WO2004098633A1 - Composition comprenant un inhibiteur de la pde-4 et un antagoniste du tnf-alpha - Google Patents

Composition comprenant un inhibiteur de la pde-4 et un antagoniste du tnf-alpha Download PDF

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Publication number
WO2004098633A1
WO2004098633A1 PCT/EP2004/050748 EP2004050748W WO2004098633A1 WO 2004098633 A1 WO2004098633 A1 WO 2004098633A1 EP 2004050748 W EP2004050748 W EP 2004050748W WO 2004098633 A1 WO2004098633 A1 WO 2004098633A1
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Prior art keywords
phthalazin
piperidin
tetrahydro
dimethoxyphenyl
pde4
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PCT/EP2004/050748
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English (en)
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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
    • A61K45/00—Medicinal preparations containing active ingredients not provided for in groups A61K31/00 - A61K41/00
    • A61K45/06—Mixtures of active ingredients without chemical characterisation, e.g. antiphlogistics and cardiaca
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • 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
    • A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
    • A61K31/50—Pyridazines; Hydrogenated pyridazines
    • A61K31/502—Pyridazines; Hydrogenated pyridazines ortho- or peri-condensed with carbocyclic ring systems, e.g. cinnoline, phthalazine
    • 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
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07K—PEPTIDES
    • C07K2319/00—Fusion polypeptide
    • C07K2319/30—Non-immunoglobulin-derived peptide or protein having an immunoglobulin constant or Fc region, or a fragment thereof, attached thereto
    • 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

