WO2009113950A1 - Therapeutic combinations of (a) an antipsychotic and (b) an alpha-4/beta-2 (a4b2)-neuronal nicotinic receptor agonist - Google Patents

Therapeutic combinations of (a) an antipsychotic and (b) an alpha-4/beta-2 (a4b2)-neuronal nicotinic receptor agonist Download PDF

Info

Publication number
WO2009113950A1
WO2009113950A1 PCT/SE2009/050242 SE2009050242W WO2009113950A1 WO 2009113950 A1 WO2009113950 A1 WO 2009113950A1 SE 2009050242 W SE2009050242 W SE 2009050242W WO 2009113950 A1 WO2009113950 A1 WO 2009113950A1
Authority
WO
WIPO (PCT)
Prior art keywords
therapeutic agent
pharmaceutically acceptable
antipsychotic
quetiapine
acceptable salts
Prior art date
Application number
PCT/SE2009/050242
Other languages
French (fr)
Inventor
Edwin Johnson
Craig Miller
Gunilla Osswald
Original Assignee
Astrazeneca Ab
Targacept Inc.
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, Targacept Inc. filed Critical Astrazeneca Ab
Publication of WO2009113950A1 publication Critical patent/WO2009113950A1/en

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K45/00—Medicinal preparations containing active ingredients not provided for in groups A61K31/00 - A61K41/00
    • A61K45/06—Mixtures of active ingredients without chemical characterisation, e.g. antiphlogistics and cardiaca
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/40—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
    • A61K31/407—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 other heterocyclic ring systems, e.g. ketorolac, physostigmine
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/55—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having seven-membered rings, e.g. azelastine, pentylenetetrazole
    • A61K31/554—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having seven-membered rings, e.g. azelastine, pentylenetetrazole having at least one nitrogen and one sulfur as ring hetero atoms, e.g. clothiapine, diltiazem
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P25/00—Drugs for disorders of the nervous system
    • A61P25/18—Antipsychotics, i.e. neuroleptics; Drugs for mania or schizophrenia

