Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K38/00—Medicinal preparations containing peptides
  • A61K38/04—Peptides having up to 20 amino acids in a fully defined sequence; Derivatives thereof
  • A61K38/12—Cyclic peptides, e.g. bacitracins; Polymyxins; Gramicidins S, C; Tyrocidins A, B or C
• • 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
• • 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
  • A61K31/445—Non condensed piperidines, e.g. piperocaine
  • A61K31/451—Non condensed piperidines, e.g. piperocaine having a carbocyclic group directly attached to the heterocyclic ring, e.g. glutethimide, meperidine, loperamide, phencyclidine, piminodine
• • 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
  • A61K31/55—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having seven-membered rings, e.g. azelastine, pentylenetetrazole
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P1/00—Drugs for disorders of the alimentary tract or the digestive system
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P1/00—Drugs for disorders of the alimentary tract or the digestive system
  • A61P1/06—Anti-spasmodics, e.g. drugs for colics, esophagic dyskinesia
• • 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

Definitions

• the invention relates to pharmaceutical compositions containing an antagonist of tachykinins, specifically neurokinin A, for the treatment of infantile colics. STATE OF THE ART
• the tachykinins are a family of neuropeptides consisting of Substance P (SP) and neurokinins A (NKA) and B (NKB), whose receptors are widely present in the central and peripheral nervous system.
• SP Substance P
• NKA neurokinins A
• B NKB
• the NKA receptor (N K2) in particular is widely expressed in the peripheral nervous system of mammals.
• NK2 antagonists can be considered agents able to control excessive contractions of smooth muscle in any pathological condition, such as irritations or spasms, in which tachykinin release contributes to the development of the disorder.
• the bronchospastic component of asthma, cough, pulmonary irritations, intestinal irritations, intestinal spasms, local spasms of the bladder and the ureter during cystitis, kidney infections and colics can be considered conditions in which the administration of an NK2 antagonist can be effective (AL Magnan et al, Neuropeptides, 1993, 24, 199).
• IBS irritable bowel syndrome
• IBS is clinically characterised by chronic abdominal pain associated with disturbed intestinal habits (constipation and/or diarrhoea).
• visceral hyperalgesia The patient with IBS exhibits a reduced sensitivity threshold to visceral pain: this means that low intensity visceral stimuli (e.g. colorectal distension) which are not perceived as painful in the healthy subject are instead perceived as painful and debilitating by the IBS patient (visceral hyperalgesia).
• visceral stimuli e.g. colorectal distension
• NK2 antagonists have proved capable of reducing visceral hypersensitivity induced by various stimuli (PM Anton et al, Pain, 2001 , 92, 219; PG McLean et al, Eur J Pharmacol, 1997, 337, 279).
• NK2 antagonists were described with a bicyclic structure; their very low solubility in water has until now prevented any possible pharmaceutical application thereof, despite their interesting in vitro activity.
• EP815126 NK2 antagonists were described with the same bicyclic structure as WO93/21227, but with a hydrophilic part which has rendered them more suitable for pharmaceutical development.
• the NK2 antagonists described in EP815126 still demonstrate poor oral bioavailability which has rendered this administration route totally unsatisfactory.
• WO0129066 in which monocyclic NK2 antagonists are described, and WO03037916 with linear NK2 antagonists with basic characteristics.
• Infantile colics (IC) are a widely diffuse disorder in infants, whose causes have not been precisely clarified.
• infantile colics affect both breast fed and artificially fed infants. Despite the favourable and short- term clinical course of infantile colics, this is very stressful for the parents, many of whom seek medical help.
• tachykinin antagonists specifically NK2 antagonists or NK2/NK3, NK1/NK2 and NK1/NK2/NK3 mixed antagonists, has hitherto never been postulated for the treatment of these latter.
• a drug capable of blocking pain symptomology and excessive intestinal motility without altering the basal functions of the infant's intestine can be successfully used in the therapy of infantile colics.
• the activity profile exhibited by tachykinin antagonists specifically NK2 antagonists or NK2/NK3, NK1/NK2 and NK1/NK2/NK3 mixed antagonists, can be made use of in the preparation of pharmaceutical compositions effective for treating infantile colics.
• NK2 antagonists have indeed demonstrated the ability, after oral administration, to prevent the increased intestinal transit induced by administration of an NK2 selective agonist, without affecting intestinal basal motility.
