Classifications

• • 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
  • A61K31/557—Eicosanoids, e.g. leukotrienes or prostaglandins
  • A61K31/5575—Eicosanoids, e.g. leukotrienes or prostaglandins having a cyclopentane, e.g. prostaglandin E2, prostaglandin F2-alpha
• • 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
  • A61K31/60—Salicylic acid; Derivatives thereof
  • A61K31/606—Salicylic acid; Derivatives thereof having amino groups
• • 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
  • A61K9/20—Pills, tablets, discs, rods
  • A61K9/2004—Excipients; Inactive ingredients
  • A61K9/2013—Organic compounds, e.g. phospholipids, fats
• • 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
  • A61K9/20—Pills, tablets, discs, rods
  • A61K9/2004—Excipients; Inactive ingredients
  • A61K9/2013—Organic compounds, e.g. phospholipids, fats
  • A61K9/2018—Sugars, or sugar alcohols, e.g. lactose, mannitol; Derivatives thereof, e.g. polysorbates
• • 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
  • A61K9/20—Pills, tablets, discs, rods
  • A61K9/2004—Excipients; Inactive ingredients
  • A61K9/2022—Organic macromolecular compounds
  • A61K9/205—Polysaccharides, e.g. alginate, gums; Cyclodextrin
  • A61K9/2054—Cellulose; Cellulose derivatives, e.g. hydroxypropyl methylcellulose
• • 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
  • A61K9/20—Pills, tablets, discs, rods
  • A61K9/28—Dragees; Coated pills or tablets, e.g. with film or compression coating
• • 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
  • A61K9/20—Pills, tablets, discs, rods
  • A61K9/28—Dragees; Coated pills or tablets, e.g. with film or compression coating
  • A61K9/2806—Coating materials
  • A61K9/2833—Organic macromolecular compounds
  • A61K9/284—Organic macromolecular compounds obtained by reactions only involving carbon-to-carbon unsaturated bonds, e.g. polyvinyl pyrrolidone
  • A61K9/2846—Poly(meth)acrylates
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P1/00—Drugs for disorders of the alimentary tract or the digestive system
  • A61P1/04—Drugs for disorders of the alimentary tract or the digestive system for ulcers, gastritis or reflux esophagitis, e.g. antacids, inhibitors of acid secretion, mucosal protectants
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P1/00—Drugs for disorders of the alimentary tract or the digestive system
  • A61P1/10—Laxatives
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P1/00—Drugs for disorders of the alimentary tract or the digestive system
  • A61P1/12—Antidiarrhoeals
• • 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
• • C—CHEMISTRY; METALLURGY
  • C07—ORGANIC CHEMISTRY
  • C07C—ACYCLIC OR CARBOCYCLIC COMPOUNDS
  • C07C405/00—Compounds containing a five-membered ring having two side-chains in ortho position to each other, and having oxygen atoms directly attached to the ring in ortho position to one of the side-chains, one side-chain containing, not directly attached to the ring, a carbon atom having three bonds to hetero atoms with at the most one bond to halogen, and the other side-chain having oxygen atoms attached in gamma-position to the ring, e.g. prostaglandins ; Analogues or derivatives thereof

Definitions

• Mexiprostil in the treatment of inflamm atory b wel disease and/or of irritable bowel syn drome
• the present invention relates to the use of mexiprostil in the treatment and/or preven ion of inflammatory bowel disease (IBD) and of irritable bowel syndrome (IBS), to the method for treating those pathologies, to combinations of mexiprostil with other drugs, and also to a novel method for the synthesis of mexiprostil.
• IBD inflammatory bowel disease
• IBS irritable bowel syndrome
• Mexiprostil is the international non-proprietary name of (Halpha, 1 1 alpha, 15 R, I 6R) 1 1 , 15 -dihydroxy- 16-methyl- 16-methoxy-9-oxoprost- 1 -cn- 1 -oic acid methyl ester, having the following formula
• Mexiprostil is therefore a synthetic derivative of PGEl prostaglandins which has been developed for the treatment of excessive gastric secretion and for the cytoprotection of the gastric mucosa.