Definitions

  • the present invention relates to a combination of (a) an antipsychotic and (b) an alpha-4/beta-2 ( ⁇ 4 ⁇ 2)-neuronal nicotinic receptor agonist.
  • the invention further relates to pharmaceutical compositions comprising said combination and to the use of the combination in therapy.
  • the invention further relates to a kit comprising the combination and use of said kit in therapy.
  • Exemplary conventional, or “typical” antipsychotics may include but are not limited to chlorpromazine, haloperidol, flupenthixol and perphenazine.
  • Atypical antipsychotics offer several clinical benefits over the conventional antipsychotics. The distinct advantages over traditional antipsychotic medications include greater improvement in negative symptoms, such as social withdrawal, and lower risk of Parkinsonian side effects and tardive dyskinesia.
  • Examples of atypical antipsychotics include but are not limited to clozapine, risperidone, olanzapine, quetiapine, aripiprazole, ziprasidone, amisulpride, sulpride, zotepine, sertindole, paliperidone, bifeprunox and asenapine.
  • Quetiapine the international nonproprietary name for 11-[4-[2-(2- hydroxyethoxy)ethyl]-l-piperazinyl]dibenzo[b,fj[l,4]thiazepine, is an atypical antipsychotic and is currently on the market as Seroquel ® for 1) treatment of schizophrenia, 2) adjunctive therapy with mood stabilizers (litium or divalproex) in the treatment of acute manic episodes associated with bipolar I disorders, 3 monotherapy in the treatment of acute manic episodes associated with bipolar I disorder, and 4) treatment of major depressive episodes associated with bipolar disorder.
  • Quetiapine and its pharmaceutically acceptable salts are described in U.S. Patent Number 4,879,288, which is incorporated herein by reference. A preparation of these compounds is also described in said US patent.
  • Cognitive dysfunction has been identified an integral feature of depression and schizophrenia (Psychol Med. 24:829 (1994); Am. J. Psychiatry 161 :25 (2004)).
  • the neuronal nicotinic receptor agonists of the present invention are those compounds having agonist or partial agonist activity against the alpha-4/beta-2, or ⁇ 4/ ⁇ 2, receptor ( ⁇ 4 ⁇ 2-neuronal nicotinic receptor agonist).
  • Particular neuronal nicotinic receptor agonists useful in the combination of the present invention are those described in US application 60/856,079 and PCT/US07/83330, which are hereby incorporated by reference.
  • Particular neuronal nicotinic receptor agonists are compounds 3-(5-chloro-2-furoyl)-3,7-diazabicyclo[3.3.0]octane, also known as N- (5-chlorofuran-2-ylcarbonyl)-3,7-diazabicyclo[3.3.0]octane, metabolites or prodrugs and pharmaceutically acceptable salts, solvates or solvated salts or co- crystals of any of the foregoing. The preparation of this compound is described in said US patent. These compounds modulate nicotinic receptors in the patient's brain.
  • the compounds have the ability to express nicotinic pharmacology, and in particular, to act as neuronal nicotinic receptor agonists.
  • the ⁇ 4 ⁇ 2 -neuronal nicotinic receptor agonists can be used to treat those types of conditions and disorders for which other types of nicotinic compounds have been proposed as therapeutics.
  • the neuronal nicotinic receptor agonists are useful in the treatment of a variety of CNS disorders, including but not limited to neurodegenerative disorders, neuropsychiatric disorders, neurologic disorders, addictions, disorders attributed to or associated with neurotransmitter system dysfunction, CNS disorders attributed to a cholinergic deficiency, a dopaminergic deficiency, an adrenergic deficiency and/or a serotonergic deficiency.
  • the present invention relates to the combination of (a) a first therapeutic agent, which is an antipsychotic agent and (b) a second therapeutic agent, which is 3-(5-chloro-2-furoyl)-3,7-diazabicyclo[3.3.0]octane, particularly, the synergistic combination of (a) and (b).
  • the combinations described herein are contemplated to provide synergistic or additive effects in treating psychiatric disorders; particularly, cognitive impairment disorders in psychotic disorders. Described combinations are contemplated to provide symptomatic relief of psychiatric disorders; particularly, cognitive impairment disorders in psychotic disorders.
  • Compositions and methods described herein are contemplated to offer advantages over previous methods for treating neuropsychiatric disorders.
  • the method of treatment described herein is contemplated to enhance the effect of the agents when taken in combination and therefore, in one aspect, permit reduced quantities of these agents to be used and, therefore, permit improved management of cognitive impairment, disease symptoms and disease-related side effects.
  • combinations are contemplated to result in reduction of drug- induced extrapyramidal symptoms (EPS) where applicable, e.g., typical antipsychotic treatment. Further the combinations are contemplated to elicit fewer side effects.
  • EPS drug- induced extrapyramidal symptoms
  • the present invention refinemplates that the combinations disclosed herein reduce the haloperidol-induced catalepsy.
  • a first aspect of the invention relates to a combination comprising (a) a first therapeutic agent, which is an antipsychotic agent and (b) a second therapeutic agent, which is 3-(5-chloro-2-furoyl)-3,7-diazabicyclo[3.3.0]octane.
  • the combination comprises the group of compounds (a) and (b) as defined below.
  • One embodiment relates to a combination wherein the antipsychotic agent (a) is an atypical antipsychotic agent.
  • the first therapeutic agent (a) comprises a typical antipsychotic agent, including but not limited to compounds selected from chlorpromazine, haloperidol, flupenthixol and perphenazine.
  • the first therapeutic agent (a) comprises an atypical antipsychotic agent, including but not limited to compounds selected from clozapine, risperidone, olanzapine, quetiapine, aripiprazole, ziprasidone, amisulpride, sulpride, zotepine, sertindole, paliperidone, bifeprunox and asenapine, metabolites, prodrugs and pharmaceutically acceptable salts, solvates or solvated salts thereof.
  • an atypical antipsychotic agent including but not limited to compounds selected from clozapine, risperidone, olanzapine, quetiapine, aripiprazole, ziprasidone, amisulpride, sulpride, zotepine, sertindole, paliperidone, bifeprunox and asenapine, metabolites, prodrugs and pharmaceutically acceptable salts, solv
  • the first therapeutic agent (a) is selected from quetiapine, metabolites, prodrugs, and pharmaceutically acceptable salts, solvates or solvated salts thereof.
  • the second therapeutic agent (b) comprises compounds which are neuronal nicotinic receptor agonists having binding action at the ⁇ 4 ⁇ 2-nicotinic acetylcholine receptor, such as 3-(5-chloro-2-furoyl)-3,7- diazabicyclo[3.3.0]octane, metabolites or prodrugs and pharmaceutically acceptable salts, solvates or solvated salts thereof.
  • Another embodiment of the invention relates to a combination comprising (a) a first therapeutic agent, which is quetiapine, metabolites, prodrugs or a pharmaceutically acceptable salt, solvate or solvated salt thereof and (b) a second therapeutic agent, which is 3-(5-chloro-2-furoyl)-3,7-diazabicyclo[3.3.0]octane, or pharmaceutically acceptable salts thereof.
  • a first therapeutic agent which is quetiapine, metabolites, prodrugs or a pharmaceutically acceptable salt, solvate or solvated salt thereof
  • a second therapeutic agent which is 3-(5-chloro-2-furoyl)-3,7-diazabicyclo[3.3.0]octane, or pharmaceutically acceptable salts thereof.
  • a second aspect of the invention relates to a pharmaceutical composition
  • a pharmaceutical composition comprising a combination comprising (a) an antipsychotic and (b) 3-(5-chloro-2- furoyl)-3,7-diazabicyclo[3.3.0]octane, together with a pharmaceutically acceptable vehicle, carrier or diluent.
  • One embodiment of the invention relates to a pharmaceutical composition comprising both agents (a) and (b).
  • Another embodiment relates to two separate pharmaceutical compositions, one for agent (a) and one for agent (b).
  • One embodiment relates to a pharmaceutical composition as described above wherein the first therapeutic agent (a) is a typical antipsychotic agent, including but not limited to compounds selected from chlorpromazine, haloperidol, flupenthixol and perphenazine.
  • the first therapeutic agent (a) is a typical antipsychotic agent, including but not limited to compounds selected from chlorpromazine, haloperidol, flupenthixol and perphenazine.
  • the first therapeutic agent (a) comprises an atypical antipsychotic agent, including but not limited to compounds selected from clozapine, risperidone, olanzapine, quetiapine, aripiprazole, ziprasidone, amisulpride, sulpride, zotepine, sertindole, paliperidone, bifeprunox and asenapine, metabolites, prodrugs and pharmaceutically acceptable salts, solvates or solvated salts thereof.
  • an atypical antipsychotic agent including but not limited to compounds selected from clozapine, risperidone, olanzapine, quetiapine, aripiprazole, ziprasidone, amisulpride, sulpride, zotepine, sertindole, paliperidone, bifeprunox and asenapine, metabolites, prodrugs and pharmaceutically acceptable salts, solv
  • a further embodiment relates to a pharmaceutical composition wherein the antipsychotic agent is selected from quetiapine, metabolites, prodrugs and pharmaceutically acceptable salts, solvates or solvated salts thereof.
  • the second therapeutic agent is 3-(5-chloro-2-furoyl)-3,7- diazabicyclo[3.3.0]octane, metabolites or prodrugs and pharmaceutically acceptable salts, solvates or solvated salts thereof.
  • One embodiment relates to a pharmaceutical composition
  • a pharmaceutical composition comprising a combination comprising (a) a first therapeutic agent, which is an antipsychotic agent and (b) a second therapeutic agent, which is 3-(5-chloro-2-furoyl)-3,7- diazabicyclo[3.3.0]octane, or pharmaceutically acceptable salts thereof, together with a pharmaceutically acceptable vehicle, carrier or diluent.
  • compositions comprising a combination comprising (a) a first therapeutic agent, which is quetiapine or a metabolite, prodrug or pharmaceutically acceptable salt, solvate or solvated salt thereof, and (b) a second therapeutic agent, which is 3-(5-chloro-2-furoyl)-3,7- diazabicyclo[3.3.0]octane, or pharmaceutically acceptable salts thereof, together with a pharmaceutically acceptable vehicle, carrier or diluent.
  • a first therapeutic agent which is quetiapine or a metabolite, prodrug or pharmaceutically acceptable salt, solvate or solvated salt thereof
  • second therapeutic agent which is 3-(5-chloro-2-furoyl)-3,7- diazabicyclo[3.3.0]octane, or pharmaceutically acceptable salts thereof, together with a pharmaceutically acceptable vehicle, carrier or diluent.
  • Suitable pharmaceutically acceptable salts may be useful in the preparation of the compounds used in the combination of the invention.
  • Suitable pharmaceutically acceptable salts of the compounds described herein include acid addition salts which may, for example, be formed by mixing a solution of the compound according to the invention with a solution of a pharmaceutically acceptable acid such as hydrochloric acid, sulfuric acid, methanesulphonic acid and fumaric acid.
  • suitable pharmaceutically acceptable salts thereof may include alkali metal salts, e.g. sodium or potassium salts; alkaline earth metal salts, e.g. calcium or magnesium salts; and salts formed with suitable organic ligands, e.g. quaternary ammonium salts.
  • pharmaceutically acceptable salts includes both pharmaceutically acceptable acid addition salts and pharmaceutically acceptable cationic salts and also includes solvates, hydrates or solvated or hydrated salts thereof.
  • pharmaceutically acceptable cationic salts is intended to define but is not limited to such salts as the alkali metal salts, (e.g. sodium and potassium), alkaline earth metal salts (e.g., calcium and magnesium), aluminum salts, ammonium salts, and salts with organic amines such as benzathine (N 5 N'- dibenzylethylenediamine) and choline.
  • pharmaceutically acceptable acid addition salts is intended to define but is not limited to such salts as the hydrochloride, hydrobromide and sulfate.
  • the pharmaceutically acceptable cationic salts containing free carboxylic acids can be readily prepared by reacting the free acid form of with an appropriate base. Typical bases are sodium hydroxide, sodium methoxide and sodium ethoxide.
  • the pharmaceutically acceptable acid addition salts containing free amine groups can be readily prepared by reacting the free base form with the appropriate acid.
  • the salts of the antipsychotic compound may be prepared according to the process described in US 4,879,288 and are preferably pharmaceutically acceptable salts, but other salts may also be prepared.
  • a preferred salt is the hemi-fumarate salt.
  • Suitable salts for the ⁇ 4 ⁇ 2 -neuronal nicotinic receptor agonist may be, but are not limited to, chloride, bromide, sulfate, phosphate, and nitrate, acetate, galactarate, propionate, succinate, lactate, glycolate, malate, tartrate, citrate, maleate, fumarate, methanesulfonate, p-toluenesulfonate, and ascorbate, aspartate and glutamate.
  • An ⁇ 4 ⁇ 2 -neuronal nicotinic receptor agonist such as 3-(5-chloro-2-furoyl)-3,7- diazabicyclo[3.3.0]octane, may be co-administered simultaneously or may be administered separately or sequentially in any order, or as a single pharmaceutical composition with an atypical antipsychotic such as quetiapine to produce a synergistic benefit over and above that obtained by administration of either compound alone.
  • composition may be administered in a standard manner such as orally, parenterally, transmucosally (e.g., sublingually or via buccal administration), topically, transdermally, rectally, via inhalation (e.g., nasal or deep lung inhalation).
  • parenteral administration includes, but is not limited to intravenous, intraarterial, intraperitoneal, subcutaneous or intramuscular.
  • the composition can be in the form of tablets or lozenges formulated in conventional manner.
  • tablets and capsules for oral administration can contain conventional excipients such as binding agents (e.g., syrup, acacia, gelatin, sorbitol, tragacanth, mucilage of starch or polyvinylpyrrolidone), fillers (e.g., lactose, sugar, microcrystalline cellulose, maize- starch, calcium phosphate or sorbitol), lubricants (e.g., magnesium stearate, stearic acid, talc, polyethylene glycol or silica), disintegrants (e.g., potato starch or sodium starch glycollate), or wetting agents (e.g., sodium lauryl sulfate).
  • binding agents e.g., syrup, acacia, gelatin, sorbitol, tragacanth, mucilage of starch or polyvinylpyrrolidone
  • fillers e.g
  • compositions for inhalation typically can be provided in the form of a solution, suspension, or emulsion that can be administered as a dry powder or in the form of an aerosol using a conventional propellant, such as dichlorodifluoromethane or trichlorofluoromethane.
  • Typical topical and transdermal formulations comprise conventional aqueous or nonaqueous vehicles, such as eye drops, creams, ointments, lotions, and pastes, or are in the form of a medicated plaster, patch, or membrane.
  • compositions described herein can be formulated for parenteral administration by injection or continuous infusion.
  • Formulations for injection can be in the form of suspensions, solutions, or emulsions in oily or aqueous vehicles, and can contain formulation agents, such as suspending, stabilizing, and/or dispersing agents.
