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
  • A61K31/075—Ethers or acetals
• • 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
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P3/00—Drugs for disorders of the metabolism
  • A61P3/12—Drugs for disorders of the metabolism for electrolyte homeostasis
  • A61P3/14—Drugs for disorders of the metabolism for electrolyte homeostasis for calcium homeostasis

Definitions

• This invention relates to a method for treatment or prevention of osteoporosis in individuals with high bone turnover by administering an effective amount of a selective estrogen receptor modulator of triphenylalkane or triphenylalkene structure, particularly ospemifene or a geometric isomer, a stereoisomer, a pharmaceutically acceptable salt, an ester thereof or a metabolite thereof.
• a selective estrogen receptor modulator of triphenylalkane or triphenylalkene structure particularly ospemifene or a geometric isomer, a stereoisomer, a pharmaceutically acceptable salt, an ester thereof or a metabolite thereof.
• Bone is constantly being rebuilt throughout life in a process of bone remodeling.
• the remodeling begins with resorption (degradation) of bone by osteoclasts.
• the resorbed bone is then replaced by new bone tissue, which is characterized by collagen formation by osteoblasts, and subsequent calcification of the tissue.
• the overall rate of remodeling is in balance, i.e. the amount of bone lost is approximately equal to the amount formed.
• Osteoporosis is a chronic, progressive condition, where the balance is shifting towards higher resorption than formation. Therefore, the amount of bone decreases and the bones become fragile. Osteoporosis is ofter called' he silent disease", because bone loss occurs without any symptoms until the bone fracture.
• osteoporosis is commonly considered simply in terms of the amount of bone present in the body.
• WHO and consensus development conferences recommend the definition'Osteoporosis is a disesase characterized by low bone mass and microarchitectural deterioration of bone tissue, leading to enhanced bone fragility and a consequent increase in fracture risk' (Consensus development conference: diagnosis, prophylaxis and treatment of osteoporosis, American Journal of medicine 1991, 90:107-110; Report of a WHO study group, WHO Technical Repost Series 843: Assessment of fracture risk and its application to screening for menopausal osteoporosis).
• the degradation and formation cycle of the bone is called bone turnover.
• High turnover is found e.g. in children, but it can follow also by drugs (e.g. by corticosteroids) and bone diseases like osteomalacia.
• High turnover generally means both rapid bone formation and rapid bone degradation. In children high turnover is necessary as the bones grow.
• elderly the bone turnover decreases and the bone mass begins to decrease.
• Steroid hormones are important factors in bone turnover. Their role is seen clearly in the elderly.
• women the decrease of estrogen levels is considered to be the main reason to bone loss. Therefore estrogens are commonly used to protect against osteoporosis.
• SERMs selective estrogen receptor modulators
• SERMs selective estrogen receptor modulators
• the mechanism of action of SERMs is mainly to decrease the number of osteoclasts. Therefore, the bone resorption is decreased and the bone amount is maintained.
• SERMs and estrogens have relatively weak effects on osteoblasts.
• osteoporosis can be followed by measuring the bone mineral density and amount of bone in the body at certain intervals.
• biochemical bone markers which are specific for bone formation and bone degradation. They can be analysed either from serum (s in the table below) or in urine (u). Such markers include e.g.
• -Total alkaline phosphatase(s) -Tartrate-resistant acid phosphatase -Osteocalcin especially its subtype 5b (TRAP5b) (s) -Procollagen typel -Total and dialyzable hydroxyproline (u) N-terminal peptide (s) Pyridinoline and -Procollagen type 1 deoxypyridinoline C-terminal peptide (s) (collagen cross-links) (u) -Crosslaps (s) -Type 1 collagen telopeptides (u)
• both formation and reso ⁇ tion markers may be increased, but high levels of resorption markers when compared to formation markers may also indicate high turnover in short run.
• SERMs have both estrogen-like and antiestrogenic properties (Kauffman & Bryant, 1995). The effects may be tissue-specific as in the case of tamoxifen and toremifene which have estrogen-like effects in the bone, partial estrogen-like effect in the uterus and liver, and pure antiestrogenic effect in breast cancer. Raloxifene and droloxifen are similar to tamoxifen and toremifene, except that their antiestrogenic properties dominate. Based on the published information, many SERMs are more likely to cause menopausal symptoms than to prevent them.