  • 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.
  • phthalazinone-piperidino derivatives are described as selective PDE4 inhibitors.
  • Emerging Drugs Vol. 5, 2000 pp. 309-319 the use of PDE4 inhibitors In the treatment of chronic obstructive pulmonary disease is reviewed.
  • WO01/58441 the combination of PDE4 inhibitors with NSAIDs is disclosed for the treatment of an inflammatory disease.
  • EP0433900 the recombi- nant human tumor necrosis factor binding protein-1 (r-hTBP-1 ; INN: ONERCEPT) is disclosed.
  • 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 4 (PDE4) and/or tumor necrosis factor alpha (TNF ⁇ ) activity is detrimental.
  • 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 (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 simultaneously an effective amount of (1) a PDE4 inhibitor and (2) a TNF ⁇ antagonist selected from the group of etanercept, onercept and pegsunercept.
  • PDE4 phosphodiesterase 4
  • 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) a PDE4 inhibitor 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 PDE4 inhibitor (a) a PDE4 inhibitor and (b) a 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 leduci ⁇ g 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 a PDE4 inhibitor 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 a PDE4 inhibitor 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 a PDE4 inhibitor 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 a PDE4 inhibitor and a TNF ⁇ antagonist selected from the group of etanercept, onercept and pegsunercept in pteventing the symptoms of, or treating a a disease in which phosphodiesterase 4 (PDE4) and/or tumor necrosis factor alpha (TNF ⁇ ) activity is detrimental.
  • the PDE4 inhibitors useful in this invention may be any compound that is known to inhibit the PDE4 enzyme ot which is discovered to act as a PDE4 inhibitor, and which is only or essentially only a PDE4 inhibitor, not compounds which inhibit to a degree of exhibiting a therapeutic effect other members of the PDE family as well as PDE4
  • PDE4 INHIBITORS One group of PDE4 inhibitors that may be usefully employed in the present invention [hereinafter referred to as "SELECTED PDE4 INHIBITORS”] include a compound of formula (1 )
  • R1 and R2 are both hydrogen or together form an additional bond
  • R3 represents a benzene derivative of formula (a) or (b)
  • R4 is 1-4C-alkoxy or 1-4C-alkoxy which is completely or predominantly substituted by fluorine
  • R5 is 1-8C-alkoxy, 3-7C-cycloalkoxy, 3-7C-cycloalkylmethoxy, or 1-4G-alkoxy which is completely or predominantly substituted by fluorine
  • R6 is 1-4C-alkoxy, 3-5C-cycloalkoxy, 3-5G-cycloalkylmethoxy, or 1-4G-alkoxy which is completely or predominantly substituted by fluorine
  • R7 is 1-4C-alkyl and R8 is hydrogen or 1 -4G-alkyl, or wherein
  • R7 and R8 together and with inclusion of the two carbon atoms, to which they are bonded, form a spiro-linked 5-, 6- or 7-membered hydrocarbon ring, optionally interrupted by an oxygen or sulphur atom,
  • R9 is 1-4C-Alkyl, -S(O) 2 -R10, -S(0) 2 -(CH 2 ) n -R11 , -(CH 2 ) m -S(0) 2 -R12, -G(0)R13, -C(0)-(CH 2 ) n -R14, -(CH 2 ) m -C(0)-R15, Hetaryl, AryM or Aryl2-(1 -4C)-alkyl,
  • R10 is 1-4C-alkyl, 5-dimethylaminonaphthalin-1 -yl, -N(R16)R17, phenyl or phenyl substituted by R18 and/or R19,
  • R11 is -N(R16)R17
  • R13 is 1-4C-alkyl, hydroxycarbonyl-1-4C-alkyl, phenyl, pyridyl, 4-ethyl-piperazin-2,3-dion-1-yl or -N(R16)R17,
  • R14 is -N(R16)R17
  • R15 is -N(R16)R17, phenyl, phenyl substituted by R18 and/or R19 and/or R20,
  • R16 and R17 are independent from each other hydrogen, 1-7C-alkyl, 3-7C-cycloalkyl, 3-7C-cycloalkyl- methyl, phenyl or phenyl substituted by R18 and/or R19 and/or R20, or R16 and R17 together and with inclusion of the nitrogen atom to which they are bonded, form a 4-morpholinyl-, 1-pyr- rolidinyl-, 1 -piperidinyl-, 1 -hexahydroazepino- or a 1-piperazinyl-ring of formula (c)
  • R21 is pyrid-4-yl, pyrid-4-ylmethyl, 1-4C-alkyl-di ⁇ nethylamino, dimethylaminocarbonylmethyl,
  • R18 is halogen, nitro, cyano, carboxyl, 1-4C-alkyl, trifluoromethyl, 1-4C-alkoxy, 1-4C-alkoxycarbonyl, amino, mono-or di-1 -4G-alkylami ⁇ o, aminocarbonyl, 1-4C-alkylcarbonylamino or mono-or di-
  • R19 is halogen, amino, nitro, 1-4C-alkyl or 1-4C-alkoxy
  • R20 is halogen
  • Hetaryl is pyrimidin-2-yl, thieno-[2,3-d]pyrimidin-4-yl, 1-methyl-1 H-pyrazolo-[3 d]pyrimidin-4-yl, thia- zolyl, imidazolyl or furanyl
  • Aryll is pyridyl, phenyl or phenyl substituted by R18 and/or R19
  • Aryl2 is pyridyl, phenyl, phenyl substituted by R18 and/or R19, 2-oxo-2H-chrome ⁇ -7-yl or 4-(1 ,2,3- thiadiazol-4-yl)phenyl
  • n is an integer from 1 to 4
  • m is an integer from 1 to 4 or a pharmaceutically acceptable salt or a N-
  • 1 -4C-Alkyl is a straight -chain or branched alkyl radical having 1 to 4 carbon atoms. Examples are the butyl, isobutyl, sec-butyl, tert-butyl, propyl, isopropyl, ethyl and methyl radicals.
  • 1 -4G-Alkoxy is a radical which, in addition to the oxygen atom, contains a straight-chain or branched alkyl radical having 1 to 4 carbon atoms.
  • Alkoxy radicals having 1 to 4 carbon atoms which may be mentioned in this context are, for example, the butoxy, isobutoxy, sec-butoxy, tert-butoxy, propoxy, isopropoxy, ethoxy and methoxy radicals.
  • 1 -8C-Alkoxy is a radical which, in addition to the oxygen atom, contains a straight -chain or branched alkyl radical having 1 to 8 carbon atoms.
  • Alkoxy radicals having 1 to 8 carbon atoms which may be mentioned in this context are, for example, the octyloxy, heptyloxy, isoheptyloxy (5-methylhexyloxy), hexyloxy, isohexyloxy (4-methylpentyloxy), neohexyloxy (3,3-dimethylbutoxy), pentyloxy, isopentyloxy (3-methylbutoxy), neopentyloxy (2,2-dimethylpropoxy), butoxy, isobutoxy, sec-butoxy, tert-butoxy, propoxy, isopropoxy, ethoxy and methoxy radicals.
  • 1 -4C-Alkoxy which is completely or predominantly substituted by fluorine is, for example, the 2,2,3,3,3-pentafluoropropoxy, the perfluoroethoxy, the 1 ,2,2-trifluoroethoxy and in particular the 1 ,1 ,2,2-tetrafluoroethoxy, the 2,2,2-trifluoroethoxy, the trifluoromethoxy and the difluoromethoxy radical, of which the difluoromethoxy radical is preferred.