  • the active ingredient can be in powder form for constitution with a suitable vehicle (e.g., sterile, pyrogen-free water) before use.
  • a composition in accordance with the present invention also can be formulated as a depot formulation. Such long acting formulations can be administered by implantation (e.g., subcutaneously or intramuscularly) or by intramuscular injection.
  • the compounds of the invention can be formulated with suitable polymeric or hydrophobic materials (e.g., an emulsion in an acceptable oil), ion exchange resins, or as sparingly soluble derivatives (e.g., a sparingly soluble salt).
  • suitable polymeric or hydrophobic materials e.g., an emulsion in an acceptable oil
  • ion exchange resins e.g., ion exchange resins
  • sparingly soluble derivatives e.g., a sparingly soluble salt
  • a pharmaceutical composition can take the form of solutions, suspensions, tablets, pills, capsules, powders, and the like.
  • Tablets containing various excipients such as sodium citrate, calcium carbonate and calcium phosphate are employed along with various disintegrants such as starch, preferably potato or tapioca starch, and certain complex silicates, together with binding agents such as polyvinylpyrrolidone, sucrose, gelatin and acacia.
  • binding agents such as polyvinylpyrrolidone, sucrose, gelatin and acacia.
  • lubricating agents such as magnesium stearate, sodium lauryl sulfate and talc may be used to form tablets.
  • compositions of a similar type are also employed as fillers in soft and hard- filled gelatin capsules; preferred materials in this connection also include lactose (milk sugar) as well as high molecular weight polyethylene glycols.
  • lactose milk sugar
  • the composition described herein can be incorporated into oral liquid formulations such as aqueous or oily suspensions, solutions, emulsions, syrups, or elixirs, for example.
  • formulations containing these compounds can be presented as a dry product for constitution with water or other suitable vehicle before use.
  • Such liquid formulations can contain conventional additives, such as suspending agents, such as sorbitol syrup, synthetic and natural gums such as tragacanth, acacia, alginate, dextran, sodium carboxymethylcellulose, methylcellulose, polyvinyl-pyrrolidone or gelatin, glucose/sugar syrup, gelatin, hydroxyethylcellulose, hydroxypropylmethylcellulose, aluminum stearate gel, emulsifying agents, such as lecithin, sorbitan monooleate, or acacia; nonaqueous vehicles (which can include edible oils), such as almond oil, fractionated coconut oil, oily esters, propylene glycol, and ethyl alcohol; and preservatives, such as methyl or propyl p-hydroxybenzoate and sorbic acid.
  • suspending agents such as sorbitol syrup, synthetic and natural gums such as tragacanth, acacia, alginate, dextran, sodium carboxymethylcellulose, methylcellulose
  • aqueous suspensions and/or elixirs are desired for oral administration, the compounds described herein can be combined with various sweetening agents, flavoring agents, coloring agents, emulsifying agents and/or suspending agents, as well as such diluents as water, ethanol, propylene glycol, glycerin and various like combinations thereof.
  • Suitable dispersing or suspending agents for aqueous suspensions include synthetic and natural gums such as tragacanth, acacia, alginate, dextran, sodium carboxymethylcellulose, methylcellulose, polyvinyl-pyrrolidone or gelatin.
  • the combinations described herein can also be administered in a controlled release formulation (definition) such as a slow release or a fast release formulation.
  • a controlled release formulation such as a slow release or a fast release formulation.
  • Such controlled release formulations of the combinations described herein may be prepared using methods well known to those skilled in the art. The method of administration will be determined by the attendant physician or other person skilled in the art after an evaluation of the patient's condition and requirements.
  • a third aspect of the invention relates to a kit comprising a dosage unit of a first therapeutic agent, which is an atypical antipsychotic and a dosage unit of a second therapeutic agent, which is an ⁇ 4 ⁇ 2 -neuronal nicotinic receptor agonist, optionally with instructions for use.
  • a first therapeutic agent which is an atypical antipsychotic
  • a second therapeutic agent which is an ⁇ 4 ⁇ 2 -neuronal nicotinic receptor agonist
  • the first therapeutic agent (a) is a typical antipsychotic agent, including but not limited to compounds selected from chlorpromazine, haloperidol, flupenthixol and perphenazine.
  • the first therapeutic agent (a) comprises an atypical antipsychotic agent, including but not limited to compounds selected from clozapine, risperidone, olanzapine, quetiapine, aripiprazole, ziprasidone, amisulpride, sulpride, zotepine, sertindole, paliperidone, bifeprunox and asenapine, metabolites or prodrugs and pharmaceutically acceptable salts, solvates or solvated salts thereof.
  • a further embodiment relates to a kit wherein the antipsychotic agent is quetiapine, metabolites, prodrugs or pharmaceutically acceptable salts, solvates or solvated salts thereof.
  • Another embodiment relates to a kit as described above wherein the second therapeutic agent is 3-(5-chloro-2-furoyl)-3,7-diazabicyclo[3.3.0]octane, or metabolites or prodrugs or pharmaceutically acceptable salts, solvates or solvated salts thereof.
  • kits comprising (a) a first therapeutic agent, which is an antipsychotic agent and (b) a second therapeutic agent, which is 3-(5-chloro-2- furoyl)-3,7-diazabicyclo[3.3.0]octane, or pharmaceutically acceptable salts thereof.
  • a kit comprising (a) a dosage unit of a first therapeutic agent, which is quetiapine, metabolites, prodrugs.
  • a dosage unit of a second therapeutic agent which is 3-(5-chloro-2-furoyl)-3,7-diazabicyclo[3.3.0]octane or pharmaceutically acceptable salts thereof, optionally with instructions for use.
  • a fourth aspect of the invention relates to the use of the combination of the present invention in therapy.
  • One embodiment relates to a method for treating psychiatric disorders; particularly, cognitive dysfuntion in schizophrenia, cognitive impairment disorders in psychotic disorders in a subject in need thereof comprising administering simultaneously, sequentially or separately, to said subject (a) a first therapeutic agent, which is an antipsychotic agent and (b) a second therapeutic agent, which is 3-(5-chloro-2- furoyl)-3,7-diazabicyclo[3.3.0]octane, or pharmaceutically acceptable salts thereof.
  • a first therapeutic agent which is an antipsychotic agent
  • a second therapeutic agent which is 3-(5-chloro-2- furoyl)-3,7-diazabicyclo[3.3.0]octane, or pharmaceutically acceptable salts thereof.
  • the psychotic disorder or condition is selected from the group consisting of schizophrenia, schizophreniform disorder, schizoaffective disorder, delusional disorder, brief psychotic disorder, treatment-resistant shared psychotic disorder, psychotic disorder due to a medical condition, and psychotic disorder not otherwise specified.
  • Another embodiment relates to a method for reducing sedative side effects of quetiapine in a subject in need thereof comprising administering simultaneously, sequentially or separately to said subject (a) a first therapeutic agent, which is an antipsychotic agent and (b) a second therapeutic agent, which is 3-(5-chloro-2- furoyl)-3,7-diazabicyclo[3.3.0]octane, or pharmaceutically acceptable salts thereof.
  • a first therapeutic agent which is an antipsychotic agent
  • a second therapeutic agent which is 3-(5-chloro-2- furoyl)-3,7-diazabicyclo[3.3.0]octane, or pharmaceutically acceptable salts thereof.
  • a further embodiment relates to a method for improving the antipsychotic effect of quetiapine in a subject in need thereof comprising administering simultaneously, sequentially or separately, to said subject (a) a first therapeutic agent, which is an antipsychotic agent and (b) a second therapeutic agent, which is 3-(5-chloro-2- furoyl)-3,7-diazabicyclo[3.3.0]octane, or pharmaceutically acceptable salts thereof.
  • Another embodiment relates to a method of reducing extrapyramidal symptoms (EPS) in a subject in need thereof comprising administering simultaneously, sequentially or separately, to said subject (a) a first therapeutic agent, which is an antipsychotic agent and (b) a second therapeutic agent, which is 3-(5-chloro-2- furoyl)-3,7-diazabicyclo[3.3.0]octane, or pharmaceutically acceptable salts thereof.
  • EPS extrapyramidal symptoms
  • One embodiment relates to a method of inhibiting acoustic startle in a subject in need thereof comprising administering simultaneously, sequentially or separately, to said subject (a) a first therapeutic agent, which is an antipsychotic agent and (b) a second therapeutic agent, which is 3-(5-chloro-2-furoyl)-3,7- diazabicyclo[3.3.0]octane, or pharmaceutically acceptable salts thereof.
  • a first therapeutic agent which is an antipsychotic agent
  • a second therapeutic agent which is 3-(5-chloro-2-furoyl)-3,7- diazabicyclo[3.3.0]octane, or pharmaceutically acceptable salts thereof.
  • Another embodiment relates to a method of enhancing quetiapine-mediated reduction of phencyclidine-induced disruption of prepulse inhibition in a subject in need thereof comprising administering simultaneously, sequentially or separately, to said subject (a) a first therapeutic agent, which is an antipsychotic agent and (b) a second therapeutic agent, which is 3-(5-chloro-2-furoyl)-3,7- diazabicyclo[3.3.0]octane, or pharmaceutically acceptable salts thereof.
  • a first therapeutic agent which is an antipsychotic agent
  • a second therapeutic agent which is 3-(5-chloro-2-furoyl)-3,7- diazabicyclo[3.3.0]octane, or pharmaceutically acceptable salts thereof.
  • a further embodiment relates to a method of increasing dopamine release in prefrontal cortex in a subject in need thereof comprising administering simultaneously, sequentially or separately, to said subject (a) a first therapeutic agent, which is an antipsychotic agent and (b) a second therapeutic agent, which is 3-(5-chloro-2-furoyl)-3,7-diazabicyclo[3.3.0]octane, or pharmaceutically acceptable salts thereof.
  • a first therapeutic agent which is an antipsychotic agent
  • a second therapeutic agent which is 3-(5-chloro-2-furoyl)-3,7-diazabicyclo[3.3.0]octane, or pharmaceutically acceptable salts thereof.
  • Yet another embodiment relates to a method of reducing haloperidol-induced catalepsy in a subject in need thereof comprising administering simultaneously, sequentially or separately, to said subject (a) a first therapeutic agent, which is haloperidol (b) a second therapeutic agent, which is 3-(5-chloro-2-furoyl)-3,7- diazabicyclo[3.3.0]octane, or pharmaceutically acceptable salts thereof.
  • a first therapeutic agent which is haloperidol
  • a second therapeutic agent which is 3-(5-chloro-2-furoyl)-3,7- diazabicyclo[3.3.0]octane, or pharmaceutically acceptable salts thereof.
  • a further embodiment relates to said methods wherein, agent (a) and agent (b), are administered simultaneously, sequentially or separately, to the subject in a pharmaceutical composition additionally comprising a pharmaceutically acceptable vehicle, carrier or diluent, by a method selected from the group consisting of orally, parenterally, transmucosally (e.g., sublingually or via buccal administration), topically, transdermally, rectally, via inhalation (e.g., nasal or deep lung inhalation).
  • Parenteral administration includes, but is not limited to intravenous, intraarterial, intraperitoneal, subcutaneous, intradermal, intramuscular, intrathecal or via a high pressure technique.
  • One embodiment of the invention relates to a method of treating psychiatric disorders; particularly, cognitive dysfuntion in schizophrenia, cognitive impairment disorders in psychotic disorders in a subject in need thereof using the kit as described above.
  • One embodiment of the invention relates to the use of the combination comprising (a) a first therapeutic agent, which is an antipsychotic agent and (b) a second therapeutic agent, which is 3-(5-chloro-2-furoyl)-3,7-diazabicyclo[3.3.0]octane, or pharmaceutically acceptable salts thereof, for the manufacturing of a medicament for use simultaneously, sequentially or separately, in therapy.
  • a first therapeutic agent which is an antipsychotic agent
  • a second therapeutic agent which is 3-(5-chloro-2-furoyl)-3,7-diazabicyclo[3.3.0]octane, or pharmaceutically acceptable salts thereof
  • Another embodiment of the invention relates to the use of the combination comprising (a) a first therapeutic agent, which is an antipsychotic agent and (b) a second therapeutic agent, which is 3-(5-chloro-2-furoyl)-3,7- diazabicyclo[3.3.0]octane, or pharmaceutically acceptable salts thereof, for the manufacturing of a medicament for use simultaneously, sequentially or separately, for the treatment of psychiatric disorders; particularly, cognitive impairment disorders in psychotic disorders.
  • a first therapeutic agent which is an antipsychotic agent
  • a second therapeutic agent which is 3-(5-chloro-2-furoyl)-3,7- diazabicyclo[3.3.0]octane, or pharmaceutically acceptable salts thereof
  • the first therapeutic agent (a) is a typical antipsychotic agent, including but not limited to the group of compounds selected from chlorpromazine, haloperidol, flupenthixol and perphenazine.
  • the first therapeutic agent (a) comprises an atypical antipsychotic agent, including but not limited to compounds selected from clozapine, risperidone, olanzapine, quetiapine, aripiprazole, ziprasidone, amisulpride, sulpride, zotepine, sertindole, paliperidone, bifeprunox and asenapine, metabolites or prodrugs and pharmaceutically acceptable salts, solvates or solvated salts thereof.
  • an atypical antipsychotic agent including but not limited to compounds selected from clozapine, risperidone, olanzapine, quetiapine, aripiprazole, ziprasidone, amisulpride, sulpride, zotepine, sertindole, paliperidone, bifeprunox and asenapine, metabolites or prodrugs and pharmaceutically acceptable salts, solv
  • One embodiment relates to a method and uses for treating cognitive impairment and/or psychotic disorder in a subject in need thereof comprising administering simultaneously, sequentially or separately, to said subject a therapeutically effective amount of (a) a first therapeutic agent, which is quetiapine, metabolites, prodrugs or pharmaceutically acceptable salts, solvates or solvated salts thereof and (b) a second therapeutic agent, which is 3-(5-chloro-2-furoyl)-3,7- diazabicyclo[3.3.0]octane, or pharmaceutically acceptable salts thereof.
  • a first therapeutic agent which is quetiapine, metabolites, prodrugs or pharmaceutically acceptable salts, solvates or solvated salts thereof
  • a second therapeutic agent which is 3-(5-chloro-2-furoyl)-3,7- diazabicyclo[3.3.0]octane, or pharmaceutically acceptable salts thereof.
  • the invention further relates to methods and uses for the treatment of Neurodegenerative Disorder(s) including, but are not limited to Alzheimer's Disease (AD), Dementia, Cognitive Deficit in Schizophrenia (CDS), cognitive dysfuntion in schizophrenia, Mild Cognitive Impairment (MCI), Age-Associated Memory Impairment (AAMI), Age-Related Cognitive Decline (ARCD), Cognitive
  • AD Alzheimer's Disease
  • CDS Cognitive Deficit in Schizophrenia
  • cognitive dysfuntion in schizophrenia Mild Cognitive Impairment
  • MCI Mild Cognitive Impairment
  • AAMI Age-Associated Memory Impairment
  • ARCD Age-Related Cognitive Decline
  • Impairement No Dementia CIND
  • MS Multiple Sclerosis
  • PD Parkinson's Disease
  • postencephalitic parkinsonism parkinsonism-dementia of Gaum
  • head trauma Huntington's Disease
