprising Roflumilast and a TNFα antagonist
Field of application of the invention
The invention relates to the combination of certain known active compounds for therapeutic purposes. The substances used in the combination according to the invention are known active compounds from the phosphodiesterase 4 (PDE4) inhibitor class and known active compounds from the tumor necrosis factor alpha (TNFα) antagonist class. Their combined use in the sense according to the invention for therapeutic purposes has not yet been described in the prior art.
Prior art
In the international patent application WO95/01338 3-cyclopropylmethoxy-4-difluoromethoxy-N-(3,5- dichioropyrid-4-yl)benzamide [International Non Proprietary Name (INN): ROFLUMILAST], its N-Oxide and the use of these compounds as selective PDE4 inhibitors is described. In the International patent application WO03/39552 the combination of Roflumilast with several disease modifying anti-rheumatic drugs (DMARDs) is disclosed. In the Journal of Pharmacology and Experimental Therapeutics Vol. 297, 2001 pp. 267-279 and 280-290 the anti-inflammatory and immunomodulatory potential of Roflumilast in vitro, and its in vivo efficacy in airway disease models is described. In Emerging Drugs Vol. 5, 2000 pp. 309-319 the use of PDE4 inhibitors in the treatment of chronic obstructive pulmonary disease is reviewed. In the European Patent Application EP0433900 the recombinant human tumor ne¬ crosis factor binding protein-1 (r-hTBP-1 ; INN: ONERCEPT) is disclosed. In the international patent application WO98/01555 a pegylated soluble tumor necrosis factor receptor type 1 (PEG sTNFRI ; INN: PEGSUNERCEPT) is disclosed. US patent No. 5,605,690 describes a method for treating TNF- dependent inflammatory diseases in a mammal by administering a tumor necrosis factor antagonist, and particularly pointing to a TNF-receptor. WO document WO91/03553 describes treating TNF- dependent inflammatory diseases, such as arthritis, by administering tumor necrosis factor receptor protein with an iπterleukin-1 receptor and/or an interleukin-2 receptor. In Clinical and Experimental Rheumatology Vol 17, 1999, pp S115-S120 several combination therapies with DMARDs and biologi¬ cal agents in collagen-induced arthritis are disclosed.
Summary of the invention
The invention relates to pharmaceutical compositions and methods for preventing or reducing the onset of symptoms of a disease in which phosphodiesterase 4 (PDE4) and/or tumor necrosis factor alpha (TNFα) activity is detrimental, or treating or reducing the severity of a disease in which phosphodiesterase A (PDE4) and/or tumor necrosis factor alpha (TNFα) activity is detrimental.
In particular it relates to compositions and methods for treating a disease mediated by phosphodiesterase 4 (PDE4) and/or tumor necrosis factor alpha (TNFα) activity by administering a PDE4 inhibitor in combination with a TNFα antagonist.
In this connection, it is the object of the present invention to make available a certain especially anti- inflammatory therapeutic, which fulfills the following conditions:
Pronounced antiinflammatory action
Minor side effects
Good suitability for long-term therapy
It has now been found that the combined use of the PDE4 inhibitor roflumilast and a TNFα antagonist selected from the group consisting of etanercept, onercept and pegsunercept outstandingly fulfills the abovementioned conditions.
Accordingly, the invention relates in a first aspect to a method for preventing or reducing the onset of symptoms of a disease in which phosphodiesterase 4 (PDE4) and/or tumor necrosis factor alpha (TNFc ) activity is detrimental, or treating or reducing the severity of a disease in which phosphodiesterase 4 (PDE4) and/or tumor necrosis factor alpha (TNFα) activity is detrimental by administering to a patient in need thereof simultaneously an effective amount of (1 ) roflumilast and (2) a TNFα antagonist selected from the group of etanercept, onercept and pegsunercept.
In a second aspect the invention relates to a method for preventing or reducing the onset of symptoms of a disease in which phosphodiesterase 4 (PDE4) and/or tumor necrosis factor alpha (TNFα) activity is detrimental, or treating or reducing the severity of a disease in which phosphodiesterase 4 (PDE4) and/or tumor necrosis factor alpha (TNFα) activity is detrimental by administering to a patient in need thereof in succession, close in time or remote in time, in any order whatever an effective amount of (1) roflumilast and (2) a TNFα antagonist selected from the group of etanercept, onercept and pegsunercept.
