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Definitions

• the disclosure generally relates to the compound (R)-N-(3-(7-methyl-lH- indazol-5-yl)- 1 -(4-( 1 -methylpiperidin-4-yl)piperazin- 1 -yl)- 1 -oxopropan-2-yl)-4-(2- oxo-l,2-dihydroquinolin-3-yl)piperidine-l-carboxamide (Compound I or the compound of formula I), including pharmaceutically acceptable salts, which is a CGRP -receptor antagonist.
• the disclosure also relates to pharmaceutical compositions and methods for using the compound in the treatment of CGRP related disorders including migraine headaches, neurogenic vasodilation, neurogenic inflammation, thermal injury, circulatory shock, flushing associated with menopause, airway inflammatory diseases such as asthma, chronic obstructive pulmonary disease (COPD), and cancer.
• Calcitonin gene-related peptide CGRP
• CGRP Calcitonin gene-related peptide
• aCGRP and CGRP Two forms of the peptide are expressed (aCGRP and CGRP) which differ by one and three amino acids in rats and humans, respectively.
• the peptide is widely distributed in both the peripheral (PNS) and central nervous system (CNS), principally localized in sensory afferent and central neurons, and displays a number of biological effects, including vasodilation.
• CGRP When released from the cell, CGRP binds to specific cell surface G protein- coupled receptors and exerts its biological action predominantly by activation of intracellular adenylate cyclase (Poyner, D. R. et al, Br J Pharmacol 1992, 105, 441-7; Van Valen, F. et al, Neurosci Lett 1990, 1 19, 195-8.).
• Two classes of CGRP receptors, CGRPl and CGRP2 have been proposed based on the antagonist properties of the peptide fragment CGRP(8-37) and the ability of linear analogues of CGRP to activate CGRP2 receptors (Juaneda, C. et al. TiPS 2000, 21, 432-438).
• the CGRP1 receptor has three components: (i) a 7 transmembrane calcitonin receptor-like receptor (CRLR); (ii) the single
• transmembrane receptor activity modifying protein type one RAMP1
• RAMP1 transmembrane receptor activity modifying protein type one
• RCP intracellular receptor component protein
• RAMP 1 is required for transport of CRLR to the plasma membrane and for ligand binding to the CGRP -receptor (McLatchie, L. M. et al, Nature 1998, 393, 333-339).
• RCP is required for signal transduction (Evans B. N. et al, J Biol Chem. 2000, 275, 31438-43).
• Inhibitors at the receptor level to CGRP are postulated to be useful in pathophysiologic conditions where excessive CGRP receptor activation has occurred. Some of these include neurogenic vasodilation, neurogenic inflammation, migraine, cluster headache and other headaches, thermal injury, circulatory shock, menopausal flushing, and asthma. CGRP receptor activation has been implicated in the pathogenesis of migraine headache (Edvinsson L. CNS Drugs 2001 ; 15(10):745-53; Williamson, D. J. Microsc. Res. Tech. 2001, 53, 167-178.; Grant, A. D. Brit. J.
• Serum levels of CGRP are elevated during migraine (Goadsby PJ, et al. Ann Neurol 1990;28: 183-7) and treatment with antimigraine drugs returns CGRP levels to normal coincident with alleviation of headache (Gallai V. et al. Cephalalgia 1995; 15: 384-90).
• Migraineurs exhibit elevated basal CGRP levels compared to controls (Ashina M, et al, Pain 2000, 86(1- 2): 133-8.2000).
• Intravenous CGRP infusion produces lasting headache in migraineurs (Lassen LH, et al. Cephalalgia 2002 Feb;22(l):54-61).
• CGRP- receptor antagonists may present a novel treatment for migraine that avoids the cardiovascular liabilities of active vasoconstriction associated with non-selective 5- HT1B/1D agonists, 'triptans' (e.g., sumatriptan).
• CGRP antagonists have shown efficacy in human clinical trials. See Davis CD, Xu C. Curr Top Med Chem. 2008 8(16): 1468-79; Benemei S, Nicoletti P, Capone JG, Geppetti P. Curr Opin Pharmacol. 2009 9(1):9-14. Epub 2009 Jan 20; Ho TW, Ferrari MD, Dodick DW, Galet V, Kost J, Fan X, Leibensperger H, Froman S, Assaid C, Lines C, Koppen H, Winner PK. Lancet. 2008 372:2115. Epub 2008 Nov 25; Ho TW, Mannix LK, Fan X, Assaid C, Furtek C, Jones CJ, Lines CR, Rapoport AM; Neurology 2008 70: 1304. Epub 2007 Oct 3.