  • ALS Amyotrophic Lateral Sclerosis
  • MND motor neuron diseases
  • MSA Multiple System Atrophy
  • GSS Guillain-Barre Syndrome
  • CIDP Inflammatory Demyelinating Polyneuropathy
  • Dementia includes, but is not limited to, Down syndrome, vascular dementia, dementia with Lewy bodies, HIV dementia, Fronto temporal dementia Parkinson's Type (FTDP), Pick's Disease, Niemann-Pick's Disease, traumatic brain injury (TBI), dementia pugilistica, Creutzfeld- Jacob Disease and prion diseases. Described combinations are contemplated to provide symptomatic relief of psychiatric disorders, for example, including but not limited to Major Depressive Disorder and Generalized Anxiety Disorder.
  • the invention further relates to methods for the treatment of Neuro inflammatory Disorder(s) including but not limited to Multiple Sclerosis (MS), Parkinson's disease, Multiple System Atrophy (MSA), Corticobasal Degeneration, Progressive Supranuclear Paresis, Guillain-Barre Syndrome (GBS), chronic inflammatory demyelinating polyneuropathy (CIDP).
  • MS Multiple sclerosis
  • RRMS Relapse Remitting Multiple Sclerosis
  • SPMS Secondary Progressive Multiple Sclerosis
  • PPMS Primary Progressive Multiple Sclerosis
  • the invention further relates to methods for the treatment of addictions such as nicotine addiction.
  • the invention further relates to methods for the treatment of CNS disorder including, but are not limited to Attention-Deficit and Disruptive Behavior Disorder(s) including but not limited to attention deficit disorder (ADD), attention deficit hyperactivity disorder (ADHD) and affective disorders.
  • CNS disorder including, but are not limited to Attention-Deficit and Disruptive Behavior Disorder(s) including but not limited to attention deficit disorder (ADD), attention deficit hyperactivity disorder (ADHD) and affective disorders.
  • ADD attention deficit disorder
  • ADHD attention deficit hyperactivity disorder
  • One embodiment of the invention relates to a method for treating CNS disorders wherein the cognitive disorder is dementia, dementia in Alzheimer's Disease, Cognitive Deficit in Schizophrenia (CDS), Mild Cognitive Impairment (MCI), Age-Associated Memory Impairment (AAMI), Age-Related Cognitive Decline (ARCD) or Cognitive Impairment No Dementia (CIND).
  • the cognitive disorder is dementia, dementia in Alzheimer's Disease, Cognitive Deficit in Schizophrenia (CDS), Mild Cognitive Impairment (MCI), Age-Associated Memory Impairment (AAMI), Age-Related Cognitive Decline (ARCD) or Cognitive Impairment No Dementia (CIND).
  • Another embodiment of the invention relates to a method for treating CNS disorders, wherein the disease is Cognitive Dysfunction in Schizophrenia.
  • CNS disorders wherein the disease is Cognitive Dysfunction in Schizophrenia.
  • Many of the above conditions and disorders are defined for example in the American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, Washington, DC, American Psychiatric Association, 2000. This Manual may also be referred to for greater detail on the symptoms and diagnostic features associated with substance use, abuse and dependence.
  • agent means the compounds comprised in the combination of the present invention, i.e. an antipsychotic or an ⁇ 4 ⁇ 2-neuronal nicotinic receptor agonist.
  • an "agonist” is a substance that stimulates its binding partner, typically a receptor. Stimulation is defined in the context of the particular assay, or may be apparent in the literature from a discussion herein that makes a comparison to a factor or substance that is accepted as an "agonist” or an “antagonist” of the particular binding partner under substantially similar circumstances as appreciated by those of skill in the art. Stimulation may be defined with respect to an increase in a particular effect or function that is induced by interaction of the agonist or partial agonist with a binding partner and can include allosteric effects.
  • a "partial agonist” is a substance that provides a level of stimulation to its binding partner that is intermediate between that of a full or complete antagonist and an agonist defined by any accepted standard for agonist activity. It will be recognized that stimulation, and hence, inhibition is defined intrinsically for any substance or category of substances to be defined as agonists, antagonists, or partial agonists. "Cognitive impairment” includes but is not limited to an acquired deficit in one or more of memory function, problem solving, orientation and abstraction.
  • Cognitive function testing may fall into the categories of attention related tasks such as simple reaction time, choice reaction time, and digit vigilance; categories of working memory such as numeric working memory and spatial working memory; categories of secondary episodic recognition memory testing, such as word recognition, picture recognition, immediate word recall, and delayed word recall; as well as other tasks such as visual tracking.
  • Other examples of standard tests for measuring cognitive impairment may include but are not limited to, the Mini Mental State Examination, the Global Deterioration Scale and Geriatric Depression Scale, the Randt Memory Test and the Alzheimer's Disease Assessment Scale.
  • “Dementia” refers to global deterioration of intellectual functioning in clear consciousness, and is characterized by one or more symptoms of disorientation, impaired memory, impaired judgment, and/or impaired intellect.
  • Cognitive impairments caused by traumatic brain injury refers to cognitive impairments, as defined herein, that are associated with or caused by traumatic brain injuries, and other traumas to the head, such as, for example, traumas caused by accidents and/or sports injuries, including dementia pugilistica, which is severe brain damage caused by repeated blows to the head (e.g., from boxing).
  • “Dementia pugilistica” is a chronic and progressive clinical syndrome characterized by neurological evidence of damage to pyramidal, extrapyramidal, and cerebellar systems with associated psychosis, dementia, personality change and impaired social functioning and/or prominent signs/symptoms of Parkinsonism (e.g., tremors, dysarthria, rigidity, bradykinesia, other extrapyramidal signs).
  • Associated physical symptoms may include inflammation-related aspects commonly associated with schizophrenia and may include conditions associated with elevated levels of inflammatory cytokines thought to modulate the symptomatology of schizophrenia, over-activation of the immune system by increases in the level of circulating monocytes or increased levels of Interleukin-6 (IL-6), necrotizing colitis, inflammation, edema and hemorrhage.
  • IL-6 Interleukin-6
  • terapéuticaally-effective amount refers to a sufficient amount of the compound to treat CNS disorders or conditions at a reasonable risk/benefit ratio applicable to any medical treatment.
  • treating refers to reversing, alleviating, inhibiting the progress of, or preventing the disorder or condition to which such term applies, or one or more symptoms of such disorder or condition.
  • treatment refers to the act of “treating” as defined herein.
  • disorder unless stated otherwise, has the same meaning as the terms “condition” and “disease” and are used interchangeably throughout the description and claims.
  • “Synergy” means an improved effect of the two agents in the combination, which is greater than the effect of the two agents together.
  • the effective dose of an antipsychotic and an ⁇ 4 ⁇ 2 -neuronal nicotinic receptor agonist in the combinations according to the present invention may vary, depending upon factors such as the condition of the patient, the severity of the symptoms of the disorder as well as the potency of the selected specific compound, the mode of administration, the age and weight of the patient, and the like. Determining a dose is within the skill of the ordinary artisan.
  • the daily dose of the combination contains from about 1 mg to about 1200 mg.
  • each dose of the first component contains about 25 mg to about 1000 mg of the quetiapine, and even more preferably, each dose contains from about 150 mg to about 800 mg or 300 mg to about 800 mg or 400 mg to about 800 mg of quetiapine.
  • the first component contains about 150-300 or 300-600 mg of the quetiapine.
  • Pediatric dosages may be less such as for example in the range of about 0.5 mg to about 40 mg daily.
  • Preferred dosages 400-800; 400-600; 150-300; 50; These dosages may be administered in one, two or more oral doses, for example: quetiapine: from about 1.0 to about 40 mg given once daily or in divided doses.
  • quetiapine from about 1.0 to about 40 mg given once daily or in divided doses.
  • One embodiment relates to the methods as descibed above wherein the quetiapine or pharmaceutically acceptable salt thereof is administered at a dosage of between about 5 mg to about 800 mg daily.
  • Another embodiment relates to the methods as descibed above wherein the quetiapine or pharmaceutically acceptable salt thereof is administered at a dosage of between about 10 mg to about 600 mg daily.
  • a further embodiment relates to the methods as descibed above wherein the quetiapine or pharmaceutically acceptable salt thereof is administered at a dosage of between about 25 mg to about 300 mg daily.
  • One embodiment relates to the methods as descibed above wherein the quetiapine or pharmaceutically acceptable salt thereof is administered at a dosage of between about 400 mg to about 800 mg daily.
  • Another embodiment of the invention relates to the methods as descibed above wherein the quetiapine or quetiapine salt is administered at a dosage of between about 150 mg to about 300 mg daily.
  • the effective dose of neuronal nicotinic receptor agonists generally requires administering the compound in an amount of less than 5 mg/kg of patient weight.
  • the neuronal nicotinic receptor agonists are administered in an amount from less than about 1 mg/kg patent weight to less than about 100 ⁇ g/kg of patient weight, and occasionally between about 10 ⁇ g/kg to less than 100 ⁇ g/kg of patient weight.
  • the foregoing effective doses typically represent that amount administered as a single dose, or as one or more doses administered over a 24 hours period.
  • the effective dose of the neuronal nicotinic receptor agonists generally requires administering the neuronal nicotinic receptor agonist in an amount of at least about 1, often at least about 10, and frequently at least about 25 mg/ 24 hours/ patient.
  • the effective dose of the neuronal nicotinic receptor agonists requires administering the neuronal nicotinic receptor agonist which generally does not exceed about 500, often does not exceed about 400, and frequently does not exceed about 300 mg/ 24 hours/ patient.
  • the amount of neuronal nicotinic receptor agonists may be between 0.25 and 5 mg/24 hours/patient.
  • administering is such that the concentration of the neuronal nicotinic receptor agonist within the plasma of the patient normally does not exceed 500 ng/mL, and frequently does not exceed 100 ng/mL.
  • One embodiment relates to a method for treating cognitive impairment and/or psychotic disorder, a method for improving the antipsychotic effect of quetiapine in reducing amphetamine-induced locomotor activity or a method of reducing sedative side effects of quetiapine whereby the dose of 3-(5-chloro-2-furoyl)-3,7- diazabicyclo[3.3.0]octane is between 0.001 and 0.5 mg/kg.
  • One embodiment relates to a method for treating cognitive impairment and/or psychotic disorder, a method for improving the antipsychotic effect of quetiapine in reducing amphetamine-induced locomotor activity or a method of reducing sedative side effects of quetiapine whereby the dose of 3-(5-chloro-2-furoyl)-3,7- diazabicyclo[3.3.0]octane is between 0.01 and 0.3 mg/kg.
  • a further embodiment relates to a method of inhibiting acoustic startle or a method of enhancing quetiapine-mediated reduction of phencyclidine-induced disruption of prepulse inhibition, whereby the dose of quetiapine is between 1 and 25 mg/kg.
  • Yet another embodiment relates to a method of inhibiting acoustic startle or a method of enhancing quetiapine-mediated reduction of phencyclidine-induced disruption of prepulse inhibition, whereby the dose of quetiapine is between 5 and 20 mg/kg.
  • a pharmaceutical composition is prepared by combining quetiapine with a neuronal nicotinic receptor agonist in a pharmaceutically acceptable carrier.
  • the composition contains respective amounts of quetiapine and the neuronal nicotinic receptor agonist to deliver on a daily basis a therapeutically-effective amount of each ingredient.
  • the composition is administered to a patient for the treatment of cognitive impairment in association with schizophrenia on a daily, twice daily, three times daily, or four times daily basis.
  • a pharmaceutical composition is prepared by combining quetiapine with 3-(5- chloro-2-furoyl)-3,7-diazabicyclo[3.3.0]octane in a pharmaceutically acceptable carrier.
  • the composition contains respective amounts of quetiapine and 3-(5- chloro-2-furoyl)-3,7-diazabicyclo[3.3.0]octane to deliver on a daily basis a therapeutically-effective amount of each ingredient.
  • the composition is administered to a patient for the treatment of cognitive impairment in association with schizophrenia on a daily, twice daily, three times daily, or four times daily basis.
  • Interaction design Interactive effects of drug combinations are tested by co- administering varying doses of the neuronal nicotinic receptor agonist with the atypical antipsychotic drug and then conducting various biological tests (e.g. antipsychotic tests) to determine the existence of interactions (positive or negative).
  • the dose range used for combination studies includes doses of the neuronal nicotinic receptor agonist known to be active in cognitive-enhancement tests (when tested alone) as well as doses below the threshold for cognitive activity (subthreshold doses).
  • the dose range includes doses in which the antipsychotic alone is active as well as sub-threshold doses.
  • Quetiapine is known to have sedative properties in humans. Quetiapine can induce sedation in rats and is manifested in various behaviors including reductions in spontaneous locomotor activitry (sLMA). A test compound that increases sLMA in quetiapine treated rats may reduce quetiapine-induced sedation in human subjects.
  • sLMA spontaneous locomotor activitry
  • LMA locomotor activity
  • Amphetamine can induce psychotic reactions in humans, typically after relatively high doses or chronic use. Amphetamine can worsen the symptoms of schizophrenia.
  • Antipsychotic drugs are well known to block many of the effects of amphetamine in experimental animals and humans.
  • D-amphetamine-induced LMA test established antipsychotic drugs have been extensively shown to block D- amphetamine-induced increases in LMA (as manifested in various behaviors including locomotor activity).
  • a test compound that enhances the effect of a known antipsychotic drug in this model would support the hypothesis that the test compound may enhance antipsychotic effects of the known antipsychotic drug in human patients.
  • Haloperidol-induced catalepsy model of EPS Haloperidol is a typical or first- generation antipsychotic drug that while effective is prone to produce extrapyramidal symptoms (EPS) in humans.
  • Other antipsychotic drugs e.g. chlorpromazine, risperidone
  • drug-induced catalepsy a trance-like state of waxy immobility
  • Haloperidol reliably induces catalepsy in mice and rats. Test compounds that reduce catalepsy in haloperidol-treated rats may reduce antipsychotic drug-induced EPS.