• IBD inflammatory bowel disease
• IBS irritable bowel syndrome
• I BD The pathogenesis of I BD is not known. It is thought that there may be a genetic predisposition but also environmental factors, viruses, bacteria, an immune component, which is perhaps why food antigens may set off an enteric inflammatory cascade.
• Ulcerative colitis typically exhibits a continuous inflammation which extends proximally from the rectum to include, in many subjects, the entire colon.
• Crohn's disease is located principally in the small intestine but may also involve the entire intestinal tract from the mouth to the anus, with granulomatous formations and discontinuous focal ulcerations and also with fistula formation.
• the drugs used are mainly 5 -ASA (or mesalazine) and its prodrugs or derivatives, such as, for example, mesalazine and its derivatives, antibiotics, corticosteroids and immunosuppressants.
• IBS irritable bowel syndrome
• IBS irritable bowel syndrome
• IBS is characterized by impairment of the intestinal function with constipation or diarrhoea, which sometimes alternate, by states of abdominal pain, by abdominal distension and by meteorism.
• the aetiology and the pathogenesis of I BS are not known, but various factors may contribute to causing its onset. Those factors often include anomalies in the regulation of the tone and activity of the smooth musculature of the intestinal wall, the effects of irritant substances of a bacterial nature and psychological and emotional influences.
• the drugs most commonly used, alone or in combination, are represented by antispastics, by antidiarrhoeals or by prokinetics. depending on the prevalence of diarrhoea or constipation, respectively, by anti-infectives, by adsorbents and by minor and major anxiolytics.
• the invention relates to the use of mexiprostil for the treatment and/or prevention of inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS).
• IBD inflammatory bowel disease
• IBS irritable bowel syndrome
• IBD ulcerative colitis
• IBS intracranial pressure syndrome
• IBS-C constipation, diarrhoea or alternating variants of I S, also known by the abbreviations IBS-C, I BS-D and IBS -A.
• mexiprostil is capable of treating and/or preventing I BD and IBS; as will be discussed comprehensively and in detail hereinafter, preclinical trials have demonstrated that mexiprostil reduces macroscopic damage to the Intestinal walls, the size of the damaged area and the laxative effect caused by the irritant agents used to induce the pathology in the animals subjected to the test. Thanks to those trials, which will be described in detail in the experimental section of the present description, it has been possible to show that mexiprostil is capable of treating IBD and IBS, reducing the damage and the lesions caused by the inflammation, and therefore bringing about actual healing of the damaged intestinal tissue. The efficacy demonstrated in the animal tests in fact shows that mexiprostil is also capable of influencing intestinal motility, being of particular use in the various forms of I BS.
• mexiprostil was tested at various doses in a model of colitis induced by acetic acid in rats. When administered topically at a dose of 10 micrograms/kg to the mucosa of the colon, mexiprostil proved to be capable of performing a powerful anti- inflammatory activity and a powerful regulatory activity in respect of intestinal motility.
• mexiprostil may be administered preferably via the oral route or, alternatively, via the rectal route.
• the oral route is in the form of capsules, tablets, granules or a powder, solution or suspension while the rectal route is preferably in the form of an enema, a suppository or a rectal foam.
• mexiprostil is administered via the oral route at doses of from 4 to 40 micrograms/kg, advantageously from 8 to 20 micrograms/kg body weight. Those quantities may of course vary in accordance with the requirements and characteristics of the subject to be treated.
• Mexiprostil for the use according to the invention may be formulated in pharmaceutical compositions for administration to mammals, including humans, for the treatment of the above-mentioned diseases, i desired or necessary in combination with pharmacologically acceptable vehicles and/or excipients.
• compositions for the use according to the invention are advantageously presented in dosage units.
