WO2007083119A2 - Methods - Google Patents
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- WO2007083119A2 WO2007083119A2 PCT/GB2007/000146 GB2007000146W WO2007083119A2 WO 2007083119 A2 WO2007083119 A2 WO 2007083119A2 GB 2007000146 W GB2007000146 W GB 2007000146W WO 2007083119 A2 WO2007083119 A2 WO 2007083119A2
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- statin
- cachexia
- medicament
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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
- A61K31/335—Heterocyclic compounds having oxygen as the only ring hetero atom, e.g. fungichromin
- A61K31/365—Lactones
- A61K31/366—Lactones having six-membered rings, e.g. delta-lactones
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K31/00—Medicinal preparations containing organic active ingredients
- A61K31/33—Heterocyclic compounds
- A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
- A61K31/40—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with one nitrogen as the only ring hetero atom, e.g. sulpiride, succinimide, tolmetin, buflomedil
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K31/00—Medicinal preparations containing organic active ingredients
- A61K31/33—Heterocyclic compounds
- A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
- A61K31/40—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with one nitrogen as the only ring hetero atom, e.g. sulpiride, succinimide, tolmetin, buflomedil
- A61K31/403—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with one nitrogen as the only ring hetero atom, e.g. sulpiride, succinimide, tolmetin, buflomedil condensed with carbocyclic rings, e.g. carbazole
- A61K31/404—Indoles, e.g. pindolol
-
- 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
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K31/00—Medicinal preparations containing organic active ingredients
- A61K31/33—Heterocyclic compounds
- A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
- A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
- A61K31/47—Quinolines; Isoquinolines
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K31/00—Medicinal preparations containing organic active ingredients
- A61K31/33—Heterocyclic compounds
- A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
- A61K31/495—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
- A61K31/505—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim
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- 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
- A61P1/16—Drugs for disorders of the alimentary tract or the digestive system for liver or gallbladder disorders, e.g. hepatoprotective agents, cholagogues, litholytics
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- A—HUMAN NECESSITIES
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- A61P17/02—Drugs for dermatological disorders for treating wounds, ulcers, burns, scars, keloids, or the like
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- A61P19/02—Drugs for skeletal disorders for joint disorders, e.g. arthritis, arthrosis
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
- A61P29/00—Non-central analgesic, antipyretic or antiinflammatory agents, e.g. antirheumatic agents; Non-steroidal antiinflammatory drugs [NSAID]
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- A—HUMAN NECESSITIES
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- A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
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- A61P3/08—Drugs for disorders of the metabolism for glucose homeostasis
- A61P3/10—Drugs for disorders of the metabolism for glucose homeostasis for hyperglycaemia, e.g. antidiabetics
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- A61P9/04—Inotropic agents, i.e. stimulants of cardiac contraction; Drugs for heart failure
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- A—HUMAN NECESSITIES
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- A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
- A61P9/00—Drugs for disorders of the cardiovascular system
- A61P9/10—Drugs for disorders of the cardiovascular system for treating ischaemic or atherosclerotic diseases, e.g. antianginal drugs, coronary vasodilators, drugs for myocardial infarction, retinopathy, cerebrovascula insufficiency, renal arteriosclerosis
Definitions
- the present invention relates to the medical use of statins for the treatment of cachexia.
- HMG-CoA reductase inhibitors also known as 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors, were originally designed to lower plasma cholesterol levels. They have revolutionized the treatment of hypercholesterolaemia. These drugs are usually well tolerated and generally safe.
- HMG-CoA 3-hydroxy-3-methylglutaryl-coenzyme A
- statins are currently subdivided according to their chemical structure (open-ring vj. closed-ring structure), their origin (natural vs. synthetic), and their solubility (hydrophilic vs. lipophilic), as set out in Example 1. It is interesting to note that only compounds with an open-ring structure inhibit HMG-CoA reductase. Thus, closed-ring statins undergo metabolic changes that eventually yield an open-ring structure.
- Natural statins like mevastatin or lovastatin, are derived ' from fungal fermentation. Replacing the highly functionalized decalin ring of the fungal products with a variety of aromatic and heteroaromatic nuclei has yielded synthetic compounds, such as atorvastatin and fluvastatin. Lipophilic statins were originally thought to penetrate cell membranes more effectively than hydrophilic ones (Liao JK, J Clin Invest. 2002;l 10:285-288), however, the evidence suggests otherwise.
