WO2007008157A1 - New combination 2 - Google Patents

New combination 2 Download PDF

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Publication number
WO2007008157A1
WO2007008157A1 PCT/SE2006/000865 SE2006000865W WO2007008157A1 WO 2007008157 A1 WO2007008157 A1 WO 2007008157A1 SE 2006000865 W SE2006000865 W SE 2006000865W WO 2007008157 A1 WO2007008157 A1 WO 2007008157A1
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WO
WIPO (PCT)
Prior art keywords
ylmethyl
tricyclo
chloro
dec
benzamide
Prior art date
Application number
PCT/SE2006/000865
Other languages
French (fr)
Inventor
Nigel Boughton-Smith
Martin Braddock
Original Assignee
Astrazeneca Ab
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Astrazeneca Ab filed Critical Astrazeneca Ab
Publication of WO2007008157A1 publication Critical patent/WO2007008157A1/en

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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
    • 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
    • A61K31/16—Amides, e.g. hydroxamic acids
    • A61K31/165—Amides, e.g. hydroxamic acids having aromatic rings, e.g. colchicine, atenolol, progabide
    • A61K31/166—Amides, e.g. hydroxamic acids having aromatic rings, e.g. colchicine, atenolol, progabide having the carbon of a carboxamide group directly attached to the aromatic ring, e.g. procainamide, procarbazine, metoclopramide, labetalol
    • 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
    • A61K31/16—Amides, e.g. hydroxamic acids
    • A61K31/165—Amides, e.g. hydroxamic acids having aromatic rings, e.g. colchicine, atenolol, progabide
    • A61K31/167—Amides, e.g. hydroxamic acids having aromatic rings, e.g. colchicine, atenolol, progabide having the nitrogen of a carboxamide group directly attached to the aromatic ring, e.g. lidocaine, paracetamol
    • 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
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P11/00—Drugs for disorders of the respiratory system
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P5/00—Drugs for disorders of the endocrine system
    • A61P5/38—Drugs for disorders of the endocrine system of the suprarenal hormones
    • A61P5/44—Glucocorticosteroids; Drugs increasing or potentiating the activity of glucocorticosteroids

Definitions

  • the present invention relates to combinations of pharmaceutically active substances for use in the treatment of respiratory diseases, especially chronic obstructive pulmonary s disease (COPD) and asthma.
  • COPD chronic obstructive pulmonary s disease
  • Respiratory diseases include Acute Lung Injury, Acute Respiratory Distress Syndrome (ARDS), occupational lung disease, lung cancer, tuberculosis, fibrosis, pneumoconiosis, pneumonia, emphysema, Chronic Obstructive s Pulmonary Disease (COPD) and asthma.
  • ARDS Acute Respiratory Distress Syndrome
  • COPD Chronic Obstructive s Pulmonary Disease
  • Asthma is generally defined as an inflammatory disorder of the airways with clinical symptoms arising from intermittent airflow obstruction. It is characterised clinically by paroxysms of wheezing, 0 dyspnea and cough. It is a chronic disabling disorder that appears to be increasing in prevalence and severity. It is estimated that 15% of children and 5% of adults in the population of developed countries suffer from asthma. Therapy should therefore be aimed at controlling symptoms so that normal life is possible and at the same time provide basis for treating the underlying inflammation. S
  • COPD is a term which refers to a large group of lung diseases which can interfere with normal breathing.
  • Current clinical guidelines define COPD as a disease state characterized by airflow limitation that is not fully reversible.
  • the airflow limitation is usually both progressive and associated with an abnormal inflammatory response of the lungs to 0 noxious particles and gases.
  • the most important contributory source of such particles and gases is tobacco smoke.
  • COPD patients have a variety of symptoms, including cough, shortness of breath, and excessive production of sputum; such symptoms arise from dysfunction of a number of cellular compartments, including neutrophils, macrophages, and epithelial cells.
  • the two most important conditions covered by COPD are chronic bronchitis and emphysema.
  • Chronic bronchitis is a long-standing inflammation of the bronchi which causes increased production of mucous and other changes. The patients' symptoms are cough and expectoration of sputum. Chronic bronchitis can lead to more frequent and severe o respiratory infections, narrowing and plugging of the bronchi, difficult breathing and disability.
  • Emphysema is a chronic lung disease which affects the alveoli and/or the ends of the smallest bronchi.
  • the lung loses its elasticity and therefore these areas of the lungs become s enlarged. These enlarged areas trap stale air and do not effectively exchange it with fresh air. This results in difficult breathing and may result in insufficient oxygen being delivered to the blood.
  • the predominant symptom in patients with emphysema is shortness of breath.
  • Therapeutic agents used in the treatment of respiratory diseases include ⁇ 2 — agonists. These o agents (also known as beta2 ( ⁇ 2 ) adrenoceptor agonists) may be used to alleviate symptoms of respiratory diseases by relaxing the bronchial smooth muscles, reducing airway obstruction, reducing lung hyperinflation and decreasing shortness of breath.
  • ⁇ 2 — agonists also known as beta2 ( ⁇ 2 ) adrenoceptor agonists
  • the P2X 7 receptor (previously known as P2Z receptor), which is a ligand-gated ion channel, is present on a variety of cell types, largely those known to be involved in the inflammatory/immune process, specifically, macrophages, mast cells and lymphocytes (T and B).
  • P2X 7 receptors Activation of the P2X 7 receptor by extracellular nucleotides, in particular adenosine triphosphate, leads to the release of interleukin-l ⁇ (IL-l ⁇ ) and giant cell formation (macrophages/microglial cells), degranulation (mast cells) and proliferation (T cells), apoptosis and L-selectin shedding (lymphocytes).
  • IL-l ⁇ interleukin-l ⁇
  • Macrophages/microglial cells giant cell formation
  • mass cells mass cells
  • T cells proliferation
  • apoptosis and L-selectin shedding lymphocytes.
  • P2X 7 receptors are also located on antigen-presenting cells (APC), keratinocytes, salivary acinar cells (parotid cells), hepatocytes and mesangial cells.
  • APC antigen-presenting cells
  • keratinocytes keratinocytes
  • the present invention provides a pharmaceutical product comprising, in combination, a first active ingredient which is a P2X 7 receptor antagonist, and a second active ingredient which is a ⁇ 2 -agonist.
  • a beneficial therapeutic effect may be observed in the treatment of respiratory diseases if a P2X 7 receptor antagonist is used in combination with a ⁇ 2 -agonist.
  • the beneficial effect may be observed when the two active substances are administered simultaneously (either in a single pharmaceutical preparation or via separate preparations), or sequentially or separately via separate pharmaceutical preparations.
  • the pharmaceutical product of the present invention may, for example, be a pharmaceutical composition comprising the first and second active ingredients in admixture.
  • the pharmaceutical product may, for example, be a kit comprising a preparation of the first active ingredient and a preparation of the second active ingredient and, optionally, instructions for the simultaneous, sequential or separate administration of the preparations to a patient in need thereof.
  • the pharmaceutical product of the present invention comprises, as a first active ingredient, a P2X 7 receptor antagonist.
  • An antagonist of the P2X 7 receptor is a compound or other substance that is capable of preventing, whether fully or partially, activation of the P2X 7 receptor.
  • the assay is carried out by taking a 96-well flat bottomed microtitre plate and filling the wells with 250 ⁇ l of test solution comprising 200 ⁇ l of a suspension of THP-I cells (2.5 x 10 6 cells/ml) containing 10 "4 M ethidium bromide, 25 ⁇ l of a high potassium buffer solution containing 10 "5 M benzoylbenzoyl adenosine triphosphate
  • bbATP a known P2X 7 receptor agonist
  • 25 ⁇ l of the high potassium buffer solution containing 3 x 10 "5 M test compound 25 ⁇ l of the high potassium buffer solution containing 3 x 10 "5 M test compound.
  • the plate is covered with a plastics sheet and incubated at 37 0 C for one hour.
  • the plate is then read in a Perkin-Elmer fluorescent plate reader, excitation 520 nm, emission 595 nm, slit widths: Ex 15 nm, Em 20 nm.
  • bbATP a P2X 7 receptor agonist
  • pyridoxal 5-phosphate a P2X 7 receptor antagonist
  • a pIC 50 figure is calculated for the test compound, this figure being the negative logarithm of the concentration of test compound necessary to reduce the bbATP agonist activity by 50%.
  • a pIC 50 figure greater than 5.5 is normally indicative of an antagonist.