Landscapes

  • Health & Medical Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Pharmacology & Pharmacy (AREA)
  • General Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Chemical & Material Sciences (AREA)
  • Medicinal Chemistry (AREA)
  • Epidemiology (AREA)
  • Engineering & Computer Science (AREA)
  • Bioinformatics & Cheminformatics (AREA)
  • Neurosurgery (AREA)
  • Biomedical Technology (AREA)
  • General Chemical & Material Sciences (AREA)
  • Neurology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Psychiatry (AREA)
  • Organic Chemistry (AREA)
  • Chemical Kinetics & Catalysis (AREA)
  • Medicines That Contain Protein Lipid Enzymes And Other Medicines (AREA)
  • Pharmaceuticals Containing Other Organic And Inorganic Compounds (AREA)

Abstract

The present invention relates to a combination of (a) an antipsychotic and (b) an alpha4/beta2 (α4β2)-neuronal nicotinic receptor agonist, which is 3-(5-chloro-2-furoyl)-3,7-diazabicyclo[3.3.0]octane. The invention further relates to pharmaceutical compositions comprising said combination and to the use of the combination in therapy. The invention further relates to a kit comprising the combination and use of said kit in therapy.

Description

THERAPEUTIC COMBINATIONS OF (A) AN ANTIPSYCHOTIC AND (B) AN ALPHA-4/BETA-2 (A4B2)-NEURONAL NICOTINIC RECEPTOR AGONIST
FIELD OF THE INVENTION
The present invention relates to a combination of (a) an antipsychotic and (b) an alpha-4/beta-2 (α4β2)-neuronal nicotinic receptor agonist. The invention further relates to pharmaceutical compositions comprising said combination and to the use of the combination in therapy. The invention further relates to a kit comprising the combination and use of said kit in therapy.
BACKGROUND OF THE INVENTION
Exemplary conventional, or "typical" antipsychotics may include but are not limited to chlorpromazine, haloperidol, flupenthixol and perphenazine. Atypical antipsychotics offer several clinical benefits over the conventional antipsychotics. The distinct advantages over traditional antipsychotic medications include greater improvement in negative symptoms, such as social withdrawal, and lower risk of Parkinsonian side effects and tardive dyskinesia. Examples of atypical antipsychotics include but are not limited to clozapine, risperidone, olanzapine, quetiapine, aripiprazole, ziprasidone, amisulpride, sulpride, zotepine, sertindole, paliperidone, bifeprunox and asenapine. Quetiapine, the international nonproprietary name for 11-[4-[2-(2- hydroxyethoxy)ethyl]-l-piperazinyl]dibenzo[b,fj[l,4]thiazepine, is an atypical antipsychotic and is currently on the market as Seroquel® for 1) treatment of schizophrenia, 2) adjunctive therapy with mood stabilizers (litium or divalproex) in the treatment of acute manic episodes associated with bipolar I disorders, 3 monotherapy in the treatment of acute manic episodes associated with bipolar I disorder, and 4) treatment of major depressive episodes associated with bipolar disorder. Quetiapine and its pharmaceutically acceptable salts are described in U.S. Patent Number 4,879,288, which is incorporated herein by reference. A preparation of these compounds is also described in said US patent.
Cognitive dysfunction has been identified an integral feature of depression and schizophrenia (Psychol Med. 24:829 (1994); Am. J. Psychiatry 161 :25 (2004)).
Significant deficits have been found in a range of neuropsychological measures covering aspects of language function, memory, both recall and recognition, attention and behavioral regulation.
The neuronal nicotinic receptor agonists of the present invention are those compounds having agonist or partial agonist activity against the alpha-4/beta-2, or α4/β2, receptor (α4β2-neuronal nicotinic receptor agonist). Particular neuronal nicotinic receptor agonists useful in the combination of the present invention are those described in US application 60/856,079 and PCT/US07/83330, which are hereby incorporated by reference. Particular neuronal nicotinic receptor agonists are compounds 3-(5-chloro-2-furoyl)-3,7-diazabicyclo[3.3.0]octane, also known as N- (5-chlorofuran-2-ylcarbonyl)-3,7-diazabicyclo[3.3.0]octane, metabolites or prodrugs and pharmaceutically acceptable salts, solvates or solvated salts or co- crystals of any of the foregoing. The preparation of this compound is described in said US patent. These compounds modulate nicotinic receptors in the patient's brain. As such, the compounds have the ability to express nicotinic pharmacology, and in particular, to act as neuronal nicotinic receptor agonists. The α4β2 -neuronal nicotinic receptor agonists can be used to treat those types of conditions and disorders for which other types of nicotinic compounds have been proposed as therapeutics. The neuronal nicotinic receptor agonists are useful in the treatment of a variety of CNS disorders, including but not limited to neurodegenerative disorders, neuropsychiatric disorders, neurologic disorders, addictions, disorders attributed to or associated with neurotransmitter system dysfunction, CNS disorders attributed to a cholinergic deficiency, a dopaminergic deficiency, an adrenergic deficiency and/or a serotonergic deficiency. In one embodiment, the present invention relates to the combination of (a) a first therapeutic agent, which is an antipsychotic agent and (b) a second therapeutic agent, which is 3-(5-chloro-2-furoyl)-3,7-diazabicyclo[3.3.0]octane, particularly, the synergistic combination of (a) and (b). The combinations described herein are contemplated to provide synergistic or additive effects in treating psychiatric disorders; particularly, cognitive impairment disorders in psychotic disorders. Described combinations are contemplated to provide symptomatic relief of psychiatric disorders; particularly, cognitive impairment disorders in psychotic disorders. Compositions and methods described herein are contemplated to offer advantages over previous methods for treating neuropsychiatric disorders. The method of treatment described herein is contemplated to enhance the effect of the agents when taken in combination and therefore, in one aspect, permit reduced quantities of these agents to be used and, therefore, permit improved management of cognitive impairment, disease symptoms and disease-related side effects.
In one embodiment, combinations are contemplated to result in reduction of drug- induced extrapyramidal symptoms (EPS) where applicable, e.g., typical antipsychotic treatment. Further the combinations are contemplated to elicit fewer side effects. Some have suggested that neuronal nicotinic agonists either worsen or have no effect on haloperidol-induced catalepsy (Sanberg, P., et al., Pharm. Biochem. Behav. 46: 303-307, (1993), and Levin, E., et al., Drug Devel. Res., 47:90-96 (1999)). However, the present invention comptemplates that the combinations disclosed herein reduce the haloperidol-induced catalepsy. The described combinations are also contemplated to complement sedatives and mood stabilizers such as lithium, as well as prophylactically address progression of psychotic conditions and/or decline of cognitive function in psychotic conditions. A further advantage of this effect may be a quicker onset of the therapeutic effect than that of the single compounds. Other features and advantages will be apparent from the following detailed description and from the claims. DETAILED DESCRIPTION OF THE INVENTION
Combination A first aspect of the invention relates to a combination comprising (a) a first therapeutic agent, which is an antipsychotic agent and (b) a second therapeutic agent, which is 3-(5-chloro-2-furoyl)-3,7-diazabicyclo[3.3.0]octane. In one embodiment of the invention the combination comprises the group of compounds (a) and (b) as defined below.
One embodiment relates to a combination wherein the antipsychotic agent (a) is an atypical antipsychotic agent.
In further embodiments of the invention the first therapeutic agent (a) comprises a typical antipsychotic agent, including but not limited to compounds selected from chlorpromazine, haloperidol, flupenthixol and perphenazine.
In further embodiments of the invention the first therapeutic agent (a) comprises an atypical antipsychotic agent, including but not limited to compounds selected from clozapine, risperidone, olanzapine, quetiapine, aripiprazole, ziprasidone, amisulpride, sulpride, zotepine, sertindole, paliperidone, bifeprunox and asenapine, metabolites, prodrugs and pharmaceutically acceptable salts, solvates or solvated salts thereof.
In another embodiment of the invention the first therapeutic agent (a) is selected from quetiapine, metabolites, prodrugs, and pharmaceutically acceptable salts, solvates or solvated salts thereof.
In one embodiment of the invention the second therapeutic agent (b) comprises compounds which are neuronal nicotinic receptor agonists having binding action at the α4β2-nicotinic acetylcholine receptor, such as 3-(5-chloro-2-furoyl)-3,7- diazabicyclo[3.3.0]octane, metabolites or prodrugs and pharmaceutically acceptable salts, solvates or solvated salts thereof.
Another embodiment of the invention relates to a combination comprising (a) a first therapeutic agent, which is quetiapine, metabolites, prodrugs or a pharmaceutically acceptable salt, solvate or solvated salt thereof and (b) a second therapeutic agent, which is 3-(5-chloro-2-furoyl)-3,7-diazabicyclo[3.3.0]octane, or pharmaceutically acceptable salts thereof.
Pharmaceutical compositions
A second aspect of the invention relates to a pharmaceutical composition comprising a combination comprising (a) an antipsychotic and (b) 3-(5-chloro-2- furoyl)-3,7-diazabicyclo[3.3.0]octane, together with a pharmaceutically acceptable vehicle, carrier or diluent. One embodiment of the invention relates to a pharmaceutical composition comprising both agents (a) and (b). Another embodiment relates to two separate pharmaceutical compositions, one for agent (a) and one for agent (b).
One embodiment relates to a pharmaceutical composition as described above wherein the first therapeutic agent (a) is a typical antipsychotic agent, including but not limited to compounds selected from chlorpromazine, haloperidol, flupenthixol and perphenazine.
In further embodiments of the invention the first therapeutic agent (a) comprises an atypical antipsychotic agent, including but not limited to compounds selected from clozapine, risperidone, olanzapine, quetiapine, aripiprazole, ziprasidone, amisulpride, sulpride, zotepine, sertindole, paliperidone, bifeprunox and asenapine, metabolites, prodrugs and pharmaceutically acceptable salts, solvates or solvated salts thereof. A further embodiment relates to a pharmaceutical composition wherein the antipsychotic agent is selected from quetiapine, metabolites, prodrugs and pharmaceutically acceptable salts, solvates or solvated salts thereof. Another embodiment relates to a pharmaceutical composition as described above wherein the second therapeutic agent is 3-(5-chloro-2-furoyl)-3,7- diazabicyclo[3.3.0]octane, metabolites or prodrugs and pharmaceutically acceptable salts, solvates or solvated salts thereof.
One embodiment relates to a pharmaceutical composition comprising a combination comprising (a) a first therapeutic agent, which is an antipsychotic agent and (b) a second therapeutic agent, which is 3-(5-chloro-2-furoyl)-3,7- diazabicyclo[3.3.0]octane, or pharmaceutically acceptable salts thereof, together with a pharmaceutically acceptable vehicle, carrier or diluent. Another embodiment relates to a pharmaceutical composition comprising a combination comprising (a) a first therapeutic agent, which is quetiapine or a metabolite, prodrug or pharmaceutically acceptable salt, solvate or solvated salt thereof, and (b) a second therapeutic agent, which is 3-(5-chloro-2-furoyl)-3,7- diazabicyclo[3.3.0]octane, or pharmaceutically acceptable salts thereof, together with a pharmaceutically acceptable vehicle, carrier or diluent.
For use in medicine, pharmaceutically acceptable salts may be useful in the preparation of the compounds used in the combination of the invention. Suitable pharmaceutically acceptable salts of the compounds described herein include acid addition salts which may, for example, be formed by mixing a solution of the compound according to the invention with a solution of a pharmaceutically acceptable acid such as hydrochloric acid, sulfuric acid, methanesulphonic acid and fumaric acid. Furthermore, where the compounds carry an acidic moiety, suitable pharmaceutically acceptable salts thereof may include alkali metal salts, e.g. sodium or potassium salts; alkaline earth metal salts, e.g. calcium or magnesium salts; and salts formed with suitable organic ligands, e.g. quaternary ammonium salts.
The expression "pharmaceutically acceptable salts" includes both pharmaceutically acceptable acid addition salts and pharmaceutically acceptable cationic salts and also includes solvates, hydrates or solvated or hydrated salts thereof. The expression "pharmaceutically acceptable cationic salts" is intended to define but is not limited to such salts as the alkali metal salts, (e.g. sodium and potassium), alkaline earth metal salts (e.g., calcium and magnesium), aluminum salts, ammonium salts, and salts with organic amines such as benzathine (N5N'- dibenzylethylenediamine) and choline. The expression "pharmaceutically acceptable acid addition salts" is intended to define but is not limited to such salts as the hydrochloride, hydrobromide and sulfate. The pharmaceutically acceptable cationic salts containing free carboxylic acids can be readily prepared by reacting the free acid form of with an appropriate base. Typical bases are sodium hydroxide, sodium methoxide and sodium ethoxide. The pharmaceutically acceptable acid addition salts containing free amine groups can be readily prepared by reacting the free base form with the appropriate acid.
The salts of the antipsychotic compound may be prepared according to the process described in US 4,879,288 and are preferably pharmaceutically acceptable salts, but other salts may also be prepared. A preferred salt is the hemi-fumarate salt. Suitable salts for the α4β2 -neuronal nicotinic receptor agonist, may be, but are not limited to, chloride, bromide, sulfate, phosphate, and nitrate, acetate, galactarate, propionate, succinate, lactate, glycolate, malate, tartrate, citrate, maleate, fumarate, methanesulfonate, p-toluenesulfonate, and ascorbate, aspartate and glutamate.
An α4β2 -neuronal nicotinic receptor agonist such as 3-(5-chloro-2-furoyl)-3,7- diazabicyclo[3.3.0]octane, may be co-administered simultaneously or may be administered separately or sequentially in any order, or as a single pharmaceutical composition with an atypical antipsychotic such as quetiapine to produce a synergistic benefit over and above that obtained by administration of either compound alone.
The composition may be administered in a standard manner such as orally, parenterally, transmucosally (e.g., sublingually or via buccal administration), topically, transdermally, rectally, via inhalation (e.g., nasal or deep lung inhalation). Parenteral administration includes, but is not limited to intravenous, intraarterial, intraperitoneal, subcutaneous or intramuscular.