• NK2 antagonists were described, in particular nepadutant, as a potential drug for the treatment of adult pathologies. It was noted however that these antagonists, including nepadutant, presented the problems of poor bioavailability when administered orally in tests undertaken in both animals and humans.
• NK2 antagonists are those described in EP815126, in particular the products of formula (I) as defined in claims 1-10, more particularly the products included in the group consisting of:
• NK2 antagonist compounds in accordance with the present invention is that represented by the compounds described in WO03037916, in particular the products of formula (I) as defined in claims 1-8, more particularly the compounds included in the group consisting of:
• a further preferred group of compounds for the purposes of the present invention are the NK2 antagonist compounds or the NK2/NK3, NK1/NK2 and NK1/NK2/NK3 mixed antagonist compounds chosen from the group consisting of: (S)-N-[4-(4-Acetamido-4-phenylpiperidin-1-yl)-2-(3,4-dichlorophenyl)-butyl]-N- methylbenzamide (saredutant, SR48968 by Sanofi-Aventis),
• compositions suitable for treating infantile colics are the oral forms, and in particular:
• the tachykinin antagonist and in particular the NK2 antagonist used as active principle, is present at a concentration from 0.01 to 50 mg/ml, preferably from 0.1 to 10 mg/ml.
• Said formulations can be used one or more times a day, as required, and based on the advice of the doctor in charge.
• Pharmaceutically acceptable excipients for pediatric use are also present, such as sweeteners (sugars, including glucose), flavour enhancers (e.g: fruit flavours, strawberry flavour, raspberry flavour, cream flavour), solubilizing agents (e.g. polysorbate, polyvinylpyrrolidone, carboxymethylcellulose), preservatives and antioxidants (e.g. sorbic acid and ascorbic acid) and others.
• these excipients also serve to mask the possible bitter taste of the active principle utilized.
• these formulations can be added to foods used for infant feeding, particularly milk.
• Example 1 Formulation in the form of drops for pediatric use containing (per 100 ml of aqueous solution):
• Cream flavour 0.0015 g.
• Example 2 Formulation in the form of drops for pediatric use containing (per 100 ml of aqueous solution):
• Cream flavour 0.0015 g.
• Example 3 Formulation in the form of drops for pediatric use containing (per 100 ml of aqueous solution):
• Formulation in the form of drops for pediatric use containing (per 100 ml of aqueous solution):
• Example 5 Formulation in the form of drops for pediatric use containing:
• 6-Methyl-benzo[b]thiophene-2-carboxylic acid [1 -(2-phenyl-1 R- ⁇ [1 -(tetrahydro- pyran-4-ylmethyl)-piperidin-4-ylmethyl]-carbamoyl ⁇ -ethylcarbamoyl)-cyclopentyl]- amide 10 mg diethylene glycol monoethyl ether 250 mg polysorbate 20 250 mg citric acid 10 mg.
• the formulations of the present invention were tested for their biological activity in vivo on newborn rats in accordance with the following method: a) The NK2 selective agonist ⁇ -Ala 8 -NKA(4-10) was administered intraperitoneally to infant rats aged between 7 and 10 days, both males and females, at a dose of
• ⁇ -Ala 8 -NKA(4-10) administered orally to infant rats aged between 7 and 10 days, both males and females, at doses of 0.5 and 2.5 mg/kg at 2, 4 and 6 hours respectively prior to intraperitoneal administration of the NK2 selective agonist ⁇ -Ala 8 -NKA(4-10) at a dose of 15 ⁇ g/kg i.p., selected as the dose able to induce a significant increase in intestinal transit.
• Nepadutant proved able to prevent the increase in intestinal transit induced by the stimulation of NK2 receptors by the ⁇ -Ala 8 -NKA(4-10) agonist in a significant manner.
• c) In the absence of ⁇ -Ala 8 -NKA(4-10) agonist administration, the administration of formulations containing nepadutant has no effect on basal intestinal transit in infant rats, measured at 6 hours after administration, at a dose of 2.5 mg/kg.

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• Health & Medical Sciences (AREA)
• Life Sciences & Earth Sciences (AREA)
• General Health & Medical Sciences (AREA)
• Pharmacology & Pharmacy (AREA)
• Animal Behavior & Ethology (AREA)
• Public Health (AREA)
• Medicinal Chemistry (AREA)
• Chemical & Material Sciences (AREA)
• Veterinary Medicine (AREA)
• Epidemiology (AREA)
• Bioinformatics & Cheminformatics (AREA)
• Engineering & Computer Science (AREA)
• Immunology (AREA)
• General Chemical & Material Sciences (AREA)
• Chemical Kinetics & Catalysis (AREA)
• Gastroenterology & Hepatology (AREA)
• Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
• Proteomics, Peptides & Aminoacids (AREA)
• Organic Chemistry (AREA)
• Medicines That Contain Protein Lipid Enzymes And Other Medicines (AREA)
• Pharmaceuticals Containing Other Organic And Inorganic Compounds (AREA)
• Medicinal Preparation (AREA)
• Plural Heterocyclic Compounds (AREA)
• Coloring Foods And Improving Nutritive Qualities (AREA)

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• 2004
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• 2010
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