  • P2X 7 receptor antagonists which may be used in accordance with the present invention include adamantyl derivatives having P2X 7 receptor antagonist properties, as for example described in WO 00/61569, WO 01/42194, WO 01/44170 and WO 03/41707, the entire contents of which are incorporated herein by reference.
  • the P2X 7 receptor antagonist is an adamantyl derivative of formula
  • X represents a bond, CO, (CH 2 )i -6 , O(CH 2 ) 1-6 , (CH 2 )i -6 NH(CH 2 ) 1-6 , (CH 2 ) 1-6 O(CH 2 ) 1-6 or NH(CH 2 ) 1-6 ;
  • Z represents NR R ;
  • R represents halogen, cyano, nitro, amino, hydroxyl, C 1 -C 6 alkyl or C 3 -C 8 cycloalkyl, which alkyl or cycloalkyl group group can be optionally substituted by one or more fluorine atoms;
  • R 2 and R 3 each independently represent a hydrogen atom, C 1 -C 6 alkyl or C 3 -C 8 cycloalkyl, which alkyl or cycloalkyl group can be optionally substituted by one or more groups selected from hydroxyl, halogen or C 1 -C 6 alkoxy, or R 2 and R 3 together with the nitrogen atom to which they are attached form a 3- to 9- membered saturated mono- or bicyclic heterocyclic ring comprising from 1 to 2 nitrogen atoms and optionally an oxygen atom, which heterocyclic ring can be optionally substituted by one or more groups selected from hydroxyl, halogen or C 1 -C 6 alkoxy; or a pharmaceutically acceptable
  • Adamantyl derivatives of formula (I) may be prepared according to known chemistry, for example by methods according or analogous to those described in WO 00/61569, WO 01/42194, WO 01/44170 and WO 03/41707.
  • the P2X ⁇ receptor antagonist used in the present invention may be capable of existing in all stereoisomeric forms including all geometric and optical isomers of the active ingredient and mixtures thereof including racemates. It will also be understood that certain P2X7 receptor antagonists may exist in solvated, for example hydrated, as well as unsolvated forms, and the present invention encompasses all such solvated forms.
  • Pharmaceutically acceptable salts of P2X 7 antagonists of formula (I) include, where applicable, acid addition salts derived from pharmaceutically acceptable inorganic and organic acids such as a chloride, bromide, sulphate, phosphate, maleate, fumarate, tartrate, citrate, benzoate, 4-methoxybenzoate, 2- or 4-hydroxybenzoate, 4-chlorobenzoate, p-
  • Salts derived from inorganic bases include aluminium, ammonium, calcium, copper, ferric, ferrous, lithium, magnesium, manganic, manganous, potassium, sodium, zinc and bismuth salts.
  • Salts derived from pharmaceutically acceptable organic bases include salts of primary, secondary and tertiary amines, cyclic amines like arginine, betaine, choline and the like.
  • the P2X 7 receptor antagonist is selected from 2-Chloro-5-[[2-(2-hydroxy-ethylamino)-ethylamino]-methyl]-iV- (tricyclo[3.3.1.1 3>7 ]dec- 1 -ylmethyl)-benzamide,
  • P2X 7 receptor antagonists examples include:-
  • the second active ingredient in the combination of the present invention is a ⁇ 2 -agonist.
  • the ⁇ 2 -agonist of the present invention may be any compound or substance capable of stimulating the ⁇ 2 -receptor and acting as a bronchodilator.
  • Examples of ⁇ 2 -agonists that may be used in the present invention include bambuterol, bitolterol, carbuterol, clenbuterol, fenoterol, formoterol, hexoprenaline, ibuterol, pirbuterol, procaterol, reproterol, salmeterol, sulphonterol, terbutaline indacaterol and tolubuterol.
  • the ⁇ 2 -agonist of the invention is a long acting ⁇ 2 -agonist, i.e. a ⁇ 2 -agonist with activity that persists for more than 12 hours.
  • long acting ⁇ 2 -agonists include formoterol, bambuterol, salmeterol and indacaterol.
  • any reference to a ⁇ 2 - agonist includes active salts, solvates or derivatives that may be formed from said ⁇ 2 - agonist and any enantiomers and mixtures thereof.
  • Examples of possible salts or derivatives of ⁇ 2 -agonists are acid addition salts such as the salts of hydrochloric acid, hydrobromic acid, sulphuric acid, phosphoric acid, methanesulphonic acid, acetic acid, fumaric acid, succinic acid, lactic acid, citric acid, tartaric acid, l-hydroxy-2- naphthalenecarboxylic acid, maleic acid, and pharmaceutically acceptable esters (e.g. C 1 - C 6 alkyl esters).
  • the ⁇ 2 -agonists may also be in the form of solvates, e.g. hydrates.
  • the ⁇ 2 -agonist is formoterol.
  • the chemical name for formoterol is N-[2-hydroxy-5-[(l)-l-hydroxy-2-[[(l)-2-(4-methoxyphenyl)-l- methylethyl]amino]ethyl]phenyl]-formamide.
  • the preparation of formoterol is described, for example, in WO 92/05147.
  • the ⁇ 2 -agonist is formoterol fumarate.
  • the invention encompasses the use of all optical isomers of formoterol and mixtures thereof including racemates.
  • formoterol encompasses iV-[2-hydroxy-5-[(lR)-l-hydroxy-2-[[(lR)-2-(4-methoxyphenyl)- 1-methylethyl] amino] ethyl]phenyl]-formamide, iV-[2-hydroxy-5-[(lS)-l-hydroxy-2-[[(lS)- 2-(4-methoxyphenyl)-l-methylethyl]amino]ethyl]phenyl]-formamide and a mixture of such enantiomers, including a racemate.
  • the combination of the present invention may provide a beneficial therapeutic effect in the treatment of respiratory diseases.
  • beneficial therapeutic effect include improvements in one or more of the following parameters: reducing inflammatory cell influx into the lung, mild and severe exacerbations, FEV 1 (forced expiratory volume in one second), vital capacity (VC), peak expiratory flow (PEF), symptom scores and Quality of Life.
  • FEV 1 force expiratory volume in one second
  • VC vital capacity
  • PEF peak expiratory flow
  • symptom scores Quality of Life.
  • the P2X 7 receptor antagonist (first active ingredient) and ⁇ 2 -agonist (second active ingredient) of the present invention may be administered simultaneously, sequentially or separately to treat respiratory diseases.
  • sequential it is meant that the active ingredients are administered, in any order, one immediately after the other. They may still have the desired effect if they are administered separately, but when administered in this manner they will generally be administered less than 4 hours apart, more conveniently less than two hours apart, more conveniently less than 30 minutes apart and most conveniently less than 10 minutes apart.
  • the active ingredients of the present invention may be administered by oral or parenteral (e.g. intravenous, subcutaneous, intramuscular or intraarticular) administration using conventional systemic dosage forms, such as tablets, capsules, pills, powders, aqueous or oily solutions or suspensions, emulsions and sterile injectable aqueous or oily solutions or suspensions.
  • the active ingredients may also be administered topically (to the lung and/or airways) in the form of solutions, suspensions, aerosols and dry powder formulations.
  • These dosage forms will usually include one or more pharmaceutically acceptable ingredients which may be selected, for example, from adjuvants, carriers, binders, lubricants, diluents, stabilising agents, buffering agents, emulsifying agents, viscosity- regulating agents, surfactants, preservatives, flavourings and colorants.
  • pharmaceutically acceptable ingredients may be selected, for example, from adjuvants, carriers, binders, lubricants, diluents, stabilising agents, buffering agents, emulsifying agents, viscosity- regulating agents, surfactants, preservatives, flavourings and colorants.
  • the most appropriate method of administering the active ingredients is dependent on a number of factors.
  • the active ingredients are administered via separate pharmaceutical preparations.
  • This embodiment may be employed, for example, when the P2X 7 receptor antagonist is conveniently administered by oral administration, and the ⁇ 2 -agonist is conveniently administered by inhalation.
  • the different pharmaceutical preparations of active ingredients may be administered simultaneously, sequentially or separately.
  • the present invention provides a kit comprising a preparation of a first active ingredient which is a P2X 7 receptor antagonist, and a preparation of a second active ingredient which is a ⁇ 2 -agonist, and optionally instructions for the simultaneous, sequential or separate administration of the preparations to a patient in need thereof.
  • the active ingredients may be administered via a single pharmaceutical composition. Therefore, the present invention further provides a pharmaceutical composition comprising, in admixture, a first active ingredient, which is a P2X 7 receptor antagonist, and a second active ingredient, which is a ⁇ 2 -agonist.