  • "Predominantly" in this connection means that more than half of the hydrogen atoms of the 1-4C-alkoxy group are replaced by fluorine atoms.
  • 3-7G-Cycloalkoxy stands for cyclopropyloxy, cyclobutyloxy, cyclopentyloxy, cyclohexyloxy or cyclo- heptyloxy, of which cyclopropyloxy, cyclobutyloxy and cyclopentyloxy are preferred.
  • 3-7C-Cycloalkylmethoxy stands for cyclopropylmethoxy, cyclobutylmethoxy, cyclopentyl methoxy, cy- clohexylmethoxy or cycloheptylmethoxy, of which cyclopropylmethoxy, cyclobutylmethoxy and cyclo- pentylmethoxy are preferred.
  • 3-5C-Cycloalkoxy stands for cyclopropyloxy, cyclobutyloxy and cyclopentyloxy.
  • 3-5G-Cycloalkylmethoxy stands for cyclopropylmethoxy, cyclobutylmethoxy and cyclopentylm ⁇ thoxy.
  • Halogen within the meaning of the present invention is bromine, chlorine or fluorine.
  • spiro-linked 5-, 6- or 7-memb ⁇ red hydrocarbon rings optionally interrupted by an oxygen or sulphur atom, may be mentioned the cyclopentane, cyclohexane, cycloheptane, tetrahydrofuran, tetrahy- dropyran and the tetrahydrothiophen ring.
  • 1 -4G-Alkoxycarbonyl is a carbonyl group to which one of the abovementioned 1-4G-alkoxy radicals is bonded.
  • Examples are the methoxycarbonyl [CH 3 0-C(0)-] and the ethoxycarbonyl [CH 3 CH 2 0-C(0)-] radical.
  • An 1-4G-Alkylcarbonylamino radical is, for example, the propionylamino [C 3 H 7 C(0)NH-] and the ace- tylamino radical [CH 3 C(0)NH-].
  • Mono- or Di-1-4C-alky)amino radicals contain in addition to the nitrogen atom, one or two of the abovementioned 1-4C-alkyl radicals.
  • Mono- or Di-1-4C-alkylaminocarbonyl radicals contain in addition to the carbonyl group one of the abovementioned mono- or di-1-4C-alkylamino radicals. Examples which may be mentioned are the N-methyl- the N,N-dirnethyl-, the N-ethyl-, the N-propyl-, the N,N-diethyl- and the N-isopropylamino- carbonyl radical.
  • Salts encompassed within the term "pharmaceutically acceptable salts" refer to non-toxic salts of the compounds which are generally prepared by reacting a free base with a suitable organic or inorganic acid or by reacting the acid with a suitable organic or inorganic base. Particular mention may be made of the pharmaceutically acceptable inorganic and organic acids customarily used in pharmacy.
  • Those suitable 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-gluco ⁇ ic acid, benzole 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 acid, hydrobromic acid, phospho
  • salts with bases are mentioned the lithium, sodium, potassium, calcium, aluminium, magnesium, titanium, ammonium, m ⁇ glumine or guanidmium salts, here, too, the bases being employed in salt preparation in an equimolar quantitative ratio or one differing therefrom
  • 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
  • SELECTED PDE4 INHIBITORS which are to be emphasized include a compound of formula (1 ), in which
  • R3 represents a benzene derivative of formula (a) or (b)
  • R4 is 1-4G-alkoxy
  • R5 is 1-4C-alkoxy
  • R6 is 1-2C-alkoxy
  • R7 is methyl
  • R8 is hydrogen, R9 is 1-4C-alkyl, -S(O) 2 -R10, -C(0)R13, -C(0)-(CH 2 ) n -R14, -(CH 2 ) m -C(0)-R15, Hetaryl, Aryll or
  • Aryl2-(1-2C-)alkyl R10 is 1-4C-alkyl, 5 d ⁇ methyiam ⁇ nonaphthal ⁇ n-1 -yl, phenyl or phenyl substituted by R18, R13 is 1-4G-alkyl, hydroxycarbonyl-1-4C-alkyl, pyridyl, 4-ethyl-p ⁇ peraz ⁇ n-2,3-d ⁇ on-1-yl oi
  • R15 is -N(R16)R17, phenyl or phenyl substituted by R18 and/or R19 and/or R20, R16 and R17 are independent from each other hydrogen, 1-4C-alkyl, phenyl or phenyl substituted by
  • R21 is dimethylamino-1 -4C-alkyl
  • R18 is halogen, nitro, 1-4G-alkyl or 1 -4C-alkoxycarbonyl
  • R19 is amino
  • R20 is halogen
  • Hetaryl is pyrimidin-2-yl, thieno-[2,3-d]pyrimidin-4-yl or 1-methyl-1 H-pyrazolo-[3,4-d]pyrimidin-4-yl, Aryh is phenyl or phenyl substituted by R18,
  • Aryl2 is pyridyl, phenyl, 2-oxo-2H-chromen-7-yl or 4-(1 ,2,3-thiadiazol-4-yl)phenyl, n is 1 or 2, m is 1 or 2, or a pharmaceutically acceptable salt or a N-oxide thereof or a pharmaceutically acceptable salt of the latter.
  • SELECTED PDE4 INHIBITORS which are preferred include a compound selected from
  • SELECTED PDE4 INHIBITORS which are particularly preferred include a compound selected from
  • PDE4 inhibitors that may be usefully employed in the present invention include a compound selected from
  • 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.
  • 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 f ctor 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 anogenital area
  • alopecia areata, hypertrophic scars, discoid lupus erythematosus, follicular and widespread pyoderm
  • 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 a PDE4 inhibitor 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 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 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 TN F ⁇ 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.
  • PDE4 inhibitor is oral.
  • PDE4 inhibitor administered by intravenous infusion or injection.
  • PDE4 inhibitor 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 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 syn- thetic 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 a PDE4 inhibitor 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 daily dose will be in the range from 0.001 to 3 mg/kg body weight of the subject to be treated, preferably by once daily administration.
  • the adult dose of Cilomilast is between 5 mg and 20 mg twice a day, preferably between 10 mg and 15 mg twice a day.
  • the adult dose for oral administration of the SELEG TED PDE4 INHIBITORS (4aS,8aR)-4-(3,4-Dimethoxyphenyl)-2-(1 -pyrimidin-2-yl-piperidin-4-yl)- 4a,5,8,8a-tetrahydro-2H-phthalazin-1-one, (4aS,8aR)-4-(3,4-Dimethoxy-phenyl)-2-(1-pyridin-2-yl- methyl-piperidin-4-yl)-4a,5,8,8a-tetrahydro-2H-phthalazin-1-one or 2- ⁇ 4-[(4aS, 8aR)-4-(3,4-Dimeth- oxyphenyl)-1 -oxo-4 a,5,8,8a-tetrahydro-1H-phthalazin-2-yl]-piperidin-1-yl ⁇ -acetamide is between 0.1 and 10 mg once a day, preferably between
  • 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