For buccal administration, the composition can be in the form of tablets or lozenges formulated in conventional manner. For example, tablets and capsules for oral administration can contain conventional excipients such as binding agents (e.g., syrup, acacia, gelatin, sorbitol, tragacanth, mucilage of starch or polyvinylpyrrolidone), fillers (e.g., lactose, sugar, microcrystalline cellulose, maize- starch, calcium phosphate or sorbitol), lubricants (e.g., magnesium stearate, stearic acid, talc, polyethylene glycol or silica), disintegrants (e.g., potato starch or sodium starch glycollate), or wetting agents (e.g., sodium lauryl sulfate). Tablets may be coated according to methods known in the art. Such compositions can also be formulated as suppositories for rectal administration, e.g., containing conventional suppository bases, such as cocoa butter or other glycerides. Compositions for inhalation typically can be provided in the form of a solution, suspension, or emulsion that can be administered as a dry powder or in the form of an aerosol using a conventional propellant, such as dichlorodifluoromethane or trichlorofluoromethane. Typical topical and transdermal formulations comprise conventional aqueous or nonaqueous vehicles, such as eye drops, creams, ointments, lotions, and pastes, or are in the form of a medicated plaster, patch, or membrane.
Additionally, compositions described herein can be formulated for parenteral administration by injection or continuous infusion. Formulations for injection can be in the form of suspensions, solutions, or emulsions in oily or aqueous vehicles, and can contain formulation agents, such as suspending, stabilizing, and/or dispersing agents. Alternatively, the active ingredient can be in powder form for constitution with a suitable vehicle (e.g., sterile, pyrogen-free water) before use. A composition in accordance with the present invention also can be formulated as a depot formulation. Such long acting formulations can be administered by implantation (e.g., subcutaneously or intramuscularly) or by intramuscular injection. Accordingly, the compounds of the invention can be formulated with suitable polymeric or hydrophobic materials (e.g., an emulsion in an acceptable oil), ion exchange resins, or as sparingly soluble derivatives (e.g., a sparingly soluble salt).
For oral administration a pharmaceutical composition can take the form of solutions, suspensions, tablets, pills, capsules, powders, and the like. Tablets containing various excipients such as sodium citrate, calcium carbonate and calcium phosphate are employed along with various disintegrants such as starch, preferably potato or tapioca starch, and certain complex silicates, together with binding agents such as polyvinylpyrrolidone, sucrose, gelatin and acacia. Additionally, lubricating agents such as magnesium stearate, sodium lauryl sulfate and talc may be used to form tablets. Solid compositions of a similar type are also employed as fillers in soft and hard- filled gelatin capsules; preferred materials in this connection also include lactose (milk sugar) as well as high molecular weight polyethylene glycols. Alternatively, the composition described herein can be incorporated into oral liquid formulations such as aqueous or oily suspensions, solutions, emulsions, syrups, or elixirs, for example. Moreover, formulations containing these compounds can be presented as a dry product for constitution with water or other suitable vehicle before use. Such liquid formulations can contain conventional additives, such as suspending agents, such as sorbitol syrup, synthetic and natural gums such as tragacanth, acacia, alginate, dextran, sodium carboxymethylcellulose, methylcellulose, polyvinyl-pyrrolidone or gelatin, glucose/sugar syrup, gelatin, hydroxyethylcellulose, hydroxypropylmethylcellulose, aluminum stearate gel, emulsifying agents, such as lecithin, sorbitan monooleate, or acacia; nonaqueous vehicles (which can include edible oils), such as almond oil, fractionated coconut oil, oily esters, propylene glycol, and ethyl alcohol; and preservatives, such as methyl or propyl p-hydroxybenzoate and sorbic acid. The liquid forms in which the compositions described herein may be incorporated for administration orally or by injection include aqueous solutions, suitably flavored syrups, aqueous or oil suspensions, and flavored emulsions with edible oils such as cottonseed oil, sesame oil, coconut oil or peanut oil, as well as elixirs and similar pharmaceutical vehicles. When aqueous suspensions and/or elixirs are desired for oral administration, the compounds described herein can be combined with various sweetening agents, flavoring agents, coloring agents, emulsifying agents and/or suspending agents, as well as such diluents as water, ethanol, propylene glycol, glycerin and various like combinations thereof. Suitable dispersing or suspending agents for aqueous suspensions include synthetic and natural gums such as tragacanth, acacia, alginate, dextran, sodium carboxymethylcellulose, methylcellulose, polyvinyl-pyrrolidone or gelatin. The combinations described herein can also be administered in a controlled release formulation (definition) such as a slow release or a fast release formulation. Such controlled release formulations of the combinations described herein may be prepared using methods well known to those skilled in the art. The method of administration will be determined by the attendant physician or other person skilled in the art after an evaluation of the patient's condition and requirements.
Kit
A third aspect of the invention relates to a kit comprising a dosage unit of a first therapeutic agent, which is an atypical antipsychotic and a dosage unit of a second therapeutic agent, which is an α4β2 -neuronal nicotinic receptor agonist, optionally with instructions for use. One embodiment relates to a kit as described above wherein the first therapeutic agent (a) is a typical antipsychotic agent, including but not limited to compounds selected from chlorpromazine, haloperidol, flupenthixol and perphenazine. In further embodiments of the invention the first therapeutic agent (a) comprises an atypical antipsychotic agent, including but not limited to compounds selected from clozapine, risperidone, olanzapine, quetiapine, aripiprazole, ziprasidone, amisulpride, sulpride, zotepine, sertindole, paliperidone, bifeprunox and asenapine, metabolites or prodrugs and pharmaceutically acceptable salts, solvates or solvated salts thereof. A further embodiment relates to a kit wherein the antipsychotic agent is quetiapine, metabolites, prodrugs or pharmaceutically acceptable salts, solvates or solvated salts thereof.
Another embodiment relates to a kit as described above wherein the second therapeutic agent is 3-(5-chloro-2-furoyl)-3,7-diazabicyclo[3.3.0]octane, or metabolites or prodrugs or pharmaceutically acceptable salts, solvates or solvated salts thereof.
One embodiment relates to a kit comprising (a) a first therapeutic agent, which is an antipsychotic agent and (b) a second therapeutic agent, which is 3-(5-chloro-2- furoyl)-3,7-diazabicyclo[3.3.0]octane, or pharmaceutically acceptable salts thereof. Yet a further embodiment relates to a kit comprising (a) a dosage unit of a first therapeutic agent, which is quetiapine, metabolites, prodrugs. or pharmaceutically acceptable salts solvates or solvated salts thereof and (b) a dosage unit of a second therapeutic agent, which is 3-(5-chloro-2-furoyl)-3,7-diazabicyclo[3.3.0]octane or pharmaceutically acceptable salts thereof, optionally with instructions for use.
Method of treatment A fourth aspect of the invention relates to the use of the combination of the present invention in therapy.
One embodiment relates to a method for treating psychiatric disorders; particularly, cognitive dysfuntion in schizophrenia, cognitive impairment disorders in psychotic disorders in a subject in need thereof comprising administering simultaneously, sequentially or separately, to said subject (a) a first therapeutic agent, which is an antipsychotic agent and (b) a second therapeutic agent, which is 3-(5-chloro-2- furoyl)-3,7-diazabicyclo[3.3.0]octane, or pharmaceutically acceptable salts thereof.
In another embodiment the psychotic disorder or condition is selected from the group consisting of schizophrenia, schizophreniform disorder, schizoaffective disorder, delusional disorder, brief psychotic disorder, treatment-resistant shared psychotic disorder, psychotic disorder due to a medical condition, and psychotic disorder not otherwise specified.
Another embodiment relates to a method for reducing sedative side effects of quetiapine in a subject in need thereof comprising administering simultaneously, sequentially or separately to said subject (a) a first therapeutic agent, which is an antipsychotic agent and (b) a second therapeutic agent, which is 3-(5-chloro-2- furoyl)-3,7-diazabicyclo[3.3.0]octane, or pharmaceutically acceptable salts thereof.
A further embodiment relates to a method for improving the antipsychotic effect of quetiapine in a subject in need thereof comprising administering simultaneously, sequentially or separately, to said subject (a) a first therapeutic agent, which is an antipsychotic agent and (b) a second therapeutic agent, which is 3-(5-chloro-2- furoyl)-3,7-diazabicyclo[3.3.0]octane, or pharmaceutically acceptable salts thereof. Another embodiment relates to a method of reducing extrapyramidal symptoms (EPS) in a subject in need thereof comprising administering simultaneously, sequentially or separately, to said subject (a) a first therapeutic agent, which is an antipsychotic agent and (b) a second therapeutic agent, which is 3-(5-chloro-2- furoyl)-3,7-diazabicyclo[3.3.0]octane, or pharmaceutically acceptable salts thereof.
One embodiment relates to a method of inhibiting acoustic startle in a subject in need thereof comprising administering simultaneously, sequentially or separately, to said subject (a) a first therapeutic agent, which is an antipsychotic agent and (b) a second therapeutic agent, which is 3-(5-chloro-2-furoyl)-3,7- diazabicyclo[3.3.0]octane, or pharmaceutically acceptable salts thereof.
Another embodiment relates to a method of enhancing quetiapine-mediated reduction of phencyclidine-induced disruption of prepulse inhibition in a subject in need thereof comprising administering simultaneously, sequentially or separately, to said subject (a) a first therapeutic agent, which is an antipsychotic agent and (b) a second therapeutic agent, which is 3-(5-chloro-2-furoyl)-3,7- diazabicyclo[3.3.0]octane, or pharmaceutically acceptable salts thereof.
A further embodiment relates to a method of increasing dopamine release in prefrontal cortex in a subject in need thereof comprising administering simultaneously, sequentially or separately, to said subject (a) a first therapeutic agent, which is an antipsychotic agent and (b) a second therapeutic agent, which is 3-(5-chloro-2-furoyl)-3,7-diazabicyclo[3.3.0]octane, or pharmaceutically acceptable salts thereof.
Yet another embodiment relates to a method of reducing haloperidol-induced catalepsy in a subject in need thereof comprising administering simultaneously, sequentially or separately, to said subject (a) a first therapeutic agent, which is haloperidol (b) a second therapeutic agent, which is 3-(5-chloro-2-furoyl)-3,7- diazabicyclo[3.3.0]octane, or pharmaceutically acceptable salts thereof. A further embodiment relates to said methods wherein, agent (a) and agent (b), are administered simultaneously, sequentially or separately, to the subject in a pharmaceutical composition additionally comprising a pharmaceutically acceptable vehicle, carrier or diluent, by a method selected from the group consisting of orally, parenterally, transmucosally (e.g., sublingually or via buccal administration), topically, transdermally, rectally, via inhalation (e.g., nasal or deep lung inhalation). Parenteral administration includes, but is not limited to intravenous, intraarterial, intraperitoneal, subcutaneous, intradermal, intramuscular, intrathecal or via a high pressure technique.
One embodiment of the invention relates to a method of treating psychiatric disorders; particularly, cognitive dysfuntion in schizophrenia, cognitive impairment disorders in psychotic disorders in a subject in need thereof using the kit as described above.
One embodiment of the invention relates to the use of the combination comprising (a) a first therapeutic agent, which is an antipsychotic agent and (b) a second therapeutic agent, which is 3-(5-chloro-2-furoyl)-3,7-diazabicyclo[3.3.0]octane, or pharmaceutically acceptable salts thereof, for the manufacturing of a medicament for use simultaneously, sequentially or separately, in therapy.
Another embodiment of the invention relates to the use of the combination comprising (a) a first therapeutic agent, which is an antipsychotic agent and (b) a second therapeutic agent, which is 3-(5-chloro-2-furoyl)-3,7- diazabicyclo[3.3.0]octane, or pharmaceutically acceptable salts thereof, for the manufacturing of a medicament for use simultaneously, sequentially or separately, for the treatment of psychiatric disorders; particularly, cognitive impairment disorders in psychotic disorders.
One embodiment relates to the methods and uses as described above wherein the first therapeutic agent (a) is a typical antipsychotic agent, including but not limited to the group of compounds selected from chlorpromazine, haloperidol, flupenthixol and perphenazine. In further embodiments of the invention the first therapeutic agent (a) comprises an atypical antipsychotic agent, including but not limited to compounds selected from clozapine, risperidone, olanzapine, quetiapine, aripiprazole, ziprasidone, amisulpride, sulpride, zotepine, sertindole, paliperidone, bifeprunox and asenapine, metabolites or prodrugs and pharmaceutically acceptable salts, solvates or solvated salts thereof.
A further embodiment relates to the methods and uses as described above wherein the antipsychotic agent (a) is an atypical antipsychotic agent. Yet a further embodiment relates to the methods and uses described above wherein the antipsychotic agent (a) is quetiapine, metabolites, prodrugs or pharmaceutically acceptable salts, solvates or solvated salts thereof.
One embodiment relates to a method and uses for treating cognitive impairment and/or psychotic disorder in a subject in need thereof comprising administering simultaneously, sequentially or separately, to said subject a therapeutically effective amount of (a) a first therapeutic agent, which is quetiapine, metabolites, prodrugs or pharmaceutically acceptable salts, solvates or solvated salts thereof and (b) a second therapeutic agent, which is 3-(5-chloro-2-furoyl)-3,7- diazabicyclo[3.3.0]octane, or pharmaceutically acceptable salts thereof.
The invention further relates to methods and uses for the treatment of Neurodegenerative Disorder(s) including, but are not limited to Alzheimer's Disease (AD), Dementia, Cognitive Deficit in Schizophrenia (CDS), cognitive dysfuntion in schizophrenia, Mild Cognitive Impairment (MCI), Age-Associated Memory Impairment (AAMI), Age-Related Cognitive Decline (ARCD), Cognitive
Impairement No Dementia (CIND), Multiple Sclerosis (MS), Parkinson's Disease (PD), postencephalitic parkinsonism, parkinsonism-dementia of Gaum, head trauma, Huntington's Disease, Amyotrophic Lateral Sclerosis (ALS), motor neuron diseases (MND), Multiple System Atrophy (MSA), Corticobasal Degeneration, Progressive Supranuclear Paresis , Guillain-Barre Syndrome (GBS), and Chronic
Inflammatory Demyelinating Polyneuropathy (CIDP). Dementia includes, but is not limited to, Down syndrome, vascular dementia, dementia with Lewy bodies, HIV dementia, Fronto temporal dementia Parkinson's Type (FTDP), Pick's Disease, Niemann-Pick's Disease, traumatic brain injury (TBI), dementia pugilistica, Creutzfeld- Jacob Disease and prion diseases. Described combinations are contemplated to provide symptomatic relief of psychiatric disorders, for example, including but not limited to Major Depressive Disorder and Generalized Anxiety Disorder.