• Appropriate unitary forms of administration include forms via the oral route, such as tablets, capsules, powders, granules and oral solutions or suspensions, or rectal forms, such as, for example, in the form of suppositories.
• these oral pharmaceutical compositions will be of the delayed-release type, and will preferably be gastroresistant or enterosoluble formulations, so that the active ingredient is not absorbed in the stomach but is released mainly at the site of action, in this particular case in the intestine (terminal ileum, colon).
• These pharmaceutical compositions are therefore advantageously intended for the treatment and/or prevention of IBD and IBS.
• Such formulations are known in the art and may be constituted, for example, by traditional tablets, granules or capsules surface-coated with a layer of polymer material which is insoluble in the stomach but soluble in the intestine, or also mixed with polymers which prevent them dissolving before they reach the intestine and/or the preselected section of the intestine. Any system may be employed for the use according to the invention provided it releases the mexiprostil mainly in the intestine.
• a particularly suitable formulation for the use according to the invention is, for example, the controlled-release formulation described in the patent application WOOO/76481, which is incorporated herein by reference.
• the mexiprostil-containing formulation suitable for the purpose of the invention therefore comprises:
• the lipophilic matrix is preferably constituted by compounds selected from fatty acids or unsaturated or saturated alcohols, their salts, esters or amides, mono-, di- or triglyceride fatty acids, their polyoxyethylated derivatives, waxes, ceramides, cholesterol derivatives or mixtures thereof having a melting point in the range of from 40 to 90°C, preferably from 60 to 70°C.
• Unsaturated or saturated fatty acids according to the invention may be, for example, palmitic acid, stearic acid, myristic acid. 1 auric acid, oleic acid or mixtures thereof.
• the amphiphilic matrix is preferably constituted by type I or II polar lipids, such as, for example, lecithin, phosphatidylcholine, phosphatidylethanolamine, ceramides, glycol alkyl esters, such as, for example, diethylene glycol monomethyl ether (Transcutol).
• hydrophilic matrix is preferably constituted by substances known as "hydrogels", or substances which, when they pass from the dry state to the hydrated state, by means of so-called molecular relaxation, a significant increase in mass and weight following the coordination of the large number of molecules of water from the polar groups present in the polymer chains of the hydrophilic substances.
• hydrogels according to the invention may be compounds selected from polymers or copolymers of acrylic or methacrylic acid, alkyl vinyl polymers, hydroxyalkylcelluloses (such as carboxyalkylcelluloses), polysaccharides, dextrins, pectins, amides and derivatives thereof, synthetic or natural gums, alginic acid.
• the formulation containing mexiprostil may also comprise a gastroresistant outer coating film, preferably of polymers of acrylic or methacrylic acid, copolymers of acrylic or methacrylic acid or mixtures thereof (Eudragit).
• the formulation according to the above-mentioned embodiment of the invention is therefore a multimatrix formulation having a macroscopically homogeneous structure (i.e. not stratified like a reservoir) along the entire axis of symmetry of the final form (see also WO00/76478).
• the dosage units may comprise from 0.25 to 2.5 mg of mexiprostil, advantageously from 0.5 to 1.5 mg of the said active ingredient. These dosage units may be administered one or more times per day, for example 1 or 2 times per day.
• Mexiprostil can therefore be used in the treatment and/or prevention of IBD and IBS, alone or in combination with other drugs, for example, with the drugs usually used in the therapy and/or symptomatic resolution of IBD and IBS.
• the invention comprises the use of mexiprostil in combination with one or more drugs normally used in the therapy and/or symptomatic resolution of IBD or IBS, for example in combination with 5-ASA (mesalazine) and derivatives, such as sulphasalazine and/or olsalazine, antibiotics, such as metronidazole, ciprofloxacin, rifamycin and/or corticosteroids, such as prednisolone, budesonide and/or immunosuppressants, such as, for example, 6-mercaptopurine.
• 5-ASA mealazine
• derivatives such as sulphasalazine and/or olsalazine
• antibiotics such as metronidazole, cip
• mesalazine also known as 5-ASA or 5-aminosalicylic acid.