- pleiotropic effects include improvement of endothelial dysfunction, release of endothelial progenitor cells, anti-inflammatory properties, and a number of anti-tumour activities.
- Cachexia (unintentional weight loss) is a devastating disorder with a poor prognosis. It is seen as a consequence of many chronic diseases, including acquired immune deficiency syndrome (AIDS), liver cirrhosis, chronic obstructive pulmonary disease (COPD), chronic renal failure (ie chronic kidney disease), chronic infections including pneumonia, cancer (cancer cachexia), diabetes and heart disease including hypertension and chronic heart failure (CHF) (cardiac cachexia). Cachexia may also occur idiopathically. Cachexia is also associated with ageing, rheumatoid arthritis, diabetes, stroke, burns, trauma and other acute injury, sepsis, HIV/AIDS and other infections.
- AIDS acquired immune deficiency syndrome
- COPD chronic obstructive pulmonary disease
- COPD chronic renal failure
- chronic kidney disease chronic infections including pneumonia
- cancer cancer
- diabetes and heart disease including hypertension and chronic heart failure (CHF) (cardiac cachexia).
- Cachexia may also occur idiopathically. Cachexia is also
- TNF ⁇ interleukin 1
- IL-6 interleukin-6
- TNF ⁇ tumour necrosis factor- ⁇
- TNF ⁇ plays a considerable role in chronic heart failure and its progression to cardiac cachexia, as this cytokine is involved in endothelial dysfunction and left ventricular impairment (von Haehling et al Basic Res Cardiol 2004;99: 18-28).
- High plasma levels of TNF ⁇ and its soluble receptors TNFR-I and TNFR-2 predict a poor survival (Deswal et al Circulation 2001;103:2055-2059; Rauchhaus et al Circulation 2000 19; 102:3060-3067).
- statins may inhibit the production of such proinflammatory substances.
- Lovastatin for example, was found to inhibit the induction of TNFa 5 IL-I 5 and IL-6 in certain rat cell lines (Pahan et al J Clin Invest 1997;100:2671-2679).
- CRP C-reactive protein
- CRP is much more than a mere marker of the body's inflammatory load.
- CRP was shown to activate endothelial cells, which, in turn, express Intracellular Adhesion Molecule- 1 (ICAM-I) (Pasceri et al Circulation. 2000;102:2165-2168).
- IAM-I Intracellular Adhesion Molecule- 1
- VCAM-I vascular-cell adhesion molecule-1
- E-selectin E-selectin.
- CRP monocyte chemotactic protein- 1
- MCP-I monocyte chemotactic protein- 1
- PRNCE Pravastatin Inflammation/CRP Evaluation
- Statins also appear to reduce the number of inflammatory cells in atherosclerotic plaques. This observation is in line with reports that showed a statin-mediated reduction in the number of adhesion sites on the cell surfaces of leukocytes.
- a study in isolated human monocytes recently found that both pravastatin and fluvastatin inhibited the expression of ICAM-I on these cells (Takahashi et al J Leukoc Biol 2005:77:400-407).
- IFN- ⁇ interferon- ⁇
- Rho proteins form a family of proteins that activate various kinases. Extracellular stimuli convert the inactive form of Rho (GDP -Rho) to its active form (GTP -Rho). In fact, efficient leukocyte extravasation requires Rho signaling not only within the migrating leukocytes but also within the endothelial lining of the vessel wall (Strey et al FEBS Lett 2002;517:261-266). Moreover, Rho mediates dynamic reorganization of cytoskeletal proteins, such as stress fibre and focal adhesion formation (Amano et al Exp Cell Res 2000;261:44-51). Thus, Rho is believed to play an important role in local inflammatory responses.
- Endothelial dysfunction is frequently seen in cachectic patients.
- Statins have been shown to improve endothelial dysfunction by a number of mechanisms, to possess anti-inflammatory properties, and to have various anti-tumour effects (the latter applies mostly for lovastatin, which has been studied in greatest detail).
- pleiotropic effects of statins appear independent of their cholesterol- lowering features.
- cholesterol reduction itself does not yield, for example, beneficial effects on endothelial function.
