Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K9/00—Medicinal preparations characterised by special physical form
  • A61K9/0012—Galenical forms characterised by the site of application
  • A61K9/0048—Eye, e.g. artificial tears
• • 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
  • A61K31/41—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with two or more ring hetero atoms, at least one of which being nitrogen, e.g. tetrazole
  • A61K31/4164—1,3-Diazoles
  • A61K31/4184—1,3-Diazoles condensed with carbocyclic rings, e.g. benzimidazoles
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P27/00—Drugs for disorders of the senses
  • A61P27/02—Ophthalmic agents
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P27/00—Drugs for disorders of the senses
  • A61P27/02—Ophthalmic agents
  • A61P27/06—Antiglaucoma agents or miotics
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P43/00—Drugs for specific purposes, not provided for in groups A61P1/00-A61P41/00

Definitions

• the present invention relates to a method of lowering intraocular pressure of a patient in need thereof which comprises administering a therapeutically effective amount of a composition comprising an alpha-2 adrenergic receptor agonist to the affected eye of said patient wherein the intraocular-lowering effect on the treated eye remains less than the baseline intraocular pressure for at least eight (8) hours.
• Alpha-2 adrenergic receptor agonists play a key role in modulating aqueous humor formation and facilitating aqueous outflow; as a result these compounds lower intraocular pressure in glaucomatous patients.
• Glaucoma is a condition that can cause damage to the optic nerve and vision loss, usually due to increased pressure in the eye.
• alpha-2 adrenergic drugs prescribed for lowering intraocular pressure.
• the compound (5-bromo-quinoxalin-6-yl)-imidazolidin-2- ylidene-amine, generically known as, brimonidine tartrate , sold under the trademark ALPHAGAN ® P (available from Allergan, Inc.) is currently prescribed for long-term treatment of glaucomatous patients.
• brimonidine tartrate is effective at lowering elevated intraocular pressure, it is approved only for a 3 times per day dosing regime, effectively managing intraocular pressure in glaucomatous patients. Considering the aged glaucomatous patient population, a 3 times per day dosing frequency is far from optimal and may result in poor patient compliance.
• the other alpha-2 adrenergic drug is the compound 2,6-dichloro-N-imidazolidin-2- ylidene-benzene-1 ,4-diamine, generically known as, apraclonidine hydrochloride sold under the trademark IOPIDINE (available from Alcon Pharmaceuticals).
• apraclonidine hydrochloride sold under the trademark IOPIDINE (available from Alcon Pharmaceuticals).
• Apraclonidine hydrochloride is only approved for the short-term to control or prevent postsurgical elevations in intraocular pressure that occur in patients after argon laser trabeculoplasty, argon laser iridotomy or Nd:YAG posterior capsulotomy.
• Apraclonidine hydrochloride is known to cause side effects such as severe allergic reactions.
• Brimonidine and apraclonidine are two compounds within the 2- imidazolidinyleneamino alpha-2 agonist structural class.
• Compound 4-bromo-N-imidazolidin-2-ylidene-1 -H-benzimidazol-5-amine may be prepared according to the disclosure of U. S. Patent Number 6,495,583 B1 which is hereby incorporated by reference in its entirety. Acheampong et al. have shown in Xenobiotica, February 2007, Vol. 37(2), pages 205-220 that this compound was found in trace amounts in the urine of rats after administration of an oral dose of brimonidine tartrate.
• this compound When administered topically in normotensive rabbits, this compound lowers intraocular pressure with unexpected long duration of action, i.e. up to 8 hours or more, with no systemic side effects when compared to other alpha-2 agonists. Drugs in this class may cause fatigue and/or drowsiness in some patients. In addition, this compound shows unexpectedly long intraocular pressure lowering, when administered topically to hypertensive monkeys.
• the 2-imidazolidinyleneamino alpha-2 agonist of the present invention has sustained level of drug being maintained for a long period of time unlike brimonidine. Nevertheless, pharmacokinetic analysis demonstrate that the level of the 2- imidazolidinyleneamino alpha-2 agonist of the present invention, in the aqueous humor is readily maintained for a prolonged period of time, at least eight (8) hours after single dose administration, unlike brimonidine.
• said compound 4-bromo-N-imidazolidin-2-ylidene-1 - H-benzimidazol-5-amine has unique and unexpected properties that enable its utilization for elevated intraocular pressure in glaucomatous patients.
• the use of compound 4-bromo-N-imidazolidin-2-ylidene-1 -H-benzimidazol-5-amine shows huge benefits such as extended duration and long term managing without side effects unlike brimonidine and apraclonidine.
• This invention provides a method for lowering intraocular pressure in glaucoma by the administration of 4-bromo-N-imidazolidin-2-ylidene-1 -H-benzimidazol-5-amine or a pharmaceutically-acceptable salt thereof.