• the invention provides technical advantages, for example, the compound is novel and inhibits CGRP. Additionally, the compound provides advantages for pharmaceutical uses, for example, with regard to one or more of their mechanism of action, binding, inhibition efficacy, target selectivity, solubility, safety profiles, or bioavailability.
• CGRP receptor antagonists have been disclosed in PCT publications including WO2003/104236.
• the invention encompasses (R)-N-(3-(7-methyl-lH-indazol-5-yl)-l-(4-(l- methylpiperidin-4-yl)piperazin- 1 -yl)- 1 -oxopropan-2-yl)-4-(2-oxo- 1 ,2- dihydroquinolin-3-yl)piperidine-l-carboxamide (Compound I or the compound of formula I) and pharmaceutical compositions and methods for modulating CGRP and treating patients with medical conditions associated with aberrant levels of CGRP or CGRP receptor signaling.
• the invention includes all pharmaceutically acceptable salt forms of the compounds.
• Pharmaceutically acceptable salts are those in which the counter ions do not contribute significantly to the physiological activity or toxicity of the compounds and as such function as pharmacological equivalents. These salts can be made according to common organic techniques employing commercially available reagents. Some anionic salt forms include acetate, acistrate, besylate, bromide, chloride, citrate, fumarate, glucouronate, hydrobromide, hydrochloride, hydroiodide, iodide, lactate, maleate, mesylate, nitrate, pamoate, phosphate, succinate, sulfate, tartrate, tosylate, and xinofoate.
• Some cationic salt forms include ammonium, aluminum, benzathine, bismuth, calcium, choline, diethylamine, diethanolamine, lithium, magnesium, meglumine, 4-phenylcyclohexylamine, piperazine, potassium, sodium, tromethamine, and zinc.
• the invention is intended to include all isotopes of atoms occurring in the present compounds.
• Isotopes include those atoms having the same atomic number but different mass numbers.
• isotopes of hydrogen include deuterium and tritium.
• Isotopes of carbon include 13 C and 14 C.
• Isotopically-labeled compounds of the invention can generally be prepared by conventional techniques known to those skilled in the art or by processes analogous to those described herein, using an appropriate isotopically-labeled reagent in place of the non-labeled reagent otherwise employed. Such compounds may have a variety of potential uses, for example as standards and reagents in determining biological activity. In the case of stable isotopes, such compounds may have the potential to favorably modify biological, pharmacological, or pharmacokinetic properties.
• NaHMDS sodium bis(trimethylsilyl)amide
• DMF N,N- dimethylformamide
• MeOH for methanol
• NBS N-bromosuccinimide
• Ar for aryl
• TSA trifluoroacetic acid
• LAH lithium aluminum hydride
• Compound I can be prepared according to Scheme 1. This synthesis is 14 chemical steps and highly convergent, coupling the three major fragments in the last three steps. As such, the synthesis begins with the preparation of major fragments A (Scheme 2) and B (Scheme 3).
• fragment A begins with Horner-Emmons reaction of N-Boc- 4-piperidone with the ylide generated from trimethylphosphonoacetate to afford tert- butyl 4-(2-methoxy-2-oxoethylidene)piperidine-l-carboxylate in excellent yield (Scheme 2).
• Catalytic hydrogenation mediated by palladium on carbon reduces the unsaturated double bond.
• Treatment of tert-butyl 4-(2-methoxy-2- oxoethyl)piperidine- 1 -carboxylate with LDA generates the enolate which upon trapping with 2-nitrobenzaldehyde provides the nitro alcohol.
• Reduction of the nitro group with iron in acetic acid followed by treatment with hydrogen chloride in dioxane completes the synthesis of fragment A.
• indazole amino acid B begins with the iodination of 2,6- dimethylaniline by the action of iodine monochloride (Scheme 3). This intermediate was temporarily set aside. N-CBZ-L-serine methyl ester undergoes a one-pot methanesulfonylation/elimination reaction to afford N-CBZ-dehydroalanine methyl ester. With the iodide and dehydroalanine in hand, they are efficiently coupled using palladium (II) acetate in a Heck coupling to afford the product in 65% yield.