  • compositions of the present invention may be prepared by mixing the P2X 7 receptor antagonist (first active ingredient) with a ⁇ 2 — agonist (second active ingredient) and a pharmaceutically acceptable adjuvant, diluent or carrier. Therefore, in a further aspect of the present invention there is provided a process for the preparation of a pharmaceutical composition, which comprises mixing a P2X 7 receptor antagonist with a ⁇ 2 —agonist and a pharmaceutically acceptable adjuvant, diluent or carrier.
  • each active ingredient administered in accordance with the present invention will vary depending upon the particular active ingredient employed, the mode by which the active ingredient is to be administered, and the condition or disorder to be treated.
  • the P2X 7 receptor antagonist is administerted via inhalation.
  • the dose of the P2X 7 receptor antagonist will generally be in the range of from 0.1 microgram ( ⁇ g) to 5000 ⁇ g, 0.1 to 1000 ⁇ g, 0.1 to 500 ⁇ g, 0.1 to 100 ⁇ g, 0.1 to 50 ⁇ g, 0.1 to 5 ⁇ g, 5 to 5000 ⁇ g, 5 to 1000 ⁇ g, 5 to 500 ⁇ g, 5 to 100 ⁇ g, 5 to 50 ⁇ g, 5 to 10 ⁇ g, 10 to 5000 ⁇ g, 10 to 1000 ⁇ g, 10 to 500 ⁇ g, 10 to 100 ⁇ g, 10 to 50 ⁇ g, 20 to 5000 ⁇ g, 20 to 1000 ⁇ g, 20 to 500 ⁇ g, 20 to 100 ⁇ g, 20 to 50 ⁇ g, 50 to 5000 ⁇ g, 50 to 1000 ⁇ g, 50 to 1000 ⁇ g, 50 to 100 ⁇ g, 100 to 5000 ⁇ g, 100
  • the P2X 7 receptor antagonist is administered orally.
  • Oral administration of the P2X 7 receptor antagonist may for example be used in a pharmaceutical product or kit wherein the other active ingredient(s) are administered by inhalation.
  • satisfactory results will generally be obtained when the dose of the P2X 7 receptor antagonist is in the range of from 5 to 1000 milligram (mg), 5 to 800mg, 5 to 600mg, 5 to 500mg, 5 to 400mg, 5 to 300mg, 5 to 200mg, 5 to lOOmg, 5 to 50mg, 20 to 1000 mg, 20 to 800mg, 20 to 600mg, 20 to 500mg, 20 to 400mg, 20 to 300mg, 20 to 200mg, 20 to lOOmg, 20 to 50mg, 50 to 1000 mg, 50 to 800mg, 50 to 600mg, 50 to 500mg, 50 to 400mg, 50 to 300mg, 50 to 200mg, 50 to lOOmg, 100 to 1000 mg
  • the ⁇ 2 -agonist may conveniently be administered by inhalation.
  • the dose of the ⁇ 2 -agonist will generally be in the range of from 0.1 to 50 ⁇ g, 0.1 to 40 ⁇ g, 0.1 to 30 ⁇ g, 0.1 to 20 ⁇ g, 0.1 to 10 ⁇ g, 5 to 10 ⁇ g, 5 to 50 ⁇ g, 5 to 40 ⁇ g, 5 to 30 ⁇ g, 5 to 20 ⁇ g, 5 to 10 ⁇ g, 10 to 50 ⁇ g, 10 to 40 ⁇ g 10 to 30 ⁇ g, or 10 to 20 ⁇ g.
  • the dose will generally be administered from 1 to 4 times a day, conveniently once or twice a day, and most conveniently once a day.
  • the present invention provides a pharmaceutical product comprising, in combination, a first active ingredient which is a P2X 7 receptor antagonist, and a second active ingredient which is a ⁇ 2 -agonist, wherein each active ingredient is formulated for inhaled administration.
  • the present invention provides a pharmaceutical product comprising, in combination, a first active ingredient which is a P2X 7 receptor antagonist, and a second active ingredient which is a ⁇ 2 -agonist, wherein the first active ingredient is formulated for oral administration and the second active ingredient is formulated for inhaled administration.
  • the different pharmaceutical preparations of active ingredients may be administered simultaneously, sequentially or separately.
  • the active ingredients of the present invention are conveniently administered via inhalation (e.g. topically to the lung and/or airways) in the form of solutions, suspensions, aerosols and dry powder formulations.
  • metered dose inhaler devices may be used to administer the active ingredients, dispersed in a suitable propellant and with or without additional excipients such as ethanol, surfactants, lubricants or stabilising agents.
  • Suitable propellants include hydrocarbon, chlorofluorocarbon and hydrofluoroalkane (e.g. heptafluoroalkane) propellants, or mixtures of any such propellants.
  • Preferred propellants are P 134a and P227, each of which may be used alone or in combination with other propellants and/or surfactant and/or other excipients.
  • Nebulised aqueous suspensions or, preferably, solutions may also be employed, with or without a suitable pH and/or tonicity adjustment, either as a unit-dose or multi-dose formulations.
  • Dry powder inhalers may be used to administer the active ingredients, alone or in combination with a pharmaceutically acceptable carrier, in the later case either as a finely divided powder or as an ordered mixture.
  • the dry powder inhaler may be single dose or multi-dose and may utilise a dry powder or a powder-containing capsule.
  • Metered dose inhaler, nebuliser and dry powder inhaler devices are well known and a variety of such devices are available.
  • the present invention further provides a pharmaceutical product, kit or pharmaceutical composition according to the invention for simultaneous, sequential or separate use in therapy.
  • the present invention further provides the use of a pharmaceutical product, kit or pharmaceutical composition according to the invention in the manufacture of a medicament for the treatment of a respiratory disease, in particular chronic obstructive pulmonary disease or asthma.
  • the present invention still further provides a method of treating a respiratory disease which comprises simultaneously, sequentially or separately administering: (a) a (therapeutically effective) dose of a first active ingredient which is a P2X 7 receptor antagonist; and (b) a (therapeutically effective) dose of a second active ingredient which is a ⁇ 2 -agonist.; to a patient in need thereof.
  • the term “therapy” also includes “prophylaxis” unless there are specific indications to the contrary.
  • the terms “therapeutic” and “therapeutically” should be construed accordingly. Prophylaxis is expected to be particularly relevant to the treatment of persons who have suffered a previous episode of, or are otherwise considered to be at increased risk of, the condition or disorder in question. Persons at risk of developing a particular condition or disorder generally include those having a family history of the condition or disorder, or those who have been identified by genetic testing or screening to be particularly susceptible to developing, the condition or disorder.
  • the pharmaceutical product, kit or composition of the present may optionally comprise a third active ingredient which third active ingredient is a substance suitable for use in the treatment of respiratory diseases.
  • a pharmaceutical product, kit or composition according to the present invention that does not include a corticosteroid as an active ingredient.

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Abstract

The invention provides a pharmaceutical product, kit or composition comprising a first active ingredient which is a P2X?7#191 receptor antagonist, and a second active ingredient which is a ß?2#191-agonist, of use in the treatment of respiratory diseases such as chronic obstructive pulmonary disease and asthma.

Description

NEW COMBINATION Z
The present invention relates to combinations of pharmaceutically active substances for use in the treatment of respiratory diseases, especially chronic obstructive pulmonary s disease (COPD) and asthma.
The essential function of the lungs requires a fragile structure with enormous exposure to the environment, including pollutants, microbes, allergens, and carcinogens. Host factors, resulting from interactions of lifestyle choices and genetic composition, influence the o response to this exposure. Damage or infection to the lungs can give rise to a wide range of diseases of the respiratory system (or respiratory diseases). A number of these diseases are of great public health importance. Respiratory diseases include Acute Lung Injury, Acute Respiratory Distress Syndrome (ARDS), occupational lung disease, lung cancer, tuberculosis, fibrosis, pneumoconiosis, pneumonia, emphysema, Chronic Obstructive s Pulmonary Disease (COPD) and asthma.
Among the most common of the respiratory diseases is asthma. Asthma is generally defined as an inflammatory disorder of the airways with clinical symptoms arising from intermittent airflow obstruction. It is characterised clinically by paroxysms of wheezing, 0 dyspnea and cough. It is a chronic disabling disorder that appears to be increasing in prevalence and severity. It is estimated that 15% of children and 5% of adults in the population of developed countries suffer from asthma. Therapy should therefore be aimed at controlling symptoms so that normal life is possible and at the same time provide basis for treating the underlying inflammation. S
COPD is a term which refers to a large group of lung diseases which can interfere with normal breathing. Current clinical guidelines define COPD as a disease state characterized by airflow limitation that is not fully reversible. The airflow limitation is usually both progressive and associated with an abnormal inflammatory response of the lungs to 0 noxious particles and gases. The most important contributory source of such particles and gases, at least in the western world, is tobacco smoke. COPD patients have a variety of symptoms, including cough, shortness of breath, and excessive production of sputum; such symptoms arise from dysfunction of a number of cellular compartments, including neutrophils, macrophages, and epithelial cells. The two most important conditions covered by COPD are chronic bronchitis and emphysema.