• pharmaceutically acceptable salts include therapeutically active, non-toxic base or acid salt forms, which compound 4-bromo- N-imidazolidin-2-ylidene-1 -H-benzimidazol-5-amine is able to form.
• the acid addition salt form of 4-bromo-N-imidazolidin-2-ylidene-1 -H- benzimidazol-5-amine that occurs in its free form as a base can be obtained by treating the free base with an appropriate acid such as an inorganic acid, for example hydrochloric acid, hydrobromic acid, sulfuric acid, phosphoric acid, nitric acid and the like; or an organic acid such as for example, acetic, hydroxyacetic, propanoic, lactic, pyruvic, malonic, fumaric acid, maleic acid, oxalic acid, tartaric acid, succinic acid, malic acid, ascorbic acid, benzoic acid, tannic acid, pamoic acid, citric, methylsulfonic, ethanesulfonic, benzenesulfonic, formic and the like (Handbook of Pharmaceutical Salts, P.Heinrich Stahal& Camille G. Wermuth (Eds), Verlag Helvetica Che
• 4-bromo-N-imidazolidin-2-ylidene-1 -H-benzimidazol-5-amine and its pharmaceutically-acceptable salts have extended alpha-2 adrenergic receptor agonist activity in lowering intraocular pressure and may be administered through different routes, including but not limited to topical eye drops, direct injection, application at the back of the eye or formulations that may further enhance the long duration of actions such as a slow releasing pellet, suspension, gel, or sustained delivery devices such as any suitable drug delivery system (DDS) known in the art. While topical administration is preferred, this compound may also be used in a intraocular implant as described in U.S. Published Patent Application 20050244463 which is hereby incorporated by reference.
• DDS drug delivery system
• Such biocompatible intraocular implants include 4-bromo-N-imidazolidin-2-ylidene-1 -H-benzimidazol-5-amine and a polymer associated with 4-bromo-N-imidazolidin-2-ylidene-1 -H-benzimidazol-5-amine to facilitate release thereof into an eye for an extended period of time.
• Figure 1 shows that a 1 % solution of 4-bromo-N-imidazolidin-2-ylidene-1 -H- benzimidazol-5-amine lowers intraocular pressure in rabbits with unexpected long duration of action, i.e. over 8 hours, with no obvious side effects when compared to a 0.15% solution of brimonidine.
• Figure 2 shows that a 0.2% solution of 4-bromo-N-imidazolidin-2-ylidene-1 -H- benzimidazol-5-amine lowers intraocular pressure in rabbits with unexpected long duration of action, i.e. over 6 hours, with no obvious side effects.
• Figure 3 A shows the results of a pharmacokinetic analysis demonstrating that the concentration of 4-bromo-N-imidazolidin-2-ylidene-1 -H-benzimidazol-5-amine in the aqueous humor is readily maintained for a prolonged period of time, unlike brimonidine.
• Figure 3 B shows the results of a pharmacokinetic analysis demonstrating that the concentration of 4-bromo-N-imidazolidin-2-ylidene-1 -H-benzimidazol-5-amine in the several ocular tissues is readily maintained for a prolonged period of time (> 8 hrs).
• Figure 4 shows that a 0.5% solution of 4-bromo-N-imidazolidin-2-ylidene-1 -H- benzimidazol-5-amine lowers intraocular pressure in monkeys, with unexpected long duration of action, i.e. up to 24 hours, when compared to placebo.
• a method of lowering intraocular pressure of a patient in need thereof which comprises, consists essentially of or consists of administering a therapeutically effective amount of a pharmaceutical composition comprising, consisting essentially of or consisting of a therapeutically effective amount of 4-bromo-N-imidazolidin-2-ylidene-1 -H-benzimidazol-5-amine or a salt thereof to the affected eye of said patient, as a single dose, wherein the affected eye maintains an intraocular pressure less than the baseline intraocular pressure for at least eight (8) hours and preferably at least ten (10) hours and more preferably at least twelve (12) hours, from the time of administration.
• baseline refers to the intraocular pressure measurement taken for the untreated eye.
• a method of treating a patient having elevated intraocular pressure with an alpha-2 adrenergic agonist to lower intraocular pressure wherein the improvement comprises, consists essentially of or consists of lowering the elevated intraocular pressure for a prolonged period of at least eight (8) hours and preferably at least ten (10) hours and more preferably at least twelve (12) hours, by administering to the affected eye of said patient a single dose of a composition comprising, consisting essentially of or consisting of a therapeutically effective amount of 4-bromo-N-imidazolidin-2-ylidene-1 -H- benzimidazol-5-amine.