• Another drug particularly suitable for combination with mexiprostil is budesonide.
• the invention therefore relates to mexiprostil for use in the treatment and/or prevention of IBD, in particular ulcerative colitis and Crohn's disease, and also for use in the treatment and/or prevention of IBS, in particular JBS-C and/or 1BS-D and/or IBS-A.
• the invention relates to a combination of mexiprostil and a drug selected from mesalazine and budesonide, for use in the treatment and/or prevention of IBD, in particular ulcerative colitis and Crohn's disease, and also for use in the treatment and/or prevention of IBS.
• the combination of mexiprostil and a drug selected from mesalazine and budesonide is formulated in a gastroresistant and controlled-release manner, for example as described in the patent application WOOO/76481, which is incorporated herein by reference.
• compositions comprising the active ingredient mexiprostil, optionally in combination with pharmaceutically acceptable excipients and/or vehicles, constitute a further subject of the invention.
• compositions comprising mexiprostil and mesalazine as active ingredients, optionally in combination with pharmaceutically acceptable excipients and/or vehicles, constitute a further subject of the invention.
• compositions comprising mexiprostil and budesonide as active ingredients, optionally in combination with pharmaceutically acceptable excipients and/or vehicles, constitute a further subject of the invention.
• compositions of the invention containing the active ingredient mexiprostil as the only active ingredient or in combination with mesalazine or budesonide and optional pharmaceutically acceptable excipients and/or vehicles, are advantageously formulated in optionally gastroresistant controlled-release manner, for example, as described in the patent application WOOO/76481, which is incorporated herein by reference.
• compositions containing mexiprostil according to the invention are homogeneous multimatrix compositions containing matrices as described above, and/or:
• e a matrix which is composed of lipophilic compounds having a melting point of less than 90°C and optionally of amphiphilic compounds in which the active ingredient is at least partially incorporated;
• the lipophilic, amphiphiiic and hydrophilic matrices and the optional gastroresistant coating film according to the invention refer to the compounds indicated and described above.
• the invention relates to a method for the treatment of IBD and/or IBS which comprises administering to a subject requiring it, an efficacious amount of mexiprostil alone or in combination with one or more drugs usually used in the therapy and/or symptomatic resolution of IBD and/or IBS as indicated above; for example, mesalazine, its derivatives, or budesonide.
• the method of the present invention comprises the admmistration of a pharmaceutical form having controlled release such as to be capable of releasing the active ingredient in the intestine, for example as described in WOOO/76481 which is incorporated herein by reference.
• the method comprises the administration of a homogeneous multimatrix formulation such as described above, containing matrices such as described above
• Mexiprostil is a compound known in the art, and various methods for the preparation thereof are known.
• the invention relates to a method for the preparation of mexiprostil as defined in Scheme 1:
• the animals were fasted with free access to water for two days before inducing colitis.
• 7- to 8-week-old male rats, under light anaesthesia, were administered a single intracolonic dose of 1 ni L of 4 % acetic acid in water through a catheter (day 1).
• the rats were treated with a single intracolonic dose of the test compound or of a vehicle (saline) for control purposes.
• the rats were sacrificed by inhaling C0 2 and subjected to an autopsy.
• the colon was isolated and 10-cm segments of the distal portion of the colon were cut off and weighed.
• the Mucosal Damage Area (MDA) and the Macroscopic Damage Score (MDS) were evaluated.
• the histological evaluation was carried out as follows: after having weighed the colon, an intermediate portion of open isolated distal colon measuring approximately 2 cm was fixed in a 10% buffered formalin solution, and then cut transversely and stained with H&E stain and PAS stain. Myeloperoxidase activity was measured on the remaining portions of the colon.