Chronic bronchitis is a long-standing inflammation of the bronchi which causes increased production of mucous and other changes. The patients' symptoms are cough and expectoration of sputum. Chronic bronchitis can lead to more frequent and severe o respiratory infections, narrowing and plugging of the bronchi, difficult breathing and disability.
Emphysema is a chronic lung disease which affects the alveoli and/or the ends of the smallest bronchi. The lung loses its elasticity and therefore these areas of the lungs become s enlarged. These enlarged areas trap stale air and do not effectively exchange it with fresh air. This results in difficult breathing and may result in insufficient oxygen being delivered to the blood. The predominant symptom in patients with emphysema is shortness of breath.
Therapeutic agents used in the treatment of respiratory diseases include β2— agonists. These o agents (also known as beta2 (β2) adrenoceptor agonists) may be used to alleviate symptoms of respiratory diseases by relaxing the bronchial smooth muscles, reducing airway obstruction, reducing lung hyperinflation and decreasing shortness of breath.
Whilst treatment with a β2 -agonist can yield important benefits, the efficacy of these S agents is often far from satisfactory. Moreover, in view of the complexity of respiratory diseases such as asthma and COPD, it is unlikely that any one mediator can satisfactorily treat the disease alone. Hence there is a pressing medical need for new therapies against respiratory diseases such as COPD and asthma, in particular for therapies with disease modifying potential. 0 The P2X7 receptor (previously known as P2Z receptor), which is a ligand-gated ion channel, is present on a variety of cell types, largely those known to be involved in the inflammatory/immune process, specifically, macrophages, mast cells and lymphocytes (T and B). Activation of the P2X7 receptor by extracellular nucleotides, in particular adenosine triphosphate, leads to the release of interleukin-lβ (IL-lβ) and giant cell formation (macrophages/microglial cells), degranulation (mast cells) and proliferation (T cells), apoptosis and L-selectin shedding (lymphocytes). P2X7 receptors are also located on antigen-presenting cells (APC), keratinocytes, salivary acinar cells (parotid cells), hepatocytes and mesangial cells.
The present invention provides a pharmaceutical product comprising, in combination, a first active ingredient which is a P2X7 receptor antagonist, and a second active ingredient which is a β2 -agonist.
A beneficial therapeutic effect may be observed in the treatment of respiratory diseases if a P2X7 receptor antagonist is used in combination with a β2 -agonist. The beneficial effect may be observed when the two active substances are administered simultaneously (either in a single pharmaceutical preparation or via separate preparations), or sequentially or separately via separate pharmaceutical preparations.
The pharmaceutical product of the present invention may, for example, be a pharmaceutical composition comprising the first and second active ingredients in admixture. Alternatively, the pharmaceutical product may, for example, be a kit comprising a preparation of the first active ingredient and a preparation of the second active ingredient and, optionally, instructions for the simultaneous, sequential or separate administration of the preparations to a patient in need thereof.
The pharmaceutical product of the present invention comprises, as a first active ingredient, a P2X7 receptor antagonist. An antagonist of the P2X7 receptor is a compound or other substance that is capable of preventing, whether fully or partially, activation of the P2X7 receptor.
Methods for assaying for P2X7 receptor antagonism are known in the art, for example from WO 01/42194 which describes an assay based on the observation that when the P2X7 receptor is activated using a receptor agonist in the presence of ethidium bromide (a fluorescent DNA probe), an increase in the fluorescence of intracellular DNA-bound ethidium bromide is observed. Thus, an increase in fluorescence can be used as a measure of P2X7 receptor activation and therefore to quantify the effect of a compound or substance on the P2X7 receptor.
In WO 01/42194, the assay is carried out by taking a 96-well flat bottomed microtitre plate and filling the wells with 250 μl of test solution comprising 200 μl of a suspension of THP-I cells (2.5 x 106 cells/ml) containing 10"4M ethidium bromide, 25 μl of a high potassium buffer solution containing 10"5M benzoylbenzoyl adenosine triphosphate
(bbATP, a known P2X7 receptor agonist), and 25 μl of the high potassium buffer solution containing 3 x 10"5M test compound. The plate is covered with a plastics sheet and incubated at 37 0C for one hour. The plate is then read in a Perkin-Elmer fluorescent plate reader, excitation 520 nm, emission 595 nm, slit widths: Ex 15 nm, Em 20 nm. For the purposes of comparison, bbATP (a P2X7 receptor agonist) and pyridoxal 5-phosphate (a P2X7 receptor antagonist) are used separately in the test as controls. From the readings obtained, a pIC50 figure is calculated for the test compound, this figure being the negative logarithm of the concentration of test compound necessary to reduce the bbATP agonist activity by 50%. A pIC50 figure greater than 5.5 is normally indicative of an antagonist.
Examples of P2X7 receptor antagonists which may be used in accordance with the present invention include adamantyl derivatives having P2X7 receptor antagonist properties, as for example described in WO 00/61569, WO 01/42194, WO 01/44170 and WO 03/41707, the entire contents of which are incorporated herein by reference. In an embodiment of the present invention, the P2X7 receptor antagonist is an adamantyl derivative of formula
Figure imgf000006_0001
(I) wherein m represents 1, 2 or 3; A represents C(O)NH or NHC(O); Y represents N or CH;
X represents a bond, CO, (CH2)i-6, O(CH2)1-6, (CH2)i-6NH(CH2)1-6, (CH2)1-6O(CH2)1-6 or NH(CH2)1-6; Z represents NR R ;
R represents halogen, cyano, nitro, amino, hydroxyl, C1-C6 alkyl or C3-C8 cycloalkyl, which alkyl or cycloalkyl group group can be optionally substituted by one or more fluorine atoms; R2 and R3 each independently represent a hydrogen atom, C1-C6 alkyl or C3-C8 cycloalkyl, which alkyl or cycloalkyl group can be optionally substituted by one or more groups selected from hydroxyl, halogen or C1-C6 alkoxy, or R2 and R3 together with the nitrogen atom to which they are attached form a 3- to 9- membered saturated mono- or bicyclic heterocyclic ring comprising from 1 to 2 nitrogen atoms and optionally an oxygen atom, which heterocyclic ring can be optionally substituted by one or more groups selected from hydroxyl, halogen or C1-C6 alkoxy; or a pharmaceutically acceptable salt thereof.
In one aspect of this embodiment, in formula (I): m represents 1; A represents NHC(O); Y represents CH; X represents a bond, CO, CH2, CH2CH2, CH2CH2CH2, OCH2, OCH2CH2 or OCH2CH2CH2; Z represents NR2R3; R1 represents chloro, bromo, fluoro, methyl or trifluromethyl; and R and R each independently represent a hydrogen atom or a C1-C4 alkyl group (e.g. methyl, ethyl, n-propyl or n-butyl) optionally substituted by hydroxyl or, alternatively, R2 and R3 together with the nitrogen atom to which they are attached form a 9-oxa-3,7-diazabicyclo[3.3.1]non-3-yl group. s
Adamantyl derivatives of formula (I) may be prepared according to known chemistry, for example by methods according or analogous to those described in WO 00/61569, WO 01/42194, WO 01/44170 and WO 03/41707.
io The P2Xγ receptor antagonist used in the present invention may be capable of existing in all stereoisomeric forms including all geometric and optical isomers of the active ingredient and mixtures thereof including racemates. It will also be understood that certain P2X7 receptor antagonists may exist in solvated, for example hydrated, as well as unsolvated forms, and the present invention encompasses all such solvated forms.
I5
Pharmaceutically acceptable salts of P2X7 antagonists of formula (I) include, where applicable, acid addition salts derived from pharmaceutically acceptable inorganic and organic acids such as a chloride, bromide, sulphate, phosphate, maleate, fumarate, tartrate, citrate, benzoate, 4-methoxybenzoate, 2- or 4-hydroxybenzoate, 4-chlorobenzoate, p-
20 toluenesulphonate, methanesulphonate, ascorbate, acetate, succinate, lactate, glutarate, gluconate, tricarballylate, hydroxynaphthalene-carboxylate or oleate salt; and salts prepared from pharmaceutically acceptable inorganic and organic bases. Salts derived from inorganic bases include aluminium, ammonium, calcium, copper, ferric, ferrous, lithium, magnesium, manganic, manganous, potassium, sodium, zinc and bismuth salts.