- Pleiotropic effects appear to be dose-dependent, and it is likely that pleiotropic effects appear even without cholesterol reduction, i.e. at doses that are so low that no cholesterol reduction is seen.
- Achieving pleiotropic effects without cholesterol reduction might be important, as a number of diseases do have better outcomes with high cholesterol levels (e.g. chronic heart failure, some types of cancer).
- Very low doses of statins may therefore exert pleiotropic effects without cholesterol reduction. In this sense, cholesterol reduction would merely be a side effect.
- simvastatin (20 mg/kg per day) negatively affected the wasting pattern induced by Yoshida AH-130 ascites hepatoma in rats.
- the organ weights of liver, spleen, heart, gastrocnemius, and soleus decreased by four days of simvastatin treatment.
- the administration of simvastatin to control animals (without hepatoma) yielded no effects with the exception of a significant reduction in heart weight (controls without simvastatin: 501 ⁇ 58 mg, controls with simvastatin: 426 ⁇ 65 mg, p ⁇ 0.05).
- statin the effect of the statin on the rats was measured after only 4 days. This duration was not even able to affect cholesterol/triglyceride levels, although HDL levels were increased. Moreover, the amount of statin used in this study may not have been the correct quantity.
- statin can be used to treat cachexia.
- a first aspect of the invention provides the use of at least one statin in the manufacture of a medicament for the prevention or treatment of cachexia in a patient, wherein the patient is human or a domestic or farm animal.
- statin can be used to treat cachexia.
- patient includes a human patient and also domestic animals such as cats and dogs, and farm animals such as cows, pigs, horses, sheep, goats and the like.
- the patient is not a rat. It is preferred that the patient is human.
- the medicament of the first aspect of the invention may be used to treat a patient diagnosed with cachexia, and to treat a patient at risk of developing cachexia.
- the patient has been diagnosed as having cachexia.
- Cachexia can be defined as a history of weight loss, for example >5% (preferably >6%) weight loss over a period of at least six months. However, in patients with cancer and aging at least 4% weight loss over three months can be used as a basis to diagnose cachexia. Cachexia can also be defined as a low body mass index, for example ⁇ 20, ⁇ 21, ⁇ 21.5, ⁇ 22 kg/m 2 over a period of time, for example six months.
- Diagnosis can be made by asking the patient for their weight over the preceding months.
- the weight of an individual can be monitored over a period of time, for example six months.
- the medicament may comprise an appropriate quantity of statin to treat cachexia.
- Existing dosage regimes for human patients are provided in the accompanying examples.
- statin may induce beneficial pleiotropic effects on the patient without substantially reducing cholesterol level.
- an embodiment of this aspect of the invention is wherein the medicament is for administering an amount of statin that does not substantially reduce cholesterol level.
- statin may induce beneficial pleiotropic effects on the patient. These pleiotropic effects may be of benefit for the treatment of cachexia. Therefore the medicament may be for administering an amount of statin that induces pleiotropic effects on the patient. This amount of statin may also not substantially reduce cholesterol levels in a patient treated with the medicament.
- pleiotropic effects we include improvement of endothelial dysfunction, release of endothelial progenitor cells, anti-inflammatory properties, and a number of anti-tumour activities.
- not substantially reduce cholesterol level we include that the cholesterol level of a patient treated with the medicament is substantially similar to the cholesterol level of a patient who has not been treated with the medicament. We also include where the cholesterol level of a patient treated with the medicament is substantially similar to the cholesterol level of the same patient before administration of the medicament. We also include where the cholesterol levels of a population of patients treated with the medicament is substantially similar to the cholesterol levels of a population of patients who has not been treated with the medicament. In each of these cases, the medicament can be considered not to have substantially reduced cholesterol levels.
- the cholesterol level is considered to be "substantially similar” if it is at least 90% of the reference cholesterol levels, preferably, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99%, 100%, 101%, 102%, 103%, 104%, 105%, 106%, 107%, 108%, 109%, 110% of those levels.
- statin we include atorvastatin, fluvastatin, lovastatin, pravastatin, rosuvastatin, simvastatin, cerivastatin, mevastatin or pravastatin.
- statin is simvastatin or atorvastatin.