The invention further relates to methods for the treatment of Neuro inflammatory Disorder(s) including but not limited to Multiple Sclerosis (MS), Parkinson's disease, Multiple System Atrophy (MSA), Corticobasal Degeneration, Progressive Supranuclear Paresis, Guillain-Barre Syndrome (GBS), chronic inflammatory demyelinating polyneuropathy (CIDP). Multiple sclerosis (MS) includes Relapse Remitting Multiple Sclerosis (RRMS), Secondary Progressive Multiple Sclerosis (SPMS), and Primary Progressive Multiple Sclerosis (PPMS).
The invention further relates to methods for the treatment of addictions such as nicotine addiction.
The invention further relates to methods for the treatment of CNS disorder including, but are not limited to Attention-Deficit and Disruptive Behavior Disorder(s) including but not limited to attention deficit disorder (ADD), attention deficit hyperactivity disorder (ADHD) and affective disorders.
One embodiment of the invention relates to a method for treating CNS disorders wherein the cognitive disorder is dementia, dementia in Alzheimer's Disease, Cognitive Deficit in Schizophrenia (CDS), Mild Cognitive Impairment (MCI), Age-Associated Memory Impairment (AAMI), Age-Related Cognitive Decline (ARCD) or Cognitive Impairment No Dementia (CIND).
Another embodiment of the invention relates to a method for treating CNS disorders, wherein the disease is Cognitive Dysfunction in Schizophrenia. Many of the above conditions and disorders are defined for example in the American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, Washington, DC, American Psychiatric Association, 2000. This Manual may also be referred to for greater detail on the symptoms and diagnostic features associated with substance use, abuse and dependence.
The term "agent" means the compounds comprised in the combination of the present invention, i.e. an antipsychotic or an α4β2-neuronal nicotinic receptor agonist.
As used herein, an "agonist" is a substance that stimulates its binding partner, typically a receptor. Stimulation is defined in the context of the particular assay, or may be apparent in the literature from a discussion herein that makes a comparison to a factor or substance that is accepted as an "agonist" or an "antagonist" of the particular binding partner under substantially similar circumstances as appreciated by those of skill in the art. Stimulation may be defined with respect to an increase in a particular effect or function that is induced by interaction of the agonist or partial agonist with a binding partner and can include allosteric effects. As used herein, a "partial agonist" is a substance that provides a level of stimulation to its binding partner that is intermediate between that of a full or complete antagonist and an agonist defined by any accepted standard for agonist activity. It will be recognized that stimulation, and hence, inhibition is defined intrinsically for any substance or category of substances to be defined as agonists, antagonists, or partial agonists. "Cognitive impairment" includes but is not limited to an acquired deficit in one or more of memory function, problem solving, orientation and abstraction. "Cognitive function testing" may fall into the categories of attention related tasks such as simple reaction time, choice reaction time, and digit vigilance; categories of working memory such as numeric working memory and spatial working memory; categories of secondary episodic recognition memory testing, such as word recognition, picture recognition, immediate word recall, and delayed word recall; as well as other tasks such as visual tracking. Other examples of standard tests for measuring cognitive impairment may include but are not limited to, the Mini Mental State Examination, the Global Deterioration Scale and Geriatric Depression Scale, the Randt Memory Test and the Alzheimer's Disease Assessment Scale. "Dementia" refers to global deterioration of intellectual functioning in clear consciousness, and is characterized by one or more symptoms of disorientation, impaired memory, impaired judgment, and/or impaired intellect. The symptoms of "dementia" are generally worse than, and can encompass, the symptoms of "cognitive impairment." "Cognitive impairments caused by traumatic brain injury" refers to cognitive impairments, as defined herein, that are associated with or caused by traumatic brain injuries, and other traumas to the head, such as, for example, traumas caused by accidents and/or sports injuries, including dementia pugilistica, which is severe brain damage caused by repeated blows to the head (e.g., from boxing). "Dementia pugilistica" is a chronic and progressive clinical syndrome characterized by neurological evidence of damage to pyramidal, extrapyramidal, and cerebellar systems with associated psychosis, dementia, personality change and impaired social functioning and/or prominent signs/symptoms of Parkinsonism (e.g., tremors, dysarthria, rigidity, bradykinesia, other extrapyramidal signs). "Associated physical symptoms" may include inflammation-related aspects commonly associated with schizophrenia and may include conditions associated with elevated levels of inflammatory cytokines thought to modulate the symptomatology of schizophrenia, over-activation of the immune system by increases in the level of circulating monocytes or increased levels of Interleukin-6 (IL-6), necrotizing colitis, inflammation, edema and hemorrhage. The term "therapeutically-effective amount" as used herein refers to a sufficient amount of the compound to treat CNS disorders or conditions at a reasonable risk/benefit ratio applicable to any medical treatment.
The term "treating" as used herein, refers to reversing, alleviating, inhibiting the progress of, or preventing the disorder or condition to which such term applies, or one or more symptoms of such disorder or condition. The term "treatment", as used herein, refers to the act of "treating" as defined herein. The term "disorder", unless stated otherwise, has the same meaning as the terms "condition" and "disease" and are used interchangeably throughout the description and claims.
"Synergy" means an improved effect of the two agents in the combination, which is greater than the effect of the two agents together.
Dosage
The effective dose of an antipsychotic and an α4β2 -neuronal nicotinic receptor agonist in the combinations according to the present invention may vary, depending upon factors such as the condition of the patient, the severity of the symptoms of the disorder as well as the potency of the selected specific compound, the mode of administration, the age and weight of the patient, and the like. Determining a dose is within the skill of the ordinary artisan.
Desirably, when quetiapine is selected as the antipsychotic agent, the daily dose of the combination contains from about 1 mg to about 1200 mg. Preferably, each dose of the first component contains about 25 mg to about 1000 mg of the quetiapine, and even more preferably, each dose contains from about 150 mg to about 800 mg or 300 mg to about 800 mg or 400 mg to about 800 mg of quetiapine. In another embodiment the first component contains about 150-300 or 300-600 mg of the quetiapine. Pediatric dosages may be less such as for example in the range of about 0.5 mg to about 40 mg daily. Preferred dosages: 400-800; 400-600; 150-300; 50; These dosages may be administered in one, two or more oral doses, for example: quetiapine: from about 1.0 to about 40 mg given once daily or in divided doses. One embodiment relates to the methods as descibed above wherein the quetiapine or pharmaceutically acceptable salt thereof is administered at a dosage of between about 5 mg to about 800 mg daily.
Another embodiment relates to the methods as descibed above wherein the quetiapine or pharmaceutically acceptable salt thereof is administered at a dosage of between about 10 mg to about 600 mg daily. A further embodiment relates to the methods as descibed above wherein the quetiapine or pharmaceutically acceptable salt thereof is administered at a dosage of between about 25 mg to about 300 mg daily.
One embodiment relates to the methods as descibed above wherein the quetiapine or pharmaceutically acceptable salt thereof is administered at a dosage of between about 400 mg to about 800 mg daily.
Another embodiment of the invention relates to the methods as descibed above wherein the quetiapine or quetiapine salt is administered at a dosage of between about 150 mg to about 300 mg daily.
Typically, the effective dose of neuronal nicotinic receptor agonists generally requires administering the compound in an amount of less than 5 mg/kg of patient weight. Often, the neuronal nicotinic receptor agonists are administered in an amount from less than about 1 mg/kg patent weight to less than about 100 μg/kg of patient weight, and occasionally between about 10 μg/kg to less than 100 μg/kg of patient weight. The foregoing effective doses typically represent that amount administered as a single dose, or as one or more doses administered over a 24 hours period. For human patients, the effective dose of the neuronal nicotinic receptor agonists generally requires administering the neuronal nicotinic receptor agonist in an amount of at least about 1, often at least about 10, and frequently at least about 25 mg/ 24 hours/ patient. For human patients, the effective dose of the neuronal nicotinic receptor agonists requires administering the neuronal nicotinic receptor agonist which generally does not exceed about 500, often does not exceed about 400, and frequently does not exceed about 300 mg/ 24 hours/ patient. The amount of neuronal nicotinic receptor agonists may be between 0.25 and 5 mg/24 hours/patient. In addition, administration of the effective dose is such that the concentration of the neuronal nicotinic receptor agonist within the plasma of the patient normally does not exceed 500 ng/mL, and frequently does not exceed 100 ng/mL. One embodiment relates to a method for treating cognitive impairment and/or psychotic disorder, a method for improving the antipsychotic effect of quetiapine in reducing amphetamine-induced locomotor activity or a method of reducing sedative side effects of quetiapine whereby the dose of 3-(5-chloro-2-furoyl)-3,7- diazabicyclo[3.3.0]octane is between 0.001 and 0.5 mg/kg.
One embodiment relates to a method for treating cognitive impairment and/or psychotic disorder, a method for improving the antipsychotic effect of quetiapine in reducing amphetamine-induced locomotor activity or a method of reducing sedative side effects of quetiapine whereby the dose of 3-(5-chloro-2-furoyl)-3,7- diazabicyclo[3.3.0]octane is between 0.01 and 0.3 mg/kg.
A further embodiment relates to a method of inhibiting acoustic startle or a method of enhancing quetiapine-mediated reduction of phencyclidine-induced disruption of prepulse inhibition, whereby the dose of quetiapine is between 1 and 25 mg/kg.
Yet another embodiment relates to a method of inhibiting acoustic startle or a method of enhancing quetiapine-mediated reduction of phencyclidine-induced disruption of prepulse inhibition, whereby the dose of quetiapine is between 5 and 20 mg/kg.
Examples
EXAMPLE 1 (Prophetic)
A pharmaceutical composition is prepared by combining quetiapine with a neuronal nicotinic receptor agonist in a pharmaceutically acceptable carrier. The composition contains respective amounts of quetiapine and the neuronal nicotinic receptor agonist to deliver on a daily basis a therapeutically-effective amount of each ingredient. The composition is administered to a patient for the treatment of cognitive impairment in association with schizophrenia on a daily, twice daily, three times daily, or four times daily basis.
EXAMPLE 2 (Prophetic) A pharmaceutical composition is prepared by combining quetiapine with 3-(5- chloro-2-furoyl)-3,7-diazabicyclo[3.3.0]octane in a pharmaceutically acceptable carrier. The composition contains respective amounts of quetiapine and 3-(5- chloro-2-furoyl)-3,7-diazabicyclo[3.3.0]octane to deliver on a daily basis a therapeutically-effective amount of each ingredient. The composition is administered to a patient for the treatment of cognitive impairment in association with schizophrenia on a daily, twice daily, three times daily, or four times daily basis.
EXAMPLE 3 (Prophetic)
Biological tests for assessing effects of combinations of a neuronal nicotinic receptor agonist and an antipsychotic agent.
The following examples from preclinical models are included for illustrative purposes should not be interpreted as restricting or limiting the invention in any way. A person with ordinary skill in the art will recognize related patient classes and other antipsychotic agents that could be substituted in the preclinical models provided.
Interaction design: Interactive effects of drug combinations are tested by co- administering varying doses of the neuronal nicotinic receptor agonist with the atypical antipsychotic drug and then conducting various biological tests (e.g. antipsychotic tests) to determine the existence of interactions (positive or negative). The dose range used for combination studies includes doses of the neuronal nicotinic receptor agonist known to be active in cognitive-enhancement tests (when tested alone) as well as doses below the threshold for cognitive activity (subthreshold doses). Similarly, for the antipsychotic drug, the dose range includes doses in which the antipsychotic alone is active as well as sub-threshold doses. I. Attenuation of quetiapine-induced sedation using spontaneous locomotor activity (sLMA)
Quetiapine is known to have sedative properties in humans. Quetiapine can induce sedation in rats and is manifested in various behaviors including reductions in spontaneous locomotor activitry (sLMA). A test compound that increases sLMA in quetiapine treated rats may reduce quetiapine-induced sedation in human subjects.
II. Enhancement of quetiapine blockade of amphetamine-induced increases in locomotor activity (LMA) Blockade of amphetamine-induced locomotor activity model: Amphetamine can induce psychotic reactions in humans, typically after relatively high doses or chronic use. Amphetamine can worsen the symptoms of schizophrenia. Antipsychotic drugs are well known to block many of the effects of amphetamine in experimental animals and humans. In the D-amphetamine-induced LMA test, established antipsychotic drugs have been extensively shown to block D- amphetamine-induced increases in LMA (as manifested in various behaviors including locomotor activity). A test compound that enhances the effect of a known antipsychotic drug in this model would support the hypothesis that the test compound may enhance antipsychotic effects of the known antipsychotic drug in human patients.
III. Blockade of haloperidol-induced catalepsy
Haloperidol-induced catalepsy model of EPS: Haloperidol is a typical or first- generation antipsychotic drug that while effective is prone to produce extrapyramidal symptoms (EPS) in humans. Other antipsychotic drugs (e.g. chlorpromazine, risperidone) can also cause EPS in patients and this side effect can limit the use of these drugs. In rodents, drug-induced catalepsy (a trance-like state of waxy immobility) can be used to assess the risk of EPS for antipsychotic drugs. Haloperidol reliably induces catalepsy in mice and rats. Test compounds that reduce catalepsy in haloperidol-treated rats may reduce antipsychotic drug-induced EPS.