• II palladium
• the chiral center is installed using a catalytic asymmetric hydrogenation utilizing (-)-l,2-bis((2R,5R)-2,5- diethylphospholano)bezene(cyclooctadiene)rhodium(I) tetrafluoroborate and hydrogen (60 psi) to give the chiral amino acid in -96% ee.
• the indazole ring is then formed by the action of iso-amyl nitrite.
• the resulting indazole is highly crystalline.
• One recrystallization from acetone/hexanes affords the indazole amino acid in excellent purity and with an improved 99.8% ee.
• Indazole amino acid B can also be prepared using enzymatic resolution of the racemic amino acid or keto acid (Hanson, Ronald L.; Davis, Brian L.; Goldberg, Steven L.; Johnston, Robert M.; Parker, William L.; Tully, Thomas P.; Montana, Michael A.; Patel, Ramesh ⁇ . Process Research and Development, Bristol-Myers Squibb, New Brunswick, NJ, USA. Organic Process Research & Development (2008), 12(6), 1 119-1 129.).
• Fragments A and B are efficiently coupled using N,N'-disuccinimidyl carbonate to install the urea moiety in 78% yield (Scheme 4). Saponification of the methyl ester with lithium hydroxide gives a nearly quantitative yield of the carboxylic acid.
• TBTU ® mediated coupling of acid with l-(l-methylpiperidin-4- yl)piperazine completes the synthesis of Compound I. Flash chromatography affords the product as an amorphous powder which can be crystallized from acetone to afford Compound I as a fine white crystalline powder.
• Trimethyl phosphonoacetate (29.0 mL, 189.82 mmoles) was added dropwise to the stirred reaction mixture. After 20 min at 0°C, a solution of N-tert-butoxycarbonyl-4- piperidone (30.41 g, 152.62 mmoles) in dimethylformamide (80 mL) was added to the mixture dropwise. The reaction was stirred at room temperature for 3 h and then diluted with diethyl ether (650 mL). The mixture was washed once with water and the aqueous layer was extracted once with diethyl ether. The combined organic layers were washed 4 times with water and the aqueous phase was discarded.
• tert-butyl 4-(2-methoxy-2-oxoethyl)piperidine-l-carboxylate A solution of tert-butyl 4-(2-methoxy-2-oxoethylidene)piperidine-l-carboxylate (35.71 g, 140 mmoles) in a mixture of 1 : 1 ethyl acetate/methanol (220 mL) was carefully treated with 50% wet 10% palladium on carbon (3.3 g). The reaction vessel was charged with 55 psi of hydrogen gas and the mixture was shaken on a Parr apparatus at room temperature for 16 h. The reaction mixture was then filtered to remove the catalyst and the filtrate concentrated in vacuo.
• the resulting solid was collected by filtration and washed with ethyl acetate. It was then suspended in 5% water- isopropanol (100 mL) and the mixture was warmed to reflux and stirred for 20 min. The mixture was cooled to room temperature and stirred at room temperature for 16 h. The solid was collected by filtration, washed with isopropanol, and dried under high vacuum. The title compound was obtained as white solid in 75% yield.
• hydrochloride salt 55 g, 194 mmoles
• methyl 2-(benzyloxycarbonyl)acrylate 59.2 g, 252 mmoles
• tetrabutylammonium chloride 59.2 g, 213 mmoles
• palladium (II) acetate 4.34 g, 19.4 mmoles
• tetrahydrofuran 1.2 L, degassed by a flow of nitrogen for 30 min.
• Triethylamine (1 10 mL, 789 mmoles) was added and the resulting mixture was heated at reflux for 3 h.
• Analytical HPLC showed 99.0 % UV purity at 230 nm.
• the enantiomeric excess (ee) was determined to be >99.9% (conditions: Chiralpak AD column, 4.6 x 250 mm, 10 ⁇ ; eluent: 70% (0.05% diethylamine)/heptane/30%ethanol; @1.0 mL/min. for 45 min.
• the retention times were 18.7 min for R and 28.1 min for S).
• Aqueous Solubility Solid free base was mixed with carbonate, and ethanolamine buffers. The pH of a third sample was adjusted with HC1. The solids were mixed with the vehicles using a mixer that was enclosed within an incubator set to 25C. After equilibration, samples of the supernatant were withdrawn, diluted as appropriate, and analyzed by HPLC.