25 Salts derived from pharmaceutically acceptable organic bases include salts of primary, secondary and tertiary amines, cyclic amines like arginine, betaine, choline and the like.
In another embodiment of the present invention, the P2X7 receptor antagonist is selected from 2-Chloro-5-[[2-(2-hydroxy-ethylamino)-ethylamino]-methyl]-iV- (tricyclo[3.3.1.13>7]dec- 1 -ylmethyl)-benzamide,
2-Chloro-5-[3-[(3-hydroxypropyl)amino]propyl]-N-(tricyclo[3.3.1.1 ]dec- 1 -ylmethyl)- benzamide, (JR)-2-Chloro-5-[3-[(2-hydroxy-l-methylethyl)amino]propyl]-iV-
(tricyclo[3.3.1.13>7]dec- l-ylmethyl)-benzamide,
2-Chloro-5-[[2-[(2-hydroxyethyl)amino]ethoxy]methyl]-iV-(tricyclo[3.3.1. I3>7]dec-1 - ylmethyl)-benzamide,
2-Chloro-5-[3-[3-(methylamino)propoxy]propyl]-N-(tricyclo[3.3.1.13>7]dec-l- ylmethyl)benzamide,
2-Chloro-5-[3-(3-hydroxy-propylamino)-propoxy]-iV-(tricyclo[3.3.1. I3'7]dec-1- ylmethyl)-benzamide,
2-Chloro-5-[2-(3-hydroxypropylamino)ethylamino]-iV-(tricyclo[3.3.1.13'7]dec-1- ylmethyl)-benzamide, 2-Chloro-5-[2-(3-hydroxypropylsulfonyl)ethoxy]-iV-(tricyclo[3.3.1.13>7]dec-l- ylmethyl)-benzamide,
2-Chloro-5-[2-[2-[(2-hydroxyethyl)amino]ethoxy]ethoxy]-iV'-(tricyclo[3.3.1.13'7]dec-l- ylmethyl)-benzamide,
2-Chloro-5-[[2-[[2-(l-methyl-lH"-imidazol-4-yl)ethyl]amino]ethyl]amino]-iV'- (tricyclo[3.3.1.13j7]dec- 1 -ylmethyl)-benzamide,
2-Chloro-5-piperazin- 1 -ylmethyl-N-(tricyclo[3.3.1.1 ]dec- 1 -ylmethyl)-benzamide,
2-Chloro-5-(4-piperidinyloxy)-N-(tricyclo[3.3.1.13'7]dec-l-ylmethyl)-benzamide,
2-Chloro-5-(2,5-diazabicyclo[2.2. l]hept-2-ylmethyl)-iV-(tricyclo[3.3.1.1 ]dec-l - ylmethyl)-benzamide, 2-Chloro-5-(piperidin-4-ylsulfinyl)-N-(tricyclo[3.3.1.13l7]dec-l-ylniethyl)-benzamide3
5-Chloro-2-[3-[(3-hydroxypropyl)amino]propyl]-iV-(tricyclo[3.3.1.13'7]dec-1- ylmethyl)-4-pyridinecarboxamide,
5-Chloro-2-[3-(ethylamino)propyl]-iV'-(tricyclo[3.3.1.13'7]dec-l-ylmetb.yl)-4- pyridinecarboxamide, 5-Chloro-2-[3-[(2-hydroxyethyl)amino]propyl]-N-(tricyclo[3.3.1. I3>7]dec- 1 -ylmethyl)- 4-pyridinecarboxamide,
5-Chloro-2-[3-[[(2^-2-hydroxypropyl]amino]propyl]-iVr-(tricyclo[3.3.1.13l7]dec-l- ylmethyl)-4-pyridinecarboxamide, N-[2-Methyl-5-(9-oxa-3,7-diazabicyclo[3.3.1]non-3-ylcarbonyl)phenyl]- tricyclo[3.3.1.13>7]decane- 1 -acetamide, or a pharmaceutically acceptable salt thereof.
Examples of particular P2X7 receptor antagonists that may be employed in accordance with the present invention include:-
2-Chloro-5-[[2-(2-hydroxy-ethylamino)-ethylamino]-methyl]-iV- (tricy clo [3.3.1.13'7] dec- 1 -y lmethy l)-benzamide, dihy drochloride
2-Chloro-5 - [3 - [(3 -hy droxypropy l)amino]propyl]-iV-(tricy clo [3.3.1.1 ] dec- 1 -y lmethy I)- benzamide, hydrochloride (ft)-2-Chloro-5- [3 - [(2-hydroxy- 1 -methylethyl)amino]propyl]-iV-
(tricy clo [3.3.1.13>v] dec- 1 -y lmethy l)-benzamide, hydrochloride
2-Chloro-5-[[2-[(2-hydroxyethyl)amino]ethoxy]methyl]-iV-(tricyclo[3.3.1.13l7]dec-l- ylmethyl)-benzamide, acetate (1:1) salt
2-Chloro-5- [3 -[3-(methylamino)propoxy]propyl]-N-(tricyclo[3.3.1.13'7]dec- 1 - ylmethyl)benzamide, hydrochloride
2-Chloro-5-[3-(3-hydroxy-propylamino)-propoxy]-N-(tricyclo[3.3.1. I3'7]dec-1 - ylmethyl)-benzamide, hydrochloride
2-Chloro-5-[2-(3-hydroxypropylamino)ethylamino]-iV"-(tricyclo[3.3.1.13'7]dec-l - ylmethyl)-benzamide, acetate (1:1) salt 2-Chloro-5-[2-(3-hydroxypropylsulfonyl)ethoxy]-iV-(tricyclo[3.3.1.13'7]dec-l- yhnethyl)-benzamide
2-Chloro-5-[2-[2-[(2-hydroxyethyl)amino]ethoxy]ethoxy]--V-(tricyclo[3.3.1.13>7]dec-l- ylmethyl)-benzamide, hydrochloride
2-Chloro-5-[[2-[[2-(l-methyl-lHr-imidazol-4-yl)ethyl]amino]ethyl]amino]-iV- (tricyclo[3.3.1.13'7]dec- l-ylmethyl)-benzamide 2-Chloro-5-piperazin- 1 -ylmethyl-N-(tricyclo[3.3.1.1 ] dec- 1 -ylmethyl)-benzamide, dihydrochloride
2-Chloro-5-(4-piperidinyloxy)-iV-(tricyclo[3.3.1.13'7]dec-l-ylmethyl)-benzamide, hydrochloride 2-Chloro-5-(2,5-diazabicyclo[2.2.1]hept-2-ylmethyl)-iV-(tricyclo[3.3.1.1]dec-l- ylmethyl)-benzamide, hydrochloride
2-Chloro-5-(piperidin-4-ylsulfinyl)-iV-(tricyclo[3.3.1.13>7]dec-l-yhnethyl)-benzamide
5-Chloro-2-[3-[(3-hydroxypropyl)amino]propyl]-iV-(tricyclo[3.3.1.13>7]dec-l- ylmethyl)-4-pyridinecarboxamide, 5-Chloro-2-[3-(ethylamino)ρropyl]-iV'-(tricyclo[3.3.1.13'7]dec-l-yhnethyl)-4- pyridinecarboxamide, hydrochloride
5-Chloro-2-[3-[(2-hydroxyethyl)amino]propyl]-iV-(tricyclo[3.3.1.13'7]dec-l-ylmethyl)- 4-pyridinecarboxamide, hydrochloride
5-Chloro-2-[3-[[(25)-2-hydroxypropyl]amino]propyl]-iV-(tricyclo[3.3.1.13'7]dec-l- ylmethyl)-4-pyridinecarboxamide, dihydrochloride, and iV-[2-Methyl-5-(9-oxa-3 ,7-diazabicyclo[3.3.1 ]non-3 -ylcarbonyl)phenyl]- tricyclo[3.3.1.13>7]decane-l-acetamide, hydrochloride.
The second active ingredient in the combination of the present invention is a β2 -agonist. The β2 -agonist of the present invention may be any compound or substance capable of stimulating the β2 -receptor and acting as a bronchodilator. Examples of β2 -agonists that may be used in the present invention include bambuterol, bitolterol, carbuterol, clenbuterol, fenoterol, formoterol, hexoprenaline, ibuterol, pirbuterol, procaterol, reproterol, salmeterol, sulphonterol, terbutaline indacaterol and tolubuterol. In one aspect, the β2 -agonist of the invention is a long acting β2 -agonist, i.e. a β2 -agonist with activity that persists for more than 12 hours. Examples of long acting β2 -agonists include formoterol, bambuterol, salmeterol and indacaterol.