L'invention concerne l'administration combinée d'un inhibiteur de la PDE4 et d'un antagoniste du TNFa sélectionné dans le groupe renfermant l'étanercept, l'onercept et le pegsunercept pour le traitement d'une maladie dans laquelle l'activité de la phosphodiestérase 4 (PDE4) et/ou du facteur de nécrose tumorale alpha (TNFa) est néfaste.
PCT/EP2004/050748 2003-05-12 2004-05-10 Composition comprenant un inhibiteur de la pde-4 et un antagoniste du tnf-alpha WO2004098633A1 (fr)

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Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5605690A (en) * 1989-09-05 1997-02-25 Immunex Corporation Methods of lowering active TNF-α levels in mammals using tumor necrosis factor receptor
WO1998031674A1 (fr) * 1997-01-15 1998-07-23 Byk Gulden Lomberg Chemische Fabrik Gmbh Phthalazinones
WO2002064584A1 (fr) * 2001-02-15 2002-08-22 Altana Pharma Ag Derives de phtalazinone-piperidine en tant qu'inhibiteurs de pde4

Patent Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5605690A (en) * 1989-09-05 1997-02-25 Immunex Corporation Methods of lowering active TNF-α levels in mammals using tumor necrosis factor receptor
WO1998031674A1 (fr) * 1997-01-15 1998-07-23 Byk Gulden Lomberg Chemische Fabrik Gmbh Phthalazinones
WO2002064584A1 (fr) * 2001-02-15 2002-08-22 Altana Pharma Ag Derives de phtalazinone-piperidine en tant qu'inhibiteurs de pde4

Non-Patent Citations (1)

* Cited by examiner, † Cited by third party
Title
WOLDA S L: "PDE4 INHIBITORS AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE", EMERGING DRUGS, ASHLEY PUBLICATIONS, LONDON, GB, vol. 5, no. 3, 2000, pages 309 - 319, XP008016335, ISSN: 1361-9195 *

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