The invention also relates to a pharmaceutical composition for preventing or reducing the onset of symptoms of a disease in which phosphodiesterase 4 (PDE4) and/or tumor necrosis factor alpha (TNFα) activity is detrimental, or treating or reducing the severity of a disease in which phosphodiesterase 4 (PDE4) and/or tumor necrosis factor alpha (TNFα) activity is detrimental, comprising as a fixed combination an effective amount of (a) roflumilast and
(b) a TNFα antagonist selected from the group of etanercept, onercept and pegsunercept and optionally
(c) a pharmaceutically acceptable carrier.
The invention further relates to a pharmaceutical composition for preventing or reducing the onset of symptoms of a disease in which phosphodiesterase 4 (PDE4) and/or tumor necrosis factor alpha (TNFα) activity is detrimental, or treating or reducing the severity of a disease in which phosphodiesterase 4 (PDE4) and/or tumor necrosis factor alpha (TNFα) activity is detrimental, comprising as a free combination an effective amount of
(a) roflumilast and optionally a pharmaceutically acceptable carrier and
(b) a TNFα antagonist selected from the group of etanercept, onercept and pegsunercept and optionally a pharmaceutically acceptable carrier.
The invention additionally relates to a method for preparing a pharmaceutical composition which is effective for preventing or reducing the onset of symptoms of a disease in which phosphodiesterase 4 (PDE4) and/or tumor necrosis factor alpha (TNFα) activity is detrimental, or treating or educing the severity of a disease in which phosphodiesterase 4 (PDE4) and/or tumor necrosis factor alpha (TNFα) activity is detrimental, which method comprises mixing an effective amount of roflumilast and a TNFα antagonist selected from the group of etanercept, onercept and pegsunercept with a pharmaceutically acceptable carrier.
The invention furthermore relates to the use of a combination of roflumilast and a TNFα antagonist selected from the group of etanercept, onercept and pegsunercept for the preparation of a pharmaceutical composition for reducing the onset of symptoms of a disease in which phosphodiesterase 4 (PDE4) and/or tumor necrosis factor alpha (TNFα) activity is detrimental, or treating or reducing the severity of a disease in which phosphodiesterase 4 (PDE4) and/or tumor necrosis factor alpha (TNFα) activity is detrimental.
Detailed description of the invention
The combination therapy, which is the subject matter of this invention comprises administering roflumilast with a TNFα antagonist selected from the group of etanercept, onercept and pegsunercept to prevent onset of a disease in which phosphodiesterase 4 (PDE4) and/or tumor necrosis factor alpha (TNFα) activity is detrimental or to treat such an existing condition. The invention thus relates to the combined use of roflumilast and a TNFα antagonist selected from the group of etanercept, onercept and pegsunercept in preventing the symptoms of, or treating a a disease in which phosphodiesterase 4 (PDE4) and/or tumor necrosis factor alpha (TNFα) activity is detrimental.
In the sense of the invention, the term "roflumilast" is understood to include the pharmaceutically acceptable salts and the N-oxide of ROFLUMILAST, which can likewise be used according to the invention.
ROFLUMILAST is the international non proprietary name (INN) for 3-cyclopropylmethoxy-4-difluoro- methoxy-N-(3,5-dichloropyrid-4-yl)benzamide [structure of formula (1 .1 )]. The preparation of 3-cyclo- propylmethoxy-4-difluoromethoxy-N-(3,5-dichloropyrid-4-yl)benzamide, its pharmaceutically acceptable salts and its N-oxide [3-cyclopropylmethoxy-4-difluoromethoxy-N-(3,5-dichloro-1 -oxypyrid-4-yl)- benzamide; structure of formula (1.2)] as well as the use of these compounds as phosphodiesterase (PDE) 4 inhibitors is described in WO95/01338.
Figure imgf000005_0001
Suitable pharmaceutically acceptable salts of ROFLUMILAST are in particular water-soluble and water-insoluble acid addition salts with acids such as, for example, hydrochloric acid, hydrobromic acid, phosphoric acid, nitric acid, sulfuric acid, acetic acid, citric acid, D-gluconic acid, benzoic acid, 2-(4-hydroxybenzoyl)-benzoic acid, butyric acid, sulfosalicylic acid, maleic acid, lauric acid, malic acid, fumaric acid, succinic acid, oxalic acid, tartaric acid, embonic acid, stearic acid, toluenesulfonic acid, methanesulfonic acid or 1-hydroxy-2-naphthoic acid, the acids being employed in salt preparation - depending on whether it is a mono- or polybasic acid and depending on which salt is desired - in an equimolar quantitative ratio or one differing therefrom.