• a method of lowering intraocular pressure of a patient in need thereof which comprises administering a therapeutically effective amount of a composition comprising 4-bromo-N- imidazolidin-2-ylidene-1 -H-benzimidazol-5-amine, to the affected eye of said patient, once or twice daily, preferably once daily, wherein the affected eye maintains an intraocular pressure less than the baseline intraocular pressure, throughout the day.
• said intraocular pressure is lowered for at least eight (8) hours subsequent to administration.
• said intraocular pressure is lowered for at least ten (10) hours subsequent to administration.
• said intraocular pressure is lowered for at least twelve (12) hours subsequent to administration.
• the composition that is used, as a single dose, to lower intraocular pressure for at least eight (8) hours and preferably at least ten (10) hours and more preferably for at least twelve (12) hours may comprise from 0.01 to 5 percent, preferably from 0.01 to 2 percent, more preferably from 0.05 to 2 percent by weight, 4-bromo-N-imidazolidin-2-ylidene-1 -H- benzimidazol-5-amine in a pharmaceutically-acceptable vehicle.
• Said composition is preferably formulated as an eye drop suitable for topical administration.
• compositions for topical administration are preferably formulated as a solution in water at a pH of 5.5 to 8.0, e.g. about 6.9. While the precise regime is left to the discretion of the clinician, it is recommended that the solution be topically applied by placing one drop in each eye one or two times, preferably once a day.
• Other ingredients which may be desirable to use in the ophthalmic preparations used in the method of the present invention include preservatives, co-solvents and viscosity building agents; bodium chloride, potassium chloride, calcium chloride dihydrate, magnesium chloride hexahydrate, boric acid and sodium borate decahydrate (as buffering agents) and purified water (Clinical Ocular Pharmacology By Jimmy D. Bartlett, Siret D. Jaanus, 2008, p 266).
• Preservatives are thus required to prevent microbial contamination during use.
• Suitable preservatives include: stabilized oxychloro complex (sold under the trademark PuriteTM), stabilized chlorine dioxide, ,benzalkonium chloride, thimerosal, chlorobutanol, methyl paraben, propyl paraben, phenylethyl alcohol, edetate disodium, sorbic acid, Onamer M, or other agents known to those skilled in the art (Review of Ophthalmology, June 2001 , Robert Noecker, MD). A common side-effect of these preservatives is burning.
• the method of the present invention offers the improvement of exposing the patient to less preservative, since the 4-bromo-N- imidazolidin-2-ylidene-1 -H-benzimidazol-5-amine containing compositions are administered only once or at most, twice a day, unlike the prior art alpha-2 adrenergic agonists which require three doses, daily, to control elevated intraocular pressure.
• the effective concentration of the preservative will range from 0.001 % to 1 %, preferably from 0.01 % to 0.5%, by weight.
• stabilized oxychloro complex Purite ®
• solubility of the components of the present compositions may be enhanced by a surfactant or other appropriate co-solvent in the composition.
• cosolvents include polysorbate 20, 60, and 80, Pluronic ® F-68, F-84 and P-103, cyclodextrin, Solutol, or other agents known to those skilled in the art.
• co-solvents are employed at a level of from 0.01 % to 2% by weight.
• Viscosity increased above that of simple aqueous solutions may be desirable to increase ocular absorption of the active compound, to decrease variability in dispensing the formulation, to decrease physical separation of components of a suspension or emulsion of the formulation and/or to otherwise improve the ophthalmic formulation.
• Such viscosity building agents include as examples polyvinyl alcohol, polyvinyl pyrrolidone, methyl cellulose, hydroxypropyl methylcellulose, hydroxyethyl cellulose, carboxymethyl cellulose, hydroxypropyl cellulose or other agents known to those skilled in the art Such agents are typically employed at a level of from 0.01 % to 2% by weight.
• compositions of the invention for topical use when indicated for treating elevated intraocular pressure associated with glaucoma.
• the free base of 4-bromo-N-imidazolidin- 2-ylidene-1 -H-benzimidazol-5-amine was dissolved in sterile distilled water, hydrochloric acid was added and the hydrochloric salt of the compound was formed in situ. The solution was titrated with sodium hydroxide until the pH of the solution reached 8.0. The final concentration of 4-bromo-N-imidazolidin-2-ylidene-1 -H- benzimidazol-5-amine is 1 % by weight.
• This example shows the intraocular pressure lowering effect of 4-bromo-N- imidazolidin-2-ylidene-1 -H-benzimidazol-5-amine containing composition, as compared to a composition comprising brimonidine.
• the free base of 4-bromo-N- imidazolidin-2-ylidene-1 -H-benzimidazol-5-amine was dissolved in sterile distilled water, hydrochloric acid was added and the hydrochloric salt of the compound was formed in situ. The solution was titrated with sodium hydroxide until the pH of the solution reached 8.0.