- Statins are well known compounds and may be obtained from a number of sources. For example, rosuvastatin (AstraZeneca); atorvastatin (Pfizer); simvastatin (Merck); fluvastatin (Novartis); pravastatin (Bristol-Myers Squibb); lovastatin (Merck), pitvastatin (Kowa).
- the medicament comprises a daily unit dose of less than 5mg of rosuvastatin or simvastatin per day; or less than 10 mg of atorvastatin, lovastatin or pravastatin per day; or less than 20 mg of fluvastatin per day.
- less than 5 mg we include between 0.01 mg and 4.9 mg per day, for example less than or equal to 4.9, 4.8, 4.7, 4.6 4.5, 4, 3.5, 3, 2.5, 2, 1.5, 1, 0.5, 0.1, 0.05, 0.04, 0.03, 0.02 or 0.01 mg per day.
- less than 10 mg we include between 0.01 mg and 9.9 mg per day, for example less than or equal to 9.9, 9.8, 9.7, 9.6, 9.5, 9, 8.5, 8, 7.5, 7, 6.5, 6, 5.5, 5, 4.5, 4, 3.5, 3, 2.5, 2, 1.5, 1, 0.5, 0.1, 0.05, 0.04, 0.03, 0.02 or 0.01 mg per day.
- nig between 0.01 mg and 19.9 nig per day, for example we include less than or equal to 19.9, 19.8, 19.7, 19.6, 19.5, 19, 18.5, 18, 17.5, 17, 16.5, 16, 15.5, 15, 14.5, 14, 13.5, 13, 12.5, 12, 11.5, 11, 10.5, 10, 9.5, 9, 8.5, 8, 7.5, 7, 6.5, 6, 5.5, 5, 4.5, 4, 3.5, 3, 2.5, 2, 1.5, 1, 0.5, 0.1, 0.05, 0.04, 0.03, 0.02 or 0.01 mg per day.
- the medicament may comprise a quantity of the statin equivalent to the daily unit dose.
- the medicament may comprise a slow release formulation of the statin having the property of releasing the daily unit dose.
- Cachexia can occur in patients with a wide variety of diseases including infectious diseases such as acquired immune deficiency syndrome (AIDS), liver cirrhosis, chronic obstructive pulmonary disease (COPD), chronic renal failure, chronic infections including pneumonia, cancer (cancer cachexia), diabetes mellitus and heart disease including hypertension and chronic heart failure (CHF) (cardiac cachexia). Cachexia may also occur idiopathically. Cachexia is also associated with ageing, rheumatoid arthritis, diabetes, stroke, burns, trauma and other acute injury, sepsis, HIV/ AIDS and other infections.
- infectious diseases such as acquired immune deficiency syndrome (AIDS), liver cirrhosis, chronic obstructive pulmonary disease (COPD), chronic renal failure, chronic infections including pneumonia, cancer (cancer cachexia), diabetes mellitus and heart disease including hypertension and chronic heart failure (CHF) (cardiac cachexia). Cachexia may also occur idiopathically. Cachexia is also associated with ageing, rheumatoi
- the cachexia is cancer cachexia, cardiac cachexia (for example cachexia due to CHF or cardiomyopathy) or chronic obstructive pulmonary disease (COPD) cachexia.
- cardiac cachexia for example cachexia due to CHF or cardiomyopathy
- COPD chronic obstructive pulmonary disease
- the cachexia may instead be, for example, cachexia associated with liver cirrhosis, chronic renal failure, rheumatoid arthritis, diabetes, stroke, burns, trauma or other acute injury, sepsis, HIV/ AIDS or other infections or ageing.
- the medicament or method of treatment
- the statin used in this aspect of the invention has been prepared using the micro-crystallisation method disclosed in WO 03/103640 (herein incorporated by reference).
- micro crystallization can improve drug activity and final product characteristics. Poor water solubility (including simvastatin, atorvastatin, and lovastatin; fluvastatin and cerivastatin) correlates with slow dissolution rate, and decreasing particle size increases the surface area, which leads to an increase in dissolution rate. This can be accomplished using micro crystallization, because such particles are small particles of drug substance, typically less than 1000 nanometers (nm) in diameter, which are produced by milling the drug substance using a wet milling technique.
- micro crystallized particles of the drug are stabilized against agglomeration by surface adsorption of selected stabilizers.