It is understood that the active compounds and their pharmaceutically acceptable salts mentioned can also be present, for example, in the form of their pharmaceutically acceptable solvates, in particular in the form of their hydrates. ln the sense of the invention, the term "etanercept" is understood to include the recombinant version of the soluble p75 Tumor Necrosis Factor Receptor (TNFR) linked to the Fc portion of the human lgG1 known under the INN ETANERCEPT, or its biologically active equivalents. Etanercept inhibits tumor necrosis factor biological activity by acting as a competitive inhibitor to the binding of tumor necrosis factor to its cell receptors. ETANERCEPT is described in U.S. Patent No. 5,605,690.
The term "onercept" is understood to include the recombinant soluble monomeric human Tumor Necrosis Factor-1 Receptor Type 1 (r-hTBP-1) known under the INN ONERCEPT, or its biologically active equivalents. ONERCEPT is described in the EP patent application EP0433900.
The term "pegsunercept" is understood to include the recombinant pegylated soluble tumor necrosis factor receptor type 1 (PEG sTNFRI ) known under the INN PEGSUNERCEPT, or its biologically active equivalents. PEGSUNERCEPT is described in the international patent application WO98/01555.
"Biologically active", as used throughout the specification as a characteristic of tumor necrosis factor antagonists, means, for example, that a particular molecule shares sufficient amino acid sequence similarity with the embodiments of the present invention disclosed herein to be capable of binding detectable quantities of tumor necrosis factor receptor, transmitting a tumor necrosis factor stimulus to a cell, for example, as a component of a hybrid receptor construct, or cross-reacting with anti-tumor necrosis factor receptor antibodies raised against tumor necrosis factor receptor from natural (i.e., nonrecombinant) sources. In one embodiment of the present invention, the biologically active tumor necrosis factor antagonists within the scope of the present invention are capable of binding greater than O.l nmoles tumor necrosis factor per nmole receptor, and in another embodiment, are capable of binding greater than 0.5 nmole tumor necrosis factor per nmole receptor in standard binding assays (see U.S. Patent No. 5,605,690).
"Diseases in which phosphodiesterase 4 (PDE4) and/or tumor necrosis factor alpha (TNFα) activity is detrimental" which may be mentioned are in particular acute and chronic (in particular inflammatory and allergen-induced) airway disorders of varying origin (bronchitis, allergic bronchitis, chronic bronchitis, bronchial asthma, severe chronic asthma, emphysema, COPD, pulmonary sarcoidosis, pulmonary fibro- sis, siliciosis); dermatoses (especially of proliferative, inflammatory and allergic type) such as psoriasis (vulgaris), toxic and allergic contact eczema, atopic eczema, seborrhoeic eczema, Lichen simplex, sunburn, pruritus in the anogenitai area, alopecia areata, hypertrophic scars, discoid lupus erythematosus, follicular and widespread pyodermias, endogenous and exogenous acne, acne rosacea and other proliferative, inflammatory and allergic skin disorders; disorders which are based on an excessive release of TNF and leukotrienes, for example disorders of the arthritis type (rheumatoid arthritis, psoriatric arthritis, juvenile rheumatoid arthritis, rheumatoid spoπdylitis, osteoarthritis, gouty arthritis and other arthritic conditions), spondylarthropathies (ankylosing spondylitis), Wegener's granulomatosis, adult Still's disease, Behcet's disease, polymyositis.myelodysplastic syndrome, scleroderma, dermatomyositis, Sjogren's syn- drome, disorders of the immune system (AIDS), autoimmune diseases (e.g., Multiple Sclerosis, allergy, autoimmune uveitis and nephritic syndrome), transplant rejection, including rejections of allografts and xenografts, graft versus host disease, types of shock [septic shock, endotoxin shock, gram-negative sepsis, toxic shock syndrome and ARDS (adult respiratory distress syndrome)] and also generalized inflammations in the gastrointestinal region (Inflammatory bowel disease, Crohn's disease and ulcerative colitis); disorders which are based on allergic and/or chronic, immunological false reactions in the region of the upper airways (pharynx, nose) and the adjacent regions (paranasal sinuses, eyes), such as allergic rhinitis/sinusitis, chronic rhinitis/sinusitis, allergic conjunctivitis and also nasal polyps; but also disorders of the heart which can be treated by PDE and/or TNFα inhibitors, such as cardiac insufficiency, ischemia of the heart and congestive heart failure, or disorders which can be treated on account of the tissue-relaxant action of the PDE inhibitors, such as colics of the kidneys and of the ureters in connection with kidney stones. The pharmaceutical compositions according to the invention can furthermore be used in the treatment of conditions associated with cerebral metabolic inhibition, such as cerebral senility, senile dementia (Alzheimer's disease), memory impairment associated with Parkinson's disease or multiinfarct dementia; in the treatment of malignancies to inhibit tumor growth, or metastasis, and/or to alleviate cachexia secondary to malignancy; in the treatment of infectious diseases like bacterial meningitis, cachexia or cerebral malaria; and in the treatment of diseases like sciatica, inflammatory bone disease, bone resorption disease, hepatitis, viral hepatitis, reperfusion injury, scar tissue formation, pyrexia, perio- dontal disease and radiation toxicity. The pharmaceutical compositions according to the invention can as well be used in the treatment of chronic fever syndromes, metabolic syndrome and sequalae, e.g. type 2 diabetes.