• Ospemifene is the Z-isomer of the compound of formula (I)
• toremifene is known to be an estrogen agonist and antagonist (Kangas, 1990; International patent publications WO 96/07402 and WO 97/32574).
• the compound is also called (deaminohydroxy)toremifene and it is also known under the code FC-1271a.
• Ospemifene has relatively weak estrogenic and antiestrogenic effects in the classical hormonal tests (Kangas, 1990). It has anti-osteoporosis actions and it decreases total and LDL cholesterol levels in both experimental models and in human volunteers (International patent publications WO 96/07402 and WO 97/32574).
• Ospemifene is also the first SERM which has been shown to have beneficial effects in climacteric syndromes in healthy women.
• the published patent application WO 03/103649 describes the use of ospemifene for inhibition of atrophy and for the treatment or prevention of atrophy- related diseases or disorders in women, especially in women during or after the menopause.
• An object of the present invention is to provide a particular subgroup of individuals especially benefiting from the administration of a SERM of triphenylalkane or triphenylalkene structure, especially ospemifene or a geometric isomer, a stereoisomer, a pharmaceutically acceptable salt, an ester thereof or a metabolite thereof in the treatment or prevention of osteoporosis.
• the invention concerns a method for the treatment or prevention of osteoporosis in an individual suffering from increased bone turnover, said method comprising administering to said individual an effective amount of a therapeutically active compound, which is a selective estrogen receptor modulator of triphenylalkene or triphenylalkane structure.
• Figure IB shows the individual changes in the bone reso ⁇ tion marker U-NTX (nmol mmol) Crea with a 60 mg daily dose of ospemifene in a 12-week clinical study.
• Figure 2 shows the individual changes in the bone formation marker S-PICP (microgram 1) with a 90 mg daily dose of ospemifene in a 12-week clinical study.
• Figure 3 is a plotter chart of individual changes in the bone formation marker S- PINP (microgram/1) at 12 weeks compared to baseline in a clinical study on ospemifene.
• Figure 4 is a plotter chart of individual changes in the bone reso ⁇ tion marker U- CTX at 12 weeks compared to baseline in a clinical study on ospemifene.
• Suitable SERM compounds for use in the present invention are triphenylalkene or triphenylalkane compounds such as compounds disclosed in WO 01/36360, US 4,996,225, US 4,696,949, US 5,750,576, WO 99/42427 and the toremifene metabolites disclosed in L Kangas, Cancer Chemother Pharmacol (1990)27:8-12.
• triphenylalkene or triphenylalkane compounds such as compounds disclosed in WO 01/36360, US 4,996,225, US 4,696,949, US 5,750,576, WO 99/42427 and the toremifene metabolites disclosed in L Kangas, Cancer Chemother Pharmacol (1990)27:8-12.
• specific drugs disclosed in the aforementioned references can be mentioned toremifene and ospemifene.
• Tamoxifen and its derivatives such as 4- hydroxytamoxifen, alpha-hydroxytamoxifen, N-desmethyltamoxifen, N,N- didesmethyltamoxifen, deaminotamoxifen, and droloxifene and iodoxifene also examples of suitable SERMs of triphenylalkene structure.
• the therapeutically active compound is a SERM of triphenylalkene structure.
• a compound of formula (I) or a geometric isomer, a stereoisomer, a pharmaceutically acceptable salt, an ester thereof or a metabolite thereof is preferred:
• the method of preventing or treating osteoporosis with ospemifene and related compounds according to this invention in individuals with increased bone turnover is particularly useful when treating women during or after the menopause.
• the method according to this invention is not restricted to women in this age group.
• the wording "increased bone turnover” means that both bone reso ⁇ tion and formation of new bone are increased.
• a normal value for bone reso ⁇ tion in postmenopausal women is considered a bone reso ⁇ tion of at least 65 nmol/mmol Crea, using aminoterminal telopeptide of type I collagen measured in urine (U- NTX) as marker or at least 680 microgram/mmol Crea, using carboxyterminal telopeptide of type I collagen measured in urine (U-CTX) as marker.
• a normal value for bone formation in the same group is considered a bone formation of at least 170 microgram/1, using carboxyterminal propeptide of type I procollagen measured in serum (S-PICP) as marker, or at least 84 microgram/1, using aminoterminal propeptide of type I procollagen measured in serum (S-PJJSfP) as marker.