In the context of the present specification, unless otherwise stated, any reference to a β2 - agonist includes active salts, solvates or derivatives that may be formed from said β2 - agonist and any enantiomers and mixtures thereof. Examples of possible salts or derivatives of β2 -agonists are acid addition salts such as the salts of hydrochloric acid, hydrobromic acid, sulphuric acid, phosphoric acid, methanesulphonic acid, acetic acid, fumaric acid, succinic acid, lactic acid, citric acid, tartaric acid, l-hydroxy-2- naphthalenecarboxylic acid, maleic acid, and pharmaceutically acceptable esters (e.g. C1- C6 alkyl esters). The β2 -agonists may also be in the form of solvates, e.g. hydrates.
In an embodiment of the present invention, the β2 -agonist is formoterol. The chemical name for formoterol is N-[2-hydroxy-5-[(l)-l-hydroxy-2-[[(l)-2-(4-methoxyphenyl)-l- methylethyl]amino]ethyl]phenyl]-formamide. The preparation of formoterol is described, for example, in WO 92/05147. In one aspect of this embodiment, the β2 -agonist is formoterol fumarate.
It will be understood that the invention encompasses the use of all optical isomers of formoterol and mixtures thereof including racemates. Thus for example, the term formoterol encompasses iV-[2-hydroxy-5-[(lR)-l-hydroxy-2-[[(lR)-2-(4-methoxyphenyl)- 1-methylethyl] amino] ethyl]phenyl]-formamide, iV-[2-hydroxy-5-[(lS)-l-hydroxy-2-[[(lS)- 2-(4-methoxyphenyl)-l-methylethyl]amino]ethyl]phenyl]-formamide and a mixture of such enantiomers, including a racemate.
The combination of the present invention may provide a beneficial therapeutic effect in the treatment of respiratory diseases. Examples of such possible effects include improvements in one or more of the following parameters: reducing inflammatory cell influx into the lung, mild and severe exacerbations, FEV1 (forced expiratory volume in one second), vital capacity (VC), peak expiratory flow (PEF), symptom scores and Quality of Life.
The P2X7 receptor antagonist (first active ingredient) and β2 -agonist (second active ingredient) of the present invention may be administered simultaneously, sequentially or separately to treat respiratory diseases. By sequential it is meant that the active ingredients are administered, in any order, one immediately after the other. They may still have the desired effect if they are administered separately, but when administered in this manner they will generally be administered less than 4 hours apart, more conveniently less than two hours apart, more conveniently less than 30 minutes apart and most conveniently less than 10 minutes apart.
The active ingredients of the present invention may be administered by oral or parenteral (e.g. intravenous, subcutaneous, intramuscular or intraarticular) administration using conventional systemic dosage forms, such as tablets, capsules, pills, powders, aqueous or oily solutions or suspensions, emulsions and sterile injectable aqueous or oily solutions or suspensions. The active ingredients may also be administered topically (to the lung and/or airways) in the form of solutions, suspensions, aerosols and dry powder formulations. These dosage forms will usually include one or more pharmaceutically acceptable ingredients which may be selected, for example, from adjuvants, carriers, binders, lubricants, diluents, stabilising agents, buffering agents, emulsifying agents, viscosity- regulating agents, surfactants, preservatives, flavourings and colorants. As will be understood by those skilled in the art, the most appropriate method of administering the active ingredients is dependent on a number of factors.
In one embodiment of the present invention the active ingredients are administered via separate pharmaceutical preparations. This embodiment may be employed, for example, when the P2X7 receptor antagonist is conveniently administered by oral administration, and the β2 -agonist is conveniently administered by inhalation. In this embodiment the different pharmaceutical preparations of active ingredients may be administered simultaneously, sequentially or separately.
Therefore, in one aspect, the present invention provides a kit comprising a preparation of a first active ingredient which is a P2X7 receptor antagonist, and a preparation of a second active ingredient which is a β2 -agonist, and optionally instructions for the simultaneous, sequential or separate administration of the preparations to a patient in need thereof. In another embodiment the active ingredients may be administered via a single pharmaceutical composition. Therefore, the present invention further provides a pharmaceutical composition comprising, in admixture, a first active ingredient, which is a P2X7 receptor antagonist, and a second active ingredient, which is a β2 -agonist.
The pharmaceutical compositions of the present invention may be prepared by mixing the P2X7 receptor antagonist (first active ingredient) with a β2— agonist (second active ingredient) and a pharmaceutically acceptable adjuvant, diluent or carrier. Therefore, in a further aspect of the present invention there is provided a process for the preparation of a pharmaceutical composition, which comprises mixing a P2X7 receptor antagonist with a β2 —agonist and a pharmaceutically acceptable adjuvant, diluent or carrier.
It will be understood that the therapeutic dose of each active ingredient administered in accordance with the present invention will vary depending upon the particular active ingredient employed, the mode by which the active ingredient is to be administered, and the condition or disorder to be treated.
In one embodiment of the present invention, the P2X7 receptor antagonist is administerted via inhalation. When administered via inhalation the dose of the P2X7 receptor antagonist will generally be in the range of from 0.1 microgram (μg) to 5000 μg, 0.1 to 1000 μg, 0.1 to 500 μg, 0.1 to 100 μg, 0.1 to 50 μg, 0.1 to 5 μg, 5 to 5000 μg, 5 to 1000 μg, 5 to 500 μg, 5 to 100 μg, 5 to 50 μg, 5 to 10 μg, 10 to 5000 μg, 10 to 1000 μg, 10 to 500 μg, 10 to 100 μg, 10 to 50 μg, 20 to 5000 μg, 20 to 1000 μg, 20 to 500 μg, 20 to 100 μg, 20 to 50 μg, 50 to 5000 μg, 50 to 1000 μg, 50 to 500 μg, 50 to 100 μg, 100 to 5000 μg, 100 to 1000 μg or 100 to 500 μg. The dose will generally be administered from 1 to 4 times a day, conveniently once or twice a day, and most conveniently once a day.
In another embodiment of the present invention, the P2X7 receptor antagonist is administered orally. Oral administration of the P2X7 receptor antagonist may for example be used in a pharmaceutical product or kit wherein the other active ingredient(s) are administered by inhalation. When administered orally, satisfactory results will generally be obtained when the dose of the P2X7 receptor antagonist is in the range of from 5 to 1000 milligram (mg), 5 to 800mg, 5 to 600mg, 5 to 500mg, 5 to 400mg, 5 to 300mg, 5 to 200mg, 5 to lOOmg, 5 to 50mg, 20 to 1000 mg, 20 to 800mg, 20 to 600mg, 20 to 500mg, 20 to 400mg, 20 to 300mg, 20 to 200mg, 20 to lOOmg, 20 to 50mg, 50 to 1000 mg, 50 to 800mg, 50 to 600mg, 50 to 500mg, 50 to 400mg, 50 to 300mg, 50 to 200mg, 50 to lOOmg, 100 to 1000 mg, 100 to 800mg, 100 to 600mg, 100 to 500mg, 100 to 400mg, 100 to 300mg, or 100 to 200mg. The dose will generally be administered from 1 to 4 times a day, conveniently once or twice a day, and most conveniently once a day.
In one embodiment of the present invention the β2-agonist may conveniently be administered by inhalation. When administered via inhalation the dose of the β2-agonist will generally be in the range of from 0.1 to 50 μg, 0.1 to 40 μg, 0.1 to 30 μg, 0.1 to 20 μg, 0.1 to 10 μg, 5 to 10 μg, 5 to 50 μg, 5 to 40 μg, 5 to 30 μg, 5 to 20 μg, 5 to 10 μg, 10 to 50 μg, 10 to 40 μg 10 to 30 μg, or 10 to 20 μg. The dose will generally be administered from 1 to 4 times a day, conveniently once or twice a day, and most conveniently once a day.
In one embodiment, the present invention provides a pharmaceutical product comprising, in combination, a first active ingredient which is a P2X7 receptor antagonist, and a second active ingredient which is a β2-agonist, wherein each active ingredient is formulated for inhaled administration.