- the result is an aqueous dispersion of the drug substance that behaves like a solution-a NanoCrystal colloidal dispersion, which can be processed into finished dosage forms for all routes of administration.
- any statin might be treated in such a way, however, the oral bioavailability of pravastatin and rosuvastatin (which are hydrophilic) appears to be less likely to benefit from such treatment.
- the lipophilic drugs cerivastatin and pravastatin have per se a high bioavailability (of approximately 60%) which could be enhanced by micro crystallization.
- statin will normally be administered orally or by any parenteral route, in the form of a pharmaceutical formulation comprising the active ingredient, optionally in the form of a non-toxic organic, or inorganic, acid, or base, addition salt, in a pharmaceutically acceptable dosage form.
- the medicament may be administered at varying doses.
- statin can be administered alone but will generally be administered in admixture with a suitable pharmaceutical excipient diluent or carrier selected with regard to the intended route of administration and standard pharmaceutical practice.
- statin can be administered orally, buccally or sublingually in the form of tablets, capsules, ovules, elixirs, solutions or suspensions, which may contain flavouring or colouring agents, for immediate-, delayed- or controlled- release applications.
- the stain may also be administered via intracavernosal injection.
- Such tablets may contain excipients such as microcrystalline cellulose, lactose, sodium citrate, calcium carbonate, dibasic calcium phosphate and glycine, disintegrants such as starch (preferably corn, potato or tapioca starch), sodium starch glycollate, croscarmellose sodium and certain complex silicates, and granulation binders such as polyvinylpyrrolidone, hydroxypropyhnethylcellulose (HPMC), hydroxy-propylcellulose (HPC), sucrose, gelatin and acacia. Additionally, lubricating agents such as magnesium stearate, stearic acid, glyceryl behenate and talc may be included.
- excipients such as microcrystalline cellulose, lactose, sodium citrate, calcium carbonate, dibasic calcium phosphate and glycine
- disintegrants such as starch (preferably corn, potato or tapioca starch), sodium starch glycollate, croscarmellose sodium and certain complex silicates,
- Solid compositions of a similar type may also be employed as fillers in gelatin capsules.
- Preferred excipients in this regard include lactose, starch, a cellulose, milk sugar or high molecular weight polyethylene glycols.
- the statin may be combined with various sweetening or flavouring agents, colouring matter or dyes, with emulsifying and/or suspending agents and with diluents such as water, ethanol, propylene glycol and glycerin, and combinations thereof.
- the statin can also be administered parenterally, for example, intravenously, intra- arterially, intraperitoneally, intrathecally, intraventricularly, intrasternally, intracranially, intra-muscularly or subcutaneously, or they may be administered by infusion techniques. They are best used in the form of a sterile aqueous solution which may contain other substances, for example, enough salts or glucose to make the solution isotonic with blood.
- the aqueous solutions should be suitably buffered (preferably to a pH of from 3 to 9), if necessary.
- suitable parenteral formulations under sterile conditions is readily accomplished ⁇ by standard pharmaceutical techniques well-known to those skilled in the art.
- Formulations suitable for parenteral administration include aqueous and non-aqueous sterile injection solutions which may contain anti-oxidants, buffers, bacteriostats and solutes which render the formulation isotonic with the blood of the intended recipient; and aqueous and non-aqueous sterile suspensions which may include suspending agents and thickening agents.
- the formulations may be presented in unit-dose or multi-dose containers, for example sealed ampoules and vials, and may be stored in a freeze-dried (lyophilised) condition requiring only the addition of the sterile liquid carrier, for example water for injections, immediately prior to use.
- Extemporaneous injection solutions and suspensions may be prepared from sterile powders, granules and tablets of the kind previously described.
- the statin can also be administered intranasally or by inhalation and are conveniently delivered in the form of a dry powder inhaler or an aerosol spray presentation from a pressurised container, pump, spray or nebuliser with the use of a suitable propellant.
- a suitable propellant e.g. dichlorodifluoromethane, trichlorofluoromethane, dichlorotetrafluoro-ethane, a hydrofluoroalkane such as 1,1,1,2-tetrafluoroethane (HFA 134A3 or 1,1,1,2,3,3,3-heptafluoro ⁇ ropane (HFA 227EA3), carbon dioxide or other suitable gas.
- the dosage unit may be determined by providing a valve to deliver a metered amount.