• the final concentration of 4-bromo-N-imidazolidin-2-ylidene-1 - H-benzimidazol-5-amine is 1 % by weight.
• the experimental animals used were normotensive Dutch-Belted male rabbits.
• a single drop (50 ⁇ ) of the drug formulation was administered topically by pipette onto the right eye (treated eye) at approximately 07:00 AM hours.
• the intraocular pressure of the rabbits (treated and untreated eyes) was measured 0 hours before and at 0.5, 1 , 2, 3, 4, 6 and 8 hours after topical eyedrop single administration.
• the intraocular pressure taken before the eye drop administration (0 hours) was used as a baseline value.
• Prior to the tonometric measurements 0.05% proparacaine (50 ⁇ ) was administered to each eye.
• Tonometric intraocular pressure measurements were obtained with a Mentor Pneumontonmeter. Additionally, all studies were masked. All animals were examined for sedation, ocular irritation, and changes in pupil diameter throughout the course of the experiments. None of these effects were observed with high dose of compound. Therefore, the lack of systemic effects is confirmed. Pharmacokinetic studies have shown that the plasma level of 4-bromo-N-imidazolidin-2-ylidene-1 -H-benzimidazol- 5-amine is low confirming the low systemic exposure of this compound. The results are reported in Figure 1 .
• the intraocular pressure of the rabbits treated with the 4-bromo-N-imidazolidin-2-ylidene-1 -H-benzimidazol-5- amine containing composition maintain the decrease in intraocular pressure for more than eight (8) hours, while the intraocular pressure of the rabbits treated with the brimonidine containing composition returns to baseline in less than six (6) hours.
• This example shows the intraocular pressure lowering effect of 4-bromo-N- imidazolidin-2-ylidene-1 -H-benzimidazol-5-amine containing composition, as compared to a composition comprising brimonidine.
• the free base of 4-bromo-N- imidazolidin-2-ylidene-1 -H-benzimidazol-5-amine was dissolved in sterile distilled water, hydrochloric acid was added and the hydrochloric salt of the compound was formed in situ. The solution was titrated with sodium hydroxide until the pH of the solution reached 8.0. The final concentration of 4-bromo-N-imidazolidin-2-ylidene-1 - H-benzimidazol-5-amine is 0.2% by weight.
• the experimental animals used were normotensive Dutch-Belted male rabbits.
• a single drop (50 ⁇ ) of the drug formulation was administered topically by pipette onto the right eye (treated eye) at approximately 07:00 AM hours.
• the intraocular pressure of the rabbits (treated and untreated eyes) was measured 0 hours before and at 2, 4 and 6 hours after topical eye drop single administration.
• the intraocular pressure taken before the eye drop administration (0 hours) was used as a baseline value.
• Prior to the tonometric measurements 0.05% proparacaine (50 ⁇ ) was administered to each eye. Tonometric intraocular pressure measurements were obtained with a Mentor Pneumontonmeter. Additionally, all studies were masked. All animals were examined for sedation, ocular irritation, and changes in pupil diameter throughout the course of the experiments. None of these effects were observed with high dose of compound. Therefore, the lack of systemic effects is confirmed.
• This example describes a pharmacokinetic analysis, which demonstrates that 4- bromo-N-imidazolidin-2-ylidene-1 -H-benzimidazol-5-amine level in the aqueous humor is readily maintained for a prolonged period of time, unlike brimonidine.
• This example describes a corneal penetration assay which shows that 4-bromo-N- imidazolidin-2-ylidene-1 -H-benzimidazol-5-amine penetrates the corneal epithelial cells poorly whereas brimonidine is a moderate penetrator.
• the compound of the present invention is expected to have a shorter duration due to poor corneal penetration. However, unexpectedly this compound showed the opposite by decreasing the intraocular pressure for an extended period of time. This particular finding showed its unique feature compared to brimonidine.
• Compound 4-bromo-N-imidazolidin-2-ylidene-1 -H-benzimidazol-5- amine has distinctive properties which allow it to control the intraocular pressure for an extended period of time in rabbits and monkeys; more importantly, the said compound in the invention has distinctive properties that allow it to control intraocular pressure (IOP) in human.
• This example shows the intraocular pressure -lowering effect of 4-bromo-N- imidazolidin-2-ylidene-1 -H-benzimidazol-5-amine containing composition of Example 1 as compared to placebo.
• the results are reported in Figure 4.
• the intraocular pressure of the monkeys treated with the 4-bromo-N-imidazolidin- 2-ylidene-1 -H-benzimidazol-5-amine containing composition maintain the decrease in intraocular pressure for up to 24 hours.

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