The phrase "combined use" (or "combination") embraces the administration of roflumilast and a TNFα antagonist selected from the group etanercept, onercept and pegsunercept as part of a specific treatment regimen intended to provide a beneficial effect from the co-action of these therapeutic agents. Administration of these therapeutic agents in combination typically is carried out over a defined time period (usually, minutes, hours, days or weeks depending upon the combination selected). "Combined use" generally is not intended to encompass the administration of two of these therapeutic agents as part of separate monotherapy regimens that incidentally and arbitrarily result in the combinations of the present invention.
"Combined use" or "combination" within the meaning of the present invention is to be understood as meaning that the individual components can be administered simultaneously (in the form of a combination medicament - fixed combination) or more or less simultaneously, respectively in succession (from separate pack units -free combination; directly in succession or else alternatively at a relatively large time interval). As an example, one therapeutic agent could be taken in the morning and one later in the day. Or in another scenario, one therapeutic agent could be taken once daily and the other twice weekly. Simultaneous administration preferably is accomplished, for example, by administering to the subject in need thereof a single capsule or subcutaneous injection having a fixed ratio of each therapeutic agent. More or less simultaneous administration or administration in succession of each therapeutic agent can be effected by any appropriate route, including, but not limited to, oral routes, intravenous routes, intramuscular routes, and direct absorption through mucous membrane tissues. The therapeutic agents can be administered by the same route or by different routes. For example, a first therapeutic agent of the combination selected may be administered by intravenous or subcutaneous injection while the other therapeutic agent of the combination may be administered orally. The sequence in which the therapeutic agents are administered is not narrowly critical.
The TNFα antagonist compositions according to the invention are preferably administered via par- enteral administration, for example, intravenous injection, subcutaneous injection, intramuscular injection, or intramedullary injection. Other routes of administration for the TNFα antagonists include, for example, intra-articular, intraperitoneal or subcutaneous routes by bolus injection, continuous infusion, sustained release from implants, or other suitable techniques. Typically, the TNFα antagonists according to the invention will be administered in the form of a composition comprising purified protein in conjunction with physiologically acceptable carriers, excipients or diluents. Such carriers will be non- toxic to recipients at the dosages and concentrations employed. Ordinarily, the preparation of such compositions entails combining the TNFα antagonists with buffers, antioxidants such as ascorbic acid, low molecular weight (less than about 10 residues) polypeptides, proteins, amino acids, carbohydrates including glucose, sucrose or dextrins, chelating agents such as EDTA, glutathione and other stabilizers and excipients. Neutral buffered saline or saline mixed with conspecific serum albumin are exemplary appropriate diluents. Preferably, product is formulated as a lyophilizate using appropriate excipi- ent solutions (e.g. sucrose) as diluents. Appropriate dosages can be determined in trials. In accordance with appropriate industry standards, preservatives may also be added, such as benzyl alcohol. The amount and frequency of administration will depend, of course, on such factors as the nature and severity of the indication being treated, the desired response, the condition of the patient, and so forth.
The most preferred mode of administration of roflumilast is oral. In another preferred embodiment roflumilast is administered by intravenous infusion or injection. In a further embodiment roflumilast is administered by intramuscular or subcutaneous injection. Other routes of administration are also contemplated, including intranasal and transdermal routes, and by inhalation.