• thermodynamically stable solution Efforts to generate a crystalline free base form of Compound I that can be equilibrated in water are ongoing. The data gathered on the gelatinous phase are listed in Table 1.
• Solution State Stability The solution state stability of Compound I was evaluated as a function of temperature, pH, high intensity light (HIL), buffer concentration, and drug concentration. The experimental matrix used is shown in Table 2. Table 2: Solution State Stability Matrix
• Succinate buffer was used for all solutions.
• a photostability chamber was used in accordance with ICH guidelines (1.2 million lux hour exposure to visible light and 200 watt hour/m 2 to UV). Analyses were performed at 4, 8 and 12 weeks.
• Solution Stability The effect of Temperature.
• the effect of temperature is summarized in Table 5.
• the enhancement in degradation rate with temperature is largely due to the enhancement in hydrolysis. At the highest temperature degradation proceeded all the way to product C, but at the lower temperatures degradation stalled at product A ( Figure 2).
• Solution Stability The effect of light. The effect of light on stability is summarized in Table 6. Seven degradants were noted for samples exposed to light, three of which did not appear in samples stored under any other condition.
• Solution Stability the effect of pH.
• the effect of pH on the degradation rate summarized in Table 7.
• the enhancement in degradation rate varied inversely with pH and was dominated by an enhancement in hydrolysis.
• pH 4 degradation proceeded to hydrolysis product C, but at pH 5 and 6 degradation stalled at hydrolysis product A.
• Solution Stability the effect of buffer concentration. Higher concentrations of succinate buffer tended to produce a higher rate of hydrolysis to degradant A (Table 8). Table 8: Solution Stability and Succinate Buffer Concentration
• Solution Stability the effect of drug concentration. High drug load slowed the hydrolysis rate and limited hydrolysis to formation of degradant A (Table 9). Degradant G, which was only detected in the high concentration samples, did not markedly grow in concentration during the study and may simply be an impurity. Degradant J could only be detected at the final time point.
• SK-N-MC cell membrane homogenate serves as the receptor source.
• Human neuroblastoma SK-N-MC cells are used for in vitro assays because they endogenously express the CGRP receptor with an identical sequence to the cloned human CGRP receptor (Aiyar et al, 2001). Cells are grown at 37 °C in 5% CO 2 in medium consisting of MEM with Earle's salts and L-glutamine supplemented with 10% fetal bovine serum to reach confluence.
• the cells are harvested by rinsing twice with phosphate-buffered saline and are incubated for 5-10 minutes at 4 °C in hypotonic lysis buffer consisting of 10 mM Tris (pH 7.4) and 5 mM EDTA.
• the cells are collected and transferred to polypropylene tubes and homogenized using a polytron. Homogenates are centrifuged at 32,000 x g for 30 min. The pellets are resuspended in cold hypotonic lysis buffer with 0.1% mammalian protease inhibitor cocktail and assayed for protein concentration. The membrane homogenate is then aliquoted and stored at -80 °C until the day of assay.
• Compound I The ability of Compound I to compete for the radiolabeled ([ 125 I]CGRP, Amersham Biosciences) endogenous peptide human alpha CGRP (haCGRP) is measured using a radioligand competition assay.
• Compound I is first solubilized in and carried through serial dilutions using 100% DMSO.
• Compound is further diluted 25 fold into assay buffer (50 mM Tris-Cl pH 7.5, 5 mM MgCl 2 , 0.005% Triton X- 100) and transferred (50 ⁇ ) into 96 well assay plates.
• [ 125 I]-CGRP is diluted to 600 pM in assay buffer and a volume of 50 ⁇ is added to each well (final concentration 15 pM in assay).
• SK-N-MC membrane pellets are thawed, diluted in assay buffer with fresh 0.1% mammalian protease inhibitor cocktail, and homogenized as previously described. Five to ten ⁇ g protein per well is then added in a volume of 100 ⁇ . The assay plates are then incubated at room temperature (25 °C) for two hours. Assays are terminated by the addition of excess cold wash buffer (20 mM Tris-Cl pH 7.5, 0.1% BSA) immediately followed by filtration over glass fiber filters pre-soaked in 0.5% PEL Non-specific binding is defined with 1 ⁇ ⁇ -CGRP.
• Protein bound radioactivity is measured using a gamma scintillation counter.
• the IC5 0 is defined as the concentration of compound required to inhibit 50% of radioligand binding.