- the pressurised container, pump, spray or nebuliser may contain a solution or suspension of the active compound, e.g. using a mixture of ethanol and the propellant as the solvent, which may additionally contain a lubricant, e.g. sorbitan trioleate.
- a lubricant e.g. sorbitan trioleate.
- Capsules and cartridges (made, for example, from gelatin) for use in an inhaler or insufflator may be formulated to contain a powder mix of a statin and a suitable powder base such as lactose or starch.
- Aerosol or dry powder formulations are preferably arranged so that each metered dose or "puff contains precise quantity of statin for delivery to the patient. It will be appreciated that he overall daily dose with an aerosol will vary from patient to patient, and may be administered in a single dose or, more usually, in divided- doses throughout the day.
- statin can be administered in the form of a suppository or pessary, or they may be applied topically in the form of a lotion, solution, cream, ointment or dusting powder.
- the statin may also be transdermally administered, for example, by the use of a skin patch. They may also be administered by the ocular route, particularly for treating diseases of the eye.
- the statin can be formulated as micronised suspensions in isotonic, pH adjusted, sterile saline, or, preferably, as solutions in isotonic, pH adjusted, sterile saline, optionally in combination with a preservative such as a benzylalkonium chloride. Alternatively, they may be formulated in an ointment such as petrolatum.
- the statin can be formulated as a suitable ointment containing the active compound suspended or dissolved in, for example, a mixture with one or more of the following: mineral oil, liquid petrolatum, white petrolatum, propylene glycol, polyoxyethylene polyoxypropylene compound, emulsifying wax and water.
- they can be formulated as a suitable lotion or cream, suspended or dissolved in, for example, a mixture of one or more of the following: mineral oil, sorbitan monostearate, a polyethylene glycol, liquid paraffin, polysorbate 60, cetyl esters wax, cetearyl alcohol, 2-octyldodecanol, benzyl alcohol and water.
- Formulations suitable for topical administration in the mouth include lozenges comprising the active ingredient in a flavoured basis, usually sucrose and acacia or tragacanth; pastilles comprising the active ingredient in an inert basis such as gelatin and glycerin, or sucrose and acacia," and mouth-washes comprising the active ingredient in a suitable liquid carrier.
- statin is the preferred route, being the most convenient.
- the drug may be administered parenterally, e.g. sublingually or buccally.
- statin For oral and parenteral administration to human patients, the daily dosage level of statin are provided above.
- the physician in any event will determine the actual dosage which will be most suitable for any individual patient and it will vary with the age, weight and response of the particular patient.
- the above dosages are exemplary of the average case. There can, of course, be individual instances where higher or lower dosage ranges are merited and such are within the scope of this invention.
- the medicament can be used for the prevention or treatment of cachexia.
- Existing treatment for this disorder include the following therapeutic agents: growth hormone, anabolic steroids, and appetite stimulants for some subgroups of cachexia.
- the medicament comprises one or more of such therapeutic agents for preventing or treating cachexia.
- a further aspect of the invention provide a method of treating a patient with or at risk of developing cachexia comprising administering an appropriate quantity of at least one statin, wherein the patient is human or a domestic or farm animal.
- the patient is human.
- An embodiment of this aspect of the invention is wherein the patient is administered an amount of statin that does not substantially reduce cholesterol level.
- statin is atorvastatin, fmvastatin, lovastatin, pravastatin, rosuvastatin, simvastatin, cerivastatin, mevastatin or pitavastatin.
- statin is simvastatin or atorvastatin.
- the method uses a quantity of the statin equivalent to a daily unit dose.
- An embodiment of this aspect of the invention is wherein the method uses a slow release formulation of the statin having the property of releasing a daily unit dose.
- An embodiment of this aspect of the invention is wherein the statin has been prepared using micro-crystallisation.
- An embodiment of this aspect of the invention is wherein the method further comprises using one or more further therapeutic agents for preventing or treating cachexia.
- An embodiment of this aspect of the invention is wherein the cachexia is cancer cachexia, cardiac cachexia or chronic obstructive pulmonary disease (COPD) cachexia.
- the cachexia is cancer cachexia, cardiac cachexia or chronic obstructive pulmonary disease (COPD) cachexia.