In case of pharmaceutical compositions, which are intended for oral administration, the therapeutic agent(s) are formulated to give medicaments according to processes known per se and familiar to the person skilled in the art. The therapeutic agents are employed as medicament, preferably in combination with suitable pharmaceutical carrier, in the form of tablets, coated tablets, capsules, caplets, emulsions, suspensions or solutions, the therapeutic agent content advantageously being between 0.1 and 95% and, by the appropriate choice of the carrier, it being possible to achieve a pharmaceutical administration form precisely tailored to the therapeutic agent(s) and/or to the desired onset of action (e.g. a sustained- release form or an enteric form).
The person skilled in the art is familiar on the basis of his/her expert knowledge with, which carriers or excipients are suitable for the desired pharmaceutical formulations. In addition to solvents, gel-forming agents, tablet excipients and other active compound carriers, it is possible to use, for example, anti- oxidants, disperεants, emulsifiers, antifoams, flavor corrigents, preservatives, solubilizers, colorants or permeation promoters and complexing agents (e.g. cyclodextrins).
Injectable preparations, for example, sterile injectable aqueous or oleaginous solutions/suspensions can be formulated according to the known art using suitable dispersing or wetting agents and suspending agents. The sterile injectable preparation can also be a sterile injectable solution or suspension in a nontoxic parenteraly acceptable diluent or solvent, for example, as a solution in 1 ,3-butane- diol. Among the acceptable vehicles and solvents that can be employed are water, Ringer's solution, and isotonic sodium chloride solution. In addition, sterile, fixed oils are conventionally employed as a solvent or suspending medium. For this purpose any bland fixed oil can be employed including synthetic mono-or diglycerides. Furthermore, fatty acids, such as oleic acid find use in the preparation of injectables. Dimethyl acetamide, surfactants including ionic and non-ionic detergents, polyethylene glycols can be used. Mixtures of solvents and wetting agents such as those discussed above are also useful.
For therapeutic purposes, formulations for parenteral administration can be in the form of aqueous or non-aqueous isotonic sterile injection solutions or suspensions. These solutions can be prepared fromsterile powders or granules having one or more of the carriers or diluents mentioned for use in the formulations for oral administration. The term parenteral as used herein includes subcutaneous, intravenous or intramuscular injections, or infusion techniques.
The therapeutic agent(s) of the present invention can be administered by a variety of methods known in the art, although for many therapeutic applications, the preferred route of administration for a fixed combination of roflumilast and a TNFα antagonist according to the invention is subcutaneous injection.
The therapeutic agent(s) are dosed in an order of magnitude customary for the individual dose, it more likely being possible, on account of the individual actions, which are mutually positively influencing and reinforcing, to reduce the respective doses on the combined administration of the therapeutic agent(s) with the norm.
In case of oral administration of 3-cyclopropylmethoxy-4-difIuoromethoxy-N-(3,5-dichloropyrid-4-yl)- benzamide (ROFLUMILAST), the adult daily dose is in the range from 50 - 1000μg, preferably in the range from 250 - 500μg, preferably by once daily administration. ln case of subcutaneous administration of 3-cyclopropylmethoxy-4-difluoromethoxy-N-(3,5-dichloro- pyrid-4-yl)benzamide (ROFLUMILAST), the adult daily dose is in the range from 50 - 1000μg, preferably in the range from 250 - 500μg.
In case of intravenous administration of 3-cyclopropylmethoxy-4-difluoromethoxy-N-(3,5-dichloropyrid- 4-yl)benzamide (ROFLUMILAST), the adult daily dose is in the range from 50 - 600μg, preferably in the range from 150 - 300μg.
For treatment of arthritis or another inflammatory disease, the TNFα antagonist is administered in systemic amounts ranging from about 0.1 mg/kg/week to about 100 mg/kg/week. In preferred embodiments of the present invention, the TNFα antagonist is administered in amounts ranging from about 0.5 mg/kg/week to about 50 mg/kg/week. For local intra -articular administration, dosages preferably range from about 0.01 mg/kg to about 1.0 mg/kg per injection.
In one embodiment of the present invention the adult dose of ETANERCEPT is 25 mg twice a week, as a subcutaneous injection. In another embodiment of the present invention the adult dose of ETANERCEPT is 50 mg once a week, as a subcutaneous injection.

Claims

Patent claims
1. Combined use of roflumilast and a TNFα antagonist selected from the group consisting of etanercept, onercept and pegsunercept for preventing or reducing the onset of symptoms of, or treating or reducing the severity of a disease in which phosphodiesterase 4 (PDE4) and/or tumor necrosis factor alpha (TNFα) activity is detrimental, in a patient in need thereof.