• the reaction mixture was agitated at -15°C for 30 minutes and was then cooled to -20°C and nerol (28.0 g, 181.5 mmols) was added dropwise, avoiding an increase in temperature. After three hours at -20° C, the starting material is completely consumed (TLC analysis, eluant hexane/ethyl acetate 8/2). The cooling bath was removed and the mixture was left to return to 0°C. At that point, water (800 mL) was added in a single portion under vigorous agitation. After 15 minutes, an aqueous solution of NaOH and NaCl (12 g NaCl dissolved in 225 mL of NaOH 8M) was added.
• the crude reaction mixture was dissolved in THF (37 mL) and HQ 2.4M (22 mL) and agitated until the more polar spots in the TLC (caused by the metal-acetal of the desired lactol 6, by-product) disappeared (normally 4-5 days). When the reaction appeared to stop, more HQ. (in solution at 37%) was added (eluant for TLC analysis: hexane/EtOAc 6/4). The reaction was stopped by adding saline and diethyl ether. The two layers were separated and the organic phase was extracted with saline.
• Example 7 Formulations containing mcxiprostil
• mexiprostil 5 g of mexiprostil were mixed for 10 minutes with 45 g of trehalose, 2 g of lecithin, 2 g of stearic acid and 80 g of microcrystalline cellulose.
• 100 g of hypromellose, a further 80 g of microcrystalline cellulose, 3 g of colloidal silica and 3 g of sodium stearyl fumarate were added to the mixture and mixed in as a lubricant for the tableting operation.
• the powder was subjected to compression in a rotary tableting machine at a unit weight of 160 mg/cpr.
• the tablets were then coated with a gastroresistant film composed of copolymers of acrylic and methacrylic acid of type A and B, talc, triethyl citrate, titanium dioxide and iron oxides.
• the gastroresistant film was applied at a rate of 20 mg/cpr.
• the tablets so obtained were capable of resistance for two hours in the dissolution test according to Eur. Pharm. using a medium at pH 1. In a medium at pi I 7, the tablet exhibited total disintegration in approximately 8 hours using the same apparatus.
• Tablets so formulated may be used in the treatment of IBD and IBS since they are intended to deliver the active ingredient principally in the colon.
• 5 g of mexiprostil were mixed for 10 minutes with 45 g of trehalose, 5 g of lecithin, 5 g of stearic acid and 280 g of microcrystalline cellulose. 20 g of hypromellose. a further 280 g of microcrystalline cellulose, 5 g of colloidal silica and 5 g of sodium stearyl fumarate were added to the mixture and mixed in as a lubricant for the tableting operation. After further mixing, the powder was subjected to compression in a rotary tableting machine at a unit weight of 130 mg/cpr. The tablets were then coated with a gastroresistant film composed of copolymers of acrylic and methacrylic acid of type A. talc, triethyl citrate, titanium dioxide and iron oxides. The gastroresistant film was applied at a rate of 15 mg/cpr.
• the tablets so obtained were capable of resistance for two hours in the dissolution test according to Eur. Pharm. using a medium at pll 1 .
• a medium at pi I 6.4 the tablet exhibited total disintegration in approximately 2 hours using the same apparatus.
• Tablets so formulated may be used in the treatment of IBD and IBS. since they are intended to deliver the active ingredient in the small intestine.
• mexiprostil 5 g were mixed for 10 minutes with 45 g of trehalose, 5000 g of mesalazine, 20 g of lecithin, 20 g of stearic acid and 1000 g of microcrystalline cellulose. 1000 g of hypromellose, 20 g of colloidal silica and 20 g of sodium stearyl fumarate were added to the mixture and mixed in as a lubricant for the tableting operation. After further mixing, the powder was subjected to compression in a rotary tableting machine at a unit weight of 700 mg/cpr.
• the tablets were then coated with a gastroresistant film composed of copolymers of acrylic and methacrylic acid of type A and B, talc, triethyl citrate, titanium dioxide and iron oxides.
• the gastroresistant film was applied at a rate of 30 mg/cpr and enabled the tablets to resist dissolution for 2 hours, using an apparatus according to Ph. Eur., in an acid medium at pH 1.

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• 2010
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