• the CGRP receptor complex is coupled to the Gs class of G proteins. Binding of CGRP to this complex leads to the production of cyclic AMP (adenosine 3'5'-cyclic monophosphate) via Gs-dependent activation of adenylate cyclase.
• cyclic AMP adenosine 3'5'-cyclic monophosphate
• Functional antagonism by Compound I is determined by measuring its ability to inhibit CGRP-stimulated formation of cyclic AMP in attached whole SK-N-MC cells.
• SK-N-MC cells are incubated at room temperature with 0.3 nM CGRP alone for 30 minutes, or pre-incubated with various concentrations of Compound I for 15 minutes before the addition of 0.3 nM CGRP and then further incubated for 30 minutes.
• the Cyclic AMP (cAMP) produced is extracted using the "Lysis Reagent” and its concentration is determined by radioimmunoassay using RPA559 cAMP SPA Direct Screening Assay Kit (Amersham Pharmacia Biotech).
• IC5 0 values are defined as the concentration of compound required to inhibit 50% of 0.3 nM CGRP- stimulated cAMP production.
• Ymax is defined as maximal percent inhibition of 0.3 nM CGRP-stimulated cAMP production.
• Compound I displays concentration-dependent inhibition of CGRP- stimulated cAMP production in attached whole SK-N-MC cells, with an IC 50 of 38.6 ⁇ 4.2 pM, and a Ymax of 95.4 ( ⁇ 1.3)%.
• the maximal (ca. 100%) inhibition observed indicates full antagonism at the CGRP receptor.
• composition in mM NaCl 130, KCl 4, KH 2 P0 4 1.2, MgS0 4 1.2, CaCl 2 1.8, Glucose 6, NaHCOs 4, HEPES 10, EDTA 0.025.
• the vessels are placed in cold Kreb's buffer (composition in mM: NaCl 1 18.4, KCl 4.7, KH 2 P04 1.2, MgS0 4 1.2, CaCl 2 1.8, Glucose 10.1, NaHC0 3 25) saturated with carbogen (5% C0 2 and 95 % oxygen).
• the vessels are cleaned of connective tissues and cut into cylindrical segments of 4-5 mm in length.
• the vessels are then mounted in tissue baths between two stainless steel hooks; one of which is fixed and the other of which is connected to a force displacement transducer.
• the vessel tension is continuously recorded using a data acquisition system (Powerlab, AD Instruments, Mountain View, CA).
• the tissue baths containing Krebs buffer and mounted vessels are controlled for temperature (37 °C) and pH (7.4) and continuously bubbled with carbogen.
• the artery segments are allowed to equilibrate for about 30-45 minutes until a stable resting tone (0.25 to 0.5 g) is achieved.
• Prior to the assay vessels are primed (conditioned) with 100 mM KC1 and subsequently washed.
• vessels are first contracted with 10 mM potassium chloride (KC1) to mimic endogenous tone, then fully dilated with 1 nM haCGRP, and finally the dilation is reversed by the cumulative addition of increasing concentrations of Compound I in half log units (allowing calculation of EC5o's).
• KC1 potassium chloride
• the effects of the drugs are expressed as % reversal of CGRP-induced dilation in each vessel.
• Data analysis is performed for each vessel individually, fitting the concentration-response data to a four parameter logistic function by non-linear regression analysis, to estimate the EC5 0 values.
• Compound I is pre-incubated with individual artery rings in the tissue bath and then a CGRP concentration-response curve is generated to achieve complete dilation (using multiple agonist and multiple antagonist doses). Higher concentrations of antagonist produce a 'right-shift' in the CGRP concentration-response curve, requiring greater concentrations of agonist to overcome the presence of antagonist and achieve full dilation.
• wire mounted artery rings are pre-incubated with antagonist, then contracted with KC1 (to mimic endogenous tone), and followed by addition of increasing concentrations of CGRP to achieve full relaxation.
• Compound I pretreatment is effective at inhibiting CGRP-induced dilation of ex vivo human intracranial arteries, and displays a parallel rightward shift of the CGRP
• Each wire mounted artery ring is pre-incubated for 30 min with a single concentration (0.1-30 nM) of the antagonist Compound I, then contracted with 10 mM KC1 (to mimic endogenous tone), followed by addition of increasing concentrations of CGRP to achieve full relaxation.
• the KC1 contraction is allowed to stabilize, such that total antagonist pretreatment time is approximately 45 min prior to application of CGRP.