Claims

1. A combination comprising (a) a first therapeutic agent, which is an antipsychotic agent and (b) a second therapeutic agent, which is 3-(5-chloro-2-furoyl)-3,7- diazabicyclo[3.3.0]octane or pharmaceutically acceptable salts thereof.
2. The combination according to claim 1, wherein the first therapeutic agent is quetiapine or pharmaceutically acceptable salts thereof.
3. A pharmaceutical composition comprising a combination comprising (a) a first therapeutic agent, which is an antipsychotic agent and (b) a second therapeutic agent, which is 3-(5-chloro-2-furoyl)-3,7-diazabicyclo[3.3.0]octane, or pharmaceutically acceptable salts thereof, together with a pharmaceutically acceptable vehicle, carrier or diluent.
4. The pharmaceutical composition according to claim 3, wherein the first therapeutic agent is quetiapine or pharmaceutically acceptable salts thereof.
5. A kit comprising (a) a dosage unit of a first therapeutic agent, which is, an antipsychotic agent and (b) a dosage unit of a second therapeutic agent, which is 3-
(5-chloro-2-furoyl)-3,7-diazabicyclo[3.3.0]octane, or pharmaceutically acceptable salts thereof, optionally with instructions for use.
6. The kit according to claim 5 wherein the first therapeutic agent is quetiapine or pharmaceutically acceptable salts thereof.
7. A method for treating cognitive impairment and/or psychotic disorder in a subject in need thereof comprising administering simultaneously, sequentially or separately, to said subject a therapeutically effective amount of (a) a first therapeutic agent, which is an antipsychotic agent and (b) a second therapeutic agent, which is 3-(5-chloro-2-furoyl)-3,7-diazabicyclo[3.3.0]octane, or pharmaceutically acceptable salts thereof.
8. The method according to any one of claim 7, wherein the first therapeutic agent is quetiapine or pharmaceutically acceptable salts.
9. The method according to any one of claim 7, using the kit of claim 3.
10. The method according to any one of claim 7, whereby the dose of quetiapine is between 5 and 50 mg/kg.
11. The method according to any one of claim 7, whereby the dose of 3-(5-chloro-
2-furoyl)-3,7-diazabicyclo[3.3.0]octane is between 0.001 and 0.5 mg/kg.
PCT/SE2009/050242 2008-03-10 2009-03-09 Therapeutic combinations of (a) an antipsychotic and (b) an alpha-4/beta-2 (a4b2)-neuronal nicotinic receptor agonist WO2009113950A1 (en)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US3512408P 2008-03-10 2008-03-10
US61/035,124 2008-03-10

Publications (1)

Publication Number Publication Date
WO2009113950A1 true WO2009113950A1 (en) 2009-09-17

Family

ID=41065474

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/SE2009/050242 WO2009113950A1 (en) 2008-03-10 2009-03-09 Therapeutic combinations of (a) an antipsychotic and (b) an alpha-4/beta-2 (a4b2)-neuronal nicotinic receptor agonist

Country Status (1)

Country Link
WO (1) WO2009113950A1 (en)

Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2005063296A2 (en) * 2003-12-23 2005-07-14 Pfizer Products Inc. Therapeutic combination for cognition enhancement and psychotic disorders
WO2006101745A2 (en) * 2005-03-18 2006-09-28 Abbott Laboratories Alpha7 neuronal nicotinic receptor ligand and antipsychotic compositions
WO2007017750A1 (en) * 2005-08-08 2007-02-15 Pfizer Products Inc. Benzoate salt of 4-(5-methyl-oxazolo[4,5-b]pyridin-2-yl)-1,4-diaza-bicyclo[3.2.2]nonane
WO2008034041A2 (en) * 2006-09-15 2008-03-20 Astrazeneca Ab Therapeutic combinations
WO2008057938A1 (en) * 2006-11-02 2008-05-15 Targacept, Inc. Nicotinic acetylcholine receptorsub-type selective amides of diazabicycloalkanes

Patent Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2005063296A2 (en) * 2003-12-23 2005-07-14 Pfizer Products Inc. Therapeutic combination for cognition enhancement and psychotic disorders
WO2006101745A2 (en) * 2005-03-18 2006-09-28 Abbott Laboratories Alpha7 neuronal nicotinic receptor ligand and antipsychotic compositions
WO2007017750A1 (en) * 2005-08-08 2007-02-15 Pfizer Products Inc. Benzoate salt of 4-(5-methyl-oxazolo[4,5-b]pyridin-2-yl)-1,4-diaza-bicyclo[3.2.2]nonane
WO2008034041A2 (en) * 2006-09-15 2008-03-20 Astrazeneca Ab Therapeutic combinations
WO2008057938A1 (en) * 2006-11-02 2008-05-15 Targacept, Inc. Nicotinic acetylcholine receptorsub-type selective amides of diazabicycloalkanes

Similar Documents

Publication Publication Date Title
US20080085888A1 (en) Therapeutic Combinations
WO2009017453A1 (en) New therapeutic combination of an antipsychotic and a gsk3 inhibitor 958
US9732059B2 (en) Methods of use of cyclic amide derivatives to treat schizophrenia
EP3206682B1 (en) Combinations comprising siponimod and laquinimod for the treatment of multiple sclerosis
WO2018081508A1 (en) Memantine combinations and use
US20070015763A1 (en) Treatment of psychosis associated with parkinson's disease and subcortical dementias using a combination of an atypical antipsychotic with a dopamine agonist
WO2009017455A1 (en) A new combination of (a) an alpha-4-beta-2 -neuronal nicotinic agonist and (b) a gsk3 inhibitor
EP1838310A1 (en) Combination of sabcomeline with a neuroleptic agent to treat psychotic disorders
US20220274951A1 (en) Methods of use of cyclic amide derivatives to treat schizophrenia
WO2010080757A2 (en) Combinations with an alpha-4beta-2 nicotinic agonist
US20120129834A1 (en) Serotonin receptor antagonists for use in the treatment of huntington's disease
US20090258084A1 (en) Mono and Combination Therapy with a M1/M4 Muscarinic Agonist (Sabcomeline) for Treatment of Cognitive Disorders in Schizophrenia
ZA200507439B (en) Use of carbamazepine derivatives for the treatment of agitation in dementia patients
US20090306040A1 (en) Mono and Combination Therapy of M1/M4 Agonist (Sabcomeline) for Treatment of Negative Symptoms of Schizophrenia
US20090318414A1 (en) Mono and Combination Therapy with M1/M4 Muscarinic Agonist (Sabcomeline) for Treatment of Prodromal Syndrome
EP3031458A1 (en) Use of 1-[(2-phenylcycloprop-1-yl)carbonyl]-2-[(1,3-thiazolidin-3-yl)carbonyl]perhydroindole in the treatment of schizophrenia-associated cognitive deficits
WO2012002583A1 (en) Method for treating schizophrenia and related diseases with a combination therapy
WO2009113950A1 (en) Therapeutic combinations of (a) an antipsychotic and (b) an alpha-4/beta-2 (a4b2)-neuronal nicotinic receptor agonist
EP1345610B1 (en) Quetiapine for treating of dyskinesia in non-psychotic patients
US9517254B2 (en) Treatment regimens
HU227813B1 (en) Pharmaceutical composition for the treatment of psychosis
KR19990045728A (en) 5-HT3 receptor antagonist for dyskinesia
KR20070022853A (en) Memantine as adjunctive treatment to atypical antipsychotics in schizophrenia patients

Legal Events

Date Code Title Description
121 Ep: the epo has been informed by wipo that ep was designated in this application

Ref document number: 09719381

Country of ref document: EP

Kind code of ref document: A1

WWE Wipo information: entry into national phase

Ref document number: 5837/DELNP/2010

Country of ref document: IN

WWE Wipo information: entry into national phase

Ref document number: 2010550638

Country of ref document: JP

NENP Non-entry into the national phase

Ref country code: DE

NENP Non-entry into the national phase

Ref country code: JP

122 Ep: pct application non-entry in european phase

Ref document number: 09719381

Country of ref document: EP

Kind code of ref document: A1