In a further embodiment, the present invention provides a pharmaceutical product comprising, in combination, a first active ingredient which is a P2X7 receptor antagonist, and a second active ingredient which is a β2-agonist, wherein the first active ingredient is formulated for oral administration and the second active ingredient is formulated for inhaled administration. In this embodiment the different pharmaceutical preparations of active ingredients may be administered simultaneously, sequentially or separately. The active ingredients of the present invention are conveniently administered via inhalation (e.g. topically to the lung and/or airways) in the form of solutions, suspensions, aerosols and dry powder formulations. For example metered dose inhaler devices may be used to administer the active ingredients, dispersed in a suitable propellant and with or without additional excipients such as ethanol, surfactants, lubricants or stabilising agents. Suitable propellants include hydrocarbon, chlorofluorocarbon and hydrofluoroalkane (e.g. heptafluoroalkane) propellants, or mixtures of any such propellants. Preferred propellants are P 134a and P227, each of which may be used alone or in combination with other propellants and/or surfactant and/or other excipients. Nebulised aqueous suspensions or, preferably, solutions may also be employed, with or without a suitable pH and/or tonicity adjustment, either as a unit-dose or multi-dose formulations.
Dry powder inhalers may be used to administer the active ingredients, alone or in combination with a pharmaceutically acceptable carrier, in the later case either as a finely divided powder or as an ordered mixture. The dry powder inhaler may be single dose or multi-dose and may utilise a dry powder or a powder-containing capsule.
Metered dose inhaler, nebuliser and dry powder inhaler devices are well known and a variety of such devices are available.
The present invention further provides a pharmaceutical product, kit or pharmaceutical composition according to the invention for simultaneous, sequential or separate use in therapy.
The present invention further provides the use of a pharmaceutical product, kit or pharmaceutical composition according to the invention in the manufacture of a medicament for the treatment of a respiratory disease, in particular chronic obstructive pulmonary disease or asthma. The present invention still further provides a method of treating a respiratory disease which comprises simultaneously, sequentially or separately administering: (a) a (therapeutically effective) dose of a first active ingredient which is a P2X7 receptor antagonist; and (b) a (therapeutically effective) dose of a second active ingredient which is a β2 -agonist.; to a patient in need thereof.
In the context of the present specification, the term "therapy" also includes "prophylaxis" unless there are specific indications to the contrary. The terms "therapeutic" and "therapeutically" should be construed accordingly. Prophylaxis is expected to be particularly relevant to the treatment of persons who have suffered a previous episode of, or are otherwise considered to be at increased risk of, the condition or disorder in question. Persons at risk of developing a particular condition or disorder generally include those having a family history of the condition or disorder, or those who have been identified by genetic testing or screening to be particularly susceptible to developing, the condition or disorder.
The pharmaceutical product, kit or composition of the present may optionally comprise a third active ingredient which third active ingredient is a substance suitable for use in the treatment of respiratory diseases. However, in one embodiment of the present invention there is a provided a pharmaceutical product, kit or composition according to the present invention that does not include a corticosteroid as an active ingredient.

Claims

C L A I M S
1. A pharmaceutical product comprising, in combination, a first active ingredient which is a P2X7 receptor antagonist, and a second active ingredient which is a p2-agonist.
2. A product according to claim 1 wherein the P2X7 receptor antagonist is a compound of formula
Figure imgf000017_0001
(I) wherein m represents 1, 2 or 3;
A represents C(O)NH or NHC(O);
Y represents N or CH;
X represents a bond, CO, (CH2)1-6, O(CH2)i-6, (CH2)1.6NH(CH2)1-6, (CH2)1-6O(CH2)1-6 or NH(CH2)J-6;
Z represents NR2R3;
R1 represents halogen, cyano, nitro, amino, hydroxyl, C]-C6 alkyl or C3-C8 cycloalkyl, which alkyl or cycloalkyl group can be optionally substituted by one or more fluorine atoms; R2 and R3 each independently represent a hydrogen atom, C1-C6 alkyl or C3-C8 cycloalkyl, which alkyl or cycloalkyl group can be optionally substituted by one or more groups selected from hydroxyl, halogen or C1-C6 alkoxy, or R2 and R3 together with the nitrogen atom to which they are attached form a 3- to 9- membered saturated mono- or bicyclic heterocyclic ring comprising from 1 to 2 nitrogen atoms and optionally an oxygen atom, which heterocyclic ring can be optionally substituted by one or more groups selected from hydroxyl, halogen or C1-C6 alkoxy; or a pharmaceutically acceptable salt or solvate thereof.
s 3. A product according to claim 1 or claim 2 wherein the P2X7 receptor antagonist is selected from:
2-Chloro-5-[[2-(2-hydroxy-ethylamino)-ethylamino]-methyl]-iV- (tricyclo[3.3.1.13>7]dec-l-ylmethyl)-benzamide,
2-Chloro-5-[3-[(3-hydroxypropyl)amino]propyl]-N-(tricyclo[3.3.1.1]dec-l-ylmethyl)- o benzamide,
(i?)-2-Chloro-5-[3-[(2-hydroxy-l-methylethyl)amino]propyl]-N- (tricyclo [3.3.1.13>?]dec- 1 -ylmethyl)-benzamide,
2-Chloro-5-[[2-[(2-hydroxyethyl)amino]ethoxy]methyl]-Λ/'-(tricyclo[3.3.1.13>7]dec-l- ylmethyl)-benzamide, s 2-Chloro-5-[3-[3-(methylamino)propoxy]propyl]-iV:-(tricyclo[3.3.1.13'7]dec-l- ylmethyl)benzamide,
2-Chloro-5-[3-(3-hydroxy-propylamino)-propoxy]-N-(tricyclo[3.3.1.13'7]dec-l- ylmethyl)-benzamide,
2-Chloro-5-[2-(3-hydroxypropylamino)ethylamino]-iV-(tricyclo[3.3.1. I3"7]dec-1 - 0 ylmethyl)-benzamide,
2-Chloro-5-[2-(3-hydroxypropylsulfonyl)ethoxy]-N-(tricyclo[3.3.1.13'7]dec-l- ylmethyl)-benzamide,
2-Chloro-5-[2-[2-[(2-hydroxyethyl)amino]ethoxy]ethoxy]-iV-(tricyclo[3.3.1.13'7]dec- 1 - ylmethyl)-benzamide, s 2-Chloro-5-[[2-[[2-(l-methyl-l/f-imidazol-4-yl)ethyl]amino]ethyl]amino]-iV-
(tricyclo[3.3.1.13>7]dec- 1 -ylmethyl)-benzamide,
2-Chloro-5-piperazin-l-ylmethyl-iV-(tricyclo[3.3.1.1]dec-l-ylmethyl)-benzamide, 2-Chloro-5-(4-piperidinyloxy)-iV-(tricyclo[3.3.1.13'7]dec-l -ylmethyl)-benzamide, 2-Chloro-5-(2,5-diazabicyclo[2.2.1]hept-2-ylmethyl)-iV-(tricyclo[3.3.1.1]dec-l- 0 ylmethyl)-benzamide, 2-Chloro-5-(piperidin-4-ylsulfmyl)-iV-(tricyclo[3.3.1.13'7]dec-l-ylmethyl)-benzamide,
5-Chloro-2-[3-[(3-hydroxyρropyl)amino]proρyl]-iV-(tricyclo[3.3.1.13j7]dec-l- ylmethyl)-4-pyridinecarboxamide,
5-Chloro-2-[3-(ethylamino)propyl]-N-(tricyclo[3.3.1.13'7]dec-l-ylmethyl)-4- s pyridinecarboxamide,
5-Chloro-2-[3-[(2-hydroxyethyl)amino]propyl]-iV-(tricyclo[3.3.1.13>7]dec-l-ylmethyl)- 4-pyridinecarboxamide,
5-Chloro-2-[3-[[(25)-2-hydroxypropyl]amino]propyl]-N-(tricyclo[3.3.1.13'7]dec-l- ylmethyl)-4-pyridinecarboxamide, o N-[2-Methyl-5-(9-oxa-3,7-diazabicyclo[3.3.1]non-3-ylcarbonyl)phenyl]- tricyclo[3.
3.1. I3'7]decane-l-acetamide, or a pharmaceutically acceptable salt of any one thereof.
4. A product according to any one of claims 1 to 3, wherein the β2-agonist is formoterol. s
5. Use of a product according to any one of claims 1 to 4 in the manufacture of a medicament for the treatment of a respiratory disease.