• marmosets receive a series of four intravenous injections of haCGRP (at 45 min intervals). The first serves as a baseline control, and is followed by subcutaneous delivery of test article. The subsequent three CGRP challenges provide an assessment of functional CGRP antagonism in vivo. In the present study, Compound I demonstrated robust, lasting CGRP antagonism. Methods. Marmosets are anesthetized and facial blood flow is increased by intravenous (IV) administration of haCGRP at 45 min intervals (-30, 15, 60 & 105 min). The effect of test compound, delivered at 0 min, on the haCGRP-induced changes in facial blood flow is measured by laser Doppler flowmetry. Effective compounds would suppress the haCGRP-induced increase in facial blood flow seen at 15, 60 & 105 min (as compared to the baseline haCGRP effect seen at -30 min).
• Subjects Adult male and female common marmosets (Callithrix jacchus) weighing 350-650 g serve as subjects.
• Animals are anesthetized by isoflurane inhalation in an induction chamber (4-5% rapid induction, maintained with 1-2.5%; Solomon et al, 1999).
• Anesthesia is maintained by delivering a constant supply of ainoxygen (50:50) and isoflurane via intubation and ventilation (with blood gas monitoring).
• Body temperature is maintained at 38 ⁇ 0.5 °C by placement on an automated temperature controlled surface with rectal probe.
• a small area of fur (approx. 1.5 cm square) is removed from one or both sides of the face by application of a depilatory cream and/or shaving. Surgical areas are clipped and prepared with betadine.
• An IV line is placed in the saphenous vein for the administration of test compounds and the CGRP receptor agonist haCGRP. Additionally this IV line provides for withdrawal of blood samples (max 2.5 ml, 10%) for blood gas monitoring and analysis of compound plasma levels.
• a solution of 5% dextrose is administered IV in order to maintain blood sugar levels.
• Anesthesia depth is monitored by measuring blood pressure and heart rate using a non-invasive arm cuff method and a pulse oximeter, respectively. Guanethidine 5-10 mg/kg IV, supplemented with 5 mg/kg IV as needed, is given to stabilize the peak flux in facial blood flow which otherwise shows progressive reduction following repeated stimulation (Escott et al, 1995).
• Microvascular blood flow is monitored by attaching a self adhesive laser Doppler flow probe to the facial skin. The probe records the number of red blood cells crossing the path of two laser beams, multiplied by their velocity (reported as changes in flux).
• Test compounds are administered SC (0.1-0.6 ml/kg) in the nape of the neck.
• the CGRP-receptor agonist, haCGRP is delivered IV (1 ml/kg) at a dose of 10 ⁇ g/kg.
• Testing Protocol To assess in vivo efficacy and duration of action, a control increase in facial blood flow is induced by administration of haCGRP (10 ⁇ g/kg IV) 30 min prior (-0.5 hr) to drug delivery.
• Compound I is then administered at time zero (0 min) and repeat haCGRP are delivered at 45 min intervals for ⁇ 2 hr (data collected at 0.25, 1 and 1.75 hrs post-dose).
• Compound I is dosed at 0.003, 0.01 and 0.03 mg/kg, SC. Plasma samples are obtained just before each haCGRP administration. Following testing, animals are returned to the transport cage which is placed on a temperature controlled surface that keep the animals warm until fully awake and ambulatory. Animals may be tested again after a 14-21 day rest and washout period.
• Compound I (0.003-0.03 mg/kg, SC) shows dose-dependent inhibition of CGRP-induced increases in marmoset facial blood flow. Robust (53- 80%) inhibition is observed at 0.03 mg/kg at 0.25, 1 and 1.75 hr post-dose.
• Compound I and Compound III One-Week Comparative Intranasal Irritation Study in Rats. This study was conducted to compare potential nasal irritation of Compound I to Compound III when given intranasally to male rats for 1 week. Male rats (10/group) were instilled intranasally with Compound I or Compound III solutions (25, 75 or 175 mg/L in 225 mM succinic acid, 0.02% benzalkonium chloride, 1.25% anhydrous dextrose, pH 5.8-6.2) once daily at a dose volume of 100 ⁇ ,/ ⁇ . Using this dosing paradigm, fixed doses of 5, 15 or 35 mg of test article were delivered daily. As a consequence, dosages normalized to body weight decreased with time as the rats grew. One control group was given succinate vehicle and a sham control group was given saline by intranasal instillation. Parameters evaluated included clinical observations, body weight, food consumption, toxicokinetics, and histological evaluation of nasal tissues.