- COPD chronic obstructive pulmonary disease
- Example 2 shows a higher likelihood of experiencing weight gain (assessed as weight gain of more than 5%) for patients treated with statins.
- Example 3 also shows a positive trend for low dose statin on body weight.
- the medicament or method is considered to be useful in assisting increase in lean tissue or skeletal muscle mass.
- Example 3 shows a positive trend for low dose statin on lean tissue and skeletal muscle mass.
- Muscle mass can be measured in humans in several ways, as will be well known to the person skilled in the art, for example: - antropometry (using calipers to assess skin fold thickness and then estimate muscle mass)
- DEXA scanning (dual X-ray absorptiometry, as described in, for example Anker et al (1999) 20, 683-693).
- DEXA is the method most often used in cachexia research projects
- the skeletal muscle mass increase may be relative to the starting point of muscle mass in the patient or as the proportion of the patient's body mass. From a muscle mass and strength point of view either is desirable. Preferably after treatment there is more muscle than before: whether this is accompanied by an increase in body weight or not is of lesser importance for muscle anabolic interventions. It is preferable that muscle increases without loss of fat, i.e. that muscle gain leads to overall weight gain.
- FIG. 2 Pathway of cholesterol biosynthesis.
- Statins block the rate-limiting step in the cascade by inhibition of HMG-CoA reductase. The inhibition can be overcome by addition of mevalonate in experimental models.
- CoA - coenzyme A HMG- 3-hydroxy-3-methylglutaryl, PP - pyrophosphate.
- Figure 3 Overview of the principal pleiotropic effects of statins on (A) the endothelium, (B) the immune system, and (C) tumour development and metastasis.
- statins have been shown to improve endothelial function by increasing nitric oxide (NO) production and release. Statins also increase the number of endothelial progenitor cells in the bloodstream.
- NO nitric oxide
- proinflammatory mediators e.g. TNF-a, IL-I, IL-6
- adhesion molecule expression e.g. ICAM-I
- statins The release of C-reactive protein (CRP) has been proven in several clinical settings.
- Anti-tumour activities of statins comprise the induction of apoptosis, growth arrest by inhibiting the cell cycle of malignant cells, and the reduction of the invasiveness of malignant cells at secondary sites.
- the following table includes information on the characteristics of statins that may be used in the invention.
- ** C max may vary according to the administered dose and the patient population investigated.
- Example 2 Use of statins for the treatment of cachexia
- statins used in the ELITE 2 trial were:
- RESULTS ELITE 2 study. Cox Proportional Hazard Analysis of the impact of being on statin at baseline (BL) on the subsequent development of weight gain >5%. The impact is highly significant (p ⁇ 0.0001) and independent of the severity of heart failure as measured by LVEF, NYHA class, clinical oedema status, degree of kidney dysfunction (i.e. creatinine [crea] levels) and heart failure aetiology. In 3030 patients all information for this analysis was available.
- Model Proportional Hazards. Row exclusion: ELITE2 11- 05B-w-change-080805.
- ELITE 2 study - the subgroup of patients with a diagnosis of chronic obstructive pulmonary disease (COPD).
- COPD chronic obstructive pulmonary disease
- statin therapy was associated with weight gain only in patients with COPD (33.4% increase in the event rate of weight gain), unlike the general population of the ELITE 2 trial in which the occurrence of weight gain due to statin therapy was 17% reduced (see Table 2).
- the animals were seen at least twice per day to ensure precise survival data.
- Body Weight was monitored every two days throughout the entire study period.
- Body Composition was measured the day before tumour inoculation and in two day intervals after that until the end of the study using NMR-scans (EchoMRI systems). Read-out is fat, lean mass, total water and free water. Locomotor Activity Assessed using Supermex system over a period of 24 hours in cages where the animals are placed individually (type 3 cage).
- Echocardiography was performed in all animals on day 0 and on day 12 using a high resolution echocardiography system (Vevo770, Visual Sonics) to determine the following parameters:
- LVEF left ventricular ejection fraction
- LVFS left ventricular fractional shortening
- LVEDD and LVESD left ventricular end-diasolic and end-systolic diameters
- M-Mode septum and inferior wall thickness
- rVSd and IVSs thickness of the inter- ventricular septum in diastole and systole diastolic filling
- Heart function Heart function was assessed by high resolution echocardiography using the Vevo 770 system (Visualsonics, Toronto, Canada).