6. Use according to claim 5, wherein the respiratory disease is chronic obstructive 0 pulmonary disease.
7. Use according to claim 5, wherein the respiratory disease is asthma.
8. A method of treating a respiratory disease, which method comprises simultaneously, 5 sequentially or separately administering:
(a) a (therapeutically effective) dose of a first active ingredient which is a P2X7 receptor antagonist;
(b) a (therapeutically effective) dose of a second active ingredient which is a β2 -agonist; to a patient in need thereof. 0
9. A kit comprising a preparation of a first active ingredient which is a P2X7 receptor antagonist and a preparation of a second active ingredient which is a β2 -agonist and optionally instructions for the simultaneous, sequential or separate administration of the preparations to a patient in need thereof.
10. A kit according to claim 9 wherein the P2X7 receptor antagonist is selected from:
2-Chloro-5-[[2-(2-hydroxy-ethylamino)-ethylamino]-methyl]-iV'- (tricyclo[3.3.1.13>7]dec- 1 -ylmethyl)-benzamide,
2-Chloro-5-[3-[(3-hydroxypropyl)amino]propyl]-iV-(tricyclo[3.3.1.1]dec-l-ylmethyl)- benzamide,
(i?)-2-Chlόro-5-[3-[(2-hydroxy-l-methylethyl)amino]propyl]-iV- (tricyclo[3.3.1.13'7] dec- 1 -ylmethyl)-benzamide,
2-Chloro-5-[[2-[(2-hydroxyethyl)amino]ethoxy]methyl]-iV-(tricyclo[3.3.1.13l73dec-l- ylrnethyi)-benzamide, 2-Chloro-5-[3-[3-(methylamino)propoxy]propyl]-iV-(tricyclo[3.3.1.13'7]dec-l- ylmethyl)benzamide,
2-Chloro-5-[3-(3-hydroxy-propylamino)-propoxy]-N-(tricyclo[3.3.1.13>7]dec-l- ylmethyl)-benzamide,
2-Chloro-5-[2-(3-hydroxypropylamino)ethylamino]-iV-(tricyclo[3.3.1.13'7]dec-l- ylmethyl)-benzamide,
2-Chloro-5-[2-(3-hydroxypropylsulfonyl)ethoxy]-iV-(tricyclo[3.3.1.13'7]dec-l- ylmethyl)-benzamide,
2-Chloro-5-[2-[2-[(2-hydroxyethyl)amino]ethoxy]ethoxy]-iV-(tricyclo[3.3.1.13>7]dec-l- ylmethyl)-benzamide, 2-Chloro-5-[[2-[[2-( 1 -methyl- lH-imidazol-4-yl)ethyl]amino]ethyl]amino]-N-
(tricyclo[3.3.1.13'7]dec-l-ylmethyl)-benzamide,
2-Chloro-5-piperazin-l-ylmethyl-N-(tricyclo[3.3.1.1]dec-l-ylmethyl)-benzamide, 2-Chloro-5-(4-piperidinyloxy)-N-(tricyclo[3.3.1.13>7]dec-l -ylmethyl)-benzamide, 2-Chloro-5-(2,5-diazabicyclo[2.2. l]hept-2-ylmethyl)-N-(tricyclo[3.3.1. l]dec- 1 - ylmethyl)-benzamide, 2-Chloro-5-(piperidin-4-ylsulfinyl)-iV'-(tricyclo[33ΛΛ3l7]dec-l-ylmethyl)-benzamide,
5-Chloro-2-[3-[(3-hydroxyρropyl)amino]ρropyl]-iV-(tricyclo[3.3.1.13>7]dec-l- ylmethyl)-4-pyridinecarboxamide,
5-Chloro-2-[3-(ethylamino)propyl]-iVr-(tricyclo[3.3.1.13>7]dec-l-ylmethyl)-4- pyridinecarboxamide,
5-Chloro-2-[3-[(2-hydroxyethyl)amino]ρropyl]-iV-(tricyclo[3.3.1.13'7]dec-l-ylmethyl)- 4-pyridinecarboxamide,
5-Chloro-2-[3-[[(25)-2-hydroxypropyl]amino]propyl]-iV-(tricyclo[3.3.1.13'7]dec-l- ylmethyl)-4-pyridinecarboxamide, N-[2-Methyl-5-(9-oxa-3,7-diazabicyclo[3.3.1]non-3-ylcarbonyl)phenyl]- tricyclo[3.3.1.13'7]decane- 1 -acetamide, or a pharmaceutically acceptable salt of any one thereof.
11. A kit according to claim 9 or 10, wherein the β2— agonist is formoterol.
12. A pharmaceutical composition comprising, in admixture, a first active ingredient which is a P2X7 receptor antagonist, and a second active ingredient which is a β2 -agonist.
13. A composition according to claim 12 wherein the P2X7 receptor antagonist is selected from:
2-Chloro-5-[[2-(2-hydroxy-ethylamino)-ethylamino]-methyl]-iV- (tricyclo[3.3.1.13'7]dec- l-ylmethyl)-benzamide,
2-Chloro-5-[3-[(3-hydroxypropyl)amino]propyl]-iV-(tricyclo[3.3.1.1]dec-l-ylmethyl)- benzamide, (Λ)-2-Chloro-5-[3-[(2-hydroxy-l-methylethyl)amino]propyl]-iV-
(tricyclo[3.3.1.13>7]dec- 1 -ylmethyl)-benzamide,
2-Chloro-5-[[2-[(2-hydroxye%l)arnino]ethoxy]methyl]-iV'-(tricyclo[3.3.1.13'7]dec-l- ylmethyl)-benzamide,
2-Chloro-5-[3-[3-(methylamino)propoxy]propyl]-iV-(tricyclo[3.3.1.13'7]dec-1- ylmethyl)benzamide, 2-Chloro-5-[3-(3-hydroxy-propylamino)-propoxy]-N-(tricyclo[3.3.1.1 ' ]dec- 1- ylmethyl)-benzamide,
2-Chloro-5-[2-(3-hydroxypropylamino)ethylamino]-iV-(tricyclo[3.3.1.13'7]dec-l- ylmethyl)-benzamide, 2-Chloro-5-[2-(3-hydroxypropylsulfonyl)ethoxy]-N-(tricyclo[3.3.1.13'7]dec-l- ylmethyl)-benzamide,
2-Chloro-5-[2-[2-[(2-hydroxyethyl)amino]ethoxy]ethoxy]-iV-(tricyclo[3.3.1.13'7]dec-l- ylmethyl)-benzamide,
2-Chloro-5-[[2-[[2-(l-methyl-lH-imidazol-4-yl)ethyl]amino]ethyl]amino]-iV- (tricyclo[3.3;l.l3'7]dec-l-ylmethyl)-benzamide,
2-Chloro-5-pip erazin- 1 -y lmethyl-N-(tricy clo [3.3.1.1] dec- 1 -y lmethyl)-benzamide,
2-Chloro-5-(4-piperidinyloxy)-iV-(tricyclo[3.3.1.13'7]dec-l-ylmethyl)-benzamide,
2-Chloro-5-(2,5-diazabicyclo[2.2.1]hept-2-ylmethyl)-N-(tricyclo[3.3.1.1]dec-l- ylmethyl)-benzamide, 2-Chloro-5-(piperidm-4-ylsulfinyl)-iV'-(1xicyclo[3.3.l.l3'7]dec-l-ylmethyI)-benzamide,
5-Chloro-2- [3 - [(3 -hydroxypropyl)amino]propy 1] -JV-(tricy clo [3.3.1.13'7] dec- 1 - ylmethyl)-4-pyridinecarboxamide,
5-Chloro-2-[3-(ethylamino)propyl]-N-(tricyclo[3.3.1.13'7]dec- 1 -ylmethyl)-4- pyridinecarboxamide, 5-Chloro-2-[3-[(2-hydroxyethyl)amino]propyl]-N-(tricyclo[3.3.1.13>7]dec- 1 -ylmethyl)-
4-pyridinecarboxamide,
5-Chloro-2-[3-[[(25)-2-hydroxypropyl]amino]propyl]-A/'-(tricyclo[3.3.1.13j7]dec-l- ylmethyl)-4-pyridinecarboxamide,
N-[2-Metb.yl-5-(9-oxa-3,7-diazabicyclo[3.3.1]non-3-ylcarbonyl)phenyl]- tricyclo [3.3.1.13'7] decane- 1 -acetamide, or a pharmaceutically acceptable salt of any one thereof.
14. A composition according to claim 12 or 13, wherein the β2 -agonist is formoterol.
PCT/SE2006/000865 2005-07-11 2006-07-10 New combination 2 WO2007008157A1 (en)

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WO2011109833A2 (en) 2010-03-05 2011-09-09 President And Fellows Of Harvard College Induced dendritic cell compositions and uses thereof

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