• Intranasal dosing of Compound I provided systemic exposure in rats out to 24 hrs, and little difference was observed between the first and last days of dosing in this 1-week study.
• Compound I and Compound II One- Week Exploratory Intranasal Irritation Study in Rats. Compound I and Compound II were also compared directly for intranasal irritation. Male rats (6/group) were instilled intranasally with Compound I or Compound II solutions (75 or 175 mg/L) in 225 mM succinic acid, 1.25% anhydrous dextrose, pH 5.8-6.2) once daily at a dose volumes of 12.5, 25 or 100 ⁇ . The only endpoint evaluated in this study was histological evaluation of the nasal turbinates.
• Compound I demonstrated superiority to Compound II, with respect to nasal irritation.
• CGRP antagonists intra-nasal ( ⁇ ) route of administration for CGRP antagonists is attractive as it affords non-invasive delivery with the potential for rapid onset of action.
• the highly permeable nasal epithelial barrier, well perfused mucosal tissue, and limited metabolic capacity/tissue residence time are potentially useful features that support intranasal delivery of a compound like Compound I that exhibits very poor oral absorption.
• the feasibility of nasal delivery was assessed in the IN rabbit model by comparing the plasma concentration-time profiles and pharmacokinetic parameters (Cmax, Tmax, AUC and bioavailability) for nasally delivered Compound I to that delivered by the IV route.
• the dosing solution concentration and delivery volume are included in the data tables for each study. Vehicle compositions are described in the footnotes below the table.
• the pharmacokinetic profile indicates that Compound I is rapidly absorbed from the nasal cavity of rabbits when sprayed as a solution.
• the time to reach peak concentrations (Tmax) occurs within 0.2-0.3 h (15-20 min) at all doses studied.
• the absolute bioavailability at 0.3, 1, and 3 mg/kg ranged from 13 to 30% and the Cmax ranged from 0.12 to 2.0 ⁇ (Table 14).
• Dosing concentrations were 10, 30, and 100 mg/ml in 50 mM succinate buffer vehicle, pH 5.
• the intra-nasal route of administration for Compound I provides rapid systemic absorption and relatively prolonged plasma levels compared to the oral route.
• the high aqueous solubility and improved solution stability favorably support the viability of a nasal spray product in an appropriate spray device.
• the delivery of drug solution and its deposition in the nasal cavity in humans is expected to be more robust and reproducible than that possible with preclinical IN animal models.
• Compound I formulations are projected to be delivered in reusable multi- dose or disposable unit dose nasal spray devices.
• Another aspect of the invention is a pharmaceutical composition
• a pharmaceutical composition comprising Compound I with a pharmaceutically acceptable adjuvant, carrier, or diluent.
• Compound I will generally be given as pharmaceutical composition comprised of a therapeutically effective amount of a Compound I, or a
• compositions encompass all common solid and liquid forms including capsules, tablets, losenges, and powders as well as liquid suspensions, syrups, elixers, and solutions. Solid compositions may by formed in timed or sustained released formulations. Compositions are made using common formulation techniques and conventional excipients (such as binding and wetting agents) and vehicles (such as water and alcohols).
• Solid compositions are normally formulated in dosage units providing from about 1 to about 1000 mg of the active ingredient per dose. Some examples of solid dosage units are 0.1 mg, 1 mg, 10 mg, 100 mg, 500 mg, and 1000 mg. Liquid compositions are generally in a unit dosage range of 1-100 mg/mL. Some examples of liquid dosage units are 0.1 mg/mL, 1 mg/mL, 10 mg/mL, 25 mg/mL, 50 mg/mL, and 100 mg/mL.
• the invention encompasses all conventional modes of administration including oral, parenteral, intranasal, sublingual, and transdermal methods.
• the daily dose will be 0.01-100 mg/kg body weight daily. Generally, more compound is required orally and less parenterally. The specific dosing regime, however, should be determined by a physician using sound medical judgement.
• Another aspect of the invention is intranasal administration.