2. Pharmaceutical composition suited for the combined use according to claim 1 , comprising as a fixed combination an effective amount of
(a) roflumilast and
(b) a TNFα antagonist selected from the group of etanercept, onercept and pegsunercept and optionally
(c) a pharmaceutically acceptable carrier.
3. Pharmaceutical composition according to claim 2, which is a fixed injectable combination.
4. Pharmaceutical composition suited for the combined use according to claim 1 , comprising as a free combination an effective amount of
(a) roflumilast and optionally a pharmaceutically acceptable carrier and
(b) a TNFα antagonist selected from the group of etanercept, onercept and pegsunercept and optionally a pharmaceutically acceptable carrier.
5. Method for preventing or reducing the onset of symptoms of a disease in which phosphodiesterase 4 (PDE4) and/or tumor necrosis factor alpha (TNFα) activity is detrimental, or treating or reducing the severity of a disease in which phosphodiesterase 4 (PDE4) and/or tumor necrosis factor alpha (TNFα) activity is detrimental by administering to a patient in need thereof simultaneously an effective amount of (1) roflumilast and (2) a TNFα antagonist selected from the group of etanercept, onercept and pegsunercept.
6. Method for preventing or reducing the onset of symptoms of a disease in which phosphodiesterase 4 (PDE4) and/or tumor necrosis factor alpha (TNFα) activity is detrimental, or treating or reducing the severity of a disease in which phosphodiesterase 4 (PDE4) and/or tumor necrosis factor alpha (TNFα) activity is detrimental by administering to a patient in need thereof in succession, close in time or remote in time, in any order whatever an effective amount of (1 ) roflumilast and (2) a TNFα antagonist selected from the group of etanercept, onercept and pegsunercept.
7. Use of a combination of roflumilast and a TNFα antagonist selected from the group of etanercept, onercept and pegsunercept for the preparation of a pharmaceutical composition for reducing the onset of symptoms of, or treating or reducing the severity of a disease in which phosphodiesterase 4 (PDE4) and/or tumor necrosis factor alpha (TNFα) activity is detrimental.
8. Pharmaceutical composition, use or method according to any of claims 1 to 7, wherein roflumilast represents 3-cyclopropylmethoxy-4-difluoromethoxy-N-(3,5-dichloropyrid-4-yl)benzamide.
9. Pharmaceutical composition, use or method according to any of claims 1 to 7, wherein roflumilast represents 3-cyclopropylmethoxy-4-difluoromethoxy-N-(3,5-dichloro-1 -oxy-pyrid-4-yl)benzamide.
10. Pharmaceutical composition, use or method according to any of claims 1 to 9, wherein the TNFα antagonist is etanercept.
11. Pharmaceutical composition, use or method according to any of claims 1 to 9, wherein the TNFα antagonist is onercept.
12. Pharmaceutical composition, use or method according to any of claims 1 to 9, wherein the TNFα antagonist is pegsunercept.
13. Pharmaceutical composition, use or method according to any of claims 1 to 12, wherein the disease in which phosphodiesterase 4 (PDE4) and/or tumor necrosis factor alpha (TNFα) activity is detrimental is selected from rheumatoid arthritis, psoriasis, psoriatric arthritis, juvenile arthritis, inflammatory bowel disease, spondylarthropathies (ankylosing spondylitis), adult-onset Still's disease, Behcet's disease, polymyositis, sarcoidosis, Wegener granulomatosis, myelodysplastic syndrome, inflammatory myositis, Sjόgren syndrome, severe chronic asthma, septic shock, uveitis and graft versus host disease.
14. Pharmaceutical composition, use or method according to any of claims 1 to 12, wherein the disease in which phosphodiesterase 4 (PDE4) and/or tumor necrosis factor alpha (TNFα) activity is detrimental is selected from rheumatoid arthritis, psoriasis, psoriatric arthritis, juvenile arthritis, inflammatory bowel disease and spondylarthropathies (ankylosing spondylitis).
PCT/EP2004/050742 2003-05-12 2004-05-10 COMPOSITION COMPRISING ROFLUMILAST AND A TNFα ANTAGONIST WO2004098595A1 (en)

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US7776893B2 (en) 2003-09-05 2010-08-17 Nycomed Gmbh Use of PDE4 inhibitors for the treatment of diabetes mellitus
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