• a particular good response to the administering of ospemifene is observed in individuals with at least 5 %, preferably at least 10 % increased bone turnover, measured as well as bone reso ⁇ tion as bone formation.
• An especially important population benefiting from the method according to this invention is postmenopausal women having a bone reso ⁇ tion, measured as U-NTX, which is at least 70 nmol/mmol Crea, preferably at least 80 nmol/mmol, and a bone formation, measured as S-PICP, being at least 180 microgram/1.
• Particularly suitable markers for measuring bone reso ⁇ tion are Crosslaps measured from serum and TRAP5b, also measured from serum. Crosslaps is marker reporting the activity of osteoclasts and TRAP5b is a marker revealing the number of the osteoclasts. The value indicating a level of normal bone turnover for both of these markers is about 3. Increased bone reso ⁇ tion is often registered as value 6, i.e. an increase of 100 %. These markers are thus very sensitive to changes in bone reso ⁇ tion.
• the bone reso ⁇ tion is measured using as markers a combination of Crosslaps and TRAP5b, both measured from serum.
• the optimal clinical dose of ospemifene is expected to be higher than 25 mg daily and lower than 100 mg daily.
• a particularly preferable daily dose has been suggested in the range 30 to 90 mg.
• ospemifene shows properties more similar to those of tamoxifen and toremifene.
• ovariectomy In female rats high bone turnover can be induced by ovariectomy (OVX). Rapidly, within days after OVX the number of osteoclasts increases and reso ⁇ tion markers increase. Shortly after OVX the bone formation is also increased, but due to the absence of bone protecting estrogens, the balance is towards bone loss. The bone loss, however, reaches within a few months a new balance, where the bone mass is lower than at baseline, but the rates of formation and reso ⁇ tion are equal. Estrogens can prevent the bone loss effectively, when it is administered immediately after OVX. If the administration is started months later, the bone structure has been changed and estrogens do not have as strong beneficial effect. Experimental
• ovariectomy Treatment with ospemifene was started at different time points after OVX: 1 day, 1, 2, and 3 months after OVX. Bone reso ⁇ tion was evaluated in short-term by bone specific TRAP5b, which is a protease secreted specifically by osteoclasts, and later by pyridinoline/deoxypyridinoline cross links, which are degradation products of bone collagen and excreted in the urine. Finally, during autopsy, usually after 3 months treatment, trabecular bone mineral density was measured.
• OVX+Ospemifene 25 mg/kg 392 ⁇ 15 OVX+Ospemifene 10 mg/kg 138 ⁇ 24 78 ⁇ 14 78 ⁇ 17
• Table 3 Effect of ospemifene on bone degradation markers 30 days after OVX.
• the administration of ospemifene was started one day after OVX and continued daily until measurements.
• Urine total pyridinoline/deoxypyridoline crosslinks were measured in the urine. Sham means rats, which were operated like OVX animals, but the ovaries were not removed.
• Ospemifene significantly decreases the excretion of crosslinks, which is a reso ⁇ tion marker.
• bone turnover was evaluated by measuring the levels of bone formation markers in serum and bone reso ⁇ tion markers in urine.
• bone reso ⁇ tion markers e.g. aminoterminal telopeptide of type I collagen (U-NTX) and carboxyterminal telopeptide of type I collagen (U-CTX)
• formation markers e.g. aminoterminal propeptide of type I procollagen (S-PINP) and carboxyterminal propeptide of type I procollagen (S-PICP) are increased in menopause, indicating high bone turnover. Bone antireso ⁇ tive therapy decreases these values reflecting inhibition of bone turnover.
• ospemifene decreases the bone reso ⁇ tion to a certain extent, but it allows the osteoclasts to work and therefore new bone to be formed. The result is a balanced decrease in bone reso ⁇ tion which does not adversely affect the bone formation.

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• 2004
  • 2004-02-23 US US10/783,092 patent/US20050187302A1/en not_active Abandoned
• 2005
  • 2005-01-19 AU AU2005215173A patent/AU2005215173A1/en not_active Abandoned
  • 2005-01-19 CN CNA2005800049712A patent/CN1972680A/zh active Pending
  • 2005-01-19 WO PCT/FI2005/000034 patent/WO2005079776A1/en not_active Ceased
  • 2005-01-19 EP EP05708122A patent/EP1718287A1/en not_active Ceased
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