• Inhibitors at the receptor level to CGRP are postulated to be useful in pathophysiologic conditions where excessive CGRP receptor activation has occurred. Some of these include neurogenic vasodilation, neurogenic inflammation, migraine, cluster headache and other headaches, thermal injury, circulatory shock, menopausal flushing, and asthma. CGRP receptor activation has been implicated in the pathogenesis of migraine headache (Edvinsson L. CNS Drugs 2001, 15(10),745-53; Williamson, D. J. Microsc. Res. Tech. 2001, 53, 167-178.; Grant, A. D. Brit. J.
• Serum levels of CGRP are elevated during migraine (Goadsby P. J. et al. Ann. Neurol. 1990, 28, 183-7) and treatment with antimigraine drugs returns CGRP levels to normal coincident with alleviation of headache (Gallai V. et al. Cephalalgia 1995, 15, 384-90).
• Migraineurs exhibit elevated basal CGRP levels compared to controls (Ashina M. et al, Pain 2000, 86(1- 2), 133-8).
• Intravenous CGRP infusion produces lasting headache in migraineurs (Lassen L.H. et al. Cephalalgia. 2002, 22(1), 54-61).
• CGRP-receptor antagonists may present a novel treatment for migraine that avoids the cardiovascular liabilities of active vasoconstriction associated with non-selective 5-HT1B/1D agonists, "triptans" (e.g., sumatriptan).
• Another aspect of the invention is a method of inhibiting the CGRP receptor comprising contacting the CGRP receptor with a compound of formula I or a pharmaceutically acceptable salt thereof.
• Another aspect of the invention is a method for treating conditions associated with aberrant levels of CGRP or CGRP receptor signaling comprising the administration of a therapeutically effective amount of a compound of formula I to a patient.
• Another aspect of the invention is the use of a compound of formula I in the manufacture of a medicament for the treatment of conditions related to aberrant levels of CGRP or CGRP receptor signaling.
• Another aspect of the invention is a method of treating migraine or headache.
• Another aspect of the invention is a method of treating neuropathic pain.
• Another aspect of the invention relates to a method of treating inflammation (particularly neurogenic inflammation), pain, thermal injury, circulatory shock, diabetes, Reynaud's syndrome, peripheral arterial insufficiency, subarachnoid/ cranial hemorrhage, tumor growth, flushing associated with menopause and other conditions the treatment of which can be effected by the antagonism of the CGRP receptor by the administration of pharmaceutical compositions comprising a compound of formula I as defined herein.
• Another aspect of the invention relates to methods selected from the group consisting of (a) immune regulation in gut mucosa (b) protective effect against cardiac anaphylactic injury (c) stimulating or preventing interleukin-lb(IL-lb)- stimulation of bone resorption (d) modulating expression of NK1 receptors in spinal neurons and (e) airway inflammatory diseases and chronic obstructive pulmonary disease including asthma.
• a) immune regulation in gut mucosa (b) protective effect against cardiac anaphylactic injury (c) stimulating or preventing interleukin-lb(IL-lb)- stimulation of bone resorption (d) modulating expression of NK1 receptors in spinal neurons and (e) airway inflammatory diseases and chronic obstructive pulmonary disease including asthma.
• Another aspect of this invention relates to a method of treatment for cancer and proliferative diseases and conditions.
• CGRP antagonists have also been proposed to show utility in the treatment of malignant disease, particularly against gliomas and breast cancer that metastasizes to the brain.
• CGRP antagonists may be especially useful against hypoxic tumors and in the prevention of metastatic implantation. See PCT application publication WO2010006168.
• Another aspect of this invention relates to a method of treatment using combinations of Formula I compounds with one or more agents selected from the group consisting of COX-2 inhibitors, NSAIDS, aspirin, acetaminophen, triptans, ergotamine and caffeine for the treatment of migraine.
• Migraine “headache,” and related terms are as understood by medical practitioners. Migraine encompasses all classes of migraine including common, classic, cluster, fulgurating, hemiplegic, opthalmoplegic, and opthomalmic.
• “Therapeutically effective” means there is a meaningful patient benefit as understood by medical practitioners.
• Patient means a person who may benefit from treatment as determined by medical practitioners. It will be evident to one skilled in the art that the present disclosure is not limited to the foregoing illustrative example, and that it can be embodied in other specific forms without departing from the essential attributes thereof. It is therefore desired that the examples be considered in all respects as illustrative and not restrictive, reference being made to the appended claims, rather than to the foregoing examples, and all changes which come within the meaning and range of equivalency of the claims are therefore intended to be embraced therein.

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