- the left ventricular (LV) ejection fraction, LV fractional shortening, LV end-diastolic diameter, LV end-systolic diameter, LV posterior wall thickness in diastole and systole, thickness of the inter-ventricular septum in diastole and systole, the LV stroke volume and the diastolic function (E/ A) were assessed.
- the results showed neutral results for all parameter assessed (ANOVA, all p>0.4).
- Fat mass did not show any significant difference between the simvastatin groups and the placebo group.
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Cited By (6)
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WO2009121623A2 (en) * | 2008-04-04 | 2009-10-08 | Summit Corporation Plc | Compounds for treating muscular dystrophy |
EP2832357A1 (en) * | 2013-07-29 | 2015-02-04 | Charité - Universitätsmedizin Berlin | Selective AT2 receptor agonists for use in treatment of cachexia |
US9486503B2 (en) | 2012-10-04 | 2016-11-08 | Shionogi & Co., Ltd. | Medicinal agent for suppressing malignant tumor metastasis |
US10675274B2 (en) | 2018-09-19 | 2020-06-09 | Forma Therapeutics, Inc. | Activating pyruvate kinase R |
US10836771B2 (en) | 2017-03-20 | 2020-11-17 | Forma Therapeutics, Inc. | Compositions for activating pyruvate kinase |
US11001588B2 (en) | 2018-09-19 | 2021-05-11 | Forma Therapeutics, Inc. | Activating pyruvate kinase R and mutants thereof |
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WO2009121623A2 (en) * | 2008-04-04 | 2009-10-08 | Summit Corporation Plc | Compounds for treating muscular dystrophy |
WO2009121623A3 (en) * | 2008-04-04 | 2010-05-20 | Biomarin Iga Limited | Compounds for treating muscular dystrophy |
US9486503B2 (en) | 2012-10-04 | 2016-11-08 | Shionogi & Co., Ltd. | Medicinal agent for suppressing malignant tumor metastasis |
US9987333B2 (en) | 2012-10-04 | 2018-06-05 | Shionogi & Co., Ltd. | Method for suppressing malignant tumor metastasis |
EP2832357A1 (en) * | 2013-07-29 | 2015-02-04 | Charité - Universitätsmedizin Berlin | Selective AT2 receptor agonists for use in treatment of cachexia |
WO2015014634A1 (en) * | 2013-07-29 | 2015-02-05 | Charite - Universitätsmedizin Berlin | Selective at2 receptor agonists for use in treatment of cachexia |
US10016397B2 (en) | 2013-07-29 | 2018-07-10 | Charité—Universitaetsmedizn Berlin | Selective AT2 receptor agonists for use in treatment of cachexia |
US10836771B2 (en) | 2017-03-20 | 2020-11-17 | Forma Therapeutics, Inc. | Compositions for activating pyruvate kinase |
US11014927B2 (en) | 2017-03-20 | 2021-05-25 | Forma Therapeutics, Inc. | Pyrrolopyrrole compositions as pyruvate kinase (PKR) activators |
US11396513B2 (en) | 2017-03-20 | 2022-07-26 | Forma Therapeutics, Inc. | Compositions for activating pyruvate kinase |
US11649242B2 (en) | 2017-03-20 | 2023-05-16 | Forma Therapeutics, Inc. | Pyrrolopyrrole compositions as pyruvate kinase (PKR) activators |
US10675274B2 (en) | 2018-09-19 | 2020-06-09 | Forma Therapeutics, Inc. | Activating pyruvate kinase R |
US11001588B2 (en) | 2018-09-19 | 2021-05-11 | Forma Therapeutics, Inc. | Activating pyruvate kinase R and mutants thereof |
US11071725B2 (en) | 2018-09-19 | 2021-07-27 | Forma Therapeutics, Inc. | Activating pyruvate kinase R |
US11844787B2 (en) | 2018-09-19 | 2023-12-19 | Novo Nordisk Health Care Ag | Activating pyruvate kinase R |
US11980611B2 (en) | 2018-09-19 | 2024-05-14 | Novo Nordisk Health Care Ag | Treating sickle cell disease with a pyruvate kinase R activating compound |
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AU2007206776A1 (en) | 2007-07-26 |
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WO2007083119A3 (en) | 2008-03-20 |
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